Dr. Lee's Dentistry Blog

August 1st, 2012

(Who Doesn’t?)

“Extreme Makeover” was a very popular TV show. It took people with self-perceived physical problems, flew them to Hollywood, and made them over in dramatic fashion. Quite possibly the main reason for the show’s great success is its relatability. Everyone at one point or another has felt self-conscious about their appearance. Perceived physical shortcomings often have negative effects on mental health as well, driving the irrational myth of the “perfect form.” The show was popular because it allowed people to change while also promoting self-acceptance and healthy lifestyle choices.

Since 1985, when I first started practicing dentistry, patients have consistently asked the same question, “How do I make my teeth whiter?” Unfortunately, the answer is not as simple as many of them would like to believe. To make teeth whiter, the bone, the gum, and the tooth must all be healthy. If they are not, the whitening process is simply a cosmetic effect, and is in no way indicative of a truly healthy smile. It is like buying a car with a beautiful exterior, only to find out after a couple of miles that the transmission needs to be replaced. For those with healthy tooth, gum, and bone, professional whitening done in a dental office is the ideal choice. For those on a budget, or those who would like to do it themselves, the same whitening products used by dentists are more often becoming available to the consumer.

These are some guidelines to make your teeth whiter:

1. Go to your dentist and ask whether teeth whitener will be safe for your mouth. The goal is to make sure that your teeth, gum, and bone are all healthy so that the teeth whitener will not damage them.

2. Ask your dentist which teeth whitener he or she recommends for you. That way you will not waste your money buying just any teeth whitener.

3. You can try over-the-counter teeth whitener first. If you do not get the results you want, step up to professional teeth whitening done by your dental office.

4. If you are on a tight schedule, and need teeth whitening done quickly (for example, getting married), your best bet is to have it done by your dental office.

5. If the teeth whitener starts creating pain or sensitivity in your mouth, stop using it right away. Give it a break for 1-2 days, or until the pain disappears. Start using it again but only for shorter lengths of time.

6. Results vary. It may take several hours, several days, or even several weeks before seeing results. This can be due to the strength of the whitener itself.

7. White teeth do not last forever. In the future, you may have to touch-up again. Certain foods with a high amount of chromogens (natural dyes found in organic substance) and acidity will accelerate discoloration. Among the most discoloring foods are Wine, Tea, and Cola drinks. A diet regular in these foods may necessitate a retouch every 2-3 years.

8. There is no age limitation for using teeth whitening products, but young people (less than 18 years) are more likely to experience teeth sensitivity.

9. Because teeth whitening is a purely cosmetic procedure, most insurance policies will not cover it.

10. If a teeth whitening product does not work for your, you can always ask your dentist about other options such as veneers, crowns, snap-on-smiles, white filling, or any other treatment appropriate to your needs.

A lawyer came to me and told me that he wished to make his teeth whiter, but didn’t want to make them too white and unnatural looking. I suggested he use a teeth whitener that allows him to control the degree of whiteness. He used it for about a week and stopped because he had already reached his goal. He was very happy with the results, and returned 10 years later to ask for a touch-up.

First Lady Michelle Obama greets the Extreme Makeover team at the White House

July 4th, 2012

“Be all you can be”

That is the motto of the United States Army. It represents the potential greatness one can achieve if one is willing to apply and discipline themselves. Being in the armed forces is not an easy task, however. It takes courage, conviction, and self-sacrifice. It is a learning experience with the possibility of giving you a career.

To serve your country, you can join any one of the armed services. These include the Army, Navy, Air Force, Marines, Coast Guard, and National Guard. Sometime ago I was commissioned as board adviser for the Army. They informed me that they recruit many dentists, doctors, nurses and other healthcare professionals to join the Army. What is very interesting is the fact that the Army attempts to recruit professionals early in their careers. One can apply to join the Army the second they graduate from dental school, and in some instances, right before graduating. They will pay for the cost of your 4-year education, and sometimes will provide a monthly stipend of about $2,000 to supplement the cost of room, board, and materials (FYI, the average cost of dental school in the United States is about $400,000). When you graduate, you must serve at least 4 years as a dental officer in the Army. Once serving, one can enroll in specialized training programs such as Advanced General Dentistry, Oral Pathology, Public Health Dentistry, Endodontist, Orthodontist, Oral and Maxillofacial Surgery, Pediatric Dentistry, Periodontist, and Prosthodontist. All of these special programs, of course, will paid for by the Army. After serving, one can decide to renew employment, or leave the service.

