My Blog

By Kyle Bouhana, D.D.S.
April 08, 2021
Category: Dental Procedures
Tags: x-rays  
HeresWhyX-RaysareaSafePracticeWithChildren

X-rays are so interwoven into dental care that we often don't think twice about them. Even so, we shouldn't take this invisible form of radiation lightly—regular exposure at high levels can affect the human body, especially in children.

The ability of x-rays to pass through tissue greatly improves our ability to diagnose tooth decay and other dental diseases. But x-rays can also potentially harm those same tissues. Because children are more sensitive to x-ray energy, they run a greater risk for cellular damage that could lead to cancer later in life.

In reality, though, these potential risks from x-rays are extremely low—so low, in fact, dental professionals regard their use as altogether safe for children. Here's why.

The ALARA principle. Dentists and other healthcare providers perform x-ray diagnostics based on a principle known as ALARA (“As low as reasonably achievable”). This means dentists only utilize x-rays to gain the most diagnostic benefit at the lowest amounts of radiation exposure. As such, ALARA guides both the development of x-ray equipment and the protocols involved in using them.

Equipment advances. Today's x-ray devices are safer and more efficient, restricting x-ray emissions to a single beam without scattering radiation into the environment. A child's radiation exposure is further lowered with the use of digital x-rays, which produce images in less time than conventional film. Because of these and other advances, children are exposed to less radiation during x-rays than what they typically receive in a day from the outside environment.

Safe practices. Following the ALARA principle, dentists are quite conservative in their use of x-rays in children. The most common means of x-ray is the bitewing, which captures images primarily of the back teeth that are more prone to decay. Bitewings, which require a lower x-ray dosage than a full mouth x-ray, are usually spaced at least six months apart or longer depending on a child's risk for dental disease.

The efficiency of modern radiographic equipment coupled with their judicious use has drastically reduced the amount of x-ray radiation to which a child may be exposed, thus lowering their risk of future health issues. The benefit for saving a child's teeth from disease is well worth their use.

If you would like more information on x-ray safety, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “X-Ray Safety for Children.”

By Kyle Bouhana, D.D.S.
March 29, 2021
Category: Dental Procedures
Tags: dental implants  
ImplantsCouldHelpYouKeepRemainingTeethLonger

It's a common practice among people slowly losing their teeth to have their remaining teeth removed. They find dentures to be less costly than replacing one tooth at a time or caring for those that remain. On the other hand, it's usually healthier for the mouth to preserve remaining teeth as long as possible, replacing them only as necessary.

This latter strategy has up to now been difficult and expensive to achieve. But dental implants are changing that—using these imbedded titanium metal devices with a variety of restorations, we're able to better plan and implement staged tooth replacement.

Most people associate implants with single tooth replacements of a life-like crown cemented or screwed into an abutment attached to the implant post. This can play an early role in a staged replacement plan, but at some point, multiple single-tooth implants can become quite expensive.

Implants, however, have a much broader range of use. A few strategically placed implants can support a variety of restorations, including bridges and removable or fixed dentures. Four to eight implants, for example, can secure a fixed denture replacing all teeth on a jaw, far fewer than the number needed to replace the teeth individually.

Implants may also improve the function of traditional restorations. For instance, dentures can't stop the bone loss that often results from tooth loss—in fact, they will accelerate it as they rub and irritate the bony ridges of the jaw. By contrast, implants stimulate bone growth, slowing or even stopping the process of bone loss.

In a traditional bridge, the outer crowns of the restoration are bonded to the teeth on either side of the missing tooth gap (the middle crowns fill the gap). These support teeth must be permanently altered to accommodate the crowns. But an implant-supported bridge doesn't depend on other teeth for support, thus eliminating the need to permanently alter any teeth.

More importantly, previously placed implants often become part of the next stages of tooth replacement, like building on an addition onto an existing house. All in all, including implants in your ongoing dental restoration can help you enjoy the benefits of preserving your natural teeth for much longer.

If you would like more information on dental restoration options, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Replacing All Teeth but Not All at Once.”

By Kyle Bouhana, D.D.S.
March 19, 2021
Category: Oral Health
Tags: osteoporosis  
CertainDrugsforOsteoporosisCouldImpactYourDentalCare

Osteoporosis is a serious bone weakening disease in older adults that can turn a minor fall into a major bone fracture. But the condition could also impact dental treatment—triggered ironically by the drugs used to treat osteoporosis rather than the disease itself.

From the Latin for “porous bone,” osteoporosis causes bone to gradually lose mineral structure. Over time the naturally-occurring spaces between mineralized portions of the bone enlarge, leaving it weaker as a result.

Although there's no definitive cure for osteoporosis, a number of drugs developed over the last couple of decades can inhibit its progress. Most fall into two major categories, bisphosphonates and RANKL inhibitors.

These drugs work by inhibiting the normal growth cycle of bone. Living bone constantly changes as cells called osteoblasts produce new bone. A different type, osteoclasts, clear away older bone to make room for these newer cells. The drugs selectively destroy osteoclasts so that the older bone, which would have been removed by them, remains for a longer period of time.

Retaining older cells longer initially slows the disease process. But there is a downside: in time, this older bone kept in place continues to weaken and lose vitality. In rare instances it may eventually become detached from its blood supply and die, resulting in what is known as osteonecrosis.

