Thursday, December 3, 2015

Cracked tooth syndrome, biting hurts

family dental care with tooth needs a crown
Cracked Tooth

During an unexpected emergency dental visit, a patient may complain a tooth has pain when biting and this may suggest cracked tooth syndrome.  They may not able to put any pressure on the tooth, and may avoid eating on that side.

A thorough visual examination with a digital x-ray would be required to determine the exact cause.  A common cause of pain upon eating is a cracked tooth, but there are other possible causes to consider that are listed below. 


  • During biting, the ligament surrounding the tooth's root has been injured.  This ligament is called the periodontal ligament (PDL)
  • The tooth recently had a filling that was close to the tooth's nerve, and you are now trying to eat on that tooth
  • The tooth recently had a root canal without a crown, and you are now trying to eat with that tooth
  • The tooth had a root canal and filling/crown many months/years back, and now it's starting to hurt when biting down.
  • The tooth has cracked and you are not able to place any pressure on that tooth


  • If a tooth's ligament is injured, the typical scenario is to allow 3-4 weeks healing time to see if the ligament will repair itself.  If the PDL ligament is still injured, the tooth may need to be evaluated for root canal treatment.
  • If the tooth had a filling that was close to the nerve due to a deep cavity, it is recommended to allow 2-3 weeks to see if the nerve will "settle down."  If the tooth still has pain upon afterwards, the tooth may need to be evaluated for root canal treatment.
  • If the tooth recently had a root canal and you are having discomfort eating on the tooth, it is highly recommended a crown be placed on that tooth, especially if the tooth is a molar or premolar.
  • If the tooth has an existing root canal and crown, and it's now starting to hurt when biting, there may be a deep internal root fracture.  This tooth would need to be evaluated for possible root canal retreatment or extraction.
  • If the tooth has cracked, it may exhibit cracked tooth syndrome.


Cracked tooth syndrome is the presence of an internal fracture inside the tooth.  A piece of tooth may or may not "feel loose" though it may be sore to place biting pressure.  The severity of the symptoms and treatment would be determined by the extent of the fracture if it is in the enamel or if it has extended to the dentin or pulp.

A typical cause is due to excessive biting forces from inherent natural heavy eating forces, or from night time grinding (bruxism).  A common symptom is you are not able to eat on that tooth, and this tooth would need to be evaluated for a porcelain crown and/or root canal treatment.  If the fracture is too extensive, the tooth may need to be extracted.

If you have any questions about cracked tooth syndrome or what may be causing pain upon biting, be sure to consult your family dentist.

From the desk of your gentle family dentist in Bellevue,

Peter Chien, DMD, MPH

Tuesday, November 3, 2015

Pregnancy, Babies, and the Dentist

babies and kids at the dentist

If you are pregnant or trying to become pregnant, you should inform your dentist so he or she can help you achieve optimal oral health for yourself and your baby.  It is recommended you continue your regular exam and dental cleaning schedule as recommended by your dentist.

Dental Tips for Pregnant Moms

  • Brush your teeth twice a day with fluoridated toothpaste to remove plaque buildup.
  • Floss daily to help remove plaque between the teeth.
  • Inform your dentist and physician of any changes in your health, medication, and diet.
  • Any elective dental procedures should be delayed until you give birth.  If dental treatment is necessary and recommended by your dentist, your dentist and obstetrician will advise you of any precautions to be taken. 
  • Moms may develop pregnancy gingivitis, gum inflammation that may include swollen and bleeding gums.

What is Pregnancy Gingivitis

  • Pregnancy gingivitis is gum inflammation induced by the mother's fluctuation in estrogen and progesterone.  Symptoms may include swollen and bleeding gums, sensitive teeth and gums, and gingival recession.
  • Pregnancy gingivitis is common during the second through eighth month of pregnancy.
  • Your dentist may recommend additional dental cleanings if the gingivitis promotes excessive bleeding and plaque buildup.

