Office News

Happy Holidays, Hag Chanukah Sameach, Merry Christmas  

At the time I am writing this, Chanukah has just ended and Christmas is here. We received a great number of holiday and Christmas cards this year and the adorn our windows and  reception room. I will keep them up through New Years as I enjoy the spirit that they intend. We will be adding the family pictures to our Two and Three Generations of My Patients framed wall gallery in the reception area. We also have received some great e-cards and holiday links. If you love more traditional holiday (Christmas cards) check out http://www.jacquielawson.com/  

I received several of her animated cards with sleighs and snow falling and they were reminiscent of cards we used to get. A static image of one of her cards is shown here.

On the other hand, another patient of Italian ancestry sent me the cutest link of Dominick the Donkey, which is Italy's answer to Rudolph the Red-Nosed Reindeer.

Some People Missed the News Items

The newsletter that went out Dec 1 had only a link at the bottom that said Newsletter and many of you missed the important items of Medical and Dental interest that I select each month to include in this newsletter. I've changed the format so that the items are now appended directly following these office notes.

We Now Will Have a Friday Hygienist

Pamela Drucker, RDH will be with us on Fridays. She brings over 25 years of Dental Hygiene experience and works in Park Avenue Periodontal Associates with Drs. Alan Pollack, Alan Winter, Paul Karen, et. al. in that office during the other days of the week. Several of our patients who are seen there for combined care with our office already know and love Pamela for her warm, energetic nature and special expertise with patients needing more advanced periodontal care. Her presence in the office brings added expertise to our patients and continuity of care between the two offices.

We therefore can now see patients who need Friday appointments for  Periodic Exams and "Cleaning" with a trained hygienist and can schedule patients who needed more advanced periodontal procedures on Fridays as well.

Saturday Appointments Now Available

The experiment to add Saturday appointments for the office worked. We will be opening every other Saturday with Jenny Borukhov, RDH doing the hygiene appointments. Lourdes and Angela with provide front desk and chairside assisting support.

HAVE A GREAT DAY!

Have you considered putting your wisdom teeth in a safety deposit box? If you are like most people, then likely not. However, it may be possible in the future for people to have stem cells taken from their own wisdom teeth and saved. The stem cells would be used to help regrow teeth, to restore nerve cells, to correct a cleft palate or periodontal defects, to regrow jawbone and to save teeth, according to Pamela Gehron Robey, Chief of the Craniofacial and Skeletal Diseases Branch for the National Institute of Dental and Craniofacial Research at the National Institutes of Health. This type of stem cell harvesting is non-controversial because the cells are removed from a person healthy teeth, not from a fetus.

Robey advised attendees at a recent American Dental Association conference that jawbone grown from bone marrow has already been used to replace lost jawbone in a patient. She hopes that stem cell technology can be used to regrow teeth for patients who have been in car accidents or suffered some other trauma that caused them to loose teeth and to help people whose nerves have been damaged from Parkinson's disease.

Some get them, some don't; some are fine, some aren't

When we are born we usually come into the world toothless, but as we age, teeth appear in our mouths on a somewhat regular schedule. For example, our first molars (large grinding teeth at the back of the jaw) usually appear when we are 6 or 7 years old, our second molars when we are 12 or 13, and our third molars (wisdom teeth) when we are typically between 18-20 years old when we are much wiser Many people have four wisdom teeth, one on each side of the upper and lower jaws, while others have only 1-3 wisdom teeth.

Unfortunately, not all wisdom teeth erupt correctly (grow out from under the soft tissue "gumline" covering the jawbone), if at all. The tooth may lie sideways in the jaw, either pointing inward toward the back of the mouth (distoangular impaction "least common), outward toward the cheek (mesioangular impaction most common) or pointing directly at the second molar (horizontal impaction). The wisdom tooth might only partially break through the soft tissue, which is called vertical impaction.

Various sources list the age range from as low as 15 years old to as high as 25 years old.

