It was bound to happen. Green tea seems to do wonders to almost all of the body, so why not the gums? The anti-oxidant properies of green tea are well know and I hope someday it will cause my head to grow some hair. But for now let's revel if the fact that  it can be very beneficial to the health of the gums. We already know from many studies have shown that green tea improves heart health and is a general body tonic. So lets explore the dental implications of this.

A new study published in the respected Journal of Periodontology and led by Dr.Y. Shimazaki of Hyushu University has show great promise. In a study of 940 men age 49-59 years old, those men who regularly drank green tea had better gum health. The researchers made measurements of the bleeding,  the gum pockets and the size of the connection of the tooth to the bone. Each of these three indicators dropped for each cup of green tea consumed daily. In other words, the more tea the better. Dr.Shimazaki speculated that green teas antioxidant catechin was the cause of the improvement. This agent has been shown to reduces inflamation in many parts of the body and can cause major damage in many organs.

 Inflamation is also one of the causes of damage to the gums. Of course great oral hygiene is the major factor in gum health as always. That is why we put such great emphasis on regular visits and why we nag incessently about it.

It is hoped that such a simple way to improve gum health will cause many people to use it daily. I recommend its use frequently not only for improved gum health, but for improved health in general.

Tip of the day. We have not seen a patient who not shown an improvement in their dental health when using an electric tooth brush. Call us for detailed advice.

Best regards,   AM

Yes we are bonding and every day. Dental bonding is a frequently used process, so I thought I would pass on a little information about it. The word bonding, in a dental sense, is the process of attaching a white filling material to a tooth. By carefully treating the surface of the tooth and creating slight porosity a thin layer of resin can penetrate into the tooth and strongly adhere. Next  a filling can be applied, with no drilling usually necessary. Dentists think this is very cool and spend tons of money trying every new product on the market. I wish them good luck.

Sometimes we use bonding  to restore a broken tooth , improve appearence, or close spaces. In addition we can change the color of the tooth, cover stains and even coat and cure a sensative root surfaces with the bonding process. Many types of cavities can be restored with a bonded white filling.

The materials we use have become very high tech and have been improving over the last several vears. Improvements seem to come almost monthly as one manufacturer competes with the others for the dentists favor.  Color and durability have been improved dramatically. Products come and go after clinical trial  despite the claims of the manufacturers. Currently I am using an advanced Japanese product that has been around a few years and has an excellent tract record. I like to see tract records, the true "the test of time".  By now you probably know I am a bit of a skeptic and want to see actual results and not just claims. As they say "talk is cheap".

I just added a detailed section to the web site on white fillings and bonding if you would like more information. If  by chance you would like to talk about the technology involved give me a call. I will wait by the phone.  Actually I have had a few engineers take me up on this offer. Give me a call and we can discuss bonding agents and the effect it has on dentinal tubules.

Today's tip. If you have food caught between your molars and are having trouble removing it, tie a knot in your floss and pull it through. It works for me.

Best regards,      AM

Jaw joint pain, often called Tempero-mandibular joint disease (TMJ/TMD) is being seen more and more frequently in my office and other dental offices in Los Angeles. I have noted that it is especially common in people living in the Encino, Tarzana, Sherman Oaks, and Woodland Hills areas. No, it is not poluted water or toxic waste. It is usually stress. There seems to be no shortage of that around here these days.

Patients with TMJ/TMD problems experience grinding of their teeth, neck and shoulder pain, headaches and a variety of ear problems. I have seen people who could not open their mouth because of the muscle spasms caused by TMJ/TMD. I have also found people with loud cliks, pops, or grinding sounds coming from the joint when they open. Another symptom is a ringing in the ears. This is a serious, painful and progressive disease. Patients often seek help from their family physician or an Ear, Nose and Throat medical specialist who in turn usually refers them to a dentist familiar with the problem.

