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Jason Aanenson, DDS | Blog in Freeman

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Dr. Jason Aanenson
Dr. Trevor Kuiper

Freeman Dental Center

1008 Industrial Rd,
Freeman, SD 57029
(605) 925-4999
 

Parkston Dental Center

116 North 1st Street,
Parkston, SD 57366
(605) 928-3363
 

Viborg Dental Center

103 W Pioneer Avenue,
Viborg, SD 57070
(605) 326-5612

Blog

 

Bad Breath

It would not be a stretch to say that every single person has experienced bad breath at some point in his or her life.  We are all susceptible to “morning breath” or “garlic breath”, which are neither surprising nor difficult to fix.  Many people suffer from persistent bad breath which seems difficult to cure.  As with most things, finding the cause of the problem will lead us much closer to a solution.  Let’s take a look at the most common causes of bad breath.

What causes bad breath?

When you get to the bottom of bad breath, most of it is caused by bacteria.  Over ninety-percent of bad breath originates in the mouth.  The rest stems from problems in the nose, throat, lungs, or GI tract.  These problems include postnasal drip, sinus infections, tonsil stones, bronchitis and other lung infections, H. pylori infections and GERD (gastroesophageal reflux disease).  These possible causes of halitosis are greatly outnumbered by problems in the oral cavity.  While you should be aware of them and inform your doctor or dentist of the presence of any of these issues, it is important to have your dentist rule out a more likely intraoral issue first.  

 

What happens in the mouth to cause bad breath?

 

  • Cavities – Cavities, especially big ones, harbor lots of bacteria.  When a cavity has gotten big enough to create a hole in the tooth, it collects food particles and plaque in addition to the bacteria that caused the cavity.  Think of it like a tiny kitchen trashcan.  It stinks!  Having the cavity fixed is like emptying the trashcan.
  • Gum (periodontal) disease – Periodontal disease affects the gum and bone supporting the teeth.  In most cases, a pocket is formed where the gum and bone detach from the tooth surface.  These pockets are also like the above-mentioned tiny trashcans, collecting plaque, bacteria, food particles, etc . . . Having the proper periodontal treatment to reduce the depth of these pockets will minimize the size of the trashcan. 
  • Food impaction – Perfectly shaped and aligned teeth and gums do not provide spaces for food to get caught.  But let’s face it: no one is perfect.  Food impaction is the term dentists use for an area in your mouth that is consistently embedded with food debris.  If not properly cleaned out, it leads to more than just bad breath.  It can cause cavities and gum disease in that area.  If you do not feel that you are able to adequately and consistently clean an area of food impaction, please ask Dr. Aanenson about your options to change the shape of the teeth so that food does not continue to be caught.
  • Tongue – Tongues are bumpy.  The bumps are called papillae.  The papillae vary in size and purpose.  There are some located near the back of the tongue that can be large and create lots of nooks and crannies for bacteria to collect around.  This is where cleaning your tongue can reduce bad breath.  For some people, simply swishing a mouthrinse can effectively clean your tongue.  For others, it may be necessary to brush the surface of your tongue.  And for still others, a tongue scraper is useful in cleaning any bacterial havens on your tongue. 
  • Surgical wounds – When you have surgery in your mouth, there is usually something that can allow for the accumulation of bacteria like an extraction socket or stitches.  Because surgical sites usually hurt, it is difficult to keep them clean.  Your dentist will give you instructions on keeping the site clean, as well as some adjuncts for your post-surgical oral hygiene like a very soft bristled toothbrush or an antibiotic solution to apply to the site with a Q-tip.  Thankfully, this is a temporary problem.  Follow the post-op instructions closely so healing occurs as quickly as possible.
  • Dry mouth – Saliva plays a big role in fighting bacteria; therefore, it plays a big role in fighting bad breath.  If you do not have enough saliva, your dry mouth puts you at risk for bad breath and various oral diseases.  It can cause bad breath by allowing an accumulation of bacteria.  You can read more about dry mouth here. 

 

What can I do about bad breath?

 

  • See your dentist – It is important to rule out cavities & gum disease as the cause of bad breath because they can progress and lead to many long-term health concerns.  If you do have any oral disease, proceed with treatment as soon as possible. 
  • Practice great oral hygiene – Keeping your teeth clean means reducing the amount of bacteria in your mouth, and therefore reducing bad breath.  Add an alcohol-free mouthwash to your daily regimen.  This helps remove bacteria from all areas of your mouth.  It is important to use an alcohol-free mouthwash because alcohol has a drying effect.  Dry=bad.  Also add brushing your tongue or using a tongue scraper to your oral hygiene routine. 
  • Take steps to improve dry mouth – Discuss the various options with your dentist.  Treatment may include using a salivary supplement, an antioxidant mouth gel, or a prescription mouthwash.
  • Chew sugar-free gum, preferably containing xylitol – Chewing gum stimulates saliva, which fights bacteria.  The flavor of the gum may provide a brief, minty odor to your breath, and the improved salivary flow will keep the bad breath at bay. 
  • Avoid substances that have a drying effect on your mouth – Cigarettes and alcohol both reduce salivary flow and predispose you to dry mouth. 

