Wednesday, April 29, 2009

Why do I need X-rays?

A large number of dental problems occur in areas we cannot physically see.
1) Between the teeth
2) Beneath the roots of the teeth and in the bone surrounding the teeth.
3) Inside of a tooth

To properly diagnose problems that occur in those areas we need to see those areas, which can only be done with x-rays.

4q x rays 2

4r x rays 3

4s x rays 4

X-Rays allow us to do a thorough job checking your teeth. Without them we can only see the tooth surfaces that are visible. Many problems with the teeth originate in areas that we cannot see.

The #1 area for cavities on back teeth is on the biting surfaces of the teeth, which we can see visually. But the #2 area for cavities is in between the teeth. Those only become visible when the decay inside the tooth is large and has eaten away a big portion of the tooth.

On front teeth the #1 area for tooth decay is in between the teeth.

Meiners Dentistry has gone all digital on all types of x-rays now.

The benefits of that are:

#1) Low Radiation needed to capture the same quality of image that we used to get with film.

#2) Fast results. It doesn't take 5-7 minutes to process the x-rays anymore.

#3) It means we've gone "green" - no more chemicals used to process the x-rays, and less waste.

White Fillings vs. Silver Fillings

White Fillings 1

White Fillings 2

You have choices today when it comes to getting cavities in teeth filled. White fillings aren't new. In fact they've been around for a long time, but the technology used to chemically bond them to your teeth keeps improving all the time. The actually white filling material (composite resin) itself has also gotten stronger with advancements.

Many people think that they have done away with the old silver filling material - not true!

Here are some pros and cons to silver vs. white fillings:

White Fillings:


- looks like your tooth! - probably advantage #1, they really look GREAT!

- chemically bonds to the tooth to seal the filling in (silver fillings are just "packed in)

- repairable if some chips away because new material can stick to the old material


- not as strong as silver filling material (metal is still stronger than resin)

- more expensive than silver material (materials are more expensive, and they take longer to do)

- need an absolutely dry surface (no saliva or blood) to place the material for it to be successful. This can make using it very challenging on a lower tooth in the back of the mouth near the tongue, on an antsy child (or adult), or in other hard to reach areas.

- In an effort for dental insurance companies to reduce benefits (this is for BACK TEETH ONLY), if you select a white filling on a back tooth, many insurance companies will downgrade your benefit to a silver filling (because they are less expensive).

Example: The standard dental insurance pays 80% on regular fillings.

So let's say a White Fillings is $120 and a silver filling is $100

If you get a white filling, the insurance pays 80% of the $100 silver filling fee instead of on the $120 White Filling fee.

Your co-pay would be $20 on the silver filling, but would be $40 on the white filling.

Silver Fillings:


- less expensive

- faster procedure

- long lasting

- not as sensitive as white fillings are to moisture, meaning they can be placed easily on kids with active tongues, and hard to reach areas.


- doesn't look good

- does not bond to the teeth

- not easily repairable (usually needs total replacement)

- silver filling material still contains a small percentage of mercury. Some people will proclaim this is a problem, but this material has been around for a very very long time with a lot of positive results.

- the small percentage of mercury does allow the filling material to expand and contract (like mercury in a thermometer), which if a filling is large, can weaken the tooth over time. It seems like I see more broken teeth with large silver fillings in them than anything else.

Lead and Bacteria found in Dental Crowns made overseas (we don't use overseas labs)

Many of you have seen stories about lead in toys that came from China. Now there are other reports surfacing of lead and bacteria found in dental crowns and bridges made in China.

To give a little background. Dental Crowns and Bridges (as well as dentures and partial dentures) are not made by dentists, they are made at dental laboratories. Some dentists use labs right here in our metropolitan area (like we do), some use labs in other parts of the country. The problems spoken of in these articles are about crowns made in other countries, most commonly China.

Here are some of those stories:

At Meiners Dentistry, we have ALWAYS and will continue to ALWAYS use local dental labs in the metropolitan area where we know the individuals making the dental prosthesis personally. We support the local economy, and would not participate with foreign laboratories in the name of cutting costs to increase profit margins.

We are proud of the relationships we've established our local dental labs, and feel they provide products with the finest workmanship and materials available. There's no question it costs us more, but it is the type of quality we would want for our own mouths, and those of our family, friends, and patients.

Whoopi Goldberg discusses gum disease on The View

Gum disease is a destructive disease to the teeth, gums, and bone that surrounds the teeth. It rarely causes any pain until there is a pretty serious problem.

Dental Erosion on Rise in U.S.

This article came from US News and World Report. I've written on this subject myself quite a bit in the past, so it was interesting that it's finally gaining some national attention.

Posted 3/12/08

WEDNESDAY, March 12 (HealthDay News) -- Dental erosion -- the loss of the teeth's protective enamel -- is on the increase in the United States, researchers say.

"This study is important, because it confirms our suspicions of the high prevalence of dental erosion in this country and, more importantly, brings awareness to dental practitioners and patients of its prevalence, causes, prevention and treatment," study co-author Bennett T. Amaechi, an associate professor of community dentistry at the University of Texas Health Science Center at San Antonio, said in a prepared statement.

Amaechi led the San Antonio portion of the study, which also included researchers at Indiana University and the University of California, San Francisco. They looked at 900 middle school students (aged 10 to 14), and found that about 30 percent of them had the condition.

Dental erosion is caused by acids found in many common products, including soft drinks, sports drinks, some fruit juices and herbal teas.

"When consumed in excess, these products can easily strip the enamel from the teeth, leaving the teeth more brittle and sensitive to pain. The acids in these products can be so corrosive that not even cavity-causing bacteria can survive when exposed to them," Amaechi said.

Regular use of some types of medications, such as aspirin, also may cause dental erosion. Certain medical conditions, such as acid reflux disease or eating disorders (such as bulimia) associated with chronic vomiting, can cause dental erosion because of the gastric acids that are regurgitated into the mouth.