Several muscles are involved in the disorder. The major ones are the masseter in the cheek and the temporalis on the side of the head. The TMJ joint itself, which is the jaw hinge, has a cartilage and several ligaments in it that can be damaged by these powerful muscles that are used for chewing. Several smaller muscles in the area are also involved and contribute to the problem in most cases by causing painful spasms.

There are several treatments for TMJ/TMD problems. A bite that is uneven can lead to persitant grinding and needs to be corrected. Several acrylic resin appliances of different designs such as the NTI appliance can take the stress off the muscles and joint. Prescription strength medications can also be helpful in reducing the muscle spasms, inflamation, and pain.

I have found stress management techniques also helpfull because of their ability to ease ay least part of the problem. In almost every case the patient reports been under major stress when the problem first arose or when it became severe. Another fairly common cause of TMJ/TMD is a blow to the jaw such as an auto accident, a brawl, or a sports injury.
The first step, as always, is to see your dentist who hopefully is familiar with TMJ/TMD problems and their treatment. I would be happy to help you find such a dentist if my office is inconvenient.

Tip of the day: A good walk every day is a great stress reducer and improves not only your TMJ/TMD problem but your overall health greatly.

Best regards, AM

Well, NO. But there is some good news. We have available a product call Arestin. I would have put a registered trademark symbol next to it but I can't find it on my keyboard. Anyway, this is good stuff. The folks at Boston University have an excellent dental research program and are very interested in gum disease. I have heard some of them speak and they are really on top of the world reasearch. They have been at it for over 30 years. Their research lead to the development of Arestin as a non-surgical treatment for gum disease in a easily used product.
Ok, Arestin is a yellow powder that
contains "microspheres" that in turn contain a tetracycline type antibiotic called minocycline. The yellow powder can be squirted under the gums where there is a deep (5mm+) crevice between the tooth and the gums. It is especially important if that pocket is bleeding. The more the bleeding the worse the infection and the more the damage to the gums is going on. Note: Any bleading in the gums is NOT normal. Arestin will remain under the gums for 10 days or so and kill all of the bacteria in the area. Once the bacteria are gone the gums can heal and the crevice, also called a pocket, shrinks to a more normal range of 2-3mm. There is no surgery or pain involved. One does have to be carefull to not disturb the Arestin but it is not too complicated. I would say that I have seen improvement in about 80% of the areas we have used it in. There are no systemic side effects such as those found with oral antibiotics. Bottom line, I have used Arestin for about a year and am very pleased with the results. If I have created in you a thirst for all the technical details, I have a full technical report on my website. If not, go back to your football. I wish you a Happy New Year and in accordance with the Laws of the State of California I grant you a license to eat all the sweets you want until 1-1-10. Best regards, AM

This sounds like a boring subject to me so I will do my best to make this a little different and a bit interesting. We have all heard the brush and floss lecture over and over and I am as sick of it as you are but there are a few aids to healthier gums that many people have not heard of and could be useful to know about. Many older dental aids have fallen out of use lately but are still worthwhile. For example, the rubber tip is a pointed round rubber end on a straight round handle. It also know as a "gum stimulator". It has be around for at least 50 years. Tested by time, it is really a nice little addition to your cleaning routine. It easily goes between the teeth from the inside and outside and removes both food and plaque. In addition it massages the gums which improves the circulation and tightens them, reduces bleeding and gives them a healthy pink color. Gum pockets can be reduced by about 2mm with daily use. It sounds like such a small number but is a world of difference where the gums are concerned. The rubber tip can be washed off with a bit of soap and rinsed off after use and unlike a toothbrush does not carry germs from day to day. The best news is that you can not hurt anything by using it unless you somehow poke your self in the eye with it. I know Dr. Butler company makes these and they cost about $2.00. I think this would be a good investment for everyone unless you have absolutely perfect gums. If you have trouble finding these tips call my office for a freebe. The tip of the day: When flossing, pull the floss down between the teeth and rub the sides of each tooth up and down with it. Let go of one end and pull it through. Presto, no more shredded floss. Best regards and happy holidays, AM

