My Blog

Posts for: February, 2018

By Paul David Epstein, D.M.D. & Associates, P.C.
February 26, 2018
Category: Oral Health
Tags: tooth decay  
AlthoughaChallengeChronicallyIllChildrenNeedToothDecayPrevention

Families of children with chronic conditions face many challenges. One that often takes a back seat to other pressing needs is the prevention of tooth decay. But although difficult, it still deserves caregivers’ attention because of the dental disease’s potential long-term impact on oral health.

Chronically ill children are often at higher risk for tooth decay, most commonly due to challenges in practicing effective oral hygiene. Some conditions create severe physical, mental or behavioral impairments in children’s ability to brush and floss: for example, they may have a heightened gag reflex to toothpaste in their mouth or they may not be able to physically perform these tasks on their own.

Some children may be taking medications that inhibit salivary flow as a side effect. Saliva is critical for disease prevention because it both neutralizes mouth acid (which can erode tooth enamel) and is a first line of defense against disease-causing bacteria. And a child’s diet, while designed to support treatment of their chronic condition, may conversely not be the best for supporting their dental health.

It’s best if caregivers and their dentists develop a strategy for decay prevention, which should include the following:

  • Regular dental visits beginning at Age One. Besides monitoring dental health, dental visits also provide cleanings and other preventive measures like topical fluoride or sealants;
  • Brushing and flossing support. Depending on a child’s physical and mental capacities, caregivers (or an older sibling) may need to model brushing and flossing, or perform the tasks for the child;
  • Medication and diet changes. If medications are causing dry mouth, caregivers can speak to their physicians about possible alternatives; likewise, they should see if modifications can be made to their diet to better support dental health.
  • Boosting salivary flow. It’s especially important with children who have dry mouth to drink more water or use aids (like xylitol gum or candies) to boost salivary flow.

Although it requires extra effort and time to give attention to a chronically ill child’s dental health, it’s well worth it. By working to prevent tooth decay early in life, these children will be more likely to enjoy good dental health in the future.

If you would like more information on dental care for children with special needs, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor article “Managing Tooth Decay in Children with Chronic Diseases.”


By Paul David Epstein, D.M.D. & Associates, P.C.
February 18, 2018
Category: Dental Procedures
Tags: bonding   chipped tooth  
WhyBearaChippedTooth

Having a chipped tooth certainly can make life more difficult. It not only keeps you from wanting to smile, but it may also make it harder to eat your favorite foods. And that can be a major problem — especially if you need to eat up to 80 pounds of bamboo every day to stay healthy.

Just ask Bai Yun, the female giant panda at the San Diego Zoo. The 23-year-old animal recently chipped one of her lower canines, and her keepers were concerned that it might impair her ability to get good nutrition (pandas spend as many as 12 hours a day munching on the woody plants). So they decided it was time for a little dental work!

What followed was not unlike a regular visit to the dental office… except that, instead of sitting in a chair, the 227-pound panda reclined on a large table. After being anesthetized, the patient’s teeth were examined, and x-rays were taken. A composite resin was applied to the damaged tooth, and it was cured with a special light. After the repair work was done, her teeth were given a professional cleaning. When the anesthesia wore off, Bai Yun was released in good health — and ready to eat more bamboo.

Tooth bonding with composite resin is the restoration of choice in many situations. This method can be used to repair small chips or cracks in the teeth, and to clear up some spacing irregularities. The resin itself is a mixture of tough, translucent plastic and glass components that can be made in a number of different shades, which look remarkably like the tooth’s natural enamel coating. And the bonding material links up so well with the tooth structure that this treatment can be expected to last for years.

Another benefit of bonding is that it can be done right in the office — there’s no lab work involved (as there could be for veneers or crowns, for example). That makes it a relatively simple and economical treatment that can typically be completed in a single visit. It’s ideal for fixing minor flaws that don’t involve a great deal of tooth structure. It’s also a cost-effective solution for teenagers who need cosmetic dental work, but must wait until they have stopped growing to get more permanent restorations.

While it isn’t usually as long-lasting as restorations like crowns and veneers, cosmetic bonding is a minimally invasive, reversible treatment that can keep your smile healthy and bright for years to come. And that’s important — whether or not you spend most of your day eating bamboo and posing for snapshots at the zoo.

If you have questions about whether cosmetic bonding could help your smile look its best, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Artistic Repair Of Front Teeth With Composite Resin.”


By Paul David Epstein, D.M.D. & Associates, P.C.
February 03, 2018
Category: Dental Procedures
No-orMinimal-PrepVeneersReducePermanentAlterationstoYourTeeth

Porcelain veneers are positive proof that unattractive teeth don't always require an intensive restoration to regain their beauty. These thin layers of translucent porcelain — custom-designed and color-matched to blend with your other teeth — are permanently bonded to the visible side of your front teeth.

Although they can't remedy every tooth defect, they're well suited for mild to moderate disfigurements like chipping, staining or gaps. There are now two types of porcelain veneers: the traditional veneer and the “no-prep” veneer.

The standard veneers require some tooth structure removal, referred to as “tooth preparation.” This is because although they're a millimeter or less in thickness, they can still appear bulky if bonded to an unprepared tooth. To accommodate their width, it's necessary to remove some of the tooth enamel. This permanently alters the tooth so that it will need some form of restoration from that time on.

In recent years, however, other veneer options have emerged that reduces — or even eliminates — this tooth alteration. No-prep veneers are so thin they can be applied to a tooth with virtually no preparation. A more common option, minimal-prep, requires only a minor reshaping with an abrasive tool to ensure the fitted veneer looks as natural as possible. Because of their thinness, these veneers also don't have to fit under the gum line like standard veneers.

To obtain no- or minimal-prep veneers, your tooth enamel needs to be in good, healthy shape. They're also best suited for people with small or worn teeth, narrow smiles (the side teeth can't be seen from the front), or slightly stained or misshapen teeth.

Because there's little invasiveness, these low preparation veneers won't typically create tooth sensitivity and they can often be applied without any form of anesthesia. And because tooth structure isn't removed, they can be “uninstalled” to return to your natural look. Of course, that's not always an easy process since the bonding between veneer and the enamel is quite strong, although today's lasers can be used to detach the veneer quite easily.

If you'd like to consider these minimally invasive veneers, talk with your dentist. If you're a good candidate, you may be able to gain a new smile without much change to your natural teeth.

If you would like more information on how veneers can change your smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “No-Prep Porcelain Veneers.”