An Army Dental Corps Officer is responsible for the dental health of the soldiers. During combat, the Dental Corps Officer assists in the emergency medial management of soldiers, identifies casualties through dental records, and makes sure soldiers are combat ready.

Here are the requirements to qualify for an Officer appointment in the Army Dental Corps:

1. Meet the prescribed medical and moral standards for appointment as a commissioned officer

2. Be a U.S. Citizen

3. Be a graduate of an American Dental Association (ADA)-accredited dental school

4. Have a current unrestricted license to practice dentistry in a U.S. state; District of Columbia, Puerto Rico, or other U.S. territory

5. Be 21-46 years of age (Dentists 47 years of age or older may apply for an age waiver)

For more information, call 1-877-4065861 or go to their websites: http://www.goarmy.com/amedd/dentist.html & healthcare.goarmy.com/n470

“BE ALL YOU CAN BE”

A NAVY dentist on duty

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June 4, 2012

“Are white fillings good for your smile?”

Everyone wants to look and feel good about themselves. Therefore, one of the most important things to have is a good smile. Obviously, in order to have a good smile, you must have healthy white teeth.

DR, one of my patients had many, many white fillings in his mouth. Almost every tooth he had was covered with at least one white filling. Those white fillings were performed on him by his previous dentist. When DR came to our dental office, his main complaint was that his mouth was hurting everywhere. He could not eat hot or cold things, and sweet things were particularly painful to his teeth. Chewing, in general, was a chore for DR. Upon examination, we found out that nearly every white filling he had was leaking very badly. Many of his teeth had large decay right underneath his white fillings. As of today, we have already performed 5 root canal treatments, and delivered 5 crowns. These 5 teeth were the exact ones DR’s previous dentist had performed on before. We still plan to perform more root canals and deliver more crowns sometime in the future. Pretty soon DR will be able to eat and drink without pain. He will have a good smile.

So, this begs the question. When is it appropriate to have white fillings? Here are some guidelines so that you can be informed and better able to discuss it with your dentist:

1. Whether awake or asleep, grinders are constantly causing damage to their teeth. I advise grinders to not get white fillings since they are likely to loosen and have the filling fall out from the pressure. I recommend instead a porcelain crown.

2. If you want an aesthetically pleasant solution, are looking for a very long-term restoration, I recommend porcelain inlays, onlays, and veneers to fill and cover large cavities.

3. Large white fillings are not nearly as strong as gold or silver fillings. Larger white fillings will last for a much shorter length of time compared to these more durable solutions, and therefore require more maintenance. Maintenance = $.

4. If a large white filling has broken while traveling, I recommend you do not replace it with another one for the sake of time. Not every dentist can perform a “good” white filling, and you may be throwing your money away. Instead, I recommend you replace the filling with a temporary restoration in the meantime, and wait until you’re home. Your regular, trusted dentist will likely be more attentive to your needs. Temporary fillings can typically be found at pharmacy-type stores.

5. If you have any doubts, ask your dentist what he/she would do in your situation. As healthcare providers, good dentists are required to give honest, straightforward counsel.

6. If a tooth with a large white filling has habitually caused you pain and sensitivity from the beginning, and has not improved after 6-8 weeks, please consult your dentist. It may be signs of something more pressing than a cavity.

I’m sure Mona Lisa has a beautiful smile. She just doesn’t know it yet.

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7 May 2012

“Why can’t my child eat? Why does he have a fever?”

During World War I, a painful bacterial infection that involved swelling ulcers on the gums became a vey common problem for soldiers, particularly those engaged in trench warfare. The problem was Acute Necrotizing Ulcerative Gingivitis, more affectionately and appropriately know as: Trench Mouth.

The natural and healthy state of a mouth contains a balance of different types of bacteria. Trench mouth occurs when an imbalance of the bacteria becomes prominent, allowing the gums to become infected and develop distinguishable and painful ulcers. Another side-effect is exceptionally bad breath. Coupled with the presence of a virus, the bacteria can grow much more aggressively. Trench mouth is similar to an immunodeficiency disease, meaning that once infection has begun in the mouth, a body’s whole immune system can become compromised.

An 11 year-old patient of ours, JC, came in with his mother and told us that he could not eat or sleep because his mouth was so painful. She noticed that every flare-up he had was usually accompanied with a fever. Upon examination of his mouth, we found out that he had Trench Mouth (ANUG). We informed them to keep his mouth as clean as possible (i.e. brush teeth 3 times a day, floss, and rinse). The pain was so unbearable, that we also had to prescribe a pain pill to be taken 30 minutes before every meal, and an antibiotic in order to fight the infection. Of course we told them that he should not share food or drink with anyone until the infection has been killed off.