Over the last few months I have written two articles for publication in the media. I was motivated to do this by an article I saw in the AARP magazine on how to live to 100. One brief paragraph referred to gum disease causing inflammation and infection and how bad that was for all of the body systems. I have known about how much damage inflammation and infection in the mouth can do to the heart but I was not aware of the cancer connection. My partients were being told about the heart connection when they came in for a visit. I have come to realize that this was such valuable life saving information that everyone needed to be informed. The word needed to be spread. My research began on the topic on the internet and continued with personal contacts with several people I know that are knowledgeable in the area. To my suprise I found many obscure studies. The published research was not meant for the public and was written in scientific and technical terms. I did my best to translate and digest it. Then I put the most important items into English that everyone could easily understand and proceeded to write my article.

The result of this work has shown some scary numbers. For example, the presence of gum disease can increase the rates of cancer, stroke and heart attacks. Heart disease increased by 18%, and all cancers combined increased by 14%. Lung disease, diabetes, liver disease and many others life-threatening diseases were found at a significantly higher rate when gum disease was present. I was startled to see in one study that head and neck cancers rose dramatically in men with advanced gum disease.

The source of the connection appears to be inflammation, which can be measured by the C-reactive protein levels in the blood. When inflammation and infection are present as in gum disease, or other diseases for that matter, the liver produces a host of agents that are harmful for every organ system in the body. Details are in the article which I urge you to read. It is a startling report that talks about large increases in the incidence of many cancers, such as lung and blood cell cancers. Men with gum disease have a 63% higher risk of developing pancreatic cancer, a very deadly form of the disease. I did not know until I completed this project that for each 1 mm of bone loss around the teeth the risk of head and neck cancer increases four times. This is bad news for those not taking care of their gums.

We now give the full report to all my patients and it will be published on the Internet. I hope my work will do a little good. I had a brilliant young Encino attorney friend that died of cancer of the tongue that was not detected untill it was too late. I am thinking of him as I write this. An oral cancer exam by the dentist or dental hygienest is so critical and is a mandatory part of a general dental exam. It is done at each visit in my office. I have a section on this exam on my web site. To be fair, I must say all of the studies put in disclaimers and noted that someday these studies may be proven wrong. For now please have your mouth checked for oral cancer and gum disease. It's on me, free at my Encino dental office.

I have looked at many other dental blogs and newsletters. Some are on very technical dental subject such as implants and others often talk about cosmetic dentstry. I realize people prefer the up beat smile news. I am sorry if I have spoiled your day with this blog but this is information I think you need to know. It might just save your life.

Tip of the Day: When we hound you to come in for a "cleaning" think of that 63% increase in pancreatic cancer in men when advanced gum disease is present. Then go ahead and make the appointment. Best regards, AM

The Good Crown

There are many types of crowns available and they are described on my web site (www.focusedcaredental.com). I go into details on all of them. What is not explaided  by most of the profession is the part of the crown that is the most critical. In dental-speak we call that area the margin. That is where the crown comes togeather with the tooth. The Americal Dental Association says that opening can be up to 40 microns. We have no way to actually measure such a tiny space before or after the crown is actually cemented. I like to take a fine pointed instrument called an explorer and run it over the margin before the crown is cemented and feel by touch and lots of experience  if there are any openings. Sometimes an x-ray is called for as at times it will show the opening if I feel a gap, and sometimes not. It a discretionary call. The secret here to achieve a durable crown is a very good mold of the tooth and a great dental technician. We have both. With that combination , I estimate that 95% of the crowns that are done in my Encino dental office meet or exceed the standard. If not, we do it again.You can trust me that my 95%  number is far, far above the average. I always try to give you my best effort.

