From time to time I like to read articles from my Alma Mater, University at Buffalo School of Dental Medicine, recently I came across an interesting article.  Dr. Sebastian Ciancio, DDS has recently published an article about the use of a nasal spray to anesthetize upper teeth as opposed to dental injections.Dentist or Doctor With Needle The study is centered around how safe and effective using a nasal spray to numb the upper teeth rather than an injection to the area. This study is now in the second phase of research by the Food and Drug Administration. So what does this mean for your dental future? Well, there is a possibility that in the future you may be able to forgo the need for injections with some procedures. This is a great option for dentists and needle phobic patients alike and may help patients seek dental care more frequently. Things that remain to be seen is duration of numbness, localization of numbness as well as possible side effects, and long term effects. But in general there are many great things on the horizon for dentistry and I, along with many others, am eager to see what is in store!  ]]>

As dentists, we already know and talk about the importance of periodontal or gum health.Fotolia_37296172_XS-200x300 Periodontal disease is the leading cause of tooth loss in adults. Recently studies have been released linking the bacteria that causes gum disease to various systemic health problems. Most recently, a study was completed that found a link between the bacteria present gum disease and Alzheimer’s. This study has found the bacteria commonly present in periodontal disease, Porphyromonas gingivalis, was present in four of ten Alzheimer’s patients and, zero of ten patients with out Alzheimer’s. This study is just a jumping off point for more research on the association of this bacteria and its link to this debilitating illness. In general, oral health does play a key role in your overall comprehensive health. Studies continue to show that maintaining healthy teeth and gums can give you more than fresh breath. By maintaining a good home care regimen and regular hygiene appointments with your dentist you can keep your teeth and gums healthy. Check out and vote for our entry into the Intuit Small Business Big Game Sweepstakes!


There is a lot of anxiety surrounding the dental injection process. Whether it be from the Dentist or Doctor With Needleexpectation of pain from the needle or the anxiety around being numb for an extended period of time, there are a lot of things that can cause distress prior to receiving an injection. So here are some frequently asked questions about what to expect from a dental injection as well as what you should expect to experience afterwards.

  • What are you injection me with?

    The days of novacaine are long gone, now most dentists will use anesthetics such as lidocaine, mepivicaine or prilocaine. These anesthetics are available with or without a small amount of epinephrine.
  • Why do you need to use Epinephrine? Epinephrine is used in local anesthetics to aid in increasing the duration and depth of anesthesia attainable.

  • Can I have an allergic reaction?

    An allergic reaction to modern local anesthetics is very uncommon. In the past some had allergic reactions to some of the components, such as esters, in novacaine. However, the formulations that are marketed in the United States are made with amides as opposed to esters,and are less likely to cause allergic reactions. Some patients may be more sensitive to epinephrine in the anesthetic which can cause some feelings of increased heart rate and a slight tremor to the hands. If this happens let your doctor know.
  • How long will I be numb for?

    Most patients will be numb for about 1-2 hours after the procedure has been completed, with the average procedure length being about 45 minutes. That being each individual is different and recovery time from anesthesia can be different for each individual.
  • What should I tell my Doctor before treatment with local anesthetics?

    Let your doctor know any medications you may be taking as any adverse reactions you may have had with anesthesia in the past. This will help your health care provider choose the appropriate anesthetic for your particular needs.
Injectable local anesthetics; PREPARED BY THE ADA DIVISION OF SCIENCE ON BEHALF OF THE ADA COUNCIL ON SCIENTIFIC AFFAIRS Epinephrine and local anesthesia revisited; Ronald S. Brown, DDS, MS, and NelsonL.Rhodus,DDS,MPH

Occasionally I run into a patient who happens to be newly pregnant. During this time most pregnancypatients have yet to be given the laundry list of do and do not’s  for their day to day lives from their obstetricians and health care providers. So to help anyone who is pregnant, may be pregnant or is planning on being pregnant I’ve compiled a list of what to do for your mouth while you are pregnant.

