Waterpiks are fun!

Ever since I got braces put on in September, I have been using my waterpik every day.  It's the only way I know how to get rid of all the "schmutz" that gets stuck on the braces.  Remember how you would take a water gun and squirt it in your mouth on a hot summer day?  Well, a waterpik is nothing more than an automatic water gun.  My routine is: I eat, I waterpik, I brush my teeth.  And I must say that I have done a pretty good job of keeping the bathroom clean from all the mess that can be made with one.  The mirror has never looked cleaner in front of the sink! ;)

My 7 year old son recently got a palatal expander placed to fix the cross-bite he has on his back teeth.  He, too, is using the waterpik and loves it.  He has so much fun having water go all over the mirror and the sink counter.  One day he went to go use it, and it wouldn't turn on.  I checked the fuse and turned it back on.  Well, he had left the waterpik turned on.  The bathroom all of a sudden had a nice water feature.  A couple of walls got a nice rinse, and water was everywhere.

So, if you wear any kind of orthodontic appliance that you cannot take out of your mouth, you should be using a waterpik.  It will help decrease the amount of plaque in your mouth, which will mean less cavities. It will make brushing your teeth much easier.  Moms, Dads, can it be a bit messy? Yes.  Would you rather have a slightly messier bathroom mirror or a child with a higher chance of having cavities?

Can you use a waterpik if you don't have braces?  Of course!  Some patients unfortunately don't floss for one reason or another (dexterity issues, they don't like to do it), but they will use a waterpik instead.  A waterpik doesn't replace flossing completely, but it does help.

If you have any questions.please don't hesitate to contact us to learn more about using a waterpik.

What is an implant?

"How does an implant work?" I get asked this a lot when discussing treatment options with my patients. Simply put, an implant is a titanium screw that is placed into your jaw to replace a broken or missing tooth. Implants have become a routine and predictable service that dentists can offer their patients.  Before implants were used, the other options to replace a missing or broken tooth were to make a bridge (a non-removable option that was made by placing crowns on the teeth on either side of the missing/broken tooth), make a partial denture to replace that one missing tooth, or do nothing.

Used with permission from BIOMET 3I

In the image to the right you can see how an implant mirrors a tooth.  The left part of the picture shows a natural tooth, with the white outer layer enamel, and the darker underlying dentin.  This picture also looks like how a dentist would shave a tooth down to make a crown for a tooth; by removing the enamel, and leaving a plateau of dentin in the middle to allow for the crown to fit over it.

Now, when an implant is placed, it replaces the root of the tooth only.  In order to replace the rest of the tooth (the crown), the dentist and the lab need to fabricate a restoration that replicates the natural tooth.

The dental implant crown, as shown in the picture, can be either be one piece (a screw-retained implant crown) or two pieces (a cement-retained implant crown).  The dentist and the lab will work together to determine what is the best way to restore the tooth based on each specific situation.  No matter which option is selected, the restoration will fit snugly with the implant, and it will at some point be held together with a screw that connects the restoration to the implant.

If the restoration is one piece, the crown sits directly on top of the implant, and is held in place by a screw that tightens the crown to the implant; a screw-retained implant crown.  No cement is used to hold the crown in place like it would if it was being placed on a tooth.  A hole is made through the middle of the crown when it is being made by the lab to allow the dentist to tighten the crown to the implant with the screw. Once the crown is fully seated and tightened, the dentist will place a bonded filling to cover the hole.

If the restoration is two pieces, the abutment replicates the plateau of dentin that remains on your tooth when you have a crown; and the crown sits on top of the abutment.  The implant screw is used to tighten the abutment to the implant, and the crown is cemented onto the abutment just like a crown is cemented onto a tooth; a cement-retained implant crown.

Implants are a great option for many patients. It allows me to offer an opportunity to replace a missing or broken tooth that minimizes affecting other teeth that can become compromised by placing a bridge, and it doesn't have to be removed nightly like a partial denture.  Besides replacing missing teeth, implants can be used to help stabilize dentures; but that's a topic for another day.

If you think you need an implant, and you want to find out more, please contact our office to set up an appointment for a consultation at your earliest convenience. 973-543-6666 or info@mendhamdentist.com.

Yes, I got braces.

"You did what?"  "Good for you!"  "Huh?"

These are but some of the responses from patients this week when they saw that I now have braces.  Yes, you read that right.  I have brackets and wires in my mouth.

