Franklin Park Dental Associates, Ltd.
General Dentistry

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9767 West Franklin Avenue
Franklin Park, IL 60131
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TO TELL THE TOOTH : Read Dr. Pietrini's current monthly article

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To Tell The Tooth
Read Dr. Pietrini's current monthly article from the Fra Noi newspaper.

 

Other Dental Services...

Dr. Pietrini writes a monthly column for Fra Noi, an Italian newspaper. Articles related to the topic of Other Dental Services are featured below. Click here to view this month's article

 

Getting Your ZZZZ's by Dr. Pietrini
How many times have you heard a wife complain of her husband's snoring or vice versa? This annoying habit may actually be a warning whistle for more serious health problems, such as sleep apnea. Apnea is a Greek word for "without sleep." The most common type of apnea is obstructive sleep apnea (OSA). Sleep apnea affects more than 12 million Americans, mostly overweight males over forty; however, it can also affect women and children.

When the structures of the throat are enlarged and the muscles are relaxed, a partially obstruction of airflow occurs. The patient often has excessive fat tissue in the throat area, enlarged tonsils and uvula or a long soft palate. When air tries to pass through the narrowed opening, the throat tissues vibrate causing snoring. OSA occurs when the tongue gets sucked back against these structures and blocks the airway causing the patient to stop breathing, often hundreds of times a night leading to low blood oxygen levels. This cessation of breathing can often last for one to two minutes. As the oxygen level in the brain decreases, the patient partially awakens with a gasp, which allows the throat to clear and for the airflow to continue. This condition is often associated with high blood pressure and heart disease. It leads to daytime drowsiness and often headaches and loss of memory.

If you suspect that you or a loved one might have a sleep apnea, your physician or dentist can refer you to a sleep disorder clinic. An extensive examination and/or sleep study will confirm the diagnosis. If a sleep disorder is ruled out, the snoring problem can be treated surgically. A laser procedure called a L.A.U.P. (laser assisted uvulopalatoplasty) can be performed, where the uvula, the tissue that hangs down at the back of your soft palate, is removed. This will eliminate much of the tissue vibration, thereby reducing the snoring sounds

When a diagnosis for OSA is confirmed, a device called a CPAP, which stands for continuous positive air pressure, can be utilized. The machine provides positive airflow through a tube that is attached to a mask that covers the nose. The air pressure helps to keep the airway open during sleep. Patients often have difficulty adjusting to these devices complaining of facial irritation, nasal congestion, gastric distention and difficulty in finding a comfortable sleeping position.

Your dentist can make you an oral appliance, which is similar to a sports mouthguard. They are worn while you are sleeping. By repositioning your lower jaw, it prevents the tongue from closing off your airway. These appliances can be used alone or with a CPAP machine. They can be used for patients with sleep apnea or to help eliminate snoring. There are several advantages to using these devices:

· They are less expensive
· They are small making them easy to take with you when traveling
· Surgery is not required
· Patients can adjust to them without much difficulty

Remember no surgical procedure should be performed or appliance made without a proper diagnosis.

 

 

Grinding It Out by Dr. Pietrini
Often patients complain about a spouse who grinds his or her teeth while they sleep. This oral habit called bruxism is not only very annoying for the patient's husband or wife, it is the main cause of TMJ (temporomandibular joint) disorder. Nearly 10 million Americans suffer from some form of TMJ, which can have a variety of causes and related symptoms.

The temporomandibular joints are the most complicated set of movable structures in the body. The joint is a complex system of bones, muscles and ligaments, which work in harmony to give us the ability to swallow, speak and chew our food. Diseases such as arthritis, injuries to the head and neck, bite problems and clenching can lead to muscle spasm and pain. This can occur when a small disc that acts as a shock absorber that lies between the bones of the upper and lower jaws gets stretched out of its normal position or becomes damaged. Some of the more common signs and symptoms of TMJ are:
· Tightness of the joint muscles
· Pain or ringing in or around the ear
· Locking of the jaw-open or shut
· Popping or clicking of the joint
· Related headache or neckache
· Pain while eating

After your dentist completes a comprehensive head and neck examination, he or she may suggest a series of diagnostic tests to help determine the cause of your signs and symptoms, including x-rays and study models of your teeth. A variety of treatments are available to relieve or eliminate the cause of TMJ symptoms and pain such as:
· Correcting the bite with selective grinding of the teeth, crowns or bridge work or orthodontic treatment
· Eliminating the pain and spasms with various treatments-stretching and icing, applying moist heat, medications such as muscle relaxants or anti-inflamatories, eating a mechanically soft diet, massage therapy and dental orthotics (night guards)
· Surgery in the most severe cases
· Counseling and/or relaxation treatments such as biofeedback or electrical stimulation

For most patients, only minor corrective treatment is required. Very few ever need surgical repair. A dental orthotic or night guard can be made to help eliminate the harmful effects of clenching or grinding of the teeth. This is a plastic, bite splint that covers the upper or lower teeth, which will reduce the muscle spasms, pain and other symptoms associated with TMJ disorders.