"It is important for dental practitioners to identify the erosion and its causes before it is too late. Because dental erosion creates a smooth and shiny appearance of the enamel and causes no pain or sensitivity in its early stages, most patients are not aware that they are suffering from the condition until the problem becomes severe," Amaechi said.The findings were published in current issue of the Dental Tribune.

Dental Bonding - a conservative, affordable cosmetic makeover.

There are many choices for ways to enhance your smile with cosmetic dentistry. From teeth whitening to porcelain veneers, there are many ways to whiten and change the shape of your teeth to make them look the way you've always wanted.

One procedure that doesn't get much media attention, but has been around for a long time, is half
the cost of veneers, and is minimally invasive is called Dental Bonding.

It gets even better, Dental Bonding can also often be completed in just ONE appointment!!

Dental Bonding 1

That's right, he same technology of white filling material in teeth can be "bonded" to your front teeth to improve appearance.

By comparison, Veneers are made by a dental laboratory and then those porcelain shells for your teeth adhere to your teeth.

Dental Bonding 2

Dental Bonding 3

Notice the gap, and overlapping teeth on the left. Stunning!

Dental Bonding 4

This person couldn't stop smiling after this was done.

Dental Bonding 9

This young girl almost never smiled before to hide her small teeth.

Dental Bonding 9.3

This young female sucked on lemons starting at a young age and she already exhibited a level of teeth wear we rarely see in anyone under 55. Bonding has given her a second chance.

If you would like to smile bigger and more confidently, it's possible bonding could be right for you!

Loose Dentures? We have found a cost effective solution!

If you've looked into getting implants to lock in your loose-fitting dentures and found that they're just too expensive, too surgical, and take too long to heal, we have got great news for you! We have been searching for years to find an easier way to provide our patients with locked-in dentures. Our search has lead us to discover an implant system that is not only a fraction of the cost of conventional implants, but many times there are no incisions or stitches, and there is no waiting for healing - you can wear your locked-in dentures home the very day the implants are placed. Absolutely unbelievable!

Stress Ravaging Men's Teeth

This is from the Chicago Tribune. I thought it was a well written article.


Stress can turn your hair gray, send you racing to the kitchen to look for chocolate and send you to the emergency room with chest pains. Now you can add dental problems to the list of the bad things stress can do to you.

"Stress can lead to teeth grinding and jaw clenching, and that can lead to serious dental issues," said Jeffrey Weller, a Chicago dentist and founder of Weller Aesthetic & Restoration Dental Care. "People came into my office with serious destruction; cracked teeth, jaw pain. Their jaws click, and they can barely bite."

"Men, especially, are literally wearing out their teeth," Weller said, adding that stressed executives are the newest wave in patients seeking cosmetic dentistry. Women, according to Weller, may be under similar stress, but because of their more delicate muscle structure, they are less likely to cause as much damage.

"Men typically want pain relief, but there's no question they also like the cosmetic effect," Weller said. Cosmetic dentists are using combinations of crowns, veneers, bonding and implants to correct bite problems and reverse years of damage. The secondary result of a better-looking mouth is giving patients something else to smile about.

"Once people started whitening their teeth, it opened the door for the dentist to suggest more cosmetic procedures," said Anna Velten, marketing coordinator for the American Academy of Cosmetic Dentistry. "We're seeing it a lot more in men and even seeing more men on the cover of our journal."

Avoidance behavior

Dentists also say that men are much more likely to wait too long to seek help than women, so by the time they do go to the dentist, they have far more tooth destruction. "Men go for years with worsening jaw pain," Weller said. Many men never went to the dentist at all, agreed William Cohen, a Glenview dentist and accredited member of the AACD. "People are better educated about dental issues now," he said.

Both dentists agree that women look in the mirror and are more self-conscious about what they see, while it is just in the last few years that men have become attuned to the benefits of cosmetic dentistry. Both dentists also credit the TV show "Extreme Makeover" for much of the interest in cosmetic dentistry as well as the Baby Boomer generation, which wants a younger look.

A study done by the AACD in 2006 concludes that people with good teeth and a nice smile were considered more attractive and more intelligent. So, Weller said, is it any wonder that his office's full-mouth restorations, which can include porcelain veneers, crowns and implants, has increased tenfold. For patients who cannot afford the full-mouth rehab, which can cost up to $40,000 and is not covered by insurance, just fixing their bite can minimize the damage, ease the pain and make them look better.

Jason Kole, an emergency room doctor at St. James Hospital in Chicago Heights, went to Weller for routine dental work. "I was having a lot of jaw pain and severe headaches, Kole said. "I had been grinding my teeth since before medical school, but it had gotten worse, and the enamel was worn down." Kole said that the grinding improved dramatically after Weller changed the dynamics of Kole's jaw, a process that took a year.

Piecemeal isn't best

Weller said he tries to get patients who need full-mouth rehab done in four to five appointments, which can last from three to five hours, over 45 days. Because the nature of the work makes it difficult to fix one tooth at a time, a longer appointment works better.

Don Ratcliff of Scottsdale, Ariz., wasn't trying for the Hollywood look, although he had porcelain veneers on his front teeth. However, about three years ago his dentist discovered his back teeth were worn down from grinding, and Ratcliff was told he would eventually need dentures. "It was functionality for me," he said.

"Men react great when I talk to them about the functional aspect," Weller said. "I talk to them about the wear and tear, not about looking better. Once they understand, they are OK with cosmetic work." Cohen too said a patient often will come in for routine work that leads to a discussion of a chronic condition that can be fixed with cosmetic work.