 

Think you may have bad breath?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson.

 

 

Why do they check my blood pressure at the dentist?

Wednesday, April 11, 2018

If you have visited our practice, you are not surprised that your blood pressure may be checked by our dental assistants, dental hygienists or dentists.  If the measurement is nor “normal”, we will point this out to you.  Sometimes we are questioned about this, and we always want to be able to adequately answer our patients’ questions.  There are three main reasons we regularly take your blood pressure, which are listed and elaborated on below. 

  1. It protects you! The medications and procedures involved in dental visits can cause in increase in blood pressure and heart rate.  We know that going to the dentist can be very stressful for some people.  Fear or anxiety may cause a patient’s blood pressure to be elevated before he or she even walks in our doors.  The sensations of something as straightforward as a dental cleaning can increase the stress on an already-anxious patient.  The ingredients in the local anesthetic used to numb your teeth and gums for dental work can cause the heart rate and blood pressure to go up even more.  All of these factors could be the perfect storm for a medical emergency.  We always keep our patients’ safety as our highest priority.  For this reason, we commit to be diligent in measuring and recording your blood pressure before, and sometimes even throughout, a dental procedure.
  2. We genuinely care about you!  Our second reason implies that we don’t want you having a heart attack or stroke on our watch, and we don’t!  We don’t want you having a heart attack or stroke anywhere.  Emergencies are not always preventable, so we want to take advantage of every preventive opportunity we are given.  If your blood pressure is recorded as consistently high when you visit our office, we will recommend that you see your physician.  The American Heart Association outlines exactly which blood pressure measurements are considered dangerous.  Don’t wait until you have a crisis to do something about your high blood pressure!

 

White Coat Syndrome

Many patients exhibit white coat syndrome.  This is a phenomenon in which patients exhibit a blood pressure level above the normal range, in a clinical setting, and normal blood pressure levels at home or in other settings.  The key to white coat syndrome is that the blood pressure is only high at the doctor or dentist and measures normal in another setting.  This requires the measurement of your blood pressure in multiple different settings.  Unfortunately, we can’t just take your word for it because we are held to account by the measurements recorded in our dental records. 

If you find yourself in this situation, please discuss your concerns with us and be open to working with your physician.  We have had great success in reducing white coat syndrome with a wide variety of therapies and medications, including meditation, breathing techniques, laughing gas, or anti-anxiety medications prescribed by your physician. 

Our goal is always to take the best possible care of you in our offices and alert you to anything that could be a concern when you are not in our office. 

Have you put off dental work because of your high blood pressure?

Due to the links between heart disease and problems with your teeth and gums, it is not safe for you to put off needed dental work.  The dental problems actually make your risk for heart problems go up! 

Schedule a consultation with our dentists to discuss what dental treatment you need and how we can help you manage your blood pressure.  It may require a consultation with your medical doctor in order to get started. 

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to schedule your appointment today!  Our kind and caring staff will put you at ease and help you get started on the path back to good health.

 

 

Back to Basics:

Wednesday, April 4, 2018

As dentists, our job is to properly communicate various dental issues and recommendations with our patients.  To improve our communication, it helps you to know some of the terms we use in describing some of the anatomy of the oral cavity, the problems that can develop, and the steps you need to take to fix them.

The Anatomy of a Tooth:

 

  • Enamel – Enamel is the hardest structure in the human body, and it covers the external surface of each tooth.
  • Dentin – Dentin is the structure that lies between the enamel and the pulp.  It forms the core substance of the tooth.  It is softer than enamel and darker yellow in color.  Dentin is responsible for giving teeth their color, and every person’s is different.
  • Pulp – Pulp is the collection of blood vessels and nerves inside the hollow chamber of a tooth.
  • Crown – The crown is the portion of the tooth that protrudes out of the gums.  You could also describe the crown by stating that it is the part of the tooth that you can see.  Enamel is only found on the crown of a tooth.
  • RootThe root of the tooth is the portion anchored into the jawbone.  Each tooth has a different shaped root.  Molars have multiple roots, and the shape of the root is important in the tooth’s stability in the bone.

