Dental X-ray equipment is

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1 Oral Health Report A newsletter for the patients of Pankey Institute trained dentists Vol. 4, No. 1 ASK THE DENTIST Should I be concerned about dental x-rays? Contributed by Dr. John F. Davis, Park Ridge, IL A not-for-profit educational foundation dedicated to improving the oral health care of the world s citizens Inside this Issue Porcelain Veneers page 3 Is it time for an electric toothbrush? page 4 Will drinking bottled water increase tooth decay? pages 4-5 Tooth decay is a disease. page 5 Are you as healthy as you feel? page 6 What is a dental articulator? page 7 Words Dentists Use page 8 Dental X-ray equipment is safe and uses very little radiation. Your dentist and dental technician are taught how to take x-rays with the smallest amount of radiation exposure to you, and you are covered with a protective lead apron that shields your body from x-rays. Your state likely has very strict regulations and inspection procedures to check the safety of X-rays and X-ray equipment. If you are going to a new dentist, have your former dentist send copies of your dental X-rays to your new dentist. If the x-rays were recent enough, you might not need more x-rays for a while. The U.S. Food and Drug Administration (FDA) recommends that adults who have no tooth decay and are not at high risk of getting cavities should have bitewing X- rays every 2 to 3 years. Teens should have bitewing X-rays every 1.5 to 3 years. Children should have bitewing X-rays every 1 to 2 Dr. Davis has been practicing dentistry since He graduated from the Loyola University School of Dentistry after earning a Bachelor of Science degree from the University of Illinois where he majored in microbiology. Dr. Davis is a member of the American Dental Association, Illinois State Dental Society, Chicago Dental Society, and the Academy of General Dentistry. Dr. Davis earned a Masters in the Academy of General Dentistry in Currently, Dr. Davis is on the Visiting Faculty of The. Pankey Institute for Advanced Dental Education. years. For people with tooth decay and a high risk of getting cavities, the guidelines are for more frequent x-rays until no tooth decay is seen. Your dentist will determine the appropriate interval for your situation. (Continued on next page) 1

2 ORAL HEALTH REPORT Should I be concerned about dental X-rays? (Cont.) The benefits of X-rays are large. Your dentist uses them to help find problems with your teeth, the bone that supports them, and your jaw joints. These images may reveal cavities, hidden teeth (such as wisdom teeth that have not erupted), abscesses, cysts, tumors, fractures, and bone loss that cannot be seen through a visual examination. Bitewing images show the upper and lower back teeth and how they touch each other. Periapical images show entire teeth, including the end of the roots and supporting bone. Panoramic images are a broad view of the jaws, teeth, sinuses, nasal area, and jaw joints. Sometimes images are made of the roof or floor of the mouth. It is becoming more common for dentists to use CT imaging for diagnosing and treatment planning purposes. CT images provide detailed, three-dimensional information about teeth and bones of the face and head. A full-mouth series of periapical images (about 14 to 21 in total) are most often done during a person's first visit to the dentist. Bitewing X-rays are used during checkups to look for tooth decay. Panoramic X- rays may be used occasionally and are very helpful in determining the position of wisdom teeth. Dental X-rays are scheduled when you need them based on your age, risk for disease, and signs of disease. Tell your dentist if you are pregnant. Routine dental X- rays are typically postponed until after the baby is born. Although there is no proof that a routine dental X-ray could harm a developing baby (fetus), dentists usually suggest you wait unless you are experiencing a dental problem that is urgent and requires an X-ray to diagnose. Some dentists use digital radiography. This method uses an electronic sensor instead of X-ray film. An electronic image is taken and stored in a computer, then viewed on a computer screen. These digital images can easily be sent to other doctors as attachments. Keep in mind that without X-rays, we may miss early stages of decay between teeth and many dental injuries, cysts, abscesses and tumors. And, we cannot see root structures and impacted (unerupted) teeth to plan the best course of treatment. Dr. Susan Hollar Located in Arlington, TX for the past 25 years, Dr. Hollar is an expert in cosmetic and restorative dentistry. She teaches on the visiting faculty at The Pankey Institute. She is the first female dentist in the state of Texas to be awarded accreditation in the American Academy of Cosmetic Dentistry. Onlays Before & After These molars were repaired with undetectable porcelain onlay. 2

