Talking, chewing, tasting and swallowing are things we do every day without a second thought. This isn’t true for a person with chronic dry mouth.

A glass of water would seem to be the simple solution, but not for most “xerostomia” patients. Their problem is usually more than dehydration. It stems from a reduced production of saliva – with any number of contributing factors.

I see this problem more and more frequently in my practice – weekly rather than just occasionally as in the past. I believe the wide use of many medications contributes to this issue. Dry mouth is highly destructive to teeth, and I think this condition needs to be treated aggressively. It affects many other aspects of living, too.

Without “spit,” talking is difficult. Have you ever gotten nervous and had your mouth go dry? Not pleasant. The croaking voice is not particularly attractive either.

Reduced saliva makes eating problematic. Saliva softens food and helps with chewing. Amylase – one of the enzymes in saliva – helps break down simple starches, aiding digestion. Without saliva, foods can be abrasive and swallowing is hard. Little cuts or scrapes in the mouth can ulcerate, leading to painful canker sores.

Saliva, which is produced by three different sets of salivary glands, is made up of water, mucoproteins, enzymes and antibodies. Because it is slippery, it lubricates the tongue, gums, hard palate, teeth and throat area, making talking and eating easier.

Dry mouth, however, is more than an inconvenience. It puts your dental health at risk. Saliva acts like a bodyguard in the mouth. Without it, teeth are vulnerable and prone to decay. Chronic bad breath becomes an issue, too.

In a healthy mouth, saliva constantly baths the teeth, washing food particles away. It minimizes plaque buildup on the teeth and exposure to plaque acids which contribute to cavity development. Saliva also has antimicrobial properties that fight fungal and bacterial growth, and it aids tooth remineralization by bathing teeth in fluoride and minerals.

So what Causes Chronic Dry Mouth?

All sorts of things can cause this condition. Here are just a few.

• Stress
• Periodontal disease
• Mouth breathing
• Hormonal changes
• Antihistamines anddecongestants
• Nerve damage or injury to glands
• Prescription medicine: antidepressants, blood pressure meds
• Diseases: diabetes,
Alzheimer’s, Sjogren’s, etc.
• Radiation therapy or chemotherapy
• Tobacco, alcohol, caffeine

If you have any of these contributing factors or suspect that your medications are causing chronic dry mouth, consult your MD or call us for a consultation. I have often worked with my patients MD to deal with the problem. Sometimes switching dosages or making lifestyle changes remedy the situation. Fluoride, oral rinses and prescriptions that stimulate salivation also can alleviate symptoms.

I know chronic dry mouth is a trying condition, but I am here to help. Your comfort and oral health are important to me!

Tip of the Day: When your mouth is dry, chewing sugarless gums or sucking on lozenges or mints will help stimulate saliva production. Look for brands containing the sugarless sweetener xylitol, which is a powerful cavity fighter. Be sure to avoid products with sugar which can rapidly damage your teeth.

Best regards, AM

New Dental DNA Technology

Two new DNA tests of saliva are in the final stages of preparation for use in dental care. Developed by a division of Quest Diagnostics this testing will help you to avoid and treat infections in the gums and in some cases the possible loss of bone around the teeth.

One new saliva DNA test helps us determine which patients are at higher risk for losing teeth. The test can measure “genetic risk factors”. With this information we can then develop the most effective treatment options to prevent gum disease. For those patients that already have active gum disease, a second DNA test can identify which bacteria are active in the infection and measure their quantity.  That allows planning to be made to customized antibiotic treatment specifically targeted for each patient. This is a highly effective way of using antibiotics.

If a patient is about to have dental implants or major dental care the test helps us to determine the best plan for post treatment care. In addition we know that the gum disease bacteria that enter the body can create inflammation in other areas of the body beyond the mouth. This inflammatory process is believed to increase the risk for diseases such as heart attack, stroke, Alzheimer’s, diabetes, and pancreatic cancer. When we can reduce the bacteria in diseased gum tissue, the patient can reduce their overall risk for these medical problems.

We are monitoring the testing closely and intend to be the first dentist in the Encino area to use this hi tech product to benefit our patients. Other salivary tests are being developed to measure the risks of oral cancer. It has been found that saliva contains a wealth of valuable information. The research on it is just beginning.

I know this material is a little heavy but interesting at least to me. It’s nice to see the large medical companies devoting time, energy and money on improving dental health. We have been neglected for many years. Hi tech dentistry here we come. Dentistry in Encino welcomes you.

Tip of the day: Dip your tooth brush in mouthwash before you put it away. The bacteria will be killed and it will taste fresher in your mouth.