Physical therapy can give patients relief from these painful spasms. A TENS unit (short for Transcutaneous Electrical Nerve Stimulation) can be used to deliver a precisely regulated, rhythmic pulse to the muscles involved in chewing. By increasing blood circulation and normal metabolism, the muscles are cleansed of chemical waste buildup and return to a more relaxed state of rest.

If you have any questions about this common disorder please call our office. We would be happy to send you a pamphlet that explains more about TMJ.

 

 

Hi Ho Silver by Dr. Pietrini
When I was in high school, my chemistry teacher asked us a trick question. What did the chemical formula HiHoAg represent? The answer is "hi ho silver" the line used by the Lone Ranger. Many years ago one of my friends was undergoing orthodontic treatment. We gave him the nickname "the Lone Ranger," because you could tell who he was by his silver teeth. Many of today's braces are less noticeable and more comfortable. The brackets, the part of the braces that hold the wires, can be metal, clear, or tooth-colored and are used more often than the large metal bands of the past.

Orthodontics is the branch of dentistry that deals with dental and facial problems. Fixed or removable appliances (braces) are used to correct these problems. Braces aren't just for kids anymore. Of the approximately 4 million people currently wearing braces in the United States, about 20% are adults. There is no reason to spend the rest of your life being embarrassed about your appearance. If your teeth are crooked or your profile is uneven, you may feel self-conscious about your looks. There is no reason to spend the rest of your life being embarrassed.

Orthodontic treatment can improve overall health, by correcting malpositioned teeth, a bad bite and some abnormalities of the jaw. Treatment will enable the patient to keep teeth and gums cleaner, and thereby prevent tooth decay and gum disease. A patient who has difficulty chewing is less likely to eat nutritious food. A poor bite can also cause extra stress on the chewing muscles, which may cause pain or problems with the jaw joints. In addition, protruding teeth are more easily chipped or fractured.

The American Association of Orthodontists recommends that children get an orthodontic evaluation by the age of seven. If an eight year old has visibly crowded front teeth, this condition will not be self-corrected by additional jaw growth. By the time the permanent six-year molars develop the space available for the erupting front teeth will not increase. We inherit certain mouth and jaws features from our parents. For children, injuries, thumb sucking, extensive decay and premature loss of baby teeth can lead to a poor bite. In adults, gum disease and loss of permanent teeth can contribute to bite problems.

How do braces work?
Braces are placed on the teeth to apply gentle pressure, which over time will move the teeth into their proper position. The orthodontist cements or bonds brackets to the teeth. A main wire called an "arch wire" is attached to the brackets and is wired in place with a certain amount of tension causing a slow controlled movement of the teeth. Pressure on one side of the tooth causes the bone to give away. As the tooth moves, new bone is deposited behind the tooth. With proper treatment, an attractive, healthy smile is the end result.


Watch For the Bump in the Road by Dr. Pietrini

As we travel down life’s road we may encounter many bumps. And, so it is when it comes to dental health. I have written in the past about oral cancer and the need for thorough screening by the dental profession. Fortunately, the vast majority of oral bumps and lesions are benign (non-cancerous). These conditions are divided into two main categories—soft tissue and hard tissue.

The most common hard tissue growths in the oral cavity are referred to as, “tori”. In the upper jaw, they are mostly found in the palate (roof-of-the-mouth). Those in the lower jaw (mandible) are usually located in the area behind and below the teeth. In a healthy mouth, tori are usually of no consequence. When it is necessary to make a full or partial denture for a patient, tori could be a source of discomfort, possibly interfering with proper placement of the appliance. Depending on the size and location of the tori, it can be more difficult to maintain good oral hygiene. While it is important to continue to examine the health of the tissue around these areas, these are benign growths, which do not require routine removal and biopsy.

