Welcome to the smile file. We'll try to give you pertinent and interesting info about the dental field from the dentist's perspective. So, let's get going!

How do you find a good dentist? Obviously a referral from a family member or friend is probably the best way. But if that is not an option, here are some other ways:
Check the internet, and check websites. Does the website look like the dental office put some thought into it? Does it have before and after photos of that dentist's work?
Call the local Dental Association-for example, here in New Jersey, it's the New Jersey Dental Association base in New Brunswick.
Check the list from Consumers Research Council of America. They pick the top dentists by amount of years in practice, continuing education, and name recognition in the community.

When you find a dentist you might want to visit here are some things to look for:
How does the person answering the phone treat you? Are you just another caller, or do they listen to your concerns and answer your questions? Do they offer to give you a tour of the facility?
Do they offer you a chance to meet the dentist before any treatment is started? How does the facility look? Is it clean, modern, and up-to-date? If it's dirty with furnishings from the 1970's, chances are the dentistry is out of date. The technology has changed so quickly, you want to find an office that is on the cutting edge.

When you meet the dentist, does he let you talk and actually listen to you? Or does he just go into a monolog of what you need, and what services he wants to perform on you? Does he address your concerns and needs? A good dentist will take the time to get to know you and listen to you.
It's probably a good sign if the dentist dresses professionally, and creates a good first impression.
If he takes pride in his/her appearance, chances are he'll take pride in his work.
Ask the dentist about his education and experience. Does he keep up with continuing education? Just because he has a diploma on the wall, it doesn't mean he is current on all the new procedures available in dentistry today. Some things you can ask about are: lasers, bonding, invisalign, lumineers, implants, whitening products and all porcelain restorations. We'll go into some of these things at a later date.

When a treatment plan is given to you, make sure you understand your financial obligations. Are they presented clearly to you?

Remember, you'll get what you pay for. If you go to a dentist looking to spend as little as possible, chances are you'll get inferior service. Like anything else in life, better quality usually means more expense. So you need to determine how important your oral health is to you. We'll also discuss this in a future episode.

Hope some of these ideas help.

Click image to view our latest newsletter, "Word of Mouth", for July, 2008 (PDF format).

There has been growing scientific evidence that poor oral hygiene boosts the risks of heart attacks and strokes. New studies link bacteria and bacterial infections as independent risk factors for heart disease.

How does this happen? If you have gum disease (and 90% of the population has some form of it), an open blood vessel from bleeding gums will give bacteria a portal to gain entry to your bloodstream. Once inside the bloodstream, certain bacteria stick onto cells called platelets, causing them to clot and decreasing blood flow to the heart.

So, while smoking, obesity and high cholesterol are the most common causes of heart disease, the importance of oral hygiene as a risk factor for heart disease cannot be overlooked.

We suggest that if you are concerned about your general health, then it is imperative to have superlative oral hygiene. This includes brushing, flossing and using a waterpik. The spray from the waterpik used with an appropriate antibacterial agent will oxidize a lot of the harmful bacteria that reside in the gums. There are up to 700 different bacteria in the human mouth. Poor oral hygiene will cause these germs to flourish.

Also, many people would benefit from more frequent dental cleanings. Many of our patients have their teeth cleaned every 3 to 4 months. As with anything in medicine, prevention is the best defense to avoid disease.

When you get a sore inside your mouth...what is it? Well it could be one of a few things:

Canker sores- Canker sores are small, white areas of swelling or soreness surrounded by redness. They are not contagious. The cause of canker sores is uncertain, but some research suggests that immune system deficiencies, bacteria, or viruses might be the culprits. Canker sores usually heal within one week. While there is no cure, over the counter topical ointments or gels can provide temporary pain relief. You could also ask your dentist if he has "bacteriol" which helps heal canker sores.

Cold sores- People often confuse canker sores with cold sores (also called fever blisters). Cold sores are groups of painful blisters filled with fluid that appear around the lips and under the nose. It is caused by the herpes simplex virus and usually infects a person in childhood. Cold sores are extremely contagious. They last 7 to10 days. Valtrex helps diminish the duration of the sores. You'll need a prescription for Valtrex.

