Archive for November, 2009
Tooth Sensitivity
Wednesday, November 25th, 2009
This condition is on the rise in our country with almost a third of all people suffering from it in one form or another. Most don’t even realize that it is usually treatable, so they suffer through it, eating on the other side or drinking through a straw. Although it’s generally considered benign, it can have far-reaching effects on the individual, not the least of which is a decrease in the quality of life.
There are many possible causes for tooth sensitivity, and very often an individual will have a combination of these. Let’s start with what happens in every case: the nerves of the tooth or teeth are being irritated, making them inflamed and hypersensitive to stimuli such as temperature, touch, or pressure. This is usually done through exposure of the inner core of the tooth, the dentin, which covers and protects the nerve. It’s a hard, calcified substance which contains nerve endings and is covered by another layer called enamel, an even harder calcium crystal.
If the enamel layer is lost through wear, erosion by acid, abrasion, fracture, or decay, then the underlying dentin can be exposed or injured. Also, the enamel only goes down to the gumline, so if the gums recede, that can expose the unprotected dentin in the root area. If wear is the cause, you can correct the bite, resurface the teeth and patch up the gumline grooves. Decay, abrasion and fracture have their remedies, but the most complicated solutions arise when dealing with erosion and gum recession.
Acid erosion is one of the main causes for the increase in tooth sensitivity. Acid reflux is definitely a cause for concern, but in general, take a look at what you drink. The diets in our country continue to contain more and more acidity due mainly to beverages. In order of increasing acidity, they are: fruit drinks, tea and coffee, sodas, sport drinks such as Gatorade, alcohol, and energy drinks being so off the scale they are a serious health hazard. You’ve seen those old movies where the villain throws the victim into a vat of boiling acid, and after the thrashing around, the camera pans in on a skeleton. Well if the villain had used Red Bull in his vat, there wouldn’t even have been a skeleton left. These constant acid baths gradually eat away your enamel, exposing and irritating the dentin. Treatments may include remineralizing the enamel and potassium nitrate toothpaste, but the best treatment is to just stick with water.
The other main cause for the increase in tooth sensitivity in the U.S. is gum recession, exposing the root surface. Here it is important to eliminate the underlying cause which is gum infection, and the use of sealants can be very effective in treating the exposure.
However, there are many other possible causes for tooth sensitivity, such as neuralgia, inflammation or infection of the nerve, cracks, leaking fillings, recent dental work, tooth whitening gels, abrasive toothpastes and even electrical currents created between teeth containing metal. That’s why it’s important to have the cause diagnosed and don’t give up hope that something can be done for that sensitivity.
Dr. Moulton’s article was published in the Desert Valley Times, August 2008
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More Options Than Ever to Quit Smoking
Wednesday, November 18th, 2009
According to the American Dental Association, an updated clinical practice guideline on smoking cessation was recently released by the U.S. Public Health Service. The new guideline identifies new counseling and medication treatments that are effective in helping people to quit smoking.
A 24-member, private-sector panel of leading national tobacco treatment experts developed the new guideline. Their information was gathered from more than 8700 research articles that were published between 1975 and 2007. They have found that seven medications approved by the Food and Drug Administration have dramatically increased the success of quitting:
bupropion SR
nicotine gum
nicotine inhaler
nicotine lozenge
nicotine nasal spray
nicotine patch
varenicline
There was also evidence that counseling by itself or in conjunction with medication can increase the success rate. One of the most popular forms of counseling is through a quitline, such as 800-QUIT-NOW. It connects callers to programs within their state, and is easy for doctors and patients to access.
Dr. K. Vendrell Rankin, a professor at Baylor College of Dentistry, served as a reviewer for the guideline. “As a dentist, teacher and tobacco treatment specialist, I believe that one of the most significant additions are the principles of motivational interviewing—express empathy, develop discrepancy, roll with resistance and support self-efficacy,” said Dr. Rankin. “We know that patients don’t walk into the dental office ready to quit smoking or chewing tobacco, nor are they equipped to do so with only the aid of a prescription.” Dr. Rankin also expresses the importance of motivating, not lecturing, the patient who may want to quit smoking.
Other recommendations include:
Dentists and doctors should be asking their patients of they smoke and offering counseling and other treatments to help them quit.
If a patient is not ready to quit, clinicians should focus on motivational treatments that will promote future attempts to quit.
Counseling, whether it is individual, group, or over the telephone is effective, and should include practical counseling and social support.
Counseling treatments are now recommended for adolescent smokers as they have been shown to be effective.
The 2008 PHS guideline update and a consumer guide are available online at www.surgeongeneral.gov/tobacco/default.htm. You can also request a copy of the 2008 PHS guideline update by calling the Agency for Healthcare Research and Quality at 1-800-358-9295. To find out more about the latest resources for tobacco cessation, log on to www.ada.org/goto/quitsmoking.
Dr. Moulton’s article was published in the Desert Valley Times, August 2008.
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Root Canal Alternatives
Wednesday, November 11th, 2009
Last week we talked about root canals, but what are your options if that’s not possible or desirable? Actually, the only alternative if the nerve has died or become infected, would be to remove the tooth. So the real choice is what to do with the space once the tooth is gone.
