Thank you for visiting the website of Signature Dental Care, a distinguished dental care provider conveniently located in Wyomissing, Pennsylvania. Dr. John Reitz and his experienced team will work to create an individualized treatment plan specifically designed to address your unique needs. We utilize state-of-the-art technology to ensure that each of our patients receives superlative care that is both efficient and effective.
Our office uses the latest general dental techniques to correct all your dental problems. Our experienced staff works together as a team to provide you with fillings, crowns and bridges, root canals and tooth extractions in order for you have a great smile.
If you worry about the appearance of your smile, then worry no more! We offer the latest cosmetic dental techniques available to meet all your unique needs, including veneers, teeth whitening, cosmetic bonding and dental implants. A dazzling, picture-perfect smile is closer than you think!
At Signature Dental Care, we look forward to seeing you smile!
Relief available for burning mouth
Dear Dr. Reitz:
During the past year I have lost some of my ability to taste food. Recently my tongue has become painful without any visual change in appearance. My dentist diagnosed the problem as burning tongue syndrome. Is there anything I can do to reduce the painful problem? - Carol, Wyomissing
The definition of burning mouth syndrome or BMS is burning pain in the tongue or other oral mucous membrane lasting for at least four months and associated with normal-appearing oral mucosa and normal laboratory findings. In many cases BMS is associated with dryness of the mouth.
In making a diagnosis of BMS, it's important to rule out a yeast infection and dry mouth because both can be painful without visual signs. Yeast infections often are associated with a bitter or metallic taste. Your dentist should measure your saliva flow rate to rule out a salivary condition before making a final diagnosis.
To be diagnosed with BMS, the condition must exist for at least four months, last throughout the day and increase in severity toward the evening. Most people find relief during eating or drinking.
Three out of four cases of BMS occur in women, usually postmenopausal, between the age of 50 and 70. Since I don't know your age or health history, I also will mention that BMS has been found to occur in patients taking a specific class of medication to control high blood pressure. If you are taking medication for high blood pressure and the name ends in "sartan" or "pril," there is a good change we found the cause of your problem. For example, Lisinopril and Candesartan were both found to cause BMS.
Until a definitive diagnosis is made, there are some things you can do to help. Eliminate any toothpaste that contains triclosan or other tartar control products. Begin using a nutritional supplement that contains vitamin B12, folate, iron and zinc. Finally, start taking alpha lipoic acid. One study found 76 percent of patients taking the nutritional supplement alpha lipoic acid had some relief from the symptoms of BMS.
If a diagnosis of BMS is made, the accepted treatment is the topical application of the antiseizure drug Clonazepam. In one study, 40 percent of the patients treated with topical Clonazepam had relief from BMS. Making a diagnosis of BMS is a process of elimination. Identifying the cause and finding a cure may be difficult.
ADA MEMBERSHIP A PLUS FOR A DENTIST
Dear Dr. Reitz:
My dentist has a sign at the door indicating he is a member of the American Dental Association (ADA). I was surprised to learn that not all dentists are members of the ADA. Is there any advantage for a patient if the dentist is a member of the ADA? - Martha, Temple
The American Dental Association is a nonprofit organization made up of dentists, dental students, dental educators and dental researchers. ADA's overall mission is to advance the oral health of the public.
It is mandatory that all dentists in the United States be graduates of an ADA-accredited dental school, plus fulfill additional individual licensing requirements of the state in which they want to practice. No state requires a dentist to join the ADA. Membership is voluntary. Currently, approximately 83 percent of the practicing dentists in the United States are members of the ADA.
I suspect your dentist posted his ADA membership because he wants patients to know he pays dues and is a proud member of a volunteer organization that funds dental research, evaluates dental products, conducts continuing education for the dentist and the staff, and is constantly lobbying in the legislative arena to improve the oral health of the nation. The ADA is a one-of-a-kind organization that is greatly responsible for the quality of dental care available in our country.