Osteonecrosis mostly affects two particular bones in the body: the femur (the long bone in the upper leg) and the jawbone. In regard to the latter, even the stress of chewing could cause osteonecrosis in someone being treated for osteoporosis. It can also occur after tooth extractions or similar invasive procedures.

If you're taking a bisphosphonate or RANKL inhibitor, you'll want to inform your dentist so that the necessary precautions can be taken before undergoing dental work more invasive than routine cleanings or getting a filling or crown.  If you need major dental work, your dentist or you will also need to speak with your physician about stopping the drug for a few months before and after a dental procedure to minimize the risk of osteonecrosis.

Fortunately, the risk for dental problems while undergoing treatment for osteoporosis is fairly low. Still, you'll want to be as prepared as possible so that the management of your osteoporosis doesn't harm your dental health.

If you would like more information on osteoporosis and dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Osteoporosis Drugs & Dental Treatment.”

EmmaRobertsConfessestoHavingaMajorSweetToothWhileExpecting

Emma Roberts, star of American Horror Story (and niece of actress Julia Roberts), welcomed her first child at the end of 2020. She confessed that her love of sweets made pregnancy challenging. She couldn't get enough of cupcakes with sprinkles and a Salt & Straw ice cream flavor called The Great Candycopia. But Roberts isn't unique. Hormonal changes in pregnancy often bring heightened cravings for certain foods. Unfortunately, this can increase an expectant mother's risk for dental disease, especially if they're consuming more sugary foods.

In fact, around four in ten expectant women will develop a form of periodontal disease called pregnancy gingivitis. It begins with dental plaque, a thin film that forms on tooth surfaces filled with oral bacteria that can infect the gums. And what do these bacteria love to eat? Yep—sugar, the same thing many women crave during pregnancy.

So, if you're expecting a baby, what can you do to minimize your risk for dental disease?

Practice oral hygiene. Removing dental plaque by brushing and flossing daily is the most important thing you can do personally to prevent both tooth decay and gum disease. It's even more important given the physical and hormonal changes that occur when you're pregnant. Be sure, then, that you're diligent about brushing and flossing every day without fail.

Control your sugar intake. If you have strong cravings for sweets, cutting back may be about as easy as stopping an elephant on a rampage through the jungle. But do give your best effort to eating more dairy- and protein-rich foods rather than refined carbohydrates like pastries or candies. Not only will reducing sugar help you avoid dental disease, these other foods will help strengthen your teeth.

Maintain regular dental visits. Seeing us for regular cleanings further reduces your disease risk. We can clean your teeth of any plaque deposits you might have missed, especially hardened plaque called tartar that's nearly impossible to remove with brushing and flossing. We'll also monitor your teeth and gums for any developing disease that requires further treatment.

Undergo needed treatments. Concerned for their baby's safety, many expectant mothers are hesitant about undergoing dental procedures. But both the American Congress of Obstetricians and Gynecologists and the American Dental Association endorse necessary dental treatments during pregnancy, even if they include local anesthesia. We will make you have only a safe type of anesthesia, and we can advise you when it is prudent to postpone certain treatments, such as some elective procedures, until after the baby is born.

Emma Roberts got through a healthy pregnancy—cravings and all—and is now enjoying her new baby boy. Whether you're a celebrity like Emma Roberts or not, expecting a baby is an exciting life moment. Follow these tips to keep your teeth and gums healthy throughout your pregnancy, and be sure to let the dental team know of your pregnancy before any treatment.

If you would like more information about dental care during pregnancy, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Pregnancy and Oral Health.”

By Kyle Bouhana, D.D.S.
February 27, 2021
Category: Oral Health
Tags: oral hygiene  
FlossinganImplant-SupportedBridgecanPreventaDamagingGumInfection

In recent years, dental implants have helped traditional bridgework take a giant leap forward. A few strategically placed implants can provide the highest support and stability we can currently achieve for this well-known dental restoration.

Implants derive this stability from the bone in which they're imbedded. Once surgically installed, the bone around a metal implant begins to grow and adhere to its titanium surface. Over time, this creates a strong anchor that firmly holds the implant in place.

But the implants' stability can be threatened if the gums around them become diseased. Gum disease, a bacterial infection caused mainly by dental plaque, can advance silently below the gum surface until it ultimately infects the bone. This can cause significant bone loss around an implant, which can weaken it to the point of failure.

To avoid this scenario, it's important to prevent gum disease by flossing daily to remove accumulated dental plaque between the implant-supported bridge and the gums, particularly around the implants. This kind of flossing around bridgework is more difficult than flossing between teeth, but it can be done with the help of a device called a floss threader.

A floss threader is a small plastic hand tool with a loop on one end and a stiffened edge on the other (similar to a sewing needle). You begin by threading about 18" of dental floss through the loop, and then work the other end of the threader between the bridge and gums to the other side.

With the floss threaded between the bridge and gums, you can now remove it from the threader, grasp each end, and floss around the sides of each implant you can reach. You'll then need to repeat the process by removing the floss, rethreading it in the threader and inserting it into the next section between implants, continuing to floss until you've accessed each side of each implant.

You can also use pre-packaged floss thread sections with a stiffened end to facilitate threading. But whichever product you use, it's important to perform this task each day to prevent a gum infection that could rob you of your implant-supported bridge.

If you would like more information on oral hygiene practices with dental work, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Oral Hygiene for Fixed Bridgework.”





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