Nutrition Tips for the Mother

  • Your baby's teeth develops during the first trimester, hence adequate calcium and vitamin D intake is important for baby's optimal teeth development
  • A well rounded diet during all trimesters of pregnancy is needed for your baby to develop his or her teeth.  A balanced diet of fruits, vegetables, dairy, lean proteins, and essential fats is recommended.
  • Morning sickness and nausea can make morning brushing difficult.  Be sure to consult with your dentist and obstetrician if you are not able to brush in the morning.
  • Be sure to drink abundant amounts of water and calcium.  Water is good for your body and your baby's development.  Daily intake of water will also help clear your teeth free of plaque when you are not able to brush and floss consistently. 

If you have any questions or concerns regarding pregnancy and how it may affect your newborn, be sure to consult your family dentist.

From the desk of your gentle dentist in Bellevue,
Peter Chien, DMD, MPH
(425) 614-1600

Thursday, October 1, 2015

How to remove tooth stains

Dental hygienist teeth cleaning removing stains
Extrinsic Stains on Teeth

Stains on teeth often look like dark spots and patches on the outside and inside surfaces of the teeth, and many patients often ask on how to remove them during their dental cleaning visit.

There are typically two types of stains, extrinsic and intrinsic stains.

  1. Extrinsic Stains may be caused by repeated short term exposures to tea, coffee, blueberries, wine, and food condiments like ketchup and soy sauce.  They may look like dark black and brown patches on certain parts of the teeth's external surfaces.
  2. Intrinsic Stains may be caused by the antibiotic tetracycline taken when the patient as a young child or repeated heavy long term smoking and tobacco habits.  It may also be a result of malformation during embryonic development.  These type of stains may present itself as a dark gray or red internal discoloration where the entire tooth is discolored, and may be very difficult or near impossible to remove.

If the stains are extrinsic they can usually be removed during the cleaning appointment.  The dental hygienist or dentist may use a combination of a high speed vibration tip with water, and hand instruments like a scaler to physically remove the stains.  Water is needed to help cool the high speed tip as it vibrates and removes the stained spots.  A low speed polish may also be used to help smooth the teeth and remove any loose "dark spots."  Minor stains may also be removed by trying an abrasive toothpaste such as whitening toothpaste.

Intrinsic stains are often much harder to treat and remove.  If these stains are a result of food exposure where the teeth have turned "yellow" over time, teeth whitening may help lighten the teeth.

In cases where the intrinsic stains are gray or reddish stains are internal (inside) the teeth, they cannot be removed via a dental cleaning or traditional teeth whitening.  More viable options to address heavily dark or red internal stained teeth include porcelain crowns and veneers or internal bleaching.  Internal bleaching utilizes a high concentration of bleaching solution placed inside the tooth after it has a root canal that allows the tooth to whiten from the inside.

If you have any questions on teeth stains and how to remove the stains from your teeth, be sure to consult your family dentist or dental hygienist.

From the desk of your friendly gentle dentist in Bellevue,

Peter Chien, DMD, MPH
(425) 614-1600

Tuesday, September 1, 2015

Kids back to school dental tips

children kids at the dentist
Back to school and the dentist

Parents and kids, it's back to school time, and below are some dental tips and hints to keep children's teeth and gums clean and healthy...and to help your kids off to a good start with great diet and oral health!


School days can be hectic and in a rush, so don't forget to include healthy snacks that are good for the teeth and the body.  Your body and mouth will appreciate it :)
  • Celery and carrot sticks contain fiber and vitamin A; the fiber helps cleanse plaque from teeth
  • Apple slices, crunchy fruit high in fiber promoted salivary flow that helps washes bacteria away
  • Grapes, raisins, and cranberries are great snacks containing natural sugars for that quick pick me up
  • Fruit and yogurt smoothies, high in calcium, good for teeth and bones
  • Nonfat or lowfat milk which are rich in calcium and fortified Vitamin D, great for making your kid's teeth strong


Important to make sure your children brush in the mornings when they wake up, and also brush and floss in the evening prior to bedtime.  Brush their tongue to remove bacteria and help keep their breath fresh.  If your kids are in current orthodontic treatment (ie. braces) it's especially important for them to brush and floss well, as plaque and bacteria can accumulate on the bands and brackets, and increase risk for cavities.