"This is a life-changing procedure," Cohen said. "People who were self-conscious because of the appearance of their mouth come out of their shell. We take before and after photos, and you can see it in their eyes; they're a different person."
- - -

Some tools of the trade

Crowns -- Grinding your teeth, an improper bite, age, fillings and tooth decay can contribute to wearing down, cracking or breaking of teeth. Dental crowns cover the entire visible surface of the affected tooth and add strength, durability and tooth stability. In other instances, crowns are used to replace actual missing teeth. Crowns are anchored to the teeth on either side, with a bridge section connecting two crowns. Instead of bridges, single-tooth dental implants may be used that eliminate the need for supporting the crowns.

There are three basic types of crowns: gold; ceramic; and ceramic-veneered gold. Gold and metal-ceramic crowns are extremely durable and normally used in molars, where the forces from chewing and grinding are most prevalent. Ceramic crowns are used primarily for front teeth, because they can best resemble the natural tooth color.

Veneers -- Veneers often are used as an alternative to crowns. Veneers are thin pieces of specially shaped porcelain or plastic that are glued over the front of teeth with little or no anesthesia. They are used to fix teeth that are severely discolored, chipped, have small holes or pits, are misshapen or crooked. They also can repair uneven spaces. Veneers do not stain and last 10 to 15 years. They usually cost less than crowns.

Bonding -- Dental bonding is a procedure in which a tooth-colored resin is applied and hardened with a special light that "bonds" the material to the tooth to restore or improve a person's smile. Bonding is an option that can be considered to repair decayed, chipped or cracked teeth, improve the appearance of discolored teeth, close spaces between teeth, make teeth look longer or even change the shape of teeth. Little advance preparation is needed for dental bonding, and anesthesia is often not necessary unless the bonding is being used to fill a decayed tooth.

The surface of the tooth will be roughened and a conditioning liquid applied. These procedures help the bonding material adhere to the tooth. The tooth-colored, puttylike resin is then applied, molded and smoothed to the desired shape. An ultraviolet light or laser is then used to harden the material. The procedure takes about 30 to 60 minutes per tooth to complete. Typically, bonding material lasts from 3 to 10 years before needing to be touched up or replaced. Generally, bonding can range in cost from $200 to $400 per tooth.

Monday, April 27, 2009

Dry Mouth Syndrome

Chronic dry mouth (xerostomia) is a serious problem affecting millions of people throughout the world. Xerostomia can affect persons of any age, but it is much more prevalent in older adults.

It causes a wide range of problems including:

· difficulty in swallowing

· loss of the ability to taste

· increased rate of tooth decay

· difficulty in speaking

· increase in oral infections

It is estimated that approximately 30% of persons over the age of 65 suffer from dry mouth syndrome.

What causes dry mouth syndrome?

1) Medications (there is not enough space here to list them all, but here are some categories):

· antihistamines (like Benadryl)

· antidepressants (like Elavil, Flexaryl, etc)

· anticholinergics (decongestants – like atropine)

· Diet Pills (often have a lot of caffeine which removes water from your body)

· antipsychotic (psychiatric drugs)

· anti-Parkinson agents, diuretics (“water pills”)

sedatives (sleeping pills)

Illegal recreational dugs

· Methamphetamines, cocaine, ecstasy

2) Medical Conditions

· Radiotherapy (radiation treatments for head and neck cancer)

· Uncontrolled diabetes

· Sarcoidosis

· Lupus

· Sjorgrens’s sydrome (a disease which attacks saliva glands)

NOTE: Persons suffering from dry mouth syndrome also frequently suffer from bad breath. Bad Breath (halitosis) is a separate problem which has its own treatment protocol.

How can dry mouth syndrome be treated?

1) Choose water as your main beverage and drink 8 glasses per day. Other beverages have sodium in them also, which will further dry your mouth.

2) Limit sodium, caffeine, and alcohol (including mouthwashes with alcohol like Listerine/Scope) intake. These things also decrease saliva flow.

3) Biotene Products (dry mouth toothpaste, gentle mouthwash, dry mouth gum, and oral balance gel). These products contain enzymes of components found in natural saliva.

4) Xylitol mints, candy, and gum often stimulate salivary flow, improve breath, and will not cause tooth decay.

5) Neutral sodium fluoride toothpaste (Prevident 5000). Prevident is high-fluoride toothpaste that guards teeth from decay and has the added benefit of stimulating saliva flow if used several times daily. This is only available by prescription.

6) Saliva substitutes such as Roxane, Salavart, or Optimoist by Colgate, when used over a two week period can restore moisture. These are solutions that you simply pour in your mouth and it simulates saliva. They should be available at most drug stores.

Why is Saliva so Important?

- Saliva provides a "first defense" against chemical, mechanical, and infectious attacks

- It helps digest food

- It protects teeth from decay

- It prevents infection by controlling against an overabundance of bacteria and fungi in the mouth

- Without enough saliva you can lose your teeth to tooth decay at a very young age or develop other infections in the mouth. You also might not get the nutrients you need if you cannot chew and swallow certain food

Prescription options:

1) Salagen (pilocarpine 5mg tablets) – taken three times a day. Some side effects noted in the minority of patients.

2) Evoxac (cevimeline HCl, 30 mg tablets) – also three times daily. Reportedly have less side effects.

Cavities in Baby Teeth on the Rise

This article was written by Web MD about a study from the Center for Disease Control on Cavities in Baby Teeth.

A fabulous documentary on this was done by CBS and can be found here:

CBS Early Show Talk About Baby Teeth Cavities

as a side-note.. while I was on the CBS site, I found this documentary about toothbrushing as well:

CBS Early Show on Brushing Teeth.

(WebMD) America's children are increasingly getting their first dental cavities before the tooth fairy arrives.

The CDC on Monday released its latest report card on the nation's oral health. The report shows that about 28% of U.S. children aged 2-5 have cavities in their baby teeth. That's up from about 24% nearly a decade ago.

