Bright Smile Teeth Whitening

 

BRIGHTEN THE HOLIDAYS WITH A BRIGHT SMILE!

The holiday season is in full swing with Christmas music playing on the radio, Christmas shoppers at the malls, and holiday parties to attend.  Then with holiday parties come wine drinking, hot chocolate, and apple cider!

But did you know some drinks and food such as wine, blueberries, and tea may stain your teeth? 

Your dentist can tell much about your health just by looking in your mouth.  Yellow stained teeth may mean you are a smoker and dark black and grey stains may mean you are an avid coffee drinker.  Your hygienist can help brighten your smile with a dental cleaning by removing superficial extrinsic teeth stains, plaque, and tartar buildup.

After your dental cleaning, you may want a whiter, more youthful smile.  If this is the case, there are some teeth whitening options to consider.

IN-OFFICE BLEACHING 

In the past, the in-office bleaching technique took longer and had post-operative tooth sensitivity.  However, more recent systems such as ZOOM whitening and BOOST whitening have reduced teeth sensitivity with advances in chemistry.  Some whitening gels now include photo-reactive and catalytic substances to break down the hydrogen peroxide (the tooth whitening agent) at a faster more efficient rate which produces more oxygen ions to shorten whitening times.  Specific wavelengths for bleaching lights have also been identified which generate less heat and discomfort.  In-office teeth whitening systems require less time and have less post-operative teeth sensitivity which make it a very convenient and comfortable option.

For extreme cases of intrinsic internal stains such as tetracycline induced stains, full porcelain crowns or porcelain cosmetic veneers may be necessary to accomplish the desired esthetics.

AT-HOME BLEACHING

At-home whitening systems have become increasingly popular.  Particularly for harder to remove stains such as internal intrinsic tetracycline staining, it may be necessary to use both the at-home and in-office teeth bleaching systems to maximize teeth whitening.  This type of system requires an impression of your upper and lower teeth to make customized bleaching trays which you then take home along with a teeth whitening gel kit. 

OVER THE COUNTER TOOTH WHITENING

Milder cases of extrinsic staining may be done with over-the-counter teeth whitening products.  These whitening products tend to be popular as they can be very cost-effective.  However, the whitest results may not be achieved due to their generic nature.  Crest 3D White Strips is a popular and fairly effective option for at home bleaching.
 
Ask your dentist which teeth bleaching system will give you the results you want.  By keeping up with your routine dental exams and cleanings and choosing the right teeth whitening system, you will be well on your way in obtaining the brightest smile for family and friends over the holidays.


From your gentle family dentist in Bellevue and Redmond,
Dr. Miki Suetsugu
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Signs Teeth Need a Dental Cleaning

Bleeding Gums

So it's been a little while since you or your kid had your teeth cleaned.  Do the teeth appear more "yellow?"  Are the gums feeling itchy?  Do your gums bleed when brushing?  You may be wondering what's going on with your teeth and gums.  Today we'll discuss some of the common signs you may benefit from a dental cleaning.

BLEEDING GUMS

If you notice your gums bleed when brushing, it may be a sign of gingivitis or periodontitis.  If it's due to gingivitis (gum inflammation), then sometimes a simple course of oral hygiene instructions and regular dental cleanings (usually every 6 months) would help reduce gingival bleeding when brushing.

If bleeding gums are due to periodontitis, you may have hardened plaque and buildup beneath your gumline.  If such is the case, you may benefit from a deep cleaning, where the hygienist or dentist would generally apply local anesthetic.  They would then scale and clean areas beneath the gum line to remove hardened plaque deposits (calculus) that may be causing the gums to bleed and also subsequent bone loss. 

If you notice your gums bleed when you floss, the same treatment apply above as with bleeding gums.  Patients sometime will let me know their gums bleed when they floss, and they stop flossing as a result.  My recommendation would be to continue flossing on a daily basis, along with twice a day brushing.  Gums that bleed when one flosses is the body's sign that the gums are irritated by bacteria and/or hardened plaque.  By continuously flossing this allows repetitive bacterial removal, and eventually the bleeding will stop.

BLEEDING GUMS MAY ALSO BE A SIGN OF OTHER SYSTEMIC FACTORS.

Such factors may include:

• Scurvy (lack of vitamin C)
• Pregnancy
• Leukemia
• Brushing and/or flossing excessively hard
• Vitamin K deficiency
• Improper fitting denture
• Systemic infection
• Tooth infection

STAINED TEETH

If you noticed a gradual darkening of your teeth, this is called extrinsic staining.  Oftentimes due to foods and drinks such as coffee, tea, red wine, and blueberries may cause certain parts of the teeth to have dark or grey streaks and spots.

Your dental hygienist or dentist may use a scaler or cavitron to physically debride and remove such stains.  Be advised though if the teeth have been internally grey, such stains are called intrinsic stains and cannot be removed with a dental cleaning.  Such stains may require teeth whitening or possible porcelain veneers depending on the severity of the staining.

BAD BREATH

If you notice you have bad breath, also called halitosis, it may be due to two factors:

• Bacterial buildup on the tongue - Look at the top surface of your tongue and see if you notice a white, grey, or dark coating.  A normal tongue should be bright pink and red.  If such is the case, this dark coating is an abundance of bacteria that usually causes bad breath, and needs to be removed.  I recommend brushing the tongue with a tongue scraper to remove the bacteria.
• Bacterial buildup around and beneath the gums - If you notice a soft white and/or yellow buildup foam/film around the gums, this foam is a buildup of bacteria and remaining food particles.  You may benefit from a re-evaluation of your brushing/flossing habits, along with a possible dental cleaning.

In certain cases a referral to a periodontist (gum specialist) may be required.  If you have any questions on bleeding gums, be sure to consult your family dentist or dental hygienist.

From your gentle family and kids dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Signs Wisdom Teeth Need Extraction

Impacted Wisdom Tooth

WISDOM TEETH

"Wisdom teeth" can be an anomaly in its own right.  Some people have them and those teeth are just fine.  Others have to put up with the occasional discomfort.  And still others have to deal with persistent throbbing pain.  So how does one know if wisdom teeth need to be extracted?

WHERE ARE MY WISDOM TEETH?

Wisdom teeth are typically the very last molars in the mouth.  Also called third molars, they are usually the most posterior teeth in each quadrant (upper right, lower right, upper left, lower left).  Most adults have four wisdom teeth, one in each quadrant.  In very rare cases, some adults have develop a "fourth molar" which is usually nonfunctional, atypical in shape, and may be located deep beneath the jaw bone.

WHEN DOES MY WISDOM TEETH NEED TO BE REMOVED?

