Doctor's Articles

Doctor’s Articles
Fillings
My tooth doesn’t hurt, why do I need a filling? Tooth decay occurs very slowly through a small hole in the enamel from the acid by-product in the bacterial plaque on your teeth, which forms everyday. Sugar and refined foods feed the plaque increasing its growth and acid secretion. Once through the enamel into the dentin, which is softer, the process accelerates and spreads horizontally as well as vertically. Most often no pain is associated with this process . Sometimes when the cavity gets large enough, you may feel sensitivity to sweets, or other chemicals . By the time you feel pain to cold or hot, the caries is very close or already in nerve, usually requiring root canal therapy. That is why it is important to get regular exams to catch caries when they are small. At the examination appointment, the dentist will check your X-rays, and feel for soft spots in your teeth. Since radiographs are two dimensional, dentists are not able to see all the cavities or exactly how much decay is present, only that it is there . You always have the choice to wait and keep an eye on smaller areas using fluoride to slow it down. However the standard of care is to remove the decay and place a filling to allow as much healthy tooth to remain. If a cavity is already very deep, the dentist may try to place a large filling or crown, but sometimes the nerve is already damaged and pain will occur after the procedure. Large fillings weaken the tooth leading to fractures, root canal treatment, crowns, and possibly tooth loss. A simple small filling is a great preventative solution to keep your teeth healthy, and breath fresh. Dentists will replace old fillings that are leaking before they hurt, in order to preserve your tooth structure. Alternatively, when cavities or older fillings are borderline in how severe the need for replacement is, and since a dentist doesn't know for sure how much decay is present before getting in there and cleaning out the problem, differences in opinion of treatment plans exist. When in doubt get a couple of opinions, and go with the one that makes most sense to you . No dentist gets rich off of fillings, and most providers honestly just want to help people . Great communication avoids unnecessary confusion. As our life expectancy increases, we want our teeth to be healthy and strong, so they will last as well.

Drugs
Many drugs, especially illegal ones, can cause severe tooth damage due to increased teeth grinding, reduced salivary
flow leading to rapid decay, and poor hygiene. Estimates suggest that about 40 per cent of people take at least one type
of medication that could cause tooth damage, while 23 million people are addicted to illegal drugs. Illegal drugs can cause dry mouth, which will allow decay to form around the teeth and weaken the enamel in a very short amount of time. This will also affect the gums, leading to your teeth becoming loose. If you are using illegal substances, start saving for your dental bills, because it could cost over $25,000 or even $100,000 to restore your mouth. Here are some of the drugs that carry the highest risk to oral health:
• Cannabis – Causes dry mouth leading to an increased risk of gum problems. The smoke can cause oral cancer. 
• Cocaine – Causes ulceration of the gums and the underlying bone. Cocaine mixed with saliva creates an extremely acidic solution that erodes tooth enamel and exposes the underlying dentin to decay-causing bacteria. Cocaine and crack cocaine cause dry mouth, which further increases the risk of tooth decay. Cocaine can cause tooth wear by tooth grinding. 
• Ecstasy –Side effects of the drug include tooth grinding, jaw clenching, and dry mouth that leave teeth prone to fracture and decay.
• Heroin –People who use heroin tend to crave sweet foods, which can increase the risk of tooth decay if dental hygiene is neglected. Heroin can also cause dry mouth and tooth grinding. 
• Methamphetamine –This drug is the worst offender, causing severe tooth decay in a very short time. Dental professionals have coined the term “meth mouth” to describe the extensive damage typically caused by this drug. Methamphetamine is highly acidic and attacks tooth enamel. Other side effects include dry mouth, bruxism, and jaw clenching. 
All of these symptoms are exacerbated by the fact that any drug dependence can cause people to neglect their personal hygiene, diet, and dental care.