The ADA's Paffenbarger Research Center in Gaithersburg, Md., has developed products that have revolutionized the practice of dentistry. Unlike private industry, any discovery it makes is given away freely without patent rights for any company to use.
The Council of Dental Education of the ADA is responsible for establishing dental education guidelines, which is the only accreditation accepted by every state dental board for licensure. The Ethics Committee of the ADA establishes guidelines for dentists to follow in administering patient care. The ADA Council on Access, Prevention and Interprofessional Relations is dedicated to promoting preventive dentistry as a cornerstone of oral health care and advancing the delivery of oral health care to the public.
The list of how the ADA benefits the public's oral health is extensive, which is why your dentist is proud of his membership. Finding a dentist that is a member of the ADA is not a guarantee of competence, but it does mean that dentist wants to be part of an organization that is constantly striving to advance the public's oral health, and that is a good thing to have in a dentist.
What Causes Black Stain?
Dear Dr. Reitz:
Do you have any idea what is causing a black stain to form on my teeth within a month of having them professionally cleaned? My dental hygienist uses a sandblaster to get the stain off during my cleanings. I don't smoke, and I am not a coffee or tea drinker. I have been pregnant or nursing the majority of the last four years. - Sara
I suspect the instrument your dental hygienist is using to remove the black stain is a prophy jet, which cleans the teeth with a pressure spray of baking soda. This indicates the stain is not on the tooth surface and is caused by something in your diet. Generally, surface stains on teeth are caused by smoking and coffee or tea; your situation requires more investigation. Black stains on teeth have been shown to occur from high concentrations of iron in the saliva, especially in people who consume dairy products (especially cheese). Dairy products play a role because they contain the protein lactoferrin, which will bind with iron in the saliva.
Lactoferrin is nature's antibiotic, necessary to fight bacteria and keep us healthy. It's found in milk, saliva, tears and nasal secretions. It is also found in high concentrations in cheese. Cheese can stick to the tooth surface and form a film that actively binds to available iron in Similar black stains have been found on teeth of infants who receive iron-fortified formula. In infants, it's likely the lactoferrin in the formula forms a film on the teeth, which then absorbs iron that produces the black stain.
You must first determine if the high concentration of iron in your diet is causing the problem. If you were taking iron supplements while pregnant and while nursing, you many be causing iron overload and raising the concentration in your saliva. It has also been found that people with iron-deficient anemia have high concentrations of iron in the saliva.
Interesting. I have a salad with feta or mozzarella cheese probably four to five times a week. Also, I was taking prenatal vitamins, which contain iron, during my pregnancy and while nursing. Do you think this could be the culprit?
Dr. Reitz: The cheese in combination with iron vitamins certainly maybe the cause. I suggest you discontinue the vitamins with iron and see if the problem continues. If your teeth continue to get black stains, you should then be tested for iron-deficient anemia.
Dental Care Vital During Pregnancy.
Dear Dr. Reitz:
My son and daughter-in-law are expecting their first child, and I am concerned for the baby. My son grew up having regular trips to the dentist, but my daughter-in-law's parents didn't value good oral care, so she only saw a dentist when there was a problem.
She is now 26 and hasn't been to the dentist in more than seven years.
During a recent conversation, she said her gums were bleeding and she was going to take care of it by brushing harder. I read there is a chance the baby can be harmed if she has dental problems during the pregnancy. I would like information to give her a reason to have her mouth checked before she has pain. - Marie, Reading
You have good reason to be concerned about the health of your grandchild. Studies indicate pregnant women with gum disease are more prone to have preterm, low birth-weight babies. In fact, having the gum disease periodontitis while pregnant increases by seven times the chance of having a premature baby. Low birth-weight babies have a higher incidence of anemia, jaundice, malnutrition and breathing problems.
Two factors come into play during pregnancy. First, during pregnancy, a women is more apt to get gum disease. Second, having gum disease is more likely to cause a premature baby. Let's look at both of these issues.
