Sunday, December 13, 2009

Quitting Smoking: A dental perspective

Last month, I had the opportunity to listen to a seminar given by Dr. Alan Blum (a professor in the Department of Family Medicine at the University of Alabama). Dr. Blum is a medical doctor, and an anti-smoking advocate. In his presentation, Dr. Blum provided many surprising tips and examples about quitting smoking, and the tobacco companies' clever ways to encourage smoking. For instance, it's believed that a pack of cigarettes costs approximately $0.25 to produce, yet they're sold for $4-6 per pack. That is an incredible profit margin for the tobacco companies (and the government takes a large portion in the form of cigarette taxes!). The tobacco companies provide many different products (those for women, those for men, those with low tar, those with filters), however ultimately all of the products are the same in terms of your health. They all contain the addictive nicotine, and they are all filled with harmful poisons and carcinogens (the filter accomplishes nothing in preventing the inhalation of harmful substances).

If you are a smoker, I, and the other members of the medical community are going to encourage you to quit. We care about your health, and smoking is not a part of a healthy life. I ALWAYS discuss smoking with my patients, and I provide educational materials, discuss prescription medications to assist in quitting, and provide follow-up on their progress. The effects of cigarette smoke due to the chemical carcinogens, radioactive carcinogens and nicotine, can cause disease of the heart and lungs, periodontal disease, cancers of the throat and mouth and pancreatic cancer. The overall life expectancy of smokers is 10-18 years less than nonsmokers. Smoking and exposure to smoke results in 443,000 premature deaths annually!

If you need more motivation to try and stop smoking, consider the educational information I use from

Within 24 hours of quitting smoking, your blood pressure and pulse rate may begin to drop. After 2 to 12 weeks, your lung function and circulation can increase. After a year, your risk of coronary heart disease drops to 50% that of a habitual smoker. After 10 years of being smoke-free, your risk of lung cancer is 50% that of a smoker. These are all amazing health benefits in and of themselves! In addition, your taste and smell may improve, you won't stink like smoke, and you can feel more in control of your life, not being addicted to cigarettes.

How long does it take to smoke a cigarette? Approximately 4-5 minutes. Multiply that by the amount of cigarettes you smoke in a day, and you can be saving hours of life every week that you can invest in other activities. For instance, if you smoke 12 cigarettes per day, at 5 minutes each, you've wasted 1 waking hour of your day smoking. That's approximately 365 hours per year! Imagine what else you could be doing in that time!

In this economy, everyone's looking to save some money. The price of the average pack of cigarettes can be $4-6 bucks. Multiply the packs you smoke per week, times the cost, and you may be shocked to find the amount of your hard-earned dollars you've spent. Let's say a pack costs $5, and you smoke 1 pack per day. This is $35 per week and nearly $2000 per year! In a month, you'd save enough money to buy a top of the line iPod, a decent high-definition TV within 6 months, and enough money to go on an awesome luxurious vacation in just one year!

I referred to the dental perspective because the dental school where I received my degree at the State University of New York at Buffalo, has a unique program where the dental students are taught a smoking cessation protocol. Dr. Othman Shibly developed this program, and he and other faculty members including Dr. Eric Schroeder, are responsible for teaching the students to implement it. Dr. Shibly says, "These efforts were based also on our goal of making dental treatment a successful long-term benefit for our patients by addressing all risk factors associated with oral disease," he said. "Research has shown that there is no match for smoking in causing harm to oral health." Dr. Shibly, a periodontist, and personal friend, is an asset to the Dental School, and the community, for his continued support of tobacco cessation.

The most serious condition in your mouth is oral cancer, which is correlated to the use of tobacco products (cigarettes, pipes, cigars and smokeless tobacco). If you are a smoker, don't be surprised if your teeth are affected not just with staining, but also the inflammatory disease periodontitis (half of cases are attributed to smoking!). Essentially, the bone sockets holding the teeth in place erode away due to the smoking.

If you are a smoker, or user of tobacco products, please consider talking to your doctor or dentist about a plan to quit. If you are a non-smoker who is concerned about an tobacco-addicted loved one, please encourage them to do the same. There's no better time to stop smoking than RIGHT NOW!

Monday, October 19, 2009

Mission: Tennessee

In my last year of dental school, I heard from several students that there was a Buffalo dentist/pilot who would fly to various locations in the USA to provide donated dental care to the under-served people there. Apparently he would take a few students along with him for each trip. Last month, I sent this dentist an email inquiring about his next trip (pointing out that though I was no longer a student, I'd still love o be involved). I was excited to read an email response saying "My next trip is to Appalachia in Tennessee on October 17 and 18th, and you've made the short-list of people invited to come. Respond ASAP!"