  • Do tell your dentist or hygienist you are pregnant

    even if it is only a slight possibility or you are in the early days of pregnancy. During pregnancy there are certain restrictions to treatment, such as epinephrine in some of the anesthetics, dental radiographs (unless necessary during an emergency situation)  and nitrous oxide. Let your health care provider know prior to your appointment about your pregnancy so that they can modify treatment accordingly.
  • Do continue to have your exam & cleaning appointments every 6 months

    . During pregnancy we recommend that you continue with hygiene appointments. There are many changes occurring in your body and often times an expectant mother can develop something called pregnancy gingivitis. Your body can become more reactive to plaque and calculus during pregnancy which can cause more inflammation and bleeding between cleanings than you may be used to. By maintaining a good hygiene schedule this can help with inflammation as well as avoid periodontal issues during your pregnancy.
  • Do Not plan on having elective dental work during your pregnancy

    . We recommend that elective dental work should be completed after the pregnancy (with the exception of  dental cleanings). Emergency dental treatment can be completed at any point, and dental treatment that should not wait until after pregnancy is best completed after the first trimester. In each situation it is important to consult your obstetrician prior to having dental treatment.
  • Do Not discontinue topical fluoride use during pregnancy.

      During pregnancy studies show it is safe to use topical fluoride rinses and toothpastes. This will help keep enamel healthy during pregnancy, which is especially useful if you are prone to morning sickness. Studies have shown that using topical fluoride is helpful, however taking a fluoride supplement is not necessary as it does not give any added benefit to mother or fetus.
  • Do Speak to your dentist and obstetrician about nutrition during pregnancy.

      Between morning sickness and pregnancy cravings be sure to speak to your health care providers about nutritious meals as well as what to avoid during pregnancy. From a dental standpoint I recommend that my patients continue using the natural sweetener xylitol. Xylitol is safe and may help with prevention of cavities as well. Also, another tip, if you are prone to morning sickness try rinsing with water and baking soda afterwards to help neutralize the acidity in your mouth prior to brushing your teeth. This will decrease your risk of enamel erosion.
Mäkinen KK. Can the pentitol-hexitol theory explain the clinical observations made with xylitol? Med Hypotheses . 2000;54(4):603-613. Söderling E, Isokangas P, Pienihäkkinen K, Tenovuo J. Influence of maternal xylitol consumption on acquisition of mutans streptococci by infants. J Dent Res . 2000;79(3):882-887. Fluoridation Facts, Published by the American Dental Association, 2005

Choosing a new dentist is not an easy task. Whether you’ve just moved to a new city, your dental insurance has changed or you simply have outgrown your old dentist and need a change. Most people in their lifetime will change their dentist at least two times.The patient admires her smile looking at the mirror And although its pretty common, some just don’t know how to go about doing it. Here are some tips about how to choose a new dentist, and what to look for in your new dental office.

  • What type of life do you lead? Are you on a tight schedule, do you need late or early hours? You’re new dentist should have a schedule that suits your needs. There’s no point to starting in an office that you will never be able to schedule an appointment for!
  • Do you like cutting edge technology or are you happiest with a more traditional office. Many offices have integrated the latest technology into their offices like digital x-rays, CAD/CAM technology and paperless charting. If this is more your speed be sure to ask the office if there’s a website available for you to see what procedures your new dentist is proficient in.
  • Men, Women, Young, Old; you should choose the practitioner that you are most comfortable with. It may sound silly or odd, but dentistry is a very personal experience and you should try and find a dentist who is a good fit with you.
  • Do you need a dentist that takes a particular insurance? Or, can you see someone who is not in your insurances network but will accept your insurance as an out of network  dentist? Depending on your insurance company you may have to see a particular group of dentists, this is something to be aware of before you sign up for a dental insurance. When looking for a dentist ask them prior to your appointment if they accept your insurance or if you are eligible for treatment there.
  • Do you strive for a fast paced dentist? Or a low key, more relaxed environment. When you visit an office for the first time be aware of your surroundings. Besides the decor and cleanliness pay attention to the front desk staff and the dental assistants. You can gain a lot of knowledge about how an office runs by your dentists supporting staff.
  • And finally, never underestimate the power of a good recommendation. Ask, your friends & coworkers, someone who you know will be honest about their dental experience.