Some common signs and symptoms that wisdom teeth need an extraction include:

• Persistent throbbing and aching pressure adjacent to the wisdom teeth that is not going away.  This may be due to insufficient space for the wisdom tooth to fully erupt.  May be also known as hard tissue impaction, and feel like a toothache, and as such may require emergency dentistry.
• Swollen and bleeding gums directly on top of the wisdom tooth.  This is also known as soft tissue impaction and pericorinitis.
• Wisdom tooth causing tooth decay and cavity to the tooth next to the wisdom teeth.  In some cases the wisdom tooth is erupting at an angle (mesial impaction) causing decay and/or external resorption of the adjacent tooth.  After the wisdom tooth is extracted, the affected tooth may need a filling or root canal and porcelain crown, or even an extraction, depending on the size of the cavity.
• When the wisdom tooth is so far back in the jaw it is hard to keep the area clean, and the tooth has a large cavity that is difficult to restore.
• If the wisdom tooth is difficult to keep clean, there is bone loss that causes the tooth to have periodontal involvement.

WHAT IS THE FUNCTION OF THE WISDOM TOOTH?

Research suggests that humans in the past had larger jaws to accommodate wisdom teeth, and it is thought that the wisdom teeth were used to help with chewing of foliage and plants due to a predominantly plant based diet.  As humans evolved and diets changed that included meat, the jaw decreased in size and wisdom teeth no longer serve its once thought to be designed function for foliage chewing.  The result is wisdom may become impacted, overgrown, and thus need to be either restored or surgically extracted.

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

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Bone Graft and Dental Implants Why Need

DENTAL IMPLANTS AND BONE GRAFTS

Dental implants have become a increasingly popular option to replace missing teeth.  But before your general dentist, periodontist, or oral surgeon places a dental implant to replace one or more missing teeth, a bone graft may be required prior to the placement of the implant.  It may sound a little intimidating at first, but bone grafts are in general a very predictable, painless, and routine part of dental care.

WHAT IS A BONE GRAFT?

As we age and get older, our oral soft and hard tissue structures change.  Specifically gingival and bone structures supporting where teeth were once present and now missing, atrophies and becomes smaller.  A predominant reason why our jaws have the current density and amount of bone they do is due to the presence of existing teeth.  With teeth in support and in constant function, it stimulates the bone and allows continuous bone regeneration and prevents bone from degeneration.  Without teeth to support the adjacent bone, the jaw bone atrophies and degenerates to a basal bone level.

Most jaw bone will atrophy within the first year and a half after the tooth is initially missing, and will then continue to undergo bone loss at a indefinite slow rate.  For patients with total complete loss of teeth, this usually results in a very thin ridge of bone in the lower jaw (mandible); for the upper jaw (maxilla) the results are less pronounced.

BONE GRAFT HISTORY

In the past, bone grafts were frequently done in a hospital setting.  It was not uncommon for surgeons to use a patient's ribs or hip bone to increase lower jaw size.  Sometimes skin grafts were also taken from a patient's thigh and placed inside the mouth to prevent the tissues from moving the denture while patient is talking and chewing.  Fortunately with modern research and technology, a more preventive and contemporary approach has made the dental implant procedure less invasive and more minimalistic. 

WHAT CAN CAUSE BONE LOSS  THAT MAKES BONE GRAFT NECESSARY?

Potential bone loss causes within the oral cavity may include the following below: 

• Tooth Extraction - In cases where it is a dental and medical necessity to remove a permanent adult tooth, bone loss within the jaw can happen if the tooth is not replaced with an implant.
• Sinus Deficiency - Whereas in cases where a molar is removed from the upper jaw (maxilla), air pressure within the sinus cavity can "push down" on the sinus floor and cause bone resorption.  The result is an enlarged sinus (hyperneumatized sinus).  A sinus lift may be necessary to "push" up the sinus floor. 
• Periodontal Disease - With periodontitis, bacteria not only affects and causes gingival inflammation, but bacteria has begun to erode the bone structure and cause bone loss.  If periodontal disease is not treated with the appropriate dental cleaning, it may lead to tooth loss and subsequent bone loss.
• Tumors - Abnormal growth can be either benign or cancerous.  If either tumors are not controlled or removed it can cause bone destruction and loss.
• Developmental Defect - Some cases of birth defects can cause portions of the jaw bone to be missing or irregular in density and amount. 
  
• Accidental Trauma - Unfortunate accidental circumstance in a dental emergency, these trauma cases may result in tooth loss.  Accidents may include inadvertent heavy sports contact, playground mishaps, automobile accidents, and accidental slips and falls.  With loss of tooth eventually follows loss of bone.
• Orthodontic Malposition and Misalignment - If a tooth does not have an opposing dentition, said tooth can super erupt (over erupt), causing bone loss.
• Dentures -  A denture is a removeable prosthesis that replaces one or more missing teeth.  The denture, complete or partial, can be anchored by a dental implant to help with retention.  The denture area that is not anchored by a dental implant can result in alveolar bone loss as the tissue beneath said area is not stimulated.
• Dental Bridge - A dental bridge is a permanent prosthesis designed to replace a missing space by attaching a "floating" tooth between two or more adjacent front and back crowns. The portion of the bridge filling in the gap of the missing tooth that does not stimulate the jaw's alveolar bone can result in bone loss.  Good oral hygiene via proper brushing and flossing is also needed to prevent bone loss around the attached crowns. 
• Osteomyelitis - Rare case where bacteria has caused an infection of the jawbone and bone marrow.  Result is bone inflammation and reduced blood flow, causing bone necrosis and loss.

SO WHY IS BONE GRAFT NECESSARY?

The jaw bone's, also called alevolar bone, main purpose is to support and hold a tooth firmly in place.  In order for a tooth to be stable and not be mobile, the area needs to have sufficient bone.  Without adequate bone, the tooth can have periodontal issues and eventually lead to tooth loss.

With a dental implant, the bone serves the same structural support purpose.  The jaw needs to have sufficient bone structure to support the implant firmly.  In the case of a tooth extraction, it may be possible to place a dental implant same day immediately after the tooth is removed.  Sometimes it may not be feasible to place an "immediate implant" due to a dental infection.  In such situations a socket preservation graft may be necessary, as this graft fills up the void from the extracted tooth.  The graft retains the bone volume while the adjacent alveolar ridge proliferates and fills the missing space with live bone.  Typically the preservation graft may take between three to six months healing times before an implant can be placed.

If you have any questions on dental implants and bone grafts, be sure to consult your family dentist.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

What causes tooth sensitivity to cold, heat, and pressure?