Best regards,     AM

Allan Melnick, DDS     Encino, CA

 How to Deal with Canker Sores

About one in six people get them. They hurt like hell and can make talking, eating and swallowing miserable for days.  Like a bee, canker sores are diminutive in size, but can wreak their own brand of misery.

I’d like to be the one announcing a permanent cure, but no one really knows what causes recurrent mouth ulcers – or aphthous stomatitis. These nasty little nuisances afflict about 20 percent of the population, causing painful sores on the tongue, gums, throat and cheeks. Sorry, ladies. You seem to be more prone to canker sores than us guys.

Canker sores appear suddenly, take about two days to form and stick around 10-14 days on average. They look like white areas, surrounded by red irritated tissue. These circular sores can erupt singly or a dozen at a time for the very unlucky. They tend to be less than ¼ inch in diameter, although I have seen some that are nickel-sized.

Canker sores are not to be confused with cold sore lesions, which are caused by the herpes virus and often appear on the outer lip. Canker sores are not thought to be virus-born, but are believed to be linked to an immune system malfunction, heredity, hormonal fluctuations or environmental stressors, such as a bacterial invasion to damaged mucosal cells in the mouth.  

Brushing too vigorously with a hard toothbrush can result in an errant jab to the gums. These minor injuries can become ulcerated – and BINGO, a canker sore!

There’s no known way to categorically prevent canker sores, but there are precautions you can take. If my patients complain of pain, I suggest a number of options to make them more comfortable. Some of the remedies numb the affected tissue, others promote healing, and some treatments are preventive in nature.

A Few Canker Sore Tips

• Brush your teeth with a soft-bristled brush. Slow down. Be gentle.
• Stay away from toothpaste and mouthwashes that contain whitening agents as some are very irritating.
• Avoid abrasive foods such as nacho chips, gum drops or crusty bread. Well, at least try to.
• Eat fewer acidic or spicy foods. Skip the OJ and the hot salsa for a while if you have active canker sores.
• Rinse your mouth with a warm salt water solution (2 tablespoons in 8 ounces of warm water) or use a commercial antimicrobial rinse, such as TheraBreath Oral Rinse or PerioTherapy Oral Rinse. Some find relief with a gentle rinse made of one teaspoon of baking soda mixed into half a cup of warm water.
• Cover sores with topical gels. Over-the-counter products such as Anbesol, Orabase B, Kank-A and Orajel offer anesthetic relief. There are junior and adult strength variations. Homeopathic remedies include baking soda pastes or daubs of milk of magnesia applied to lesions.

At times some of my patients need stronger intervention. Aphthasol is an FDA-approved canker sore treatment, available by prescription only. It reduces pain and speeds healing. Debacterol, another prescription medicine, cauterizes sores chemically and can cut healing time in half. Serious canker cases may require a corticosteroid.

• Reduce stress. Go for walks. Do yoga or tai chi. Listen to chill music. Cross off some things on your calendar. Stress is a known factor.
• Take a vitamin/mineral supplement that includes B-6, B-12, zinc, folic acid and iron, but don’t overdo it.
• Quit smoking. Cigarette use may make you more prone to canker sores.

Tip of the Day: Each year 15 million dental injuries occur during sporting events. Trauma to teeth and soft tissue can become ulcerated and painful and difficult to restore. Invest in a good sports mouth guard to avoid injury, pain, healing time and the outrageous expense of dental restoration.

Best regards,  AM

Some of the most frequent questions I am asked these days regard implants. So here is a quick review of some of the facts on the subject.

~Can everyone who has lost a tooth have an implant?   Well, almost everyone. There are a few things that  would be reasons not to have an implant. For example, osteoporosis, inability to keep the area very clean and smoking are problems. Smoking is such a negative factor in the success of an implant that I do not do implants on smokers.

~What is an implant made of ?   Titanium is used because of the body’s friendly acceptance of this material. The use of titanium has been the standard for over 40 years with a success rate over 90%. Occasionally I use a ceramic implant for people who can not tolerate any metals.

~How much bone will I need to have an implant?   As a rule of thumb, 50% of the original bone is usually enough. Fortunately, there are several procedures to augment or graft in new bone when inadequate bone is present.

~Does the process hurt?   A small amount of local anesthetic is placed in the area and the procedure becomes pain free. After the procedure mild pain medications are given for a day or two. My patients often comment that the procedure was much easier than they had  expected.

~How many visits are required?   Simple cases involving one or two implants typically require four visits from start to finish. The highest success rates are achieved when the procedure is spread over several months so that the bone and implant can grow together.