The most common soft tissue growths found in the mouth are called fibromas. They can be located in the gum (the area surrounding the teeth), cheek, lip or tongue. These growths are fatty tumors, which usually develop from a traumatic injury, unnatural biting habits or irritation caused by fractured teeth or dental appliances. I have treated patients who have had fibromas ranging in size from smaller than a pea to one inch or more in diameter. There are several reasons for considering removal of fibromas:

  • Cosmetics
  • Continued trauma to the area when the patient is eating
  • Difficulty in maintaining good oral hygiene
  • Despite reassurance from the dentist that the growth is benign the patient prefers to have a biopsy for positive confirmation

Frequently, soft tissue growths and lesions are associated with infections of the teeth and gums. In some cases a biopsy or bacterial culture may be in order to determine the nature of the lesion and bacteria. Several years ago, I was called in for a consultation of a patient who was hospitalized with a recurrent knee infection. The doctor in charge of infection control at Gottlieb Memorial Hospital obtained a bacterial culture from the knee and determined that the bacteria present were the same type as are commonly found in the oral cavity. Even though the patient was not aware of any dental problems, examination and x-rays revealed that the patient had several infected teeth, which were causing bacteria to travel through the bloodstream to the soft tissue in the knee. After removing the offending teeth, the infection in the knee cleared up within a few days and never returned.


A Little Young to Be Hitting the Bottle by Dr. Pietrini

 When my daughters were growing up, my wife was in charge of most of their day-to-day care. I enjoyed the occasions where I was able to hold them in my arms giving them a bottle. That period of their lives seemed to pass so quickly. In the past few months, I’ve had the pleasure to be able to bond with my granddaughter. Lately, when feeding her she has developed the habit of slapping at the bottle with her open hand prompting my question to my daughter, “Isn’t she a little young to be hitting the bottle?”

 Whether an infant receives nourishment by breast-feeding or with a bottle, they are susceptible to ‘baby bottle tooth decay’ if certain precautions are not taken. You should prepare for the care of your baby’s primary teeth before the first tooth erupts. Use a clean, wet cloth to carefully wipe the baby’s gums. After several of the primary teeth appear, brush them twice a day with a small, soft-bristled brush. There are toothpastes available that will not harm your child if a small amount is swallowed—use a dab no larger than the size of a pea, especially if the paste contains fluoride. Too much fluoride can cause mottled (spotted) enamel.

 Fermentable liquids such as milk (both cow’s milk and mother’s milk), formula and juices contain sugars. Bacteria break down the sugars into acids, which attack the teeth and create cavities. If you observe the following suggestions, you can help prevent ‘baby bottle tooth decay’:

 

·        Never give your baby juices or other liquids containing sugar in a bottle.

·        If your baby needs a bottle to fall asleep, it should be filled with water only making sure that the water contains fluoride.

·        Do not allow your baby to walk around using a bottle as a pacifier. An anatomically correct pacifier will help satisfy the baby—never dip it in honey or sweet liquids.

·        Once the teeth have erupted, stop the nursing or bottle-feeding if the baby falls asleep.

·        Start teaching your child to drink from a cup before the first tooth erupts. By 12-14 months, your child should be drinking from a cup only.

I know of a case of a dentist and his wife, who allowed their child to fall asleep with a bottle containing sugar water. Even though they knew better, they could not cope with the baby crying during the night. As a result, the child developed ‘baby bottle tooth decay’, requiring extensive oral rehabilitation, including crowns on several of her front teeth. It is better to suffer with a few sleepless nights, than to deal with the heartache associated with your child developing extensive dental problems.

 

A You Too Sensitive? by Dr. Pietrini

Imagine taking twelve of your family members to your favorite Italian restaurant for dinner. Perhaps you have a Campari and soda while looking over the menu. Then you have some piping hot minestrone along with some hard-crusted Turano bread followed by a cold iceberg salad with vinegar (acetic acid) and oil. After completing your hardy hot main course accompanied by a nice red wine and ice water, you have Cappucino and a biscotte with your spumoni, finally sipping some Sambuca, while waiting for your bill. You scan the check when it arrives, grit your teeth and sign the credit card slip. Is there any wonder why nearly 20% of all Americans have sensitive teeth?

Teeth can be sensitive to foods and drinks that are acidic, sweet, hot or cold. Hypersensitivity occurs when the hard shell of enamel is decayed or worn away exposing the inner core of the tooth called dentin. Tooth sensitivity occurs because exposed dentin has thousands of tiny tubes (tubules), which contain microscopic nerve endings. Also, when gum recession develops, the root surface made up of dentin becomes exposed. There are several causes for gum recession and sensitive teeth:

·        Periodontal (gum) disease

·        Brushing with a hard-bristled toothbrush

·        Using a toothpaste which is too abrasive

·        Clenching or grinding your teeth

·        Eating or drinking acidic foods

Sometimes, things that appear to be healthy for us can increase hypersensitivity. Patients try to reduce calories and sugar intake by consuming diet soft drinks. These products contain carbonic acid, which can destroy sound tooth structures. Some people are in the habit of sucking on the rinds of oranges, grapefruits or lemons. The citric acid can etch the enamel and dentin. One of the most destructive habits is crunching ice. The cold cause the tooth to contract at the same time that a damaging of force is placed on the teeth, which can cause minute fractures in the enamel.