School days can be busy, so here are some ideas to help keep your kids' teeth and gums healthy at school:
  • If your child has an orthodontic retainer, make sure the retainer is worn in the mouth at all times unless it's during lunch or snack time.  To prevent retainer loss, keep the retainer in sight at all times and make it habit to wear it when not eating.  It's not uncommon to see kids digging through the school trash  looking for a lost retainer!
  • Avoid sucking on hard candy or chewing sugary gum during the day.  Try sugarless gum.
  • Avoid sipping on soda or energy drinks during the day.  They are often high in sugar and the high phosphoric acid content can weaken the teeth's enamel.  Bottled or tap water are good substitutes. 
  • The occasional soft or hard candy is OK.  Try to rinse the mouth with water after eating to help prevent sugar from remaining on the teeth.
  • For lunch try to choose salads and low fat milk.
 If you have questions on how to help and improve your children's oral health at school, be sure to consult with your family dentist and hygienist.

From your gentle family dentist in Bellevue,
Peter Chien, DMD, MPH
(425) 614-1600

Tuesday, August 4, 2015

Pregnancy and Going to the Dentist

pregnancy newborn going to dentist
Pregnant? Might be time to the dentist!
There has long been a common misconception to avoid the dentist when one is pregnant.  The previous thought process was that dental treatment may cause complications during pregnancy.  However recent studies are suggesting that going to dentist while pregnant is actually a good idea because of the excessive time constraints the newborn baby may likely require after the mother has given birth.

Physicians and researchers have determined that a pregnant woman's oral health can directly affect the newborn's systemic and oral health.  For example, a common health concern is cavity causing bacteria such as Streptocacus Mutans can be directly transmitted from the mother to the fetus.  The newborn baby may then be exposed to the bacteria, which can then multiply and grow in the fetus' body, affecting the tooth's development even before the teeth are erupted.  Such excessive bacteria, if not removed, may increase risk of tooth decay and subsequently periodontal and gum disease.

Another common occurrence is if an expectant mother is experiencing tooth pain or has a dental emergency related infection, this may cause physical stress on the mother, which may then indirectly cause systemic stress on the fetus.

Unfortunately most pregnant mothers do not receive sufficient dental care.  Census data in 2010 from the Center for Disease Control show that less than fifty percent of expectant mothers had a dental cleaning while they were pregnant.

It is our hope to increase public awareness the importance of seeing a dentist when a mother is pregnant.  If you have any questions regarding pregnancy and its relationship on the mother's and newborn's oral health, be sure to consult with your family dentist and hygienist.

From your gentle family dentist in Bellevue and Redmond,
Peter Chien, DMD

Wednesday, July 1, 2015


thumbsucking pediatric dentist
Child Thumbsucking

Thumbsucking is a perfectly natural habit children engage in.  Does your child suck his thumb and the parent may be wondering why.  Kids suck on their thumbs, pacifier, finger, or any other small object to give them more security, feel less lonely, and to help them observe their new surroundings.  Children may also suck their thumbs as they go to sleep.

At the age of six years old when children's permanent teeth begin to erupt, continuous thumb sucking may cause issues with the mouth's growth formation, the mouth's roof shape, and as well as teeth position and alignment.  The main factor that determines if a child may develop dental problems with thumbsucking is the intensity of the sucking.  Simply resting the thumb inside the mouth is much less likely to cause oral issues then vigorously sucking the thumb.


