Teeth Bleaching (Whitening)

A child's baby teeth are generally whiter than the adult teeth that follow. As a person ages, the adult teeth often become darker due to changes in the mineral structure of the tooth and the enamel becoming less porous. Teeth can become stained from bacteria, tobacco, and foods and drinks, i.e. red wine, tea, coffee, soda, and berries. Certain antibiotic medications (esp. tetracycline) can also cause teeth stains or a reduction in the brilliance of the enamel. Excessive fluoride can also cause tooth discoloration or mottled enamel.

There are several methods to whiten teeth.

• Bleaching Strips
  
• Bleaching Pens
  
• Bleaching Gels
• Laser bleaching

The degree of whiteness will vary from patient to patient, depending on the individual, the shade and type of staining. Intrinsic staining (stain within the the tooth) is much harder to bleach, and may not achieve the results one is expecting. Tooth mottling from excessive fluoride is also tricky when it comes to whitening because sometimes the mottled spots only become whiter.

Bleaching can be done with over-the-counter (OTC) products or in office at a dental office.

If you're thinking about (OTC) bleaching, we would advise sticking with a reputable brand of a bleaching product, such as Crest, Colgate, or Rembrandt. We advise staying with these companies because they have been around for years and have a long standing reputation to maintain. Therefore, their bleaching products are safe to use. We cannot be sure of the efficacy and side effects of the many other brands that are available.

If you're thinking of using an OTC bleaching product, do not use more than once in a 6 month period. Also, generally, we do not recommend bleaching, whether OTC or in office, for individuals under 18 years of age. It depends on the bone growth completion of the adolescent. This is due to eruption not fully completed or additional jaw growth not yet completed. If done too early, an area not bleached could show up later,on the exposed tooth , making it difficult to match.

Professional dental whitening is performed in a dental office and monitored by a licensed dentist. In office bleaching can be done two ways:

• Gel in trays performed at home (monitored by a dentist)
• Gel and light combination performed at the dental office
  

When performed under the supervision of a dentist, whitening is safe.

The side effects of any bleaching procedure, at home or in office, may include sensitivity and minor tingling sensations. These side effects always dissipate.

If you have any additional questions regarding dental whitening or are thinking about having your teeth whitened, please feel free to discuss it with us at your next visit or call us at (908)-232-8455!

We hope you found this information helpful!

The above information is for general educational purposes only and does not constitute health or medical advice. Consult a qualified dentist to determine an individualized treatment plan.

Gingival Recession

Receding gums is a condition found most common in adults over the age of 40. Therefore, we felt it would be a topic well received by many of our patients. We hope you find this article beneficial.

Recession refers to the roots of the teeth being exposed caused by a loss of gum tissue or retraction of the gingival margin from the crown of the teeth. Although it is a common problem in adults over the age of 40, it can occur starting in the teens.


There are several possible causes of gingival recession:
* Abnormal tooth position
* Thin, fragile or insufficient gingival tissue
* Overaggressive brushing
* Periodontal disease
* Inadequate brushing or flossing (allows bacteria to build up between the teeth)
* Eating disorders (self inducing vomiting)
* Dipping tobacco (it affects the mucus membrane lining in the mouth and cause receding
gums over time)
* Adult orthodontic movement of teeth
* Piercings in the lip or tongue (wears away the gum by rubbing against it)
* Sensitivity to Sodium Lauryl Sulfate (SLS), an ingredient in most commercial toothpastes

The following signs and symptoms may indicate gum recession:

* Sensitive teeth
* Teeth may appear longer than normal (if gums are receded, a larger part of the crown in visible)
* The roots of the teeth are exposed and visible
* The tooth feels notched at the gumline
* Change in the tooth's color (color difference between enamel and the root)
* Larger spaces between teeth (gums don't fill in between anymore)
* Cavities below the gum line (roots are more susceptible to decay due to the softness of the
root surface)

If gum recession is caused by gingivitis, the following symptoms may also be present:

* Puffy, red, or inflamed gums
* Gums bleeding while brushing or flossing
* Bad breath (halitosis)

The first step to treatment is the address the problem which has caused the recession.

Some advice to arrest the recession or prevent it is:

* Use a soft toothbrush
* Gentle brushing technique
* Improved oral hygiene
* Regular dental check ups and cleanings

For more advanced cases, treatment may include:
* Soft tissue graft surgery which uses tissue from another site in the patients' mouth to replace receded gums
* New research is focusing on using stem cells to culture the patients' own gums to replace receded gums

Most cases of recession can be monitored, coupled with changes in technique or hygiene, and may never require invasive treatment. If you have any questions regarding recession, please feel free to talk to us about it on your next visit, or email us at dentalinfo@drdaviddersh.com.

