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Dr. LeVos is now A Fellow in the Pierre Fauchard Academy

October 2016

Dr. LeVos was inducted as a Fellow in the Pierre Fauchard Academy at the 2016 annual meeting in Denver. Fellowship in the Academy is by invitation only and is designed to honor past accomplishments in the field of dentistry and encourage future productivity. Professional leaders select fellows based on contributions to dental literature, service to the profession of dentistry, and service to the general community. The membership is made of dentists who are among the most outstanding leaders in various fields of dentistry and is currently comprised of over 8,000 Fellows divided into 120 sections, 55 in the United States and another 65 in many other parts of the world, including South America, Europe, Asia, and Australia.

Teeth in a Day

A question I’m frequently asked is, “How can they do teeth in a day?”  The question is sparked by dental implant centers’ advertisements promising the delivery of a complete set of teeth the same day that dental implants are placed. Bad teeth are removed, implants are placed and a new set of teeth is attached all in the same day.  Candidates for this type of treatment are usually missing numerous teeth, already wearing dentures, or have teeth that are in such bad shape that they can’t be saved.  “Teeth in a day” uses four or six dental implants to anchor a set of teeth.     

The old saying “The devil is in the details” couldn’t be truer than it is in this case.  Anyone considering this type of treatment needs to understand that the teeth you get in a day are temporary ones.  The final teeth or prosthesis is made once the jawbone has finished growing around the implants, from three to five months after surgery.  Some people are good candidates for attaching temporary or provisional teeth to implants right after surgery, but for others it’s a bad idea.  Research and advances in dental implants and surgical technique allow teeth to be attached sooner than they could be a decade ago, but you still need to understand the risks and benefits of doing this immediately after surgery and discuss with your dentist whether this is an acceptable risk.  There are some cases where the success rate is significantly increased by allowing the bone to heal and grow around the implants before attaching teeth. 

There are many important factors to consider and understand if you’re in need of a new smile supported by dental implants—more important than how quickly it can be done.  You and your dentist should always begin with the end in mind:  What kind of smile are you trying to create, a smile you used to have or a smile you never had?  These are very different outcomes, and if your wishes aren’t clearly communicated, you may be disappointed with the results. Your new smile and how it’s created should be planned only after your dentistunderstands where the teeth belong in your face, based on your facial characteristics and the smile that‘s being created.  This information must be precisely communicated with the laboratory technician, and then the number of implants and their location can be determined.  Too often I see implants that have been placed before the final result was planned, which often causes aesthetic or design compromises. Ideally, when the plan is in place, you’ll be able to “try in” your smile to see what it will look like.        

And what about cleanse-ability?  How easy or difficult is it to clean the prosthesis?  As with most things, maintenance is important for the longevity of a beautiful set of teeth anchored by implants.  This means cleaning around the teeth and implant connections.  Many designs for a full smile supported by implants are challenging, and some are nearly impossible to clean.  This may mean food debris continually sticks under the teeth and connectors, causing a range of problems from simple annoyance to gum irritation to infection around the implants.  One of the implant designs we use in our practice was developed by a renowned prosthodontist and our laboratory technician and allows rock-solid stability and easy cleaning.  

Another important factor is what can go wrong even when you do everything right.  These types of procedures require significant training and a high level of planning and communication—along with a commensurate investment—but all the preparation in the world can’t ensure that you won’t chip or break a tooth.  This can mean having to remove the entire prosthesis and have it repaired.  But what will you do while it’s being repaired?  There’s tremendous peace of mind in having a backup system in place, and we often make more than one final set of teeth so that if something breaks or worn teeth need to be replaced, patients never have to go without teeth.

Digital imaging, scanning and milling technology are providing faster and improved outcomes in implant dentistry today, and 3-D printing advances promise even quicker results. Ultimately, though, successful implant procedures are more about the planning and design than the technology.  If you’re in need of a new smile using implants, don’t get too attached to the advertising claims.  Sure, it can be done in a day, but same-day teeth won’t work for everyone.  Get more than one professional opinion.  Ask lots of questions.  More so than a certain technique or technology, personalized care that’s focused on excellence will give you the best results.  Seek that out!   

Six Cavity Myths Busted!

Are you blaming your favorite sweet treat for your cavities? Do you think you get more cavities because you have soft enamel? These myths have existed for years, so let’s set the record straight!

