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Cold sores/fever blisters

According to Wikipedia Herpes labialis, or orolabial herpes, is an infection of the lip by herpes simplex virus (HSV-1). An outbreak typically causes small blisters or sores on or around the mouth commonly known as cold sores or fever blisters. It t take up to 3 weeks for the blisters to heal, but the herpes virus remains dormant in the facial nerve, it might reoccurs in the future.

HSV-1 affected 57.7% of Americans tested in a 1999–2004 study. By age 50, 80%–90% of adults have the virus. More than 50 million adults in the U.S. develop symptomatic episodes every year. Cold sore has a rate of frequency that varies from rare episodes to 12 or more recurrences per year. People with the condition typically experience one to three attacks annually. The frequency and severity of outbreaks generally decrease over time.
According to WebMD, you can’t cure HSV or a cold sore, but you can alleviate the pain it causes by avoiding spicy or acidic foods, applying ice, and using over-the-counter remedies. Look for medicines that contain numbing agents such as phenol and menthol to reduce cracking and soften scabs. Abreva is an over-the-counter topical remedy used to help speed healing and minimize pain from a cold sore.

If your cold sore is especially painful or irritating, your doctor may prescribe an anesthetic gel to alleviate pain or an antiviral oral medication to speed healing or prevent recurrence. You can follow the instructions bellow, to prevent or minimize the cold sore effect.

It’s important to remember to wash your hands after touching a cold sore. Don’t rub your eyes after touching your cold sore; you could develop an ocular herpes infection, which may lead to blindness if left untreated. Don’t touch your genitals after touching your cold sore; you could develop genital herpes. Replace your toothbrush. Don’t kiss someone who has a cold sore or use that person’s utensils, towels, or razors. Apply sunscreen to the face and lips before prolonged exposure to the sun. Cold sores could get complicated with bacterial infections, so keeping them clean, and avoid irritants is important.

The effects of chewing gum on your teeth

According to the American Dental Association Clinical studies have shown that chewing sugarless gum for 20 (make it 10 minutes) minutes following meals can help prevent tooth decay.

The chewing of sugarless gum increases the flow of saliva, which washes away food and other debris, neutralizes acids produced by bacteria in the mouth and provides disease-fighting substances throughout the mouth. Increased saliva flow also carries with it more calcium and phosphate to help strengthen tooth enamel.

The only varieties of gum with the ADA Seal are sugarless. They are sweetened by non-cavity causing sweeteners such as aspartame, xylitol, sorbitol or mannitol. Of course, chewing gum containing sugar increases saliva flow too, but it also contains sugar which is used by plaque bacteria to produce decay-causing acids. Further research needs to be done to determine the effects of chewing gum containing sugar on tooth decay.

Don’t let chewing sugarless gum replace brushing and flossing. It’s not a substitute. The ADA still recommends brushing twice a day with fluoride toothpaste and cleaning plaque from between your teeth once a day with dental floss or other interdental cleaners. Look for chewing gum that carries the ADA Seal. The ADA Seal is your assurance that the sugar-free chewing gum has met the ADA criteria for safety and effectiveness. You can trust that claims made on packaging and labeling for ADA-accepted products are true.

Chewing gum for longer than recommended may aggravate or lead to TMJ pain and soreness.

Which is better, a dental implant or a bridge?

I want to start with an important statement “A bridge is no longer the standard of care”. Dental implants are the proper choice for replacement of teeth that are lost due to accident, gum disease, failed root canal or tooth decay. Properly cleaned and maintained Dental implants can last a lot longer than bridges, removable partials and dentures.

Dental implants don’t rest on your gum tissue, as a removable partial, which can lead to irritations. Removable partials also have metal clasps that sits on teeth, which could overload teeth with force, cause decay and be aesthetically challenging. Dental implants don’t require adjacent anchoring teeth (abutments) grinding and shaving like a fixed bridge. Your natural teeth are left untouched. Shaved teeth are susceptible to decay. Most of the old bridges are often replaced due to abutment teeth decay (decay under the bridge).

