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When I discuss new cavities, let�s be clear about what I�m talking about. A new cavity is one that develops on a tooth in an area that has never decayed before. Dental caries is the technical term for cavities and some times it�s just easier to say decay. So which ever term you would like to use is fine but for this article, I will stay with cavities or decay. When a tooth first erupts into the mouth it is vulnerable to the bacteria. Bacteria produce an acid that dissolves enamel. So have you ever wondered why certain parts of a tooth or even certain teeth get more cavities than others? Are bacteria that selective and hate back teeth more than front teeth? Of course not, but we have to look at where bacteria can collect easier on a tooth and which teeth collect more bacteria and are more difficult to clean. The primary area on any tooth that decays easily is any place that plaque can collect and remain long enough to allow the acid to start to dissolve the enamel. Remember, plaque is the pasty stuff that forms on your teeth that is formed by the bacteria. When you wake up in the morning and you feel the scum on your teeth, that�s the plaque that formed from the bacteria over night. So where does it stick and stay the easiest? Any crack or groove on a tooth. These are more prominent in back molars. The deeper the groove, the more plaque/bacteria it can hold and the more likely it will decay. That is the reason molars are usually the first teeth to decay. All the front teeth have more smooth surfaces and fewer grooves. With this in mind we have to consider other factors that make plaque stick to a tooth long enough to allow the acid to demineralize the enamel. Plaque that tries to adhere to the smooth surface of enamel is easily wiped away by the lips, cheeks, and tongue. So that leaves plaque to collect at the gum line, between the teeth, and in the cracks and grooves. All of these areas are difficult for natural cleansing to occur. This is why we always instruct our patients to use a sulcular brushing technique (Aim for the Gum line). You can brush the smooth surface of the cheek and tongue sides of the teeth, but you�re wasting your time, those areas are already plaque free. Keep in mind that plaque is very sticky and it takes more than one stroke of the tooth brush to remove it. In most cases you�ll need 4-5 strokes over an area to remove the sticky plaque. So if you multiply the number of strokes need to each area by the number of teeth you have, you�ll find that it will take 2-3 minutes to properly remove all the plaque when you brush. So how do you prevent cavities in the deep grooves of the teeth? It�s difficult because most of those areas are too deep for the bristles to reach and remove all the plaque. If the grooves that are at risk are identified early they can have a liquid plastic flowed into them to prevent decay. These are called Sealants. Sealants can be a great way to prevent decay but they are weak and can chip out. If the sealant comes out and is left undetected, then the decay process will start. If a cavity forms in the groove it will need to be removed and a filling placed. The filling then becomes the sealant to prevent further decay. Fillings are much stronger than sealants which are why they last longer. Fluoride varnishes are also an excellent way to prevent cavities. A fluoride varnish is far more effective than traditional fluoride treatments. The ADA now recommends a fluoride varnish over any other type of fluoride application because it has a 76% uptake into the enamel. At best, other fluoride treatments have only a 34% uptake. This is why in my office; we only offer fluoride varnish treatments to our patients. We now know that Saliva plays a major role in preventing cavities. In saliva are antibodies that control the bacteria in the mouth. If the mouth dries out then the decay rate will increase. There are several reasons why the mouth can dry out. The most common is while we sleep. Saliva slows down while we sleep which puts us a greater risk for cavities at night. Brushing and flossing is vitally important before bedtime to help prevent cavities. The next most common reason is medication. There are many medications that are commonly prescribed that have dry mouth as a side effect. Diabetics also fight dry mouth as well as the elderly! We have more cavities in this country today than we�ve ever had. It�s not in the children, it�s among the elderly. So does genetics play a role in cavities? There are several possibilities that implicate genetics. One is the genetic make up of the enamel. All enamel is a Calcium Hydroxyapatite crystal, but the density can vary. Also the developmental uptake of fluoride can also make the enamel stronger. Genetics plays a role in the depth of the grooves of our teeth. The other genetic role is in the type of bacteria you have in your mouth. There are different genotypes of the same bacteria that can make them more virulent and cause more cavities. I�m sure there are other genetic factors that we have not yet discovered but hopefully, further research will add to our understanding. In summary, remember you are always at risk for new cavities but how you brush and floss; how you keep your mouth moist; and your genetic factors will all play a role. Control the things you can control and allow us to help you with the things you can�t control. Remember, it is far more important what you do daily than what we do for you!