Impaction is not a good thing

Impaction, simply stated, means that the wisdom tooth has either not erupted at all or has not fully pushed up through the gumline. An impacted wisdom tooth can cause serious and even deadly health problems. For example, the person can experience pain, get jaw and gum infection (pericoronitis), a tooth abscess**, have crowded or crooked teeth, or the nearby teeth and roots can be harmed. One of the more serious problems is the development of a cyst. If not treated, the cyst can form a tumor or cause jawbone destruction; it can move other good teeth out of position or damage nearby teeth.

In late 2005, a late 1990s study was made public that showed that 60 percent of the pregnant women in their twenties who participated in the study already had early gum disease around their wisdom teeth. The study's position is that pregnant women who have their wisdom teeth are at a risk of having complications with their pregnancy and other health issues. The women who had the most serious gum disease were twice as likely to have a premature baby, according to the American Association of Oral and Maxillofacial Surgeons. The most significant aspect of the study is that in the 1990s, it was thought that only adults 35–40 years old suffered from complications caused by gum disease, and now professionals know that age is not a factor.

Sometimes, the person is unaware that any damage has occurred, which presents an even more dangerous situation.

**Read the November 2006 issue of SmileLink, "Ow, my Tooth is Killing Me"

The good, the bad and the ugly

Here is the good and the bad about impacted wisdom teeth. If treated early (early teen years) complications from impacted wisdom teeth seldom arise. If not treated until later years, after 20 years old, serious complications may occur. During the teen years, the jawbone is not as dense and hard as it is when the person ages, and the tooth root is comparatively short; thus, extraction of a wisdom tooth is a relatively uneventful procedure. A teen also heals more quickly than an older person. Once the jawbone is hardened and the tooth’s roots have grown longer, one might as well loop a 1-inch cable around the tooth and hook the other end of the cable to the bumper of the family sedan, figuratively speaking of course. Older adults can suffer nerve damage from a difficult extraction. The American Association of Oral and Maxillofacial Surgeons and the Oral and Maxillofacial Surgery Foundation recommend that wisdom teeth be removed while the patient is still a teenager, which brings up an ongoing controversy: The Ugly.

It has been a customary practice to routinely extract wisdom teeth at an early age. However, there is a growing body of research that shows that there is no substantial evidence to either support wisdom teeth removal or to leave them in place (Refer to link below to the Cochrane Collaboration.). Their position is that 60 percent of wisdom tooth surgeries are unnecessary.

From statistics the other side of the fence, however, show that about 85 percent of wisdom teeth will need to be removed. These contradicting ideas and statistics might indicate that there is a substantial amount of subjectivity in deciding whether or not to remove wisdom teeth.

So, what is a person supposed to do?

As usual, good oral health care is the Golden Rule. Dr. Trey Petty, a spokesperson for the Academy of General Dentistry , advises people to take good care of their erupted wisdom teeth The key to preserving them (wisdom teeth) is maintaining good oral health by brushing twice a day and going to see the dentist twice a year.” states Dr. Petty.

If you are concerned about your wisdom teeth, talk to your dentist. Your dentist will advise you about the risks, complications and outcomes related to keeping or removing your wisdom teeth.

Keep your teeth healthy; your future dental needs and your
health are depending on you. You can take that to the bank!

For more information, you may find the following Web sites useful:
Academy of General Dentistry http://www.agd.org/
American Association of Oral and Maxillofacial Surgeons http://www.aaoms.org/patient_info.php
Cochrane Collaboration http://www.cochrane.org/
National Institute of Dental and Craniofacial Research http://www.nidcr.nih.gov

December 2006

Caregiving is a 6-Letter Word: STRESS

With a heavy sigh Clarise sat down in the dentist’s examination chair. She had dark circles under her eyes, and she had lost a significant amount of weight. Curiously, Clarise had not been to the dentist’s office in over a year. As the hygienist examined Clarise’s teeth and asked Clarise questions, she was shocked by what she was seeing in Clarise’s mouth. Clarise always brushed and flossed regularly, just like she had been advised. Yet, Clarise’s gums were red and swollen in several places, evidence that Clarise was not taking care of her teeth. The hygienist discovered that for the past year Clarise had been providing 24-hour, 7 -days a week care for her elderly, disabled husband.