During pregnancy, a woman has increased levels of the hormone progesterone in her system. This hormone has the effect of causing swollen, bleeding and tender gums because progesterone reduces the woman's immune system against bacterial growth, resulting in gingivitis. The simple treatment is to remove the bacteria by having professional cleanings at the dental office and following proper brushing and flossing techniques at home.
The second problem of delivering the baby prematurely is caused by the chemical prostaglandin, which is found in oral bacteria and appears to induce labor. Very high levels of prostaglandin are found in women with severe periodontal disease.
We know the mouth is physically connected to the rest of the body; new research is showing how the health of one affects the other. I suspect your daughter-in-law is busy getting ready for the new arrival. If she realizes the health of her newborn is related to her oral health, I am sure she will make the time for a dental exam and cleaning.
You did the right thing by instilling the importance of regular dental care in your son at a young age. It's not too late to get your daughter-in-law ascribing to the same philosophy.
Should dentists give flu vaccintions?
In January a bill was introduced in the Illinois General Assembly that would allow dentists to administer vaccines for common ailments such as shingles, tetanus and influenza. Getting the flu vaccine to as many people as possible is the most effective way to protect our population. Unfortunately, there are organizations opposing the effort, the main one being the Illinois Medical Association.
One argument is that health care reform puts the physician in the position to coordinate treatment and maintain complete medical records. I understand how allowing additional health care providers to administer vaccinations may make it more difficult for physicians to maintain complete records on their patients. However, pharmacists have already eliminated that argument.
Each day in my practice I administer injections to numb the mouth. Technically those injections require more skill than administering a vaccine.
Pennsylvania currently does not have pending legislation such as Illinois. If the proposed legislation passes in Illinois, I suspect other states will quickly follow - including Pennsylvania.
There has been no talk among my dental colleagues desiring the ability to administer vaccinations. I see a definite benefit to the people of Pennsylvania, and I am certain many of my colleagues would incorporate it into their practices if allowed.
Dentistry in midst of a changing face
I just returned from a meeting in Baltimore where dentists debated when and how to treat tooth decay. You read that correctly: It's been more than 150 years since Dr. G.V. Black (father of modern dentistry) created amalgam filling material and guidelines for drilling and filling teeth that are still in existence. Years of additional research is making dental educators rethink when a break in the surface of a tooth is decay and how it should be managed.
In 1836, when Black was born, there were many theories of why teeth decay. Some believed decay was caused by worms making holes in teeth; others believed that tooth-eating bacteria caused decay. It wasn't until Black's time that we understood that bacteria caused decay because of the acid they secreted while fermenting carbohydrates.
Today, everyone accepts bacteria's role in causing tooth decay, but there is not universal acceptance among dental educators as to when tooth decalcification is decay. Patients know dentists use sharp, pointed instruments to check for cavities. In fact, dentists were taught in dental school to check for decay by poking into the grooves of teeth with the sharp end of an instrument called an explorer. If the explorer sticks, it is considered decay.
That method of checking for decay was one of the topics discussed and debated at the meeting. Some dental educators believe poking the tooth with an explorer is not an effective indicator of decay and should be discontinued. That would be a drastic change for many dentists, and unfortunately there is not a good alternative universally accepted by educators.
Some dental educators believe small breaks in the surface of teeth should be treated with medications instead of drilling and filling. No, there is not a pill that cures cavities, but there is strong evidence that small decalcified areas on the teeth can be rehardened using concentrated fluoride toothpaste and creams containing calcium and in some cases sealants.
Since tooth decay is caused by carbohydrates in the diet, especially sugar, treating small areas of decalcification requires diet modification. Sugar doesn't cause decay, but if you have small decalcified spots on your teeth, reducing the time carbohydrates linger in the mouth is important to prevent beginning decalcified breaks in the teeth from advancing to an area of decay that needs to be drilled and filled.
Dentistry is changing from a profession that treats disease by drilling and filling to one that looks for a cause and treats disease.
