Tucson Dentist, Dr. Wexler, Frequently Asked Questions:

What is gum disease?

Gum disease affects more than 80% of the adult population. Gum disease has two stages: gingivitis and periodontitis. Gingivitis is the earliest form of gum disease and is completely reversible. Gingivitis involves bleeding of the gums when brushing or flossing.

Periodontitis is a more serious form of gum disease and the major cause for tooth loss and loose teeth. Research from 2009-2010 estimates the prevalence of periodontitis in U.S. adults to be 47.2% (~64.7 million adults), and for adults over 65, the prevalence increases to 70.1%. Periodontitis is not reversible and involves the same signs and symptoms as gingivitis, discussed above, along with the loss of bone support and oftentimes gingival support. Bacteria infested plaque is the main cause of periodontitis. Plaque is a sticky film that forms continuously on your teeth. The bacteria in the plaque produce toxins which cause redness and irritation which destroys the gum tissue and bone support around the teeth. A diagnosis of periodontal disease is often a surprise to a patient since there is rarely any pain associated until the disease has progressed to a more severe state where tooth loss is probable. The scary thing about chronic periodontitis is that you don't always feel the symptoms since in most healthy people, the disease progression is slow. All it takes is improper daily disease control, such as improper brushing or flossing technique to allow the bacterial infection to slowly take over your mouth. People with added stress, diabetes, cancer, autoimmune disorders, the common cold, the flu, or anything else that would suppress your immune system, will see this disease progress at an exponential rate. Patients with periodontal disease are at higher risks to various others diseases and health problems including stroke, low birth weight babies, cardiovascular diseases, pre-eclampsia, preterm labor, respiratory diseases, Alzheimer's disease, kidney disease, impotence, various cancers, and others still unknown (www.perio.org/consumer/other-systemic-diseases)

How do I treat and get rid of periodontal disease?

Periodontal disease is normally a chronic disease process, which much like cancer, goes in and out of remission. The initial gum therapy treatment regimen involves a procedure called scaling and root planing where plaque, tartar, and bacterial toxins are removed from the root surfaces below the gum line of your teeth. This is more involved than the usual healthy dental "cleaning" which most of us are used to getting every six months. In more difficult infections, direct antibiotic or laser therapy may be required to get the infection stabilized. Periodontal disease is not a curable disease where the destroyed supporting bone and gum tissue around our teeth can be re-grown; therefore, our goal is to prevent more supporting tissue from being lost. In order to keep the disease in remission (stabilized) after initial gum therapy, it is mandatory to see you more than twice a year for a different procedure called periodontal maintenance. Each periodontal maintenance appointment and how often they’re done is customized to each individual patient.

What do you mean I have gum disease? When I brush and floss I don't see any bleeding!

Everyone has areas in their mouth that are not reached with brushing and flossing. These areas are susceptible to the bacteria which forms in the mouth continuously. When not properly removed daily, this bacteria will cause the gum tissue to become infected and bleed during inspection at your hygiene visit. The body's response to this infection causes the gums and the bone that supports the teeth to pull away, forming a space (“pocket”) between the tooth and gum. It only takes 90 days of infection being present in the gum tissue to start causing the bone to pull away. This loss of the bone supporting the teeth is the worst form of Periodontal Disease, called periodontitis.

What did all those different numbers and measurements mean during my gum tissue exam?

The probing measurements completed during your hygiene visits check for spaces that are created by bacteria living between your teeth and gums. Over time, when infection is present, these pocket depths will increase in size as the gum tissue and bone fall away from the teeth due to infection. The deeper the pockets become, the more serious the disease. When you hear readings of 4mm or higher and there is bleeding, you have active periodontitis. Periodontitis requires gum therapy to properly stop the disease process.

If I have gum disease, and I choose not to do the gum therapy, can I still be seen by Dr. Wexler?

