Health Talk With Dr. Gross

When I Stick My Finger in My Mouth, I Catch My Nail on the Outside of My Tooth.

Well that’s really not a question. It’s more of a statement of a finding. The hidden implication is that something is not right. Those of you who know me can anticipate my response. Your fingers should not be in your mouth. It’s okay for me to put my fingers in your mouth, but not for you. Except for brushing and flossing, fingers in the mouth invariably lead to trouble. However, now that the subject is brought up, let’s spend a little bit of time discussing it.

Those areas on the outside of your teeth which develop craters or fingernail catches develop in a couple of ways. Cavities or decay is usually not one of them. Areas of decay are composed of slowly breaking down tooth structure that is being destroyed by the acid from bacteria in plaque. This plaque sticks to your teeth and causes decay or rotting of the tooth.. The decay doesn’t usually turn into hard and sharp catches for your fingernail. So a cavity is usually not the cause.

The areas that this patient referred to are usually caused by overzealous brushing or excessive tooth wear. Let’s spend some time with both of these. In sports certain injuries are called “overuse injuries”. It usually refers to too much of one motion or movement that wears out a certain body part. Baseball pitchers can wear out their shoulders if pitching too long or too often without proper rest. The same thing can happen in your mouth with either the wrong type of tooth brush or too much pressure. The outer surface of the tooth in the area near the gum is very thin. It is very easy to wear this away and then get into the inner layer of the tooth. This is much softer and these concave area or craters develop. As long as you continue to abuse the area, the greater will be the destruction. I had one patient who was so aggressive that he destroyed his tooth all the way down to the nerve. This caused him tremendous pain just by breathing in air and he required a root canal treatment to alleviate his pain

The other cause for these “catches” on the outer surface of the tooth is grinding. The  force of grinding causes the outer surface to fracture. I just saw a patient yesterday, who grinds ice in his mouth. We commonly call this, “chewing on ice”. Even though one could thing of this as harmless eating as there is no sugar or chemicals in the ice. However the cold and pressure of purposeless ice chewing ends up with fractures along the gum line. He had 13 such fractures along his gum line.

The fix for both of these causes is rather easy. In the past, we had to drill large holes to fill this defect and prevent you from further destroying tooth structure resulting in fracture or root canal treatment was we pointed out above. With newer techniques we no longer have to drill large holes and even get you numb. We can use bonding to adhere the material. We can do 3-4 teeth, if needed, at once without even using local anesthetic. The result is quick and you can get back to your life without a numb mouth. Bonding is one of my favorite techniques as it is usually simple and non-invasive. I routinely do in office veneers as or cosmetic corrections as well,  as fix damaged teeth in them form our “overuse injury”.  This exciting technology allows us to solve many problems that were so difficult to treat in the pre-bonding era. If you see some area of your mouth that has changed and are curious as to what it if, please call me at 440.951.7856 and we can discuss it. Many times the fix is really easy, simple and pain free.

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Local Doctor Can Guide Your Nutrition

Nutrition is so important to our general health and this extends to our dental health as well. I have written quite a bit about the oral and full body relationship. I have found a great website with a tremendous amount of good nutrition information. Best of all, the doctor who  is responsible for its content is a local doctor, Dr. David Gutman. Click here to visit the site and improve your total body health

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My Dentist Did a Root Canal on the Wrong Tooth! What Do I Do?

I heard this complaint a couple of weeks ago. I also heard yesterday “ I have a tooth ache on both the bottom and top. I can’t pick which tooth is hurting me.” And last and not least, “whenever I chew I get a pain up to my ear”. Believe it or not all of these statements are really related and are rooted in the same source. When I examined all of these patients, there was nothing that was obviously wrong either visibly or on an x-ray. Yes, all of these problems and issues stem from a biting problem or a misalignment of the teeth. Those who follow me regularly know my mantra when it comes to teeth and biting. You need to keep you teeth apart and your lips together when you are not eating. Teeth only are meant to come together when we eat, not at any other time. This is one reason why gum chewing is so bad for you. Your teeth clash in a meaningless action. Chewing food is meaningful, gum chewing is meaningless. In addition to gum chewing, grinding or clenching does not have any purpose. Your teeth meet and press on each other. These actions of clenching or grinding have far reaching consequences.