 

Other Dental Terms Defined:

What is a cavity?  A cavity, or tooth decay, is the destruction of enamel and dentin by bacteria in your mouth.  The bacteria in your mouth eat sugar and produce acid as a by-product.  When the acid is allowed to stay in contact with the tooth surface for an extended period of time, it begins to eat its way through the enamel.  Once it passes through the enamel layer, it begins to spread through the dentin.  If the decay isn’t stopped, it will extend all the way to the pulp.  Once it reaches the pulp, the nerves and blood vessels become infected.

What is a filling?  When a cavity is removed from a tooth, the dentist ensures that he has removed all unhealthy enamel and dentist, leaving only solid, healthy enamel and dentin.  This cavity removal process creates a hole in the tooth.  The dentist repairs this hole by filling it with a dental restorative material to restore the normal shape, size and contour of a tooth.  This allows you to use the tooth for normal function again.

What is a composite?  Composite is a type of dental filling material.  It is a resin polymer that forms a bond to the tooth structure.  Composite requires a blue light to “cure” it (harden it after it has been formed to the proper shape).

What is plaque?  Plaque is a soft material that accumulates on the teeth every single day.  Plaque is made up of food particles, bacteria, and minerals present in your saliva.  Plaque is easily removed with a SOFT toothbrush and floss, and it is attracted to rough surfaces.

What is tartar?  Tartar, also called calculus, is a hard material that forms on the teeth from plaque that is not adequately removed.  When plaque stays on a tooth surface for more than 24 hours, it begins to calcify or harden.  This hardened substance is impossible to remove with a toothbrush or floss.  It can only be removed by being scraped off by a dental hygienist or dentist.  Tartar that is not removed causes periodontal disease.

What is gingivitis?  Gingivitis, also called gum disease, is an inflammation of the gums, and it is almost always caused by plaque and/or tartar buildup at the gumline of the teeth.  Gingivitis is characterized by swollen, red, painful or bleeding gums. 

What is periodontal disease?  Periodontal disease, if left untreated, will cause you to lose your teeth.  When tartar accumulates on the teeth, it irritates the gum tissue and bone that help hold the tooth in place.  This irritation, over time, causes destruction of the bone, which results in a lack of stability for the tooth.  If periodontal disease is caught in its early stages, it can usually be easily treated in your dentist’s office.  More advanced stages may need to be treated by a specialist called a periodontist.  Periodontal disease can be “silent”, not causing any pain or discomfort, so it is important to see your dentist regularly. 

What is bruxism?  Bruxism is the term dentists use to describe the habit of clenching or grinding your teeth.  It can occur at night or during the daytime, and it leaves noticeable signs inside your mouth.  Your dentist can tell if you have this habit.

Are There Other Dental Terms You’d Like to Understand?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to speak with one of our dental experts.  They can answer any question you have about dental terminology and set you up for a consultation with our dentists.

 

 

Spring Cleaning

Wednesday, March 28, 2018

Spring has sprung!  This time of year is a time for new beginnings and fresh starts.  Trees are budding, and flowers are in bloom.  Most people are familiar with the concept of spring-cleaning.  We clean out our closets and our flowerbeds.  We throw out things we do not use anymore. 

Obviously, spring-cleaning carries with it the idea of cleaning up the things to keep.  It also implies cleaning out things that are past their usefulness. 

When you spring-clean, you strive for a clean slate, bringing things back to a state that is more easily maintained so that they stay cleaner for longer.

As your dentists, of course we want you to apply this concept to your mouth!

Spring Cleaning for Your Mouth

Cleaning Up the Things to Keep

We want you to keep your teeth.  Forever.  We want your teeth to outlast you!  In order to keep your teeth for the rest of your life, they must have healthy gums and supporting bone.  They also need to stay cavity free.

The key to keeping teeth free of decay with healthy gums and bones is keeping them as clean as possible.  There are two essential steps you must take to keep your mouth clean.

Professional Teeth Cleanings – To achieve a perfectly healthy mouth, it is absolutely necessary for you to have professional teeth cleanings on a consistent basis.  Our wonderful dental hygienists are masters at removing every trace of bacteria from your teeth and gums.  No matter how diligent you are, you can never clean every bit of plaque and tartar on your own at home.  Professional teeth cleanings are a must for a clean mouth.

  • Interval of Teeth Cleanings – All men are not created equally when it comes to plaque and tartar buildup.  We are all unique, with specific risks and needs.  For this reason, some people need to have professional teeth cleanings at different intervals than the average of six months.  Ask your dentist and dental hygienist which interval will give you the healthiest outcome!

Great Home Care – As amazing as our hygienists are, they cannot do all of the work for you.  Their job stops when you walk out of our doors, and the ball is then in your court.  They leave you with a clean slate and all the information you need to keep it clean.  If you have a particularly difficult area to clean on your own, ask your dental hygienist.  They each have customized ways of teaching you how to clean your teeth to the best of your ability.  Follow this regimen for great home care.

