Vanity with Style? Should You Get Tooth Jewellery?

Can you spot the diamond on my canine?

Human beings have been interested in their appearance for thousands of years. Decorating their bodies with tattoos, piercing ears and other parts of body but also decorating their teeth. Already 2500 years ago were the Native Americans making their teeth stand out with gems. This is a phenomenon that has lasted ever since.

Tooth Jewels – Any Harm?

Well in the mid-nineties I had my first tooth jewel. I was a dental student when the tiny golden figures for the teeth came in fashion. Heart, star, droplet were the figures to choose from. I chose a heart and it was attached to my upper right incisor with a bonding adhesive they use to bond the filling.

For a very long time I was happy with it but then I saw other people who had similar jewellery on their teeth. I thought it looked like people had something stuck on their teeth that needed to be scraped off with a finger nail. It didn’t look like you had golden figure on your tooth and the shape was only visibly in very close distance. I did not want people to think I had food stuck on my teeth – after all I was working as a dental professional already.

But then! I saw somebody having a diamond on his tooth and I was sold there and then. It wasn’t a diamond inserted on a golden figure or a diamond glued on the surface of the tooth. It was a diamond that was planted inside the tooth – to the level of the surface of the enamel.

So I went to a jewellery shop and asked for a small diamond. I asked my colleague to attach it to my canine tooth. He used a diamond bur which had the tip shaped like a cone – similar to the shape of the bottom of the diamond. The dentist drilled a small hole on the enamel with the tip of the bur. The hole was just slightly larger than the diamond’s size. Then he prepared the hole the same way as he would do when making a filling – back then it was first the blue etching gel, then the primer and then the bonding adhesive (nowadays the primer is normally self-etching). Then he took a small piece of a blu-tack and took hold of it with the forceps. He attached the top of the diamond to the blu-tack. Like this 

I know what you are thinking.

Blu-tack!? What the… it’s not something we use in dentistry…

Let me tell you that this dentist was very inventive and clever. He had found a way to keep hold of the difficult shape of the diamond. The last thing you would need is to see the patient’s precious piece of rock flying past your eyes and on to the floor where you, the nurse and probably the patient would be spending the rest of the appointment bottoms up.

Anyway, the dentist placed a small amount of composite filling to the bottom of the cavity he had just made and inserted the diamond to it’s place. Then he light cured it (for non-professionals this means the special light will harden the filling material).

So Is There? Harm I Mean?

It was in 1997 when the diamond was attached to my tooth and yes, it is still there! Some people notice it, some don’t. Often I forget it is there until someone mentions it. I have never regretted I let the dentist drill my intact tooth to insert a diamond.

So to the question on the title – is there any harm in having jewels attached to your teeth.

The ones that are attached to the surface of the tooth

  • are not harmful in any other way than if you’ve chosen a jewel that looks like you have lettuce from your lunch stuck on your teeth. The reason why people are staring at your teeth is not because of your sparkling smile. They are simply going through a silent debate whether or not to tell that you have something stuck on your teeth. Normally they decide not to (this is something I would like people to have more courage at. You should always tell if someone has food stuck on their teeth – we all know how it feels like when you come home after work and look in the mirror and see the parsley between the front teeth…)
  • can be removed without any sign on the tooth you ever had one

The ones that have required tooth material to be filed or drilled away

  • will require a filling or similar to replace the jewellery if you decide to remove it. And it means the tooth is never the same as when it was intact
  • are best to be attached to the teeth that already have filling/s. Do not follow my example!

But there are also removable tooth jewellery as well. Read further to find out.

You Sure You Want to Look Like a Rapper?

If you plan to have large tooth jewel that requires extensive preparations on teeth, remember that

  • you might look like a rapper/jail bird – do you have a habitus to go hand in hand with your new looks of the teeth?
  • some employers dislike visible jewellery and it can be the one single reason not to choose you for the job
  • some of the extensive jewellery like grills look like you have an orthodontic appliance attached to your teeth, which I’m sure is not the intention

About grills. They can pose a risk to your occlusion and cause decay, abrasion (type of tooth wear, see my post about them) and gum problems. It is advisable to wear removable grill only when absolutely necessary. Do not try to glue it to your teeth if it is meant to be removable.

Here’s further reading on the subject (honestly, what was Madonna thinking?).

  • extensive preparations mean that you will need extensive restorations if you decide to remove the jewellery from your teeth

Conclusion

The most important thing is to consult your dentist before you do any extensive alterations on your teeth. It should always be a dental professional who attaches the jewellery on your teeth.

 

 

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Vaping: An Attractive Option or a Destructive Alternative for Oral Health?