You may have noticed that many offices are switching to digital radiography and paperless Tooth signcharting. There are a lot of big changes coming in your dental and medical offices.

  • With the advent of digital technology and advances in imaging many offices are switching to lower radiation digital radiography and some are even pursuing digital impressions.
  • Digital impressions means no more ooey-gooey mold taking for records to send to dental labs. By imaging the mouth with a dental camera, your dental records can be a mouse click away from the dental lab or in office equipment, such as a CEREC machine, and your new restoration.
  • CAD/CAM technology is also becoming more prevalent in dentistry. Using chairside dental imaging, various restorations can be fabricated in the dental office, providing fast, convenient, esthetic, and conservative dental restorations. A popular system that is being seen in more dental offices through out the United States is the CEREC system. CEREC technology allows you take a digital impression of your tooth chair side and fabricate a restoration for you while you wait, which will be inserted that very same day.
  • Another change that you’re sure to notice soon are paperless charts and records. By centralizing all of your information digitally, practitioners can easily access it in their office. And, if necessary can send it effortlessly to you or another dental provider.

During my dental career I have noticed that upon meeting a new patient I am often greeted with the same remark: “This has nothing to do with you… but I hate going to the dentist.”Dental visit I have long since learned that in reality it’s not in fact an offensive remark, but more or less a clearing of the air and really just addressing the elephant in the room. It is common knowledge that the majority of the population dislikes going to the dentist, and the main reasons are not because of the actual dentist and their performance. Read on for the top 5 reasons why people hate the dentist.

  1. Small space with too many people in it.  Dental work is completed in close quarters and commonly your dentist or hygienist is sitting quite close to you. Their face is mere inches from yours and often accompanied by an assistant. Needless to say, some simply cannot feel comfortable with someone in their personal space. Especially someone with pointy instruments! If you find that you feel a little claustrophobic in the dental office let your dentist or hygienist know. The best way to ease anxiety is to be honest about what makes you most uncomfortable, this gives you and your dentist the opportunity to address it and find a solution to make you more comfortable.
  2. Everything smells and tastes weird there.  Well, this category really is self explanatory. The dental office has an odd aseptically clean smell and feel to everything in it. Some people love it, some people hate it, and some people may never have noticed it before. But, when entering a dental office it is a good thing to be greeted with a fresh aseptic smell with clean dressings and fresh instruments.
  3. What if it hurts? The fear of the unexpected, this is one of the top reasons some find dentistry uncomfortable. Even though 99% of their appointments are quick  and pain free, that 1% can set the precedent for future dental experiences spent simply waiting for something to occur. By finding a dentist you trust and feel comfortable with this dental fear can be minimized. Although, most people who have a slight dental anxiety will feel uncomfortable in the dental office, the right dentist can put you at ease. And, if needed offer solutions to ease your anxiety during treatment if necessary.
  4. They’re going to tell me I have a cavity.  For some, the simple possibility of being told you aren’t doing a good enough job with your home care, or that you’ll have some need for more dental work, can cause people to come in with soured expectations. Although this is a tough situation to avoid it is best to keep up with your regular hygiene appointments so that your dentist and hygienist can give you helpful advice in order to avoid more complex and invasive dental treatment. Also, it is much better to have a small cavity filled rather than wait until it becomes a large cavity or something more complicated such as a root canal treatment.
  5. I don’t like being numb.    There really is no confusion as to why this one is on the list. It can be nerve wracking getting an injection and then dealing with the resulting numbness of your lip, tongue and cheek afterwards. But, that being said there is nothing like having pain free dentistry completed!

Are dental amalgams dangerous? Recently, it was brought to my attention that a popular preventativedaytime television show, Dr. Oz, brought up the safety of dental amalgams in the mouth. This is a topic that has been under speculation by the general public for many years and is the source of many questions from our patient family.

Many studies have been done over the years by many sources whether it be the American Dental Association, the American Academy of Pediatrics, the National Multiple Sclerosis Society or the Alzheimer’s Association. Throughout all the research performed, there has been insufficient evidence found to support claims that dental amalgams are dangerous. Dental amalgam restorations are still an option recommended by the American Dental Association. So is there any truth to the speculation? Are dental amalgams dangerous?