  • Brush twice daily with a fluoride toothpaste after breakfast and before bedtime.  If possible, use an electric toothbrush, which is proven to remove more plaque buildup than a manual toothbrush.
  • Floss every night before bed.  Brushing alone does not get the job done.  Flossing is the only way to remove plaque and food debris from between the teeth. 
  • Add a mouthwash to your daily routine.  There are so many different types of mouthwash available today, and they have different purposes.  Ask your hygienist which type is best for your specific needs.

 

 Cleaning Out Useless or Obsolete Things

Okay, this may seem like a strange concept when applying it to your oral health.  We have two ways that you should “clean out” things related to your mouth.

  1. Throw Out Your Toothbrush – Toothbrushes are wonderful tools that have greatly improved dental healthcare.  But they do not last forever.  If yours is frayed or splayed or otherwise “worn out”, toss it.  For electric toothbrush users, buy the replacement heads, and throw this one out.  Old toothbrushes can harbor bacteria and even grow mold.  Once the bristles are worn out, they may not even touch the tooth surface as they should. 
  2. Take a Tip from Marie Kondo – The bestselling author of “The Life-Changing Magic of Tidying Up” has a unique tactic for cleaning out your closet.  Hold up an item and think about how it makes you feel.  If it does not bring you joy, get rid of it.  If we were to apply that tactic to your mouth, what would you get rid of?  Is there an old discolored filling that you hate?  Do you have a tooth that you try to hide when you smile?  If there is something in your smile that does not bring you joy, please schedule a consultation with Dr. Aanenson to discuss how we can change that for you.

 

Maintaining a Clean Mouth

Have you noticed the phenomenon that it is much easier to keep something clean once it is clean?  The fact that the countertops are free of clutter makes you want to keep any clutter from building up. 

The same is true for your teeth.  The feeling of a perfectly clean mouth just after your professional teeth cleaning is so good that you are more motivated to follow a great home care regimen.  Don’t let that momentum fizzle out.  Commit to keeping up that great home care routine so that your “spring clean” lasts all year!

Do You Need a “Spring Cleaning”?

It is time for a fresh start!  Call our offices at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg today to schedule your professional teeth cleaning with our fabulous hygienists or a consultation with Dr. Aanenson.

 

 

Sparkling Water: A Surprising Cause of Cavities

Wednesday, March 21, 2018

Most people know that foods and drinks high in sugar can cause cavities.  It is common knowledge that sodas and candy are bad for your teeth. What many people are unaware of is that sparkling water can also damage the teeth.

Due to an increase in its popularity in recent years, we are frequently asked about sparkling water (carbonated water) and whether it can damage your teeth.  Although most sparkling water contains nothing more than carbonated water (perhaps with a few minerals) and natural flavors, most people do not expect it to be as acidic as soda, which typically contains phosphoric acid. Unfortunately, sparkling water is very acidic due to the carbonation process, which forms carbonic acid.

Yes, Sparkling Water Can Harm Your Teeth!

A group of researchers at the University of Birmingham in the United Kingdom wanted to find out if sparkling water could cause enamel erosion.

First, they measured the pH of various sparkling waters and found a pH of around three (ranging from 2.7-3.4). This pH level is just as low as most sodas!

This research group took some extracted teeth and placed them in glasses filled with different types of flavored carbonated waters. They found that the sparkling water does erode away tooth enamel.  In fact, they found that flavored sparkling water has as much or more of an erosive effect on teeth as orange juice, which is known to be very damaging to teeth.

The following is what this group of researchers concluded:

"Flavored sparkling waters should be considered as potentially erosive, and preventive advice on their consumption should recognize them as potentially acidic drinks rather than water with flavoring."

In other words, sparkling water can erode your tooth enamel and should not be considered “water” at all. Rather, it is more appropriately classified as an “acidic drink”. 

 What does this mean for your teeth?

Enamel is the hardest substance in the human body.  It is a protective coating over the core nerves and blood vessels in our teeth.  The purpose of our teeth is to chew food; the enamel serves to withstand the mechanical and chemical forces that teeth are subjected to as they do that job.  Anything that softens, erodes, or breaks enamel is bad because it weakens the tooth.  Enamel erosion makes it easier for the bacteria in our mouths to cause cavities and can cause major breakdown of your teeth, which causes the need for more dental work in your future.

A healthy mouth has a pH level slightly above neutral (7.0).  Anything below neutral is an acid.  Enamel begins to soften or demineralize at a pH of 5.5 or below.  Many of the things we eat and drink are lower than 5.5 pH.  In a normal, healthy mouth, saliva can act as a buffer and bring the pH back up to neutral once the acid is gone (i.e. once you have stopped eating or drinking).

What should you do?