Of course! You still are welcome to be seen in our office. We will even encourage you to come in more often for evaluations since periodontal disease can spread throughout your whole mouth and infect other areas of your body. Just know these evaluations will include examinations, any needed x-rays, and gathering of diagnostic information so we can best update you on your oral health condition. Did you know, current research has found over 50% of adults have some level of periodontal disease, and several health issues are linked to periodontal disease including: heart disease, high blood pressure, stroke, various other cardiovascular diseases, diabetes, rheumatoid arthritis, osteoporosis, respiratory diseases such as pneumonia and lung cancer, and various other cancers? Men with gum disease were found to be 49% more likely to develop kidney cancer, 30% more likely to develop blood cancers, and 54% more likely to develop pancreatic cancer (Find out more about this invasive disease by visiting: www.perio.org/consumer/other-systemic-diseases

What does it mean when I need to have a dental laser used?

When using a dental laser to treat gum disease, the dentist or certified hygienist uses energy in the form of light to obliterate bacteria and inflamed, diseased tissue within your periodontal pockets. Before dental lasers were used, invasive dental surgery used to be the only way to reach the more severe areas of infection. The periodontal laser does not affect healthy tissue, it only affects the diseased tissue.

What are the benefits of the Dental Laser during gum therapy?

A more predictable and successful result from gum therapy is achieved when the dental laser is used. No local anesthetic (“no shots”) is typically needed when using the dental laser. Pain, bleeding and swelling are reduced due to the immediate healing effects.

What is fluoride and how do I know I am getting enough?

Fluoride is a natural occurring mineral in the environment and found naturally occurring in food and water supplies. In the 1930’s, it was found that people who grew up with naturally fluoridated water had fewer cavities than those without (fluoride strengthens teeth during the remineralization process). Since then, there has been a push to raise the natural fluoride levels of drinking water. If your community has 1 part per million of fluoride in its drinking water, then you have sufficient fluoride in your diet and supplemental fluoride would not be normally recommended. Tucson city water does not have quite the optimal level of fluoride in its drinking water. This does not necessarily mean you should supplement your diet with ingestible fluorides. Ingestible fluoride supplements are only affective when teeth are developing (in utero to late childhood). Fluoride is found in ADA (American Dental Association) approved toothpaste and certain oral rinses. Prescription level fluoride has been found to help adult patients who suffer from general teeth sensitivity and may be suggested by Dr. Wexler or his team members, but, Dr. Wexler does not commonly prescribe or recommend fluoride supplements to infants or younger children since the cosmetic drawbacks of fluorosis (severe white or brown spotting/blotching of developing teeth) are unpredictable when giving a child ingestible fluoride. Recent studies have shown that a topical fluoride varnish for children have significantly reduced the caries rate in children. Dr. Wexler recommends topical fluoride varnish for children 2-4 times/year, for adults with a higher caries rate, and for patients who received gum therapy in order to help protect their thin, exposed root surfaces from future cavities.
Visit: https://www.mouthhealthy.org/en/standard-items/search-results#q=fluoride&sort=relevancy

Can my teeth get stained from swimming and what do I do about it?

“Swimmers calculus” is a term used for brown staining on a swimmers teeth. This staining is seen in swimmers who swim over 6 hours/week in chemically treated pools and needs to be removed by a dentist or hygienist.

What should I do if my tooth falls out?

If a baby tooth comes out, it is too risky to the developing permanent tooth to try and replace it so place it under your child’s pillow for the tooth fairy. If an adult tooth comes out, it is important to replant it within a couple of hours for any chance of the body accepting it. First you should gently rinse the tooth without scrubbing it or touching the root surface in order to remove any debris. Immediately place the tooth back into the socket (hole in the mouth) it came out. If you are unable to replace the tooth into its socket, place the tooth in milk or saline and call Dr. Wexler for advice. After a tooth is replaced in the mouth, it oftentimes requires stabilization via a splint made by your dentist.

What can I do about chipped teeth and how do I prevent them from chipping?

Chipped teeth are oftentimes caused by some form of trauma. The types of trauma will decide on the best way to prevent any future chipping. Trauma from an accident usually is non-recurrent so does not usually require any preventative treatment except protective gear where indicated. Chipping from habits such as ice chewing, biting your nails, biting foreign bodies (e.g. nails, pens, pencils, needles, etc.), clenching or grinding your teeth will require you to stop the habit in order to prevent more advance chipping of your teeth. Patients who clench and grind their teeth on a regular basis should talk to Dr. Wexler about fabricating a splint in order to prevent future tooth damage or TMJD (temporo-mandibular joint disorder). About 70% of the population suffer from bruxism (clenching/grinding your teeth) and are not aware of it since they do it unconsciously. Ask Dr. Wexler if you are concerned.

