I guess it’s because I don’t watch a lot of TV, but I confess that – until quite recently – I had absolutely no idea who this guy Dr. Oz is. A friend recently told me that Dr. Oz has some really good material about dental health that can be shared, and since it’s sometimes easier to use someone else’s material instead of having to write it all from scratch myself 🙂 , I figured I’d check it out, and WOW! I’m impressed! It’s sad to say, but many physicians really have no idea about how the health of the mouth is connected to the rest of the body, and how valuable their dental colleagues can be in diagnosing a number of medical conditions. Dr. Oz is definitely not one of them! I’ll kick things off here with one of his articles. I have added some bold italics for emphasis (all mine).
One look inside the mouth will reveal that there are bacteria everywhere. For the most, part we cohabitate without a worry – but badly-behaving bacteria can collect in gum pockets to cause swelling, bleeding and bone loss that in turn can cause teeth to loosen and fall out.
People with gum disease (periodontal disease and gingivitis), may harbor up to 500 species of bacteria, and the proximity of that bacteria to the normally sterile bloodstream can be worrisome. Bacteria can enter small blood vessels, travel to other parts of the body and release toxins and trigger inflammatory chemicals that assault arteries and organs. Gum disease and tooth loss is now considered a harbinger for coronary artery disease, infective endocarditis, bacterial pneumonia, diabetes, kidney disease and stroke. Periodontal bacteria have also been detected in the mouths and amniotic fluid of women who have experienced threatening premature labor, miscarriage and may contribute to low-birth weight.
Breath can be telling too. More than 90% of the time bad breath (halitosis) emanates from bacteria living in gum pockets, under dentures and on the surface of the tongue. It is not only unpleasant to people close to you, but it may also be a clue to other medical conditions.
Oral cancers, lung cancer, certain leukemias and dry mouth syndromes such as Sjogren’s syndrome can cause bacterial overgrowth that contribute to bad breath. And sometimes a systemic disease produces distinct chemical odors:
- Sweet or fruity odor may indicate uncontrolled diabetes
- Mousy ammonia odor may indicate liver disease
- Urine-like fishy odor may indicate chronic kidney failure
- And fecal odor may indicate intestinal blockage.
To find out if you have foul-smelling breath, ask a truthful friend, or lick your hand and smell the saliva.
Changes in the tongue can also be a tip-off to disease. A pale, smooth, flattened and sometimes tender tongue can point to iron or vitamin B12 deficiency, a hallmark of the common blood disorder, iron-deficiency anemia. People with Crohn’s disease and ulcerative colitis may notice tiny ulcers. If the tongue looks like a geographic map with areas of dark and light it may indicate an autoimmune disorder such as psoriasis or discoid lupus erythematosus. Recurrent episodes of white patches indicate thrush, an overgrowth of the yeast Candida, which may indicate diabetes. Strawberry red swollen tongue with a white coating and big red bumps is a symptom of Kawasaki disease.
Hairline cracks in the teeth can indicate tooth-grinding, the sleep disorder bruxism or mental stress. People with bulimia have enamel loss on their front teeth from the assault of stomach acid from repeated vomiting.
Keep Oral Traditions
Keeping up with a good program of oral hygiene and tending to dental and gum problems before they worsen is key to keeping mouths healthy. People with declining dexterity may need to make modifications that assure that good dental care continues. Electric toothbrushes, vibrating gum massagers and dental water jets can help. Routine dental visits are crucial, especially if you are planning to become pregnant or are facing a course of chemotherapy, which can reduce immunity against oral bacteria and cause mouth sores.
Here’s some help for halitosis, guidance for gums and tips for tooth care.
- Investigate any changes in your oral health
- Brush in the morning, at night and after meals with a soft toothbrush or African chew stick
- Use a tongue scraper along the length of the tongue to remove odor-causing bacteria
- Use an antiseptic mouth rinse
- Floss between teeth and inside the crease where the gum and tooth meet
- Keep well hydrated and avoid mouth breathing
- Don’t smoke or be near someone smoking (that can cause smoker’s breath too!)
- Try chewing on neem leaves, green cardamom, cloves, parsley, guava peels and gum mastic for breath control
- Visit the dentist regularly
A Full-Mouth Smile Reconstruction
Quite some time ago, I showed this case as an example of how badly teeth can be damaged by grinding them, whether at night, in the daytime, or both, and why something as simple and inexpensive as a nightguard (my recommendation is a NTI-tss). It is especially inexpensive in comparison to the cost of rebuilding a smile that is so broken down. This gentleman came to us in 2008, looking for options to feel good about his smile again for various reasons. After plenty of discussion, we agreed that the only option that would truly give him the smile that he wanted was a Total Smile Makeover/Reconstruction with porcelain crowns. After showing the Before-After pictures of his smile, I’ll discuss some of the issues you need to consider if you are thinking about significant cosmetic dentistry for yourself.