  • A very narrow and arched shaped upper palate
  • Top front teeth are excessively flared outwards
  • The child's entire upper teeth appears very narrow and arched
What are some things parents can do to help their child stop thumbsucking?


  • Kids tend to suck their thumbs or fingers when they feel insecure or when they need a "blanket" for comfort.  Try finding the root cause of the insecurity issues and address them if possible.
  • When the child goes to sleep, have the child wear gloves or a sock to discourage the habit.
  • Place a bitter paste on the child's thumb after they go to sleep.  Your dentist may be able to prescribe a safe yet bitter medicine to coat the thumb.
  • Praise him/her for not sucking the thumb
  • If all else fails, have your dentist reinforce the importance of the need to stop sucking the thumb.  The dentist may refer the child to an Orthodontist to place an appliance (ie. fixed palatal crib) that makes thumbsucking uncomfortable to quell the habit.

Children typically stop sucking their thumb prior to the age of six when their permanent teeth start to erupt.  If you notice your child is still sucking their thumb beyond the age of six years old and you notice changes in the child's arch shape and teeth position, be sure to consult your family dentist or orthodontist.

Your family dentist in Bellevue,
Peter Chien, DMD, MPH
(425) 614-1600

Wednesday, June 3, 2015

Why do I need to floss my teeth?


Why do I need to floss my teeth? Flossing is effective at removing food, bacteria, and plaque between your teeth and along the gum line where the toothbrush cannot reach. While tooth brushing removes bacteria and food debris on the outside surfaces of the teeth, the toothbrush cannot remove plaque and bacteria that is between the teeth.


  • Removes bacteria between the teeth
  • Removes food and plaque that can be stuck and caught between your teeth and along the gum line
  • Can help improve your breath and decrease likelihood of halitosis, bad breath.  Food and bacteria between the teeth can cause halitosis.
  • Helps prevent cavities between your teeth.
  • Helps prevent gingivitis (bleeding gums) and periodontitis and the possible need for deep cleaning
  • Can help your teeth remain whiter by removing foods that can cause extrinsic stains
  • If someone is currently undergoing orthodontics (braces), brackets and bands can act as an annoying food trap.  Flossing will help remove such food and bacteria stuck between the teeth.


  • Increased risk of tooth decay
  • Increased risk of gingivitis, gum bleeding, and bone disease
  • Increased risk of halitosis (bad breath)
  • If someone is currently undergoing orthodontics (braces), if one does not floss, this exponentially increases one's risk of gingivitis and tooth decay.


Studies have shown that daily flossing is efficient at removing bacteria, food, and plaque between the teeth.  Along with twice a day brushing, daily flossing is an effective method at keeping your teeth and gums healthy and vibrant. 

It's debatable whether one should floss before or after tooth brushing, but as long as the flossing is done daily, that's the important thing!


  1. Start with approximately 18-20 inches of fresh new floss each time.  Waxed floss is a good choice as the wax may flossing easier go between the teeth.
  2. Wind most of the floss around each of your middle fingers, leaving about an inch of floss in between the middle fingers
  3. Hold the floss tightly between the thumb and index finger, and slide it up and down between the teeth gently
  4. Very gently curve the floss at the end base of the tooth.  Make sure the floss gets underneath the gums.  Try not to force the floss down as this may injure or bruise the gums.
  5. Use clean sections of the floss as you move tooth to tooth.
  6. When done flossing, dispose of the floss and wash your hands with water and soap.
  7. Repeat steps 1-6 daily.
If you have any questions about the importance of flossing your teeth, be sure to ask your dental hygienist and dentist.

