Harry is a 14 year old high school student who had recently completed orthodontic treatment.  He is a fine young man, very personable and polite.

In Harry’s case, the orthodontics was done well to place the teeth in their proper position.  However, there were other concerns that could not be corrected with braces alone.   The upper front teeth were undersized and as a result, spaces remained after the orthodontics.  In addition, Harry and his mom had concerns regarding the general discoloration of his teeth.  The teeth appeared stained.

Spaces between teeth

As we always do with cases such as this, I sat down with both patient and parent, in this case, Harry and his mom to discuss their objectives and the options for treatment.  Harry and his mom desired for the spaces to be closed and his smile brightened.

In this kind of a case, there are usually two options to discuss: porcelain veneers and composite bonding (resin veneers).  Each option has its’ own set of advantages and disadvantages and we like to take the time go over these with our patients so that they can make the best decision for their particular situation.

A bright and happy smile!

In discussing the options for treatment, we decided to whiten the lower teeth a bit and then place composite resin veneers on the upper front teeth. 

As a rule, whenever we do a “combination” case where we want to place veneers and whiten the remaining teeth, we always want to whiten the teeth first.  These kind of cases can many times be completed very conservatively as well with minimal removal of any tooth structure.

The result was awesome!  The treatment was completed in just a few hours, but made a dramatic improvement in Harry’s smile.  Harry and his mom were ecstatic with his new and vibrant smile.

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I’ve had interesting conversations with some of my patients lately regarding the topic of headaches and teeth grinding.  We all get headaches, some more frequently than others and some more intense than others.  

While there are numerous causes of headaches, few people make the connection that teeth grinding can cause headaches, specifically muscle tension headaches.  

Many times, it comes down to an unbalanced bite or one that is not in harmony with the proper position of the jaw joints (TMJ).  This misalignment causes the jaw muscles to become hyperactive and just like any other muscle that is overworked, they eventually become fatigued and sore.  The result is that we complain of a headache. 

It takes a trained dentist to determine if in fact the bite is in harmony with the jaw joints or it is not. 

It may have everything or nothing to do with how your teeth look.  I’ve seen what appeared to be a rather nice smile but the bite was off by a mile… without the patient even realizing it. 

Interestingly enough, headaches are just one of many signs and symptoms of a bad bite.  Other signs include worn teeth, loose teeth, chipped teeth or even teeth that have moved over time.  I have even seen patients with sensitive teeth who thought they needed a root canal, only to find that their bite was the culprit.  The bite was adjusted and the pain went away. 

For many patients the key is in balancing the bite with the proper position of the jaw joints.  There are several ways to do this depending on the severity of the bite discrepancy.  Only a comprehensive bite analysis will reveal the best route to take. 

Patients can typically find some relief with custom made bite guards.  However, it is important to note that these bite guards must be fitted properly or they can cause more harm than good.  And regardless, even a custom-made bite guard won’t correct the underlying problem.  In fact problems can still worsen. 

The first step in correcting the problem is a comprehensive examination and bite analysis by a dentist trained in this discipline to determine if indeed an unbalanced bite may be causing headaches.

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Woman’s Day Magazine may not be a scientific journal but in this December’s issue, a friend of my wonderful wife Amy found an article that piqued her interest.  The article entitiled “Take care of your teeth and protect your health” by Sara Reistad-Long addresses a health topic that continues to get exposure.  Your dental health affects your overall health.

There’s no escaping the fact that the health of your mouth affects the health of your entire body.  As my staff and I have professed to our patients, research indeed indicates a link between dental disease and your systemic health and in particular four of the top ten leading causes for death according to the Centers for Disease Control.  These include heart disease, stroke, diabetes and Alzheimer’s disease. 

Your mouth houses a lot of bacteria, which cause cavities and periodontal (gum) disease.  If you have inadequate dental health, the gum around each tooth can be weakened and thinned, thus allowing bacteria to seep from the mouth and into your body.  The bacteria then settles in susceptible areas of the body including your heart and blood vessels and leads to what can be pretty major problems.

 Woman’s Day is but one of several magazines that have had articles on this important topic.  Some of our new patients are coming to us specifically because of concerns they have for their overall health and not just their dental health.  

