January 04, 2021

Can crooked teeth really cause an infection?

January 04, 2021/ Sonia Gupta

“I don’t need orthodontics because I’m not worried about how my (or my child’s) teeth look”.

I often hear this when I suggest orthodontics (braces, invisalign, jaw expansion, etc) to someone. When this happens, I like to gently remind people that straightening teeth is not just about beauty. It’s about function, oral health and being free from pain and cavities. And in most cases, orthodontics is much more conservative than other treatment options such as crowns, veneers, oral surgery, etc (in my humble opinion).

If we don’t straighten our crooked teeth (or those of our children), sadly we could be putting ourselves at higher risk of the following:

Unstable bite (malocclusion). For example, if the front wheel on your car is higher than the back wheel of your car, it’s not just a bumpy ride - it could be a serious disaster. Same goes for upper and lower teeth that are not coming into contact evenly.
Pain. An unstable bite can lead to jaw pain and problems with the jaw joint (TMJ).
Cavities. Teeth that are super crowded attract and hold on to more yucky bacteria that gets stuck in the nooks and crannies between the teeth. Try cleaning a white picket fence where all the pickets are sideways or upside down…it will probably be filled with dirt and rot out super fast! Just like our teeth :(
Infection. Cavities and malocclusion can lead to infection.
Excess wear. If the bite is unstable, the teeth may wear out unevenly. Similarly, a car with uneven wheels will wear out the tires quickly, and eventually, the tire can pop! If the unstable bite causes the teeth to wear out down to the nerve, it can get infected and “pop” by forming an abscess.
Gum disease. Crooked teeth attract more bacteria, which makes the gums unhappy and “inflamed”. Just like the crooked white picket fence that is impossible to clean and attracts more dirt.
Speech difficulties. Teeth that are not in the ideal position may affect one’s speech by not being able to pronounce certain words such as “the” or “sunset” where your tongue comes into contact with your teeth.
Self Esteem. One may not think of this as part of healthcare, but it is. We are constantly bombarded with images of the perfect smile in all kinds of media and our community. Although I am a strong believer of loving every part of yourself just the way you are, I also understand that a healthy smile can improve quality of life.

Orthodontics is not for everyone and that’s okay! But I feel it’s worthwhile to understand the pros and cons of straightening our teeth or other orthodontic treatments. And most orthodontics consultations are free!

Hope this helps.

With aloha,

Sonia

Please feel free to reach out any time if you have questions by visiting www.mauidental.com

*Disclaimer: This article is provided for information and education purposes only. No doctor/patient relationship is established by your use of this site. No diagnosis or treatment is being provided. The information contained here should be used in consultation with a dentist of your choice. This web site is not intended to offer specific medical or dental advice to anyone.

January 01, 2021

Teeth Veneers for an instant, perfect smile?!

January 01, 2021/ Sonia Gupta

I think I get asked on a daily basis by friends, family or patients if they should get dental veneers on their teeth.

My first response is: “Why? Do you realize that once your tooth is cut, you can never get that tooth structure back and it is more prone to cavities and infection for life?”.

There are some situations where the dentist does not have to cut the tooth to place the veneer, but the majority of veneers placed involve cutting the tooth. If the reason for veneers is purely aesthetic, I usually recommend first considering less invasive procedures, such as:

Orthodontics: braces, invisalign, and other procedures that can move teeth do not involve cutting the teeth and can improve your smile dramatically.
Teeth Whitening: I’m all for natural beauty, but teeth whitening is far less invasive than cutting teeth and placing crowns or veneers. With a simple take home bleaching tray or teeth whitening in office, you can achieve a beautiful white smile without losing your tooth structure!

My practice philosophy is on the conservative side, “less is more”. Generally speaking, the less we “mess” with our teeth, the better off we are. Now, if your teeth require dental treatment due to cavities, infection, etc., then I recommend choosing the most conservative option that still achieves the results you desire.

After considering the benefits and risks, if dental veneers are the best option for you, then my recommendation is: “If you are going to have dental veneers, make sure you commit to the following”:

Floss: Floss twice a day for life.
Nightguard: Wear a dental nightguard for the rest of your life
Dental hygiene: Maintain excellent dental hygiene.
Diet: Maintain a healthy diet with frequent water rinses and limit sugary drinks and foods.