This is probably one of the most difficult dental choices people face. It’s difficult to lose the tooth in the first place, but then what do you do? There is the Zen choice of course, called the no choice. You wake up five years later and that space is still there.
Unfortunately, it is usually not that simple. The other teeth gradually collapse into that space from the sides and from the opposite arch, causing an increase in the tendency for decay and gum disease because of their unnatural relationships. There is a loss of function and comfort in the affected area, and a general malocclusion from the change in the way the teeth bite together. This in turn increases the muscular tension around the temporomandibular joints, causing premature arthritis, headaches, and cervical spine misalignment. It’s a cascading effect that seems very far reaching and maybe a little far fetched.
But these are very real consequences. The sneaky part is that it happens so gradually, like the old boiling frog adage. It’s like after three or four years you wonder why you hear a crunching noise when you open your jaw, or why you get those tension headaches.
There are some priorities, however, when considering whether to replace a tooth. A wisdom tooth of course is virtually disposable, and although it’s recommendable to replace any lost second molars, I must admit the loss in function and the shifting in the other teeth is minimal. But the first molars bear more stress than any other tooth, so replacing those or anything forward is an absolute must. And there is also the obvious cosmetic concern if the space is visible.
You usually have three basic ways to replace a missing tooth. The first is a removable partial denture. Although it’s the least expensive and it will maintain the correct relationship between the teeth, it’s not very functional or comfortable, or natural looking. It’s also a little overkill for one or two missing teeth, and is more useful when there are more spaces than teeth.
The second choice is a fixed bridge. This typically consists of two crowns that have the replacement tooth fused between them. The one piece ceramic construction can be computer generated for unparalleled accuracy. It is permanently cemented in place for a completely natural appearance and function.
The third choice is a dental implant. It is a titanium post coated with calcium that is very biocompatible. It functions like a root, and then a crown is attached at its surface. It is as close as you can come to a natural tooth.
The cost and appearance are similar for the bridge or the implant, but there are other pros and cons that may influence your choice. Although the success rate is better for the implant, it can take up to eight months after the extraction to finish, whereas the fixed bridge can be done much sooner. Whatever the choice though, it is much better for you in the long run to replace a missing tooth.
Dr. Moulton’s article was published in the Desert Valley Times on November 10th, 2009
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Dangerous Imposter
Wednesday, November 11th, 2009
By now, most of you will have heard of or may even be using an artificial sweetener called Splenda (sucralose) in your daily diet. Splenda is best known for its popular marketing logo, “made form sugar so it tastes like sugar”, convincing many consumers that it is as safe as sugar when used.
But is Splenda really as safe as they say it is? As of 2006, only six trials performed on humans have been published on Splenda. Of these trials, only two were completed and published before the FDA approved sucralose for human consumption. Also, these two trials had a combined total of only 36 human subjects. As if that isn’t bad enough, only 23 people were actually given sucralose, and the trial only lasted four days, hardly enough time to determine the long-term effects on health.
There have been no long-term human toxicity studies published after the FDA approved sucralose for human consumption. A human toxicity trial was conducted after approval, but lasted only for three months. That is probably a fraction of the time that most Splenda users would consume the product. To add to the concern, no studies have been done on children or pregnant women. Hmmmmm, what does that tell you?
The sugar industry is currently suing McNeil Nutritionals, the manufacturers of Splenda, for implying that Splenda is a natural form of sugar with no calories. There is no question that sucralose begins as a sugar molecule, but what happens to it in the factory is what is concerning. Sucralose is a synthetic chemical created in a laboratory. The process involves adding three chlorine molecules to a sucrose or sugar molecule. The chemical process alters the chemical composition of the sugar so much that it is converted to a fructo-galactose molecule. This type of sugar molecule does not occur naturally and therefore your body is unable to metabolize it. As a result, McNeil Nutritionals makes the claim that Splenda is not digested or metabolized, making it have zero calories. However, research has shown that about 15% is ABSORBED by your body.
If you are concerned about whether use of Splenda has adversely affected your health, try this test. First eliminate it and other artificial sweeteners from your diet for a period of one to two weeks, then reintroduce it in sufficient quantity. For example, use it in a beverage in the morning, and eat at least two products that contain sucralose throughout the day. It is important that you avoid other artificial sweeteners so that you can differentiate which one may be causing problems for you. Follow this program for several days, and take notice if how your body feels, particularly if it is different from when you were refraining from using artificial sweeteners.
During this trial, keep these facts in mind:
-There have only been six human studies to date
-The longest trial was only 3 months long
-At least 15% of Splenda is not excreted from your body in a timely manner
Splenda is actually more chemically similar to DDT than to sugar, so why would you want to take that risk with your health? Remember that fat soluble substances, such as DDT, can remain in your fat for decades and have a devastating effect on your long-term health.
So always check the ingredients! Especially with “diet” or so called “health” foods. Check all processed foods for sucralose or Splenda because they will sneak it in to just about anything. And if you find it, then set the package down, make a little X with your forefingers, and slowly back away.
Dr. Moulton’s article was published in the Desert Valley Times July 2008
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