SENSITIVE TOOTH!

 
"I was eating a cold ice cream fruit bar and suddenly my tooth started to ache.  I must have bit down wrong!"

Patients occasionally come to me complaining their teeth are sensitive.  The pain may come suddenly, other times it may be a gradual onset.  Even simple oral hygiene techniques like flossing, brushing, eating, and drinking can cause a temporary pain and discomfort in the teeth.  Discomfort can range from mild to excruciating, and can be lingering or nonlingering.  Sometimes it is obvious as to the cause of the discomfort, sometimes it may not. 

WHAT ARE SYMPTOMS OF TEETH SENSITIVITY?

Tooth discomfort can be subjective; some common symptoms include:

• Throbbing pounding acute pain that occurs by itself
• Pain that is temperature dependent to cold and/or heat, such as drinking cold water or hot coffee
• Pain that comes about from eating and biting pressure
• Bleeding and sore gums
• Pain caused from breathing in cold air

CAUSES OF SENSITIVE TEETH

While the causes may vary, it is likely that the tooth's nerve has been affected.  Within the inner most layer of the tooth is a pulp chamber consisting of live nerve tissues.  If the nerve has been affected, the result may be sensitivity and/or pain.  The dentist will need to do an evaluation via an examination to determine the cause of the sensitivity; an x-ray may also be necessary to determine if there is decay, fracture, or infection.

• Tooth decay (also known as caries) that has invaded the pulp
• Tooth decay that has not invaded the nerve
• Broken teeth that has pulpal involvement
• Fractured cusp that has caused the tooth to weaken
• A chipped tooth that has caused worn enamel
• Root exposure
• A root fracture that violated the tooth's root
• Tooth has localized abscess and infection
• A tooth that has exposed dentinal tubules
• Periodontal involvement with bleeding gums/gingiva

TREATMENT OF SENSITIVE TEETH 

To bring adequate relief of the sensitive or painful tooth, it may be necessary via a process of elimination to rule out certain causes first.  A conservative approach is usually taken so as to appropriately treat the condition.

• A tooth colored filling if the sensitivity is from decay that has not intruded onto the nerve
• A porcelain crown if it's due to cusp fracture or weakened cusp
• A root canal and crown if the nerve has been affected to either a fracture or abscess
• Tooth extraction if the tooth is not restorable due to extensive coronal and/or root fracture
• Fluoride varnish for exposed dentinal tubules
• Dental cleaning to remove plaque, bacteria, calculus, and tartar buildup along the gumline
• Antibiotics and analgesics as necessary adjunctive treatment
• Anti-sensitivity toothpaste (ie. Sensodyne) for exposed dentinal tubules, exposed enamel and root surfaces

Generally speaking, if you develop any of the above mentioned sensitivity and discomfort with your teeth, be sure to schedule an evaluation with your dentist.  It may also warrant emergency dentistry treatment if you have tremendous lingering tooth ache pain, discomfort, and/or swelling.  If you have any questions on the causes and treatment of sensitive teeth, be sure to consult your family dentist.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants with Dentures, the Overdenture

DENTAL IMPLANTS

Dental implants have become an increasingly popular method to replace one or more missing teeth.  With an average time span of three to six months after the implant has solidified and osseointegrated into the jawbone, the implant abutment and dental crown are then placed to complete the implant restoration, helping the patient achieve optimal esthetics, chewing, and speech.

IMPLANT SUPPORTED OVER-DENTURE

Complete full dentures often rely on the existing bone ridge and gingiva for retention (ie. to ensure the denture does not fall out and stays in properly).  Denture adhesives can help to ensure the denture stays in, but must be used periodically throughout the day.  Dental implants can also be used in certain denture case to help make sure the denture stays in place.  Also known as implant over-dentures, multiple single implants are placed on top of the ridge.  The dentures then "snap" in place on top of the implants, firmly holding the denture in place.  The result is increased fit and retention, without the need for denture adhesives.

How can Dental Implants Help Hold the Denture in Place?

• There is sufficiently thin bone ridge, denture adhesive does not help and the denture still "wobbles" and moves around.
• The patient does want the constant need to apply adhesive to the denture and wants a more permanent solution.
• Due to extreme muscle and bone atrophy, there is near nonexistent bone structure and ridge to support a denture in place.
• One does not have the physical ability or dexterity to apply denture adhesive, and would like a easier and more convenient method to hold the denture in place

Benefits of A More Secured Denture

• Increased ability to chew
• Eliminates need for denture adhesive
• Increased self confidence
• No need to worry the denture falling out

If you have any questions on how dental implants can help support and retain a complete denture, please contact you family dentist.

From you gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants of Multiple Teeth

Multiple Dental Implants

DENTAL IMPLANTS

A dental implant, which is also known as an endosseous implant or dental fixture, is a type of dental treatment to replace a single missing tooth.  There are however, times when it may be necessary to replace more than one missing teeth, and multiple dental implants may be a viable treatment solution.

WHEN ARE MULTIPLE DENTAL IMPLANTS INDICATED

There are times when more than one dental implant may be considered:

1. There is an existing dental bridge that has failed due to extensive tooth decay or root fracture, and the teeth supporting the bridge needs tooth extraction.  Multiple dental implants may be used to replace the teeth supporting the bridge.
2. There are multiple missing front teeth, and a long span fixed dental bridge is not desirable as part of conservative dentistry and to prevent over treatment, or when a  partial denture or flipper is not a desired option.
3. There are more than one missing consecutive posterior / back teeth in a row, and one wants to gain back chewing function of their back teeth.
4. One is missing all of their teeth, and as part of a comprehensive dental reconstructive program, multiple dental implants may be used to restore the patients smile, form, and give back proper chewing and occlusion.  Such cases may be done by the prosthodontists, dentists who specializes in full mouth rehabilitation scenarios.
5. One has a denture that is loose, and is not able to be supported well by adhesive or denture relines.  By placing several dental implants, the implant will help anchor the denture in place.
6. There is severe periodontal disease (gum and bone disease) and more than one teeth have to be extracted due to advanced bone loss and/or gum infection.

AM I A CANDIDATE FOR MULTIPLE DENTAL IMPLANTS?

You, your dentist, and dental surgeon will discuss together if more than one dental implants are suitable for you.  Factors that need to be considered include medical history, bone width, age, existing conditions and habits that may delay healing (ie. smoking presence, diabetes), conditions that may prolong bleeding (ie. blood disorder), and finances.

If you have any questions or concerns regarding multiple dental implants, the steps and costs involved, please consult with your family dentist.
 
