Tuesday, May 29, 2012

Water Flouridation and Infant Formula Safety

The proper amount of fluoride from infancy through old age helps prevent and control tooth decay. Community water fluoridation is a widely accepted practice for preventing and controlling tooth decay by adjusting the concentration of fluoride in the public water supply.

Fluoride intake from water and other fluoride sources, such as toothpaste and mouthrinses, during the ages when teeth are forming (from birth through age 8) also can result in changes in the appearance of the tooth’s surface called dental fluorosis. In the United States, the majority of dental fluorosis is mild and appears as white spots that are barely noticeable and difficult for anyone except a dental health care professional to see.

Recent evidence suggests that mixing powdered or liquid infant formula concentrate with fluoridated water on a regular basis may increase the chance of a child developing the faint, white markings of very mild or mild enamel fluorosis.

You can use fluoridated water for preparing infant formula. However, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula; these bottled waters are labeled as de-ionized, purified, demineralized, or distilled.

What is the best source of nutrition for infants?

Breastfeeding is ideal for infants. CDC is committed to increasing breastfeeding throughout the United States and promoting optimal breastfeeding practices. Both babies and mothers gain many benefits from breastfeeding. Breast milk is easy to digest and contains antibodies that can protect infants from bacterial and viral infections. More can be learned about this subject at http://www.cdc.gov/breastfeeding/.

If breastfeeding is not possible, several types of formula are available for infant feeding. Parents and caregivers are encouraged to speak with their pediatrician about what type of infant formula is best suited for their child.

Why is there a focus on infant formula as a source of fluoride?

Infant formula manufacturers take steps to assure that infant formula contains low fluoride levels—the products themselves are not the issue. Although formula itself has low amounts of fluoride, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis.

Infants consume little other than breast milk or formula during the first 4 to 6 months of life, and continue to have a high intake of liquids during the entire first year. Therefore, proportional to body weight, fluoride intake may be higher for younger or smaller children than for older children, adolescents, or adults.

What types of infant formula may increase the chance of dental fluorosis?
There are three types of formula available in the United States for infant feeding. These are powdered formula, which comes in bulk or single-serve packets, concentrated liquid, and ready-to-feed formula. Ready-to-feed formula contains little fluoride and does not contribute to development of dental fluorosis. Those types of formula that require mixing with water—powdered or liquid concentrates—can be a child’s main source of fluoride intake (depending upon the fluoride content of the water source used) and may increase the chance of dental fluorosis.

Can I use optimally fluoridated tap water to mix infant formula?

Yes, you can use fluoridated water for preparing infant formula. However, if your child is exclusively consuming infant formula reconstituted with fluoridated water, there may be an increased chance for mild dental fluorosis. To lessen this chance, parents can use low-fluoride bottled water some of the time to mix infant formula; these bottled waters are labeled as de-ionized, purified, demineralized, or distilled.

How can I find out the level (concentration) of fluoride in my tap water?

The best source of information on fluoride levels in your water system is your local water utility. Other knowledgeable sources may be a local public health authority, dentist, dental hygienist, or physician. CDC’s Web site My Water’s Fluoride allows consumers in some states to learn the fluoridation status of their water systems. Nearly all tap water contains some natural fluoride, but depending on the water system, the concentration can range from very low (0.2 mg/L fluoride or less) to very high (2.0 mg/L fluoride or higher). More than 18,000 water systems serving 204 million people in the U.S. provide fluoridated water to their residents.

Will using only low fluoride water to mix formula eliminate my child’s risk for dental fluorosis?

Using only water with low fluoride levels to mix formula will reduce, but will not eliminate, the risk for dental fluorosis. Children can take in fluoride from other sources during the time that teeth are developing (birth through age 8). These sources include drinking water, foods and beverages processed with fluoridated water, and dental products, such as fluoride toothpaste, that can be swallowed by young children whose swallowing reflex is not fully developed.

Article Source: http://www.cdc.gov/fluoridation/safety/infant_formula.htm

David Kitchen, D.D.S.
Scripps/Ximed Medical-Dental Center

9850 Genesee Avenue, Suite 540
La Jolla, CA 92037
http://www.cosmeticdentistryforsandiego.com

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Tuesday, May 22, 2012

Endodonic Treatment (Root Canals)


Once upon a time, if you had a tooth with a diseased nerve, you'd probably lose that tooth. Today, with a special dental procedure called a root canal therapy you may save that tooth. Inside each tooth is the pulp which provides nutrients and nerves to the tooth, it runs like a thread down through the root. When the pulp is diseased or injured, the pulp tissue dies. If you don't remove it, your tooth gets infected and you could lose it. After the dentist removes the pulp, the root canal is cleaned and sealed off to protect it. Then your dentist places a crown over the tooth to help make it stronger.