- Dr. David A. Dersh, Tracy, & Phyllis

The above information is for general educational purposes only and does not constitute health or medical advice. Consult a qualified dentist to determine an individualized treatment plan.

The Truth About Thumb-Sucking

Many children have a habit of sucking their thumb. Parents need to be aware of the complications of thumb sucking and when it should be addressed.

Two questions are most frequently asked regarding thumb sucking:

* Does thumb sucking interfere with dental development?
* Does my child need to stop thumb/finger sucking?

Many dentists are satisfied to wait until the child is ready to be seen by an orthodontist; they let the orthodontist "deal" with it.

Preventative dentists would like to see the thumb sucking cease early as to not interfere with the normal processes of orofacial growth and development, but usually not until permanent teeth begin to erupt. Many times as the child starts school , peer pressure can stop the habit.

Most orthodontists feel it is crucial to address the thumb/finger sucking habit by the time the adult incisors (front teeth) begin to erupt.

Dental Complications

If a thumb or finger exerts a force for hours per day against anterior (front) teeth, positional changes of the teeth can occur. The most common changes to the teeth that can occur include the development of posterior crossbites, anterior teeth that overjet, and an open bite of the anterior teeth. The direction of jaw growth may also be affected. Constant pressure of the thumb or finger against the roof of the mouth can also contribute to the development of a narrow, high arched palate.

Other Complications

Thumb sucking can also lead to :

* Abnormal tongue rest and functional patterns
* Altered respiration
* Open rest posture of the lips
* Skin, cuticle infections or calluses

The American Dental Association and the American Academy of Pediatrics agree and believe that until the age of 6, thumb sucking usually does little or no damage to the teeth or the orofacial structure. After age 6, however, chronic thumb sucking may begin to do damage and should be addressed.

The above information is for general educational purposes only and does not constitute health or medical advice. Consult a qualified dentist or physician to determine an individualized treatment plan.

Beware of Acid and the Effects It Has on Your Teeth

We all have our vices. It might be soft drinks, coffee with sugar, wine, fruit and juices, energy drinks, or sucking on hard candies. But are you aware of the harmful effects these can have on your teeth?

The acid in food and liquids can cause irreversible erosion of tooth enamel. The results of the erosion can include, pain, sensitivity, higher incidence of decay, and a darker appearance in your teeth because the layer below the white enamel is a darker shade.

Generally, teeth affected by this type of damage cannot always be fixed with fillings; more often the treatment consists of veneers or crowns.

The following are ways to minimize the damage:

* Limit consumption of high-acid foods and drinks
* Use a straw for soda or juice - it helps minimize contact with the teeth
* Eating acidic foods as part of a meal will help neutralize and eliminate acids. The worst time to consume these foods is just before bedtime (saliva production decreases during sleep)
* Neutralize acid consumption by eating cheese or swishing with water or a fluoride rinse
* Brush your teeth with a fluoride toothpaste 30 minutes before consuming acidic food or drinks is most beneficial
* Chewing sugar-free gum can help stimulate saliva, therefore, neutralizing the acid in your mouth

People who suck on lemon or orange slices, as well as runners who suck on hard candies while they run, are "bathing their teeth in acid". That's not a good idea.

In addition to acidic foods and drinks, people with eating disorders, such as bulimia, are at a high risk of enamel erosion due to the vomiting. Many people have acid relux who are also at risk because of the acid that may be coming into their mouths from their digestive systems.

If you suspect you or a family member may be suffering from any of the above conditions, you should be evalulated by a medical doctor for a diagnosis.

The above information is for general educational purposes only and does not constitute health or medical advice. Consult a qualified dentist to determine an individualized treatment plan.

Oral Cancer

The death rate for oral cancer is higher than that of all the cancers we hear about on a more regular basis.

The rate is so high not only because it is hard to diagnose, but due to the fact that is is discovered late in its development. It is often discovered when it has spread to another location, often times the lymph nodes of the neck.

Oral cancer screening and early detection is key to a favorable prognosis.

One of the reasons oral cancer is so dangerous is that the early stages may not be noticed by the patient. There are several types of oral cancer, but 90% are squamous cell carcinomas.

More recent data leads us to believe the fastest growing segment of oral cancer are non smokers under the age of 50.