Guest post by Jack Simon

Here it is my dear readers – the very first guest post on Dental Revelations Blog. Jack Simon is a skilled writer and I am happy that he has offered to write on my blog. Today’s subject is an important one.

Many people are turning to e-cigarettes as the conventional cigarettes are increasingly considered as anti-social. Plus there is this false belief that vaping is safer health wise than conventional cigarettes. Vaping is not safe and there are many health aspects you should consider if you opt for vaping. Jack Simon has comprehensively pointed out those health aspects in this guest post.

Please read it though before the whole vaping business blows up in your face. Literally.


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Are e-cigarettes harmful to your health? Image source: http://www.pixabay.com

The flare of e-cigarettes (ECs) in the recent years has put the health professionals’ in a situation to race against time and discover whether its introduction has been for better or for worse.

ECs, also known as ENDS (Electronic Nicotine Delivery Systems) are the battery operated devices with a metal heating element, which vaporizes a solution comprising a range of chemicals.

These days, more and more individuals are taking it up in preference to or in addition to traditional cigarettes. This hot trend in the market has raised some serious questions for government and public health professionals, as the growth of the products has seriously outpaced the regulations.

People consider e-cigarettes to be a healthier option. A common line that they use to give themselves a false gratification is

“I just vape & don’t smoke and it is not injurious to health”

This fake sense of security in e-cigarettes that they pose no harmful impact, as they use water vapor is actually not true. In reality, the notion that these products are no threat is in fact not 100% verified. If you also have the same approach, then it would be a good time to take a closer look at them and consider the effect they may have on our oral health.

Background

Its introduction in the US led to its extensive use by both smokers and non-smokers. Statistics indicate that about 20.1% of adult smokers tried ECs in 2011 and the rate of its use by school children has doubled during 2011-2012 in the US.

Sales of ECs in 2012 were estimated to be $1.7 billion in the US. If not regulated properly, the economics of ECs are expected to have remarkable growth possibility for the tobacco industry and beat the sales of tobacco smoking cigarettes in the coming decade.

Researchers are conducting a range of experiments to look at them closely. One of such findings showed that e-cigarettes consumers are acquiring much higher levels of chemical toxins – this is in clear-cut contrast to the harm decreasing patter in the ads on offer by ECs companies.

These devices have initially escaped scrutiny for safety standards and rules, but the FDA has latterly begun efforts to form regulations that would control the marketing of these products. In view of their warm acceptance and usage, the National Institutes of Health (NIH) held a workshop in 2013 to find-out the future research concerns relating to the effects of ENDS on health, potential use in cessation of smoking, addictiveness and public well-being. Furthermore, rate of queries from patients to medical practitioners relating to the safety and effectiveness of ECs as smoking cessation devices are increasing with increased acceptance.

In recent study by the U.S. Department of Health and Human Services, it has been clarified that during the process of nicotine vaporization, a variety of chemicals and metal particles are produced by these devices. The chemicals identified in the aerosols of ECs are: propylene glycol, formaldehyde, glycerine, acetaldehyde, toluene, acrolein, nickel, cadmium, nitrosamines, silicon, aluminum, and lead.

While the levels of these identified compounds and metals in ENDS are quite lower than tobacco smoke, some of them have been found to be carcinogenic and genotoxic by many studies. In addition, smoking characteristics and potential for exploitation by consumers of ECs, periodontal and upper aerodigestive tract epithelial cells, nicotine yield and degree of exposure of oral, physical characteristics of vaporized nicotine and other chemical products are tremendously different if compared to conventional cigarettes.

Let’s Unveil Its Effects on Oral Health

Apart from the recognizable health implications, vaping pose severe damage to your oral health (teeth, gums and tongue). Problems like tooth decay, teeth loss, gingivitis, periodontal disease and oral cancer are the most common ill-effects caused by conventional cigarettes and e-cigarettes. The nicotine absorbency is very high in ECs.

The Journal of the Indian Society of Periodontology published a report to disclose that nicotine significantly contributes to the development of gum problems (gingivitis and periodontitis), which can be the leading cause for bad breath and inflammation throughout the body.

The Journal of Cellular Physiology published the result of recent study, showing that a high rate of mouth cell die with the increased exposure to e-cigarette vapor.

Studies have also revealed that the menthol additive in ECs liquids have a destructive effect on the epithelial cells and the fibroblasts within the periodontal ligament. Its longer term use may also increase the risk of oral cancer; however this is still under investigation.