From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Teeth Whitening At the Dentist

Teeth Whitening

Teeth whitening has become a popular part of cosmetic dentistry, and is easy to do!  Thinking about getting your teeth whitened?  What is it like getting your tooth bleached?  Ever wonder what exactly it is?  How and why does it work? 

A tooth has essentially three layers: enamel, dentin, and pulp.  Enamel is the hard outer layer, dentin is the softer inner layer of the tooth, and the pulp is where the nerve and live tissues are.  Children's teeth (baby teeth) are naturally white when they first erupt.  Over time, as people age and permanent teeth erupt, teeth become less porous and the teeth appear darker and stained.

FOODS THAT CAUSE DARK AND GREY STAINS

Foods and drinks such as tea, wine, soy sauce, coffee, blueberries, and betel nuts can cause dark and yellow stains within the enamel of the teeth.  Over time, the stains can penetrate the enamel layer and the dentinal tubules, causing teeth to appear grey, dark, and yellow.  Other products than can also cause teeth staining include coke, certain antibiotics like tetracycline, and excessive fluoride.

HOW TEETH WHITENING WORKS

Bleaching products use hydrogen peroxide that interacts with water to form carbamide peroxide.  The peroxide travels within the enamel tubules to the dentin, breaking down the stains in the enamel and dentin.  Teeth thus appear to be whiter and brighter as the stains are dissolved and the enamel and dentin are more porous in the process.

TEETH WHITENING WITH STORE PRODUCTS

In the store, one can purchase whitening toothpastes, paint-on gels, and whitening mouthwashes.  These products may contain a mild abrasive that remove very mild extrinsic surface stains.  Some companies such as Crest sell whitening strips, which can help remove mild to moderate dark stains.  Most of these products contain very little hydrogen peroxide and have not been tested, so such whitening effects may not be as effective.

IN-OFFCE TEETH BLEACHING

• The dentist can fabricate custom whitening trays for one to do tooth whitening at home.  Once molds of teeth are taken and trays are made, one places a hydrogen peroxide gel within the custom trays.  The trays are worn over a period of two to three weeks.
• Some dentists also offer same day bleaching.  A high concentration of carbamide peroxide gel up to 40% is placed on the teeth for a duration of 25-30 minutes and repeated two to three times.  This method is effective against moderate to heavily stained teeth due to the gel concentration, and usually takes a single 90 minute session.

TEETH WHITENING SIDE EFFECTS

Dental bleaching is relatively safe but as with any dental procedure there are side effects.  Tooth whitening side effects include minor cold/hot tooth sensitivity, gums irritation from the hydrogen peroxide gel, and lingering tooth sensitivity to cold.

Interested in teeth whitening?  Be sure to consult with your family dentist.  Tooth bleaching can be a regular part of your regular dental care; you and your dentist can discuss which whitening method may be appropriate.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants Single Tooth

Dentistry today is vastly different due to increases in oral health research and technology, and dental implants is one of the leading services dentists are able to provide today for their patients.  Implants are many times a viable option as to afford a long term replacement and viable solution to missing teeth.

Today, let's go over the single tooth dental implant, which is also known as an endosseous implant or dental fixture.

WHAT IS A DENTAL IMPLANT?

A dental implant is a component that is surgically placed within the jaw bone, which in turn supports a prosthesis (ie. dental porcelain crown, bridge, or denture).  Via a biological process called ooseointegration, the implant fixture (typically made from titanium), forms an intimate bond to the bone.  At this point the dental surgeon would also determine if a bone graft is required.  If there is insufficient bone structure to hold the implant firmly in place, additional bone may need to be be added to the implant site via a bone graft.  If the implant area is in an area of esthetic importance (ie. front tooth with an exposed smile line) the dentist may elected to add additional gingival tissue to improve the appearance of the implant fixture via a soft tissue graft.

After the implant is placed, the implant fixture is given time to heal and integrate with the bone, usually for 3-6 months.  Once the implant osseointegrates with the bone, an abutment is attached to the implant which contains and hold the dental prosthetic (ie. crown, bridge, or denture).  The dental prosthetic may then be attached to the abutment and implant via cement or screw..

WHEN IS A SINGLE TOOTH IMPLANT INDICATED?

There are situations when a single implant may be desirable:

1. Accidental trauma to a single tooth, while the teeth adjacent to the affected area are normal and healthy.  An example would the loss of a front tooth due to an accident.
2. A tooth has cracked from heavy occlusal trauma (bruxism and nighttime grinding) and is not saveable with a root canal and/or dental crown.
3. A tooth that has such severe decay it is no longer restorable with a root canal and crown.
4. A tooth with an existing filling or crown that has such deep and severe decay it is not longer saveable with a new restoration.
5. A tooth that has luxated (tooth fell out of its socket) from a sports or playground accident, or physical altercation. 
6. A tooth has cracked and sustained a fracture after a root canal from normal chewing, and the tooth is no longer saveable and requires tooth extraction.
7. A tooth that has severe localized periodontal disease with aggressive bone loss.  With such periodontal involvement and bone loss, the tooth may be mobile and have poor bone support and susceptible to infection.
8. One particular area of the jaw has an inherent missing tooth.  For example, some people are genetically born with a single missing adult tooth, and this may cause difficulty chewing, self awareness in their smile, or food-induced gum trauma and irritation.

AM I CANDIDATE FOR A SINGLE TOOTH IMPLANT? 

The dentist and surgeon would determine if you are a viable candidate for a single tooth dental implant.  A successful implant would require healthy jaw bone and gingiva.  Oral hygiene, diabetes, smoking, a compromised immune system, and heavy uncontrolled bruxism/grinding are important factors to take into consideration of the implant's success.  Age may be a factor; one may want to wait until the age of 20 as that is when the jaw bone has completed its full maturation growth cycle. 

COST OF DENTAL IMPLANTS

What does a dental implant cost?  The costs of the implant from start to finish will vary widely and dependent on many factors. These factors include: type of material used, state where the service is performed, the type of insurance coverage, if a bone graft is required, the type of abutment used, and the type of crown that is placed.  The dentist's front office would be able to give you an estimate of the costs associated with the dental implant. 

If you have any questions or concerns regarding dental implants, the steps involved, and the costs involved, please consult with your family dentist.
 
From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Medication Effects on Teeth, A Dental View

 MEDICATIONS EFFECTS ON TEETH, A DENTAL VIEW

There are unfortunate (sometimes emergency) cases where one can sustain a traumatic and inadvertent injury to the dentition and oral cavity.   Such dental trauma may also stem from a medical or pharmacological condition, such as a drug's side effect or due to a body's physical condition.
A cursory understanding of medical conditions, diseases, and side effects from drugs will help one see how said conditions relates from a dental point of view, and also allows one to see how the body and the oral cavity, teeth, and gums inter-relate with one another.