3 Vol. 4, No. 1 PORCELAIN VENEERS Strong, natural, stain-resistant Contributed by Dr. Susan Hollar of Arlington, TX Porcelain veneers have become the flagship procedure in cosmetic and restorative dentistry. Their success can be traced to NASA and the space shuttle program in the late 1970s. Having trouble with missing tiles during re-entry, NASA developed a method of bonding the porcelain tiles to the space shuttle's undercarriage. This bonding technology was adapted to dentistry, and allowed us to bond porcelain directly to the tooth surface. The mechanical chemical bond creates an amazingly sturdy restoration, which is as strong as natural tooth structure, and one that will not stain. Meet Sharon. Sharon's discolored front teeth were veneered with all-porcelain veneers giving her a youthful radiant smile. "I'm so proud of my teeth. Thank you, Dr. Hollar." The porcelain veneer can be quite thin (as tiny as 1mm), allowing for minimal tooth reduction. Preservation of the strong enamel tooth structure provides for a longer-lasting veener. The semi-translucent veneers can be made to match the light transmitting properties of natural teeth, and being metal-free, will never have the black marginal lines found around some old porcelain to metal crowns. Exquisite natural esthetics are achieved through the use of veeners, and it they can be used to close spaces, replace worn enamel, repair broken or chippeg teeth, re-shape crooked or misaligned teeth, and to cover permanently stained or discolored teeth. The porcelain veneer or onlay can also used on back teeth, and is our preferred method to restore broken molar teeth or to replace large mercury silver fillings. Porcelain onlays and veneers appear as natural as a tooth, in other words, totally invisible. Sharon Before Sharon After 3

4 ORAL HEALTH REPORT Is it time for an electric toothbrush? You can achieve good results from gentle, thorough brushing with a manual toothbrush. However, some studies have indicated that properly used electric toothbrushes remove plaque and reduce gum disease more effectively than properly used manual toothbrushes. The timing devices on many electric brushes do help people brush the full two minutes generally recommended for thorough brushing. Consult with your dentist and oral hygienist about proper brushing techniques and the type of toothbrush, dental floss, and inter-dental cleaning tools they recommend for you. Visit our website to learn more about your dentist s special training at The Pankey Institute for Advanced Education. We re on the Web at Will drinking bottled water increase tooth decay? Some dentists are concerned that people who drink mostly bottled water and little tap water may not be getting enough fluoride for good dental health. If your dentist observes tooth decay in your mouth, ask about fluoridation in your water. The American Dental Association (ADA), on the Web at has compiled a 70- page Fluoridation Facts booklet with over 200 scientific references. According to the ADA, There are no scientific studies to indicate an increase in the tooth decay rate because more people are drinking bottled water. This may be due to the fact that most of us are brushing with fluoride toothpaste, and we may be getting fluoride through other fluids in our diet. Nonetheless, the ADA wants people to be aware that if they drink bottled water as their primary source of water they could be missing the decay preventive effects of optimally fluoridated water available from their community water source. 4

5 Vol. 4, No. 1 Tooth decay is a disease. Tooth decay ( caries ) is an infectious and transmissible disease. The bacterial film that covers teeth is composed of more than 700 bacterial species. Drilling away decayed tooth structure may be only part of the disease elimination process. The bad bacteria that caused the decay may still reside in your mouth in an unhealthy number. Thus, the decay process can easily continue. You may even pass on the bad bacteria to others. The film of bacteria on your teeth can be very resistant to change. Shifting this film from an unhealthy balance to a healthy one can take significant time and persistence. Brushing and flossing breaks up the film, and this break up is essential for preventing cavities. Unfortunately, the bacteria that destroy tooth enamel can reattach to your teeth and begin to increase in number ( colonizing ) within 12 to 24 hours. If you are experiencing tooth decay, your dentist may recommend swishing an anti-bacterial mouth rinse for 30 seconds a day and also frequent professional cleaning of your teeth and the surrounding gum tissue until the bad bacteria are under control. The Center for Disease Control and Prevention in Atlanta reports most bottled water in the U.S. contains only 1/2 to 1/4 of the amount of fluoride that is considered optimal for preventing tooth decay. This can be especially detrimental to children with developing teeth. The ADA also warns that some types of home water treatment systems can reduce the fluoride levels in water supplies. If you use one of these home water treatment systems, you are not receiving the full benefit of optimally fluoridated water. Is Fluoride Safe? For over five decades, the American Dental Association has continuously endorsed the fluoridation of community water supplies and the use of fluoride-containing products as safe and effective measures for preventing tooth decay. Go to and click on Fluoride under Public Topics to learn more about what the ADA says about fluoride. 5

