Fluoride

Everyone knows that fluoride is good for your teeth, however few people realize that there are actually two different mechanisms by which Fluoride can be introduced to tooth structure. First is a systemic introduction through ingestion which occurs inside the jaw and before exposure to the oral cavity. Second is a topical application to teeth that have already erupted.
The actual mechanism of fluoride action is still a subject of debate. A dogma has existed for many decades, that fluoride has to be ingested and acts mainly pre-eruptively. However, recent studies concerning the systemic effect of fluoride supplementation concluded that the caries-preventive effect of fluoride is almost exclusively posteruptive. Moreover, epidemiologists have cast doubt on the validity of the 'old' studies dealing with fluoride use. The concept of the posteruptive fluoride effect is supported by in vitro and in situ investigations demonstrating that the mode of action of fluoride can be attributed mainly to its influence on de- and remineralization of dental hard tissues. Therefore, topical fluoride application in the form of fluoridated dentifrices(tooth paste or mouthwash) should be encouraged.

Bruxism/TMD

Bruxism put simply is the conscious or subconscious grinding and/or clenching of teeth. Most people have heard of the abbreviation; TMJ, this stands for Temporomandibular joint which are the jaw joints directly in front of the ears. TMD is any dysfunction that is associated with the TMJ.
There are various severities of TMD, ranging from slight pressure or discomfort to very severe pain and dysfunction. The etiology or cause of TMD is usually some form of occlusal discrepency or unbalanced bite. When the teeth don't line up and come together evenly, our bodies natural and often subconscious rection is to clench or grind in certain spots. This in turn will lead to problems with the jaw joints or some form of TMD. Bruxism is often cyclical( comes and goes) and progressive( tends to worsen with time). The good news is that for most people there is an easy fix in the form of an occlusal appliance or custom fitted hard night guard.

Prosthodontist.

As most of my patients and colleagues know, in addition to a family practitioner I am also a Prosthodontist. I received a DDS from Columbia University School of Dental Medicine, a General Practice Residency Certificate from Montefiore Medical Center and a Prosthodontics Certificate from New York University.
In this entry I will attempt to explain what a Prosthodontist is. The American Dental Association(ADA) recognizes a handful of specialties in the practice of dentistry. The ADA's definition is as follows; Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes. In simpler terms a Prosthodontist has additional training in various techniques and procedures in restoring and/or replacing teeth.
It is a unique specialty in the sense that is relatively diverse as compared to other specialties. A Prosthodontist has a distinct advantage of not only being the primary restorative dentist, but also having a unique insight into all other specialties, allowing him/her to better coordinate a multi-disciplinary team of specialists.
Prosthodontics allows the capability and expertise to handle many different treatments from a simple procedure such as an onlay to a rather complex one such as a full mouth rehabilitation or cosmetic make over.

The true value of teeth.

Time and time again I see new patients who are dissatisfied with work that was done previously. More often than not, the condition is irreversible and more complex treatment is necessary to rectify the situation.
As adults we all have approximately 32 teeth and there are no spares. Once a tooth is damaged or lost it is not coming back. This is the reason why every single tooth is so valuable and irreplaceable.
In my opinion the key to better dental care is proper diagnosis and treatment in the first place. Too many people assume that a dentist is a dentist and that you get the same caliber of dentistry no matter where you go. Unfortunately this is far from the truth. Even more unfortunate is that by the time a patient realizes that previous treatments were faulty, it is often too late.
My staff and I have many years of training and experience and pride ourselves in providing the most conservative and clinically sound treatment bar none. There is absolutely no substitute to doing it right in the first place!

Dental care in a down economy.

Before I start, I would like to recognize that some of the materials that are mentioned may seem repetitive. This is due to the fact that various tips and recommendations are relevant to different topics and circumstances. One such recommendation is a minimally invasive approach to oral health in conjunction with a preventative and comprehensive philosophy.
In a down economy the last thing you should be doing is avoiding the dentist completely. It is very important to maximize your care by continuing all routine visits such as bi-annual cleanings and examinations. This will ensure that firstly, the status quo is maintained and any potential problem is avoided(preventative approach). Second, if a pathology is diagnosed, it can be treated in a timely manner before it progresses and require more aggressive treatment in the future(minimally invasive approach). Finally, in those instances where multiple pathologies need to be treated, seeing the whole picture will allow you and your dentist to devise an appropriate treatment plan with beneficial sequences(comprehensive approach).
Remember that just as in life in general, ignoring potential and/or existing problems will usually lead to bigger ones.

Tooth Whitening

Many people are not pleased with the appearance of their own teeth and one of the easiest methods of improving this appearance is by tooth whitening.
Enamel, the first layer of tooth surface, is actually semi-translucent, or clear. The layer underneath the enamel, known as dentin, is typically yellow, but may be gray, brown or black. This hue is what is seen penetrating through the enamel. In order to whiten the dentin, a peroxide solution is placed on the enamel. This process opens the pores of the enamel, allowing the solution to reach the layer of dentin. The solution will then begin to lighten the dentin, resulting in the appearance of whiter teeth.
As far as specific techniques and systems go, there are three basic categories. The first and least effective are over-the-counter products such as whitening strips. The second used to be the only professional option and consists of trays that are made by dentists and worn at home by the patient. The newest and most effective are chairside methods in which the entire procedure is preformed in the office over the course of approximately two hours. In this system a special light is used in conjunction with the whitening agent in multiple applications.
The good news for the patient is that many options are available nowadays and many are proven safe and effective.

A question of priority

In my 18 years of private practice as a family practitioner and Prosthodontist, I've heard all kinds of excuses for avoiding and/or delaying dental treatment. Regardless of what the excuse is, I think in most cases it is simply a question of priority. Most people can understand, on an intellectual level, that an existing pathology needs to be removed and corrected. However unless the person is in pain or discomfort, they may feel that the recommended treatment can wait or in some extreme cases totally avoided. Of course the problem with this line of thinking is that clinical pathologies never go away and as a matter of fact usually lead to irreversible damage which will require even more treatment down the line. I have seen patients regret not following through with recommended treatment too many times and those who remain consistently healthy are the ones that do not procrastinate!