 

  • Be aware of the sparkling water that you consume. Some sparkling waters are flavored with citrus flavorings such as lemon, lime, orange, etc…, which add citric acid on top of the carbonic acid. 
  • Pay attention to the amount of sparkling water that you consume.  You should never be drinking more sparkling water than regular water.
  • Do not slowly sip on acidic drinks throughout the day. This makes it more difficult for your saliva to keep your mouth at a neutral pH.  Drink it quickly.
  • After drinking a sparkling water, rinse your mouth with water to help quickly return it to a neutral pH.
  • Chew sugar-free gum after drinking something acidic.  This helps to stimulate good saliva flow and return the pH to neutral.

 


Special Considerations:

If you have a high risk for cavities, you should stay away from all acidic drinks.  If you do not know your cavity risk, ask Dr. Aanenson at your next dental visit.

If you have a dry mouth, you do not have the proper amount of saliva to counteract the acid in these drinks, so you should stay away from all acidic drinks.

Would you like more information about how acidic drinks like sparkling water can affect your teeth? 

Call our office today at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to schedule a consultation with Dr. Aanenson.  He will assess your cavity risk and describe how sparkling water could be specifically harming your teeth.

 

 

 

Dental Trauma: What to Do When Your Child Suffers an Injury to the Teeth

Wednesday, March 14, 2018

Spring is almost here, and children’s sports are going to be in full swing!  This means an increased risk for injuries to your child’s teeth.

As children grow and learn new things, the risk of injury is relatively high.  Toddlers fall down when they are learning to walk.  Children have accidents when learning to ride a bicycle.  Adolescents suffer trauma when learning to play sports.

Accidents and injuries happen.  In children, often these accidents involve injuries to the mouth and teeth.  This blog highlights what you need to know about trauma to the teeth.

Different Types of Trauma to the Teeth

Baby Teeth vs. Permanent Teeth

All of these types of trauma can happen to both baby teeth and permanent teeth.  The consequences of trauma to baby teeth are usually less severe than those for permanent teeth, simply because baby teeth fall out. 

The only serious consequence of trauma to a baby tooth occurs when the trauma affects the underlying permanent tooth as it is developing.  The crown (or visible part) of the permanent tooth forms underneath the roots of the baby tooth.  If an injury occurs which forces the baby tooth or its roots into the developing permanent tooth during this formation stage, the permanent tooth can be deformed.

The majority of injuries to teeth occur on the front of the face and affect front teeth.  It is possible for a back tooth to be injured if a child is hit from the side, for instance with a baseball.  The recommendations below apply to both front teeth and back teeth.

Injuries that Move a Tooth

When force from an injury moves a tooth, it needs to be addressed quickly. 

What You Will See:

The tooth looks whole, but it is in a different position.  It could be pushed up into the gums, hanging down out of the gums, or protruding at an unusual angle.  It is very common to have bleeding in the gums around a tooth that has been moved.

Baby Teeth vs. Permanent Teeth

In general, the treatment for this type of injury is the same for baby teeth and permanent teeth.  In severe cases, the baby tooth may be extracted.

What You Should Do:

Call your dentist immediately and start heading toward the office.  Attempt to move the tooth back to its normal position using light finger pressure only.  Whether you are able to reposition it or not, go to the dentist for an x-ray of the tooth to evaluate the health of the root, and the bone around the tooth.

Follow-Up Care:

Your child will need a soft diet for a period of a few days up to two weeks.  The goal is no additional pressure on the injured tooth as it is healing.  You may need to give your child over-the-counter pain reliever such as Children’s Advil or Children’s Motrin as needed for pain.

Follow-up with your dentist in 3 months.  He will x-ray the tooth to confirm healing and the health of the tooth and its surrounding structures.

Possible Long-Term Consequences:

When a tooth moves, it is possible that the nerve supply to the tooth has been broken where it enters at the tip of the root.  In many cases, the nerve supply can reattach, and the tooth heals.  In other cases, the nerve does not reattach, and the tissue inside the tooth dies.  A dead nerve must be removed, and the tooth needs a root canal.

The injury to the surrounding structures may also damage the connection between the tooth and the jaw bone.  A condition called ankylosis often develops, in which the tooth becomes fused to the bone and is unable to move.  This is a major concern in orthodontic treatment, when you desire to move that tooth.

Injuries that Chip or Break a Tooth

If an injury to a tooth causes a portion of the tooth to chip or break off, the consequences are usually a little milder than a tooth that is moved or knocked out.  In minor cases, the small chip can be filled in to return the tooth to its natural shape.  In severe cases, the chip extends into the nerve of the tooth, and a root canal is needed.

What You Will See:

The tooth looks broken or jagged on the edge.  Look specifically for any pink or red spots in the center of the tooth.  This is the nerve inside the tooth, and large breaks may extend this far. 