JC came back a week later. He followed our directions and had no more fever, no more pain, and no more bad breath. He was a very happy boy.

If your child has exceptionally bad breath, and experiences chronic fever and headaches, consult your dentist and doctor.

As we can see, there’s inflammation all along the perimeter of the teeth and on the gums. The unhealthy gum is much darker than the rest.

The film War Horse depicts the trench warfare conditions that lead to the discovery of “trench mouth.”

An example of necrotizing ulcerative gingivitis. If left untreated, this patient could experience symptoms similar to those found in trenches

Unsanitary, cramped, brutish, and inhumane, those fighting in trenches could be stationed there for months on end

“Where is Batman when I need him?”

March 1, 2012

In comic books, the superhero always appears to rescue distressed characters just before the bad guys can inflict any harm. Batman, Spiderman, and Superman: all of them are always watching over us, defending us, and promoting justice wherever they may be. It would be nice to have such a hero protect the population at large. Unfortunately, things just don’t work that way in the real world. Anyone working independently to defend the citizens of the city may be labeled vigilantes. These defenders may have an extra-legal sense of justice that might conflict with the laws of the city. Likewise, sometimes help arrives just a little too late. From time-to-time we need an individual with a singular sense o what’s just and good.

Late on a Sunday in November, a young man named JB (one of our patients), was walking on the street after buying something from the grocery store. A gang of people ambushed him unawares as he was walking home. They smashed his face in, robbed him blind and left him there on the street. The attack bruised his body, broke 3 upper-front teeth, and cut up his tongue, lip, cheek, and chin. Fortunately, a Good Samaritan found him and took him to the nearest hospital. The Good Samaritan was never found.

There is a set of procedure that we recommend anyone take if confronted with a situation similar to this one. Regardless of whether or not you are a legal US citizen, it is important that you:

1. Go to the nearest hospital to treat your injury

2. Go to the police and file a report about the incident

3. Ask the police about a “Victim of Crime Compensation Form”

In about 1-2 weeks, the California Department of Victims of Crime (CalVCP) will contact you and inform you about what to do and where to go to have your injuries treated properly. We are one of many dental providers in the State of California that work with the Victim of Crimes Program. We can treat injuries related to crime incidents after receiving authorization from the Department of Victims of Crime. The CalVCP may be able to subsidize the treatment of any injuries sustained during a crime. For our patient, JB, this meant that after giving an exam and x-rays, we were able to treat him. His big upper incisor had been broken very badly, so we removed it, put stitches and made him false teeth to replace it. We also administered one root canal treatment to his upper-left incisor. The gentleman was not happy that circumstance had brought him to us, but he was grateful that people were there to help him in a time of need.

Those who give in to short-term weakness and commit crimes are thugs with no respect for themselves or other. They are base, low and utterly without any redeeming quality. It ca be easy to forget that there are genuinely good people out there, people who will go out of their way to help others because human decency and justice is what motivates them. They are Good Samaritans.

We can see tooth #8 is pushed up into his gums and into #9, causing him a great deal of pain

A mirror shows us just how far back his tooth was pushed, displaying the trauma inflicted on his teeth

After removing tooth #8, stitches were applied so as allow the gums to heal

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“Citric Acid and its effect on Teeth”

February 1st, 2012

Many American childhood summers are spent going outside, engaging in fun physical activities and enjoying the break from school’s persistent obligations. A staple of any summer day is ice lemonade. Something about that intoxicating mixture of squeezed lemons, water, sugar and ice quenched our thirst on even the most scorching of summer days. The love affair with lemonade was made more enduring when young entrepreneurs of the neighborhood saw an opportunity to supplement their weekly allowance by peddling their brand of the drink. Ubiquitous stands lined the sidewalks, offering their nectar for a nominal fee.

Ice lemonade does taste good, there’s little doubt about that. However, the main component of lemonade, lemon, when eaten directly can pose some problems to the welfare of your teeth. Some people may like to suck on them. Others may like to peel and eat them. No matter how you cut it, citric acid in excessive amounts will dissolve tooth enamel. If eating foods with a high content of citric acid becomes habitual, then the second layer of teeth, dentin, may begin to dissolve. The erosive nature of citric acid on teeth may result in a toothache or highly sensitive teeth.