Financially, implants are almost the same price as a bridge. However, due to the durability of implants, they are much better economical options long term.

Finally Dental implants have a great impact on the quality of life, especially for denture wearers. No glue, no embarrassing clicking and wobbling, improved food tasting and better phonetics and speech.

Tooth decay

“I have a cavity and need a deep gum cleaning? But Doc, my teeth don’t hurt, why do you want to drill them?”. This is a common daily conversation in many dental offices.

Dental x-rays and clinical exams might reveal the presence of decay in your tooth, or gum inflammation, regardless of pain. In medicine and dentistry, pain is one way problems are diagnosed. Most of the serious disease like high blood pressure, diabetes and even cancer are painless.

If your dentist informs you that you have a problem but you have no symptoms, the lack of pain could be due to many reasons. Let me explain why. When tooth decay is still within the enamel layer (the outer layer of the tooth), where there is no nerve, or the decay and infection has taken a chronic painless pathway. It’s more often than not, we see infection from decay to the nerve and around the tooth, but the patient has no pain, or just a dull periodic discomfort.

It’s also possible that the decay could be in a tooth that had a root canal done previously, hence there is no nerve and, no sensation, yet the tooth structure is being weakened by the decay. Moreover, advanced gum and bone inflammation (periodontitis) is totally painless. Patient might notice redness and bleeding gums, while the teeth are being stripped off the supporting bone slowly, and painlessly. It’s often called “the silent killer of teeth”.

Periodic checkup and exam is very important, because it help diagnosing the problems at an earlier stage. The treatment (if needed) will be simple, not as costly, with a lot less time and complications.

When should my child have braces?

An orthodontist, or a dentist with additional training evaluation, is the right person to answer this question case by case. A 4 years young child might need a space maintainer, which is in fact a form of braces. Most of the time orthodontic treatment might be recommended during the mixed dentition stage. That is when the child has lost a bunch of baby (deciduous) teeth, and a number of the permanent teeth have erupted into the mouth. This usually happen between the age of 8-12 for boys, and even earlier for girls.

The early treatment is called phase one. Most of the time this is accomplished with appliances (retainer like devices) or with dental braces. The first phase most of the time deals with enhancing jaw growth and/or attempting to intercept potential problems with the permanent teeth. After phase one is completed, in most cases, we observe the kid until all permanent teeth fully erupted to start the second phase. That varies depending on the pace of growth that is normally between the age 12 and 14.

Which toothpaste?

One of the most frequent question my patients ask me is “what is the best tooth paste?”. My answer is always, tooth paste doesn’t really matter that much. What’s more important is the brushing and flossing frequency, duration and reach.

The tooth brush should reach all surfaces of the teeth properly, and for long enough time. The recommended brushing time is two minutes for adults and at least one minute for kids. Most of my patients brush the front teeth from the outside properly. However the back teeth and the inside surfaces get shortchanged.

Please remember that the floss is a brush that can be inserted in-between to clean the teeth and the gum tissue. So if you are only brushing, you are not cleaning more than 60% of the tooth surfaces. Flossing will take care of the rest. Water picks and proxy-brushes are also nice tools to use when cleaning in between the teeth. Rinsing with a mouth wash will not substitute brushing and flossing.

If you have fillings, crowns, implants your teeth are not immune to decay, and gum disease, as many of my patients think. In fact the brushing and flossing become more important. Most tooth pastes available over the counter have Sodium Fluoride as their active ingredient, along with some abrasive and base. Parents should pay attention that the little kids would not swallow tooth paste. It’s also worth mentioning that you only need tooth paste the size of a pea when you brush.
uring your check ups and cleaning in our office, we routinely give our patients tips, and feedback about ways to improve oral hygiene. Remember the old saying goes “brush and floss only the teeth that you want to keep”.