Let's examine some possible dental and teeth damage due to various medical conditions:
1) Xerostomia 2) Sjogren's syndrome 3) Bulimia and Gastroesophageal reflux disease 4) Methadone side effect 5) Recreational drug use side effect 6) Medication side effects 7) Chemotherapy and radiation

XEROSTOMIA

Xerostomia, or dry mouth, can be due to aging, immunosuppressive medications, prescription medications, and chemical and radiation therapy.  With dry mouth saliva production is lowered, placing the teeth at higher risk of dental decay, necessitating the need for tooth colored fillings (resins).
Medications are many but can include antihypertensives, antidepressnats, diuretics, steorids, anticonvulsants, antianxiety agents, antipsychotics, and acne treatments.

SJOGREN'S SYNDROME

Sjogren's Syndrome is an autoimmune disorder that is characterized by excessive antibody production that are directed against certain tissues in the body.  Gland inflammation is a distinct characterization of Sjogren's, and affects the lacrimal glands in the eyes and also causes inflammation of the salivary glands.  The affected glands result in decreased tear production in the eyes and decreased saliva production in the mouth, hence dry eyes and dry mouth and lips are key indicators of this Sjogren's Syndrome.  With dry mouth dental decay may be more prevalent and may require tooth colored fillings to restore the dentition. 

BULIMIA / GASTROESOPHAGEAL REFLUX DISEASE

Bulimia is a psychologically induced condition where vomiting is forced and self-induced. Patients have tremendous fear of weight gain and have a severe negative overweight image of their bodies, thus forcing themselves to vomit in order to lose weight .  Hence the teeth are constantly exposed to acids in the stomach, if untreated can lead to enamel erosion and deterioration, which can then affect the dentin.  Tooth colored fillings or porcelain crowns may be required.

METHADONE SIDE EFFECTS

Methadone, a prescription medication by one's physician, is used as an anti-addictive medication for opioid addiction (ie. oxycodone, hydrocodone), and may also be used as an analgesic and antitussive. 
Methdaone's damage on the teeth can be extremely extensive, from enamel and dentin erosion to teeth fracture.  Such cases often require extensive dental treatment including porcelain crowns, surgical tooth extractions, and dental implants.

RECREATIONAL DRUG USE SIDE EFFECTS

Methamphetamine is a recreational drug when taken due to dependence, can cause severe teeth erosion and rampant dental decay / cavities.  Dental fillings, root canals, and porcelain crowns may be required in such cases to restore the dentition. 

MEDICATION SIDE EFFECTS

Tetracycline is an antibiotic, when taken during tooth formation, can cause malformations of the teeth.  Malformations may range from relatively minor enamel striations to complete enamel discoloration and dentin weakness, causing eventual tooth failure and fracture.  If the effects are minor, treatment may not be required.  If the effects are major, dental treatments may include porcelain veneers, dental crowns, and/or root canal therapy.

CHEMOTHERAPY / RADIATION

Chemotherapy and radiation, commonly used for cancer treatment, can negatively affect salivary production and thus cause dry mouth, which increases one's risk of tooth decay and gum disease.  Common dental affects may include rampant and extensive cavities and swollen & bleeding gums.  Patients undergoing chemotherapy and radiation may thus be at increased need of fillings.

CONCLUSION

It is this author's hope that after reading this blog, one will have a little more appreciation of the negative side effects of various drugs and medical treatments on the oral dentition.  While in most cases dental treatment can be rendered to address aforementioned negative effects on the dentition, a close relationship between the patient's dentist and physician is necessary to control and maintain the drug side effects, and to prevent the drug from overpowering teeth and periodontal health.

From your family Bellevue dentist,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Oil Pulling and Dental Health, Coconut Oil

Some may have heard or see the term "oil pulling" which some swear to its positive effects.  Not sure what it is?  Let's find out...

WHAT IS OIL PULLING?

Oil pulling has actually been used as an traditional old style remedy in India, originating from Ayurvedic medicine.

It involves swishing your mouth with oil anywhere for 5 to 15 to 25 minutes so it coats your teeth and gums with the oil.  The oil is then spit out from the mouth.  That's it.  

So which oil can be used?  The most common oil used is coconut oil; other oils used to a lesser extent include sunflower oil, sesame oil, corn oil, rice bran oil, and soybean oil.

HOW DOES OIL PULLING WORK ON THE TEETH AND GUMS?

The concept is simple and as follows: There exists in everyone's mouth a colony of microbial bacteria that are beneficial and bacterial that are harmful.  The mouth has an extremely favorable environment for bacteria: it is constantly warm due to body heat, moist with saliva, has a narrow neutral pH of ~7.0, and has a constant source of nutrients from food and liquid ingestion. 

Some of the beneficial bacteria include: Streptococcus sanguinis, Streptococcus oralis, Actinomyces naeslundii, Neisseria subflava, and Veillonella dispar.  Some negative bacteria include: Streptococcus mutans, Tannerella forsythia, Porphyromonas gingivalis, and Fusobacterium nucleatum.

The body's goal is to keep the "good" bacteria and the "bad" bacteria in check and in balance.  If such microbial are dominated by the negative bacteria, the result in one's oral health and dentition may include dental decay (cavities), gingivitis, and periodontal disease (gum disease with bone loss).  Bacteria causes such negative oral health effects by creating a visible biofilm, or a thin layer of plaque on the teeth.

The theory with oil pulling is that the oil disrupts the binding of bacteria to food particles, and that the oil traps and kills the bacteria.

WHAT IS THE COMPONENT IN THE OIL THAT IS EFFECTIVE AGAINST BACTERIA?

Coconut oil appears the most effective oil in oil pulling.  Coconut oil contains Lauric acid, a medium-chain fatty acid.  Lauric acid is rarely found in nature; aside from coconut oil, which contains the highest concentration of Lauric acid available, human breast milk also contains Lauric acid.  

The body converts Lauric acid into monolaurin, a monoglyceride compound that has antimicrobial and antibacterial properties.  The monolaurin disrupts the mechanical formation of the gram negative bacteria's lipid membranes, hence destroying the bacteria.  The monolaurin is also high effective against fungus (Giardia Lamblia) and lipid coated virus (ie. HIV, herpes).

Sesame oil and sunflower oils contain high concentrations of Oleic acid and Linoleic acid and are regarded as less desired than coconut oil.  Sesame and sunflower oils are lesser used oils as such  acids are respectively omega-6 fatty acids (high concentrations can disrupt the healthy effects of omega-3 fatty acids found in fish and nuts) and omeg-9 fatty acids (a nonessential acid the body can manufacture).