We likely all know of someone who provides home care for a family member. Maybe that someone is you. Take heart in knowing that you are not alone. The U.S. Department of Labor states there are over 22 million caregivers in America . That is the population of Texas ! A survey reported by the Family Caregiver Alliance states that there are 52 million caregivers in America . That is the population of Texas and California combined! The reason this latter number is so much larger is because of the difference in the  definition of being a caregiver. But no matter; either way you look at it, that is a tremendous number of people who provide home care for someone else.

 Caregivers might need a reality check

The life of a caregiver is no picnic. There are long hours and sometimes burdensome tasks that must be done. You might feel alone, isolated and overwhelmed. You never take any time away from your responsibilities, even to the point of ignoring your own physical and mental health. After all, Clarise took a vow when she married her loved one, and she intends to uphold that vow no matter the consequence. “It’s a labor of love, you might say. It is common for a caregiver to have the attitude of ”If I don’t help, who will?”

However, did you know that if you become seriously ill from ignoring your own health that you might be doing additional harm to your loved one? Instead of having one seriously impaired person in the house, you now have two! And one of those two can no longer provide adequate care for the other.

As a caregiver, it is not selfish to look after your own health. It is an important part of being a caregiver so that you can effectively care for the other person.

  The body reacts to many factors

There are several ways that caregiving affects you. Current studies indicate that 46–59 percent of caregivers are experiencing depression, and as shown below, depression is an indicator of stress.

If you experience even a few of these signs, you need to immediately seek help and make changes in your routine.

*Gingivitis: redness and swelling caused by bacterial infection in the soft tissues (gums) surrounding the teeth. Gingivitis is the result of plaque, that sticky substance that clings to your teeth after you eat food or drink a beverage. An unchecked bacterial infection in the gums can result in other more serious conditions. (Read Ow! My Tooth is Killing Me! in the November 2006 issue of SmileLink.)

Chronic stress affects the body’s ability to protect itself. The immune system is weakened. People who suffer from stress can develop allergies, high blood pressure, migraines and heart attacks, to name a few. Caregivers who show signs of stress are more likely to have poor eating habits, to not get enough exercise, to work when sick and to not make or keep doctor and dental appointments.

Dr. Holly Prigerson, director of the Center for Psycho-oncology and Palliative Care Research at the Dana-Farber Cancer institute in Boston , states, “…caregivers are experiencing a clinically significant level of distress, yet they seem to be neglecting their own mental health needs, quite possibly due to the lack of time, energy, or financial resources associated with caregiving. She feels that front line health care professionals can play a major role in identifying stressed caregivers and offering them guidance and help.

 Stress is an enemy of your teeth

We know that stress can wreak havoc with our bodies causing illnesses and even death. Until recently, none of the research had focused on dental conditions. Now there is evidence that teeth are victims of stress.

We also know that not having or keeping a proper dental care routine can seriously affect our health. A study published in June 2006, in the Journal of Periodontology focused on dental health. It reported that caregivers are four times more likely as non -caregivers to have increased plaque when the caregiver experiences short-term stress. Long-term physical stress made caregivers twice as likely to suffer from gingivitis. The report also stated that stress might cause the caregiver to not take an interest in keeping a regular dental care routine.

However, it is not the stress that directly causes gum or periodontal diseases. Stress occurs when caregivers focus only on the loved one’s health. The caregivers’ health is not a priority. Making and keeping dental appointments is not a priority. Brushing and flossing is not a priority. Caregivers feel selfish and guilty about concerns for their own health needs. This sets up a perfect situation for plaque and gingivitis to attack your teeth.

We are responsible for our own good dental health

A regular program of brushing and flossing helps the body in so many ways. It is easy to do; it doesn’t take long to do and the rewards are worthwhile. Simply stated, you cannot effectively help your loved one if you don’t first help yourself.

For more information, you may find these Web sites useful:
Academy of General Dentistry http://www.agd.org/
Administration on Aging http://www.aoa.gov
American Academy of Periodontology http://www.perio.org/
American Dental Hygienists' Association http://www.adha.org
ARCH National Respite Network and Resource Center www.chtop.com/ARCH
Eldercare Locator www.eldercare.gov
Family Caregiver Alliance http://www.caregiver.org
|National Association of Area Agencies on Aging http://www.n4a.org
December 2006

Good Guys in White Hats

In the early days of television, it was easy to see who the good guys and bad guys were. The Good Guys always wore white hats. The villainous Bad Guys in black hats were always caught and sent to jail. Today, dental patients are faced with a Bad Guy black hat versus a Good Guy white hat dilemma: whether or not to replace dark metal fillings with white fillings or to have a new metal filling.