If you enjoy lemons or any other food with high amounts of citric acid, and eat them often, please be sure to visit your dentist regularly. Citric acid in excessive amounts can damage teeth, and damage can only be properly evaluated by a dentist. More likely than not, the dentist will put a filling, sensitivity gel, crown or veneer to fix the affected tooth.

When life gives you lemons, make lemonade

Acid erosion caused by sucking lemons. Notice the discoloration streaks.

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“Snoring Devices and Sleep Apnea”

January 1st, 2012

Once upon a time there was a couple who lived happily ever after… That is until one night the husband began to snore violently. It was so loud that the snoring lifted the roof and the shingles right up off the house. The wife, fed up with the loss of both the quantity and quality of her sleep, decided to move to a separate room, away from her husband. The problem was not resolved. In fact, moving to a separate room only seemed to exacerbate the problem. The husband and wife divorced over a simple matter of snoring.

Don’t let this happen to your marriage; Dentistry has a simple solution to your problem

Snoring is not just loud, annoyingly senseless noise. Snoring can be attributed to much more serious health problems including sleep apnea. When a person snores, the tongue falls into the airway. With the tongue blocking the airway, air cannot freely flow into the lungs, causing a sporadic sleep pattern. People who snore wake up feeling very fatigued, and may have chronic headaches as a result of a lack of quality sleep.

A patient of mine, JL, came into my dental office recently because his snoring appliance had broken. Without a proper snoring appliance, he began to develop sleep apnea and major migraine headaches every time he went to bed. The snoring device I made for him was about 4 years old. It worked well for him in those 4 years and it was only until it broke that he began to have problems again. I gladly fixed the device for him.

There are several snoring devices available. Ask your dentist which one is best for you.

Dentists are not marriage counselors, but we will do what we can to ensure your health and happiness.

Does this look familiar? (PD-old-80)

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“A Bridge that can help you eat more comfortably”

December 1st, 2011

The Golden Gate Bridge in San Francisco is one of the world’s most famous bridges. The bridge is characterized by its orange color and is the most well-known landmark in San Francisco. It is so well-known in fact that it has become one of the modern wonders of the world. The bridge attracts millions of tourists from all over the world every year. The tourists are drawn to the bridge and all of the memorabilia, souvenirs, restaurants and hotels associated with it.

There are different kinds of bridges as well, not just ones that allow traffic to flow freely over water. Bridges that help people eat better and live happier, healthier and longer lives. They are Dental Bridges. Dental Bridges replace missing teeth and allow people to chew food much more comfortably. They allow a fixed solution for missing teeth and are more subtle than dentures or valplast.

RC, a woman who came from Mexico to the United States, enjoys food very much. After finishing her regular mouth exam, I informed her that the best option would be to replace her missing lower-left molar with a brand new dental bridge. She told me that she would do it as a Christmas gift to herself. We did preparation and delivered the crown within the next two appointments.

The next time she came in, she told me that she can enjoy her food and is no longer bothered by pain when she chews.

The Golden Gate Bridge in San Francisco. Photo courtesy of Jon Sullivan/ pdphoto.org

A Smaller Bridge

A Bigger Difference

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“Why are my gums growing?”

November 1st, 2011

Thoughts of France immediately conjure images of Paris, the Eiffel Tower, and baguettes. Another one of France’s claims to fame is its wine. The Bordeaux region of France is well renowned for its red wine. Mixing the intimately French Cabernet Sauvignon grape with a blend of other varieties, wine from the Bordeaux region in France is among the world’s finest and most complex tasting.

Grapes taste and look great whether they’re eaten off the vine or fermented into alcohol. A discomforting sight, however, is when your gums begin to resemble grapes.

A woman came into my dental office and asked me why her gums looked so weird? I checked her mouth and found that her gums were swollen very badly, so much so that they began to look like grapes. Upon further examination and questioning, I found that the woman had started taking diet pills about 3 weeks ago. The next thing she knew, her gums were swelling up uncontrollably.

What happened was this woman was taking an assortment of medication for high blood pressure and other illnesses. The chemical reaction that occurred between her diet pills (phentermine) and her hbp pills stimulated the growth of her gum. I recommended that she stop her diet pill regimen immediately and that we reshape and trim her gums back to their normal shape and size. 

Observing your gums is a great way of knowing if you have an infection or problems in the mouth. If you notice prolonged discoloration or other abnormalities on your gums, please consult your dentist.

As we can see, the patient’s gums are incredibly swollen.

Despite being swollen, the patient said her gums weren’t causing her pain.

Cabernet Sauvignon

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