The Role of Nicotine in Destroying Your Oral Health

  • In Gum Recession
    Nicotine is a vasoconstrictor; therefore it has the tendency to contract the muscular wall of the blood vessels and cutting-down the amount of blood that flows through the veins. With restricted blood flow, the gums do not get sufficient oxygen and nutrients that is necessary for them to stay healthy. Moreover, it chokes mouth tissues, thus cause death of the gum tissues.

  • In Causing Bad Breath
    Nicotine constrains the body’s ability to produce saliva. Lack of saliva can leave your mouth prone to bacteria buildup, tooth decay and dry mouth. This also affects the mouth’s normal inhibitory function of cleaning and reduces the body’s innate capacity to heal and generate new cells.

  • In Intensifying Grinding
    Nicotine acts as a stimulant that fires-up the muscles, making you grind your teeth more intensely or might prompt you to start grinding even if you aren’t a grinder.

  • In Hiding Tell-Tale Signs of Gum Problem
    Nicotine can mask the initial signs of gum disease and makes it hard for a dentist to diagnose it.

Various researches have clarified that vaping impose many potential ill-effects to our oral health. This should be enough to the most rabid vapers to see the whole picture clearly that it is not safe.

The manufacturers of ECs claim that their product is a healthier therapeutic alternative to conventional smoking, but in the absence of any verified scientific study to back this contention, it would be ideal to avoid it.

Nicotine inhalation puts the person’s dental health at greater risks. Regardless of whether these devices pose less harmful effects than conventional smoking, health specialists concur that they are by no means safe.

Your likelihood of getting gum problem is higher as long as you are using nicotine, so visit your dentist in a frequency of three months to prevent tooth loss, bone loss, gum recession and many oral issues.


Author Biography

Jack Simon is a content strategist at Irresistible Smiles. He has flair of writing engaging articles about oral health care. His keen interest in presenting the dental care issues in a simple and straightforward manner is appealing to the readers.

Told You So

 

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You think the floss is effective? In most cases it is not.

I couldn’t hide my satisfaction when I read the news in the US about effectiveness of the floss. Finally something I have been preaching about is out and in the open for everyone to read.

You see I have met many dental professionals who have doubted my way of giving oral hygiene instructions especially regarding the floss. I have met so many of them that I have stopped explaining the reasons behind my recommendations.

My hope has been that some day they would get enough experience to notice that the floss isn’t doing a proper job. Or that they would start using the disclosing solution (I use Rondell Disclosing Pellets) which would definitely prove it.

We’ll see what happens. My fear is that many will stubbornly stick to their old ways. Change will always bring along resistance.

If you haven’t read my blog before, please take a look at this page about my recommendations.

And click this link if you haven’t read the news about the effectiveness of floss yet.

Eeny Meeny Miny Moe – Which Type of Tooth Wear?

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There are four types of tooth wear that we diagnose from patients’ mouths. Erosion, abrasion (I’m sorry for a missing link – I did not agree with any of the images of abrasion), abfraction and attrition. The easiest ones from these to diagnose are the erosion and attrition. You can’t go wrong with them. But it is completely different case with abfraction and abrasion. I run into this very often with my patients.

When a dentist or a hygienist sees tooth wear on the neck of the tooth they diagnose it by default as abrasion caused by too vigorous brushing. They recommend softer toothbrush and this silly brushing technique called Bass (it is so silly that I think I am going to dedicate one post entirely to this technique).

This normally leads into a situation where patient begins to be too careful with the brushing because she doesn’t want to cause further damage to the teeth. That’s when the plaque starts to build up to the gum line, gum gets inflamed because of the plaque and the patient begins to notice bleeding when brushing. Now she’s even more careful with the brushing as in her mind bleeding means she’s doing something wrong – brushing too hard like the dentist said she is.

But what if the dentist/hygienist misdiagnosed the tooth wear? What if the correct diagnosis was the abfraction?

Tooth wear – What to Check?

When you see a tooth wear that you are tempted to diagnose as abrasion, stop for a moment before you proceed giving advice on brushing. Instead do the following:

1. Check if there is mobility on the teeth affected by tooth wear

2. Check if there are interferences on side movements and protrusion

3. Check if there are shiny facets on occluding surfaces

If you get positive answer to even one question the chances for the tooth wear to be abfraction are great. And in this case telling patient that the tooth wear is caused by her brushing can be damaging in many ways:

  1. It is hard to convince a patient that they are not actually brushing too hard and that they have not damaged their teeth by it. I have my ways of convincing the patient but life would be soooo much easier if I didn’t have to.
  2. The dentin will decay very easily (as I’m sure you know) and plaque accumulating and staying there undisturbed for longer period of time because of too careful brushing will very quickly cause decay. And we all know how these fillings in the cervical area are pain in the butt. Somehow they always seem to have overhangs or they come off when scaling. Sound familiar?
  3. The teeth where the surface of the root (dentin) has been exposed by receding gums will get sensitive if the plaque builds up.
  4. If the tooth is mobile and has already bone loss the plaque building up to the gum line and inflaming the gum can be disastrous. Please memorize that

MOBILITY + PLAQUE = RAPID BONE LOSS

The Cause for Abfraction Needs to Be Dealt With

When a tooth interferes with full closure, it will trigger deflective interferences6-8 and cause any of the 7 signs and symptoms of occlusal disease such as hypersensitivity, abfractions, mobility, excessive wear or fractures, and muscle or temporomandibular (TM) pain.