For example, we have known for many years that diabetics are three times more susceptible to periodontal (gum) disease.  But research is now showing that periodontal (gum) disease increases one’s susceptibility to diabetes!  It’s a vicious cycle. 

We pay particular attention to the “oral-systemic connection” and when red flags come up regarding a patient’s periodontal (gum) health, we may bring the patient’s physician into the loop just to make sure there aren’t any other systemic problems going on. 

So when you are brushing and flossing, you are not only saving your teeth, you may very well be saving your life!

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By now most of us have heard that the actor Michael Douglas has Stage IV oropharyngeal cancer.  In his case he has a walnut-sized tumor at the base of his tongue.  For treatment, Douglas will require the works – surgery, radiation therapy and chemotherapy.  Needless to say, he has a tough road ahead of him for recovery. 

But as usual, it’s only when someone famous gets a disease that the world finally notices. 

While most Americans probably never even heard of this type of cancer, the reality of it is that the incidence of this disease is growing at an alarming rate. 

According to the American Cancer Society, oral cancer occurs about as frequently as leukemia.  More people die of oral cancer than from melanoma or cervical cancer. 

According to the American Dental Association, the incidence of oral cancer in the under-40 population has grown almost five-fold, with many patients with no known risk factor.

 Going back to my dental school days (more years ago than I care to admit), we had always thought that it was the people who either smoked too much or drank too much alcohol who got oral cancer.  As a side note, Michael Douglas apparently indulged in both smoking and drinking.

 Today, research is showing us that the increase in the disease may be attributable to the human papillomavirus (HPV).  In fact, according to the Centers for Disease Control (CDC), 25% of mouth and 35% of throat cancers may be linked to HPV.  And although the topic may be uncomfortable, what you might not realize is that HPV is a sexually-transmitted virus.  In fact, according to the Centers for Diseased Control (CDC), HPV is the most common sexually transmitted virus in the United States.

 According to Brian Hill, the executive director of the Oral Cancer Foundation “Social and sexual behaviors have changed.  Oral sex is more common.  The virus is spreading, especially among young people because sexual contact is more common, that this virus is not only ubiquitous in our society, but the mechanism of transfer is simple.”

 But still, 25% of those who develop oral cancer do not use tobacco or alcohol and have no other lifestyle risk factors.

 What makes this disease so dangerous is that unless someone (like your dentist) is actually examining and looking for it, oral cancer often goes unnoticed until the later stages.  Why?  Because often there are no symptoms in the early stages.

 Sadly, according to a study by the CDC in 2008, less than 30% of adults aged 18 years orolder had ever had an oral cancer examination. 

 Finding these abnormalities early strongly improves prognosis.  It is the key to success.  In our office, not only do we perform oral cancer screenings on each adult patient, we also use a specialized rinse and light that makes abnormal tissue stand out.  It’s called Vizilite Plus and you can find more information on it at www.vizilite.com.  It’s painless, fast and may save your life.

 Let me leave you with this:  Only 57% of all diagnosed oral cancer patients will be alive five years after their diagnosis.  I strongly believe that this is because of delayed diagnosis.  Make sure you have an oral cancer screening when you visit your dentist!

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Undersized lateral incisor tooth

Matching a single veneer or crown on a front tooth to the adjacent natural teeth is one of the most difficult procedures to do in dentistry.  This patient had recently finished wearing braces for a few years but found himself dissatisfied because of an undersized lateral incisor tooth.  He wanted the gap filled but wanted the treatment to be long lasting.  Together we decided that a porcelain veneer would fit the bill.

Whenever we do a case like this, we carefully evaluate the adjacent teeth first.  We don’t just look at the color or shade, but also the size and shape and even little nuances such as the white splotching on the teeth so that the veneer seems to disappear when it is placed.

Porcelain Veneer to fill the gap

Using our CAD/CAM technology, we made the actual porcelain veneer in our office and then color-matched the veneer to the patient’s natural teeth.  We have the technology that allows us to do that as well.

The result was awesome, the patient was happy and it was all done in one appointment.  I love it when a plan comes together!

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Let’s see if you remember some of your high school chemistry.  pH is the measure of acidity or basicity of a solution.  Pure water is neutral and has a pH of 7.0.  Solutions with a pH less than 7.0 are considered acidic.  Solutions with a pH higher than 7.0 are considered basic or alkaline. 