OIL PULLING STUDIES AND EFFECTS ON ORAL HEALTH

Studies of oil pulling remain unfortunately not widespread.  I was able to find a few published studies of oil pulling below.

A 2008 oil pulling study of S. Mutans count in plaque and saliva demonstrated the benefits of coconut oil on reducing the level of S. Mutans in the mouth, and has been shown to approach that of chlorohexidine, though not as effective as the chlorohexidine. 

A 2010 study of oil pullling on microorganisms showed similar results of reduced bacteria count.

CONCLUSION

Oil pulling originally started in India many years ago, but its use is currently not commonplace in the United States.  Though it has started to gain traction and popularity due to recent media events, it is the humble opinion of this author that oil pulling holds promise within its regard to positive antimicrobial oral health effects with respect to the teeth, gingiva, and periodontal bone structures, and that oil pulling has a sound scientific basis.  More and larger prospective epidemiological studies are needed and recommended before the author can deem oil pulling a definitive practical recommendation to practice as one's daily oral hygiene habits .

From your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Debunking the Myth that Root Canals Cause Cancer

Tooth with Root Canal Treatment

Cancer, a disease the medical, research, and practicing physician community have been battling since the dawn of the late 20th and early 21st century.  Cancer is a condition that has eluded the much needed cure; its etiology and causes are many and likely multi-factorial, some unknown, some known.

Some recent articles circulating on the internet have stated that a prevalent dental procedure is the cause of terminal cancer: root canals.  The information in the article claims that "97% of Terminal Cancer Patients Have Had This Dental Procedure" and therein it claims that the root canal is the cause of said disease.  The article then claims that the bacteria in the root canal tooth is the causal factor for cancer (among other regenerative diseases).   

This article claims that the cure of cancer is as simple as extracting root canal teeth, which allows one's immune to rebuild.

WHAT IS A ROOT CANAL?

First let's go over briefly what is involved in the root canal procedure.  During endodontic treatment the nerve of a tooth is removed out of necessity (ie. tooth infection, deep decay/cavity that has intruded the pulp, necrotic pulp, severely fractured tooth and/or restoration, failing restoration, traumatized pulp/ligament around the root).  The nerve and pulp in the root is mechanically cleaned out with a stainless steel instrument, filled with out a material called gutta percha, and which is then combined with a material called a sealer.

ARE THE MATERIALS USED SAFE?

The instruments used during a root canal procedure to remove the nerve are a stainless steel surgical grade quality.  It's the same material constructed in kitchen utensils people use everyday during meals.  It's the same material used in cooking knives and during surgery and most other routine physical examinations and medical/dental treatment.

The gutta percha used to obturate the canal (ie. fill the canal of the teeth) is made from a natural latex produced from the sap of a tree.  Gutta-percha is malleable, biologically inert, and biologically compatible.

Sealers are used to fill spaces within the root that the gutta-percha is not physcically able to fill.  Different types of sealers include zinc oxide-eugenol, resins, glass-ionomer, and silicon based materials.  Such materials have shown to be biologically compatible, and the vast majority of the population suffer no side effects from its presence or touch.

DO THE BACTERIA MENTIONED IN THE ARTICLE CAUSE CANCER?

No.  A major flaw of the article is its premise the research dentists found within the root canal teeth, the following bacteria:

Capnocytophagaochracea
Fusobacteriumnucleatum
Gemellamorbillorum
Leptotrichiabuccalis
Porphyromonasgingivalis

The dentists claim that the bacteria were found within root canal teeth, and it can affect one's heart, kidneys, brain, and sinus.  While this may be true, one has to realize that the above bacteria is found EVERYWHERE.  They have been shown to be common and present among immunologically compromised patients.  Such said bacteria are NOT exclusive to teeth with root canal treatment, and are present on the body due to the body's inability to ward of infections.  The bacteria are not present because of root canal treatment, and such claims from the article has no causative basis.

ARTICLE CLAIMS "DEAD BODY PART CAN LAUNCH AN ATTACK BY THE BODY"

False.  Another claim the article asserts is that leaving a dead part of the body within the body is ill-advised.  The article compares a gangrened finger or toe, or an aborted fetus in-utero due to a dead baby, which results in a miscarriage.  Granted yes, a gangrened finger or toe is surgically removed because if not removed in a timely manner, the bacteria within the necrotic finger/toe can travel and affect its neighboring healthy tissues.

And yes, the body may spontaneously removed the dead baby in-utero from the uterus, resulting in a natural miscarriage.  However one has to realize the dead fetus is expelled from the body naturally because the body recognizes the fetus as an organically necrotic material, and does not want to expend its nutrients and blood supply on necrosed tissue.

In comparison, a "dead tooth" is composed of inorganic materials.  Much like hair, fingernails, and eyelashes, the body recognizes such body parts as inorganic, including the root canal tooth.  Comparing a "dead" tooth to gangrened finger/toe or a fetus is not a viable comparison.  If such claim is true, then we can also state that one's body hair, head hair, or toe nails are a cause of cancer, and that our natural hairs and nails should be removed as such.


ARTICLE CLAIMS ROOT CANALS LEAD TO BONE, HEART, KIDNEY, AND BRAIN DISEASE

False.  The article further claims that he transplated root canal teeth fragments into rabbits, and found that such transposition caused a heart attack within a few weeks in 100% of the rabbits.  The Arthur further claims such teeth fragments caused bone, kidney, and neurological damage in 80% of the rabbits.

Such above claims have again no causative factors and have no relevant cause in cardiovascular disease in rabbits.  Rabbits as an overall population suffer from unfortunate sudden death, and is linked to inherent heart failure and heart disease.  The article's assertion that root canal fragments cause heart disease in rabbits is no more true than claiming that drinking water causes heart disease, as there is no causation.

Additional claims of bone, hepatic, and neurological damage caused by root canal fragments has also no basis.  Rabbits in general also suffer from inherent bone, kidney, and neurological issues as common causes of death, and again, has no causation with respect to root canal treated teeth.

ARTICLE FINALLY ALLEGES ONE TO AVOID ROOT CANAL

Depends, but one should NOT avoid a root canal for the fear of it being carcinogenic and cancer causing.  A root canal is a safe and biologically compatible dental procedure.  Though there are inherent risks of any dental or medical procedure, and no biological results can be guaranteed, its overall efficacy is time and results proven, and its benefits far outweighs its risks.