Warm  Regards,

Peter Chien, DMD, MPH

Friday, May 1, 2015

Warning Signs Impacted Wisdom Teeth

Oral surgery extraction at dental office
Impacted Wisdom Tooth

Wisdom teeth can have a mind of its own.  For the majority of people, they usually erupt from 17 years to 21 years of age.  Sometimes they don't develop at all, but when wisdom teeth (also known as 3rd molars) develop and erupt, they can cause pain and swelling.  Often times their may not be enough room for the wisdom teeth to erupt normally.  If there is not enough room for the wisdom teeth to come about, they are considered impacted, and which later on can cause issues.

There are two types of wisdom teeth impaction:

  • SOFT TISSUE IMPACTION: When wisdom teeth attempt to erupt with insufficient room, the gums surrounding the tooth may be red, inflamed, puffy, and sore.  The gums may even bleed and  be painful to touch.
  • HARD TISSUE IMPACTION: In some cases wisdom teeth may be positioned at a horizontal or semi-vertical angle.  These teeth may look like they are on the path to hit the adjacent tooth, possibly causing damage (external resorption or decay) to the tooth in front.

What are warning signs of impacted wisdom teeth to look out for?

  1. There is a constant dull ache coming from the very back of your upper and lower teeth.  This ache may progress to severe pain that may radiate down the lower jaw, or up towards the sinus and temple of the forehead.  This pain may be suggestive of hard tissue impaction.
  2. Your dentist takes a x-ray that shows the wisdom tooth is causing tooth decay and resorption (tooth damage) to the tooth in front.
  3. You look in your mouth and see that the gums directly behind your last molars is swollen, puffy, and painful to touch.  The gums may also bleed to touch or by itself.

Treatment of impacted wisdom teeth:

  • Palliative treatment - Sometimes pain from wisdom tooth impaction can be managed by a warm moist towel and non-steroidal medication (NSAIDS) such as ibuprofen or aspirin.  Such treatment is usually temporary however.
  • Extraction - If the wisdom tooth is causing damage to the adjacent teeth, or palliative treatment is not able to provide relief, your dentist or oral surgeon would surgically remove the offending wisdom tooth. Extraction would also be required in soft tissue impaction cases where the gingival tissue continues to remain swollen and painful if due to the wisdom tooth.
  • Doing nothing - A curious choice this may be, but because wisdom tooth movement can be so unpredictable, their movement may suddenly stop, thus halting the pain.  This may be a suitable conservative "watch and see" approach in milder cases.

If you have any questions regarding impacted wisdom teeth, be sure to consult your family dentist or oral surgeon.

Warm Regards,

Peter Chien, DMD, MPH

Wednesday, April 1, 2015

Is mouthwash effective; how choose a rinse?

children kids fluoride rinse
Mouthwash, is it effective?

I have noticed quite a few people use mouthwash as part of their daily oral health care routine.  Mouthwashes can be a good addition, but it's important to know what the mouthwash does and doesn't do.  Some mouthwashes only freshens breath temporarily, while others may contain antibacterial ingredients to help prevent plaque buildup, and some contain fluoride that offers anti cavity benefits.

There are myriad mouthwash to clean debris (ie. Listerine, ACT, Crest ProHealth, and the "right" choice is one that best meets your dental health needs.