The Dentist's Chair: Oral sex may result in virus, cancer
Dear Dr. Reitz:
It was recently reported that, having recovered from oral cancer, actor Michael Douglas revealed his throat cancer was caused by the human papillomavirus as a result of having oral sex with an infected woman. What do warts look like in the mouth? Is it only possible to get the virus through oral sex, and is there a test to find out if I have it? - Anonymous
Squamous cell carcinoma of the oral cavity affects approximately 40,000 individuals in the United States each year. Although smoking and chewing tobacco are the major risk factors, many cases of oral cancer occur in patients infected with the human papillomavirus (HPV), the virus that causes warts.
Every day in my dental practice, I perform oral cancer screenings on patients as part of their dental visit. The exam includes looking for suspicious lesions and lumps. Often I observe lesions that look like small tissue tags, an area of irritation or white, fibrous, nonbleeding tissue, all different in appearance but likely caused by variants of HPV. More often oral HPV does not have any visible signs.
It is estimated there are more than 100 strains of HPV. Recent research has identified several high-risk strains of HPV that are implicated in cases of oral cancer. HPV is transferred by contact between people. However, it is not fully understood whether the high-risk strains are transmitted only sexually. With 20 million Americans currently infected with HPV, this infection should be a bigger health concern. Fortunately, it is now possible to have a simple test to determine if one of the more dangerous strains is present in a person's mouth.
Going to the dentist can be an uncomfortable experience if you need a root canal or extraction, but having the test to determine HPV is as simple as spitting into a cup. The dentist sends your saliva sample to OralDNA Labs, where their lab determines if you harbor one of the known dangerous strains of HPV. Unfortunately, if you discover you have the virus, there is no effective way to get rid of it. Prevention prior to infection is the only answer.
The vaccines Gardasil and Cervarix are the only available way to prevent getting four of the main sexually transmitted forms of HPV. The vaccine is to be used by both girls and boys between the ages of 9 and 26. Unfortunately, many people are not taking the infection seriously, and utilization of the vaccine is very low.
The Dentist's Chair: Pondering a dental procedure in Mexico
Dear Dr. Reitz:
My teeth need to be extracted, and I would like to replace them with implants. I understand it is cheaper to take a vacation to Cancun, Mexico, and have the teeth pulled and implants placed than having it done in the United States. Is there a way of checking on the credentials of the dentist in a foreign country? - Bill, Morgantown
You are describing what is termed a "dental vacation": traveling out of the country hoping to save on a dental procedure. To answer your question, I did an Internet search for dentists in Mexico that do implant dentures and combined that with my knowledge of implant dentistry.
As a dentist who does implants, I understand the many options available to a person seeking to replace teeth with implants. They include low-cost plastic teeth that snap over two mini-implants; a hybrid metal-frame, plastic-teeth screw-retained prosthesis over four standard-size implants, sometimes called all-on-four; to the most sophisticated porcelain over precious metal screw- or cement-retained prosthesis over six or more standard-size implants. Before we can compare price, we need to know if we are comparing apples to apples or apples to oranges, as the saying goes.
I discovered on my Internet search that a few Mexican dentists described the low-cost plastic teeth over two mini-implants, but compared their fee to what a U.S. dentist would charge to do a porcelain over multiple standard-size implants, somewhat like comparing a motor scooter to an automobile.
Planning implant dental cases involves quite a bit of time and often the combined efforts of more than one dentist. Measuring the available bone for the ideal size implant to prevent future failure frequently requires using a three-dimensional imaging X-ray machine and consultation between the dentist who will surgically place the implants and the dentist who makes the teeth over the healed implants, often not the same person.
Prior to making your dental vacation plans to a foreign country, sit down with a local dentist and ask for options on replacing your teeth with implants. The dentist should be able to describe at least three different ways to replace your teeth with implants, from the low-cost two-implant overdenture to the most sophisticated porcelain over metal multiple-implant prosthesis. Don't be fooled into thinking dentistry is more expensive in America than other countries.