Data came from two national health studies that included interviews and oral health checkups.

The first study, conducted from 1988 to 1994, included more than 26,000 U.S. civilians. The second study, conducted from 1999 to 2004, included more than 25,000 U.S. civilians. The CDC compared the two studies, looking for oral health trends.

Overall, the CDC's report shows that oral health improved for most Americans between 1988 and 2004. For instance, dental cavities declined for every age group except children

aged 2-5, and the number of seniors losing all of their teeth continues to decline.

The statistics don't explain why dental cavities are rising in baby teeth. But the study shows that boys, non-Hispanic whites, and youths living in poverty were particularly affected.

"This report shows that while we are continuing to make strides in prevention of tooth decay, this disease clearly remains a problem for some racial and ethnic groups, many of whom have more treated and untreated tooth decay compared to other groups," the CDC's Bruce Dye, DDS, MPH, says in a CDC news release. Dye was among the researchers who worked on the CDC's report.

Worst Beverages for your Teeth

Ranked from #1 - #6

1) Lemonade

Lemonade is a dangerous combination of acid and sugar. The formula for tooth decay is: bacteria that cause cavities (which we ALL have in our mouth, yes, dentists included) + acid (to penetrate the hard enamel layer of the teeth) + sugar (what the bacteria feed on) = tooth decay. Lemons are one of the most acidic fruits there are. Combining this acidic fruit with sugar makes it a potent cavity causer.

Many of you have asked if a lemon slice in your water is bad. This is certainly not nearly as bad as lemonade because there isn't sugar involved, but it does make your water more acidic.

2) Energy Drinks (Red Bull, Rooster Booster, Full Throttle, etc.)

These are the newest latest craze in beverage consumption and these drinks are giving you more energy by ramping up the sugar and caffeine. Caffeine isn't hard on teeth, but these beverages are still harder on teeth than soda.

3) Sports Drinks (Gatorade, Powerade, etc)

People tell me all the time that they have cut down their soda consumption thanks to some of the "Stop the Pop" information we've had around the office. Unfortunately when I ask them what they switched to, it's almost ALWAYS Gatorade/Powerade. Gatorade/Powerade's marketing leads you to believe this is a healthier choice than soda, they always show images of it being good for replenishing you after a hard day or working or working out, and it doesn't have a fizz , or caffeine.

What they DO have in them though are additives and organic acids not found in soda that are very erosive to dental enamel because of their ability to breakdown calcium which is needed to strengthen teeth. And if this can harm your dental enamel think of what it may do to your bones, which are much softer than dental enamel.

4) Fitness Water (Propel, etc.)

"Wait a minute, you're saying water is bad too?" Well, no, fitness water has the same organic acids as the Gatorade (they are made by the same companies) and therefore do significant damage even without the sugar component. In many ways, fitness water is just diet Gatorade.

5) Iced Tea (sweetened is even worse)

I got some new information about iced tea recently which may please some of you. It seems that the canned iced teas are much worse than a home brewed iced tea (especially if you aren't adding a lot of sugar). I cannot find what about the canned iced teas makes them worse, but that is what the literature has to say. Part of this could be that Lipton/Snapple adds a lot more sugar to tea than you would at home. So if you are brewing your own tea and not adding sugar, it isn't bad for teeth. As a side note though, this has no basis in science, but it seems I see the WORST stains on people's teeth that tell me they consume Green Tea (which is a very healthy tea).

6) Soft Drinks (Coke, Pepsi, Mountain Dew, Dr. Pepper, Sprite, 7-up, etc.)

Most sodas have the following ingredients listed right on the can: Phosphoric Acid and High Fructose Corn Syrup (sugar). That pretty well sums it up, you are drinking a combination of acid and sugar, and that is what leads to tooth decay. The average 12 oz. can of soda has TEN teaspoons of sugar.

Diet Soda - Diet Soda does not have sugar, but does still have the same amount of phosphoric acid. Meaning its less bad, but still not great.

Clear Soda - For some reason it is perceived that Sprite, 7-Up, Fresca, etc. are a "healthier" choice than Coca-Cola or Pepsi. It is better in the sense that it won't stain your teeth, but they still have all the acid and all the sugar. It is not a healthier choice at all.

Alcoholic beverages - I was amused by those who wrote to thank me that beer wasn't on the list. And it's true, beer doesn't have sugar, and is significantly less acidic than soda/gatorade.

Wine is very acidic, it is probably the worst alcoholic beverages for teeth, especially since it is generally sipped over long periods of time (more on this in a minute).

Tonic Water is a pretty popular mixer for various spirits. People often forget this is basically a soda pop as well. It's sugary, and acidic. Consider Club Soda as a substitute, it's calorie free too.

The Margarita is another very acidic beverage with a lot of sugar in it as well.

The Missouri Dental Association (MDA) has been very proactive about helping kids and adults make healthy choices for their teeth. In fact, they started a program that other states have began to mimic called "Stop the Pop".

There is a wealth of information at the MDA website about stop the pop, including fun projects for children if you are involved in education.

An easy-to-read excellent brochure is here.

The article I took the following information from can be read here.

Hey, I really enjoy these beverages and can't quit. Now What?

Here are some tips for safely enjoying these beverages in moderation

1) Drink through a straw, it avoids the teeth a bit more that way.

2) Don't brush IMMEDIATELY after drinking the beverage. The enamel is a bit softer for 20-30 minutes after consuming a soda and your toothbrush could actually accelerate the wear. Wait a bit.

3) Don't sip all day.. just drink it! When you drink an acidic beverage the acid level (or pH) of your mouth drops. It takes your mouth about 20-30 minutes for that to recover. When you sip a beverage for hours, like the people that get a big gulp from a convenient store and then drink on it all day, the acid level of your mouth stays low ALL day, creating an optimum environment for the bacteria in your mouth that do cause cavities to work away on your teeth.