The dentist, Dr. D'Angelo, belongs to a group called Remote Area Medical Volunteer Corps , which is a collection of health professionals providing health-care free of charge to needy people around the globe. I was excited about this particular RAM event, since it would be benefiting my fellow Americans. Dr. D'Angelo (a pilot with over 2500 hours of flight experience and a Captain of the Civil Air Patrol) flies his own Cessna 210 and his friend Joe, also a RAM volunteer, would be flying in his Cirrus SR22, each taking as many dental volunteers that would fit.

The 4 of us in the plane all had head-sets, and we listened to Dr. D'Angelo describe the mission trips. He has been participating in RAM missions for years, has traveled across the USA, and to countries like the Dominican Republic, providing dental care. For this mission, we were going to Winchester, Tennessee, and would work 7am-7pm Saturday, & until 2pm on Sunday.

The participants from UB's Dental School in Buffalo, NY, for this trip were the pilots, Dr. D'Angelo and Joe, senior dental students Eric and Matt, junior dental students Nina, Chintin, Aman, Laura and Vera, Dr. D'Angelo's assistant Pat, and me.

Saturday morning we all woke up at 6am at our Hotel, ate breakfast, and then were off to the Franklin County High School for the mission work. This high school is the largest one I've ever seen. It serves the whole county, and is located in Winchester. Although it was cold (35F) and windy, there were over 100 people waiting outside to register. Inside, there were many more people (many having arrived the night before to get in line!). What I didn't realize prior to the event was there would be other health professionals there including a large optometry group, general health and HIV testing as well.

The dental group was set up in an auxiliary gym. There were 30 dental chairs set up, a large sterilization table, a long table with hundreds of instruments, along with dentists, hygienists and assistants ready to work. I worked straight through from 7am until 2pm before stopping for lunch. In the afternoon I was happy to have the help of Kayela, a student interested in a career in the dental profession who was volunteering her time at the mission by assisting not only me, but many of the dentists in the operative and oral surgery procedures. She's going to be a valuable asset to the dental community once she is finished with school, and I wish her the best of luck! We wrapped things up around 6pm, ate dinner at the high school, and then headed back to the hotel. I was completely exhausted, however, the whole group of us went to Dr. D'Angelo's room for a little party before bed-time.

At the party, Joe, the other pilot, discussed about another branch of charity work that he and Dr. D'Angelo participate in. Not only do the two of them fly on dental mission trips, but also participate in 'Angel Flight,' which takes transplant patients to hospitals across the country to receive their transplants (absolutely for free). They're on-call for this group, and make one or more flights per week at the drop of a hat.

The next morning, I woke up around 6am again, and again, we were off to the races. We arrived at 7:30am, and I got started with extractions and fillings right away. By 9am, I was approached by a lady I was introduced to the day before named Catherine (a nurse from Colorado who was at the mission on her own hoping to provide medical assistance). Serendipitously, she was asked to help in the dental clinic, and boy was she great to have as an assistant! Even though she had no prior experience helping with tooth extractions or fillings, she was immensely helpful! She also provided a unique perspective as a nurse offering health advice to the patients.

After a quick lunch, I wrapped up the afternoon with a marathon tooth pulling, taking out 8 rotten teeth in one lady's mouth. By 2:30pm, all of our bags were packed up, equipment was loaded in the van, and we were off to the airfield once again.

Between the people such as Catherine and Kayela who assisted me, the students from Georgia's Augusta Dental School, the dentists from all over the country, and the other volunteers, I was happy to have met such nice people. In addition, the patients on this mission were incredibly appreciative and kind.

In total, I pulled 37 teeth, and did 7 fillings. Assuming a general dentist may charge at a minimum around $100 per simple extraction, $150 per surgical extraction, and approximately $100-200 per filling, I did about $5000 of donated dental service for the mission. Overall, our group of 11 did around $52,000 in donated dental services: an outstanding accomplishment!

The knowledge I received while in the mission clinic from Dr. D'Angelo and the other dentists, combined with the unique experience of flying to this mission, and all of the new people I met, made this an incredibly memorable and rewarding weekend. Also, Dr. D'Angelo let me fly the plane for a while. How unbelievably cool is that?