Leukoplakia- Leukoplakia appears on the inner cheeks, gums or tongue and often appears as a thick, white-colored patch. It is usually associated with smoking or smokeless tobacco use. Other causes include poorly fitting dentures, broken teeth, and cheek chewing. It is extremely important to report any signs of Leukoplakia to your dentist, because an estimated 5 percent of cases can lead to cancer. Leukoplakia usually dissipates after the behavior causing it is ceased.

Candidiasis- Candidiasis is a fungal infection also called "oral thrush". Candidiasis appears as yellow-white or red patches in the mouth. It is most common in newborns or in people whose immune systems are not functioning properly. Also, dry mouth syndrome, or people taking extensive antibiotics are susceptible. People who do not remove their dentures to clean, and let the oral tissues breathe can also get candidiasis.
Antifungal medications are usually used to treat candidiasis.

Oral Cancer- Oral cancer often starts as a tiny white or red spot or sore. Sometimes oral cancer presents itself as a sore that bleeds easily or does not heal. It can affect any area of the mouth. If you have pain, tenderness, or numbness anywhere in the mouth or lips that does not go away after a week, contact your dentist. Your dentist can do a brush biopsy or us the "Veloscope" to check if your sore is indeed cancer. Remember, with cancer, early detection is the key.

This is another question I get asked frequently. What is an amalgam filling? It's basically a combination of different metals, including about 50% mercury. Studies have shown that that over time, fillings lose their mercury content. The longer the fillings are in your mouth, the higher the amount of mercury will be released from the fillings. Studies also have shown that mercury vapor is released every time you chew and subsequently, concentrations of mercury levels do indeed increase in your bodies' tissues.

The American Dental Association's stance is that amalgams are safe, and that the amount of mercury released into the body is too minute to be harmful. The ADA does not believe dentists should remove amalgam fillings unless there is existing decay around the filling. However, several states, including New Jersey where I practice, now require dentists to separate the amalgam waste out of the water before it reaches the sewer line. So, common sense dictates that amalgam fillings may be harmful and toxic to the human body. Amalgam fillings also fracture and crumble at the edges, and cause teeth to fracture due to the expansion and contraction of the mercury in the filling. On a personal note, when I remove an old amalgam filling, there is a 90% chance there is recurrent decay under the filling. This is due to the microscopic leakage that occurs along the edges of the filling.

So, should you let your dentist put in an amalgam filling? My personal feeling is no. In my practice, we have not placed mercury fillings in the last 15 years. There are many options, like composite bonded restorations that are chemically attached to the teeth, and contain no toxic metals.

Should you replace your existing amalgam fillings? My advice would be to remove old amalgam fillings that your dentist discovers to have cracks, leakage or decay. Also, if you suffer from an autoimmune disease, such as Multiple Sclerosis, studies have shown that mercury and other toxic metals in your bloodstream may exacerbate your disease. So you may want to remove existing amalgams if you suffer from these types of diseases.

There are also some over the counter products that claim to block the absorption of mercury into your body. These are usually mouthwashes that claim to have a chelating agent, or chemical that attaches to the mercury so it can't be absorbed. If you don't want to have the amalgam fillings replaced by a dentist, these mouthwashes may be an option. However, the evidence is inconclusive as to the efficacy of these products.

You've probably heard of someone complaining of TMJ pain, or have experienced it yourself. What is it? The TMJ is the joint where the upper and lower jaws meet. Temporomandibular disorders can represent a wide array of head pain problems such as: ringing in the ears, clicking or locking of the jaw, headaches, and pain on the sides or back of the head.

What causes TMJ pain? The New England Journal of Medicine writes: "the cause is considered multifactorial, with biologic, behavioral, environmental, social, emotional and cognitive factors, alone or in combination, contributing to the development of signs and symptoms of temporomandibular disorders."

Whew, sounds like almost anything can cause TMJ pain. In my experience, the most common causes are clenching of teeth, grinding at night when asleep, or oral habits like frequent gum chewing. The majority of people with TMJ symptoms are women. Some studies put the number at 90% of cases reported are from female patients. The most common TMJ problem is known as myofacial pain disorder, a neuromuscular problem of the chewing muscles characterized by a dull, aching pain in around the ear that may radiate to the side or back of the head.