You would be better off (teeth wise) chugging a large soda fast, than sipping on a small glass all day.

4) Drink and rinse your mouth with water after consuming the beverage.

Think of this: Thousands of years ago humans didn't get many cavities. Wild animals don't get cavities with much frequency. Neither of these creatures has any better tooth enamel than we do, and certainly don't benefit from great toothbrushes, paste, and dental visits. Why? They consume meat, plants/vegetables, and drink water. With all the advances in oral health care, fluoride, sealants, xylitol, etc. you'd think we'd have tooth decay all but eliminated. Unfortunately what has kept that from happening is that the American diet includes over 100 lbs. of sugar every year, and people are drinking everything BUT water. Poor diet has more to do with tooth decay than inadequate personal oral care. The United States has a higher decay rate than other developed nations, but we have the best oral health care in the world. Why? We also consume the most soda, candy, and other sugary products.

American Heart Association changes guidelines for Antibiotics before Dental Treatment

Article reposted from the American Dental Association.

For decades, the American Heart Association(AHA) recommended that patients with certain heart conditions take antibiotics shortly before dental treatment. This was done with the belief that antibiotics would prevent infective endocarditis (IE), previously referred to as bacterial endocarditis. IE is an infection of the heart’s inner lining or valves, which results when bacteria enter the bloodstream and travel to the heart. Bacteria are normally found in various sites of the body including on the skin and in the mouth.

The AHA’s latest guidelines were published in its scientific journal, Circulation, in April 2007 and there is good news: the AHA recommends that most of these patients no longer need short-term antibiotics as a preventive measure before their dental treatment.
The American Dental Association participated in the development of the new guidelines and has approved those portions relevant to dentistry. The guidelines were also endorsed by the Infectious Diseases Society of America and by the Pediatric Infectious Diseases Society.

The guidelines are based on a growing body of scientific evidence that shows the risks of taking preventive antibiotics outweigh the benefits for most patients. The risks include adverse reactions to antibiotics that range from mild to potentially severe and, in very rare cases, death. Inappropriate use of antibiotics can also lead to the development of drug-resistant bacteria.

Scientists also found no compelling evidence that taking antibiotics prior to a dental procedure prevents IE in patients who are at risk of developing a heart infection. Their hearts are already often exposed to bacteria from the mouth, which can enter their bloodstream during basic daily activities such as brushing or flossing. The new guidelines are based on a comprehensive review of published studies that suggests IE is more likely to occur as a result of these everyday activities than from a dental procedure.

The guidelines say patients who have taken prophylactic antibiotics routinely in the past but no longer need them include people with:
  • mitral valve prolapse
  • rheumatic heart disease
  • bicuspid valve disease
  • calcified aortic stenosis
  • congenital heart conditions such as ventricular septal defect, atrial septal defect and hypertrophic cardiomyopathy.

The new guidelines are aimed at patients who would have the greatest danger of a bad outcome if they developed a heart infection.

Preventive antibiotics prior to a dental procedure are advised for patients with:
  1. artificial heart valves
  2. a history of infective endocarditis
  3. certain specific, serious congenital (present from birth) heart conditions, including
    • unrepaired or incompletely repaired cyanotic congenital heart disease, including those with palliative shunts and conduits
    • a completely repaired congenital heart defect with prosthetic material or device, whether placed by surgery or by catheter intervention, during the first six months after the procedure
    • any repaired congenital heart defect with residual defect at the site or adjacent to the site of a prosthetic patch or a prosthetic device
  4. a cardiac transplant that develops a problem in a heart valve.

The new recommendations apply to many dental procedures, including teeth cleaning and extractions. Patients with congenital heart disease can have complicated circumstances. They should check with their cardiologist if there is any question at all as to the category that best fits their needs.

Patients and their families should also ask careful questions of their health care providers anytime antibiotics are suggested before a medical or dental procedure.

The AHA guidelines emphasize that maintaining optimal oral health and practicing daily oral hygiene are more important in reducing the risk of IE than taking preventive antibiotics before a dental visit.


There are so many choices in the oral health care isle of your grocery store, Wal-mart, or wherever you shop for dental supplies.

I can't possibly cover all of the choices or this entry would be way too long. However, I will break down the most popular brands and hopefully help you choose the product that will work the best for your mouth.

Not all mouthwash was created equally; different mouthwashes have different benefits.

I am going to break the mouthwashes down into these categories:

1) anti-gingivitis 2) anti-cavity 3) for dry-mouth 4) pre-brush rinses 5) for bad breath 6) whitening rinses

1) Anti-Gingivitis

a) Listerine - This mouthwash has been around for a long time and has had the American Dental Association seal for fighting plaque and gingivitis for a long time.

- is great if you have gingivitis (bleeding gums) and collect a lot of plaque around your teeth.

- the new citrus or vanilla mint (less "harsh") flavors do perform at the same level as the mint and peppermint flavors. All the flavored varieties are equally effective to the old brown flavor from long ago.

- contains a high level of alcohol in it: nearly 22%. Alcohol dries out the mouth, which can be very negative if you already have trouble with dry mouth. Some researchers have also shown high alcohol has a negative effect on white fillings.

b) Crest Pro-Health - This is a newer mouthwash that Crest came out with as an alternative to Listerine. The benefits are that Crest Pro-Health doesn't have any alcohol and therefore does not have the harsh taste or drying of the mouth. It kills germs using an ingredient called Cetylpyridinium Chloride. Crest Pro-Health is a very promising product, but does not have the longevity, or years of results to back it up like Listerine.

There are some prescription strength mouthwashes for gingivitis that I will discuss later.