  • The best dental restoration is no restoration! By following proper home care and maintaining a good hygiene schedule you may avoid the need for future fillings altogether.
  • If you do have to have a filling place, be aware of your options. There are many choices of dental materials based on the size of the cavity, location of the tooth in the mouth, and the patient’s at home habits. Your dentist will recommend to you the best restorative material for your particular situation.
  • I normally will recommend that a patient replace an amalgam filling only if the filling begins to show signs of breakdown and is no longer properly sealed. Other reasons for replacement are if there is recurrent decay present or it is unable to be cleansed properly, causing inflammation or further decay.
  • Always remember if you have any questions or concerns regarding your dental care it is always best to go directly to the source. Ask your dentist why they recommend a particular type of filling or restoration. Ask what alternatives are and what the risks or benefits of those alternatives are if you are unsure of the treatment presented.

Many of my friends ask me questions such as: When people eat garlic does it make you mad? Or, should I always see the same hygienist or is it okay to switch? These are legitimate Physicianquestions that most people don’t exactly know the answer to. Today’s post is about dental office etiquette, the Do’s and Do Not’s of the dental office.

  • Do show up on time. Most dental offices schedule a time block for one patient and one patient only. If you can’t make it to your appointment or if you are going to be a few minutes late it helps to give the office a heads up as soon as you know. This helps the front desk to adjust the  dentists schedule as best as possible so they can see you and others on time.
  • Do bring old records. If you are a new patient to an office and you have recent x-rays bring them with you. Many people feel very awkward taking their old records when they leave a place to seek a different dentist. Although it is a slightly awkward situation it is not uncommon to see more than one dentist in your lifetime. We know that situations change, people move, change insurances or simply grow out of their relationship with their current dentist. The few minutes of awkwardness asking for your records can save you the trouble of having new ones taken as well as decreasing any unnecessary exposure to radiation.
  • Do try different hygienists, if you feel like it. It is okay and completely acceptable to use different hygienists for your recall appointments. Many people will see different hygienists depending on their schedule or preference, and it is not offensive to switch. Switching between dentists within an office, although not as common, is okay as well. However, if switching dentists it is best to finish any major treatment you may be in the middle of, such as a crown or a root canal before switching.
  • Do Not worry about what you just ate… And finally, if you ate garlic before you came or forgot to brush its not as big a deal as you think! If you do remember it is greatly appreciated, but in general  you are more conscious of the slight garlic breath and food between your teeth than we are!

Bad breath, always the first thing you think about when right before you open your mouth.Silence ‘Does my breath smell bad? I can’t tell, it must smell bad…’ You breathe, you sniff, and still you just can’t tell. That moment of doubt can ruin a social situation by flooding you with insecurity. So what do you do?

  • Although caused by many things, the top reasons your breath may not be as fresh usually is from a few common problems. Such as:  poor oral hygiene, diet and nutrition, or some health problems such as dry mouth, acid reflux or debris from post nasal drip and respiratory tract infections.
  • To keep your bad breath under control try to avoid garlic and onions. These types of foods can stay in your system for up to 72 hours after your consumed them.  Cigarettes, coffee and other odor inducing foods can hang out on the back of your tongue and between your teeth as well. Be sure to brush and floss after you eat and follow with a good mouth rinse. Maintaining a well balanced diet and keeping hydrated as well can help reducing bad breath as well.
  • Be sure you actually have bad breath, check with a friend if you really aren’t sure, or if you are able to, run some floss through your teeth and smell. If your floss is discolored or has a bad odor there is a good chance your breath is smelling the same. Interestingly enough there is a small percentage of the population who believe they have bad breath when they do not and patients who are obsessed with their breath. These people are categorized as being either halitophobic’s or pseudo-halitosis patients.
  • Keep in mind that although gum, breath mints and some mouth rinses are short term quick fixes if you have chronic bad breath or halitosis be sure to see your dentist and evaluate what can be causing it.
Breaking paradigms: a new definition for halitosis in the context of pseudo-halitosis and halitophobia; D. Falcao, C. Vieira, R. Batista de Amorim