There is no consensus amongst the dental professionals over the right approach to occlusion. Is this the reason why signs of interferences on occlusion are ignored or unchecked and the tooth wear is so easily made as patient’s fault?

The quote above is from an article The Three Golden Rules of Occlusion in dentistrytoday.com and you can read a full article here.

But by Whom?

To be honest – and like I have expressed in my previous post – I would not let just anyone touch my occlusion. I would love if the dentists would refer patients to the specialist in prosthodontics and stomatognathic physiology because they have the best knowledge and skills to treat the occlusion. And that’s something every patient is entitled to.

Guilt Is a Heavy Load to Carry

I have often noticed that patient feel unnecessarily guilty over damaging their teeth. They feel guilty and desperate over the fact that the damage done by brushing is irreversible. And that they are not sure if their brushing technique is still damaging their teeth hence too careful brushing to make sure they are not.

I believe that guilt does not lead us forward in life, it does not bring anything positive into our lives. Therefore I always try to relieve my patient’s guilt whenever it is possible.

In the case of tooth wear and some dental professionals way of putting the blame on patients’ brushing technique I always have the same conversation with a patient. It goes like this.

Me: Have you been told that you brush too hard?
Patient: Yes I have.
Me: I thought you might have. You see when a patient is told this, she starts to be too careful and then the plaque starts to build up and there is actually plaque in the gum line of your teeth. (I take a mirror and show the plaque to the patient)
Patient: Eww..
Me: I personally try not to tell patients that they are brushing too hard because this leads to too careful brushing which will cause more problems like decaying and gingivitis. Instead I interview the patients about how they brush their teeth and correct it if necessary. You see the tooth wear can be caused by other things than just vigorous brushing… 

Prior to this conversation – in the beginning of the treatment – I have interviewed the patient and asked about her oral hygiene habits. Which brush she uses? How often? How often does she replace the brush head/brush? How does the brush head look like before replacing it? Spread or still like new apart from colour fading? This is why I can continue the above conversation like this.

Me: In your case I doubt it that the tooth wear is caused by your brushing but I will just in case show you the right technique. I will first just check couple of things…

And then I check the mobility, the interferences and the occluding surfaces. I feel great satisfaction when the teeth affected by tooth wear have mobility on the side movements. I am on the right path!

The patient is visibly relieved when they can stop worrying about their brushing. Well who wouldn’t be! There is enough to worry about in life even without worry over brushing.

 

 

Ever Seen a Patient with an Implant? Read This!

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Today I saw a patient who had had an implant done to replace upper right first molar. The implant treatment was finished a year ago in another practice.

Since then the patient had seen hygienist twice in my practice. The implant crown itself looked immaculate but the gum was very red and puffy and it bled heavily after probing.

I knew what to ask next and I even knew the patient’s reply to this.

“Were you told how to clean the implant at home?”

“No I wasn’t” replied the patient with is-it-supposed-to-be-cleaned-expression on his face.

This happens too often. Almost every time I see a patient who has recently had an implant done.

Note for all the dental professionals who make the implant treatment’s final stages and do not give oral hygiene instructions (OHI) for the patient:

You should always tell and show how the patient can clean these costly pieces of metal and porcelain. It is your responsibility as a dental professional and the paying patient’s right!

Can you give me any other excuse for not giving OHI than the fact that you are too busy making money and forgetting the basics? I believe you cannot.

And you hygienists who see patients with implants:

  1. Always check how the patient is cleaning them. More so if the gum around the implant is either bleeding or there is plaque around it
  2. Advice if necessary and show in their mouth how it is done
  3. Check if the patient understood your instructions by asking them to show they can do it. Teach them if they struggle
  4. Check on a follow-up visit that the gum has healed. If not, refer to a dentist

Why Is It So Important?

With the implants it is vital that there is no bleeding in the surrounding gum. They will get an implant’s equivalent to gingivitis – peri-implant mucositis which can lead to the peri-implantitis (same as periodontitis with teeth) very rapidly. The worst case scenario is that the implant will lose it’s integration to the bone which could have been easily prevented.