Why? A couple of the most common reasons failures of veneers is from (1) cavities from not flossing, (2) cavities from a high sugar diet, or (3) fracture or veneer falling off from grinding the teeth (which a nightguard can alleviate).

Hope this helps!

With aloha,

Sonia

Please feel free to reach out any time if you have questions by visiting www.mauidental.com

January 01, 2021

Tooth Implants are so expensive!

January 01, 2021/ Sonia Gupta

Friends often and patients often ask me: “Why are these dental implants so expensive? Should I just go to another country to get them done cheaper? Is it ok if I get them done at a cheaper dental office?”.

My first response is: “If you are going to have a dental implant placed, make sure you commit to the following”:

No smoking
Wear a dental nightguard for the rest of your life
Maintain excellent dental hygiene

Why? A couple of the most common reasons for implant failure is from smoking (implant infection) and grinding the teeth (implant fracture). If you’re going to invest the time and money, make sure you are committed to this for life.

The second question I ask is: “Do you know a dental implant is a permanent screw implanted into your skull?” This is important to note because there is, for example, a significant difference between a dental implant and a dental bridge. Here are some of the options for replacing missing teeth, ranging from the most invasive to least invasive option:

Most invasive. Dental implant: Requires surgery in which a screw is implanted into your maxilla or mandible (jaw bone).
Less invasive. Dental bridge: Does not require surgery and usually only involves cutting your tooth, but not the maxilla or mandible bone.
Not invasive. Denture or flipper: Does not require cutting anything (usually) and involves using a removable appliance.
Do nothing: No treatment is always an option. There are sometimes consequences to no treatment of a missing tooth, such as loss of bone, amongst others.

I also like to explain to friends that there are risks to any dental procedure, as well as risks to doing nothing. As a professor at the dental schools, we often saw the worst complications and outcomes from dental implants gone wrong. Some of the complications of implants (even if done properly), are the following:

Infection
Injury to surrounding tissue
Nerve injury (temporary or permanent tingling feeling of your teeth, gums, lips, or chin.
Sinus problems
Implant fracture

I like to inform people of the potential risks to consider so they can make an educated decision. In my dental practice, I have seen these complications and have done everything I can to help these people who are suffering. Sometimes, there is no good solution to the problem and the person has to live with permanent discomfort. Although surgery often has positive outcomes, it is important to note the real risks of a surgical procedure and balance all your options.

And to answer the question about cost, I recommend evaluating the following instead of basing your decision solely on cost:

What type of dental implant and components is the dentist planning to use?
Is the doctor trained in oral surgery? Are they an oral surgeon or a periodontist?
Is the doctor familiar with updates in implants and surgery?
Is the doctor affiliated or teaching at a dental school or study club?
Is the doctor conservative or aggressive in their surgical approach?
Is the doctor using 2D radiographic xrays or 3D?
Is the doctor planning to use a surgical stent?
What are the complications that your doctor has seen?
Do you feel good in your doctor’s care?

Hope this helps!

With aloha,

Sonia

Please feel free to reach out any time if you have questions by visiting www.mauidental.com

December 26, 2017

No teeth yet? Delayed tooth eruption?

December 26, 2017/ Sonia Gupta

I know it's so exciting to see your baby's first tooth! We wait and watch and keep hoping it's coming. We look for that tiny little speck of white in their tiny mouth so we know their tooth is coming. But when all our friend's babies first tooth has come and our baby's tooth still isn't there, we wondering what's going on? Is there something wrong? What do I do? In some cases there could be a reason for this with our infants and it is important that the parent asks questions and sees a dentist.

1. When Does The First Tooth Usually Show Up?

When babies are born, their teeth are actually already formed but they are under the pink gums and we cannot see them without an xray. The teeth usually start to come up at six months of age. It starts with the two lower front teeth, then the four upper front teeth and then the two more lower front teeth. Usually we see the baby with all 20 primary teeth by the age of three years old.