Why are my teeth sensitive to hot and cold?

Sensitivity of your teeth to temperature changes can be signs of normality or due to severe tooth problems. Usually, if temperature sensitivity is more general, effecting several teeth, and occurs occasionally, it can be considered a normal response (e.g. biting into an ice cream cone). If the sensitivity is more general, but happens more often, it could be a sign of a clenching or grinding habit known as bruxism and should be discussed with Dr. Wexler. If you have localized sensitivity on one specific tooth, then it can be a more serious problem which needs immediate dental treatment. This problem requires x-rays and specific testing and examination of your teeth to properly diagnose. It is pertinent to seek dental treatment immediately since this type of matter can progress quickly and lead into a very painful situation over night.

My child’s baby teeth are not out yet but permanent teeth coming through. Is this normal?

Do not be alarmed if you see the permanent teeth are coming through, and your child’s baby teeth are still in. This is a very common situation we see and the majority of times is not a concern at all. If after 6 months you find the baby tooth/teeth have not loosened, but the new, permanent tooth/teeth have come in completely, it may be necessary to remove the baby tooth/teeth (Tooth Eruption and Loss In Children Article). Another reason to possibly have Dr. Wexler remove the baby tooth is if it is causing your child any pain or discomfort. Very seldom does a baby tooth not coming out when a permanent tooth has come through contribute to an orthodontic (braces) concern. Most crowding and orthodontic concerns are caused from genetic variables.

I have white spots on my teeth. What can I do about them?

White spots on teeth when they come into a child’s mouth usually occurs during tooth development. This could have been caused by trauma such as a fall when an infant or toddler, from certain medical treatments, from chronic illnesses, excessive fluoride intake when an infant (check for fluoride in formula), or an event that happened while pregnant with your child. White spotting which occurs later in life can be due to the start of a cavity. We oftentimes see this after a teenager gets their braces off, especially if their homecare was poor. Sometimes the white spotting, when caught early on (called decalcification spots), can be reversed with prescription fluoride treatments.

How do I know when I need braces?

There is a fine line between needing and wanting braces. Very few people need braces, but they are candidates for them. Braces tend to be done mainly for cosmetic reasons nowadays. Dr. Wexler checks you at every maintenance visit for any changes in your jaw relationship or for crowding concerns. He will bring up any concerns of his too you, but please, do not hesitate to voice your concerns with how your teeth look to you.

Why are my teeth sensitive after dental work and what can I do about it?

Any time we do any dental treatment for you, you will likely feel some discomfort for up to a week afterwards. If you had any dental discomfort that does not diminish after a week, you should call our office for an evaluation. Oftentimes, if your bite is not normalized after dental treatment, you can experience discomfort from chewing or cold liquids. A quick adjustment of your bite can often cure this problem within a few days.

My teeth and jaw hurt in the morning. Why and how can I get the pain to stop?

Jaw and tooth pain in the morning is usually a tell tail sign of a clenching or grinding habit know as bruxism. About 70% of the population suffers from bruxism and is not aware of it. Most of us tend to clench and grind our teeth during stressful times or when we have upper respiratory problem (sinuses, allergies, common cold, etc.). Treatment for bruxism is very challenging. When people say they have “TMJ, “ they usually are implying they have jaw/facial muscle pain and/or popping in their jaw joints. When you hear jaw sounds when you open and close your mouth, it is likely your TMJ has been permanently damage. Bruxism can accelerate the damage, if not be the initial cause of TMJ destruction. Since bruxism has more psychological causes, curing it is very difficult. Our goal in dentistry is to prevent the bruxism habit from causing future irreversible damage to your jaw joint (TMJ) and teeth. We achieve this goal by fabricating a hard acrylic splint which is customized just for you. We find these splints to oftentimes lessen, and even stop the pain associated with bruxism. Dr. Wexler will evaluate you for any TMJ and/or bruxism problems at your first visit and regular maintenance visits.