Dry mouth

Dry mouth is one of the most common issues that my patients have, most of whom are not aware of it, or they are but, don’t understand the implication of it on their oral health, and how to deal. From my experience the condition affects all ages. Young patients exhibit dry mouth mostly due to allergies and airway problems. Older patients have an added reasons for dry mouth, which quite often is a side effect of a lot of medications, and some medical conditions. I would like to share with you some important information from the American Academy of Oral Medicine about dry mouth.

The medical term for dry mouth is ‘Xerostomia’ (zeer-oh-stomia), a term derived from the Greek words xeros, meaning “dry” and stoma, meaning “mouth. It’s most often caused by a decrease in the amount of saliva or a change in the quality of saliva. The exact number of people affected by dry mouth is unknown but it appears to be a common condition. Estimates range from 1% to 65%, depending on the types of patient populations studied.

Saliva is an essential body fluid that contributes to the protection and preservation of the oral cavity and plays a major role in maintaining oral health and comfort. It is produced by the three pairs of major salivary glands and hundreds of minor salivary glands. Its value is seldom appreciated until there is not enough. Saliva is necessary to moisten the mouth, to lubricate food for easier swallowing, to protect oral hard and soft tissues, to modulate oral microbial populations, to provide initial digestive enzymes and to promote soft tissue repair and oral cleansing. Cleary, the lack of adequate saliva can lead to numerous clinical conditions affecting one’s oral and systemic health, comfort and quality of life. As a result, detecting the early signs of dry mouth is critical.

Role of Saliva:

  • Protect, lubricate and cleanse the oral mucosa
  • Aid chewing, swallowing and talking
  • Protect the teeth against decay
  • Protect the mouth, teeth, and throat from infection by bacteria, yeasts, and viruses
  • Support and facilitate our sense of taste

Warning Signs and Symptoms of Dry Mouth

The dentist and dental hygienist are trained to detect dry mouth and can often identify its presence long before the patient becomes aware of its existence. One of the more common signs of a dry mouth is insufficient pooling of saliva under or around the tongue, a phenomenon easily noted by your dentist or hygienist. Other clues to the presence of a dry mouth are cavities affecting the necks of the teeth near the gum line9see below) or chewing edges of the teeth and a red parched or fissured tongue (see bellow). Common patient complaints or symptoms of dry mouth include difficulty swallowing food (especially dry food) without liquids, changes in the sense of taste, a burning sensation or pain in the mouth, and difficulty talking.

Causes of Dry Mouth

Dry mouth is typically caused by a multitude of factors including: medication side effects, various disease states, head & neck irradiation, dehydration, surgery, smoking, and mouth breathing.

Diseases Associated with Dry Mouth

  • Allergies and airway problems
  • Sjögren’s syndrome
  • HIV / AIDS
  • Diabetes
  • Hypertension
  • Hepatitis C
  • Lymphoma

Diagnosing Dry Mouth

The diagnosis of dry mouth is usually made after your dentist or physician carefully assesses your medical history and the clinical findings. Your doctor will want to determine if your dry mouth is caused by a change in salivary function, its severity, and its cause. In some cases, they may need to order more specialized tests to assess your particular situation.

General Treatment Strategies

See your dentist regularly: Due to your increased risk for oral disease, your dentist may recommend you undergo more frequent check-ups, professional cleanings and in-office fluoride applications. It is important to have any necessary dental work done as soon as possible, since oral conditions such as caries, periodontal disease, and yeast infections may progress more rapidly in the patient with a dry mouth.

Perform oral hygiene as instructed: Your dentist or dental hygienist will reinforce the importance of regular brushing and flossing and may offer additional instructions regarding your daily oral hygiene. He or she may also recommend a prescription strength fluoride to be used in addition to your regular toothpaste. Your ability to consistently accomplish these daily oral hygiene measures, as instructed by your dentist, is one of the most important steps in successfully managing the complications of oral dryness.