Yes, I really do have braces.

So, why did I do it?  Well, it was time for me to take care of myself.  My teeth are relatively straight.  They are slightly crooked due to them moving over time, and if I was interested in just having them look straight I could have done invisible braces; or even veneers.

However, I have been getting food trapped in between my teeth along my gums for awhile, and the contacts between my teeth (the thing that causes the "snap" of the floss when you put it between your teeth) was very light or not there at all between many of my teeth.  When you floss you want to hear a definitive "snap" of the floss.  It means your teeth are touching each other well, and you are much less likely to have problems with food getting trapped in between your teeth.  Besides being a constant irritation, if you continually get food trapped in between your teeth, it can cause cavities, problems with your gums, and ultimately bone loss around your teeth.

So, I went to the orthodontist for a consultation.  The best way to treat my concerns was traditional braces; not invisible braces. He expects my problems to be corrected in 4-6 months.  The braces are going to straighten the teeth, and also tighten the contacts (that "snap") between the teeth.  If necessary, he will "slenderize" or "slim-down" some teeth on the sides to make my teeth have a longer, or more broad, contact.  This is a routine procedure in which a disc or strip is taken to the outside edge of a tooth to "shave" it down a little bit.  I like to describe this procedure as if you have a broken finger nail & you take an emery board to smooth it down.  It does not cause sensitivity, and it does not hurt.  It simply removes a tiny amount of enamel to allow the teeth to touch better.

I am, obviously, happy with my decision to go ahead and get braces.  Long-term it will improve my health, and short-term I hope to lose some weight since eating is a little more cumbersome.

So, if you have had similar problems (crooked teeth, food getting caught) with your teeth, come to the office and we can have a discussion about what options are best for you. It may be traditional braces, it may be invisible braces, it may be something else.

Just because it's on the internet doesn't mean it's (completely) true

I just read an article on cnn.com that states if you grind your teeth at night (also known as bruxism) that is a "major indication" of obstuctive sleep apnea.  The article also goes on to state the following:

"Sufferers of sleep apnea never get the benefits of the deepest stages of sleep, which is what reverses the aging process and repairs tissue damage. After just one night of the lack of deep sleep that the body craves, you awake in a damaged state. Cumulative damage could lead to expression of the Alzheimer's gene, high blood pressure, depression, mood disorders, suppression of the immune system, diabetes, cancer and weight gain."

That's some pretty scary words that are intended to evoke an emotional response from the reader, and the hope is that you will call your dentist immediately asking to be checked for bruxism so that you can avoid any of the POTENTIAL long term affects of sleep apnea.

So what are the points that I am trying to make?  The first point is people grind their teeth for different reasons.  In some, it is a response to stress, in others the muscles that help you move your jaw are trying to position it a certain way, and in others it MAY be related to sleep apnea.  

The second point is that there are also other possible reasons besides grinding your teeth for a person to have sleep apnea. Some of those reasons include the following: the person may be overweight; the person may have a small airway in the throat, large tonsils, or even narrow or small airways in the nose; the person's jaw may slide back into the throat when they are sleeping causing the airway to become smaller.

Diagnosing problems in dentistry, and medicine, cannot always be solved by using the equation A=B; where "A" causes "B".  Sometimes it can, but most times there is more than one cause of a problem; and just because you have one cause does not mean it's causing the problem you are having.  In other words, just because you grind your teeth does not mean you have sleep apnea.  You may have one, or both, but just because you grind ("A"), does not mean you have sleep apnea ("B").

If you are concerned that you may have sleep apnea, what should you do? Come see me or your physician.  We can then prescribe for you to have a sleep study.  This is the only way to diagnose if you have sleep apnea.  If you are concerned that you grind your teeth, what should you do?  Come see me, and we will figure out what's causing it together.

Here is the link to the article on ccn.com: http://www.cnn.com/2013/04/16/health/dental-screening/index.html?hpt=hp_c4

So you like gum & candy...

OK.  Admit it.  At least at one point in our lives all of us probably liked candies like tic-tacs and other types of mints, and ate them all the time.  Plenty of us also chew gum on a regular basis.  While there are some benefits to using mints or gum (freshening breath, increasing saliva flow), there are also some major negatives too; they can cause cavities if they are high in sugar.