Let�s start with bleeding. After you brush or floss your teeth do you sometimes see blood when you rinse? Do you always see blood? If your finger started bleeding after shaking someone�s hand, would you think something was wrong? Of course you would. Fact number one is the body doesn�t bleed normally (except menstruation). Our blood is supposed to stay in our bodies not leach out. So if you see bleeding you should be concerned. In the mouth we call this gingivitis. Gingivitis is the first stage of gum disease (periodontal disease). The cause of the bleeding is too much bacteria at or under the gum line. The amount of bacteria that it takes to cause the gums to bleed depends upon You. Your natural immune system fights off these bugs everyday. If the quantity of bacteria over rides your ability to fight it off, then the gums bleed. Have you ever known a person that brushes and flosses every day but still fights gum disease? And then that same persons spouse never flosses and only brushes occasionally and they never seem to have gum disease? That�s all in relationship to your natural immunity and to the type and quantity of bacteria in your mouth. As we get older, our immunity will start to drop. So the need to remove the bacteria more thoroughly increases with age. We diagnose gingivitis by two measures, bleeding and pocketing. Around every tooth there is a cuff or collar that when measured, should be under 3mm and shouldn�t bleed. If the pocket measures 4-5mm and bleeds, we consider this gingivitis. In my office our hygiene goals are to keep the percentage of sites that bleed less than 10% and no pockets over 3mm.

So what happens after Gingivitis? If the bacteria is allowed to remain under the gum and has caused the gums to swell and bleed, your immune system starts to breakdown and the bacteria begin to infect the bone that holds your teeth into your jaws. We call this Periodontitis. Now we have a big problem! With gingivitis, the gums can heal and everything is fine. But with periodontitis, if we lose bone, it�s gone for good! And it�s the bone that holds the teeth into the jaw bones. Treating periodontitis takes more than what you can do at home. The first step is always to remove as much of the bacteria deep under the gum as possible. This procedure is called different things by different dentists. In my office, I call it deep scaling and root detoxification. If the periodontitis has not destroyed much bone, this procedure followed by regular care can be all that is needed to control the disease. If there has been a lot of bone destruction, then a specialist called a Periodontist will be needed to not only help you control the disease, but also repair surgically the damage done. There are also many other types of specialty treatments that can be used to fight gum disease. The goal of course is not to allow the disease to progress to this point. Diagnosing periodontitis is done by several modalities. Here, the pockets measure usually over 6mm, there is bleeding when probing and x-rays detect a change in the bone levels around your teeth. Once you have lost bone, you will always be classified as having periodontitis. The question then is it stable or unstable. Like diabetes, you can control periodontitis, you just can�t cure it!

There are many variables that can accelerate gum disease that all need to be addressed. Smoking, uneven bite forces, and immune response are the three most common. Smoking can be addressed the easiest�..Don�t! If you smoke, you have gum disease in some form�guaranteed! If your bite is off, there are many ways to correct those forces. Your immune response is who you are and unless your physician can help, we have to live with who you are! In later editorials, I will discuss the role of uneven bite forces in more detail but for now think of this example and how the force we place on our teeth can accelerate gum disease. If you see an old fence post poured in concrete in the middle of a field and you walk over and start pushing and pulling on it, you can eventually rock the post out. But if you first soak that post with water for two hours then start rocking the post, it will come out much faster. This is the same relationship that plaque does to teeth. It causes inflammation (soaking the post with water) and then rocking the teeth with uneven bite forces will loosen the tooth much faster.