First of all those actions or habits, put continual pressure on your teeth. According to Dental Health Directory Library, the human jaw is capable of applying approximately about 68 lbs/sq inch of pressure on the back teeth. If you intentionally clench your teeth you may increase that force to about 150 lbs/sq inch. However, an individual who clenches and grinds their teeth subconsciously at night can place up 1200 lbs/sq inch of force. Teeth were never meant to have continual pressure. The act of chewing applies forces, then lets up, and then re-applies these pressure. These forces far exceed what a tooth is capable of withstanding. The result can be a fractured tooth, a loose tooth, or a tooth that requires a root canal as the nerves and blood vessels inside the tooth are irreversibly damaged. Many of the crowns that I make for teeth are done on fractured teeth. These teeth fracture due to excessive forces. Oftentimes these harmful habits are the culprit.

In addition to the tremendous forces that are exerted on the teeth, there are forces that apply to the teeth, the jaw bone also is a recipient of these forces. The lower jaw transmits its trauma resulting from excessive forces to the muscles and ligaments that attach the lower jaw to the head. These delicate structures all come together right in front of the ear. This intersection of jaws and soft tissue is called the temperomandibular joint. We call it TMJ for short. Those three letters are mentioned a lot when people have non-descript jaw pain. It is not sinus, it is not tooth related, it is joint inflammation caused by inappropriate biting forces applied.

So what is the cause of these forces that wreak havoc in our mouths? Sometimes it is stress in our lives. This can be family or job related. Some people get ulcers, other people pull their nails, and others clench or grind. Let me take a moment to say that it doesn’t matter if you are a clencher or grinder or both. These actions are all bad for you. So one solution is too eliminate the stress in one’s life and the clenching, etc gets better. Many times that is easier said than done. Some of these oral actions become ingrained habits that are hard or difficult to break. This is where, the dentist steps in and makes a custom fitted mouth appliance to either help you break the habit or protect your teeth from the damage that will happen. There are many styles and shapes of these devices. A professional needs to assess you, make recommendations and fit you properly. As a patient told me last week, “ I was so skeptical of you grinding hypothesis. Now that I am wearing a device, I feel great and everything is comfortable. You have made a true believer out of me”. Our initial patient with the wrong root canal complaint, was actually grinding with a denture on her natural teeth. We see from this that although dentures can not create the same amount of forces as natural teeth, in the right situation, they can wreak havoc. So if you find that you have teeth breaking, fillings are always falling out, crowns are popping loose too frequently, or a toothache that you can’t pinpoint the tooth, give me a call at 440.951.7856. Together we can play detective and work on figuring out the problem. You only have one set of teeth, let’s do all that we can to take care of them.

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My Last Root Canal Was Years Ago. Has Anything Changed in the Procedure?

It’s been a long time since I discussed root canal treatments. Like all techniques in dentistry, we are striving to make things better for both the patient and the dentist. Therefore, I think that it’s time that we reviewed some of the concepts that are common to all root canals and what’s new in this exciting field today. All root canals have a common goal. The center of a tooth is filled with soft tissue, including blood vessels and nerves. This tissue is alive and this is what gives a tooth it’s feeling. This tissue’s initial function is to create a tooth as a baby or even before the baby is born. It also directs the shape of the tooth’s hard structure. Once the tooth is formed, the soft tissue inside serves as a pain mechanism and warning system if the tooth is injured. It is also the source of a dental infection or abscess. This leads us to a specific treatment choice when this happens.

Without treatment, the infection will spread. Eventually, the tooth will become very painful and need extracting. Some patients may prefer to have the tooth pulled out, especially if it hurts a lot or if the tooth cannot be restored. This can happen if there is large decay, trauma, or loss of bone due to periodontal, or gum, disease. However, removing a tooth may mean that the surrounding teeth start to move and become crooked. This not only looks unsightly, but can make it hard to have a good bite.

If the tooth cannot be saved or a decision is made to remove the tooth, then we need to talk about replacement with an implant or bridge. In most cases, it is better to save the natural tooth if possible, because nothing functions as well as a natural tooth. Root canal therapy will usually save the tooth and eliminate the pain.

When the tissue becomes injured, it may create pain. This happens more often than not when we diagnose a tooth and determine the appropriate treatment as being a root canal procedure. Our task is then to clean out the damaged tissue and create a sealed sterile environment which will allow the tooth to remain in the mouth and function.