What are the options to treat TMJ? Resting the jaw is paramount. You want to give the joint and surrounding muscles time to recuperate. Your dentist can construct a custom mouth guard for you to wear at night to prevent you from clenching or grinding your teeth in your sleep. Heat applied at the side of the face also helps, as well as nonsteriodal anti-inflammatory medications for up to 2 weeks. In more painful cases, some patients are helped by a low dose antidepressant or antianxiety medication. If you're under a lot of stress, stress management can do wonders to rid yourself of the myofacial pain. Sometimes, physical therapy to retrain the positioning of the head, jaw and tongue can also help. Certain jaw exercises can help diminish the discomfort. Obviously, you will want to cease any oral habits like gum chewing or biting your fingernails.

These treatments mentioned above will help alleviate probably 95% of all TMJ issues.
If further treatment is necessary (and this is very rare), I would recommend visiting a multidisciplinary temporomandibular clinic, found at many leading hospitals and dental schools.

I get a lot of patients who come to my office for 2nd opinions wanting to know if their previous dentist messed up, misdiagnosed, or was just plain incompetent.

A lot of issues between patients and doctors are due to miscommunication. The doctor is not listening to the patient, and the patient does not understand the treatment he is receiving. Another issue is when the patient is not happy with the results and feels the doctor has delivered substandard care. This is usually due to unrealistic expectations by the patient, and the doctor not communicating the limitations of the treatment to be rendered.

Like any other profession, dentistry has all types of practitioners. Most are excellent technicians. Some are superlative. Others seem to have limited skills.

How do you find an excellent dentist? Ask a lot of questions about any treatment you will be receiving. Also, ask the doctor if he has been taking continuing education on a consistent basis. Many superior dentists do indeed continue to learn and grow through continuing education. Dentistry is constantly changing with technology improving yearly. Make sure your dentist is up to date. Does he use digital x-rays? Is he fluent in the new procedures you're interested in?

As far as trusting your dentist, let me say this: I would say the great majority are extremely trustworthy. Dentists do not need to "make up" work. There are too many downside risks. Make sure you communicate with your dentist before starting treatment to eliminate results that may not meet your expectations. If your dentist does not communicate well, find a new dentist.

Halloween is fast approaching, and we know the kids love to trick or treat and load up on the goodies. While it is all in good fun, and only once a year, it might be wise to think about what exactly your kids will be loading up on. Candies loaded with processed sugars and corn syrup are non-nutritious, high in calorie content, raise blood sugars, and help destroy your child's teeth. Some suggestions:

Limit your child's stash. Have your child pick out some of his favorite candies and chuck the rest.
Have your child eat his treat after dinner, like a dessert. Then have him brush his teeth before bedtime.
Put a time limit on how long your child can keep the treat. If not eaten by a certain date, throw the candies into the trash (or you can hide them until next year).

At our office, we are offering a candy "buy-back" program. For all children that bring in their Halloween candy, we will give them a $10 gift certificate to a toy store. We also will make a matching donation to St. Jude’s Hospital for the care of children with cancer.

Enjoy the holiday, but remember good health is the best treat of all.

As a dental hygienist, I am constantly asked by my patients which toothpaste is the best. The number of choices available today certainly can be overwhelming, but my answer is always the same. It's not the toothpaste you use, but how you brush that makes all the difference.

Plaque is the cause of everything bad that can happen in your mouth: cavities, gingivitis and gum disease. It has even been linked to serious systemic conditions such as heart disease, stroke and diabetes. Thorough removal of plaque is so important for the health of your mouth and as well as your whole body.

One secret to brushing better is brushing longer. It takes a minimum of 2 minutes to adequately clean all your teeth. Most people brush for 30 seconds. Use a timer if you have to but don't skimp on brushing time. Also, it is very important to clean between your teeth. Over 40% of you tooth's surface is between the teeth. If you are not doing something to clean this area, you are missing nearly half of all your teeth's surfaces. Floss is usually the best choice for this but there are other implements available that can do the job. Just ask your hygienist.

So find toothpaste that you like and enjoy using, brush longer and clean in between. It will not only benefit your oral health but your total body health.

Written by Kathy C