Dry-mouth remedy spurs tooth decay
Dear Dr. Reitz:
I think it's important for your readers to know the danger of sucking hard candy to compensate for a dry mouth. My longtime dentist retired, so I switched to a new dentist who did a full examination of my mouth, including X-rays of all my teeth. The new dentist discovered that my four lower front teeth have extensive decay and need to be extracted. I told the dentist I place a sugar candy lozenge in my mouth during the day to stimulate saliva. My habit caused extensive damage. Hopefully, this information will prevent someone else from having the same problem. - Bill, Reading
Your decision to stimulate salivary flow by sucking on hard candy is very common and very damaging to teeth. I have witnessed many dry mouth patients place sugar candy like Altoids and Tic Tacs inside the mouth to stimulate saliva, only to cause rampant decay on multiple teeth. I still remember my elementary school teacher sucking hard candies all during the school day. I have to assume she ultimately lost all of her teeth from decay.
Chewing gum or sucking hard candy is an excellent way to stimulate salivary flow, as long as they are sugarless. My sweetener of preference is xylitol, because it is not fermentable by the oral bacteria that cause tooth decay. Found in nature and obtained from sources such as birch wood, nut shells and straw, xylitol is similar to other carbohydrates, except the human body does not absorb the available calories as readily.
Xylitol hard candy may help your dry mouth during the day, but until recently there was not a product that helped keep the mouth moist during sleep. A clever new product termed XyliMelts is now available, designed to prevent dry mouth during sleep.
To solve the problem of choking on the lozenge during sleep, XyliMelts has an adhering disc that sticks wherever you place it in the mouth. Just moisten the adhesive side, place it on the upper teeth or gums and allow the XyliMelts to dissolve while you are sleeping to stimulate saliva flow.
My office has recommended XyliMelts to a few of our patients, and so far the reviews have been positive. I was initially concerned the adhesive would come loose, causing a choking hazard, but to my knowledge that has not occurred. This product does not require a prescription and can be found in many drugstores or on the Internet.
A substitution for mouth rinse?
Dear Dr. Reitz:
Why hasn't someone invented a carbonated mouth rinse? My teeth have been replaced with dental implants, and instead of manufactured mouthwash I like to swish carbonated diet soda around my mouth to rinse away food particles and freshen my mouth. The fizz from the carbonation feels like it is eating away the food particles better than most mouth rinses I have tried. - Jimmy, Wyomissing
Your idea has merit, but the problem is the acidity of the carbonated soda. All carbonated drinks damage natural teeth by causing acid erosion. The degree of damage is dependent on the length of contact and the acidity of the liquid. Dental implants are made of a combination of titanium, porcelain, plastic or other metals, none of which are susceptible to erosion by carbonated beverages.
There is not a lot of research on the most effective way to clean around dental implants, however some recent studies have shown that a water flosser might be the ideal product for cleaning in the hard-to-reach areas under and around implants. In fact, the force of water was more effective than string floss in cleaning around implants. Your use of carbonated diet soda is a unique variation on the tried-and-true water flosser.
Water is neutral with a pH of 7. As a solution's pH value gets closer to 0, the ability to erode tooth enamel increases. Carbonated soda has a pH of around 3, which is certainly more erosive to tooth enamel than water. In fact, there is a documented condition termed "soda swishing" in which individuals swish soda in their mouths until the bubbles are gone to make it easier to swallow. If done for long periods of time, the habit of "soda swishing" results in extensive loss of tooth structure.
I did some research and discovered you are not the first person to suggest a carbonated mouth rinse. A patent is already filed with the U.S. Patent and Trademark Office for a carbonated mouthwash. In fact, swishing carbonated soda has been suggested in the medical literature as an effective treatment to break up that "mucus in the throat" feeling that plagues many individuals.
I suspect designing a dispenser that doesn't allow a carbonated mouth rinse to go flat after opening is the main obstacle stopping production. Since you don't have any natural teeth, I am not aware of any clinical reason you can't use your technique of carbonated soda as a mouth rinse. I suggest you ask your dentist if your home care is working at your next visit.