Frequently Asked Questions about Smile Reconstruction
When rebuilding a smile such as this, it is crucial to establish a proper bite relationship of the top and bottom teeth. Sometimes this can take a little while to figure out, because – when the teeth are so worn, the patient has long since adapted to a very bad bite relationship. The muscles have to be relaxed, accurate records taken, and excellent communication is necessary among the patient, the doctor, and the lab, to ensure that the crowns are made to look good, feel good, and last a long time. However, in severe wear cases, we always remind the patient that s/he already did a pretty good job destroying their natural set of teeth, so a nightguard is an absolute requirement as “insurance” to protect their investment, and even then they are more likely to break or chip the porcelain than others who don’t have that history. Simply put, these cases are far more complicated and require a great deal of time to get right, so you need to be absolutely committed to proceeding and working closely with your dentist to get a good result.
How Much Does a Smile Reconstruction Cost?
It’s not unusual for a patient to ask why it costs so much to do a Smile Reconstruction like this; it often seems like there should be a “volume discount,” so-to-speak, when doing a lot of crowns instead of just 1 or 2. The difference between such scenarios is the amount of time involved, the skill, training and experience required to successfully diagnose, complete, and treat, and that your dentist will have to work with a highly knowledgeable lab to make the crowns to not just look good, but fit properly and work smoothly in eating motions. Your dentist will likely spend at least a couple hours just in the planning stages! It’s usually a case of “You get what you pay for.” IOW – if you want a cheap smile makeover, you should reasonably expect a cheap outcome. To get excellence……it won’t come cheap. Depending on various factors, a case such as this will be the equivalent of buying a fairly nice car. The main difference, of course, is that you should expect to be “driving” your smile for a lot longer than most people keep a car!
- How Long Will This Take to Finish?
When doing so many teeth, you need to plan on a minimum of several appointments that could take 1/2-day to a full day each, as well as several other appointments to refine, modify if needed, polish, etc. From beginning to end, if everything goes perfectly, you might be done in as little as 1 month. That would be somewhat rare; more likely, you should plan on the entire process taking at least 2 months, and maybe many more. Extremely complex cases that involve implants, different specialists, and very complicated lab work may take a year or more due to the time needed for healing, verifying each stage is correct, and even just the time needed for lab technicians to do the custom work.
- What kind of Crowns will/should you get?
Due to improving materials and with the right techniques, in most cases nowadays you can have all-porcelain crowns made to rebuild a smile. The crowns used in this case are made of E.max porcelain, which is extremely strong and resistant to breakage. Numerous studies now show that this type of porcelain will likely last for 15-20 years, and quite possibly longer. For certain cases, though, and for patients who are even worse grinders than this gentleman was, gold crowns might still be necessary for the back teeth, simply because they are the strongest, longest-lasting crowns available. They can also take more abuse than any other material. Porcelain-to-metal crowns are also an option and have a long track record, but it is very important for the lab to be highly skilled so that you don’t see dark grey lines at the gum from the metal showing through.
- How Do I Choose the Right Dentist?
This is one of the trickiest questions, because the public doesn’t usually know enough about the training necessary beyond dental school that trains dentists to handle complex full-mouth reconstructions with skill and confidence. But here’s my recommendation: ask to see pictures of their other cases that might be similar to yours. That’s one of the reasons digital photography is such an instrumental and daily part of our dental practice – you will be able to see similar cases and know how the outcome will be before ever committing. The large majority of dentists who are well-trained in these cases also use digital photography, both for communicating with you as well as for documenting and tracking their own work over time. If you meet a dentist who can show you pictures of cases that were completed 5-10 (or longer) years ago AND s/he has recent follow-up pictures to show how well it has held up, THEN you should feel very confident that your dentist can take good care of you.
And then start imagining how much better you’ll feel when you can smile like Wayne does now!
Please feel free to ask questions or post a comment below, or to share with your friends! If you’re interested in a Complimentary Consultation in our office, please call 704-364-7069 or Request an Appointment Online.
News segment with Terrie Reeves & Dr. Payet on “Train for Life”, on TVNews 14 in Charlotte – coming soon!