FINAL STATEMENT

It is the humble opinion of this author that root canals have no causative biological factors in the role of cancer.  such articles circulating on the web is an attempt at sensationalism and are astray from the sound scientific medical and dental community, and are merely attempting to instill ignorance and fear on the overall general population.  Again, the claims such articles are no more relevant to stating that drinking water causes stroke and heart disease, or that owning a parrot causes dementia.  

If you have ANY questions regarding root canal treatment, be sure to consult your family dentist or endondontist. 

Warm Regards from your family Bellevue dentist,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com 

Healthy Teeth Healthy Mouth Happy Kids

 Here at Bellevue Family Dentistry, we place an emphasis on adults and kids oral health alike.  In light of the American Dental Association's National Children's Dental Health Month in February, let us examine the benefits of oral health in kids.

Why is Children's Oral Health So Important?

• In the United States, oral disease (ie. tooth decay, gum infections) causes kids to miss more an astounding 50+ million hours of school, and also their parents to miss more than 25 million hours of work per year.
• If cavities and oral health infections are left untreated, the pain and infection may result in problems with eating, learning, speaking, and concentration. 
• Early premature tooth loss may result in reduced self esteem and reduced confidence.
• Children and adolescents with oral health problems, compared to those without oral health issues, are unfortunately more likely to have problems at school, and less likely to complete their homework.  Those with oral health problems are also more likely to feel interior, shy, unhappy, uncomfortable, sad, and depressed.
• When children's oral health issues are treated and the kids are not experiencing pain or discomfort, studies show they are able to learn better and their attendance at school improves.

America's Tooth Fairy

America's Tooth Fairy has great resources and information on programs on community-based educational, treatment, and preventive services to children of all income levels.  In the year 2012, volunteers from America's Tooth Fairy were able to provide children with over 200,000+ dental cleanings, dental sealants, fluoride treatments, screenings, and oral health education.

What Can I do Help my Kids at Home?

The best care begins at home!  Starting at the age of 6 months when kids first baby/primary tooth erupts, start brushing their teeth right away with a soft toothbrush.  Use a pea-sized amount of nonfluoridated toothpaste if your child is unable to spit out yet.  Brush your kids teeth twice a day (morning and before going to bed) and start flossing as soon as you see two or more teeth adjacent to one another.  Use an over the counter anti-cavity fluoride rinse (ie. ACT) to help decrease the risk of cavities.  Bring your kids to the dentist twice a year for regular checkups, cleanings, and fluoride treatments.

Happy brushing and flossing everyone!

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600
 

Painful Canker Sores in the Mouth

Canker Sore

What are Canker Sores?

Ouch!  Ever get that annoying and painful sensation inside your mouth?  Often times it can suddenly occur without warning, and it can be very painful to touch, making it difficult to eat.

Also known as aphthous ulcers, or aphthous stomatitis, these are benign and non-contagious lesions that form anywhere inside the mouth.  It can occur on the tongue, inside the cheek, on the gums, the roof of the mouth, on the floor of the mouth, or inside the lips.  Some people may notice a discoloration or an unusual feeling prior to its onset.  When the canker sores are fully formed, it is usually a small white circular lesion in the middle, while the outside border is bright red.  In severe cases the interior of the lesion may even bleed, while also causing a slight fever.  Such cases would suggest the body is fighting an infection.

However, be careful if one notices sores on the outside of the lips.  These are not canker sores, but rather herpetic lesions that are very contagious.  Such lesions should be treated accordingly by your dentist and physician.

What causes Aphthous Ulcers?

Unfortunately we don't really know what causes aphthous ulcers (canker sores).  Some studies suggest it may be due to environmental factors like stress, physical trauma and injury to the affected area, or even smoking.  Highly acidic foods may also play a role (ie. lemon, lime, figs, and tomatoes).

A Journal of American Board of Family Medicine  suggests that low levels of Vitamin B12 may also be a possible cause of canker sores.  Other studies also suggests that folic acid and iron may play a similar role, but its unclear if such supplements may improve healing or reduce occurrence.

Despite common misconceptions, there is no established association between canker sores and autoimmune diseases.  Recent studies show that such occurrences have no common antibodies, and are believed to be independent of each other.

How to treat and manage Canker Sores?

Treatment for aphthous ulcers is palliative at best (ie. controlling and managing pain and its symptoms).  Prevention is difficult because the exact cause is not clearly demonstrated and not understood.

• Most sores (minor aphthous ulcers) will heal on its own within 7-10 days.  Over the counter ointments such as Zilactin-B may help with pain relief).
• For sores that are larger in size and severity (termed major aphthous ulcers) medications such as a corticosteroid rinse may help (ie. hydrocortisone sodium succinate aka Solu Cortef and beclomethasone dipropionate aerosol).

Other methods that may decrease the occurrence of canker sores include:

• Wearing a sportsguard to prevent injury to the gums and gingiva during athletic events
• A diet high in Vitamin B12, folic acid, and iron (ie. dark and leafy green vegetables like spinach and kale, red meats like beef, and fortified dairy products like milk and yogurt)
• Good oral hygiene  and regular dental cleanings and checkup
• Avoiding foods that may irritate the gums and mucosal lining (ie. spicy foods, acidic vegetables and fruits like lemon, lime, escarol, pimento, tomatoes, and any vegetables processed with vinegar, such as canned artichokes, pickles, sauerkraut). 

If you have any questions or concerns regarding canker sores, or if you notice your sore has not healed within 14 days, please consult your doctor or dentist.

Warm Regards from your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Mouthguard and Sports in Dentistry

MOUTHGUARD

With the start of the new year in 2014 and Superbowl XLVIII coming up in February 2, 2014 I thought it would be a good idea to talk about the relationship between dentistry and sports.

Contact sports like football, basketball, soccer, rugby, boxing, lacrosse, and hockey often subject the human body to physical trauma, and one area is the teeth and gums.  To help prevent and reduce injury to said teeth, lips, and gums, a sports mouthguard is recommended.  Incidentally a mouthguard may also be used as adjunctive treatment for bruxism and tooth bleaching.

HISTORY

In the mid 1940s Dr. Rodney Lilyquist, a dentist in Los Angeles, is credited with the introduction of the modern mouthguard for athletes.  A UCLA basketball player and a San Francisco 49er quarterback were among the first athletes to utilize the mouthguard.  1940s/1950s studies show that dental injuries accounted for as much as 50% of all injuries in football in the US.  By 1960, the American Dental Association (ADA) began recommending the use of mouthguards in contact sports.  In 1962, all US high school football players were required to wear mouthguards.  In 1973 the NCAA required mouthguards for all college football players.  The result has been a reduction in dental trauma, injuries, and contact related dental emergencies.