6 ORAL HEALTH REPORT Are you as healthy as you feel? Contributed by Dr. Jeffrey Dolgos, Lancaster, New York Ac o m p r e h e n s i v e evaluation is important for every new patient. Your dentist is one of a small percentage of dentists who have invested in postgraduate training at one of the world s premiere continuing dental education institutes, The Pankey Institute for Advanced Dental Education. The comprehensive examination you receive in this office may be unlike any you have received before. Your dentist wants to know you as a unique individual and to examine you in such a way that you can discover together the aspects of your oral health and appearance that can be improved. You and your dentist will gain valuable insights as you talk about your past dental experiences and what you want for yourself. Hearing about your concerns and opinions will enable the dental team to help you achieve the results you want. A complete clinical examination is accomplished with your help and input. Comprehensive clinical examinations are more thorough than the cursory check-up you may have come to expect. In order to reach a complete understanding of your present state of health, your dentist must gather data about your chewing muscles, jaw joints, and how your teeth come together against each other. Your dentist also must gather information about how these three components work together in your mouth. Evaluating the health of your gums and other soft parts of your mouth is part of the process. Your dentist will be looking for signs of disease, oral cancer, and injury during this part of the exam. A complete assessment of the health of each individual tooth, as well as the condition of any existing restorations (such as fillings, crowns and bonding) or tooth replacements (such as dentures), is an integral part of the process. An esthetic evaluation is apt to be included. If you have expressed concern about the way your teeth look, you will have the opportunity to tour your mouth with your dentist and discuss each point of concern. In addition to examining your mouth with you, your dentist will suggest appropriate x- rays. These may include images of your teeth, entire jaw sysem, and if necessary, specific images of your jaw joints. Diagnostic impressions of your upper and lower teeth will be made using an elastic material. These impressions are a mold into which special plaster material will be poured to make an accurate copy of your mouth. The resultant casts will be mounted on an articulator, which is an instrument that simulates how your teeth come together and move against each other as you bite and chew. A final step in gathering data is a complete set of close-up photographs of your teeth and face. During this entire process, you and your dentist will be talking about each portion of the examination and what you are discovering. Your dentist will be actively listening for your ques- 6

7 Vol. 4, No. 1 tions, concerns, and opinions. Time will be taken to address them. You will be a collaborative member of your oral health team. After the examination, before advising you on treatment, your dentist will take time, in solitude, to study all of the gathered information and form a thoughtful plan that addresses your concerns and any uncovered health problems. Your dentist invests substantial time in this phase of the process, as well as tremendous care, knowledge and advanced technical training. You will be invited to schedule a subsequent appointment to discuss the findings and how to best proceed with treatment that meets your goals and objectives. What is a dental articulator? An articulator as a "dental machine" that works as close as practical to the way the mouth works. At The Pankey Institute, your dentist receives advanced training in the diagnosis and treatment of malocclusion (an uneven bite ) that if left untreated can result in tooth wear, discomfort, and disease. At The Pankey Institute (above), your dentist receives advanced training in the articulation of dental casts (models of a patient s mouth made from impressions). Your dentist mounts casts of your upper and lower teeth on an articulator. The articulator is an instrument that simulates how your teeth come together and move against each other as you bite and chew. Dr. Jeffrey M. Dolgos Williamsville, NY If your teeth do not come together evenly, the forces they apply against each other may negatively affect your teeth over time. Studying this very accurate model of your mouth and its function helps your dentist plan appropriate care to address your concerns and improve your oral health. 7

8 ORAL HEALTH REPORT Words Dentists Use Contributed by Dr. Lee Ann Brady, Clinical Director, The Pankey Institute Here are some common terms used by dentists. Bite Splint: An appliance, sometimes worn only at night, to protect teeth and allow the jaw to relax. Bonding: A tooth colored filling material that is used to change the appearance (shape or color) of a tooth. Bruxism: Grinding or clenching of the teeth, either while asleep or awake. Dry Mouth (Xerostomia): Decreased salivary secretion, which can create a burning sensation in the mouth. Fixed Partial Denture: Replacement of one or more missing teeth, cemented into place. Commonly called a fixed bridge or bridgework. Impacted Tooth: A tooth that has not fully erupted, but is against tooth, bone or soft tissue and is unlikely to completely erupt. Malocclusion: Improper alignment of teeth. Orthognathic Surgery: Surgery done to correct abnormalities of the jaw bone. Removable Partial Denture: Replacement of one or more teeth that can be removed from the mouth. Sleep Apnea: A sleep disorder where breathing stops for periods of time. Scaling & Root Planing: Cleaning teeth above and below the gum line to remove calculus and plaque. Temporomandibular Joint Dysfunction (TMJ/TMD): Abnormal functioning of the jaws. Veneer: A thin layer of material, usually composite or porcelain, that is attached to the tooth to improve appearance The L.D. Pankey Dental Foundation, Inc., Oral Health Report. Reproduction in whole or in part is forbidden without the publisher s written permission. The L.D. Pankey Dental Foundation, Inc., a.k.a., The Pankey Institute, is a not-forprofit corporation chartered in the State of Florida. It accepts no commercial funding. It s mission is to improve the health and well being of the world s citizens by helping dentists achieve professional excellence through the practice of personalized, relationship-based, comprehensive dentistry. Managing Editor: Gary DeWood, DDS, MS Consulting Editor: Deborah E. Bush Subscriptions: (305) or pshaw@pankey.org One Crandon Boulevard, Key Biscayne, FL