2) Anti-Cavity

a) Act - This mouth rinse has also been around for a long time. It contains a 0.05% sodium fluoride, which if used daily can decrease the decay rate up to 50% in some studies. It is a great rinse for both adults and children that have had troubles with tooth decay, or are at risk for tooth decay.

b) Act Restoring Mouthwash - this is a version of Act that they are marketing to adults. This mouth rinse has the same amount of fluoride as the other rinse, the difference is that this rinse contains 11% alcohol to provide more of a breath freshening effect. This rinse is a great cavity fighter. If you are a teenager to adult that has no trouble with gingivitis, but are always fighting tooth decay. This is your rinse.

c) Listerine Tooth Defense - This is Listerine's brand new mouthwash that is their answer to Act. This rinse is not for children. It has the same nearly 22% alcohol content that the regular Listerine rinses have. Unfortunately it also only has HALF the fluoride content of the Act Restoring Mouthwash. It is a fine product, but Act Restoring would be a better choice for an adult anti-cavity rinse.

3) For Dry Mouth

a) Oasis Mouth rinse (by the makers of Sensodyne) - this mouthwash contains no alcohol (which would dry your mouth out further), but instead contains glycerin and other organic oils that coat and moisturize your mouth. They also make a spray to carry with you and use progressively throughout the day.

b) Biotene Mouth rinse - Biotene has an entire line of products dedicated to help with dry-mouth. I really like that this particular rinse has xylitol, which is a sweetener that actually fights decay. This rinse also has calcium, which helps the enamel on your teeth. If you'd like to know more about xylitol, check out my article on preventing cavities.

4) Pre-Brush rinses

a) Plax - This rinse has also been around a long time. Its advertised claims are that it loosens up plaque before you brush. Numerous research studies have been done on this product, and a review of the literature states that it is not a recommended product.

5) Bad Breath Rinses

Technically, many of the products already mentioned are good for bad breath as well, like Listerine, Crest Pro-Health, etc.

However, the products I'm listing now are simply breath fresheners and really nothing more.

I'll have a separate entry devoted to bad breath, but the best thing you can do for yourself if you're trying to fight bad breath is to get a tongue scraper.

a) Scope - essentially flavored alcohol. This rinse has been a favorite for years. It works for masking bad breath, and tastes pretty good. It will dry your mouth out with the alcohol content, and is not approved for anti-gingivitis or anti-plaque.

b) Breath Rx - this is an effective rinse for bad breath. It contains the same anti-gingivitis ingredient as Crest Pro-Health. Has no sugar or alcohol, and has Zytex to neutralize odor. An expensive product, but works really well.

6) Whitening Rinses

a) Listerine Pre-Brush Whitening

b) Cresh Pro-Health Whitening

These two rinses are very similar. They are both a flavored hydrogen peroxide that will foam up in your mouth. The peroxide may reduce surface stains, but will not whiten your teeth. Brilliant marketing though. They took a quarter's worth of hydrogen peroxide, added some flavoring, some marketing, and clever packaging and charge you $5.00+ with the hope that you'll have beautiful white teeth. It's selling like hot cakes.

Unfortunately the results aren't there to back up the claims.

Much like whitening toothpaste, you may decrease surface stains, but won't get white teeth by using it.

Prescription Rinses:

a) Peridex

b) PerioGard

Both of these rinses are also similar. They are by prescription only and contain chlorhexidine gluconate which is a proven potent bacteria killer. This rinse is commonly prescribed after a deep cleaning or to help reduce gum inflammation.

The downside is that these rinses can cause staining of the teeth that can only be removed by a dental office.

Hopefully you can use this information to make your next purchase of a mouthwash an effective one.

Teeth Whitening Update for 2009

If you have ever considered whitening your teeth, there has never been a better time than now at Meiners Dentistry.

Teeth whitening has become a popular way to make your smile look brighter and your teeth to look younger and healthier.

Teeth whitening has been studied extensively and the American Dental Association has stated it is safe for teeth in an article you can read by clicking: here

We have made significant improvements in our whitening products over the last year.

Our options now include:

1) Crest Whitestrips Professional Supreme - These whitestrips are our most economical form of teeth whitening. This particular product is not sold in retail stores and is only available in dental offices. It is 43% stronger than the whitestrips you can purchase from retail stores. I have seen good results from this product for people that do NOT have sensitive teeth AND that are under 30. Why under 30? We've had adults over 30 attempt to use this product as well as admitting to have tried some of the retail products. The results are inconsistent and generally disappointing for this age group.

2) Teeth Whitening while you sleep - This is what 95% of our patients choose for their teeth. For this procedure, we take an impression (mold) of your top and bottom teeth and build a customized tray that fits your teeth precisely.

We recently received some continuing education on making these trays. Our new trays are now significantly more comfortable, have a more precise fit, and allow you to whiten your upper and lower teeth at the same time. The most important fact is that because these trays do a better job sealing OUT saliva and sealing IN the tooth whitener, our results have improved significantly. We have also dramatically altered the directions for whitening, adding steps and recommendations that all add up to better results. You can read about them here.

Do you have sensitive teeth?
Have you tried whitening in the past only to find your teeth were too sensitive to continue? We now have the answer! We have a new to the market whitening gel called Acquabrite that was made specifically for sensitive teeth. We have found the results to be marvelous, and that those who had struggled with whitening products in the past were now able to accomplish their treatment with little to no sensitivity to cold.

3) Deep Whitening - This is new technique in whitening that produces outstanding results. It combines night-time whitening with two visits of in-office power bleaching. The picture you see at the beginning of this blog entry is a patient that recently had his teeth Deep Whitened. Beginning with a visit of power bleaching, you then take home whitening trays and whiten for 2-3 weeks. Finally, we have a follow-up power bleaching visit. We have been able to take out years of the ill-effects of coffee drinking and smoking using this technique. Your smile will definitely look younger.

Here are some answers to frequently asked questions I have on whitening:

1) Does whitening toothpaste work?