Dentists also can look for skin cancer
Dear Dr. Reitz:
In addition to looking for problems inside my mouth, my dentist has begun examining my face and neck for suspicious looking lesions that could be cancerous. He said it's not possible to diagnosis skin cancer by visual exam. However, if he finds a suspicious lesion I would be referred to my physician to make the final diagnosis.
I think this is a great service and just wanted to let your readers know that going to the dentist may be more beneficial than just healthy teeth. - Diane in Bernville
Dentists' checking inside the mouth for oral cancer has been the standard of care for many years, but only recently have some begun to examine the face and neck for suspicious lesions. It is estimated that one in five Americans will develop skin cancer, which relates to more than one person per hour dying from melanoma. Each year 35,000 people are diagnosed with oral cancer, compared with 1 million people diagnosed with skin cancer resulting in 12,000 deaths each year. Since most people see their dentists more frequently than their physician, the dentist can play an important role in finding suspicious lesions.
Tell your dentist if you have had a persistent mouth sore, difficulty swallowing, chronic sore throat, persistent earache or a nontender lump in your neck. In addition, if you notice a new mole or nonhealing sore on your face or neck, bring that to your dentist's attention. Although it's not possible to identify a lesion by just visual exam, your dentist may be able to determine if the lesion requires a biopsy and either perform the biopsy or refer you to a dermatologist. After a visual screening of the skin on your face and neck, your dentist may palpate the floor of your mouth and the sides of your neck. Swollen lymph nodes can be a cause for concern.
It is believed that most skin cancer is the result of ultraviolet exposure from the sun, so with proper precautions, it is preventable. Avoid long periods in the sun, or wear protective clothing and a hat in addition to sunscreen on exposed areas of your face and lips. Sunscreen is only effective for a few hours, so reapply if you are in the sun for long periods of time.
Dentists are concerned with your overall health, even though their primary focus is on your oral health. I am delighted your dentist is performing a cancer screening. It just makes your trip to his office more beneficial.
Do baseball players need mouthguards?
Dear Dr. Reitz:
My son plays Little League baseball. Last summer one of his teammates was hit in the face with the ball. Fortunately there was no damage to his teeth, but he did require a few stitches to his lip.
None of the players on his team wears a mouthguard. Is there a mouthguard designed specifically for baseball? - Michelle, Shillington.
Baseball is one of the most popular youth sports in the United States, and a relatively safe sport compared with many other athletic activities. According to the U.S. Consumer Product Safety Commission, nearly half of the injuries (44 percent) that occur playing baseball involve the head, with 25 percent to the face, of which 5 percent are to the mouth. Some studies claim 16 percent of baseball injuries to the mouth and teeth are attributed to being hit by a batted ball.
A blow to the face can result in broken, displaced or traumatized teeth. A few years ago I treated a young batboy who had the misfortune to be in the wrong place as a batter was warming up and took a bat to the teeth. His father was smart to call me from the ballfield so I could meet him at the office within an hour of the accident and stabilize his mouth.
Mouthguards in baseball have not received the universal support they have in other contact sports. Currently the only sports that require a mouthguard are ice hockey, lacrosse, field hockey and football. In addition to protecting the teeth from direct trauma, they reduce the risk of concussion to the brain by cushioning impact injuries from a blow to the chin.
My first choice of mouthguard is one made by a dentist. A custom-made guard from an impression is less bulky and more comfortable. If cost is a concern, you can purchase a "boil and bite" type of guard from a sporting goods store or the Internet.
A creative variation on the mouthguard is a product called Bite Tech, which is made by the sports-clothing manufacturer Under Armour. Bite Tech is a mouthguard that claims to protect the mouth and improve athletic ability by opening the airway space.
I am not convinced that the scientific evidence supports the increase in athletic ability from wearing a mouthguard, but the claim may help your son justify wearing a mouthguard to the rest of the team while satisfying your parental concern for his safety.
Defeat gingivitis with proper care
Dear Dr. Reitz:
Brushing and flossing are the two most important things you can do to maintain a healthy mouth. But doing it effectively is the key to eliminating gingivitis.