For more information on these mission trips, and the wonderful people involved, check out:
Remote Area Medical Volunteer Corps
Flying Dentists Association
Dr. D'Angelo's articles on Flying Dentists
Angel Flight

Monday, September 28, 2009

Tongue Studs & Lip Rings

Oral piercings are becoming more and more popular with young adults and teenagers. They're a fashion statement and they're very distinctive! Are you thinking of getting one? It's important to consider the risks and benefits. The benefits are they look cool and unique!

Now, familiarize yourself with the risks (and how to avoid potential problems):

First, for the person who's going to be doing the piercing: How do they clean their instruments? Are they autoclaved, and cleaned with a disinfectant (glutaraldehyde)? Are they wearing masks and gloves? Are sterile needles used? What is there plan in case of an emergency during the procedure?

Second, know the complications and possible adverse effects of the piercing procedure: Pain (duhh!), swelling (tongue swelling may require anti-inflammatory agents to control, to prevent your airway from being blocked), prolonged bleeding (if a blood vessel is cut), nerve damage, high risk of infection (mouths are filled with germs!) and a risk of endocarditis in people with certain heart problems.

Third, keep in mind that the stud or ring itself can produce adverse effects and possible trauma: An increase in saliva, difficulty in pronouncing words, aspiration (breathing the stud/ring into your lungs if it comes loose), chipping teeth and gingival recession (where the gums pull away from your teeth). According to a review of the research literature, 'Jewelry-related complications mainly consisted of tooth fractures and wear (14%-41%) and gingival recessions (19%-68%).' Also, the stud or ring itself will become a haven for bacterial plaque, so keep it clean (remove and wash it with soap whenever you brush and floss your teeth!).

Check out these links if you’d like more information about tongue and lip piercings, and their possible side-effects:

Oral Piercings
Oral Piercing and Health
Tongue Piercing - Case Report and Review of Current Practice

Thursday, September 24, 2009

Sports Drinks and Teeth

When I was in grade-school, every student knew in their mind that they could instantly be turned from a mediocre kid in gym class, to a professional athlete, simply by consuming a sports drink like Gatorade, PowerAde, or the carbonated drink All-Sport. They were delicious, thirst-quenching, gave us energy, and the pros drank them so they must be amazing!

Today, the number of these sports-drinks on the market are astounding! Gatorade itself has several different beverage products (Gatorade G, No Excuses, Shine On, Be Tough, Bring It, Focus, G2). There are also 'sports waters' including Gatorade's Propel Fitness Water!

Why am I bringing these up? Because the one thing they have in common is they contain sugar (sucrose and glucose-fructose). While you or your kids are fighting off your thirst with these drinks, the sugar is soaking into the teeth (figuratively speaking). Because you're exercising, there's decreased salivary flow in your mouth, meaning the sugar isn't naturally washed off your teeth as well (or as quickly) as it would if you were at rest. This allows the bacteria and germs to take over and start the early processes of tooth decay (metabolizing the sugar and producing acids on the tooth surface). What's worse, is these beverages (like most soft-drinks) are acidic, which promotes an even more suitable environment for the germs to thrive!

Now, I enjoy these beverages, and I think many athletes would agree that they help to keep their energy levels high during sporting events. What I am suggesting to you, the parent or athlete, is to take measures to prevent the progression of tooth decay processes.

One suggestion is to have a separate bottle of water that you can use during a sports event to rinse with after consuming the sports drink. Glug-glug (sports drink), glug-glug or rinse-rinse (water). This will help flush excess sugar off your teeth. Another suggestion is to rinse out your mouth after the sporting event with a antiseptic mouthwash (rinsing for at least 30 seconds). This will help remove the excess sugar, and kill many of the germs on the tooth surfaces. Of course, before bed at night, go through your regular routine of brushing your teeth gently for two minutes, followed by flossing all of your teeth.

Check out these two research articles (one, and two) discussing how exposure to soft-drinks (such as sports drinks and colas) roughens up the surface enamel of teeth. Yikes!

Wednesday, September 23, 2009

Help! My Kid's Tooth Got Knocked Out!

What happens if your child's adult tooth gets knocked out in an injury? This situation is no fun for anyone. Your poor son or daughter is going to be upset and in pain, and if you haven't read this article in time, you might not know what to do.

Thankfully, the answer is straightforward: Get that tooth back in your child's mouth NOW!

If you're able to place your child's tooth back into the tooth socket within 5 minutes of the injury, there's a much higher chance that the tooth will heal itself back in place. By 30 minutes of the tooth being out, there's no ability for the tooth to recover. If you can help it, do NOT touch the root of the tooth, as you can damage the ligament cells that act to hold the tooth in place. If the tooth has landed in dirt or sand, pick it up by the crown and gently rinse it of loose debris before putting it back in the socket.