~Will I be able to chew normally ?   Research has found that chewing ability becomes as good as with natural teeth. The same pressure and force can be applied to food with an implant as a natural tooth. In addition, the implant crown will look like a natural tooth.

~Is age a problem?   Age is not a problem. Health is much more of a factor than age. People that are in average health and can tolerate normal dental care can usually tolerate implant placement. I have seen several people in their 90s doing very well with implants.

~How long will my implants last?   There really is no time limit that can be given. Implants last indefinitely. I have seen a very few failures but these were in situations where the persons health had taken a turn for the worse. In some cases a new implant can be placed after the failed one is removed.

~How do I care for an implant?   A person cares for an implant just like you would care for your natural teeth only better. The area around an implant must be kept very, very clean or the implant can fail. You just need to be sure you are keeping your mouth extra clean.

For a detailed review of  implants click to see our dental implant page.

Tip of the day: The type of floss you use makes very little difference. Pick what works best for you.

Best regards,     AM

Before you come to the conclusion that I have lost my mind, please read on. Yes, chocolate is ok for your teeth and is good for your  health. Chocolate contains polyphenols and flavinoids which are strong antioxidants that inhibit the growth of bacteria that can cause decay. Here is how it works. Decay is caused by certain bacteria called oral streptococci that are found in you mouth.  This results in the production of  acids that damages  the tooth  enamel. Polyphenols prevents the bad bacteria from turning sugar and starches in chocolate into decay producing acids. The sugars are in the form of starch and dietary fibers  with a small portion of simple orally active sugar. This is good news.

Actually chocolate candy has several ingredents. Cocoa, cocoa butter, sugar, and various flavorings and preservatives. The polyphenols are actually good for your health. They are anti-oxidant, anticancer, and  anti-inflamatory . They reduce the chances of hypertension and stroke. They are also know to protect the heart. Some research have also shown beneficial effect for problems of cognition and diabetes.

The next issue of concern is the cocoa butter and sugars  in chocolate. The cocoa butter has a coating effect the reduces the ability of plaque to stick to the teeth. Although the sugar is high, yum, is dissolves quickly and has little time to increase acid levels. Cocao butter and chocolate have been  shown to not raise cholesterol. Once again, good news.

Another concern with chocolate is caffeine. There is actually very little caffeine in chocolate.  A regular cup of coffee has about 150 mg of caffein. One ounce of chocolate has only 5mg .

 Also nice is that dark chocolate has about four times the antioxidents of green tea. The same anti-bacterial effect of flavinoid and polyphenols is shared by the now popular green tea. As an extra benefit  seratonin and phenylethamine that are used as mood enhancers are present.

Plant polyphenols are found in many foods. A very tart fruit that makes you pucker as they are high in tannins which contain polyphenols so they too are  beneficial. The following are some of the foods with especially high polyphenol content. You have probably seen a similar list as foods that have beneficial health effects. Foods such as red wine , grapes, black tea apple juice, cinamin, cumin, cranberries and of course dark chocolate. These foods are high in a substance called flavanoids, a part of several components of polyphenols that were mentioned earlier.

In amounts of  one ounce portion per day, chocolate can be good for you. It tastes good, doesn’t hurt your teeth and has beneficial effects on  your body. In an Italian study, all the benefits are achieved in three one ounce pieces  a week.

Now the down side. You knew it was coming. Dark chocolate has lots of calories. It has been measured at 150 caleries in one ounce . So if you are on a diet, and who is not, you have to watch the quanity. Try to control yourself.

So, as a dentist I recommend dark chocolate three times a week as perfectly safe for your teeth  and good for your body. Yea.

Tip of the Day:  Only Listerine has lasting antibacterial properties. Spend you money on it if you use a mouth wash. The others really don’t have much effect.

Best regards,     AM

I had the opportunity a few day ago to do something that was really meaningful to me. I would like to share that with you. My web site advisors are probable cringing about now because I am not on a dental topic but since I pay the bills I will let them stew. In fact, I am my own webmaster and have written and designed virtually every word of this web site myself. I guess that makes me the boss.

A few days ago I had the honor and privilidge of speaking to one of my heroes Coach John Wooden. I don’t think any introduction is necessary. I would say he is the the greatest coach that ever lived, but I will not argue the point as there were many great coaches out there and everyone has their own opinion.  A good part of my admiration comes from the fact that he was always a gentleman, on and off the court. In addition, I have great respect for his philosophy of human relations.