Baby Teeth vs. Permanent Teeth

In general, the treatment for this type of injury is the same for baby teeth and permanent teeth.  Minor cases will be restored with filling material. In severe cases, a permanent tooth will need a root canal, and the baby tooth may be extracted.

What You Should Do:

Call your dentist immediately and start heading toward the office.  Try to locate any fragments of the tooth, and bring them with you.  Whether you are able to find it or not, go to the dentist for an x-ray of the tooth to evaluate the health of the root, and the bone around the tooth.  The dentist will evaluate the depth of the chip and determine whether or not the nerve is affected. 

Follow-Up Care:

If you have the tooth fragment, your dentist can reattach it to the tooth.  If not, he can rebuild the tooth back to its normal shape and size. 

Your child will need a soft diet for a period of a few days.  You may need to give your child over-the-counter pain reliever such as Children’s Advil or Children’s Motrin as needed for pain.

Follow-up with your dentist in 3 months.  He will x-ray the tooth to confirm healing and the health of the tooth and its surrounding structures.

Possible Long-Term Consequences:

The force to the tooth, which chipped it, could also have disrupted the nerve supply, as noted above.  Your dentist will monitor the tooth closely for any signs of a dead nerve.  If a root canal become necessary, your dentist will guide you in the steps involved in treatment.  It is important to know that the nerve inside a tooth could die at any point in the future, even decades later.

The tooth could also become ankylosed

The dental treatment, which restores the broken tooth, may need replacement at any point in the future.  Be careful not to use that tooth for anything besides chewing and speaking (i.e. holding hair pins or cutting fishing line).

Injuries that Knock Out a Tooth

A tooth that is completely knocked out needs immediate action!  The longer you wait, the less chance the tooth has of surviving.

What You Will See:

The tooth is completely gone from the mouth.  Evaluation of the tooth should show the crown (visible part) of the tooth, as well as the root.

Baby Teeth vs. Permanent Teeth

There is no treatment for knocked out baby teeth.  The child will have a space in that tooth’s site until the permanent tooth comes in.

For a permanent tooth, we make every attempt to save and reattach the natural tooth.

What You Should Do:

Call your dentist immediately and start heading toward the office.  Hold the tooth by the crown ONLY.  Do not touch the root.  If you can, put the tooth back into the socket after very gently rinsing off any dirt or debris.  If you are unable to put the tooth back into the child’s mouth, place it in a cup with milk or saliva.  That’s right: fill up a cup with enough spit to cover the tooth.  Saliva is the best thing to keep the cells and fibers on the knocked-out tooth alive until it can be reimplanted into the mouth.

Whether you are able to reinsert it or not, go immediately to the dentist.  The dentist will clean and reinsert the tooth, using anesthetic if the child is in pain.  The sooner the tooth is reimplanted, the better the chances of its full healing.

Follow-Up Care:

Follow the recommendations for a soft diet and OTC pain relievers noted above.  The dentist will follow-up with you more frequently to confirm healing and reattachment of the tooth.

Possible Long-Term Consequences:

The consequences noted above, a dead nerve and ankylosis, are both highly likely when a tooth is completely knocked out.  Another possible consequence is failure of the tooth to reattach.  In this case, it is necessary to extract the tooth and replace it with a dental implant. 

Adhering to your dentist’s prescribed follow-up schedule will keep you informed of any of these consequences as they occur.

Be Prepared for Injuries to Your Child’s Teeth

As you can see from the instructions listed above, getting in to see your dentist as soon as possible is very important!  Save our number in your phone, and call us at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg as soon as an injury happens.  Dr. Aanenson will treat your child’s emergency and give you all the information you need for the right follow-up care. 

 

 

 

Your Child’s First Dental Visit

Wednesday, March 7, 2018

At our Dental Centers in Freeman, Parkston and Viborg, our goal is for every dental visit to be a good one.  We understand that setting the right expectations can help us meet that goal.

When it comes to kids, not knowing what to expect can generate fear, anxiety and/or misbehavior.  Here is what to expect from your child’s first dental visit.

When to Make the Appointment

The American Academy of Pediatric Dentistry recommends that children have a dental evaluation by their first birthday or within 6 months of getting their first tooth, whichever comes first.  The purpose of a dental visit this early in life is not to perform dental treatment.  Education is the main purpose. 

If your child is already past this recommended age, do not worry!  Simply make an appointment as soon as possible.  The visit will vary a little based on the child’s age.  The purpose remains the same.

Educating the Child

If your child is an infant or toddler, the education comes in the form of the experience.  The child learns from the senses of sight, sound, taste, smell and touch.  He will see the smiling face of the dentist and his staff and learn what the dental tools look like.  He will hear the normal sounds of a dental office.  He will taste and smell the toothpaste or dental cleaning paste used by the dental hygienist.  And he will feel the gentle touch of the dentist evaluating his mouth.