MYTH 1: Brushing and flossing are enough to fight decay.

FACT: Brushing and flossing are important for removing plaque and decreasing inflammation, but brushing and flossing alone do not kill the bacteria that cause decay. Dental caries is a complex infection of the biofilm, a thin layer of bacteria, that covers your teeth. There are currently more than forty identified strains of bacteria in human biofilms that produce the acids responsible for causing tooth decay. So no matter how much you brush and floss, you still may be at risk for the disease. At our office, we check your bacterial levels with a quick painless test. This lets us know if you have a bacterial imbalance and may be at risk for decay so we can help you to prevent it. Wouldn’t it be great to never have another cavity?

MYTH 2: Cavities are not contagious.

FACT: Studies show that infants are not born with the bacteria that cause cavities but that they are infected most often by their parents or caregivers. This route of infection is referred to as “vertical transmission.” This vertical transmission takes place when the infant is kissed, milk or food is “sampled” for temperature and pacifiers are “cleaned” in the parents’ mouths. Sometimes entire families are affected by the caries infection.

MYTH 3: Sugar is the reason I get cavities.

FACT: Bacteria that cause cavities thrive in an acidic pH. Prolonged acidic conditions in the mouth (pH below 7) cause a shift in the species of bacteria that form the biofilm on your teeth.  When this shift occurs, cavity-causing bacteria take over and good bacteria die out. Even some types of good bacteria can become harmful in a prolonged acidic environment. Once the cariogenic bacteria dominate the biofilm, it’s more likely for tooth structure to be “eaten away” by the acids the bacteria produce. So while sweets don’t cause cavities on their own, if you have cavity-causing bacteria in your biofilm, eating lots of sugary snacks will increase your risk for decay.

MYTH 4: Fluoride is the answer to stopping decay.

FACT: Tooth decay is an epidemic among American children, with 50 percent of fifth-graders showing active signs of the disease. The World Health Organization says that worldwide, dental caries affects from 60 percent to 90 percent of schoolchildren and the vast majority of adults. While fluoride is one of the ways to help manage decay, it is not the sole answer. There are five key elements of treating tooth decay. A caries risk assessment and bacterial test will help us to provide you with the targeted and comprehensive therapy plan you need to lower your risk.

 MYTH 5: I get cavities because I have soft or weak enamel.

FACT: The acid produced by bacteria is no joke! It’s a scientific fact that when the pH in your mouth drops below 5.5, demineralization of teeth begins. This is the beginning process of tooth decay. If you’re getting cavities, it’s not because your enamel is “softer” than someone else’s—it’s because you have risk factors that are keeping your mouth too acidic. Your saliva helps neutralize the acids in your mouth and provides a reservoir of minerals for your teeth, and many medications have the side effect of decreasing your saliva flow. If you’re taking one or more medications with this side effect, your risk will be significantly increased. We can help identify what risk factors you can change and what elevated-pH products are right for you.

MYTH 6: Filling my cavity cures the disease.

FACT: Only a targeted treatment of your biofilm can change the bacterial makeup on your teeth. Drilling and filling is a necessary intervention when the cavity has reached a point of significant damage, but patching a hole in the tooth does not address the larger issue of the biofilm infection. Once a biofilm is infected with “bad” bacteria, it must be treated with the appropriate agents before long-term dental health can be achieved. Patching holes in teeth with no biofilm therapy is like building a deck on a house while it’s burning down—the work won’t last. If your cavity risk is high, you need to lower it before having cosmetic dentistry or even getting just a single crown or filling. That way your dentistry will last as long as possible.

If you struggle with tooth decay or would like more information about preventing dental caries, come by our office for a complimentary book on the topic while supplies last. Lowering your risk for decay is valuable no matter what your age because it will decrease the amount of dentistry you need to have. And that’s no myth!

For more information about preventing decay and health-centered esthetic dentistry, contact us at 303-674-5725

This article was adapted and republished with permission from Carifree, a leading company in cavity prevention.  www.carifree.com/dentists/blog/education/6-truths-about-decay.

Three Things That Eat Your Teeth

When I ask new patients what they eat that might be hurting their teeth, some of them say candy. Then they assure me, “I usually brush after I eat sweets.” While that sounds good and brushing removes the plague on teeth that bacteria feed on, many people don’t know that the toothpaste they’re brushing with may be eroding their teeth.