Earlier this year, I had the pleasure of recording a short interview with the Founder and President (and one of my patients) of the Wellness Coalition of America, Ms. Terrie Reeves, for her weekly segment on TVNews 14 (every Sunday) called “Train for Life.” Each week, Terrie interviews people in different areas of life, all of which are somehow related to our total health and well-being. My first interview was how dentists can be an important part of your health-care team, because many diseases can be diagnosed through various conditions that come up in the mouth – diabetes, leukemia, gum disease – especially this one, because it has been shown to be linked to an increased risk of heart disease, stroke, and more. You can see the video segment that was aired in late spring 2009 at this link: Dental Health and Total Body Health Links (please note that the video must be viewed on Internet Explorer or Safari, but does not play on Firefox – sorry!).
Well, today we’ll be recording 2 new segments to be aired this fall. The first will be on the NTI-tss, an FDA-approved and non-medication treatment for Chronic Migraine and Chronic Tension Headaches, and the second spot (won’t air until November) will cover the most effective and comfortable treatment for periodontal (gum) disease available: the LANAP (Laser Assisted New Attachment Procedure) protocol, which can only be performed by a dentist licensed in the use of the Periolase MVP-7 free-running pulsed Nd:YAG dental laser.
I’ll be sure to post links to each of these as they become available! I must admit, it’s kind of fun to become a local expert on dentistry for the media. 🙂
I really, truly love treating patients for migraines and chronic headaches, and this was a case that was even more satisfying than usual, because my patient was only 10 years old when we made his NTI. He was in for a 6-month exam and cleaning today, and in talking with both him and his mother, we found that he was faithfully wearing his NTI and having 100% relief! Here’s what his Mom wrote to us in thanking us for helping her son, even though the other doctors he’d seen said there was nothing wrong with him:
“Hassan began suffering from frequent headaches last year. It took a while to pinpoint the source of these headaches until Hassan visited Dr. Payet’s office for a routine cleaning. During the exam, jDr. Payet asked Hassan if he had headaches in the morning and how often. This was a key question that eventually led to the discovery that Hassan would need a NTI to assist in aiding him with the necessary buffer to relieve the pressure of him clenching his teeth @ night. The clenching was the direct cause of his headaches.
I’m happy to say that Hassan has been 100% pain free since he received his nightguard!
We cannot thank Dr. Payet enough for the major role he played in correcting a major issue for Hassan.”
This is a question I’m frequently asked, especially when a patient is considering a significant investment of time and money into some form of cosmetic dentistry, such as:
- Porcelain veneers
- Bonding (tooth-colored fillings)
- Porcelain crowns and bridges
- Teeth whitening
- Even Six-Month Braces
It’s a very understandable question, and the simple answer to the question, “How long will my dental work last, Dr. Payet?” is “It depends.”
Just like a car, your teeth and gums require regular care to ensure that they are working properly. Sure, you can go 10-20,000 miles between oil changes given how improved cars are nowadays, but do you really want to take the risk? Same thing with teeth……….some people go for 5-10 years with no dental check-ups and are fortunate when they come in to find no problems, such as cavities or gum disease. But it’s not many people that are so lucky!
I always remember a quote from some lecturer at a dental conference years ago telling us his response whenever a patient asks the question, and it’s really the most honest, best answer that can be given, “Clearly the teeth that God gave you haven’t lasted your entire life, and since I can assure you that my work is not nearly as good as God’s, unless you die first, the work I do (no matter how excellent) will not last forever either.”
So what can cause your dental work to fail?
- Grinding your teeth — when the human jaw clenches, it can create an amazing amount of force, and over time, enough clenching will cause teeth to crack and break.
- Acidity — anything that increases the acidity in your mouth is good for the bacteria that cause cavities in particular, including Acid Reflux, Sodas, Power drinks (Monster, Red Bull, etc), Sports drinks (Gatorade, Powerade, etc).
- A very sugary diet — the bacteria that cause cavities love sugar. High sugar content means the bacteria feed like crazy, produce acid, and the acid is what eats away the teeth to cause cavities.
- A compromised immune system — your saliva contains important antibodies that help keep the cavity-causing bacteria under control. If your immune system is knocked back due to a disease or some medication, those antibodies will be decreased, allowing the bacteria to grow uncontrolled.
- Decreased saliva (dry-mouth syndrome) — again, due to medications or illness, the amount of saliva may be decreased. With less saliva, there is less “washing” action of the teeth.
- Trauma — obviously. LOL One of my patients a few years ago fainted and fell face-first into a brick wall, shattering a front tooth. Another ran into a pole, shattering another front tooth. Clearly, if you are injured in such a way that your natural teeth would break, any dental work will break, too.