When Should My Child First See A Dentist?

As soon as your baby's first tooth appears, you should have them see a dentist. At your baby's first dental visit, Dr. Wexler and his team will discuss with you how to keep your baby's oral cavity healthy, discuss a healthy diet to prevent cavities, how best to take care of your baby's teeth, and do a full examination of your baby's oral cavity. At this visit, we will also discuss proper homecare customized to your child's needs.

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When should my children’s teeth be coming in or falling out?

The average age range for a baby to cut his/her first tooth is between 6-10 months. With that said, my oldest daughter, Lily didn’t get her first tooth until she was 14 months old. Yet, at age 6, she was one of the first in her class to lose her 1st baby tooth. There is no correlation between when baby teeth erupt and when they will shed. I have had patients not lose their first tooth until they were 9 years old. Others have 18 month old babies still waiting for those little bottom teeth to appear. Use the Primary teeth chart below only as a guide on the sequence of teeth eruption/shedding. Keep in mind the ages could be plus or minus 6-12 months. Another parent concern I hear is when a permanent tooth starts to erupt before the baby tooth sheds. This frequently occurs with the lower front teeth. If the baby teeth are loose and you are still within range of the chart below, give it another 6 months and a little wiggling of the baby tooth before being overly concerned. It is unlikely that this will affect your child’s need for braces. The majority of orthodontic issues are due to uncontrollable genetic factors. Don’t hesitate to call me anytime with questions related to your children and their teeth. I’m happy to assist you.

Thumb Sucking....When is it a Problem

Many parents have expressed concerns about their children sucking their thumbs (or fingers). Thumb sucking is quite normal for infants. An estimated 70-90% of infants suck their thumbs to some extent. It can be quite an effective self soothing technique. Thumb sucking is usually a self-limited activity in infants. Some babies stop on their own at around 6 months. Although many children continue to suck their thumbs after this age, about 85% will stop on their own by age 3 or 4. The American Dental Association notes that thumb sucking does not usually cause problems with tooth development until eruption of permanent teeth. Thumb sucking after this could be cause for concern. Before the eruption of permanent teeth, however, it is probably best to let the child stop on his/her own. It is important to avoid shaming or embarrassing your child when addressing your concerns about his/her thumb sucking. Punishing your child for thumb sucking can result in a power struggle between parent and child. It’s inappropriate and counterproductive. Please call our office if you have additional questions regarding this matter.

How Much Radiation am I Getting from X-rays?

The amount of radiation exposure in a full series of old film x-rays (18 films) is equivalent to less than 3 weeks of everyday exposure to our environment? The amount of radiation with digital x-rays can be as much as 1/5th the amount of radiation as film x-rays. It takes approximately 5 digital x-rays to equal the amount of radiation you get everyday from the environment.

I Have Dental Insurance....Why do I have to Pay Anything?

Dental insurance is not really insurance at all. It is actually a money benefit typically provided by an employer to help their employees pay for routine dental treatment. The employer buys a plan based on the amount of the benefit and how much the premium costs per month. Most dental benefits are designed to cover only a portion of the total cost. If you are unhappy with your dental benefits, it is best to talk to your human resource department or employer to possibly change plans.

Why Should I Worry About Oral Cancer if I Don't Smoke or Drink Alcohol?

Did you know one person dies every hour from oral cancer in the United States. The American Cancer Society states that more women in the U.S. will be diagnosed with oral cancer this year than will be diagnosed with cervical cancer. The extremely common sexually transmitted disease, Human Papilloma Virus, has long been known to cause cervical cancer, and now studies suggest it also plays a role in as many as 70% of oral cancer cases. In our continuing efforts to provide the most advanced technology and highest standard of care available to our patients, Dr. Wexler and his team our proud to announce the inclusion of Fluorescence Visualization oral cancer screening exams as an integral part of our annual comprehensive oral screening program. Proven screening technologies such as mammogram, Pap smear, PSA and colonoscopy offer the same type of early detection of cancer. Oral cancer has the worst mortality rate of any cancer with an annual screening available. Fluorescence Visualization is an easy and painless examination that gives Dr. Wexler the best chance to find any oral abnormalities you may have at the earliest possible stage. This exam is recommended on all patients 18 and older.