If a tooth has been sensitive for several days, it is best to have a dentist determine the extent of the problem. Sometimes the pain is associated with a decayed tooth. Once it has been established that the problem is exposed dentin, there are several possible remedies. Toothpastes with desensitizing agents can block the dentinal tubules. Patients usually get relief within a few weeks using these products. If the problem persists, there are a number of treatments available. Your dentist can place sealants or varnishes over the exposed dentin. For more than twenty years, we have used a process in our office called iontophoresis. A cotton applicator soaked in fluoride and attached to a low-level electrical current is placed over the exposed dentin for a few minutes. The fluoride is drawn into the tubules and desensitizes the nerve endings. This treatment will usually reduce or eliminate the sensitivity for several months to several years. Check with your dental office to see what treatment is best for your condition.

 


The Tooth Fairy By Dr. Dennis R. Pietrini

I decided to surf the Internet to see if there was any information about the Tooth Fairy. There are literally hundreds of articles and books available on the subject. The legend seems to have started in the British Isles. The tradition in England is for the child to drop the tooth in a fire to avoid the unpleasant task of looking for it after death. The Vikings had a tradition of paying children for the use of a baby tooth. They believed that having a child’s tooth in their possession would empower them in battle. American children placing a tooth under their pillow for the Tooth Fairy seems to be a kinder, gentler approach.

Each year, I find that I am removing fewer teeth for children. As the American public becomes better educated about healthcare issues and nutrition, children are not losing as many teeth through decay. Fluoride in the drinking water, in toothpaste and in mouth rinses has reduced the number of decayed and missing teeth by more than 50 percent. When a cavity does occur, it is important to attempt to restore the tooth. When I first started my practice, parents would frequently say to me, “just take it out, it’s only a baby tooth.” Modern dentistry has made the dental experience more tolerable for all patients, especially for children.

With the aide of conscious or unconscious sedation and better methods of delivering local anesthetic, most dental procedures can be done quickly and virtually without pain. While high-speed dental drills continue to be the most common instrument for tooth preparation, high-tech devices such as air abrasion machines and dental lasers are being used by a growing number of dental practices. Most pediatric dentists and many in general practice are affiliated with hospitals where extensive treatment can be done under general anesthesia. This may be especially useful for the growing number of children born outside the United States who present with more complex problems and where there may be a language barrier.

The primary (baby) molars usually erupt at ages 1 to 21/2. It is important to retain these teeth until the ages of 11 to 13 to aide the child with proper nutrition and speech. Occasionally, a large cavity might require a treatment referred to as a pulpotomy (a simplified type of a root canal treatment). If the tooth structure is weakened, a stainless steel crown might be advisable. The early loss of a primary tooth could effect the eruption of the permanent teeth resulting in crooked or crowded teeth affecting function and appearance. Your dentist can make a space maintainer to hold the position of the teeth until the permanent tooth develops. Interceptive orthodontics in a young child can often prevent the need of more complex treatment at an older age.


Technology That Would Amaze da Vinci By Dr. Dennis R. Pietrini

Frequently, when I speak to dental organizations, I title my presentation “Technology that Would Amaze da Vinci.” Leonardo da Vinci was an artistic genius that most dentists admire. Leonardo was born in Vinci, Italy in 1452. While his paintings “The Last Supper” and the “Mona Lisa” are his most recognized works, he also had many other talents. Leonardo’s fascination with science and nature lead him to record these studies in illustrated notebooks. His works covered several areas—sculpturing, painting, human anatomy, mechanics and architecture. Being left-handed was considered the work of the devil, but this did not deter Leonardo. He was able to draw with both hands at the same time and had the uncanny ability to write backwards. I often describe dentistry as the only profession that requires a person to work on a moving patient, through a small opening with both hands, upside-down and backwards using a mirror.

Da Vinci would have been an ideal dentist. When I took the Dental Aptitude Test, we were required to carve objects from pieces of chalk. In dental school we had to produce anatomical drawings and carve teeth out of wax. Repairing fractured, malpositioned and discolored teeth calls for skills of a mechanic, artist and sculptor.

Among da Vinci’s mechanical drawings were studies of a tank and other weapon systems, a submarine, a helicopter and other flying machines. He was centuries ahead of his time, since the industrial revolution did not begin until the eighteenth century. As forward thinking as he was, I still believe that he would be amazed at the advances that have occurred in dentistry.