Some studies estimate that 75 percent of adults have areas of gingivitis in their mouths, and I suspect many of same adults brush and floss their teeth regularly. Sticky bacteria - not food particles - growing on the tooth and under the cuff of gum tissue at the base of the tooth is what causes gingivitis.
All toothpastes contain abrasive particles that help remove the sticky bacteria. However, toothpaste is only effective if you get it to the bacteria under the gums, which is where the toothbrush and floss come in.
Many patients ask which they should do first, brush or floss. The correct answer is brush. Begin by taking a dry toothbrush and adding a small amount of toothpaste. In addition to brushing the teeth, work the toothpaste down into the gums around the neck of the teeth. After you have cleaned all four quarters of your mouth, put the brush down and pick up the floss.
Spit out any excess saliva, put a little toothpaste onto your finger and rub it around the quadrant you plan on flossing. That is correct: Toothpaste working with floss is more effective than floss alone, and since it's not possible to put the paste on the floss, you need to put a little around the teeth.
Before flossing the next quarter of your mouth, you may need to add a little more toothpaste by repeating the process of using your finger. If you look in the mirror you will see the toothpaste all around the teeth; just assume some is working with the floss to remove that sticky bacteria.
Initially you may notice some bleeding as your work the floss under the gums. Gingivitis causes ulcerations in the tissue that easily bleed when touched. After two weeks of effective cleaning, the bleeding should stop.
Following these guidelines once a day (my recommendation is prior to bed) should be effective in ridding your mouth of gingivitis. This entire process takes at least five minutes; any less and you are only fooling yourself that your home care is effective.
It's tough to whiten a 'dead' tooth
Dear Dr. Reitz:
When I was a teenager, my front tooth needed a root canal because of an injury. The tooth has always looked darker than the surrounding teeth. Tooth whitening by my dentist made my teeth whiter, but the tooth with the root canal is still dark. Is there a whitening product that can be applied to just the dark tooth to make it the same color as the rest? - Michael, Sinking Spring
The pulp chamber in the center of a tooth contains a nerve, which is often injured when a tooth is traumatized. If the injury is severe, the nerve can die and require root canal treatment to remove the dead material. For some reason, which is not fully understood, these teeth often turn dark in color.
The most accepted theory to explain the change in color of the tooth suggests that when the tooth dies, iron is released from the blood cells in the pulp chamber. The dark tooth presents a great challenge to dentists because the stain does not respond as readily to the whitening products on the market.
The current tooth-whitening techniques are based on using hydrogen peroxide coming in contact with teeth for an extended period of time to change the inherent color of the teeth. Although the exact mechanism of action is unclear, it appears the peroxide soaks into the tooth and oxidizes and dissolves the stains.
Since your stain is mainly internal, most of the topically applied products, similar to what you have already tried, don't penetrate deep enough to make a difference. To get the whitening solution where it's needed requires drilling into the back of the tooth and placing the solution inside the tooth. That may sound painful, but remember the tooth had a root canal and the nerve has been replaced with filling material. In essence, the whitening solution (usually 34 percent hydrogen peroxide gel) is placed into the root canal space.
The technique is termed "walking bleach" because after the whitening solution is placed into the center of the tooth, a temporary filling is placed and the patient leaves the office. So the patient is walking around with the solution inside the tooth doing the job of whitening. After three to five days, the patient returns to the office to check the results. It is usually necessary to repeat the process a few times before obtaining the desired result.
Because the tooth had a root canal, tooth sensitivity is never a problem. Unfortunately, a dead tooth is difficult to whiten, even with repeated attempts at applying "walking bleach." In that case, your next option is to have the tooth crowned.