After you've placed the tooth back, make an 'emergency appointment' with your dentist to evaluate the situation, as they may want to temporarily bond the tooth to the adjacent teeth to promote stability during the healing process (for a couple of weeks).

This is just a 'nuts and bolts' discussion I'm presenting. If you'd like more information on the topic, please visit the website listed below that has resources for you to download to learn more about teeth injuries and what to do when they occur!

The Knocked-Out Permanent Tooth: Information for the patients/parents/caregivers

Sports Dentistry

I was fortunate enough today to hear a seminar on dental injuries from an area dentist who is a member of the Academy of Sports Dentistry. I learned many surprising facts that I wanted to pass on to you!

Did you know that 1 in 3 boys and 1 in 4 girls will sustain some kind of tooth or dental related injury before they turn 18? 90% of these injuries are chipped teeth, and 80% involve the two upper front teeth (the maxillary central incisors).

Even more surprising is the sports that cause the most injuries. You may be surprised to learn that 40% of all sports injuries are from either.... basketball or baseball! I'm sure you were thinking either hockey or football right? Well, kids playing these sports are required to wear helmets and face-masks, which provide excellent protection.

Recommendation: If your child enjoys playing sports, I advise you to have a custom mouthguard made by your dentist in order to protect your kid's teeth. Ask your dentist about mouthguards before your child starts playing on the team!

Learn more about Sports Dentistry at

Tuesday, September 22, 2009

Favorite Toothpaste

Two of my favorite and most popular brands of toothpaste today include Crest Pro-Health and Colgate Total. Both are accepted by the American Dental Association.

Crest Pro-Health includes the active ingredients stannous fluoride and sodium hexametaphosphate. The stannous fluoride protects against gingivitis, plaque, cavities and tooth sensitivity. The sodium hexametaphosphate fights stain and tartar build-up. It is advertised as the most comprehensive protection for your teeth.

The other product, Colgate Total, in addition to having the ADA approval, it is also approved by the Food and Drug Administration (in its effect to fight gingivitis). The proven effects of Colgate Total last for up to 12 hours after you brush your teeth (even after eating and drinking). Along with fluoride, this toothpaste has another active ingredients called triclosan (an antibacterial chemical). Linked with a copolymer, triclosan is able to attach to teeth, providing the 12 hour protection.

Obviously, there is a lot of scientific research going into the development of these products.
Two recent studies include this one for Colgate Total, and this one for Crest Pro-Health.

What it comes down to for each person is a matter of taste. I for one enjoy Colgate Total's taste and texture, whereas I find Crest Pro-Health to have a gritty feeling on my teeth when I brush (although the flavor is very pleasant).

I haven't discussed proper brushing technique yet, however for now just remember to brush your teeth at least twice a day (once after breakfast, and once before bed). Use a fluoride-containing toothpaste, and consider giving one of the two listed above a try!

Monday, September 21, 2009


Imagine no longer having any surprises at the dentist about cavities hiding between teeth. If there's one thing that you can be doing to improve your oral hygiene (reduce cavities, gum disease and bad breath), without having to spend a lot of money or invest a lot of time into, it's flossing your teeth.

I have patients who tell me "Doctor, my gums bleed when I brush my teeth!" and "I get sensitive feelings between my teeth!" When I ask them about their flossing habits, they often say the same thing, "Oh I only floss when I get something caught in my teeth," or "The last time I flossed? Ummm, I think you did it!"

No one seems to like to floss!

Listen closely folks... Want to keep your teeth in your mouth nice and healthy? Go out, buy yourself some floss (whether it's Oral B Satin, or Crest's Glide, or any other brand that looks appealing to you), and start flossing your teeth ONCE A DAY! Here's how:

  1. Take a strip of floss in your hands, and wind it around your middle fingers.
  2. Slide the floss between your teeth gently, and guide it between your teeth and the gums.
  3. 'Hug the tooth,' with the floss and make several up-and-down strokes. Then, move the floss to hug the tooth on the other side for several up-and-down strokes.
  4. Remove the floss, and move on to the next interproximal area (ie. the area between two teeth).
If you're new to flossing, it may be necessary to do this in the bathroom in front of a mirror. If you're relatively comfortable with flossing, I have an even better tip for you: Keep some floss near your television set, and floss at night while watching TV! You're sitting there doing nothing while watching your favorite show, so you may as well floss! This will make flossing much less of a tedious habit, and more of an enjoyable activity.