In the early 1960’s the high-speed, water cooled dental drill was developed. Equipped with various sizes and shapes of interchangeable burs, this dental instrument affords the dentist the ability to rapidly remove decay and sculpt teeth to restore function and cosmetics. In recent years advancements in air-abrasion and lasers have allowed dentists other options to reduce the need for drilling—often without the need of local anesthetic. While many patients complain of the high-pitched sound and vibration of the drill, it will remain the instrument of choice for many dental procedures.

Several advances in dental diagnostics have occurred. Intra oral cameras and digital recording of x-rays allows the dental team to be able to create a computerized record of the patient’s dental condition that can be displayed on a monitor for easy viewing and provides the ability for electronic transmission of information. A small laser can be used to scan the teeth to painlessly detect if decay is present. High-intensity light sources can be used to illuminate teeth to aide in detecting fractures and decay.

Our office recently purchased a new dual-wave laser that allows us to treat hard tissue (teeth and bone) with one laser wavelength and to be able to perform soft tissue surgery with an additional wavelength. The downside of all these advances is the cost of the equipment. While many of these new technologies give the dentist the ability to provide faster more comfortable treatment to the patient, it is their knowledge, training and artistic skills that count the most.


The Wisdom of it All By Dr. Dennis R. Pietrini

I am often asked, “What are wisdom teeth?” Most people have three molars in each corner of their dental arches. They are referred to as the six year-old and twelve year-old molars and the wisdom teeth (third molars), which usually erupt between the ages of 18-23—“the age of wisdom.”

For some people wisdom teeth will erupt like the other molars. If they grow in properly and are in normal function, they can remain healthy. Most patients do not have sufficient room in the jaw for their third molars. These partially or totally unerupted teeth are referred to as being impacted. By taking a panoramic (full mouth) x-ray, a dentist can often determine the position of the wisdom teeth several years before they are due to erupt.  

All teeth develop in a follicle or sac. When the tooth erupts fully, the follicle becomes part of the ligament that holds the tooth in the bone and gum. If the tooth remains impacted, this sac can develop into a tumor or cyst. Fortunately these cysts are almost always benign; however, they frequently will fill up with fluid and blow up like a balloon resulting in swelling, pain and infection. Antibiotics can be prescribed to treat the infection, but this is usually just a temporary measure. Eventually the teeth will require removal. Fully erupted teeth may also need to be removed, if they become decayed, interfere with proper biting, increase the risk of periodontal disease or are non-functional.  

Some of the common symptoms and concerns associated with wisdom teeth are:

·        Pain

·        Swelling of the gum tissue surrounding the tooth

·        Swelling of the jaw

·        Infection

·        Pressure against the roots of the twelve year-old (second) molars

Impacted third molars may be the most common medical-dental problem. Depending on the complexity of the case, your dentist will help you determine your treatment options. Many general dentists prefer to refer their patients to an oral surgeon. With the aid of nitrous oxide or a general anesthetic and local anesthetic, this experience should be virtually pain free. In our office we use a dental laser to help reduce post-operative bleeding, swelling, pain, infection and often the need for sutures.

 


Dentistry and Sea Hunt By Dr. Dennis R. Pietrini

In the 1950’s actor Lloyd Bridges starred as Mike Nelson in the popular television series Sea Hunt. He played the part of a professional SCUBA diver. In several of the episodes, divers were treated for the “bends”. This occurs when a diver returns to the surface too quickly, not allowing the body to adjust to the sudden change in atmospheric pressure. Gas bubbles, especially nitrogen, build up throughout the body reducing the normal oxygen levels, resulting in pain, hemorrhaging of blood vessels and in severe cases death. The faster the victim is treated, the better the recovery. The divers are placed in a hyperbaric chamber that increases their oxygen levels.

So, what does diving have to do with dentistry? Shortly after oxygen was discovered in the 1700’s, it was used to treat patients for a variety of ailments. In Europe compression chambers called “pneumatic spas” were in vogue. Today, hyperbaric chamber therapy is used in medicine and dentistry. By increasing the levels of oxygen under pressurized conditions, wound healing occurs faster for patients who have severe cases of diabetes or who have received radiation treatment.

This year, nearly 30,000 Americans will be diagnosed with cancer in the head and neck region. Depending on the size and location of the tumor, radiation therapy may be advisable. Techniques have been developed to attempt to reduce the size of the area covered by the radiation to avoid damage to the surrounding normal tissues; however, if the tumor lies in or near the bones in the head and neck, a condition known as radiation necrosis may develop. Damage to the salivary glands, nerves and blood vessels will interfere with normal healing and may cause increased tooth decay. It is often necessary to remove all of the teeth in the area of treatment to avoid future serious complications.