		September 2007 New Cavities: They can develop at any Age! When I discuss new cavities, let�s be clear about what I�m talking about. A new cavity is one that develops on a tooth in an area that has never decayed before. Dental caries is the technical term for cavities and some times it�s just easier to say decay. So which ever term you would like to use is fine but for this article, I will stay with cavities or decay. When a tooth first erupts into the mouth it is vulnerable to the bacteria. Bacteria produce an acid that dissolves enamel. So have you ever wondered why certain parts of a tooth or even certain teeth get more cavities than others? Are bacteria that selective and hate back teeth more than front teeth? Of course not, but we have to look at where bacteria can collect easier on a tooth and which teeth collect more bacteria and are more difficult to clean. The primary area on any tooth that decays easily is any place that plaque can collect and remain long enough to allow the acid to start to dissolve the enamel. Remember, plaque is the pasty stuff that forms on your teeth that is formed by the bacteria. When you wake up in the morning and you feel the scum on your teeth, that�s the plaque that formed from the bacteria over night. So where does it stick and stay the easiest? Any crack or groove on a tooth. These are more prominent in back molars. The deeper the groove, the more plaque/bacteria it can hold and the more likely it will decay. That is the reason molars are usually the first teeth to decay. All the front teeth have more smooth surfaces and fewer grooves. With this in mind we have to consider other factors that make plaque stick to a tooth long enough to allow the acid to demineralize the enamel. Plaque that tries to adhere to the smooth surface of enamel is easily wiped away by the lips, cheeks, and tongue. So that leaves plaque to collect at the gum line, between the teeth, and in the cracks and grooves. All of these areas are difficult for natural cleansing to occur. This is why we always instruct our patients to use a sulcular brushing technique (Aim for the Gum line). You can brush the smooth surface of the cheek and tongue sides of the teeth, but you�re wasting your time, those areas are already plaque free. Keep in mind that plaque is very sticky and it takes more than one stroke of the tooth brush to remove it. In most cases you�ll need 4-5 strokes over an area to remove the sticky plaque. So if you multiply the number of strokes need to each area by the number of teeth you have, you�ll find that it will take 2-3 minutes to properly remove all the plaque when you brush. So how do you prevent cavities in the deep grooves of the teeth? It�s difficult because most of those areas are too deep for the bristles to reach and remove all the plaque. If the grooves that are at risk are identified early they can have a liquid plastic flowed into them to prevent decay. These are called Sealants. Sealants can be a great way to prevent decay but they are weak and can chip out. If the sealant comes out and is left undetected, then the decay process will start. If a cavity forms in the groove it will need to be removed and a filling placed. The filling then becomes the sealant to prevent further decay. Fillings are much stronger than sealants which are why they last longer. Fluoride varnishes are also an excellent way to prevent cavities. A fluoride varnish is far more effective than traditional fluoride treatments. The ADA now recommends a fluoride varnish over any other type of fluoride application because it has a 76% uptake into the enamel. At best, other fluoride treatments have only a 34% uptake. This is why in my office; we only offer fluoride varnish treatments to our patients. We now know that Saliva plays a major role in preventing cavities. In saliva are antibodies that control the bacteria in the mouth. If the mouth dries out then the decay rate will increase. There are several reasons why the mouth can dry out. The most common is while we sleep. Saliva slows down while we sleep which puts us a greater risk for cavities at night. Brushing and flossing is vitally important before bedtime to help prevent cavities. The next most common reason is medication. There are many medications that are commonly prescribed that have dry mouth as a side effect. Diabetics also fight dry mouth as well as the elderly! We have more cavities in this country today than we�ve ever had. It�s not in the children, it�s among the elderly. So does genetics play a role in cavities? There are several possibilities that implicate genetics. One is the genetic make up of the enamel. All enamel is a Calcium Hydroxyapatite crystal, but the density can vary. Also the developmental uptake of fluoride can also make the enamel stronger. Genetics plays a role in the depth of the grooves of our teeth. The other genetic role is in the type of bacteria you have in your mouth. There are different genotypes of the same bacteria that can make them more virulent and cause more cavities. I�m sure there are other genetic factors that we have not yet discovered but hopefully, further research will add to our understanding. In summary, remember you are always at risk for new cavities but how you brush and floss; how you keep your mouth moist; and your genetic factors will all play a role. Control the things you can control and allow us to help you with the things you can�t control. Remember, it is far more important what you do daily than what we do for you! July 1, 2005 Gum Disease: One of the most common bacteria infections in the body My gums have always bled. It doesn�t hurt. Doesn�t everybody have gums that bleed? These comments are heard in