Below are some types of mouthwashes one can consider when choosing a mouthwash:
  • Plaque control - These mouthwashes contain ingredients that help decrease plaque and bacterial levels and help decrease gingivitis.  Such bacteria can create toxins that cause gingivitis, and if not treated, can progress to periodontitis (bone disease that can affect tooth stability).  This mouthwash can also help control halitosis (bad breath).
  • Fluoride - With the proper amount of fluoride this can help decrease small cavity lesions on the tooth's enamel, and also help decrease risk of tooth decay.
  • Cosmetic mouthwashes - This category of mouthwashes may contain astringent salts or an odor neutralizer that may help temporarily reduce bad breath / halitosis, however the main cause is not addressed.  Some mouthwashes may even claim to whiten your teeth, but such gains are likely nonexistent at best and not substantiated with controlled studies.
 When choosing that right rinse, please also keep the following in mind:
  • Alcohol -  Some mouthwashes and rinses can contain a significant amount of alcohol, which in my opinion, may cause more harm than good.  Alcohol can significantly dry out one's gingival tissues and teeth, which may also cause dry mouth and increase risk of tooth decay.  Some rinses contain such a high level of alcohol it may be a source of alcohol abuse.  With so many choices out there, it is my personal recommendation to choose a mouthwash that does NOT have alcohol.  Examine the active and inactive ingredients carefully, as alcohol may not be visibly listed or advertised.
  • Sensitivity -  In certain individuals, mouthwash ingredients may irritate the gums and/or cause the inner cheek lining to be ulcerated.  Alcohol is a common gingival irritant.  If you find your mouth is sensitive to mouthwashes, either discontinue use of the rinse or choose one that is more "natural" that contains aloe vera and chamomile.  
Be advised though, mouthwash is not a substitute for regular flossing and brushing.  If you have any questions about which mouthwash or rinse would best meet your oral health
needs, be sure to ask your dentist or dental hygienist for recommendations.

Warm Regards,

Peter Chien, DMD, MPH

Tuesday, March 3, 2015

Why Baby Teeth Cavities Need Fillings

Kids Dental Care Cavities
Taking Care of Baby Teeth

Every week I have moms, dads, and grandparents bring in their kids and/or grandchildren in for their regular preventive visit that consists of a checkup/exam, dental cleanings, x-rays once a year, and fluoride treatment.  As part of kids dentistry children ranging from 1 year to 4 years old, up to 12 year old, will typically have primary dentition (baby teeth) remain in their jaw.  Even some adults will have the occasional baby tooth!

When kids come in for their 6 month checkup, after the dental assistant or the dental hygienists clean their teeth to be free of plaque, I (the dentist) will check their mouth for signs of cavity, or tooth decay, via a visual exam and digital x-rays.

If I do see a cavity, depending on the size of the decay, I may recommend either leaving the tooth as a "watch" or a tooth colored filling.   However every now and then, I'll get a question from the parents or grandparents, "it's just a baby tooth, can we just not fill the cavity and leave the tooth alone?"  My usual response would be "the tooth needs a filling and we do not want the cavity to continue to get bigger."  Here's why:


 A cavity can be ascertained visually and by x-rays.  If the cavity is contained within the enamel, the cavity can be left alone and treated with fluoride and proper oral hygiene (ie. daily brushing with a fluoridated tooth paste, daily flossing, and fluoride rinses).  If the cavity is small enough, proper oral hygiene and fluoride can arrest (stop the cavity from growing" and may even remineralize the cavity (ie. shrink the cavity).   This stage is when the cavity can be "watched" and left unteated.

If a cavity has progressed beyond the enamel and has extended into the dentin layer, depending on how big the cavity is, treatment is highly recommended.  If the cavity is relatively small, a tooth colored filling is recommended.  If the decay is deep enough to have hit the nerve/pulp of the tooth, a pulpotomy or "baby root canal" may be needed.  The reason a pulpotomy is needed in this case is because once decay/bacteria has reached the nerve, the nerve is at risk for infection.   Thus a baby root canal is needed to remove the nerve and decrease likelihood of infection.  After the pulpotomy is performed, a stainless crown is usually recommended to allow normal chewing.


If a cavity has extended beyond the dentinal layer, a filling is required to prevent the cavity from getting larger.  Left untreated the cavity has a chance to continue to get bigger and deeper, this may cause the child to have tooth pain.   The tooth may then require a pulpotomy and stainless crown as part of emergency dentistry treatment, increasingly likelihood of inconvenience, discomfort, and financial costs.


If the cavity is deep enough that restoration is not possible or has poor long term prognosis, the baby tooth may need to be extracted.  Once remove, the space once occupied by the baby tooth may need to be held by in place by a space maintainer until the permanent tooth erupts.