By administering hyperbaric therapy (several sessions may be necessary) to patients prior to tooth removal or oral surgery, the patient can be treated more effectively with the positive effects lasting approximately two years.  Because the increase of oxygen in the tissues allows for better healing of the surgical sites, it is now possible to delay the early loss of teeth prior to radiation treatment.

The Oral Surgery Department at Loyola University Medical Center provides treatment for patients who would benefit from hyperbaric therapy.  For additional information, please contact our office or Loyola University.

 


Dental Insurance - At Best A Limited Fringe Benefit By Dr. Dennis R. Pietrini

I would like to have a dollar for every time I have heard a patient state, “I can’t afford that treatment Doctor. I don’t have dental insurance.” In the early 1970’s, you could purchase a very nice home for under $50,000. Today, it could cost that much for a modest sized room addition. Many employers began to offer dental plans in the 70’s. At that time the annual maximum benefit averaged about $1,000. Today the average benefit limit is still $1,000—not even a reasonable cost-of-living increase. Can you imagine if there was an annual limit for your medical plan and your physician told you that you needed a four-way heart bypass, but your insurance will only pay for two this year?

Dental insurance has become one of the most requested employee benefits. Not all plans are alike. They are business arrangements between an employer and an insurance company. The best plans allow the patients the freedom of choosing their dentist. These dental policies are generally more costly to purchase. 

Less expensive for employers and employees, yet more restrictive, are policies that fall into the group of  “managed care plans.” Preferred Provider Organization (PPO) programs allow the patient to select a dental office from a list of providers who have agreed to discount and/or cap their fees. Usually the patient’s co-payment is less. Many PPO’s permit patients to have treatment by a non-participating dentist of their choice; however, the deductibles and co- payments may be higher. Dental Health Maintenance Organization (DHMO) or capitation plans are usually the least costly, but most restrictive. The patient is assigned a dentist or clinic that has contracted with an insurance company and employer, usually for a monthly fee per patient. The dentist agrees to perform certain services at no charge to the patient, while some treatment requires a co-payment. In theory, the DHMO system rewards the dentists who keep their patients healthy by lowering their costs. The drawback is that many clinics are overcrowded, poorly staffed and under-funded. These plans might not provide for prompt emergency care or for urgent care for patients away from home.

In recent years, “fee-for-service plans” have become more popular. When an employer establishes a Direct Reimbursement (DR) plan, a percentage of the patient’s treatment is paid directly to the dentist of their choice. This method of financing dental care is the plan most preferred by the American Dental Association (ADA). The ADA provides a service to assist companies in developing alternative reimbursement programs like DR. 


No Easy Way Out By Dr. Dennis R. Pietrini

Each year, Americans spend more than a billion dollars on feel-good oral hygiene products. Instead of brushing and flossing on a regular basis, we look for the easy way out by using other products such as oral irrigating devices, mouthwashes and other rinses. These alternative methods often feel better and seem to be faster, but nothing is more efficient than the old tried and true—a brush and floss.

Recently, the U.S. District Court in New York ruled that Pfizer, the manufacturer of Listerine, must stop promoting their claim that its mouthwash was as effective as flossing in fighting plaque and gingivitis. Several studies have shown that using non-prescription oral rinses and/or oral irrigating devices can help to loosen and reduce plaque. Actually, it is the mechanical action and friction of the brush and floss that are the best methods for removing plaque, which cause decay and gum disease. I recently did a search and found that in a typical well-stocked pharmacy there are more than thirty brand-named mouthwashes and rinses available, as well as many generic products. There are several varieties available, which are marketed for use as a(n):

·        Antiseptic (to mask bad breath)

·        Anti-cavity rinse

·        Anti-plaque rinse

·        Whitening and stain removal rinse

·        Rinse for patients with dryness of the mouth

Many dentists will prescribe anti-bacterial rinses containing chlorhexidine gluconate, which helps to inhibit the formation of calculus (tartar) and plaque. These rinses are usually used for a short period of time and are not a substitute for professional treatment or routine home care.

There are several brands of mechanical toothbrushes that are very effective. At one time there was some concern that these devices might be too abrasive; however, the newest generation of products are well designed with soft, polished toothbrush bristles. I recommend trying one of the many disposable mechanical brushes available. They are an inexpensive way of seeing if you prefer to replace your hand-held brush with a mechanical one.

