My Blog

By Philip Girgis DDS
April 17, 2019
Category: Oral Health
Tags: tooth decay  
HowaNewApproachtoTreatingDecayCouldBenefitYou

Dental caries (tooth decay) is a leading cause of tooth loss. But with prompt diagnosis and care we can often stop it before it causes too much damage.

The traditional treatment approach is simple: remove all diseased tooth structure and then restore the tooth with a filling. But this otherwise effective treatment has one drawback: you may lose significant healthy structure to accommodate a suitable filling or to make vulnerable areas easier to clean from bacterial plaque.

That's why a new treatment approach called minimally invasive dentistry (MID) is becoming more common. The goal of MID is to remove as little of a tooth's natural enamel and dentin as possible. This leaves the treated tooth stronger and healthier, and could reduce long-term dental costs too.

Here's how MID could change your future dental care.

Better risk assessment. MID includes a treatment protocol called caries management by risk assessment (CAMBRA). With CAMBRA, we evaluate your individual tooth decay risk, including oral bacteria levels, the quality of saliva flow to neutralize mouth acid, and sugar consumption. We then use our findings to customize a treatment plan that targets your areas of highest risk.

New detection methods. The real key to fighting tooth decay is to find it before it can destroy tooth structure with the help of new diagnostic technology. Besides advances in x-ray imaging that provide better views with less radiation exposure, we're also using powerful dental microscopes, lasers and infrared photography to show us more about your teeth than we can see with the naked eye.

"Less is More" treatments. In contrast to the dental drill, many dentists are now using air abrasion rather than a dental drill to remove decayed tooth material. Air abrasion emits tiny material particles within a pressurized air stream that leaves more healthy tooth structure intact than with drilling. We're also using new filling materials like composite resin that not only resemble natural tooth color, but require less structural removal than other types of fillings.

Using MID, we can treat tooth decay while preserving more of your natural teeth. This promises better long-term outcomes for future dental health.

If you would like more information on new treatments for tooth decay, 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 “Minimally Invasive Dentistry: When Less Care is More.”

IsYourSmileTooGummyHeresHowWeMightBeAbletoImproveit

Your gums not only support and protect your teeth they also help present them in a visually attractive way. But some people’s gums seem to stand out too much — what’s commonly called a gummy smile — which diminishes their smile appeal. There’s no precise definition, but as a rule of thumb we consider a smile too gummy if four or more millimeters (about an eighth of an inch) of the gums show.

Fortunately, there are some techniques to improve a gummy smile. Which technique is best for you, though, will depend on why the gums are prominent — and causes vary. For example, you could have a gummy smile because your teeth appear too short compared to your gums.

Permanent teeth normally erupt to about 10 mm of visible length. But less than that, say 8 mm, could skew the visible proportion of gums to teeth too much toward the gums. Teeth can also appear shorter due to accelerated wear caused by grinding habits. Another cause could be the amount of upper lip rise when you smile. The lip may rise too high in a condition called hypermobility. This could reveal too much of the gums when you smile.

It’s important then to match the treatment to the cause. For example, we can enhance the appearance of shorter teeth through a surgical procedure known as crown lengthening.├é┬áDuring this procedure a surgeon reshapes the gum tissues and underlying bone to expose more of the tooth’s length.

For upper lip hypermobility, we can restrict movement with Botox, a drug that paralyzes tiny parts of the involved muscles. This approach, though, will wear off in a few months — a more permanent solution is surgery to reposition the muscle attachments so as to prevent excessive movement.

If you’re concerned about a gummy smile, see us for a full examination and consultation. Once we know the reason why, we can offer a solution that will make your smile more attractive.

If you would like more information on enhancing the appearance of your gums, 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 “Gummy Smiles.”

By Philip Girgis DDS
March 28, 2019
Category: Oral Health
Tags: nutrition  
NutritionfortheBestOralHealth

It's National Nutrition Month! Good nutrition is key to overall health, but poor dental health can have a big impact on your ability to get the right nutrients. Your mouth is the first step in the digestive system, so if teeth and gums are in poor shape, food choices can be severely limited. Here are some nutritional guidelines that will benefit your oral health as well as your overall health.