dental offices everyday around the world. So why is there so much misunderstanding when it comes to gum disease? My goal for this editorial is to continue my role as Doctor (Educator) and help you sift through the myths and misinformation that has been circulating around for years. Let�s start with bleeding. After you brush or floss your teeth do you sometimes see blood when you rinse? Do you always see blood? If your finger started bleeding after shaking someone�s hand, would you think something was wrong? Of course you would. Fact number one is the body doesn�t bleed normally (except menstruation). Our blood is supposed to stay in our bodies not leach out. So if you see bleeding you should be concerned. In the mouth we call this gingivitis. Gingivitis is the first stage of gum disease (periodontal disease). The cause of the bleeding is too much bacteria at or under the gum line. The amount of bacteria that it takes to cause the gums to bleed depends upon You. Your natural immune system fights off these bugs everyday. If the quantity of bacteria over rides your ability to fight it off, then the gums bleed. Have you ever known a person that brushes and flosses every day but still fights gum disease? And then that same persons spouse never flosses and only brushes occasionally and they never seem to have gum disease? That�s all in relationship to your natural immunity and to the type and quantity of bacteria in your mouth. As we get older, our immunity will start to drop. So the need to remove the bacteria more thoroughly increases with age. We diagnose gingivitis by two measures, bleeding and pocketing. Around every tooth there is a cuff or collar that when measured, should be under 3mm and shouldn�t bleed. If the pocket measures 4-5mm and bleeds, we consider this gingivitis. In my office our hygiene goals are to keep the percentage of sites that bleed less than 10% and no pockets over 3mm. The type of bacteria we have in our mouths can vary. It has been show that mothers transmit the same genotype (genetic strain) of bacteria to their children. So if mom has been fighting gum disease or cavities all her life, then her children are a risk. Infection from dad and others can also occur but the relationship seems to be less. So if mom can pass on a bug that might cause her child to have more problems, can we help prevent aggressive disease? At this time one simple method is using Xylitol products the last 3 months of a pregnancy and for the first six months after the child is born. Xylitol is a natural sugar that bacteria can�t utilize and if mom�s bacterial count is down in the early months of development, there seems to be a decrease in passing the infectious bacteria to the child. This does not mean your child would never develop gum disease or cavities, but research shows it can be a definite help. But no matter what type of bacteria you have, the goal for you as the patient is to keep the quantity low! Bacteria form colonies and these colonies need to be disrupted every 24 hours. If you only brush your teeth, then you are only cleaning 60% of the tooth. You have to floss to reach the other 40%! And as you can guess, it�s that 40% of the tooth where most gum disease gets started. Like most habits, flossing takes repetition to create the habit. Just remember, it�s a healthy choice habit! Gum disease has a strong correlation to other systemic disease such as heart disease and diabetes. So if you are at risk for either of these, you should pay close attention to the amount of bacteria you allow to grow in your mouth. Sometimes people tell me, �I�ve heard that an electric toothbrush can replace flossing�. There is not an electric toothbrush on the market that can replace flossing! Electric toothbrushes can improve your brushing and I recommend them all the time, just not in place of the floss! Then there�s the question does mouthwash replace flossing? No! Mouth rinses only inhibit bacterial reproduction for a short time. So they can slow things down but do not replace the flossing. If you elect to use a mouth rinse, be sure to select a non-alcohol based rinse. The alcohol as it evaporates will dry out the mouth which allows for more rebound bacterial activity when the bacteria �wake up�. So what happens after Gingivitis? If the bacteria is allowed to remain under the gum and has caused the gums to swell and bleed, your immune system starts to breakdown and the bacteria begin to infect the bone that holds your teeth into your jaws. We call this Periodontitis. Now we have a big problem! With gingivitis, the gums can heal and everything is fine. But with periodontitis, if we lose bone, it�s gone for good! And it�s the bone that holds the teeth into the jaw bones. Treating periodontitis takes more than what you can do at home. The first step is always to remove as much of the bacteria deep under the gum as possible. This procedure is called different things by different dentists. In my office, I call it deep scaling and root detoxification. If the periodontitis has not destroyed much bone, this procedure followed by regular care can be all that is needed to control the disease. If there has been a lot of bone destruction, then a specialist called a Periodontist will be needed to not only help you control the disease, but also repair surgically the damage done. There are also many other types of specialty treatments that can be used to fight gum disease. The goal of course is not to allow the disease to progress to this point. Diagnosing periodontitis is done by several modalities. Here, the pockets measure usually over 6mm, there is bleeding when probing and x-rays detect a change in the bone levels around your teeth. Once you have