The patient I saw today left home with instructions on how to look after his implant. And I will see him for a follow-up visit to make sure the gum has healed (can you see the shining halo around my head?).

Honestly, it’s not that hard to do your job properly so shape up please!


Here‘s further reading on the subject.

Superiority of the Philips Sonicare Toothbrush

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Philips Sonicare forever!

I used to be brainwashed by one of the biggest electric toothbrush manufacturers and thought that there is no better toothbrush than these round-headed ones. I was so stuck in this illusion that I didn’t even give another toothbrush a chance to be better.

But then I moved to another country where two of the biggest toothbrush brands were almost equally popular compared to my country of origin where this manufacturer with round-headed toothbrush was and is dominating the markets.

In my new country of residence I was offered a free trial of the Philips Sonicare. I was amused by the looks of it (it was the old model) and thought it wouldn’t be a very good toothbrush. I almost declined the free trial because I was so convinced about the superiority of this round-headed toothbrush.

But then I gave it a go. It was ticklish as hell at first but thankfully my colleague dentist had warned me about it. I carried on using it for the full two minutes. Once I was done I got my moment of awakening.  My teeth had never felt better. So smooth, so clean.

Patient Case

I was treating a lady – lets call her Sue – at her early twenties for severe gum disease. She had already had periodontist treatment and understood the severity of the situation considering her young age. Sue was very motivated to look after her teeth and did everything she was advised to do.

Sue had a surface retained glass fibre reinforced periodontal splints (everStick®PERIO) on her lower and upper teeth. She was using Tepe interdental brushes of various sizes twice a day and an electric toothbrush – the round head one. She changed the brush heads every month (even though she was informed it was necessary every 3 months). Her brushing technique was checked many times and it was perfect.

But every time I saw Sue for the 4-monthly scale and polish she had supragingival (visible) calculus on her lower front teeth. Lots of it. And she started to be very distressed about it because she was doing all the right things to prevent it. I tried to ease her worry and told that the supragingival calculus was not a problem gum wise as long as it was removed regularly. And in her case the gum didn’t even get inflamed by the presence of supragingival calculus. But it did not calm her mind. She didn’t like the looks of it as it was clearly visible for anyone when she smiled.

I had no idea what to advice more than I already had. She had all the right tools – interdental brushes and a latest model of an electric toothbrush. She used them often enough and with a correct technique.

Then I thought about Philips Sonicare I was using. I suggested to Sue that she could change her toothbrush. I expressed my frustration over the fact that she had spent quite a lot of money for the current toothbrush but this was all I could think of that might help her. I showed her the correct technique of the Sonicare just in case she followed my advice.

Next time Sue came in she had a wide smile on her face when she entered my surgery. She said the calculus had not built up at all! Sue had gone straight to the shop after the last visit and bought the Philips Sonicare toothbrush. She was very happy and thankful for the advice I had given.

This was even more of an eye opener for me than my own first experience with Philips Sonicare.

Why Is It Better?

The name says it all. It’s because of the sonic vibration. When used correctly the sonic vibration can reach beyond the bristles as the sonic vibration travels through the liquids in mouth.

People who think Sonicare is not a good toothbrush have not used it with a correct technique.

Conclusion

In my country where I live and work now the Philips Sonicare toothbrush is not very widely used or recommended by the dental professionals. I am considered as odd one out when I tell I use one. And even stranger it seems that I recommend it to some of my patients. Almost as if I didn’t know my business.

In the dental show case I didn’t even find a representative of Philips Sonicare from any stands. And I cannot find any contact details for a rep to invite her to my practice or to express my views over their marketing strategy. You see the marketing is very poor compared to their competitor who has given trial models to my practise with disposable brush heads so that the patient can be shown the correct technique etc. They give out free electric toothbrushes to the professionals (I have written about it on my previous post) and visit practices regularly to promote their products.

But thankfully the Philips Sonicare toothbrush is available in the shops. And I am doing a small-scale marketing for them. My hope is that they would take more aggressive approach to the almost non-existing marketing. I could even go to the next show case as their representative just to annoy the rep of their competitor who told me that the Philips Sonicare is as effective as manual toothbrush (you can read about it here).

It would definitely make my work easier when convincing the patients about the superiority of the Philips Sonicare toothbrush. And perhaps my colleagues will start to recommend it too.

Here are couple of models of Philips Sonicare electric toothbrush:

Basic model with 31000 brushstrokes per minute (don’t buy anything lower than 31000)

The flagship model with 31000 brushstrokes per minute