Jobs in the Dental Field
While many companies are cutting back on their labor force, and other occupations are over saturated, personnel in the
dental field are still in very high demand. If you have ever experienced tooth pain, you would understand that dentistry is one of those services that everyone will always need no matter how the rest of the economy is doing. Therefore job security is strong for those who work hard . Since dentistry is so specialized, most employers require education, training, or some experience. The programs are short, and many can work while at school. The dental team consists of the front and back office employees. The dentist is the team leader. This position requires 3-4 years of college, followed by 3-4 years of specialty training. One must have great dexterity, problem-solving ability, handle stress well, manage people, and enjoy math and science to excel in this field. The second in command is the Office Manager. The manager usually has worked their way up through the years as an assistant or financial coordinator. This person is in charge of the en tire office , making sure all staff are do ing their jobs, and the business is running well , so that the dentist can concentrate on patient care. Working under the manager's supervision are the schedule and insurance or financial coordinator s. In small offices these jobs are often combined into one position . While medical billers are a dime a dozen, effective dental insurance coordinators are much more in demand. Learning dental procedure codes, fees, documentation needed to send claims , and the various dental software programs takes time and skill. Poorly documented claims delay payments to the office reducing cash flow. On the other hand, the scheduler, often the receptionist is equally important. They are the face of the office, and first line in creating an impression . Their scheduling ability can make or break the business. A well-planned day reduces stress, increases production, and makes a better patient experience, with less stress for the team. Some offices also hire filers or office clerks, but with paperless offices increasing, those unskilled jobs are disappearing. In the back, the dental assistant aids the dentist with patient care. That position is similar to that of a nurse , as one is in direct contact with the patient. Great dental assistants are hard to find, and the rate of attrition is high contributing to their increasing demand. Consequently, job security exists for outgoing, dexterous, gentle, high-energy individuals . Registered dental assisting programs take 6 months or longer to achieve certification.
The more certificates and experience lead to higher compensation. Sterilizing assistants are trained by the office, and can take their dental x-ray license and become an unregistered dental assistant without going through the program. Out of the office but related jobs include dental sales representatives, and dental equipment repair personnel. Those individuals work directly through dental supply companies , but are indirectly part of the team. Another indirect team member is the lab technician . This position requires a certificate , like dental assisting. The lab fabricates by hand a variety of prosthetics , such as crowns and dentures for the dentist to deliver to the patient. A passion for dentistry is required to be successful in this field .

Baby Teeth
Baby teeth do more than provide a pretty smile. Many people assume because primary teeth will be replaced eventually
by permanent teeth, it is not necessary to invest in the care or treatment to save them. Contrarily, children’s teeth
perform many important functions: Provide nutrition benefit- Without healthy, reasonably well-aligned teeth, a child
may have difficulty chewing and eating a well-balanced diet. When a child's mouth is sore because of cavities, loose teeth, or sore gums, she may refuse to eat. Pain will also distract a child from being able to sleep and function well during the day. 
Contribute to speech development - Speech is more difficult without healthy, reasonably well-aligned teeth, and may cause permanent pronunciation problems requiring speech therapy.
Aid in the normal development of the jaw bones and facial muscles - Like muscles in other parts of the body, children's face and jaw muscles need exercise to help them develop properly. Chewing provides exercise for a child 's jaw, cheek, and tongue muscle.
Reserve space for the permanent teeth and help guide them into position- Primary teeth must last five to ten years or longer. As a permanent tooth reaches the stage of development when it is ready to emerge through the gum, the roots of the primary tooth begin to break down and dissolve. Gradually, the permanent tooth pushes the primary tooth out and takes the place the primary tooth has been reserving for it. If a primary tooth is lost too soon, the permanent tooth has no guide to follow and the teeth next to a missing tooth may drift into the space meant for another tooth, causing the adult tooth to come in to the wrong position. In conclusion, baby teeth are vital in many ways during a child's development, and should be cared for until they naturally exfoliate.

Periodontal Disease
The old saying, “ The way to someone’s heart is through their stomach ,” appears to be accurate. Researchers have
found that people with periodontal disease are almost twice as likely to suffer from coronary artery disease than those
without. Many unexplained heart attacks and strokes can be traced back to oral cavities where gum disease is present. Several theories exist to explain the pathology link between these two different areas of the body. One general rule of thought claims that when we brush our teeth, bacteria from our mouth get into the blood stream and attach to fatty plaque in the blood vessels. Coronary artery disease is the thickening of the walls due to a build up of plaque. Therefore gum disease may increase the build up inside the vessel restriction the flow of nutrients and oxygen to the heart. In addition, arterial plaque can break away forming clots which can stop the flow of blood causing an infarction which lead to heart attacks and strokes. A recent alternative theory describes that people who are prone to an inflammatory condition in the oral cavity which causes periodontal disease , also are prone to inflammatory processes in the vessels leading to arterial plaque build up. Since periodontal disease is an inflammatory process destroying bone, the same reactive process may occur on the lining of the vessel. Periodontal disease can also exacerbate pre-existing heart and other medical conditions. In some patients with artificial joints and heart valves, heart murmurs, and organ transplants may be required to take antibiotics prior to their dental appointment, to help prevent infective endocarditis or other medical complications. Your physician or cardiologist will be able to determine if your medical condition requires the use of antibiotics. Periodontal disease can be treated, controlled, and even reversed in many cases by seeing a dentist or periodontist.