In the past and in many offices this was all done through the use of hand instruments. This was a long and tedious process requiring multiple visits. Today we use specialized instruments which clean the teeth very efficiently and gently in a matter of minutes, rather than hours. We use a single instrument to do what multiple instruments and tools did in the past. This alone is a time saver.

These new instruments were developed for single use, removing the risk of cross-contamination and dramatically reducing the potential for dangerous instrument breakage. These instruments are purchased exclusively in sterilized and sealed packages and are never used more than once. They are opened right before I use them just for that patient. This insures maximum efficiency and assurance that you will get the most leading edge treatment.

Once we are done cleaning the inside of the tooth, we need to disinfect the tooth and create an environment which can be closed off. The main aim of root canal therapy is the removal of microbial contaminants in conjunction with the total closure of the tooth. This way bacteria from the mouth will not be able to get back in and recontaminate the tooth. Root canal sealers along with the latest filling materials play a major role in achieving the three dimensional sealing of the tooth. New sealers help us fill the canals and accomplish this goal. These sealers are binding agents which are used to adapt the filling material to the interior of the tooth and to fill up the voids and gaps inside the tooth. Root canal sealers, although used only as an accessory material in the sealing of root canals, have been shown to influence the outcome of root canal treatment. A perfect combination of sealing ability and compatibility with the tooth is what an ideal root canal sealer should possess. We now offer our patients sealers which are state of the art and create a dense fill with no voids. This helps to ease pain from a tooth and allow the patient to get back to the business of chewing in no time at all.

The next time that you have a painful tooth, give me a call and we can discuss options and treatments for you. There are so many ways to save a tooth from extraction. This allows you to get back to your life and do all those activities that you enjoy without being troubled with mouth pain. Call me at 440.951.7856. I’m always happy to talk to you.

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Can Fees for Dental Implants Vary A Lot?

Like any other product or service, the cost of replacing a tooth or teeth can differ from patient to patient and from doctor to doctor. Let me share with you some of the behind the scenes facts that can affect the final fee that you may be responsible for. First and foremost is how many doctors and people are involved in the total procedure. If you follow, the general dentist and specialist model, you will have at least two offices involved. Each doctor charges their top fee for this high-end and modern procedure. Since the specialist really starts off the billing process, the funds that you have from insurance, if you have insurance, will get used up before you can blink an eye. Specialists charge more money and your annual insurance maximum gets used up more quickly. Remember, virtually all insurance companies have a maximum amount that you can use.

If we go away from the two practitioner model and have one doctor do everything, a whole new set of cost increases rear their ugly head. Most doctors who are new to implant dentistry rely heavily on the support and hand holding from the manufacturer. This means that the company has a dedicated salesperson for that doctor. That salesperson, who is in the field, and the support staff that is in the home office all drive up the cost of the implant as there are now salaries to be met.

Those of us who have been doing dental implant for decades, do not need all the hand holding. This allows practitioners like myself to save money and pass this cost on to the patient. This can be a huge difference for all those involved. The procedures are simpler and the cost comes down.

Another way to save money is to find a dentist who does a lot of cases and has a rapport with the dental laboratory. Typically the lab is the one who makes the final crown on the dental implant. There are many choices in crowns today and the fees for these can also vary significantly. The dentist, who works with a large laboratory, has a better choice of materials and can offer the best crown at the best cost to the patient.

As we begin July, let’s also remember that it is the beginning of the second half of the year. If we want teeth or a tooth for the holidays, many times the treatment will take months to accomplish. Now is the time to plan for these procedures so that we can finish them in time for that special event or get together in the fall or early winter. To help you along, I have two cost saving opportunities for you. Once again, I will be teaching a course to doctors and I am looking for a candidate to be the patient for the course. I will be placing the implant and finishing the case with a crown. All this is at no charge to the patient. Since it is a teaching course, the patient will have to meet certain criteria. If you are interested, please call and make an appointment. In addition to this, during the month of July, I am offering a 20% discount on all implant cases that I examine and develop a plan for this month. Now is a great time to get the dentistry that you need at a fee that you can afford. Please call me at 440.951.7856 and make an appointment for a complimentary consultation. Just mention this article when you call. If you are shy, just call and ask to speak to me on the phone. I will be more than happy to speak with each and every one of you.