- Bad habits like chewing hard candy or ice regularly — hard candy and ice are just that — HARD! Ice, in particular, is easily as hard as your enamel and as porcelain or bonding. So if you bite down on ice frequently enough and/or hard enough, you can break your teeth and dental work.
That covers most of the major causes of dental work failing. With regular care, use of appropriate mouthrinses and toothpastes, proper brushing and flossing, regularly scheduled check-ups and dental x-rays, using a nightguard, and being aware of diet, etc, your dental work can and should last a very long time.
But always remember — my dental work isn’t as good as the natural teeth God gave you, so my work probably won’t last forever either. 😉
Snoring Isn’t Sexy has recently added a FREE DOWNLOAD eBook and Self-Test on their website. I HIGHLY recommend this website for anyone who has concerns about sleep apnea, who is looking for a dentist in Charlotte who treats sleep apnea with oral appliances, and general information.
As a practicing dentist for almost 11 years now, in a practice that does accept assignment of dental insurance benefits, I have seen almost every conceivable attempt by dental insurance companies to hold up payment, deny payment, or anything they can do to keep the money that should rightfully help pay for your dental care. But this one took the cake for me, and I have to share. Which insurance company? Metlife. Seriously……..they said there was not enough missing tooth structure due to decay or fracture on these teeth, and therefore they don’t need crowns. Are they CRAZY!!!!!?!?!?!?!?
13yo girl with back pain, headaches, jaw pain, acid erosion of teeth, ADD, gastric reflux, sleeps poorly….
So what’s the connection amongst all these things? Is it possible there’s one condition/issue that is a primary driving force behind all of these that, if addressed, could make an amazing difference in a young girl’s life……for her entire life? The answer is (of course, or I wouldn’t be asking such obvious leading questions, right? LOL 🙂 )
So what’s the driving force behind all these health-issues, and what can be done about it?
Let’s list all those conditions out again and start connecting the dots:
- Lower back pain (no history of any accidents or trauma — this one is a bit of a stretch, but since there are no other contributing factors, and she’s been checked for scoliosis (curvature of the spine) and cleared, the fact that she’s been suffering from back pain is most likely due to the muscle spasm involved in the other issues, and perhaps she needs a new mattress for better lower back support.
- Long history of headaches (decreasing somewhat recently, but still significant for a girl only 13 years old) – quite a bit of research now indicates that both chronic tension and migraine headaches are connected to sleep disorders, and it makes sense – if you can’t breathe well at night and your brain gets less oxygen than it really needs, your brain/nervous system will get hypersensitized; any little trigger will make it go haywire, make muscles spasm like crazy, and result in headaches.
- Jaw pain/TMJ pain – Same as with the headaches; when the nervous system goes haywire, the muscles spasm like crazy, and your jaws will hurt; the joints get way too much pressure and pain can result, also the tissue in the joint gets scarred.
- Acid erosion of teeth, signs of wear/bruxism on teeth – Connected to both the last 2 items (jaw pain/TMJ pain and headaches) AND to the next one (gastric reflux/GERD), if the muscles are spasming like crazy and making your teeth grind, they will show signs of wearing down. When acid from the stomach gets sucked up the esophagus during that snoring (it’s a vacuum, really) and put in the mouth, especially at night, it sits there for hours and eats away at the enamel just like soda does.
- Gastric reflux (very odd in a 13yo girl) – With sleep apnea, the throat gets closed off and you literaly stop breathing for short periods. When your throat suddenly opens again, it’s like a vacuum suddenly releasing and acid gets sucked up your throat from your stomach. VERY dangerous, and lots of research shows it can drastically increase your risk of Barrett’s Esophagitis, which can lead to throat cancer and is VERY VERY VERY NASTY!!!!
- ADD (Attention Deficit Disorder) – Again……decrease the oxygen level to the brain every night…..do you think your brain will function at normal levels? Nope! Common sense, really, and yes, the research is pointing in this direction.
- Poor sleeping – Just like anyone who can’t breathe well at night, do you think you’ll sleep well? Nope! You can sleep for 10 hours, but if you have trouble breathing well for 6 of those hours, how do you think you’ll feel in the morning?
- Asthma – The research on this is a little bit more in the initial stages from what I understand (could be further along and more definitive, though), but again it just makes sense. After all, what is asthma but inflammation of the lungs, right? Well, if you have some acid reflux at night, it’d be pretty easy to inhale just a little bit of that acid during the episodes of apnea, and imagine even a tiny bit of stomach acid getting into your lungs…..talk about irritated lungs!