And as such, a baby tooth serves the following purpose:
  • Allows the child to chew properly and normally, thus permitting adequate nutrition.  Certain foods may be difficult to eat without teeth.
  • Allows the child to speak normally.  Without a baby tooth in place for a sustained period of time, normal speech and certain sounds may be difficult to pronounce.
  •  Holds space necessary for the adult teeth to erupt.  If a primary tooth is removed, adjacent teeth in front, back, and opposite may start to collapse into the space.  This may make it difficult for the adult tooth to coming in properly, and may cause malocclusion, prompting possible need for orthodontic treatment (braces).
  • Esthetics and self confidence.  A child may feel self conscious if he or she is missing a tooth for a sustained period of time, especially the front tooth.
Though in some cases baby teeth treatment may not be necessary or possible, hopefully this article will have shed some light as to why cavities on baby teeth need treatment and why baby teeth are important to a person's health.  If you have any questions on kids dentistry, please feel to contact your dentist or dental hygienist.

Your family Bellevue dentist,
Dr. Peter Chien

Thursday, February 5, 2015

Oral Ecology of Mouth and Bacteria

Oral ecology microflora
Ferocious Teeth!

You may have gone to dentist and had fillings on your teeth done due to cavities.  You may also have had root canals and crowns because a tooth broke.  Why did they happen?  How did I get a cavity?   Why did my tooth break?  And over time they may need new replacement fillings or crowns, and you may be thinking why needed to be replaced.


When dentistry first started, dentists needed materials that could withstand the harsh environment in the mouth.  The mouth is truly an inhospitable environment!
  1.  Consistently moist due to saliva.  Moisture, much like that of rain causing wood rot, can cause wear and tear on the teeth and promote bacterial growth.
  2.  Oral temperature is approximately 98.2 degrees Farenheight.  This temperature is favorable to bacteria growth.
  3.  As such due to constant moisture and heat, the mouth contains 500-1000 types of bacteria,  with Streptococcus Mutans as the predominant bacterial strain.
  4.  Constant exposure to foods and drinks that are acidic.  A low pH wreaks havoc on teeth  and may make it prone to wear and tear.
  5.  Exposure to foods that are hard and crunchy.  Carrots, celery, nuts, hard sugar candies, chips, cookies, and ice.  These foods can cause quite a bit of trauma to our teeth, and have been known to crack a few teeth!
  6.  Bruxism, grinding, and clenching.  These "parafunctional habits" cause a tremendous amount of pressure on our teeth.  Molars generate well over 200 pounds per square inch, stronger than that of a gorilla and chimpanzee!  Imagine having this force subjected on your teeth on a consistent night time basis.  Due to life stress, this may even occur during the daytime.


With a moist and warm environment, bacteria favors the tooth's smooth enamel surface, and is a place for bacteria to reside.  Exposure to food and plaque permits bacteria to feed off plaque that unleashes enzymes that promote tooth decay.  Add on daily exposure to hard foods and potential grinding and clenching, the mouth can be a combat zone.


With tooth decay or cavities, dentists require materials that can mimic tooth structure and with stand natural tooth flex and stress.  Tooth colored fillings, when small and moderately sized, has been shown to hold up well within the mouth.  If teeth break or if a cavity is excessively large, porcelain crowns due to its monolithic porcelain layering, can mimic natural tooth in terms of esthetics and withstand harsh chewing forces.

Much like a natural tooth and our bones, they can weaken, break, and crack.  No dental material can last forever, but studies have shown with proper care, fillings and crowns can last anywhere from two to ten years or longer before needing replacement.


Daily brushing and flossing are two of the most effective ways to decrease bacterial levels.   Changing the toothbrush head every 3 months to ensure the bristles stay effective and to avoid exposure to growing bacteria.  Going to the dentist twice a year for checkups and dental cleanings will help remove excessive bacteria and plaque.  Using a nightguard if you grind your teeth at night will help prevent tooth fracture that may require extraction or emergency dentistry.  And getting a filling when the cavity is small will help avoid more expensive treatments down the line.