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How Do I Know If I Will Need Implants for My Dentures?

That’s a great question and I am glad that you asked it. Before we answer that, let’s talk about life before implants. Our natural teeth are anchored into bone in our mouths. This bone holds the teeth tightly and is surrounded by pink gum to aid in protecting the bone from harmful bacteria which could cause infection and destroy the bone. The same way that our skin protects whats in side the body from the environment, our gums protect our bone in the mouth which support the teeth from damage from external sources.

Once we lose our teeth, we need something to replace them to allow us to eat the proper foods and reduce the load on our digestive system. If we can’t chew, then the stomach and the rest of the digestive system would have to break down foods in their entirety to obtain the nutrients that they contain. This puts a lot of strain on these organs and is not the way they are intended to work.

I used the phrase “lose our teeth”. There are two common reasons for tooth loss. The first is cavities and the second is gum disease and the associated bone loss.

If teeth are lost due to decay, then the bone is essentially intact. If we have gum disease leading to tooth loss, then the supporting bone around the teeth is gone. It has been destroyed, Now let’s fast forward to a denture. A denture is not glued or attached to your gum and underlying bone. It rest on the bone and gums. The more bone that is present, potentially gives more stability to the dentures. If they are more stable, then they become more efficient during chewing. This does not mean that they may not move, but it means that there is less movement. This allows you to control them better with your cheeks and tongue. All this translates into the ability to chew better.

If teeth are lost due to gum disease, the underlying bone is minimal or almost non-existent. This greatly reduces the stability of the denture and you need much more effort to chew your foods. This is because you are also trying to stabilize a loose denture. Even if you loose teeth due to tooth decay, the bone eventually shrinks and you may transition from dentures that once fit well to a sloppy fit.

This is where implants fit in. Dental implants allow your denture to be held more securely to the jaw and reduces or eliminates movement. You can now concentrate on chewing rather than expending your energy trying to balance the denture. So the short answer to the question is that everyone can benefit from a more stable denture. Implants, depending on the amount and placement, will give you various degrees of stability. This will range from minimal to totally stable depending upon the techniques used and number of implant. However, for some people, living with a denture is not a hardship and implants are just the icing on the cake.

When I see a patient for a consultation regarding dentures. I tell them oftentimes that first we will make their denture and assess the need for implants. The implants can always be added to help anchor a new or existing denture. So my patients do not have to worry about making a decision from the beginning regarding implants unless they desire to do that. Whether we make a digital denture, conventional or even our newest custom denture which is more affordable to some, implants can be added after the fact.

If you are struggling with your denture or are contemplating moving to a set of dentures, let me advise you on what is best for your situation. You will always see me and not worry about seeing a different dentist at different appointments. I will follow you through from start to finish and be there after all is completed to take care of you. As my patient told me yesterday, “: I am impressed with you level of dedication to me” I just smiled and said “thank you” because I am committed to you. Call me at 440.951.7856 and make an appointment for a free consultation.

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I Haven’t Been To The Dentist in Years. I’m Afraid That I Will Be Reprimanded!

I certainly hope not! Yet, I hear this statement all the time as patients are worried about being yelled at or having to apologize for not making an appointment before they ran into a problem. I have never and will never yell at a patient. In fact, I am ecstatic that they are finally coming in and taking care of their oral health.

It was just today, that I saw a patient for the first time in 4 years. He came back to me because, he was treated very well, the last time that I saw him. He was pleased with the quality of care and he was looking for more of that type of dentistry. However, I just wasn’t a priority in his life. He had other things to tend to as we all do. Now he presented with broken, loose and worn teeth. He was in pain and needed some emergency care. He also needed a general plan to move him away from emergency dentistry into a plan and new life style which centered around the health of his mouth.

I made room in my schedule to treat his immediate problem and map out a plan for him. We figured out his dental insurance and helped him obtain funding for his portion after the dental insurance would be over. This is something that we do on a routine basis for our patients. We understand dental insurance plans in depth and know what to ask the insurance company to make sure that the patient receives what they are entitled do under their plan. He was grateful for this. We also found an affordable monthly budget plan to fit his desires and need.

And it is not just I, who am on board regarding a postive attitude toward the patient. My excellent hygienist, volunteered to come in on her day off to help remove the bacteria and deposits from the gums. This, as we all know, is one of the keys to reducing disease in the mouth. A big shout out goes to her for making herself available to help this patient get past his concerns and even embarrassment for staying away so long.

There is no point or positive benefit in berating a patient. The key to turning one’s mouth to a state of health is to forget the past. Today is the first day for this journey. It may consist of better diet or less junk food. It might be something as simple as rinsing your mouth after eating. These are all small steps that move us on this route to a state of health. We will help you find the right devices to clean, brush and floss your teeth. Sometimes pairing the right device with the right patient is all that is needed to turning around a mouth that is a disaster to one that is pristinely clean.

This Thursday, June 23rd, at 6PM, I am hosting another patient seminar at my office. We will talk about what constitutes health and what we need to do to attain this state. We will talk about how we can fix problems and the options that are available to you. There is no charge for the seminar and I will have visual aids to help illustrate my points. You can ask me any question that you like and I will to my best to answer them for you. And of course, I will never yell at you for staying away from a dental office. If you have any questions or would like to reserve a spot as space is limited, please call us at 440.951.7856 and educate yourself about dental care and oral health. If you are shy on the phone , then go to my website, www.jeffreygrossdds.com and register online. You have nothing to lose and everything to gain. I’m looking forward to seeing you and meeting you this Thursday.

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Some People Look Toothy and Others Don’t. Which is Correct?

This is another common question that I hear in my office. Before we answer this question let’s describe the situation that is being explored. All of our teeth are embedded in the gums and most teeth are usually in a general range of width and length. Depending on the amount of gum tissue present will determine how “long” or “short” the tooth is. This can be seen by pulling the lip up to expose the teeth and their appearance. That portion that is covered can be anywhere from two thirds to three quarters of the tooth in a normal healthy individual.

In addition to the gums covering a portion of the tooth, your lips hide your visible tooth also. By visible tooth, I mean the part of the tooth that sticks above the gum. Depending on the length of the tooth and lip will determine how much tooth shows when others see you. This amount also varies when you are at rest with your lips at rest or whether you just heard some good news and are smiling ear to ear. Your lips and muscles of the face will go up and down showing more or less teeth.

In the younger years after the teeth have first come into the mouth. The teeth are at their full length and the facial muscles and lips are very tight. When we talk we see the lowest edges of our upper teeth and when we laugh we see the entire tooth. We may possible see some pink gum as we laugh also.

As the years go on and we use our teeth, they wear down making them shorter. This means that there is less to be seen under the upper lip. So now when we talk we see a fraction of the tooth that we once saw a few decades ealier. Those people who’s upper front teeth do not overlap the lower teeth, but rather meet the lower front teeth directly get more wear and even a shorter tooth. Besides the teeth wearing down, gravity and lack of exercise of the facial muscles cause the mouth to droop and therefore, the upper lip covers more tooth to the point that it is not visible at all.

So you see that showing tooth and gums is a sign of youth, while showing no teeth at all is a sign of advancing in life. When people don’t show teeth for years, they get used to the look and don’t want to show any more teeth. They think that showing teeth looks artificial. Nothing could further from the truth. Showing teeth and gums is a sign of youth. We wear nice clothing, color our hair, wear the latest fashions to look younger, tooth length should not be any different. If you can have this youthful smile then why not?

In the area of dentures, we see this a lot. A patient comes in showing no teeth and that’s what they want to see. With a denture, I can position the front teeth to show as little or as much as I want. I can even move them while you are at your appointment before the denture is finished so you get to see a very individual and customized smile. Beauty is in the eye of the beholder. I can only advise on what looks natural. You have the ultimate control over how much tooth shows or not. Old crowns or dentures wear can wear down also giving you a shorter or “lack of tooth” look. When new dentures or crowns are made, I have many ways to control how much or little of your teeth show. If you would like to discuss or explore your teeth showing possibilities, please feel free to call me at 440.951.7856 I enjoy talking to each and every one of you.

Want more information? Attend a FREE seminar on Thursday, June 23, 2016, 6:00 PM at 34586 Lakeshore Blvd.
We’ll talk about dental implants, tooth replacement and more!
Call 440.951.7856 to reserve your spot as seating is limited

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