Most of the time, a root canal is a relatively simple procedure with little or no discomfort involving one to three visits. Best of all, it can save your tooth and your smile!

Frequently Asked Questions


What is root canal treatment?

Your dentist uses root canal treatment to find the cause and then treat problems of the tooth's soft core (the dental pulp). Years ago, teeth with diseased or injured pulps were removed. Today, root canal treatment has given dentists a safe way of saving teeth.

What is the dental pulp?

The pulp is the soft tissue that contains nerves, blood vessels and connective tissue. It lies within the tooth and extends from the crown of the tooth to the tip of the root in the bone of the jaws.

What happens if the pulp gets injured?

An abscessed (infected) tooth caused by tooth decay. When the pulp is diseased or injured and can't repair itself, it dies. The most common cause of pulp death is a cracked tooth or a deep cavity. Both of these problems can let germs (bacteria) enter the pulp. Germs can cause an infection inside the tooth. Left without treatment, pus builds up at the root tip, in the jawbone, forming a "pus-pocket" called an abscess. An abscess can cause damage to the bone around the teeth.

Why does the pulp need to be removed?

When the infected pulp is not removed, pain and swelling can result. Certain byproducts of the infection can injure your jaw bones. Without treatment, your tooth may have to be removed.

What does treatment involve?

Treatment often involves from one to three visits. During treatment, your general dentist or endodontist (a dentist who specializes in problems of the pulp) removes the diseased pulp. The pulp chamber and root canal(s) of the tooth are then cleaned and sealed.

Here's how your tooth is saved through treatment:
  1. First, an opening is made through the crown of the tooth.
  2. An opening is made through the crown of the tooth into the pulp chamber.
  3. The pulp is then removed. The root canal(s) is cleaned and shaped to a form that can be filled.
  4. The pulp is removed, and the root canals are cleaned, enlarged and shaped
  5. Medications may be put in the pulp chamber and root canal(s) to help get rid of germs and prevent infection.
  6. A temporary filling will be placed in the crown opening to protect the tooth between dental visits. Your dentist may leave the tooth open for a few days to drain. You might also be given medicine to help control infection that may have spread beyond the tooth.
  7. The pulp chamber and root canals are filled and sealed.
  8. The temporary filling is removed and the pulp chamber and root canal(s) are cleaned and filled.
  9. In the final step, a gold or porcelain crown is usually placed over the tooth. If an endodontist performs the treatment, he or she will recommend that you return to your family dentist for this final step.
  10. The crown of the tooth is then restored.

How long will the restored tooth last?

Your restored tooth could last a lifetime, if you continue to care for your teeth and gums. However, regular checkups are necessary. As long as the root(s) of a treated tooth are nourished by the tissues around it, your tooth will remain healthy.




David Kitchen, D.D.S.
Scripps/Ximed Medical-Dental Center
9850 Genesee Avenue, Suite 540
La Jolla, CA 92037
 

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Tuesday, May 15, 2012

Eating Disorders and Dental Health

It has been estimated that more than 10 million Americans currently are affected by serious eating disorders such as anorexia, bulimia and binge eating. While anyone can suffer from an eating disorder, they are most common in teen and young adult women. Eating disorders can have a large negative impact on an individual’s quality of life. Self-image, relationships with families and friends as well as performance in school or on the job can be damaged. It is critical for anyone with symptoms of an eating disorder to seek professional help since an individual can die from the medical complications these disorders can cause.


Types of Eating Disorders


Anorexia typically involves an extreme fear of gaining weight or a dread of becoming fat. Even though these individuals may be very thin or even extremely underweight, they see themselves as “fat.” They may attempt to reach or maintain what they think is their perfect body weight by literally starving themselves. They may also exercise excessively. Others may eat excessive amounts of food in one sitting and then attempt to get rid of the food and calories from their bodies by forcing themselves to “throw up” or by the misuse of laxatives or enemas.

Bulimia also includes the fears of being overweight. But it also includes hidden periods of overeating (binge eating) which may occur several times a week or even several times a day. While overeating, individuals may feel completely out of control. They may gulp down thousands of calories often high in carbohydrates and fat – in amounts of food that would be greater than what an average person would eat at one sitting. After they overeat, the individuals try to “undo” the fact that they ate too much as quickly as possible by forcing themselves to “throw up” or by the misuse of laxatives or enemas. This is often referred to as “bingeing and purging.”