Fractured Teeth
As we age, tiny cracks form in our teeth from habits such as clenching, grinding, chewing hard candy or ice, or using
teeth as a tool to hold or open things. Fractures move through a tooth like a crack in a windshield, with no way to
repair itself. The angle and depth of the fracture determine what type of treatment can be used to save the tooth if possible. Teeth sensitive to cold and biting are signs that a crack may be present. Basically there are three types of tooth fractures: A small fracture in the crown of the tooth, which often can be held together with a bonded filling, or a crown . This type is usually not very sensitive, and is most often noticed by the dentist when a filling is replaced. The second type, a complete break where a piece is missing, is only sensitive until the break occurs. Because of this, the tooth is often left broken with bacteria entering the unprotected area harming the nerve. Without much delay, the tooth can be repaired with a crown, but sometimes needs root canal therapy as well. The most severe type of fracture is a vertical tooth split; the tooth is cracked down the root, often loose and infected. In this case the tooth is very painful, and extraction is the only treatment option. All types of fractures can lead to tooth loss and infection if not treated right away. Although some problems come from posts after root canal therapy, or large silver fillings, others may be prevented. Night guards are helpful to protect teeth from clenching and grinding. Avoid diets containing hard objects such as candy, ice, corn nuts, and unpopped popcorn kernels. When playing contact sports, always wear a mouth piece. Never use teeth as tools to hold or tear things. If you experience symptoms of a fractured or cracked tooth, see your dentist immediately . If detected and treated early, a cracked/fractured tooth may be saved.

Sleep Apnea
Many factors cause fatigue, but we are now more aware of a growing concern for a condition called, Sleep Apnea.
Basically, it is the inability to get enough oxygen at night to sleep well leading to incomplete rest. Over long periods of
time, damage to your body can occur from low levels of oxygen linked to High blood pressure, stroke, heart disease, diabetes, depression, worsening of ADHD, among other health problems still in discovery. Adults and children may be afflicted with this condition, although it is more common in men over 40. Many Sleep Apnea sufferers show symptoms of snoring, low energy or falling asleep during the day. In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work and school, motor vehicle crashes, and academic underachievement in children and adolescents. The two types of Sleep Apnea are Central and Obstructive . The central type is when the brain actually misfires and causes one to stop breathing for a short period of time. This disorder is very rare and must be diagnosed and treated by a physician. The more common type is from obstruction ; usually the tongue and the soft palate partially or fully block the airway. Sleep apnea can be managed by losing weight , wearing an appliance at night to bring the jaw forward, but sometimes surgery is necessary. Often a physician will recommend a C-pap in which forced air is supplied during sleep. Removing large tonsils may help as well. In a dental office, Sleep apnea is diagnosed by not only by a questionnaire or history, but also by oral signs commonly associated with this disease. As dentists, we look for signs of obstruction, excessive wear of the teeth or grinding , and cavities on the roots of the teeth from stomach acid that is forced up from positive pressure due to tongue placement. Once a referral is made to the physician, a definitive test can be done. Usually that consists of wearing a pulse oximeter at nigh t to evaluate the oxygen level in the blood . Dentists work with physicians to diagnose and treat this ailment.

Acid Reflux
An apple a day may help keep some doctors away, but unfortunately not the dentist. However Dentistry is one field of
medicine whereby prevention can eliminate needless costs, and discomfort associated with dental disease and
treatment. Although tooth decay is more commonly caused by poor diet, and hygiene, less is known about the adverse
effects of stomach acid in otherwise healthy people and in those with an acid reflux disease (GERD). GERD has been mainly known for causing heartburn, lung, and esophageal problems until recently when studies such as those by the Medical College of Wisconsin now suggest gastric acid reflux and regurgitation can result in eroded carious teeth and gums disease, as well as sinus infections. Since most damage by the stomach acid appears to occur at night when less gravity, swallowing, and protective neutralizing salivary secretions are available, many suffers go without symptoms. Upon a dental exam the location and pattern of decay and erosion along with bad breath can suggest GERD, which will help the physician in the diagnoses so that treatment can be initiated. Without medical attention, excessive stomach acid may continue to cause erosions of the teeth, possibly leading to unnecessary tooth loss, as well as adversely affecting one's overall health. Good hygiene using a baking soda tooth paste, restricting sugar in the diet, drinking more water, and using a strong fluoride application daily after brushing are helpful while undergoing medical therapy for GERD. Work with a dentist and physician to keep your body healthy.

