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

Benefits of chewing gum on teeth

In season with the approaching holidays, I would like to elaborate a little more on the oral benefits of chewing sugar-free gum.  Sugar-free gum can actually play a helpful in one's proper oral care routine.

Tooth decay is a prevalent and leading chronic disease among children, and among adults in certain geographic and socioeconomic areas.  Hence its importance that dentists and dental hygienists realize the impact of teeth decay, and how to promote oral health education and how to help protect one's teeth from dental caries.

Orbit Sugar Free Gum

One such method to lessen the risk of tooth decay is by chewing sugar-free gum.  In chewing the gum, it promotes and stimulates salivary flow (ie. increased saliva production from the Submandibular gland and the Parotid gland).  Saliva production is increased up to ten times the normal rate; this helps protect teeth by washing food debris away from the teeth, and also neutralize the acids found in food/drinks by raising the pH levels.   Saliva also protects the mucosal lines of the oral cavity by promoting sufficient hydration and thus helps prevent desiccation (drying).

A good time to chew sugar free gum are between the times one brushes during their teeth in the morning and at night. This could be as much as a 12-15 hour gap where one's teeth is more susceptible to tooth decay.

Examples of sugar free gum include Orbit and Trident.

If you have any questions on the role of sugar free gum in one's diet, be sure to consult with your Bellevue family dentist or hygienist.  Happy holidays!


Warm Regards,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Holiday Foods and Treats, dental eats?

Holiday Treats and Oral Health, a Dentist perspective

Now that the holidays are upon us, there are likely plenty of foods and drinks that tempt our appetite.
Have you wondered which how these tasty treats affect our oral health?

Let's take a look at a few foods and drinks, and how they affect your teeth and gums:

The good ones:
Sparkling Water - Water is great for your body and teeth and gums alike. It hydrates your body and teeth alike, and also helps wash away plaque and bacteria away from your teeth.  As long as the sparkling water does not contain sugar (if it contains flavors, that's okay), Dr. Chien and your dental hygienist at Bellevue Family Dentistry in Bellevue, WA recommends you drink away!
Chewing Gum (sugar free) - Chewing gum promotes salivary flow, which helps remove bacteria and plaque off the teeth's enamel.  Studies have shown that chewing gum is correlated with lower risk of dental decay and cavities.
Sugar free and pure cocoa - Coca has been to have a power positive affect one's cardiovascular health, and it has also shown be cariostatic (halts development of dental decay).  Try mixing cocoa with hot water and a splash of sweet and low for a delicious sugar free drink that is good for your teeth!

The not so good:
Milk - Though milk is good for the development of strong teeth and bones due to its high calcium and Vitamin D content, milk contains lactose, a type of sugar.  Infants and toddlers should be kept from drinking milk at night during bed time to prevent baby bottle decay.  Otherwise drink milk during the day and be sure to brush your teeth immediately afterwards.
Candy cane - This popular candy is made 100% from sugar and sugar products. It really adheres to the teeth's enamel and promotes plaque buildup, gum disease, and tooth decay.
Cookies and cake - Often loaded with sugars and unhealthy fats, it can be unhealthy for the body and teeth, increasing the risk of cavities.  Try to find sugar free and low fat cookies and cake when possible.
Coffee - People sometimes have a tendency to load their coffee with sugars and high fat milk sweeteners.  Plus coffee can promote extrinsic tooth stains that may be difficult to remove, even during a dental cleaning.
  
Regardless of times though, be sure to always brush and floss your teeth daily to help prevent cavities and gum disease.

If you have any questions about how some of the above foods and drinks can affect your teeth during these holiday times, your family dentist in Bellevue is here to address your concerns. 

Warm Regards,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental handpieces

You may be wondering what type of equipment your dentist uses when he/she works on your tooth.  The "drill" is actually called a hand piece, and there are two types of "drills" or dental handpieces your dentist typically uses, the high speed and the low speed.

The high speed handpiece is controlled by a sensitive amount of air pressure placed on the foot control.  The maximum speed of the high speed handpiece is 350,000 rpm and requires 32 psi of air.

The high speed is typically used for:

•  Initial cavity removal and preparation
•  Preparation of a tooth for a crown.  
•  It also used sometimes during a surgical preparation for a tooth during a surgical extraction.

The low speed handpiece is used for other operations, and has a speed range of 0 to 8,000 rpm and requires 40 pis of air.  The actual speed is also controlled by pressure on the foot control.  Unlike the high speed, the low speed handpiece can change direction of rotation (forward and reverse).  Such uses of the low speed include:

• Cavity refinement/removal
• Removal of decay
• Finishing and polishing of an amalgam and resin restoration
• Drilling pins and posts to assist in retention of a large filling
• Prophylaxis (dental cleaning)
• Laboratory grinding, finishing, and polishing

If you have any questions on the dental handpiece, be sure to ask your family or cosmetic dentist.

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

Dental crowns, what makes it stay on?

Dental Porcelain Crowns

Dental crowns (ie. gold, porcelain fused to metal, and all porcelain) are used to reinforce a tooth's structural integrity and to allow normal functional occlusion.

But what makes the crown stay on the tooth?  A crown's retention is dependent on the following factors:

1) Taper.  The prepared tooth should ideally have 3 to 5 degrees of taper to allow for the restoration to be properly placed on the tooth. There should be no undercuts, as the restoration will not be able to be removed from the die and from the prepared tooth.  Conversely excess taper will limit the grip that the crown has on the prep, thus contributing to debonding of the restoration. Generally 6° of taper around the entire circumference of the prepared tooth, giving a combined taper of 12° at any given axial section through the prep is appropriate to both allow the crown for a proper fit and to allow enough retention.

2) Prep length.  The prepared tooth should also ideally have a minimum occlusal-gingival height of 4mm for molars and 3mm for anterior and premolars.  When such prep height is not possible, sometimes a core buildup is necessary to allow sufficient height and crown retention.


3) Adhesion.  There are two fundamental types of dental cements available, resin-based and acid-base cements.  Such cements allow the crown to adhere to the tooth by forming a chemical bond with the dentin and enamel.  The cement also forms an insulating and protective layer around the pulp.

If you have additional questions on the process of making sure a crown has sufficient retention, be sure to ask your family dentist.

From your family dentist in Bellevue,
Dr. Peter Chien
info@bellevuefamilydentistry.com
www.bellevuefamilydentistry.com