The Coach and I exchanged just a few words. Now at 99 years old I could see a sparkle in his eyes and an amazingly sharp mind. What a thrill that was. We spoke about  some of his players but I could not get him to singe out any one  as the greatist.  Smart man. In those few brief moments you could tell that there was something special about this man.

Later in the day I did a Google search and discovered that the Coach has a web site and I checked it out.  It didn’t take long to see that Coach Wooden is not only a world class coach but a very wise man. His philosophy is very impressive. Very briefly, he never chose to criticise, yell at or berate his players to get them to achieve. He chose to encouraged them. He built their self esteem and taught them how to put a situation into the best possible perspective and keep a positive attitude. How much wiser it was to built them up rather than tear them down.  You can look at his results to see that he was right.

Each day I walk into the office and give each case my very best effort. I often see people that have neglected their mouths badly. Sometimes it is just terrible to look at the extent of the neglect. I have had a philosophy of  “no guilt” for a long time and I always apply it no matter what the situation is.

 Reading what the Coach has said and looking at his results reinforced for me that I have been doing the right thing all along.  I always try to build  up and never tear  down. Funny thing, the results of that philosophy just keep getting better and better. We want to make relationships not just fill teeth. People seem to appreciate that attitude very much. Thanks Coach.

Best regards,    AM

How many times have we all heard that sugar is bad for our teeth? Now we hear over and over that we need to cut down on our carbos. Well darn, I like deserts and snacks.  So I want to pass along a tip or two that will reduce the bad things these comfort foods can do to harm our beautiful teeth. First some background.

Carbohydrates breakdown at some point into the simple sugars. As you may remember from high school science, the simple  sugars are lactose, fructose, maltose and glucose.  Some foods in the carbohydrate family break down in the mouth and others breakdown later in the digestive tract.  Those that break down in the mouth feed the oral bacteria and they inturn produce acids.  Unfortunately these acids can dissolve the mineral parts of the tooth. Destruction of the mineral portions of the tooth is the cause of the damage found in tooth decay.

Foods That Will Harm Your Teeth

The obvious foods to watch for are sugars, soft drinks, candy, etc. There are some less obvious food to also watch for including crackers, bread and bananas. As soon as these foods are eaten the acids begin to be produced. This bacteria, the sticky white film called plaque that forms on the teeth and the available sugars cause the problems. Time is the most significant factor in the amount of damage that will occur.  Simply put, the more  time there is food in your mouth the more acids that will be produced. When people snack throughout the day the production of acids will be continuous. As long as food is available the acids produce more and more decay. Even after you eat, the bacteria will produce acids for 1/2 hour. Bad news.

The Good News

Not to be discouraged, remember that there are things working for you. When we eat more saliva flows and the teeth are actually washed. Food and acid are removed. In addition, the acids are weakened by the liquid portion of the saliva. Another plus is the increase in saliva actually washes the whole mouth and cleans the tongue. The tongue is a major cause of bad breath and the extra saliva removes food and plaque. To top it off saliva also has an anti-bacterial agent that is very helpful to oral health.

There are certain foods that can help protect the teeth.  Cheese can actually change an acid into a neutral substance. Milk has a buffering action that reduces the strength of the oral acids. A big suprise is the action of sugarless gum and candy containing  Xylotol. One great property of  Xylotol is that it reduces the number of bacteria in the mouth substantially and with less bacteria, you guessed it, there is a reduction in the amount of acid and decay.

Your Diet Plays a Role

While most of us really don’t like to watch our diet carefully there are many reasons to do so just for oral health reasons alone. For example, the mouth is quite sensative to nutritional problems. The surface cells lining the mouth are replaced as often as every three to seven days. With this rapid turnover your nutrition needs to be good for healthy new tissue to form properly. Poor nutrition, including a lack of certain vitamins, has been shown to be a common contributing  factor in gum disease. We know that a weakened immune system is clearly involved in gum disease.

The question now becomes what can we eat that is not bad for us. Remember the old food pyramid from high school? The US Dept. of Agriculture has finally, after over 50 years,  has come up with a new and more effective tool to help us decide on the best diet for us. It is now an  interactive internet tool that is called “My Pyramid”. It  is easy to find on Google. The new pyramid makes a customized plan depending on physical activity, age and gender. I recommend you look at it.

Here is the bottom line. Time  is the critical factor. The less time there is food in your mouth the less time the bacteria  have to make acid. Less time, less acid, less decay. Key word: Time

What is a person to do about all this. How can I reduce the time factor? Check out the section on Prevention on my web site for some helpful ideas. It is full of helpful suggestions.

Best regards,    AM

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