If you have any questions about your mouth and its oral environment, be sure to consult with your family dentist or hygienist.

From your friendly dental office,
Dr. Peter Chien
(425) 614-1600

Tuesday, January 6, 2015

Fluoride Benefits on Teeth

Fluoride Varnish on kids and children
Fluoride Varnish

What is Fluoride?

Fluoride is a naturally occurring mineral in water and foods.  Through demineralization and remineralization, minerals are added and lost repeatedly from a tooth's enamel layer.  Via demineralization, minerals are lost at the enamel layer when acids attack the enamel via its low pH.  Bacteria utilize plaque and sugars in the mouth to produce acids that over time may destroy teeth enamel and eventually dentin via tooth decay.

Minerals like fluoride, calcium, and phosphate can redeposit themselves to the enamel from exposure of water and food containing such minerals.  If the rate of demineralization exceeds that of remineralization, tooth decay can result.

How does Fluoride Prevent Tooth Decay?

Fluoride can help reduce tooth decay risk by making teeth less susceptible to the effects of acidic bacterial enzymes.  Fluoride can also reverse mild tooth decay via remineralization in children, teens, and adults.  In children under 6 years of age while the permanent dentition is still in development, fluoride can incorporate itself into the permanent tooth and lower the effects of bacterial induced acids that may cause tooth decay.

Think of fluoride as a tooth vitamin.  In the right amounts taken daily, it makes your teeth strong!

Who Benefits Most from Fluoride?

For most people, infants and children age 6 to 17 should have exposure to fluoride, since during this time period most permanent teeth start to erupt.  Adults can also benefit from fluoride, as fluoride can diminish the demineralization process.

Certain people with specific conditions may sometimes be at an increased risk for tooth decay.  Because these conditions may increase the demineralization rate, fluoride treatment may help with remineralization.
  • Dry Mouth:  Also known as xerostomia, dry mouth may be present in people who are on certain medications (antihistamines, anti hypertensive drugs for high blood pressure, anti-anxiety drugs), people with Sj√∂gren's syndrome, and people with history of radiation and chemotherapy treatment due to cancer.
  • Previous history of cavities: People who develop cavities every year may benefit from additional fluoride treatment
  • Teeth with fillings, crowns and bridges, and orthodontic treatment: Dental restorations and braces/brackets are often a source to trap and collect plaque, which can put teeth at higher risk for tooth decay. 

Where is Fluoride Found?

Fluoride can be found in select toothpastes and mouth rinses.  However, not all toothpastes and mouth rinses contain fluoride, so be sure to check the label to ensure fluoride is one of the ingredients.  Your dentist and dental hygienist can also apply a topical application during the dental cleaning and checkup visit.

Fluoride can be naturally found in the air as gases or particulates.  It can also be released into the environment through rock weathering and through volcanic and seawater emissions.

Is Fluoride Safe?  Are there Risks with its use?

When use as directed per label instructions, fluoride is safe and effective.  At high doses it can be toxic and causes undesired effects to the body.  Excessive fluoride can also cause tooth fluorosis, the presence of enamel defects such as minor white spots or rampant yellow and brown discolorations.  Fluorosis tends to occur in children less than 6 years of age who ingest excessive fluoride, as it starts when teeth are in its initial forming states.

Cosmetically, excessive fluorosis discolorations can sometimes be treated with cosmetic porcelain veneers and teeth whitening.  Your dentist can evaluate the proper treatment in such cases.

Again, think of fluoride as vitamin.  In just the right amounts, it has a positive effect.  In excessive amounts, it can be harmful.

If you have any questions on fluoride, its benefits, treatment, and risks, please consult with your family dentist or dental hygienist.

From your gentle dentist in Bellevue,
Dr. Peter Chien