Binge Eating or Compulsive Overeating may affect almost as many men as women. In the past, these individuals were sometimes described as “food addicts.” They overeat (binge eat) as noted in bulimia above, but do not regularly try to get rid of the food immediately by throwing up or by misusing laxatives or enemas. Feelings of guilt may make it easier for the person to overeat again.

Symptoms



Each of these eating disorders can rob the body of adequate minerals, vitamins, proteins and other nutrients needed for good health. Individuals with eating disorders can display a number of symptoms including dramatic loss of weight, secretive eating patterns, hair loss, feeling cold, constipation and, for women, the loss of their monthly menstrual period. Eating disorders may also cause numerous other physical health complications, such as heart conditions or kidney failure, which can lead to death.

Eating disorders can also affect oral health. Without the proper nutrition, gums and other soft tissue inside your mouth may bleed easily. The glands that produce saliva may swell. Individuals may experience chronic dry mouth. Throwing up frequently can affect teeth, too. When strong stomach acid repeatedly flows over teeth, the tooth’s outer covering (enamel) can be lost to the point that the teeth change in color, shape and length. The edges of teeth become thin and break off easily. Eating hot or cold food or drink may become uncomfortable.

Photographs

IMAGE: Damaged tooth enamel resulting from eating disorder front view IMAGE: damaged tooth enamel resulting from eating disorders upwards inside view
Photos courtesy of Craig Mabrito, D.D.S.

Prevention


Eating disorders arise from a variety of physical, emotional and social issues all of which need to be addressed to help prevent and treat these disorders. Family and friends can help by setting good examples about eating and offering positive comments about healthy eating practices. While eating disorders appear to focus on body image, food and weight, they are often related to many other issues. Referral to health professionals and encouragement to seek treatment is critical as early diagnosis and intervention greatly improve the opportunities for recovery.

Treatment of Oral Health Consequences of Eating Disorders

  • Maintain meticulous oral health care related to toothbrushing and flossing.
  • Immediately after throwing up, do NOT brush but rinse with baking soda to help neutralize the effects of the stomach acid.
  • Consult with your dentist about your specific treatment needs.
  • See your dentist regularly.

Article Source: http://www.ada.org/5898.aspx?currentTab=1


David Kitchen, D.D.S.
Scripps/Ximed Medical-Dental Center
9850 Genesee Avenue, Suite 540
La Jolla, CA 92037


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Monday, May 7, 2012

Dr. Kitchen At CDA 2012

Dr. David Kitchen attending CDA in Anaheim this past weekend.  Had a fun time and looking forward to next year.





David Kitchen, D.D.S.
Scripps/Ximed Medical-Dental Center
9850 Genesee Avenue, Suite 540
La Jolla, CA 92037



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Tuesday, May 1, 2012

Dental Filling Options Explained

Thanks to advances in modern dental materials and techniques, dentists have more ways to create pleasing, natural-looking smiles. Dental researchers are continuing their often decades-long work developing materials, such as ceramics and polymer compounds that look more like natural teeth. As a result, dentists and patients today have several choices when it comes to selecting materials to repair missing, worn, damaged or decayed teeth.

These new materials have not eliminated the usefulness of more traditional dental materials, such as gold, base metal alloys and dental amalgam. That’s because the strength and durability of traditional dental materials continue to make them useful for situations, such as fillings in the back teeth where chewing forces are greatest.



What's Right for Me?


Several factors influence the performance, durability, longevity and cost of dental restorations. These factors include: the patient's oral and general health, the components used in the filling material; where and how the filling is placed; the chewing load that the tooth will have to bear; and the length and number of visits needed to prepare and adjust the restored tooth.

With so many choices, how do you know what's right for you? To help you better understand what's available, here are the advantages and disadvantages of commonly used dental restorations.
The ultimate decision about what to use is best determined by the patient in consultation with the dentist. Before your treatment begins, discuss the options with your dentist.

Types of Dental Restorations


There are two types of dental restorations: direct and indirect.

Direct restorations are fillings placed immediately into a prepared cavity in a single visit. They include dental amalgam, glass ionomers, resin ionomers and some resin composite fillings. The dentist prepares the tooth, places the filling and adjusts it during one appointment.