The chemical process of dental erosion is one of the environmental factors that take a toll on teeth. It’s insidious because it’s usually pain-free and the damage isn’t noticed right away. Most toothpaste is too abrasive, and the ones that boast tartar control or whitening are the worst.

Toothpaste abrasiveness is rated with a “relative dentin abrasivity” number called an RDA value. The American Dental Association recommends using toothpaste with an RDA below 100, but additional research and clinical experience confirm that there’s a significant advantage to keeping the RDA below 70. The challenge for consumers is that RDA values aren’t listed on the packaging, so you’ll have to do some research to find out. If you’d like to see the ratings for many of the popular toothpastes, contact us for a free copy of the Toothpaste Abrasion Chart.

Just remember, you’re safest using a low-abrasive toothpaste (non-whitening) and a soft toothbrush. 

Soft Drinks Are Hard on Teeth

Another teeth-eater is citric acid. This potent acid dissolves tooth structure, and it lurks in many beverages and sweets. Soft drinks, sport and energy drinks and even good old orange juice are chock-full of citric acid, and so are some sweets, including gummy bears and jam.

Citric acid is added to products to extend shelf life and enhance flavor. But while it may be pleasing to your taste buds, that doesn’t make it good for your teeth. Read labels so you can reduce the amount of citric acid in your diet. And while you’re at it, keep an eye out for phosphoric acid, commonly found in cola drinks, because it’s a teeth-eater, too.

Drinks and treats that are hazardous for your teeth have a pH level of 5.5 or lower (neutral pH is 7.0). Most beverages have a level below this critical threshold, so they can dissolve tooth structure. The pH level of nearly all soft drinks, energy drinks, canned ice tea, sports drinks and some fruit juices is less than 3.5, and many drinks have a pH below 3! Just for the record, diet soda won’t help you dodge the acidity bullet. As far as your teeth are concerned, diet drinks are just as destructive as the rest.

Taming the Effects of Citric Acid

If you can’t give up your favorite acidic drinks, here are a few ways you can minimize damage to your teeth:

  • Reduce the amount of citric acidic you’re consuming by drinking less of your favorite acidic beverages at a time and drinking them less frequently.
  • Don’t hold or swish acidic drinks in your mouth.
  • Avoid sipping an acidic beverage over an extended period of time.
  • If you’re a big fan of orange juice, buy the kind with added calcium; it’s gentler on your teeth.
  • Drinking milk (pH of about 6.5) can help neutralize the acid. Soy and nut milks tend to have pH levels close to neutral, so they can be a good dairy-free alternative.
  • Avoid brushing your teeth right after consuming something acidic. Instead, rinse your mouth with water (tap water is close to neutral), or better yet, use a rinse that contains fluoride. But keep in mind that many over-the-counter rinses have a low pH, which means they’re not good for your teeth. (In addition to the Toothpaste Abrasion Chart, we have a list of popular rinses and their pH levels that we’re happy to share with you.)

Stomach Acid Can Destroy Your Teeth

The citric acid that damages your teeth comes from the food and drinks that pass through your mouth, but stomach acid is also destructive to teeth. People who have gastroesophageal reflux disease (GERD) may have a slew of common symptoms, including heartburn, chronic dry cough, hoarseness or sore throat, and trouble with swallowing. But many people with GERD don’t know it’s harmful to their teeth.

Whenever stomach acid makes its way into your mouth, it ruins more than your day. It ruins your teeth. If you suspect you have GERD, talk with your physician about treatment options and possible diet modifications. Controlling stomach acid and keeping it from going where it shouldn’t is critical for preventing tooth-structure loss, and this is particularly important for people who have GERD and for those who have the eating disorder bulimia.

Keep Your Teeth Strong With Proper Diagnosis and Care

Managing the loss of tooth structure is much more involved than simply preventing cavities. The complexity and interplay of many factors affecting oral health underscore the importance of getting a proper diagnosis and having a dentist who knows and understands how to manage your individual risks.

At LeVos Dentistry, we recommend proactive strategies to limit tooth erosion caused by acid, including using re-mineralizing toothpastes and gels, acid-neutralizing mouth rinses or sprays, and protective fillings. For more information, contact us at 303-674-5725 or visit our office at 30752 Southview Drive, Suite 200, Evergreen or our website, LeVosDentistry.com.