When it comes to eating, everyone has certain tendencies.  For example, when you chew your food you most likely chew it on the same side the majority of the time.  Me? I usually chew my food on the left side of my mouth.  Now, when someone eats a mint, they generally let it sit in one place in their mouth every time; usually in the back somewhere resting between the cheek and a tooth.

If someone is eating mints all day, and placing the mints in the same place every time, you are creating a very sugary environment that allows the bacteria in your mouth to grow and accumulate; eventually, causing a cavity to form on the side of your tooth.

Now, I will admit that the candy and gum companies have become better over the last few years concerning what types of sugars they use.  There is one ingredient that most companies have started using more and more that actually HELPS the mouth FIGHT cavities and the bacteria in your mouth.  It's called XYLITOL.

What's "Xylitol?"  It is a sugar alcohol sweetener used as a sugar substitute.  Basically, the bacteria in mouth can't use xylitol for energy, so they starve and can't multiply.  Xylitol has also shown to have less calories than regular sugar (sucrose), and can be beneficial for diabetics as well by lowering one's blood sugar.  **Please consult with your doctor or nutritionist before using xylitol if you are on a diabetic diet to make sure  using xylitol is safe for you.

Now, what gums and candies have it?  Like I said before, most companies now have at least one type of gum or mint that has it in it.  The next time you are in the supermarket look at the ingredients of your favorite gum or mint, and see if xylitol is listed.  IN ORDER FOR XYLITOL TO BE EFFECTIVE, IT MUST BE LISTED WITHIN THE FIRST THREE (3) INGREDIENTS.  It it's not, find another gum or mint to use.

Some gums that I have seen it in are: Hershey's Ice Cubes, UP2You, and Trident.

If you like to go to Whole Foods, they sell xylitol-based gums and candy.  I'm sure Trader Joe's does as well.

So, if you want to keep chewing gum or mints, that's fine; just make sure that it has xylitol in it!

You can learn more about xylitol and it's benefits by going here: www.xylitol.org and here: WebMD

**PLEASE NOTE**: Xylitol is also a laxative.  If taken in high doses of more than 50 grams a day for adults & 20 grams a day in children (per WebMD), it can cause stomach irritation.  You would have to chew a lot of gum and mints in order to reach that amount!
**DOG OWNERS**: While xylitol is not toxic to humans, it is toxic to dogs. So, please be safe & make sure you put your xylitol sweets in a place where they cannot be reached by your pet!

The Tooth Fairy can help clean up a room

Some of you may have seen this on the web recently.  If you haven't, the tooth fairy decided to leave this letter instead of money recently for a girl named Emily.

Hopefully, Emily cleaned up her room!

CEREC Omnicam video

Here is a video that shows how our new CEREC machine works and allows you to have a crown made in 1 visit.

“Crowns in one visit? You can do that?”

“Crowns in one visit?  You can do that?”

“Yes!”

“How?”

“Well, we have a new machine, the Cerec Omnicam, which allows us to do everything in about 2 hours.  There are 3 parts to the machine: a small video camera, a computer program, and a milling machine.  After we remove the damaged parts of your tooth we take a 3-D color video image of your teeth.”

“Wait! You don’t need to use that gooey stuff to make a mold of my teeth?”

“That’s right; no more messy goo is needed to go into your mouth to take an impression.  Once I know that we have enough information from the video, I use the computer program to help me design the crown that is needed to restore your tooth.  Then, we send that information to the milling machine that will create the crown out of a ceramic block immediately while you wait.”

“I really don’t have to come back?”

“No, you don’t.  It takes about 10-15 minutes for the machine to mill, or create, the crown out of the ceramic block.  Then, we will place it in your mouth to make sure your bite is correct, it fits to your tooth well, and everything is sealed.  Then, we will take the crown and place it in an oven to bake it for 15 minutes.  Once it is cool, we use a very strong cement to keep it in place.  The total time you are in the chair is about the same, maybe a little less, as compared the total time needed to do a crown the traditional way; but you don’t have to get numb twice, and there is no temporary crown to worry about."

“Why don’t you need metal for the crown anymore?”

“Are there situations where metal is still necessary? Yes.  However, in your case and the majority of other patients as well, ceramics will do as great a job as their metal-based counterparts.  If used properly, the ceramic crowns are as strong as crowns with metal in them.  Another advantage is that the ceramic crowns are more esthetic than traditional crowns.”