Bad Guys in black hats

If you have fillings in your teeth, you likely have what are called amalgam fillings, those silver-colored fillings that eventually turn a  dark grayish-black color. Because amalgam is a combination of several metals, including silver, mercury, zinc and tin, the filling darkens over time. When those dark fillings are in the back teeth, they are not so noticeable.

But, when teeth near the front of the mouth have dark amalgam fillings, a person may feel self-conscious about talking or smiling.

There is, however, a more serious concern when considering replacing (or having new) amalgam fillings. The amalgam is 50 percent mercury. Because mercury is a toxic metal, some believe an amalgam filling is hazardous to a person’s health. However, according to the American Dental Association, amalgam has been used in dentistry for a very long time without evidence that the mercury in a filling is dangerous to a person. There is a small amount of mercury vapor that leaks into the body when chewing. So far, it has not been proven that that small amount of vapor has harmed anyone.

Good Guys in white hats

White fillings, on the other hand, do not contain any metal. They are made from a combination of glass and acrylic and thus, are called a  composite filling. A composite filling does not turn dark grayish-black; so you can let that smile shine through! The dentist can place a clear plastic coating over the composite to help to prevent any color change.

Composite fillings are not a new technology. They have been used since the early 1960s, but typically, only on front teeth because the composite was not strong enough to withstand heavy chewing pressure from the back teeth. In the 1980s a better bonding method was developed, and more recent technologies improved a composite’s strength.

A balancing act

When your dentist discusses filling options with you, you will need to weigh the advantages and disadvantages of the amalgam filling versus the composite filling. The chart below shows a comparison of the two filling types.

*Composite filling strength is embroiled in controversy as well. According to some in the dental profession, an amalgam filling is stronger than a composite filling. However, that must be balanced against the fact that the composite is directly bonded to the tooth. The composite is actually stronger than the amalgam because it is bonded to the tooth, making the tooth less likely to fracture.

Whether you choose the Good Guys in the white hats or the Bad Guys in the black hats, your dentist is a reliable source of information about filling options.

For more information, you may find the following Web sites useful:
Academy of General Dentistry http://www.agd.org/
Ask Doctor Spiller at http://www.doctorspiller.com
Canadian Dental Association http://www.cda-adc.ca/en/oral_health/index.asp
December 2006

Leonardo Da Vinci, David Duchovny, Chelsea Clinton, Jerry Seinfeld All Did It

You may have something unique in common with numerous famous people including Paul McCartney, Hank Aaron, Mr. Rogers and Candice Bergen. No, it’s not that you are all left-handed or snore or share a birthday. Actually, all of you chose a vegetarian lifestyle.

You might think that vegetarians are only a minority of people; however, studies show that there are over six million adults who consider themselves vegetarians.

The Myth: Vegetarians are sickly and unhealthy

Some might think that vegetarians are poorly nourished and unhealthy. That couldn’t be further from the truth. As with any diet, it is a matter of choosing foods that adequately nourish your body and keep you healthy and strong. That being said, however, vegetarians need to be more cautious about the foods they eat. They need to make sure they eat foods high in iron, vitamins B12 and D, calcium, protein, iron and zinc.

For example, studies indicate that teens today drink twice as much soda ”no calcium” than milk ”good calcium source. Girls who consume large quantities of soda are getting maybe 800mg calcium each day. The U.S Department of Agriculture recommends teen girls get 1300mg calcium each day. Boys who drink  soda face the same health risks as girls. In fact, boys 12-29 years old drink more soda than anyone according to the Center for Science in the Public Interest. Growing bones need a diet rich in calcium, otherwise osteoporosis, broken bones and tooth decay could be eminent.