If you like the fresh feeling of a mouthwash, rinse with it before you brush and floss—it will help loosen the plaque and food between your teeth and gums.


Here Comes The Judge By Dr. Dennis R. Pietrini

A few weeks ago, a new patient asked me, “Are you a judge?” My immediate reply was, “No, I’m a dentist. Why would you think I am a judge?” Her response was, “I asked one of the women at the front desk if I would need an injection for my treatment and she told me that the doctor will judge what is best for you.”

Traditionally, many patients were too intimidated to question their dentist’s judgment about their treatment and care. Many times patients will tell me, “You’re the doctor. Do what you think is best.” While I appreciate the confidence that they have in me, to borrow a familiar line, I often tell them, “I believe in one God and I have discovered that it is not me.” 

In recent years, patients have been able to access many different sources for healthcare information.  On a daily basis, you can find articles pertaining to oral health in magazines, in the newspaper on radio and on television. More and more patients are asking questions about information obtained from surfing the Internet. I find myself spending more time than ever reviewing treatment options with patients. Modern dentistry offers many options for safe, comfortable care. Frequently, I will write up three or more treatment options for a patient outlining the various procedures and the costs. There is nothing wrong with seeking a second opinion. I often tell patients that you could have a panel of several well-known dentists review a treatment plan and they would recommend a variety of excellent approaches for your care and the related costs.

High-tech dentistry makes the dental experience more efficient and comfortable. The horror stories of sitting through long uncomfortable treatment sessions are a thing of the past. With good treatment and prevention, teeth can last a lifetime.

If you link to my website @ www.laserdentist.com, you can find past articles that I have written and you can also link to the websites of the American Dental Association (ADA), the Academy of General Dentistry (AGD) and the Academy of Laser Dentistry ALD). Use the search site to get more information about your area of concern.


Women's Oral Health (Part I) By Dr. Dennis R. Pietrini

Women tend to be more concerned about their oral health than men. In my general dentistry practice, we treat female patients more than 60% of the time, yet their oral health is no better than the average male. Hormonal changes throughout a women’s life, as well as local factors such as bacteria found in plaque, smoking, drugs and alcohol consumption, can make her more susceptible to a variety of oral diseases.

A women’s oral health care needs change as she transitions from puberty through menopause. During puberty, the sex hormones—progesterone and estrogen that cause a female’s body to mature—can affect periodontal health. The hormonal changes that occur during menstruation, along with the irritation of bacterial plaque can contribute to gingivitis (red, swollen and bleeding gums).

Some women will avoid visits to the dentist during pregnancy, fearing that it might harm the baby. Actually, untreated dental disease may put the baby and mother at a greater risk of developing infection. Researchers have found that as many as 75% of pregnant women can develop “pregnancy gingivitis”. Often, isolated areas between the teeth become swollen resulting in what is referred to as a “pregnancy tumor”. These enlarged areas are usually difficult to keep clean resulting in pain and bleeding while eating or brushing. If they do not reduce in size after the birth of the baby, it may be necessary to remove them surgically. Studies indicate that women with active periodontal disease are 7-8 times more likely to deliver babies prematurely with a low birth weight.

Women taking oral contraceptives may experience symptoms similar to those of pregnant women—gums that are swollen, bleeding and often painful. Following tooth extraction, women are at greater risk than men in developing a condition called “dry socket”. If they are on birth control pills, the risk is doubled. A “dry socket” occurs when an incomplete blood clot fails to form, resulting in localized, painful inflammation of the extraction site. The estrogen in the pill apparently interferes with the healing process. To reduce the chance of this post-op complication, it is best to perform the surgery during the non-estrogen days at the end of the pill cycle. Also, women should be reminded that taking antibiotics could interfere with the effectiveness of the pill. Other measures should be taken to prevent an unwanted pregnancy.

In my next article, I will discuss the effects of menopause and other conditions and their relationship to women’s oral health. 


Women's Oral Health (Part II) By Dr. Dennis R. Pietrini

Last month, I began the discussion of the unique oral health needs and problems for women at the various stages of life. In this article, I want to relate some of the concerns for women during and after menopause. They may experience several changes in their mouths, including: burning sensations in the oral tissue, dryness and alteration in taste, especially relating to foods that are sour, salty or peppery. Women also have a higher incidence of certain oral conditions such as Sjogren’s Syndrome, yeast infections and lichen planus. These conditions must be monitored to make sure they do not undergo cancerous changes.