“OK.  What is the difference in cost between a ceramic crown and a crown with metal?  It costs more right?”

“What if I told you it costs less?”

“WHAT??? HOW???”

“It’s simple.  When we used metal in the past for either the strength underneath porcelain or as an all-metal crown, we made sure our lab used nothing but the best (or noble) metals available: gold, palladium, etc.  Now, with gold rising in price significantly over the years, our lab bill, and in turn the fee we charge for our metal-based crowns, also increased.  When using a ceramic restoration, the lab bill is less.  Instead of charging you the same, or more, than a metal-based crown, I have lowered the fee to match the savings.”

Pictured: The camera, the computer, and the milling machine used
to make a crown in one visit.

“Wow! So, are they really just as strong as metal crowns?”

“Yes, if used properly.  As I said before, there will be times where a metal-based crown will be more beneficial; but in this case, and a majority of other cases, ceramic is a great material to use. “

“So, what made you get this machine now?  Why didn’t you get it before?”

“The technology is now where I want it to be.  What made me decided to get it now was the new camera.  It’s amazing.  Like I said before, it’s a 3-D color video camera.  The previous camera that was used, while also giving excellent results, was like a regular camera.  It took black-and-white still photos.  When the images from the video Omnicam camera are on the screen, you see it just as it is in your mouth.  Your gums will be pink, your silver filling in the back of your mouth will be silver.  Since the images with the old camera came up as black and white there could be situations where it would be difficult for the dentist to properly identify where the tooth ended (the margin) and the gums began.   With the omnicam, since everything is in color, it is much easier to identify the margin.”

“This seems really cool.  So, when can we do this?”

“As soon as you’re ready.”

Winter is coming; and so are sinus infections

Fans of "Game of Thrones" on HBO know the phrase, "Winter is coming".  For those who have not read the books, or have watched the show, it is motto of the Stark family; a family of nobles that oversee the northern-most lands of the kingdom.  Today, the weather feels like summer has ended, fall is here, and that means winter is on its way; which brings me today's post.

Banana Spray doesn't taste good.

In dental school, I was encouraged by some professors to make sure that I tried every dental product that I was going to use when seeing a patient.  The reasoning was simple.  I should know what the material tastes and feels like so that I can understand and empathize with what my patient was experiencing.  Most things tasted, and felt, ok.  For example, the impression material, or “gook”, that we use to take molds of your teeth was fine; it didn’t taste bad, but it wasn’t great tasting either.  One of the worst things to taste was “banana spray”.  What’s banana spray you ask?  It is an anesthetic spray that is used for a patient that has a severe gag reflex.  It tastes awful, and personally, I really don’t think it works.   There are much better ways to get someone with a severe gag reflex to stay calm while doing dental work.  I used it once or twice in dental school on the insistence from a professor.  I wasn’t happy about it, and you can bet neither was the patient.

So, what does my experience of trying different dental products in dental school have to do with winter and sinus infections?  Well, over the years I have had a number of patients come in swearing that they had a terrible tooth ache in the back teeth of their top jaw.  Even though this can happen any time of year, it tends to be more prevalent during the fall and winter months for our patients.  When this situation occurs in my office, we talk about their symptoms, do an exam, and take an x-ray or two.  If everything appears to be ok on the x-ray and in the mouth, one of the questions I always ask is, “Do you have any sinus issues right now?” If the answer is “yes”, I have the patient put their head between their legs to see if this causes any kind of change in pressure or relief on the teeth that are bothering them.  If they do have a sinus infection, we give them an antibiotic prescription, and we call them back in a few days to make sure they are feeling better.

However, until last year, I had never personally experienced a sinus infection.  Yes, I could diagnose the problem, but I was never able to empathize and fully understand what my patients were feeling.  Then, I had one.  IT HURT LIKE CRAZY!  If I wasn’t a dentist, I would have sworn that I would have needed at least 3 root canals.  It felt like I was getting lightning bolts put straight into the roots of my teeth.  In a weird way I was actually happy to have had it, because now I know exactly what my patients were telling me about.  I was able to finally say, “I know exactly what you are feeling right now.”

Why am I telling you this? Simple, I have a sinus infection right now that is causing my teeth to hurt, so I figured I would warn you that winter is coming; and so are sinus infections!

Happy Labor Day!