According to the Center for Disease Control,

The American Dietetic Association states that a vegetarian’s diet can provide adequate nutrients to have a healthy body and teeth. It is extremely important for vegetarian children to eat enough of the essential ingredients such as zinc, iron, vitamins D and B12, and calcium.

Good sources of calcium include

Teeth are victims of inadequate diet

One of the foremost victims of inadequate nourishment are your teeth. Teeth fall prey to the sugar in soda and other foods when the sugar converts to acid. The acid dissolves the calcium out of the tooth enamel; then bacteria can cause serious tooth decay.

Vegetarians can be particularly vulnerable to tooth decay if they are not including foods high in calcium in their diet. They need to carefully read food labels and count the percentage of calcium they eat each day.

To prevent periodontal disease, the Academy of General Dentistry recommends that vegetarians monitor their intake of vitamin D and calcium and consult a dentist about their diets and oral health.

Counting calcium, counting iron, counting, counting, counting

I remember the days when I counted each cereal box top to know when I had enough to send away for a Captain Midnight Secret Decoder Ring. Now I have to count nutrients! All these years later I wish I still had that ring to help me understand exactly what is I am buying at the grocery store. If you are like me, you ponder over each nutrition label to determine whether a product is healthy for you based on your dietary needs. How much is serving of fruit? A slice of bread? One potato? It boggles the mind.

Consider how much more complex this head scratching gets if you have decided to embrace a vegetarian lifestyle. Not only do you need to monitor the animal products that may be lurking in that food, but you also have to be more careful to eat foods that are higher in certain nutrients such as calcium.

Food labels unmasked and exposed

Even though a food label may seem like hieroglyphics or some ancient unknown language, it is easy to read once you understand what each element of the label is.

1. Label, top section: tells the serving size, the number of calories and nutrient information.
2. Label, left middle section: lists the nutrients in the food
3. Label, right middle section: lists the Daily Values (DV) for either a 2, 000 - or 2,500-calorie daily diet. This number is always written as a percentage.
4. Label, footnote in bottom section: lists the Daily Values (DV) for either a 2, 000 - or 2,500-calorie daily diet. This section tells consumers what the recommended nutrients are.*

First, from the top of the label, determine what portion of one serving you actually eat. If one serving is equal to one cup, and you eat only half that amount, then the nutritional value (DV) of the food decreases by half. Thus, if the label states that one cup of the food provides 20% of the daily requirement of calcium (DV from the bottom of the label), your half serving gives you only 10% of the daily calcium requirement.

Second, go to the middle of the label where vitamins and elements are listed, and see what the DV percentages are. Based on what the usual serving size is that you eat, recalculate that percentage as referenced above: one-half a serving is equal to one-half of the DV.

If you take a multi-vitamin or other supplements each day, add those milligrams or percentages into your total daily intake.

Understanding the DV will help you compare nutrient claims on similar products such as those that advertise as reduced fat, low fat and light

*This footnote is printed only on larger food packages.

Caveat emptor ”let the buyer beware

Be careful of making assumptions about nutrient values. For example, the calcium value for whole milk or skim milk is typically the same per serving. However, for 8-ounce containers of regular, light or fat-free yogurt, the amount of calcium can vary from 20-45% DV.

Understanding a food label can help you to not only limit bad nutrients (perhaps sodium or fats), but most importantly, to help you increase the nutrients you need to eat in a vegetarian lifestyle. You can maintain a healthy body and healthy teeth!

Eat healthily all year long

Once you know what foods are high in calcium, it is easy to build a menu that will have variety and be tasty.

For example, try these suggestions to add calcium to your diet; eat:

Breakfast

Lunch

Dinner

Academy of General Dentistry http://www.agd.org/
American Academy of Periodontology http://www.perio.org/
Center for Disease Control: http://www.cdc.gov
U.S. Department of Agriculture http://www.usda.gov/wps/portal/usdahome or MyPyramid.gov
Newswise http://www.newswise.com December 2006

XX vs. XY or She Said vs. He Said

You might giggle or groan at the old song lyrics Anything you can do, I can do better. No, you can’t. Yes, I can. We often come across certain aspects of our daily lives that a person of one persuasion truly does something better than a person of the opposite persuasion. No sexual discrimination involved or intended, merely a serious fact.