2. When Should I Be Worried About A Delay?

According to the American Academy of Pediatric Dentistry, the baby should be taken to the dentist no later than their first birthday, or when their first tooth appears. The general rule we think about is the rule of fours: the baby will have four teeth come in every six months, beginning with the lower front central teeth. A more exact chart of expected tooth eruption dates can be found on the AAPD website. If teeth do not follow this chart exactly, it may or may not be a concern. It is best to see the dentist if there is a delay in tooth eruption.

3. Why Are My Baby's Teeth Delayed?

There are many reasons why teeth can come in later than the normal schedule. Sometimes, it's totally normal. There is a large range of possible contributing factors, including everything from normal development, to nutritional deficiency, genetics and low birthweight, among other medical concerns. There are some rare genetic conditions such as amelogenesis imperfecta, which interferes with normal enamel formation, as cited in an article on the AAPD website.

Usually, with a delay in your baby's teeth coming in, there is nothing to worry about and you can take the extra time to read and ask questions about caring for their teeth. It is important to arrange a dental visit if you are concerned that there could be a problem or by the time their first tooth arrives or by their first birthday, as recommended by the AAPD. And whenever your baby's teeth do finally come in, please make sure to care for them right away by following all the recommendations on good oral hygiene. This includes habits such as wiping the teeth after feeding, sips of water, healthy diet, diluting juices and brushing and flossing. I also wrote an article here on caring for baby teeth while nursing.

Just remember, you only have to brush and floss the teeth you want to keep! Happy brushing and flossing!

Please feel free to reach out any time if you have questions by visiting www.mauidental.com

August 24, 2017

Sedation dentistry?

August 24, 2017/ Sonia Gupta

I recently responded to a wonderful article in the New York Times. Here is the link to the article and my response below. I hope it is helpful.

NY Times Article - Should Kids be Sedated for Dental Work

Great article, Catherine St. Louis. Thank you.

I agree that sedation should be a last resort in all cases. There are many psychological techniques we can use to calm the child - we call this behavior management or tell-show-do. Let the child "play" with dental instruments, create a story, attack sugar bugs together, and make the experience fun. We have a therapist we work with who will also come to the office and help the child through the experience. Sometimes the only goal of the appointment is to conquer the child's fear, make the dental office "fun" and not do any treatment at all.

In some cases, these techniques are not sufficient, so the next course of action would be minimal sedation (nitrous) in office. Sometimes nitrous is sufficient and it is quite safe.

When nitrous is not enough, the next level of sedation is oral sedation (liquid or a tablet), which I prefer to avoid due to possible negative outcomes, which this article points out. Also, the child sedated in a dental office is likely being sedated without a patent airway (oral/nasal intubation). IMHO this creates a risk of aspiration - meaning our tiny little dental pieces such as crowns and filling material could be aspirated (going down the "air pipe" instead of the "food pipe"). IMHO a dental office is not as safe as a hospital setting where a trained anesthesiologist and a team of providers are handling the medication, the intubation and monitoring the patient. Unfortunately, most of the tragedies people hear about in the news take place in dental offices, not in a hospital.

Hospital dentistry is the absolute last resort imho, but sometimes it is necessary due to the extensive dental treatment required, the patient being unable to cooperative for treatment and the potential psychological damage from papoosing (restraining) the patient. Furthermore, many patients (young and older) have medical conditions such as cerebral palsy, autism, dementia and developmental delay which make treatment in the office difficult, if not impossible.

In nursing homes, many of these geriatric people suffer in pain in silence. I have witnessed firsthand a nursing home patient with dementia whose family called me because they had stopped eating, stopped smiling and had gone into a depression. After we repaired/removed all of their infected teeth with general anesthesia in a hospital setting, they started smiling and eating again and their quality of life increased dramatically. It was the greatest experience of my life.

There are many children who also suffer with oral disease, carious teeth and multiple oral abscesses (infections of the teeth). It creates a whole different set of problems - low confidence, missed school, chronic pain, halitosis (bad breath) and chronic infection (yes your teeth are connected to your whole body - infection of the mouth means infection circulating through the entire system). Some of these children who cannot tolerate in office treatment due to anxiety or being medically compromised are candidates for sedation dentistry once all other possibilities have been exhausted. But, the caveat for me is that the parents and the child receive extensive information on preventing future cavities/infections and making several changes in lifestyle so they never end up in this situation again.