Get plenty of fruits and vegetables. Plant foods provide many oral health benefits:

  • Crunchy fruits and vegetables scrub debris from your teeth during chewing and stimulate the production of saliva, which neutralizes acid and helps rebuild tooth enamel.
  • Dark, leafy greens are a good source of iron, calcium and many vitamins that are good for your teeth and gums.
  • Several fruits have vitamin C, an essential for healthy gums.
  • Bananas have magnesium, which builds tooth enamel.
  • Many yellow and orange fruits supply vitamin A, which keeps the soft membranes in your mouth healthy.

Go for dairy. Dairy products—for example, cheese, milk and unsweetened yogurt—neutralize acid as well as contribute tooth- and bone-strengthening minerals such as calcium and phosphorus.

Eat whole grains. An excess of refined carbohydrates can lead to chronic inflammation, which contributes to gum disease and many other ailments. However, the complex carbohydrates found in whole grains work against inflammation.

Incorporate all food groups. Strive to eat a balanced diet that includes healthy foods from all food groups. For example:

  • Lean proteins are essential for keeping your teeth and gums healthy.
  • Good fats such as those found in salmon and nuts work against inflammation. In addition, nuts stimulate the production of saliva and contain vitamins and minerals to keep teeth strong.
  • Legumes are a great source of many tooth-healthy vitamins and minerals.

Limit sugary or acidic foods and beverages. Acid from certain foods and beverages can weaken tooth enamel, leading to cavities. The bacteria in your mouth feed on sugar and release acid that eats away at tooth enamel, causing cavities. How you eat and drink also affects dental health. For example, if you indulge in sugary treats, do so with a meal if possible so that other foods can help neutralize the acid. And if you drink lemonade or soda, don't brush your teeth immediately afterwards. Instead, wait at least 30 minutes before brushing to give your saliva a chance to neutralize the acid.

Getting the right nutrition for a healthy body requires good dental health, so it pays to take good care of your teeth. For a lifetime of good oral health, choose foods that keep your teeth and gums healthy, and don't forget to schedule regular dental checkups to make sure your teeth and gums are in great shape. If you have questions about diet and oral health, please contact us or schedule an appointment for a consultation.

By Philip Girgis DDS
March 18, 2019
Category: Oral Health
Tags: celebrity smiles   retainer  
MargotRobbieKnowsAGreatSmileIsWorthProtecting

On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.

“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”

Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.

Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.

A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.

Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.

So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.

If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”

FactorsBesidesOralHygienethatInfluenceYourRiskforToothDecay

Tooth decay is one of the world's most prevalent diseases — and one of the most preventable. We've known the primary prevention recipe for decades: brushing and flossing daily, and dental cleanings and checkups at least twice a year.

But consistent oral hygiene isn't enough — you should also pay attention to your overall health, diet and lifestyle habits. Each of these areas in their own way can contribute to abnormally high mouth acid, which can soften enamel and open the door to tooth decay.

Lower saliva production is one such problem that can arise due to issues with your health. Among its many properties, saliva neutralizes acid and helps maintain the mouth's optimum neutral pH level. But some health conditions or medications can reduce saliva flow: less saliva means less neutralization and chronic acidity.

You can also inhibit saliva flow with one particular lifestyle habit — smoking. Tobacco smoke can damage salivary glands. Nicotine, tobacco's active ingredient, constricts blood vessels, leading to fewer antibodies delivered by the blood stream to mouth tissues to fight disease.

A diet heavy on acidic foods and beverages can also increase mouth acidity. It's not only what you're eating or drinking — it's also how often. If you're constantly snacking or sipping on something acidic, saliva doesn't have a chance to complete the neutralizing process.

In addition to your daily oral hygiene practice, you should also make changes in these other areas to further lower your risk of tooth decay. If you're taking medications that cause dry mouth, see if your doctor can prescribe a different one or try using products that stimulate saliva. Quit smoking, of course, as much for your mouth as for the rest of your health.

On the dietary front, reduce your intake of acidic foods and beverages, especially sodas, energy or sports drinks. If you've counted on the latter for hydration, switch to water instead. And limit acidic foods to mealtime rather than throughout the day.

It's all about maintaining a healthy pH level in your mouth. Doing so along with good oral hygiene will help you better avoid destructive tooth decay.

If you would like more information on preventing tooth decay, 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 “Tooth Decay: How to Assess Your Risk.”





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