So……..it really doesn’t seem like a stretch, does it? You probably first thought…….no way! But when looking at all of the different problems that this young lady faces at such a young age, there has to be something going on. Given she has a pretty big tongue, big tonsils, and a very narrow throat, it was easy to determine she is at high risk for sleep apnea.
I can only hope that her mother listened and takes her for a thorough evaluation. Besides keeping her teeth healthy, proper diagnosis, perhaps removal of her tonsils, an oral appliance, and some other possibilities for treatment, treatment could literally add years of healthy living!!!
I’d like to supplement the last post about Kat’s treatment with the story of a discussion we had after an appointment sometime in 2008, when she’d had her NTI-tss nightguard for about 18-20 months. It demonstrates just how “miraculous” a treatment the NTI can be for chronic migraine headaches.
When Kat first came to us, she had suffered migraine headaches for as long as she could remember (I’m not allowed to tell you how long that is, of course – a gentleman never asks nor tells a lady’s age!), and she had tried practically every medication, had every scan done, had allergy testing done, massage, chiropractic, physical therapy……….you name it, she’d tried it. I think the only thing she hadn’t done was Botox, ’cause she doesn’t like that idea.
2 weeks after starting to wear her NTI, Kat came in for her first follow-up visit and told us in amazement and pleasure that the ONLY headache she’d had in those 2 weeks was the day after drinking a bit too much and forgetting to wear her NTI. It was one of the first days in years she had no headache and no migraine! And that continues today…….
But the cool thing…..because sometimes people are hesitant to pay $600+ for a “nightguard” from a DENTIST, of all people, to treat their headaches……after she’d had her NTI for those 18 months, I asked her the following question:
“Kat, if I were to offer you $1,000 (One Thousand Dollars) to buy your NTI back from you, with the condition that you could never get another one, would you take it?”
Kat looked at me as if I were crazy for a moment before bursting out laughing and asking, “Are you crazy???? No way!”
So there you go…she wouldn’t even accept $1,000 for a piece of acrylic and lexan, because it’s made that big a difference in her life.
Would you be willing to pay $1,000 if all you had to do to get rid of your migraine headaches was to wear a custom-fitted and adjusted dental nightguard? Instead of all the medications? What if your insurance would not cover it?
Given that I occasionally suffer migraine headaches myself (usually when I’m overworked, not sleeping well, not eating enough, AND most importantly, not wearing MY NTI), and I know just how excruciating the pain can be, I am often amazed that someone would not pay $650, which is our usual fee, to stop the suffering, but they would prefer to keep suffering because their insurance won’t take it. Huh? I don’t get it……
There are several factors that can make a Smile Makeover much more difficult to look good or great, and this was an instance in which pretty much ALL of them were in place, so this was quite a challenge for me; fortunately, I had the distinct pleasure of working with a terrific patient and an amazingly good dental lab to create a pretty beautiful smile in the end.
When Kat first came to us in August 2006, she’d always taken good care of her teeth, but she was ready for some real changes and improvements to her smile and wanted someone with experience in fixing real problem smiles. During my initial exam, I quickly realized there were several complicating factors that had been overlooked for years that had directly contributed to the problems she recognized. She knew about the significant gum recession, was unhappy about the dark metal lines around her dental bridge, and wanted to brighten/straighten her whole smile.
What I recognized as problems that she didn’t:
- Crowded lower front teeth that were banging against the back of the upper dental bridge
- She clenched her teeth intensely, pushing the lower front teeth powerfully against the back of the upper dental bridge
- A history of chronic migraines that did not respond to conventional treatment, and as she’ll tell you in a heartbeat, she tried EVERYTHING.
- The 2 teeth holding up the bridge had cracks in the roots deeply below the gum level.
- A very high smile line, meaning that – when she smiles big – her lip rises way up high so that even the gums show (most people don’t do this)
We spent quite a while talking about how all these things fit together, as well as discussing the possibilities to give her a beautiful smile she felt good about. Ultimately, we decided on extracting the 2 cracked teeth, placing 2 dental implants, Six-Month Braces to straighten the lower front teeth so they wouldn’t bang against the top ones, using the NTI-tss for resolving the chronic migraines (resulting from the incredibly intense muscle clenching), and finally a dental porcelain-to-metal bridge to replace the upper missing front teeth, supported by the 2 dental implants. The entire process took just under 2 years, but even Kat will tell you – it was worth it! She recently got married and says she felt so good smiling for her wedding photos with total confidence.
You know — this is the kind of thing that makes dentistry really enjoyable. We get to help people LOOK GOOD, FEEL GOOD, AND EAT THE FOODS THEY WANT. 🙂