MOUTHGUARD AND DENTAL TRAUMA

The role of mouthguards is prominent where accidental or incidental impacts to the face, mouth, and oral cavity can cause physical harm and oral and maxillofacial trauma.  Schools and various sports associations have begun mandating mouthguard use.  Unfortunately some studies have shown such individuals in high contact sports have low compliance of regular mouthguard usage.  However, studies have also shown that even with regular usage, complete effectiveness against dental trauma is not always achieved due to poor fit and size.

SOME TYPES OF MOUTHGUARDS

There are a few types of mouthguards available today:

• READY MADE: These mouthguards are already premade.  The only adjustment possible is via a scissor or trimming knife to approximate shape.  Protection and fit is considered poor.
• MOUTH ADAPTED/STORE BOUGHT:  These are readily available in many over the counter pharmacies and sports stores.  They come in a prefabricated thermoplastic material that one takes home and boil to allow the material to adapt to the teeth.  Protection and fit are considered average and better than the "ready mades" but overall protection is compromised due to the soft vinyl material.
• CUSTOM MADE: Your dentist takes a custom mode of your teeth via an impression material, usually via a hyrdo-colloid alginate or vinyl-polysiloxane material.  The mouthguard is hence made from the impression taken.  Protection and fit is considered more optimal with this type due to the indirect custom impression, and the material is a hard, rigid, durable, and protective.

If you have any questions regarding sports and mouthguards be sure to consult your family dentist to discuss which mouthguard is right for you.

Warm Regards from your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Toothbrushes, which one should I use?

With so many toothbrushes out there to choose, how do I select a proper toothbrush?  All toothbrushes are the same, right?

While any toothbrush combined with a fluoridated toothpaste will be effective in helping one achieve optimal oral health and dental hygiene, there are a few factors and variables in a toothbrush one should be aware of:

• Manual toothbrush - This is your traditional toothbrush as shown in the photo above.  Through trial and error, the fundamental design of the manual toothbrush is a thin handle along with a head containing bristles.  Often times a thinner head can help reach and clean difficult areas of the mouth.
• Electric toothbrushes - Essentially a handle with a motorized head that either vibrates or rotates the bristles of the toothbrush, it actually vibrates the bristles faster than one can achieve by hand.  Studies have shown that while it can be more effective in removing plaque surrounding the teeth's enamel and around the gingiva, if one has optimal brushing habits via a manual brush, there is no need to switch.  The bristles on electric toothbrushes are typically replaceable.
• Soft bristle head - Your dentist or dental hygienist usually recommends a soft bristle head as hard bristles can actually damage the tooth's enamel and dentinal layer. Harder bristle tooth brushes eliminates plaque more efficiently but can cause more physical stressful to the teeth and gum.  Studies have shown that using a soft to medium tooth brush achieves the best compromise between cleaning effectiveness, tooth wear, and gingival health.
• Bristle lifespan - One should be aware the condition of the bristle.  If one notices the bristles to be flared and worn out, the toothbrush head needs to be replaced to allow for optimal cleaning effectiveness.  The typical lifespan of a toothbrush should be approximately 2-3 months.  Excessive wear of the bristles may suggest over aggressive brushing with possible re-evaluation of brushing techniques.

If you have any questions on how to select a toothbrush, be sure to ask your family dentist or dental hygienist at your next dental cleaning and oral checkup appointment.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

It's a New Year! Dental Insurance Benefits Overview...

Happy New Year everyone!  As the year 2014 gets off to a new starts, I thought it would be a good idea to go over some common questions on dental insurance and dental benefits.

Question: "I have new dental insurance.  Does it cover everything?"
Answer:  It really depends on the type of services being done.  Each insurance plan is different, and can vary by each individual and company.  The best way to find out much is covered by the insurance and how much the patient portion is to contact the dental insurance and to get a benefit breakdown.


Question: "What does PPO mean?"
Answer:  PPO stands for Preffered Provider Organization.  An office that is signed up to be a PPO for a dental insurance means the dentist and its providers at the office has agreed to accept the insurance's fees and benefit coverage by being in the insurance's network.  If an office is not a PPO with your dental insurance, it does not prevent you from going to that office; it just means your benefit MAY differ.  The best way to find out again is to check with your dental insurance company and inquire about benefit details.

Question: "My insurance doesn't cover it.  That means I don't need it right?"
Answer: Unfortunately no.  For example some insurance plans will not cover full coverage porcelain crowns when a tooth has suffered a large cuspal fracture, or if the decay has caused need for a root canal and/or crown.  Without a full coverage crown, the tooth has a chance to further break off at the gum line, causing possible need for extraction.  Your dentist will be able to discuss the best treatment options with you and why such services are needed or not needed.


Question: "Why do I need a deep cleaning?  There is an out of pocket expense.  Can I just get a regular dental cleaning instead?"
Answer: A deep cleaning is highly recommended in cases of periodontal disease.  A deep cleaning is the very best way to control periodontal disease and to remove bacteria and tartar/calculus buildup that is underneath the gumline.  While a regular dental cleaning/adult prophy is helpful, it does not allow your dentist or dental hygienist to remove the bacteria/buildup trapped underneath the gumline.

Question: "What do these terms mean: Preventative Services, Basic Services, Major Services?"
Answer: Preventative Services typically refers to regular adult and children cleanings/prophy, exams/checkup, fluoride, and x-rays (ie. bitewings, periapicals, and full mouth series).

Basic Services often include dental fillings (resins and amaglam), tooth extractions, and root canals.

Major Services usually refers to buildups, crowns, implants, dentures, nightguards, and orthodontics (braces).

Because the benefit level is specific to each dental insurance plan, be aware what one insurance may cover, another insurance may not.

Question: "What is a deductible?  Why do I have to pay it?"
Answer: A deductible is a contracted fee the dental insurance company sets, and will differ by each plan and service type.  The deductible is usually a one time payment per year your dental office will collect the amount when services are performed.  Your plan has specific guidelines on when and which services the deductible applies.

Question: "What are names of a few dental insurance companies? Can you recommend one?" 
Answer:  Each dental insurance company and its plans have its pros and cons.  The best way to find out which plan is suitable for you and your family is to discuss with your dentist to find out your long term needs.  Some names of common insurances include Aetna Dental, Metlife Dental, Premera, Blue Cross/Blue Shield, Delta Dental, Guardian, Standard, and Cigna.

If you have any specific questions regarding insurance and its benefits, be sure to contact your family dentist. 

Wishing everyone's 2014 off to a great start, from your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com