Of the nearly one-and-a-half million bone fractures suffered by adult, Americans each year, most affect women. Hormonal changes can result in the loss of bone density leading to osteoporosis and periodontal (gum) disease—several studies are being conducted to determine if there is any connection between the two. Besides maintaining good oral health, with daily homecare and regular dental visits, good nutrition and taking supplements such as folic acid, calcium and vitamins B and C may be helpful.  Hormone Replacement Therapy (HRT) can help to reduce bone loss. It is advisable to discuss the risks versus benefits of HRT with your physician.

Due to factors like hormonal changes, smoking and poor oral hygiene, nearly half of the women over the age of 55 have periodontitis (gum disease). The bacteria found in the plaque attached to the teeth and the surrounding gum tissue produce toxins that are released into the bloodstream, which causes an immune response in the body. In healthy women, their immune system can overcome this attack; however, in some women this increase of bacteria in the blood can lead to a greater risk of heart disease, stroke and more severe cases of diabetes. 

Most of us are aware of the many risk factors for heart disease, including family history, poor nutrition, lack of exercise, obesity, high blood pressure and cholesterol and smoking. In recent years scientists have discovered the connection between poor oral health and heart disease suggesting that these patients have twice the risk of a fatal heart attack.

Proper, regular monitoring by your physician and dentist can help reduce a women’s risk of oral health problems.

 


Mandatory Back-To-School Dental Exams By Dr. Dennis R. Pietrini

A new law was passed in Illinois requiring parents to show proof that their children have had a dental exam before they register for kindergarten, 2nd and 6th grades. The law allows schools to withhold final report cards if a child has not been examined. While the law exempts students who are religiously opposed to or cannot afford dental treatment, it may end up excluding the children who most need the treatment. Some school administrators are concerned that this well-intended law may be difficult to enforce.

The Academy of General Dentistry and the American Academy of Pediatric Dentistry recommend that children have their first dental check-up no later than the age of one and every six months thereafter. This may not be practical for many families; however, I believe that children should be examined by at least the age of 2 ½. The sad reality is that I frequently see children ages 3-4 that have a mouthful of cavities. Nearly half of the children in the United States have dental decay by the time they start second grade.

The legislation was written to coincide with the three grade levels when preventive care is most beneficial. By the time a child starts kindergarten, they should learn about good oral hygiene and eating a proper diet. The first adult molars usually erupt by the time a child is in second grade and the second molars by sixth grade. Shortly after eruption, these adult molars should be evaluated for restoration with dental sealants by:

·        Visual inspection

·        X-ray examination

·        Scanning with a diagnostic laser

If no evidence of dental decay is noticed, the teeth (including all grooves and pits) should be thoroughly cleaned, etched with a weak-acid solution, rinsed and sealed. The sealant is a tasteless, odorless plastic-type material that is painted into the grooves and pits. A high-intensity light is used to harden the sealant. This is a fast and painless procedure for the child. When the other adult teeth, referred to as the premolars, erupt they also should be evaluated for sealant therapy.  


All I Want For Christmas Is My Two Front Teeth By Dr. Dennis R. Pietrini

As a child growing up in post-World War II, America, one of my earliest memories of Christmas was listening to a song by Spike Jones and His City Slickers—All I Want For Christmas Is My Two Front Teeth (1948). Since starting my private dental practice in 1972, I have treated as many as five generations of patients in some families. Recently, a darling seven-year-old girl presented with her two front teeth missing. It seems as though it was just yesterday that her mother was a little girl with her front teeth missing.

When I examined the seven-year-old, I found that she had several cavities in her primary (baby) molars. Due to the extent of the decay, I had to give her a local anesthetic to perform the required treatment. As the numb feeling began to take effect, she quipped, “My tongue feels wavy like a camel’s back.” She was very co-operative and allowed me to complete the treatment necessary to retain these teeth. For future function and development a child should not loose the primary teeth prematurely.

In the last sixty years, there has been a dramatic reduction in the number of decayed, missing and filled (DMF) teeth in American children. The main reason for this improvement has been the addition of fluoride to drinking water, toothpaste and mouth rinses as well as fluoride applications in dental offices. In the October 24, 2005 issue of Time magazine, an article discussed the ongoing debate about fluoridating communal drinking water.

In the past, I have avoided editorializing in this column; however, I feel in this case I must express my opinion. As stated in the Time article, the Center for Disease Control (CDC) considers the addition of fluoride in the drinking water to be “one of the 10 great public-health achievements of the 20th century.” To quote the CDC’s director of oral health, William Maas, “A community can save about $38 in dental-treatment costs for every $1 invested in fluoridation.” Nearly every major medical/dental organization or institution endorses the use of fluoride, yet there are several antifluoridation groups voicing their opposition. In a future article, I will discuss why I believe that these groups are very misguided.

 

 

 

 

 

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