It is important for parents to know that it is normal and acceptable for a small child to cry.  The dentist or hygienist may use that as an opportunity to look inside the child’s mouth and see as many teeth as possible. 

Educating the Parent

Even more important than the child’s education is the parents’.  The cause of most preventable problems that arise with children’s teeth is a simple lack of information and education.

A Child’s Oral Hygiene

At this dental visit, every parent receives instruction on proper oral hygiene of the child’s teeth and tips on various ways to accomplish this.  Keep in mind that not every technique or trick works on every child.  You may have to try several different approaches before you find the one that works best for you and your child. 

An example of a unique approach to flossing a toddler’s teeth is this:  Sit on the floor cross-legged.  Have your child lay down with his head in your lap and look straight up at you.  When the child opens his mouth, you will be able to easily see and access the teeth for flossing. 

This technique also works well with brushing.  If you use this technique for brushing, use only a pea-sized dot of toothpaste and no water.

Oral hygiene for baby teeth is just as important as it is for permanent teeth.  Do not make it an optional part of the bedtime routine.  This link has some great songs to sing while brushing and flossing your child’s teeth.  We know it can be a chore; do your best to make it a fun one.

A Child’s Nutrition

At the first dental visit, parents are taught how to help prevent cavities with good nutritional choices.  Your dentist will ask questions about current nutritional habits and eating patterns.  The most common error parents make is sending their child to bed with a sippy cup full of juice or milk.  The only thing a child should have access to overnight is water.

A Child’s Habits

Your dentist will assess risk for damage to the teeth and developing jaws by any habits like thumb-sucking or pacifier use.  For more information on these habits, please read our previous blog.

A Child’s Growth and Development

At this visit, the dentist evaluates the teeth and jaws for proper growth and development.  There is a pretty wide range of “normal” when it comes to teeth coming into the mouth.  The dentist’s objective is to detect any abnormalities in a child’s development as early as possible so that you can plan for the future.

For example, your dentist would inform you if there appears to be a deficiency in the growth of the jaws that would require early orthodontic treatment.  We want you to be as prepared as possible for any future dental work.

 Dental X-rays

Dental x-rays are only taken on children under the age of 5 if there is evidence of a problem.  An x-ray is necessary if a large cavity is present with the risk of spreading infection into the jawbone.  Any injury to the teeth also requires an x-ray.

Around age 5-6 years, we take dental x-rays to evaluate the proper development of permanent teeth underneath the baby tooth roots.

Fluoride

Professional fluoride treatments are proven to reduce a child’s risk for developing cavities.  We recommend fluoride as a preventive treatment for most children because we strongly believe in prevention.

If you have questions about professional fluoride treatments, please ask Dr. Aanenson or your dental hygienist at your next visit.  We are more than happy to discuss the benefits of fluoride and the reasons we strongly recommend it for children.

Is it Time for Your Child’s First Dental Visit?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a happy visit for your child with Dr. Aanenson and our fabulous dental hygienists.  They will get you and your child started with a great dental experience.

 

 

Are Baby Teeth Really That Important?

Yes!

We hear this question a lot.  Some parents tend to be less concerned about a child’s baby teeth because they know these teeth will eventually fall out.  This blog will explore all of the reasons baby teeth DO matter and need to be healthy for the years they are in your child’s mouth.

What are Baby Teeth?

Also called primary teeth, baby teeth are the first set of teeth a child gets in his or her mouth.  Other names for baby teeth include deciduous teeth and milk teeth.  There are 20 baby teeth in all, and they enter the mouth from age 6 months through 2 years. 

Baby teeth are fully developed teeth, with the same physical makeup as permanent teeth.  They have nerves and blood vessels on the inside, and they are covered in enamel.

Baby teeth can feel pain, they can get cavities, and they show damage from teeth grinding.

Why Do Humans Have Baby Teeth?

It is all about growth.  A baby’s jaws are too small to hold the full set of permanent teeth.  This initial set of teeth allows a baby to begin chewing and speaking as the jaw continues to grow.

Without baby teeth, a child would not be able to obtain the nutrition necessary for his or her overall growth.  Baby teeth also help in guiding the growth of the jaws.

What are the Purposes of Baby Teeth?

Baby teeth are important for all of the following reasons. Even just one of these functions is reason enough to take great care of your child’s baby teeth. 