 Tip of the day: One, if the dental assistant is taking the impression it is likely agaist the law and two, I consider that to be  second class care.     Best regards,      AM

Dental Floss - The Magic Little String

A  patient asked me last week when was the best time to floss. My answer was"anytime". Before brushing is fine, after brushing is fine, watching TV is fine. The secret is to do it at least once every twenty-four hours. Twenty- four hours is about the time that it takes for the bacteria under your gums to start making trouble. I added to my story that 1/3 0f the tooth just can't be reached by a brush. Also you should be aware that the ultrasonic toothbrush can not get to those areas either.In those areas the plaque and food particles accumulate and often contribute to bad breath, decay and gum diseases.

The world is complicated these days and you have  decisions to make. Flavored floss, thick floss, thin floss, coated floss, flouride floss and so many more are available. Pick the one you like the best and is the easyest for you to use. That will increase the chances that you will actually use it to clean your teeth and not to sew up the Thanksgiving turkey with it. I like J&J waxed regular mint myself.

If you can't get the floss into some tight areas there are plenty of gadgets in the drug store to help you. You may have to look a bit, but in upscale Encino, Tarzana, Woodland Hills and the like  there are a large variety of floss aids. We have some different types for you to try at the my office, but some experimenting will be necessary. I believe in the 8th  dental commandment, "whatever works". I went to a seminar a few years back and a very well known gum specialist recommended a tooth pick to clean between the teeth. He clamed excellent results. Fine with me. Oh, and please , it is NOT normal for gums to bleed when flossing. That is a good indication of inflamation and possibly infection. If you see bleeding,  it is time for a check-up.

Even I have limits on this subject. I no longer ask anyone when was the last time they flossed. I don't like to see people lie. Fortunately our Dental Hygienest is the real expert on this and has a ton of patience to teach you the most effective techniques. She really gets excited about flossing and has been known to tie a bow around the finger of someone to remind them to floss. Fine with me. I never argue with a lady that has sharp instruments nearby.

Tip of the day: Rinse with mouthwash before you floss. You will then be pulling some nice anti-bacterial under the gums at the same time. It helps me.      Best regards,   AM

We American are very concerned about how others see us. Having a bad breath problen is a big negative to people image. That is why we spend many million of dollars each year on breath improving products. Here in Encino it is a major issue. Let me give you some insights on the subject. Billions of bacteria live in the mouth. The mouth is warm and moist and these bacteria are the most common cause of bad breath. Morning bad breath is from the reduced flow of saliva during sleep and the loss of its cleaning action. Other less common causes include decay, gum disease, poor oral hygiene, dry mouth, smelly foods, mouth infections and resperatory tract infections. There are also several medications and illnesses that can cause bad breath.

Remedies include brushing, flossing, tongue cleaning, mouthwashes, sugar -free gum and mints, and raw carrots or celery.

The best start at eliminating  as many of the causes mentioned. Next is to visit your dentist. If all is well with you mouth, then a visit to your physician is in order.

Here is my tip of the day. I use Listerine blue.             Best regards,  AM

Careful, I hear you. What now! Fluoride is for kids. Well, in so many words, wrong. Most kids have very little decay these days. So here is how this fluoride thing works. As a person grows older the gums recede and the soft root surface is exposed. A root surface is only about half as hard as enamel and prone to decay. To make matters worse the root surface is where the most plaque accumulates. Plus, as we grow older and a little arthritis set in, our brushing skills decline. This all adds up to a bad situation. Then the unthinkable happens. The root surface decays. If you are lucky and the decay is very small, it can be restored. Often and even worse the decay is where a crown meets the tooth. Up and under the crown the decays goes and a new crown is necessary to stop the decay. Do not despair. Smart Encino dentists like myself push hard for fluoride treatments for all our adult patients. Sometime we add 3x strength fluoride toothpaste to the regimen. In my dental office the "gold standard" is a fluoride treatment, a prescription for Prevident toothpaste and a Sonicare toothbrush. I believe that gives you cheap insurance to keep everything healthy and happy. My tip of the day is this. "Brush up and down and all around, but do the gum lines twice"       Best regards,    AM