Oral Ecology of Mouth and Bacteria

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.

IS MY MOUTH REALLY DIRTY AND HARSH?

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.

WHAT HAPPENS INSIDE THE MOUTH?

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.

CAN FILLINGS AND CROWNS REALLY WITHSTAND THE MOUTH?

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.

FOR OPTIMAL DENTAL CARE, WHAT CAN I DO TO PROTECT MY TEETH?

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
www.bellevuefamilydentistry.com
(425) 614-1600

Fluoride Benefits on Teeth

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 Sjögren'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
425-614-1600
www.bellevuefamilydentistry.com

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