Risk Factors

- Tobacco use
- Alcohol use
- HPV (human papilloma virus)

HPV is sexually transmitted between partners and is conclusively implicated in the increasing incidence in young non-smoking oral cancer patients. It should be noted that tobacco use in all forms is the number one risk factor in people over 50. However, for people under 50, HPV is replacing tobacco as the primary causative agent in the initiation of the disease process.

Signs & Symptoms

- white or red patch in the mouth
- small indurated ulcer
- lump or mass
- pain or difficulty swallowing
- wart-like mass
- hoarseness (lasting a long time)
- numbness is oral/facial region
- persistent ear ache

Have any sore or discolored area that does not heal within 14 days looked at by a dentist or doctor.

Patients with Dentures should also be checked yearly.

The above information is for general educational purposes only and does not constitute health or medical advice. Consult a qualified dentist to determine an individualized treatment plan.

Participating Vs. Non-Participating Dental Insurance Providers

So, what is the difference between a participating and a non-participating dentist with an insurance company??

A participating provider chooses to enter into a contractual agreement, agreeing to accept the benefits that the insurance company is willing to pay for a particular procedure as payment in full.

A non-participating provider does not enter into a contractual agreement; and, therefore, is not bound by the limits of what a particular insurance company is "willing" to pay for a procedure.

Here's a way to look at this insurance scenario:

A participating dentist is working "FOR" the insurance company, as he or she is being governed by them as to what he or she will receive as payment. Keep in mind that participating dentists need to see a volume of patients to close the monetary gap that the insurance company leaves open. In most cases, the quality of care can be affected due to the fact that they have to see more patients to cover their overhead. Procedures may be recommended which are more costly. Treatment can be guided by covered procedures and fee scheduled rather than by chosen treatment plan by patient and dentist.

A non-participating dentist is working for YOU, the patient. He or she is not willing to accept the much lower payments for their procedures, and is not willing to sacrifice the quality of care in order to see a volume of patients. By not participating, decisions regarding your treatment are made between you and your dentist based upon YOUR dental needs and YOUR desires rather than the plan restrictions of the insurance policy.

Of course, the insurance companies encourage you to see participating providers, as they keep more money in their pockets when that situation exists. This is a common practice with insurance companies.

The bottom line is choose a provider that you trust, feel comfortable with, and provides you with quality care. After all, you are the patient and you do have a choice. Although many patients do not have any dental insurance, many of those who do have dental insurance have chosen our practice for all of these reasons.

Dental Sealants - A Quick Guide from the DMD

Dental sealants are used to seal the chewing surface of children's back teeth (molars). It is the molars that have pits and grooves on the biting surface and are, therefore, more susceptible to decay.

The age of the child may vary on when the sealants are placed depending on the eruption of the molars. The first permanent molars erupt at around 6 years of age, but some children will experience the eruption earlier or later. However, the molar must be fully erupted (fully positioned above the gum) before a sealant can be placed. The second permanent molars usually erupt around 12 years of age, but, again, this will vary in each child.

Not all teeth require the protection that dental sealants provide. It is the shape of the grooves and pits that place some teeth at a greater risk than others. Children with deep and narrow grooves have a more urgent need for sealants.

How long a dental sealant lasts will vary. A sealant in place for 3-5 years would be considered a success. However, any length of time a sealant is in place and protecting the tooth is beneficial. Many sealants placed on the teeth of children can remain intact in the grooves as an adult.

If you notice a portion or even the entire sealant has come off, you should let your dentist know. Additionally, the integrity of the sealants should be checked at 6 month recall visits.

The procedure for placing a sealant requires no drilling. The tooth is first etched with a liquid to prepare the tooth for the sealant. Then a flowable material is applied to the chewing surface of the tooth and then cured with a light to harden the material.

In addition to dental sealants, a dentist will consider other variables that might contribute to decay. This should include the amount of plaque that is present, the amount of decay in the past, and the patient's exposure to fluoride.

David A. Dersh, DMD, PA serves its patients by educating them on their options to best meet their dental needs, empowering them to make informed decisions about their oral health. We work with individuals and organizations to provide efficient and cost-effective dental care.


The above information is for general education purposes only and does not constitute health or medical advice. Consult a qualified dentist to determine an individualized treatment plan. Although every reasonable effort has been made to ensure the contents of this article are current, accurate and complete, neither David A. Dersh, DMD, PA nor any other party involved in the publication of this article make guarantees of any kind as to its accuracy, merchantability or fitness for a particular purpose and are not responsible for any errors or omissions of any kind.