She Said vs. He Said

As a woman, brushing and flossing your teeth may be so common to your daily routine that you really don’t even have to remind yourself  to do it. On the other hand, as a man, brushing or flossing your teeth may be something you do only when someone threatens you with bodily harm if you don’t do it.

For example, surveys done by the American Dental Hygenists Association (ADHA) show that more women than men brush their teeth—

• before going out
• at work
• in a restaurant restroom
• three times a day.

A scant 22 percent of men reported that they brush their teeth one time a day—or less!

More women than men could correctly identify the way to brush teeth: use a circular motion close to the gumline, and hold the brush at a 45 º angle to the teeth.

Flossing ranks even lower with men. Surveys show that 20 percent of men never floss; only 10 percent of women fall into that category.

The major reason for not brushing or flossing regularly typically fell into either the I don’t have time or I forgot/didn’t think about itâ€� categories. Interestingly, the number two reason stated by men was because there were lazy

Equality at Last: There is Light at the End of the Tunnel

Both women and men said they knew they should brush their teeth for a longer period of time about one minute longer than they actually brush. You should brush for 2-3 minutes. Some state that if you sing the Happy Birthday song, you will brush the recommended length of time.

In their favor, woman and men also regularly replace their toothbrushes. The survey reported that they replaced their toothbrushes every 2–6 months, but sales indicate that it is more like every 9 months. But you need to keep in mind that many dentists give toothbrushes to patients when they have their teeth cleaned, which would dramatically affect sales figures.

Here We Go Again: Sounding Like a Broken Record

You have heard it over and over as you sit in the dentist chair: You must brush and floss to maintain healthy teeth.

Maria Perno, former president of the ADHA, claims that men have a higher rate of gum disease.

That fact does not excuse the reported 16 percent of women who do not brush or floss regularly from establishing a regular dental care routine. The statistics about gum disease* in the U.S. are shocking:

• 50 percent of youth 17 years old and under have gum disease (according to the ADHA).
• 80 percent of the entire population has gum disease (according to the National Institute of Dental and Craniofacial Research organization). Many people do not know they have gum disease because it is in the early stages.
• The number one reason that adults lose their teeth is gum disease that advances to periodontal disease, a serious, non-reversible condition.

  Wanted: Dead or Alive

Periodontal disease is a serious condition that should not be ignored. It is the underlying cause of several deadly diseases, including:

• heart disease ”the number one killer of men and women affects over 60 million people and kills nearly one million people each year;
• diabetes affects nearly 16 million people and causes nearly 200,000 deaths each year; and
• oral cancer more common than other lethal cancers, including skin cancer, leukemia, Hodgkin’s disease, brain cancer, stomach cancer and ovarian cancer, to name a few.

Periodontal disease is also linked to low birthweight, premature babies who come into the world already facing a life-and-death struggle.

Dentists and dental hygenists know that some of life’s most serious diseases show up first in the patient’s mouth. They are on the front line of preventative health and can guide you when they see a potential problem.

You can help to protect your health and your teeth by brushing regularly and correctly, flossing, and getting dental check-ups twice each year. If you have soreness or tenderness around your teeth, immediately contact your dentist.

If you are going to be a statistic—be a GOOD statistic!

For more information, you may find the following Web sites useful:
Academy of General Dentistry http://www.agd.org/
American Academy of Periodontology http://www.perio.org/
American Dental Hygienists' Association http://www.adha.org December 2006 

The information contained in this web site is for the sole purpose of identifying dental care or treatment which may be available from a qualified dentist.
This web site does not offer any form of medical or dental advice.
Simon W. Rosenberg, D.M.D., does not represent, warrant or guarantee that
 any specific treatment is appropriate to your present or future dental needs.
Please contact a dentist or hospital if you are experiencing dental pain
or have a dental emergency.
The rights to the names of products or services mentioned are the property of their respective registered trademark owners.

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to our patients. Capital One Healthcare Finance is a convenient, no initial payment, low monthly payment plan
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For treatment under $1000 there's a no interest for 90 days. There’s no interest for one year if treatment is over $1000.)

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