About Teeth
It’s not difficult to understand the structure and function of the tooth. When you open your mouth and smile, what you are seeing is the crown of each tooth, an outer egg-type shell. The substance of which the shell is made is called enamel. Enamel provides resistance to the acid from dental plaque, your stomach, and other sources. It’s the hardest substance in the body – harder than bone – but it is weaker in tensile strength. The enamel can withstand the forces of your jaw muscles, but it can’t bend if you bite sideways, and it can’t change from hot to cold quickly. Because of this, everyone has small fractures on their teeth, though some are larger and easier to notice. Once a small hole forms in the enamel, disease can quickly spread into the inside of the tooth (called the dentin). This can destroy large areas of the tooth, down to the pulp and causing necrosis. A great way to prevent these holes is with topical fluoride treatment. It’s especially effective in children systematically and early on, because it combines with the enamel and strengthens it. Adults can also benefit from extra topical fluoride treatments. The second layer of the crown structure is called dentin. It’s much softer than the enamel, and when you put it under a microscope, it looks like a hard natural sponge. The spaces, called tubules, are filled with moisture and nerve endings from the pulp. These nerves are sensitive to changes in water pressure, temperature, and chemistry, resulting in pain. The dentin cannot resist acid or bacteria. If they get past the enamel, they can infect the pulp and cause the tooth to die. The innermost layer of the tooth is the pulp. This is the soft nerve and blood tissue inside the hollow center of the tooth. This pulp helps to form the tooth, and then it keeps the tooth from drying out and weakening. The nerve can repair itself after trauma. If you feel that your tooth is tightening up, even if no other symptoms are present, have it evaluated regularly for nerve health. The tooth will remain at its healthiest if it has a healthy pulp, because this helps the tooth avoid fractures. When this pulp is removed, as it is during a root canal, the tooth will dry out and be unable to sense hard objects, leading to cracks and fractures. This is why teeth that have been treated with a root canal are often covered with crowns. A nerve dies when the pulp becomes inflamed. There are many possible causes for this, such as excessive bruising, malocclusion, deep caries, replacing large fillings or crowns, regularly drinking hot beverages, chewing on ice, trauma, deep fractures, periodontal disease, missing fillings, and rapid movement in orthodontics are some of them.

Understanding insurance and dental benefits
As you may be aware, insurance companies offer benefits which are becoming more confusing with less coverage, as employers demand cheaper policies.
Some types of insurance cover much of one's dental costs, while others only a fraction designed just to offset but not completely insure the dental needs of that individual. 
Most policies fall with in three groups:

1.)HMO - during enrollment you must sign up and go to one provider on the list. Be careful with this plan. Although many items are covered well, large hidden expenses as well as lower quality may exist. Additionally, the provider can only be changed once a year.

2.)PPO - you may choose to go in or out of network. Insurance companies want you to go in-network as that saves them money. The network provider drops their fees in exchange for patients referred to them. One might ask why a good provider would need to make that deal. Out of network usually has higher quality using better materials and labs, plus you may choose your own dentist. Often you can negotiate with the out of network office to make your out of pocket costs similar to what it would be in- network. Watch out for fee schedules. Negotiated in-network PPO fees are different from a set fee schedule. For example, out of network providers are often reimbursed by the PPO plan at UCR (usual and customary for the area), while a fee schedule is non UCR plan with very low fees that the employer has purchased to reimburse the employee for a particular service. No practitioner will accept that amount, in or out of network.

3.)Indemnity insurance where you may choose any private practice provider and the plan pays at UCR. 

Other plans include direct reimbursement which is not insurance but an alternative program that many small businesses are using which provide excellent benefits while limiting costs. The employee has a certain amount of funds which he may use for his dental needs each year. The employer saves money by eliminating premium costs, and counting on the fact that many employees will not utilize their benefits completely.

With healthcare in flux, it is important to verify and understand your dental coverage. Your employer or provider may call on your behalf for a break down of your benefits and explain them to you. Sometimes the information given by the insurance representative is not complete or correct, therefore preauthorizing extensive treatment may eliminate unpleasant surprises.

Tip from Dr. Humphrey
Dental treatment will cause inflammation.  If your health allows, taking ibuprofen before and after restorative treatment for at least 2 weeks will lessen the irritation and the chances of needing root canal therapy. Some pain is normal.  The pain should diminish each day and be virtually gone in 3-6 weeks.  If it worsens after 3 days, have the bite adjusted.  If your tooth throbs constantly after 3 days and does not respond to ibuprofen, see your dentist.  
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