Indirect restorations generally require two or more visits. They include inlays, onlays, veneers, crowns and bridges fabricated with gold, base metal alloys, ceramics or composites. During the first visit, the dentist prepares the tooth and makes an impression of the area to be restored. The impression is sent to a dental laboratory, which creates the dental restoration. At the next appointment, the dentist cements the restoration into the prepared cavity and adjusts it as needed.
Amalgam Fillings

IMAGE: Amalgam fillingUsed by dentists for more than a century, dental amalgam is the most thoroughly researched and tested restorative material among all those in use. It is durable, easy to use, highly resistant to wear and relatively inexpensive in comparison to other materials. For those reasons, it remains a valued treatment option for dentists and their patients.

Dental amalgam is a stable alloy made by combining elemental mercury, silver, tin, copper and possibly other metallic elements. Although dental amalgam continues to be a safe, commonly used restorative material, some concern has been raised because of its mercury content. However, the mercury in amalgam combines with other metals to render it stable and safe for use in filling teeth.

While questions have arisen about the safety of dental amalgam relating to its mercury content, the major U.S. and international scientific and health bodies, including the National Institutes of Health, the U.S. Public Health Service, the Centers for Disease Control and Prevention, the Food and Drug Administration and the World Health Organization, among others have been satisfied that dental amalgam is a safe, reliable and effective restorative material.

Because amalgam fillings can withstand very high chewing loads, they are particularly useful for restoring molars in the back of the mouth where chewing load is greatest. They are also useful in areas where a cavity preparation is difficult to keep dry during the filling replacement, such as in deep fillings below the gum line. Amalgam fillings, like other filling materials, are considered biocompatible—they are well tolerated by patients with only rare occurrences of allergic response.
Disadvantages of amalgam include possible short-term sensitivity to hot or cold after the filling is placed. The silver-colored filling is not as natural looking as one that is tooth-colored, especially when the restoration is near the front of the mouth, and shows when the patient laughs or speaks. And to prepare the tooth, the dentist may need to remove more tooth structure to accommodate an amalgam filling than for other types of fillings.

Composite Fillings


IMAGE: Composite fillingComposite fillings are a mixture of glass or quartz filler in a resin medium that produces a tooth-colored filling. They are sometimes referred to as composites or filled resins. Composite fillings provide good durability and resistance to fracture in small-to-mid size restorations that need to withstand moderate chewing pressure. Less tooth structure is removed when the dentist prepares the tooth, and this may result in a smaller filling than that of an amalgam. Composites can also be "bonded" or adhesively held in a cavity, often allowing the dentist to make a more conservative repair to the tooth.

The cost is moderate and depends on the size of the filling and the technique used by the dentist to place it in the prepared tooth. It generally takes longer to place a composite filling than what is required for an amalgam filling. Composite fillings require a cavity that can be kept clean and dry during filling and they are subject to stain and discoloration over time.

Ionomers


IMAGE: Ionomor fillingGlass ionomers are translucent, tooth-colored materials made of a mixture of acrylic acids and fine glass powders that are used to fill cavities, particularly those on the root surfaces of teeth. Glass ionomers can release a small amount of fluoride that may be beneficial for patients who are at high risk for decay. When the dentist prepares the tooth for a glass ionomer, less tooth structure can be removed; this may result in a smaller filling than that of an amalgam.
Glass ionomers are primarily used in areas not subject to heavy chewing pressure. Because they have a low resistance to fracture, glass ionomers are mostly used in small non-load bearing fillings (those between the teeth) or on the roots of teeth.
Resin ionomers also are made from glass filler with acrylic acids and acrylic resin. They also are used for very small, non-load bearing fillings (between the teeth), on the root surfaces of teeth, and they have low to moderate resistance to fracture.

Ionomers experience high wear when placed on chewing surfaces. Both glass and resin ionomers mimic natural tooth color but lack the natural translucency of enamel. Both types are well tolerated by patients with only rare occurrences of allergic response.

Indirect Restorative Dental Materials (Two or more visits)


Sometimes the best dental treatment for a tooth is to use a restoration that is made in a laboratory from a mold. These custom-made restorations, which require two or more visits, can be a crown, an inlay or an onlay. A crown covers the entire chewing surface and sides of the tooth. An inlay is smaller and fits within the contours of the tooth.

An onlay is similar to an inlay, but it is larger and covers some or all chewing surfaces of the tooth. The cost of indirect restorations is generally higher due to the number and length of visits required, and the additional cost of having the restoration made in a dental laboratory. Materials used to fabricate these restorations are porcelain (ceramic), porcelain fused to a metal-supporting structure, gold alloys and base metal alloys.