lost bone, you will always be classified as having periodontitis. The question then is it stable or unstable. Like diabetes, you can control periodontitis, you just can�t cure it! There are many variables that can accelerate gum disease that all need to be addressed. Smoking, uneven bite forces, and immune response are the three most common. Smoking can be addressed the easiest�..Don�t! If you smoke, you have gum disease in some form�guaranteed! If your bite is off, there are many ways to correct those forces. Your immune response is who you are and unless your physician can help, we have to live with who you are! In later editorials, I will discuss the role of uneven bite forces in more detail but for now think of this example and how the force we place on our teeth can accelerate gum disease. If you see an old fence post poured in concrete in the middle of a field and you walk over and start pushing and pulling on it, you can eventually rock the post out. But if you first soak that post with water for two hours then start rocking the post, it will come out much faster. This is the same relationship that plaque does to teeth. It causes inflammation (soaking the post with water) and then rocking the teeth with uneven bite forces will loosen the tooth much faster. I hope this has brought some light on the subject of gum disease and maybe it has made you think of some questions relating to your own situation. Please feel free to discuss these with me at any time. If you are not a patient of record, consult your dentist or call Kristi at my office for an appointment so I can better help you achieve the level of health you deserve! Together Choosing Health! Craig Gaugh, DDS The next editorial will be on cavities and evaluating old restorations (fillings, crowns, etc.) November 12, 2004 Together Choosing Health I sincerely hope you will enjoy my new website! First, I want to thank my son Evan for developing this site. In the months to come, I will be posting my opinions on various topics that relate to dentistry and my office. Please feel free to contact me with your opinions or questions to any editorial posted. If you are not a current patient of my practice, please consult with a dentist before acting upon any advice given in these editorials. If you are a current patient in my practice I hope to hear your responses soon My mission statement says it all. Can a doctor make you healthy? Can any caregiver be solely responsible for your health? By taking medicine, filling cavities or having your teeth cleaned, will that make your mouth healthy? The simple truth is no. No one can make you healthy, only you can do that. Every day for the past 22 years, I�ve heard �I only want my teeth cleaned�, � I don�t have time to floss�, �I would like to stop smoking�. What�s wrong with this picture? Very simply, those statements reflect an attitude that it�s someone else�s responsibility for their health! If you truly want to be healthy, if you truly want to have a healthy mouth, you have to take responsibility. So what is my role in your oral health? The definition of the word doctor is �educator�. That is my role. Yes, dentist deal everyday in doing fillings, crown, root canals, gum surgery, etc. but do those things make you healthy? NO! That just repairs the damage done by disease�.it�s disease control! Everyone working in my office knows I live by the statement �its far more important what we tell our patients than what we do to them�. We have to realize that when a person comes to a dental office seeking care, far more often than not, repairing damage done by disease is important and has to go hand in hand with educating that person on what lead them to their present state of disease and how THEY can change to make themselves healthy! First ask yourself if you want to be healthy then ask yourself what are you willing to do to achieve it? In order to be healthy, you first have to know what healthy looks and feels like. For this article, I will focus on oral health but the principles can be applied to the entire body. If you are a person that has become a new patient in my practice in the past 4 years, you went through what we call our new patient process. The ultimate goal in this visit is to educate you on your own reality�.how healthy is your mouth! Unless you truly understand how healthy your mouth is, you can�t make good decisions on what you need to do to stay healthy or get healthy! Evaluate yourself with these questions: If your gums bleed, is that healthy? If your tooth has a brown spot on it, is that healthy? If your filling is chipped, is that healthy? If your teeth are worn, is that healthy? If your teeth are pretty, is that healthy? I have seen people walk into my office that have come straight from the gym with their bottled water in one hand and a book on dieting in the other. Is this person�s mouth healthy? I have seen people walk into my office slightly overweight carrying their briefcase in one hand, cell phone and palm pilot in the other. Is this person�s mouth healthy? The honest answer is I don�t know until we look and evaluate. And it�s not just me as the dentist that needs to evaluate! It has to be a Co-discovery to mean anything. Because it�s far more important for you to know your own reality than for me to know your reality! There are five areas of oral health we will be looking at over the next few months. These are gum disease, new cavities, your old dental work, your bite and jaw joints, and finally, cosmetics. In the mean time, take an honest look at how healthy YOU think your mouth is and feel free to discuss any concerns with me the next time you are in the office. Together Choosing Health! Craig Gaugh, DDS