The lower the number the more acidic a solution is.  The important thing to understand here is that when the pH of a solution on a tooth surface is less than 5.5, tooth surface damage occurs. 

Gatorade, for example, has a pH of 3.3.  In fact, research by a British dentist, Dr. Milosevic, found the pH levels of sports drinks ranged from approximately 4.5 to 2.4. 

Why do sports drinks have such a high acid content to begin with?  My understanding is that the acidity improves the taste and increases the shelf life of the products. 

But the acid components are just one part of the equation.  Sports drinks can also have a rather high amount of refined sugar.  Any beverage that has high acid content can weaken the enamel.  Sugar can worsen the situation by encouraging bacterial growth.  So acid is bad, sugar is bad and many of these sports drinks have both.  Together, they cause tooth decay. 

Realize that there are a lot of liquids that we consume that contain acid – sodas, sports drinks, wine.  So why aren’t everyone’s teeth just rotting away?  Your saliva contains minerals that naturally re-mineralize or re-harden teeth after they have been exposed to acid solutions.  But in the presence of a significant exposure to acid, there is only so much repair that saliva can do. 

Fortunately, there are sports drinks out there that don’t have so much sugar and aren’t so acidic.  One that I have personally used is HEED made by Hammer Nutrition.  This company has been around since 1987, developing a wide range of nutrition products for the endurance athlete. 

For sweeteners, HEED contains Xylitol and Stevia, which are both healthier alternatives to the refined sugars and/or artificial sweeteners found in most sports drinks.  In addition, HEED doesn’t contain the high amounts of citric acid found in most sports drinks.  The result of these modifications, according to Steve Born at Hammer Nutrition, is that the pH of HEED is 7.04 – almost neutral.   Pretty impressive. 

So what exactly is Xylitol and Stevia?  Xylitol and Stevia are both natural sweeteners.  Xylitol can be found in a variety of fibrous fruits and vegetables.  The human body even naturally produces some Xylitol via normal metabolic processes.  Stevia comes from a plant found in subtropical and tropical Central and South America.

From a dental standpoint, Xylitol and Stevia are very “tooth-friendly”.  Remember, bacteria in the mouth love refined sugars.  They metabolize it to create acids that cause cavities.  On the other hand, oral bacteria are unable to ferment Xylitol and Stevia. 

The result is that the number of cavity-causing bacteria is remarkably reduced, no acid is created, and thus no cavities are formed. 

“Tooth-friendly” sports drinks can be found in almost any triathlon, running and cycling store. But for those people who continue to drink sports drinks that are high in refined sugar and acid components, There are things you can do to at least reduce their risk of damaging your teeth. 

First, use the sports drink for its intended purpose during and after extended exercise, training or competition, and not as an everyday beverage. Second, one of the most important factors is how long one holds the liquid in their mouth.  The longer the drink sits in the mouth, the more damage it will cause. Third, there are some toothpastes on the market that are designed to re-mineralize teeth that have been exposed to liquids that contain acid such as wine, soda and sports drinks.Lastly, research suggests that brushing your teeth immediately after consuming a sports beverage can actually make tooth erosion matters worse. 

 Better to rinse with water to dilute the acid and then wait 30 minutes before brushing your teeth to allow softened enamel to naturally re-harden via the minerals in saliva.

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Interview from Charlotte Weekly, 7/17/09

Q: Dr. Van Gurp, I understand that today’s focus is on hormones and women’s oral health.

Dr. Van Gurp: Women have an increased propensity for oral health problems because of the hormonal changes that take place throughout their lives.

In general, these hormonal changes affect both the blood supply to the gum tissue and the body’s response to the toxins (poisons) that result from plaque build up.  As a consequence of these changes, women are more susceptible to the development of periodontal disease at certain stages of their lives, as well as to other oral health problems. (more…)

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This interview with Dr. Richard Van Gurp first appeared in The Charlotte Weekly – 4/25/2008

Q: I think that most parents recognize that fluoride is a proven means to protect the dental health of children primarily by making teeth more resistant to cavities. But today, you wanted to talk about how fluoride can benefit adults as well.

Dr. Van Gurp: That’s right. Research now indicates that everyone – children and adults – can benefit from fluoride. (more…)

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