All-Porcelain (Ceramic) Dental Materials


IMAGE: All-Porcelain (Ceramic) dental overlayAll-porcelain (ceramic) dental materials include porcelain, ceramic or glasslike fillings and crowns. They are used as inlays, onlays, crowns and aesthetic veneers. A veneer is a very thin shell of porcelain that can replace or cover part of the enamel of the tooth. All-porcelain (ceramic) restorations are particularly desirable because their color and translucency mimic natural tooth enamel.

All-porcelain restorations require a minimum of two visits and possibly more. The restorations are prone to fracture when placed under tension or on impact. The strength of this type of restoration depends on an adequate thickness of porcelain and the ability to be bonded to the underlying tooth. They are highly resistant to wear but the porcelain can quickly wear opposing teeth if the porcelain surface becomes rough.

Porcelain-fused-to-Metal


IMAGE: Porcelain-fused-to-metal dental overlayAnother type of restoration is porcelain-fused-to-metal, which provides strength to a crown or bridge. These restorations are very strong and durable.

The combination of porcelain bonded to a supporting structure of metal creates a stronger restoration than porcelain used alone. More of the existing tooth must be removed to accommodate the restoration. Although they are highly resistant to wear, porcelain restorations can wear opposing natural teeth if the porcelain becomes rough. There may be some initial discomfort to hot and cold. While porcelain-fused-to-metal restorations are highly biocompatible, some patients may show an allergic sensitivity to some types of metals used in the restoration.

Gold Alloys


IMAGE: Gold alloy crownGold alloys contain gold, copper and other metals that result in a strong, effective filling, crown or a bridge. They are primarily used for inlays, onlays, crowns and fixed bridges. They are highly resistant to corrosion and tarnishing.
Gold alloys exhibit high strength and toughness that resists fracture and wear. This allows the dentist to remove the least amount of healthy tooth structure when preparing the tooth for the restoration. Gold alloys are also gentle to opposing teeth and are well tolerated by patients. However, their metal colors do not look like natural teeth.

Base Metal Alloys


Base metal alloys are non-noble metals with a silver appearance. They are used in crowns, fixed bridges and partial dentures. They can be resistant to corrosion and tarnishing. They also have high strength and toughness and are very resistant to fracture and wear.

Some patients may show allergic sensitivity to base metals and there may be some initial discomfort from hot and cold. However, due to their metal color, gold alloys do not look like natural teeth.

Indirect Composites


IMAGE: Indirect composite dental inlayCrowns, inlays and onlays can be made in the laboratory from dental composites. These materials are similar to those used in direct fillings and are tooth colored. One advantage to indirect composites is that they do not excessively wear opposing teeth. Their strength and durability is not as high as porcelain or metal restorations and they are more prone to wear and discoloration.

Frequently Asked Questions


If my tooth doesn’t hurt and my filling is still in place, why would the filling need to be replaced?

Constant pressure from chewing, grinding or clenching can cause dental fillings, or restorations, to wear away, chip or crack. Although you may not be able to tell that your filling is wearing down, your dentist can identify weaknesses in your restorations during a regular check-up.
If the seal between the tooth enamel and the restoration breaks down, food particles and decay-causing bacteria can work their way under the restoration. You then run the risk of developing additional decay in that tooth. Decay that is left untreated can progress to infect the dental pulp and may cause an abscess.

If the restoration is large or the recurrent decay is extensive, there may not be enough tooth structure remaining to support a replacement filling. In these cases, your dentist may need to replace the filling with a crown.

Are dental amalgams safe?

Yes. Dental amalgam has been used in tooth restorations worldwide for more than 100 years. Studies have failed to find any link between amalgam restorations and any medical disorder. Amalgam continues to be a safe restorative material for dental patients.

Is it possible to have an allergic reaction to amalgam?

Only a very small number of people are allergic to one or more of the metals used in amalgam fillings. In these rare instances, the filling may trigger a localized reaction that produces symptoms similar to a skin allergy. Often patients who have this reaction to amalgam have a medical or family history of allergy to metals. Another dental filling material will be used instead of amalgam in these situations.
 
Is there a filling material that matches tooth color?

Yes. Composite resins are tooth-colored, plastic materials (made of glass and resin) that are used both as fillings and to repair defects in the teeth. Because they are tooth-colored, it is difficult to distinguish them from natural teeth. Composites are often used on the front teeth where a natural appearance is important. They can be used on the back teeth as well depending on the location and extent of the tooth decay. Composite resins are usually more costly than amalgam fillings.

Article Source: http://www.ada.org/3094.aspx?currentTab=1 

David Kitchen, D.D.S.
Scripps/Ximed Medical-Dental Center
9850 Genesee Avenue, Suite 540
La Jolla, CA 92037




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