Yesterday, Mendham held it's annual Labor Day parade.  The threat of rain did not keep everyone away from enjoying the activities.  Here are some pictures taken as the parade passed the office and headed to Borough Park and the last day of the carnival.  We hope everyone had a great time this weekend!

Did you buy your 50/50 tickets?

Morris County Police Officers leading the parade.

Mendham's Boy Scouts Troop

View from the office looking towards Borough Park

Mendham Bourough Fire Department

Brookside Fire Department

Mendham's Cub Scouts Pack

Mountain View's 8th grade float

Mendham High School's Marching Band

Mendham High School's Cheer Leaders

A clown band

Twin Boro Bears Cheerleaders

Schiff Nature Preserve

Candy, candy, candy.  This is only one of the bags that my kids filled.

Here are some pictures from the carnival:

Deep fried pb&j????

Zeppole.  No carnival would be complete without that.

Toothbrushes, Toothpastes, and Floss (Oh, my!)

We love it when patients ask us questions, and we get lots of them every day.  “Which toothpaste is best?” “Is this one better than that one?”  “Which mouthwash is good for my kids?”

I took this picture at the Shoprite in Chester. 

The next time you are in the supermarket or pharmacy, walk down the health & beauty aisle, and look at the abundance of options available to take care of your teeth.  For floss alone there are so many options.  Is it waxed, un-waxed, rope-like, flavored, unflavored, does it have a handle, etc. You get the idea.  For every dental product available for you to buy, there are so many choices it can be overwhelming that you may not know where to start.

When patients come visit us for their cleanings the topic of what they should be using at home comes up at some point.  Depending on your needs we will recommend specific oral hygiene products that will help you keep your mouth as healthy as possible between your visits.  However, the simplest answer I can give anyone is this: “Whatever works for you.”  -WHAT?

What I mean is I want you to brush your teeth at least twice a day, I want you to floss once a day, and I want you to use mouthwash.  I want you to use whichever toothbrush, toothpaste, floss, and mouthwash that you like and will use.  Let’s be honest.  There are very few people in the world who actively enjoy brushing their teeth; the majority of people view it as a necessary evil that must be done.  We only get to see you a few times a year for about an hour each time.  We need you to take care of your teeth and gums at home on a regular basis; and you are more likely to take better care of them at home using products you like.

Pickle-flavored floss? Yup!

So, if you have toothpaste that tastes a little funny, try a new one.  You don’t like the type of floss you have? Come by the office, and we will give you a couple of different types for you to try.  We’ve got plenty (except for pickle-flavored).

If you ever have any questions or comments we would love to hear them below; or you can always call us at 973-543-6666.  

Thanks for reading!

-Paul Ferraioli, DMD

Do you use Tylenol? If you do, please read this!

It has come to our attention that Johnson & Johnson have cut the maximum recommended daily dose of the pain reliever Extra Strength Tylenol from 8 pills (4000 mg)  to 6 pills (3000 mg) a day.  These new dosing instructions will be seen on packages beginning in the very near future (fall 2011).  HOWEVER, packages with the current labeling (allowing you to take 8 pills a day) will remain on the shelves, and will not be removed.

The reason that McNeil Consumer Healthcare Division, the pharmaceutical arm of Johnson & Johnson, is decreasing their recommended dosage of Extra Strength Tylenol is that acetaminophen, the active ingredient that helps with pain reduction in products like Tylenol, has been known to cause liver damage and fatal overdoses in those who misuse the medication.

Starting sometime early next year (2012), the recommended daily dosage for Regular Strength Tylenol and other acetaminophen products will be lowered as well.  Once we learn about the changes, we will pass them along to you.

What to expect from this blog

Our new website is up and running (www.MendhamDentist.com), we have a facebook account (www.facebook.com/MendhamDentist), we have a twitter account (http://twitter.com/#!/MendhamDentist), and we have this blog.  What are we going to do with all of these social media accounts?

We want to be able to keep you, our patients, informed about the latest news and topics in dentistry, and in our office, that affect you and your dental care.

Do you have a question about your teeth, mouth, and/or how it affects your body?  If so, let us know.  We want to post discussions that are of interest to you!

We look forward to hearing from you!

Richard E. Derrick, DMD
Paul Ferraioli, DMD

Our new site is coming!

Our newly designed website will be launching soon!


www.MendhamDentist.com