- Whitening toothpaste is often only called "whitening" because it has extra abrasives in it to brush off stain. So if your teeth are stained, it may "whiten". But if you are expecting color change, it is false hope.

- The BEST whitening toothpaste in my opinion is Rembrandt PLUS - it is the only toothpaste I know of with active whitener in it (9% Carbamide Peroxide). It is unlikely whiten your teeth alone, but it is the toothpaste we recommend for our whitening patients. In addition, it is not abrasive because it dissolves stains using papaya enzymes. Your teeth will feel very slick and smooth after using this toothpaste for a few weeks.

2) Do whitening mouthwashes work?

- The Listerine whitening mouthwash and the new Crest Whitening Mouthwash are both basically flavored hydrogen peroxide (just look at the ingredients). Mouthwashes are exposed to your teeth for about 1 minute. I have not had anyone yet show me actual results using this product.

3) Why don't you use the blue light (ZOOM) like on "Extreme Makeover" ?

- We choose products at Meiners Dentistry that have a significant amount of positive research and results behind them. All of the current literature shows that ZOOM lights produce a short term effect, and not a long term effect. Meaning if you were getting pictures tomorrow ZOOM would be a nice option because it provides good instant results. But most offices that provide ZOOM also give their patients trays to wear at night to sustain the result. And Zoom costs more to provide.

4) At what age is it safe to whiten your teeth?

- Once all of the permanent teeth are in place and the roots are developed it is safe. Meaning that it can be safe at ages as low as 14. However, we are VERY cautious with young people who want to whiten however, and use very low safe concentrations of the gel to insure their safety. Young teeth whiten EXTREMELY well though. Many of our teenage patients whiten their teeth after braces and get AMAZING results.

Do you hate flossing? Check this out.

The vast majority of people do not floss with any regularity. Reasons generally cited for avoiding it are: time, discomfort, unpleasant experience, difficult to do, contacts between teeth too tight... and there are countless others.

If you do use regular dental floss, this is one of the best animated descriptions I've seen on how to use it effectively: FLOSSING DEMO

If you are like me and have tight contacts between your teeth and are sick of cutting up your gums or getting floss stuck between your teeth, try out Glide Floss It was the solution for me.

Disclaimer: I have no financial interest in the following products in any way, I just think they are great alternatives for those who dislike traditional floss.

Many have tried the popular "Water Pik", which is method of water irrigation in between teeth and had good success with it. Water Pik is a great product especially for people with braces and bridges. The downside is that most people find it messy.

Another great water irrigation device is the Hydrofloss. This particular device magnetically ionizes the water you put into it which makes it more difficult for the plaque bacteria to adhere to your teeth. It has very positive research articles written about it. Again though this is a fairly messy product, is expensive, and I have no personal experience with it.

The following flossing alternative is a great little product at a very reasonable price.

Showerfloss - People have often told me if there were a device that could combine flossing with showering they would be FAR more likely to do it. This product is another water irrigation device, adds just a few minutes to your daily shower, has no mess, and is under $30. The only downsides are that it is only available for purchase online, and that there is a bit of installation effort on your part. However, if you are capable of unscrewing your shower head, you can install this product. Check out and see if this might be right for you.

Flossing doesn't have to be boring and a hassle anymore.

Monday, April 13, 2009

Give Kids a Smile Day

Friday, February 2nd 2007 was the nationwide dental charity day Give Kids a Smile. For four of the past five years, I have participated in this charity event.

February is children's dental health month, and five years ago this event was created to have a special day for underprivileged children.

Our office even had a feature article written in the Independence Examiner about us two years ago. You can view that article here.

Shannon, one of our dental assistants, accompanied me down to St. Vincent's Family Services Center at 30th and Troost. You can read more about their charitable program at:

Part of what St. Vincent's provides for the children they take care of, is a two-chair dental clinic in their basement.

Shannon and I worked all day Friday and saw over 20 children between the ages of 2 and 10. It was an exhausting day, but we really enjoyed ourselves and delivered some outstanding care to those in need.

Brushing and Flossing Could Prevent Pancreatic Cancer

This is an excellent video from ABC News on the relationship between gum diesase, heart disease, and pancreatic cancer:

Brushing Teeth Could Save Lives

Gum Disease Linked To Pancreatic Cancer

10:27 a.m. EST January 17, 2007

HARTFORD - Taking care of one's teeth and gums may help ward off one of the deadliest cancers, researchers said. When Harvard researchers analyzed 16 years of health information on more than 50,000 men, gum disease stood out as a risk factor for pancreatic cancer -- even after researchers factored out smoking, obesity, diabetes and other potential risks. The research was conducted at the Harvard School of Public Health.

"We found that individuals with a history of periodontal disease had about a 60 percent increase in their risk of getting pancreatic cancer," said Dr. Charles Fuchs, a cancer researcher with the Dana Farber Cancer Institute.

The scientists speculated that the chronic inflammation caused by gum disease might play a role. More studies were planned to confirm the link and to see if there's an oral health connection to other cancers.

"There's a lot of good reasons to take good care of your teeth -- and here's another one," Fuchs said.

Men who had both gum disease and tooth loss had the highest risk for pancreatic cancer, NBC 30 News reported.

Pancreatic cancer is the fourth leading cause of cancer death in the United States. More than 30,000 Americans are expected to die from the disease this year, according to the American Cancer Society.

Sour Candy Is Extremely Hard on Teeth

Sour candies can produce acid levels so strong in the mouth, that they can contribute to chemical erosion of your teeth.

These candies include, but are not limited to: Warheads, Extreme Air Heads, Sour Skittles, Laffy Taffy, Starburst, Sweet Tarts, BubbleTape, and Baby Bottle Tops.

Sour candies contain citric or phosphoric acid in them that produce a sour sensation on the tongue.