Monitor your mouth for oral candidiasis (thrush): Patients with a dry mouth are at risk for oral candiasis, particularly the erythematous form.If you suspect you may have oral candidiasis, you should promptly see your dentist for an evaluation and management. Avoid sugary food and drinks: Decrease your fermentable carbohydrate intake, especially for sticky foods such as cookies, bread, potato chips, gums, candies. Avoid the frequent intake of acidic beverages (such as most carbonated and sports replenishment drinks) and lemon products.

Frequently sip fluids: Frequent sips of small amounts of fluids, especially water, can be quite helpful in diminishing the effects of oral dryness. Many patients keep a bottle of water handy to moisturize their tissues. However, excessive sipping of water can actually reduce the oral mucus film lining the mouth and worsen your symptoms. Letting chips of ice dissolve in the mouth may also be useful.

Use fluids while eating: Taking fluids while eating is an essential common sense strategy for dry mouth patients. A useful approach is to take a drink of water or beverage to hydrate the mouth, take a bite of food, and then wash it down with another sip.

Avoid caffeine: Caffeine is as a mild diuretic which promotes fluid loss and may worsen dry mouth. If possible, one should avoid or limit items which contain significant amounts of caffeine such as coffee, tea, and certain soft drinks.

Protect dry lips: Dry cracked lips contribute to the annoyance of oral dryness. The regular use of topically applied oil-based balms or lipsticks may provide soothing relief. The use of vitamin E-containing balm may also be helpful. These products should be replenished on regular basis to ensure their effectiveness.

Use a humidifier: The dry ambient air of most modern homes contributes to one’s sensation of dryness. The use of a humidifier, particularly at night, helps address this concern.

Use sugar-free salivary stimulants: To the extent that functional salivary tissue remains, the regular use of gums, mints, and candies can help stimulate salivary flow. Mints, lozenges, and candies should be allowed to dissolve slowly in the mouth. Dry mouth patients with natural teeth should avoid agents that contain sugar, due to their increased caries risk, and are encouraged to use products containing xylitol.


Hello friends and patients, this is my first blog posting. Most of you would expect me to write about Veneers or sell you teeth whitening. However, I elected to talk about a subject that has a great impact on our population – health.

Dentists in the last decade have become an important partner with the medical doctors to help diagnose and treat Sleep Apnea. According to Wikipedia, SA Sleep Apnea is a sleep disorder characterized by abnormal pauses in breathing or instances of abnormally low breathing, during sleep. Each pause in breathing, called an apnea, can last from 10 seconds to minutes, and may occur 5 to 30 times or more an hour. Similarly, each abnormally low breathing event is called a hypopnea. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram, or “sleep study”.

Individuals with sleep apnea are rarely aware of having difficulty breathing, even upon awakening. Sleep apnea is recognized as a problem by others witnessing the individual during episodes or is suspected because of its effects on the body. Symptoms may be present for years, or even decades, without identification, during which time the sufferer may become conditioned to the daytime sleepiness and fatigue associated with significant levels of sleep disturbance.

Sleep apnea can affect anyone at any age, even children. Risk factors for sleep apnea include:

  • Overweight male 40 years and older
  • Having a large neck size (17 inches or greater in men and 16 inches or greater in women)
  • Having large tonsils, a large tongue, or a small jaw bone
  • Nasal obstruction due to a deviated septum, allergies, or sinus problems
  • Having a family history of sleep apnea
  • Gastroesophageal reflux, or GERD

There is solid scientific evidence that Sleep apnea could be a contributing factor to a growing list of a serious medical conditions. These include High blood pressure, stoke, heart failure, irregular heart rhythm, diabetes, and worsening of ADHD. In addition, untreated sleep apnea may be responsible for poor performance in everyday activities, such as at work, school, driving, and academic achievement in children and adolescents.
Treatment could include one or more of the following options: continuous positive airways pressure (CPAP), oral appliances to be made by your dentist, surgery and medication.

A professional, like a sleep medicine MD and your dentist could help you with this condition. If you or someone you love has a snoring problem or difficulty breathing while asleep, you can schedule a free consultation with us to address your problem.