How Accurate is the Diagnodent Laser in Detecting Cavities?

The Diagnodent LASER diagnoses the depth of cavities in tooth structure and deciphers cavities from stains caused from foods we eat or habits we have such as smoking or chewing tobacco, which stains our teeth similar to the stains caused from cavities. Dr. Wexler had participated in research with the Diagnodent in the past and has found it to be over 98% effective in diagnosing when to treat a cavity and when to monitor one. The Diagnodent is very beneficial to the patient by allowing us to treat a cavity when it is small, instead of when it causes a patient discomfort or pain. The majority of the time when a patient has pain due to cavities, the tooth will require more than a simple filling, and oftentimes, it will require a larger procedure such as a root canal and/or a crown which is much more involved and costly to the patient. When having cavities treated after being diagnosed with the Diagnodent, a local anesthetic (“shot”) oftentimes is not necessary. Dr. Wexler may give you the option based on your preference.

Did you know Xylitol Gum Can Help Fight Cavities?

Xylitol is a natural occurring sweetener found in strawberries, raspberries, and some mushrooms. You can now find it in chewing gums like Trident and Orbit. It works by decreasing the acidity of your saliva so it slows the destruction of your teeth. It is best to chew after meals and only if you don’t suffer from TMJ problems.

What Foods Cause Cavities?

Help fight tooth decay by avoiding foods and dietary habits which cause an acidic environment in your mouth. Avoid starchy foods like pretzels, crackers, cookies, and foods that stick to your teeth. Snack on fresh fruits and veggies and drink water instead of juices, sodas, sport drinks, or drinks high in sugars. Cheese is a great snack and actually helps prevent tooth decay.

What is Sleep Apnea and Why should I be concerned?

We have seen a rise in patients diagnosed with sleep apnea and/or snoring. Sleep apnea is a very serious condition where one stops breathing during their sleep for extended periods of time (episodes >10 sec.) mainly because of an airway obstruction. Some reasons your airway can become obstructed is due to large tonsils and adenoids (usually in children), large tongue, large neck or collar size, narrow airway, nasal obstruction, and obesity. Symptoms of sleep apnea include: restless sleep, personality changes, poor concentration, morning headaches, memory difficulties, depression, insomnia, frequent waking during the night to urinate, etc. Sleep apnea has been known to lead to serious health issues such as stroke, high blood pressure, heart arrhythmias, heart failure, and even death. People who suffer from sleep apnea and/or snoring will oftentimes have episodes of bruxism (clenching and grinding of teeth) while sleeping. Sleep apnea is still best treated by a CPAP device which delivers a positive flow of oxygen to a person while sleeping, but some cases can be helped by utilizing a dental device (Snore Guard or type of splint) to move the lower jaw forward in order to open your airway while sleeping. Part of Dr. Wexler’s exam during your 6 month visits includes a bruxism and sleep apnea/snoring evaluation. When Dr. Wexler sees damage done to your teeth including excessive wear, pitting, fractures, chipping, or when you complain of cold and/or chewing sensitivity, he may discuss bruxism and sleeping patterns with you. If you’re a candidate, he will suggest a night guard or splint, be checked for sleep apnea, or consider options for treating a snoring habit.

How can I treat my cold/canker sores?

Cold sores (fever blisters) are caused by a type of herpes simplex virus infection (HSV-1), whereas, canker sores (aphthous ulcers) can be caused by various factors such as trauma, acid foods, hormonal changes, allergic reaction to food or toothpaste, vitamin deficiencies, stress, and other unknown causes. Cold sores are contagious since caused by a virus which can be transferred through saliva, but canker sores are not. Both can be found in the oral cavity. Cold sores can also occur on the lips. Both will last around 10 days to 4 weeks and can be very irritating and painful. There are several OTC medications to try to mask the pain, or even some antiviral prescription medications which can speed the healing process of cold sores if you take them before they visually occur. Dr. Wexler has found success with using a special painless dental laser to reduce the sensitivity from cold sores along with speeding the healing process. Call us now at (520) 888-SMILE (7645) to schedule for a consultation.