Also, if you're new to flossing or haven't flossed in many days, don't be alarmed if your gums bleed a bit. The reason for the bleeding is your gums are inflamed. This is called 'gingivitis.' The gums are inflamed from having bacteria/germs built up in these areas (which happens within minutes/hours of eating without properly cleaning your teeth). After flossing once a day for a few days, you should notice this bleeding goes away (as the inflammation of the gums goes away). If bleeding is profuse, or it doesn't go away after a week of careful flossing, contact your dentist.

Sunday, September 20, 2009

Baby's First Visit to the Dentist!

Having a baby in the house can be pretty hectic, exciting and all-consuming! Late night feedings, diaper changes, vaccinations.... the list goes on and on! As time flies by, many new parents want to know when they should first bring their baby to the dentist.

The rule of thumb is to bring the baby in within 6 months of the first tooth erupting in the mouth, or by age 1.

This first appointment serves a few important functions:
  1. Teaching the parent(s) the proper way to care for the baby's newly erupting teeth,
  2. Allowing the dentist to evaluate the baby's mouth to insure proper development and health
  3. Providing mom/dad an opportunity to address any questions/issues they have with baby's mouth,
  4. Makes the crucial first step in introducing a young person to the dental environment.
The dentist will often do a 'lap exam,' looking into the baby's mouth while the baby is held by mom or dad. You can be certain your baby will be comfortable at the appointment, since you'll be right there for the exam!

Another question is what type of dentist is suitable to look after your baby's dental health. There is a sub-specialty of dentistry known as pediatric dentistry, where pedodontists treat only people from birth to late teens. They have the most training, experience and education when it comes to children, however your family dentist may also be equally qualified (especially a general dentist with many years of experience). Ask your family dentist and see who they would recommend to see.

The American Academy of Pediatric Dentistry is an excellent resource to assist parents in finding a local pediatric dentist.

Chewing Gum

Why kick things off discussing something only kids like you ask? Well as it turns out, chewing gum isn't just for kids. It's marketed to adults as well, and it's incredibly popular. I often have patients tell me they chew gum all the time, and even I for one, chew at least one piece of gum everyday. I find it helps lower my stress level and I like the taste!

With all of their fancy colors, who isn't mesmerized by the gum-ball machine in the grocery store? For just a quarter, you get a huge gum-ball that even Tiger Woods might confuse for a golf ball!

The problem with these gum-balls, is they're pure sugar. Chewing them allows the sugar to remain in your mouth, where bacteria have a field-day digesting the stuff (and rotting your teeth in the process!!!).
Sugar + Bacteria + Your mouth ----> Cavities!

What are some healthy alternatives? Well, believe it or not, the American Dental Association has placed their seal of acceptance on certain chewing gums! The one common feature is they're all sugar-free (instead getting their taste from sugar substitutes):

Wrigley's Extra Sugarfree Gum
Wrigley's Orbit Sugarfree Gum
Dentyne Ice Sugarless Gum
Stride Sugarless Gum
Trident Sugarless Gum

Studies have shown that chewing sugarless gum increases salivary flow in your mouth, which reduces the amount of acids produced by germs! These acids are responsible for breaking down your teeth (causing decay). Check out the literature (here's one example article):
Sugar Substitutes, Chewing Gum and Dental Caries

It's important to remember that chewing gum (even sugar-free) is no substitute for proper brushing and flossing (which will be discussed in a future post!).

Still, if you're feeling the need to chew... you may as well chew something that promotes a healthy mouth. When your mouth is healthy, it puts a smile on your face!

Oral Health Overview

Hi Everyone,

If there's one thing I've learned as a general dentist in a hospital setting, it's that even in America (a land of abundance), many people suffer from poor oral health (cavities, and periodontal disease for starters) .

This blog is meant to give tips from my personal professional experience, so that you can improve your oral hygiene, and hopefully improve your life. It is not meant to replace the advice given by your physician, or your family dentist, and nothing I write is expressly approved by the American Dental Association. I'm simply writing from my own experience. Also, I am not sponsored by any dental product companies, so I'm free to discuss them all!

Topics may range from home dental care, oral hygiene instruction, description of common dental procedures to the review of products I commonly use and recommend.

Occasionally, I'll write about topics not related to oral health, but to general health and healthy living. Who knows, I may throw in a movie review or discuss an important issue of the day, just to keep things fresh and fun!

If anyone has suggestions for topics or improvements, please don't hesitate to send me an email: