Laser Use in Dentistry

Laser technology had entered the field of dentistry by 1994 itself. The lasers used for dental treatment are not the cold lasers, which are used for treating inflammation, headache, and pain, and also used in phototherapy. Though it is useful in treating many dental problems, laser is yet to be fully accepted by the American Dental Association. The treatment mode does have FDA’s acceptance, but not that of ADA, whose standards appear to be more exacting. ADA is still not fully convinced of the efficacy and safety of using lasers for dental treatment.

However, the technology is being used by some in treating the following problems:

• Tooth decay. Lasers are useful in removing the decayed portion from the tooth and readying the remaining enamel for the fresh filling. It is also useful in hardening the filling.
• Gum problems. For removing bacteria during a root canal treatment, and reshaping gums, lasers are useful.
• Biopsy. For removing a lesion, or any tissue from the mouth, lasers are used. Tissue removal sometimes becomes necessary for cancer testing. Lasers are also effective in the treatment of mouth ulcers.
• Teeth whitening. Some teeth whitening procedures nowadays employ lasers. Whitening is basically done by the application of a bleaching solution on the surface of the teeth, but the action of this peroxide solution is enhanced by employing lasers.

The Working of Lasers

All forms of laser appear as light and provide energy in the way in which it is required for different operations. When used for hardening the tooth filling, the laser binds together the filling and the tooth. During teeth whitening, it acts as a source of heat which increases the activity of the whitening agents. In surgical use, sometimes it functions as a vaporizer for annihilating tissues. At other times it functions as a cutting implement.

What Are the Pros and Cons of Using a Laser in Dentistry?

Pros
Compared to the traditional dental drill, lasers:

• May cause less pain in some instances, therefore, reducing the need for anesthesia
• May reduce anxiety in patients uncomfortable with the use of the dental drill
• Minimize bleeding and swelling during soft tissue treatments
• May preserve more healthy tooth during cavity removal

Cons
The disadvantages of lasers are that:

• Lasers can't be used on teeth with fillings already in place.
• Lasers can't be used in many commonly performed dental procedures. For example, lasers can't be used to fill cavities located between teeth, around old fillings, and large cavities that need to be prepared for a crown. In addition, lasers cannot be used to remove defective crowns or silver fillings, or prepare teeth for bridges.
• Traditional drills may still be needed to shape the filling, adjust the bite, and polish the filling even when a laser is used.
• Lasers do not eliminate the need for anesthesia.
• Laser treatment tends to be more expensive since the cost of the laser is much higher than a dental drill. Lasers can cost between $39,000 and $45,000 compared to about $600 for a standard drill.

How to Keep Your Kids Cavity-Free

Wipe baby gums. A quick once-over with a damp cloth before bed removes bacteria that can harm soon-to-erupt teeth.

Brusha brusha. Once those pearly whites pop, brush once (realistically) or twice (ideally) a day with a soft, toddler brush. Use a pea-size drop of non-fluoridated toothpaste until age 4, or when your kid can reliably spit it out (swallowing fluoride regularly could make him sick and cause spots on the adult teeth).

Floss. Okay, we might as well be asking you to trim a wild bear's claws. But start using those plastic flossers now and your kid just might get used to it. Give your child a batch of colorful plastic flossers to encourage her to clean between her teeth. Even if she does only a few teeth a night it will help.

Ditch the bedtime bottle. The milk or juice can pool in your child's mouth as he dozes off, causing serious decay known as "bottle mouth."

Visit the dentist by age 1. Ask your doctor for a referral or find one at the American Academy of Pediatric Dentistry website: Aapd.org.

Say cheese! And eat some, too. The protein in it -- casein -- helps prevent tooth decay, so pass the cheese sticks. Another tasty idea: lollipops with xylitol (for kids over 4), a natural sweetener that prevents plaque buildup.

Spin it. Get her a battery-operated spin brush for more effective plaque- and bacteria-removing motion (a cheap model is just fine).

Brush to the beat. Have your kid scrub along to her favorite song to get her to hang in there for the recommended two minutes.

Finish up. If your child is younger than 8, do a final sweep with the brush after she's done to hit all the nooks and crannies -- and especially the back molars.

Be snack savvy. It's not just sugary foods you have to watch out for. Any starchy or processed high-carb food can get stuck in the crevices of teeth. Some surprising offenders: potato chips, wholewheat bread, crackers, and cereal bars. Follow with a glass of water to rinse them out.

Do You Have Tooth Enamel Erosion?

Tooth erosion forms from the process where acidic chemicals erode, or melt away, the enamel from your teeth. It is different from tooth abrasion or tooth attrition which are caused from brushing with too hard of a toothbrush, grinding your teeth, or eating a rough diet of foods. Both processes lead to enamel loss, but the patient with enamel erosion is usually unaware of the cause of the problem, or even that there is a problem.

Acidic chemicals can come into tooth contact from many different avenues such as consuming acidic foods and beverages, gastroesophageal reflux disease (GERD), bulimia, and swimming in chlorinated swimming pools, among others.

Let's look at some common foods that are highly acidic.

FOOD	pH
Lemon/Limes	1.8-2.4
Oranges/Juice	2.8-4.0
Apples	2.9-3.5
Grapefruit	3.0-3.5
Black Coffee	2.4-3.3
Wines	2.3-3.8
Coke	2.7
Vinegar	2.4-3.4
Pickles	2.5-3.0

Your risk for tooth erosion increases if you consume these highly acidic foods often, or in large quantities. If you are concerned that you may be at risk, please have your teeth checked for enamel erosion with your dentist. Enamel erosion can make your teeth sensitive and increase your chances of tooth decay.

Does chewing ice harm my teeth?

Q:

I have a habit of chewing ice, it feels good and relaxes me after a long day. Will this have any long term impact on my teeth? via email Saturday August 21, 2010

A:

Thanks for the question! Chewing ice can be detrimental to your teeth as it is a repetitive force that is applied to your teeth. Ice a hard substance which when chewed between teeth over time can have the potential to cause small fractures on the tooth surface. These small fractures on the surface of the tooth can over time become larger until a piece of tooth actually fractures off.

As well, ice is cold thus the temperature change in the mouth may cause existing fillings in the teeth such as composite (white) or amalgam (silver) fillings to contract and when the ice is taken away to once again expand. When this happens repeatedly, the area between the filling and the tooth can become weaker and allow leakage between the tooth which has the potential to irritate the pulp and nerve of the tooth.

I would recommend trying to stop this as it can be harmful to the dentition. As well, I would suggest you seen your physician as repetitive ice chewing can be related to anemia (low iron levels), this is called Pica.

Have a great day!

Dr.tushar

Braces for teeth that are crooked

Q:For as long as I can remember my teeth have been crooked and over the years they have seemed to become even worse. I am very unhappy with the look of my smile and thinking about straightening them. I want to do the best thing possible, what do you suggest for crooked teeth? Via email Thurs. August 10, 2010

A:It is hard to answer your question on a whole since I have not examined your teeth in person, but I will provide some answers below which you may explore to see what is the best option for you.The first choice is orthodontics (braces) as these will address the alignment of both your teeth and jaw, thus providing a more harmonious bite and long term aesthetics. Orthodontics are optimally done by an orthodontist who has many years of expertise/training with straightening teeth and ensuring it is done properly. The time span for orthodontics can vary from a short period of time (sometimes less than a year) to multiple years depending on the situation that presents upon examination and x-rays.Another choice is veneers. Veneers are thin tooth coloured shells that are cemented onto the teeth. When teeth are out of alignment, crooked or have small spaces between them, custom made veneers may be permanently adhered to individual or groups of teeth to give the appearance of straight, evenly spaced teeth and smile. Veneers are not an option for everyone and prior to going with this choice the dentist should fully examine and assess whether veneers are a good long term option for your teeth, smile and aesthetics. Veneers do not last forever, the lifespan can be anywhere from 5-10 years and then they will need to be changed to new ones.Regardless of which route you take to straighten your teeth, please see a qualified dentist to assess the right route to go.

Great question!

Dr.Tushar Kherde

Sore on lip that is not healing

Q:

I have had a sore on my bottom lip for two months, the size stays about the same but over the last two months it has formed a scab a few times and then fallen off. When the scab falls off it seems to heal for a few days then it comes back again. I am concerned only because it never seems to heal and go away completely. I am 45 years old, a previous 1 pack a day smoker up until 4 years ago. Should I go see my dentist?
Via email

A:

Hello , sorry to hear about the sore on your lip. I urge you to see your dentist or physician as soon as possible to assess the lesion as any lesion within the oral cavity or the surrounding structures should heal and go away within two weeks maximum. The fact that you have been a smoker in the past puts you at higher risk for possible changes in your oral tissue due to the exposure to harmful chemicals within cigarettes.

Your dentist and physician should be made aware this has been occurring for two months and it has not went away, this will help them diagnose the lesion better. As well, they may also perform a biopsy to test the tissue to see what it is.

Good luck and if I can be of any assistance please do not hestitate to ask.

Regards,

Dr.Tushar

Dry mouth due to medication's side effects

Q:
I have been on Celexa for over a year. About one month after I started this medication my mouth became very dry, upon reading the side effects for this medication it said that one of the possible side effects was dry mouth. I have found it has become worse during the year, so much at times that my tongue can stick to the top of my mouth and when I wake up in the morning my mouth is like a desert. If I continue on this medication long term, can my body become used to it and will my mouth become less dry? I am unhappy with the side effect (this seems to be the only one so far) but it has helped tremendously in other aspects so I want to continue. (via email)

A:
Thank you for your question . The medication you are on is a SSRI(selective serotonin reuptake inhibitor), which is commonly used for people who have depression and anxiety. I am glad to hear it is helping you! A common side effect of SSRI's is decreased salivary flow/dry mouth. I cannot tell you if this side effect will go away or not, as everyone's body responds differently to medication and I am not in a position as a dentist to answer that question.

What I can help you address is the dry mouth. Dry mouth and decreased salivary flow can put you at higher risk for developing dental cavities and possibly gingivitis/periodontitis. Salivary is important for it's ability to 'wash' the teeth. The liquid component of the saliva helps to rinse/wash the teeth of debris (food and bacteria) so they can be swallowed and not stuck on or in between the teeth. When food becomes stuck and it is not washed away then the potential for cavities to form is much higher. Saliva also has what is called amylase which is an enzyme which begins the process of digestion, specifically starches in the mouth. As well, saliva has the ability to buffer the oral cavity (decreasing the acidity level) to lower the risk of cavity formation.

Tips to help with dry mouth both to help your mouth feel better and prevent cavities

1. Drink water during the day (preferably water with fluoride in it as this will help keep the teeth strong).

2. Chew sugar-free gum after meals if you are not able to brush/floss, this will help mechanically remove food from the teeth and may increase salivary flow to help buffer the mouth).

3. Brush a minimum 3x day for 2 minutes with a fluoridated toothpaste to remove plaque from the teeth

4. Floss a minimum of 1x day to remove plaque from between the teeth

5. Use a fluoride mouthwash 1x day to help remineralize the teeth to prevent decay.

6. You can use a product called Biotene which are dental products specifically designed for those who have dry mouth, it can help stimulate saliva flow.

7. Use a humidifier at night to put moisture into the air that can be transferred to the oral cavity.

8. Use Sorbees sugar-free hard candies during the day to stimulate saliva flow. These candies were created for diabetics but they are also great for people who have dry mouth as they are sugar-free.

9. See your dentist and dental hygienist regularly for cleanings and check-ups to help prevent problems before they begin.

I hope this has been of some assistance to you.

Regards,

Dr.Tushar