The lifestyle changes I generally review are: water rinses after every meal, avoid all sticky foods/sweets, brush AND floss every night (only floss the teeth you want to keep!), drink only 100% juice and dilute with water (or only drink water), wipe baby's teeth with a damp cloth after nursing and most of all, AVOID SUGAR AND READ NUTRITIONAL LABELS to find out the sugar content of every single thing we eat or drink.

It really breaks my heart to see so many 1 and 2 year old babies with cavities and oral abscesses. I wrote this article below a while ago and hope it helps all the moms and dads out there. I need to write more articles to get the word out. But I am so thankful that Catherine St. Louis is taking such an interest in oral health and educating our community about the importance of oral health. Mahalo (thank you) Catherine! Kudos to you :)

Please feel free to reach out any time if you have questions by visiting www.mauidental.com

October 03, 2016

Can breastmilk or formula really cause cavities in baby teeth?!

October 03, 2016/ Sonia Gupta

Yes!

Unfortunately, while breastmilk is very healthy for a baby, it does contain some sugars that can cause cavities.

The only way to absolutely prevent cavities is to only give your baby water in the bottle at night. In many cases this is not an option.

Here is some information on cavities and baby teeth:

1. Baby bottle tooth decay (cavities in baby teeth) is most often caused from putting the baby to sleep with a bottle of formula, juice or milk.

2. Breastmilk does contain some sugar and can cause cavities. Therefore, it is important to care for the baby's teeth after breastfeeding.

3. Breastmilk is less likely to cause cavities in baby teeth compared to formula, juice or milk.

4. Wipe the gums regularly with a damp cloth starting at birth.

5. Wipe the teeth and gums with a damp cloth after breastfeeding or using the bottle.

6. Keep a separate bottle with only water to rinse the teeth after breastfeeding or giving your baby milk, juice or formula.

7. Cavities in baby teeth can cause severe pain and an oral abscess. Cavities in baby teeth should be prevented at all costs and taken very seriously.

8. Floss all teeth that are touching each other. Yes, even at 1 or 2 years old! Bacteria, sugars, starches get stuck between the teeth and will cause cavities if not flossed regularly. If there are large gaps between the baby teeth, you are very lucky :)

Excellent information and Q&A from the American Academy of Pediatric Dentistry: http://www.aapd.org/resources/frequently_asked_questions/

The American Dental Association has additional information here: http://www.mouthhealthy.org/en/az-topics/b/breastfeeding

The American Academy of Pediatrics recommendations can be seen here: https://www.healthychildren.org/English/ages-stages/baby/breastfeeding/Pages/Where-We-Stand-Breastfeeding.aspx

Please feel free to reach out any time if you have questions by visiting www.mauidental.com

February 21, 2016

Healthiest ways to keep our smile beautiful.

February 21, 2016/ Sonia Gupta

1. Baking soda rinses.

2. Brush with baking soda WET (not dry). Dry baking soda is too abrasive.

3. Don't use toothpaste or any paste in a tube.

4. Coconut oil pulling. Swish and spit coconut oil. No rules on time, but the longer, the better. :)

5. Wheatgrass. You can juice it and brush with it or drink it.

6. Clove oil. Excellent to relieve tooth pain.

7. Garlic. Excellent to relieve tooth inflammation.

BE CAREFUL OF:

Apple cider vinegar, lemons, lemon/citrus water, lemon/orange peels. While these are therapeutic for our body, due to their acidic nature, they have the ability to destroy our enamel. Rinse or drink sips of water constantly while drinking anything acidic.

February 21, 2016

What is the secret to natural, white teeth?

February 21, 2016/ Sonia Gupta

The secret to natural, bright white teeth is simple! And it's one word:

WATER!

Water, like saliva, constantly rinses your teeth off of all the things that cause staining and cavities. Water washes away food and drink that would normally stain your teeth like coffee, soda, tea, tobacco and red wine. Water washes away the acidic content that can destroy teeth from foods such as lemons, lemon water and citrus. Constantly rinsing with and drinking water has a huge impact on preventing cavities and keeping our teeth bright and white. It's nature's most wonderful medicine. And it's free!

Please feel free to reach out any time if you have questions by visiting www.mauidental.com