The term "pH" is a measure of acid level. Your mouth's acid level when healthy hovers around a pH of 7.0, which is neutral. A 1.0 is the most acidic. Your enamel can begin to erode when the pH of your mouth is at 5.5 or below for over 20 minutes. The tooth structure at your gumline can begin to erode at closer to 6.0.

Some of these candies have acid levels so strong, your mouth pH can be at 1.5 after sucking on them for 20 minutes. By comparison, battery acid is 1.0

Be very careful consuming these candies, they can cause more cavity and tooth destruction than chocolate or caramel.

Here is an example of a specific sour candy:

Sour Candy 1

Here are the specific ingredients

Sour Candy 2

The first THREE ingrediants are all types of sugar, then after corn starch there are FOUR CONSECUTIVE ACIDS.

Remember the formula for cavities is:
Bacteria (that's already in your mouth) + Sugar + Acid = Cavity.

This product (and if you pick up nearly any sour candy, the ingrediants are similar) should really come with a warning like you see on a package of cigarettes or a bottle of an alcoholic product that says: "Consumption of this food item will cause cavities".

With candy like this being so accessible to your children and teenagers, it is no wonder that cavities in children's teeth are on the rise!

Cavity Prevention

If Dr. Meiners has given this for you to read, most likely you or a family member has a problem with tooth decay (cavities). The patient may have numerous large areas of decay, may have decay occurring under existing dental restorations (such as fillings or crowns), or there may be very small cavities just starting between the teeth that we are trying to stop from getting bigger. Or you may just want to PREVENT getting cavities.

There are about 650 types of bacteria that can be found in our mouths. At any one time, there are about 350 types of these bacteria in our mouth. Of all these types of bacteria, there is only ONE that actively causes tooth decay – Streptococus mutans is it’s name. When you eat a food with ANY sugar in it (even very small amounts of sugar cause problems), the S. mutans bacteria also eat the sugar. When these bacteria eat sugar, their waste product given off is lactic acid. You know what acid does don’t you? That’s right, it eats holes in your teeth. No S. mutans = no tooth decay. No sugar = no tooth decay.

If you were to have no tooth decay, you would probably still have S. mutans in your mouth, but it would be found in very low numbers. But if you do have tooth decay, the cavities act as S. mutans bacteria hatcheries, and your mouth becomes LOADED with high numbers of S. Mutans. Our job is to get rid of the tooth decay (unless you only have small cavities between the teeth that we are trying to stop), your job is to lower the number of S. Mutans bacteria in your mouth. If the numbers stay high, you will just form new cavities as fast as we can fix them, and the small cavities will continue to grow.

Lowering the numbers of Streptococcus mutans in your mouth:

1) Brush well, at least twice a day. This means using a good brush, either manual, or better yet, electric. If we haven’t done so yet, we’ll be telling you how to properly use the brush.

2) Floss well at least once per day (twice a day is better).

3) Reduce the FREQUENCY of sweets. For instance, sucking on Tic Tacs several times a day will ‘kill’ your teeth.

4) Rinse with a fluoride rinse for 60 seconds twice a day (not for children age 5 or younger). One of these rinses should be immediately before sleep. Do not rinse with water, eat, or drink for at least thirty minutes after rinsing with the fluoride rinse. We want the fluoride rinse to continue working even after you spit it out. Children may use ACT fluoride rinse in multiple flavors. Adults would be better using ACT Restoring Mouthwash because in addition to fluoride, it helps keep gums healthy (although adults may use ACT if they’d like – even the bubblegum ACT FOR KIDS)

5) Chew Xylitol Gum or use Xylitol Mints. You need to eat or chew xylitol products at least five times throughout each day (about 5 minutes each time). One or two times a day has nearly NO value. You may use xylitol gum, xylitol mints, and xylitol also comes granulated like regular sugar, to be used in place of regular granulated sugar. 100% xylitol products can be hard to find. You can find them at health food stores (listed on back page) or at

The products you find at these places have 100% xylitol. Popular gums such as Orbit or Trident ADVERTISE on their package that they have Xylitol, but if you read the ingredients you’ll notice that they also have sorbitol, manitol, sucralose, aspartame, etc.. and that Xylitol is often the 3rd or 4th ingredient. These products do not have a high enough percentage of Xylitol to be effective.

6) Have the active areas of decay (cavities) removed (that’s our job)

7) Get a fluoride treatment each and every time you have your teeth professionally cleaned. Effective for both children AND adults. This professional strength fluoride is absorbed really well by the teeth and gives excellent added protection.

8) Seal off the tiny natural pits where bacteria hide and start cavities, and replace defective fillings/crowns that allow bacteria to seep under and cause decay (that’s also our job)

Brushing and flossing will lower the numbers of Streptococcus mutans by physically removing them. Reducing the FREQUENCY of sugar intake reduces the number of times per day that acids are produced by bacteria. Fluoride rinses help make the teeth stronger against the acids produced by S. mutans. And the xylitol gum actually helps kill bacteria.

There are many types of natural sugars. There is glucose found in honey, lactose found in milk, fructose found in fruits, and sucrose (table sugar) found in sweets and other foods. It’s the sucrose (sometimes listed as corn syrup) that causes the problems. Xylitol is also a natural type of sugar found in some fruits, berries, and vegetables. When S. mutans bacteria try to eat Xylitol, it kills many of them. And it injures the other ones so that they cannot produce acid for a few hours. You can see that chewing the Xylitol gum can be very beneficial. Not only will it NOT cause tooth decay, but it can actually help prevent it.

Please don’t think that by chewing Xylitol gum it means you don’t have to do the other things above. Xylitol is not a ‘magic bullet’ , but it is useful in the fight against tooth decay.

Closely follow the instructions above, and you will have much success in preventing new cavities. You’ll also be amazed at how much better your mouth will feel.