Most medications safe for pregnancy
Dear Dr. Reitz:
I am three months pregnant with our first child. My dentist said I have gingivitis and wants to use Novocain to numb my gums prior to doing a deep cleaning. Is it safe for my unborn baby if I have dental work done while pregnant? - Beth, Shillington
Congratulations on the beginning of your journey into parenthood. That trip has some bumps in the road, including an increased risk of gum disease and tooth decay during pregnancy. Your increased levels of the hormones progesterone and estrogen cause the capillaries in your gums to dilate, causing increased bleeding. In addition, if you have morning sickness or acid reflux, the stomach acid in the mouth causes tooth erosion and decay.
If you require dental procedures, you can be comfortable in the knowledge that most of the medications used in dentistry do not jeopardize the health of your unborn baby. The benefit to your oral health by treating your gingivitis greatly outweighs any risk to your baby.
Lidocaine with epinephrine is the most commonly used local anesthetic to numb the mouth; it is also fortunately the safest for you and your unborn baby. Unfortunately, the anesthetic that is usually applied to your gums prior to injecting the needle (benzocaine) must be used sparingly because it has been known to interact with the iron in your blood that carries oxygen, thereby reducing the blood's ability to oxygenate your body.
The antibiotics penicillin and cephalosporin are commonly used to treat dental infections, and are both considered safe for use during pregnancy. Antibiotics to avoid are erythromycin (because it can cause liver toxicity in a pregnant mother) and tetracycline (because it is known to cause tooth discoloration).
As you get into the second and third trimesters, you may find it uncomfortable to sit in the dental chair for long procedures. Lying on your back allows the pregnant uterus to compresses the large vein that returns blood to your heart, which can lower your blood pressure, causing you to faint. So I suggest you ask the dentist to only schedule short appointments or allow you to get up and walk around frequently.
Your baby's health is very important, but neglecting your dental care can result in long-term dental problems for you and your child. A newborn's mouth is free of any bacteria, and most likely the first bacteria it will receive will be from your mouth. A healthy mouth has harmless bacteria that don't cause tooth decay and gum disease.
Patients can help monitor dentists
Dear Dr. Reitz:
Last month an oral surgeon from Tulsa, Okla., was accused of following improper sterilization procedures and using rusty surgical instruments, resulting in a patient being infected with hepatitis C and HIV. I have always assumed that health care in the U.S. was the best in the world, and although going to the dentist is never pleasant, I don't expect it to be life-threatening.<
What measures are taken in Pennsylvania to protect dental patients, and how can I be certain my dentist is following proper procedures to safeguard my health? - Michelle, Shillington
In 1998 I had the privilege of being appointed to the Pennsylvania State Dental Board by Gov. Tom Ridge. While also working in private practice, I spent 12 years on the board, the last two years serving as chairman. Compared with most states, Pennsylvania has some of the most rigid requirements to ensure patient safety, some of which I helped to enact. Concerning putting patients to sleep under anesthesia, Pennsylvania established some of the first guidelines in the nation, requiring office inspections to verify compliance.
Rules and regulations can be written, but in everyday practice it requires a dedicated dentist to make sure the rules are being followed. Every dentist is taught to sterilize instruments in a heat/pressure autoclave. Yet for some unknown reason, the oral surgeon in Oklahoma decided to soak dental instruments in Clorox bleach. Every dentist also knows the needles used to inject medications are not designed to be reused, yet that is an additional allegation in the Tulsa dental case.
There is no way to guarantee your dentist is following all the regulations in place to protect your safety. With more than 1,600 licensed dentists in Pennsylvania, the state does not have the money to send inspectors into every office to verify the rules are being followed. For that reason, it's incumbent on you to be observant when visiting any health care facility. The dentist or dental staff member should put on new gloves before working in your mouth. The instruments should be unwrapped in your presence. Plus, don't be afraid to ask about their sterilization procedures.
People want dental care at reasonable rates, but at the same time deserve to be safe when visiting the dentist. Unfortunately, the Tulsa dentist may have felt the cost constraints working within the reimbursement rates dictated by Medicaid and insurance companies and therefore cut corners to save money. Usually, the Pennsylvania State Dental Board learns of a problem with a dental office when a patient files a complaint.