 

  • Chewing – A child can only live on milk, formula, and baby food for so long.  In order to receive the proper nutrition, he or she has to begin eating solid foods.  This is only possible with healthy teeth to chew those foods.
  • Speaking – Many of the letter sounds required for speaking involve interactions between the tongue, lips and teeth.  Without teeth, a child cannot learn to make these sounds.  Often, the speech habits formed in early childhood persist for many years and require speech therapy to correct.
  • Jaw Growth – A proper bite relationship between the upper and lower teeth is vital to normal, healthy growth of the upper and lower jaws.  When teeth are lost and shift into inappropriate positions, it can negatively influence how the jaws grow.
  • Formation of Permanent Teeth – Permanent form from the cells in baby teeth.  If a baby tooth is missing, the permanent tooth will not develop.  If a baby tooth is infected or injured, the developing permanent tooth is often damaged.  This damage may result in an abnormal shape or weakened enamel on the growing permanent tooth, which would cause an unsightly appearance and a higher risk for cavities.
  • Holding Space for Permanent Teeth – Healthy baby teeth maintain the health of the jawbone and keep space available for permanent teeth to come in.  If a baby tooth is lost from infection or injury, the teeth around it begin to shift into that space.  This results in a lack of space for the underlying permanent tooth to come into its correct position in the jaw.  It leads to crooked, crowded teeth, which will require years of braces to fix.

 

How are Baby Teeth Different from Permanent Teeth?

Baby teeth are not meant to last forever.  Their purposes are temporary, lasting only until the permanent teeth replace them in the arch.  Because they are only temporary, they are slightly different from permanent teeth.

Baby teeth have thinner enamel.  The layer of enamel covering a baby tooth is about half the thickness of that covering a permanent tooth.  Thin enamel makes it easier for bacteria to penetrate through and cause cavities to spread very quickly.

Baby teeth roots dissolve under pressure.  The baby teeth fall out at just the right time by this mechanism.  The underlying permanent tooth begins to push toward the oral cavity and put pressure on the roots of the baby tooth.  As the roots dissolve, there is nothing holding the baby tooth in the jawbone, and it becomes loose. 

Other Reasons to Keep Baby Teeth Healthy

Big cavities on baby teeth cause toothaches.  Babies and young children may experience or communicate that they are experiencing pain differently than an adult does.  You should never assume that a decayed baby tooth is not painful.

Infections on baby teeth can spread to the brain or bloodstream!  These can be extremely dangerous situations.  If there is visible swelling in or near your child’s mouth, seek emergency care immediately!

Baby teeth with dental problems require dental treatment.  By keeping them healthy, you can prevent the need for expensive and traumatic dental visits for your child.

Do You Have More Questions about Baby Teeth?

Call Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or an evaluation of your child’s baby teeth.  He will discuss with you all you should know about caring for your child and his or her teeth.

 

 

Sugar and Its Effects on Teeth

Wednesday, February 21, 2018

It is commonly known and well supported by scientific research that sugar is bad for teeth.  When dentists say “sugar”, most people think of soft drinks and candy.  There are many other sources of sugar that are damaging to teeth, which often get overlooked.  This blog will address why sugar is bad for teeth, which specific sugars are especially dangerous, and how you can fight sugar’s effects on your child’s teeth.

Why is Sugar Bad for Teeth?

Our mouths are full of bacteria.  Some bacteria are good, and some are bad.  The bad bacteria are those which feed on sugar to produce dangerous acids. (Some people have higher levels of bad bacteria, which gives them a higher risk for cavities!)

Bad Bacteria + Sugar = Acid --> Enamel Damage --> Cavities

Which Specific Sugars are Bad for Teeth?

If you have taken part in any low-carb or no-carb diets, you probably know the important differences between simple and complex carbohydrates.  Nutrition experts emphasize the way these carbs are digested and how they affect your metabolism.

The distinction between simple and complex carbohydrates is also important for your teeth. 

Simple carbohydrates are short-chain sugars that bad bacteria in the mouth quickly and easily break down.  Complex carbohydrates are long, complex chains of sugar molecules that are more difficult for bacteria to break down.

Simple carbohydrates make it easy for bacteria to cause cavities.  Complex carbs are also a sugar source for bacteria, but they take longer to digest, slowing the cavity process down enough for you to intervene and stop them. 

Examples of simple carbs include the sugar in soft drinks, candy, cookies and other baked sweets, cereal, fruit juices and milk.  Complex carbohydrates include whole grains, starchy vegetables (like potatoes), green vegetables, and beans/peas.

Complex carbs are better for your teeth than simple carbs, but there is still a risk for cavities.  Often, complex carbs are sticky and become stuck in or between the teeth.  If they are not quickly cleaned from the teeth, the bacteria have more time to break them down into simple sugars and cause cavities.

How You Can Fight Sugar’s Effects on Teeth

1. Limit intake of simple carbohydrates – Cutting simple sugars from your or your child’s diet is a sure way to lower cavity risk.  Sodas have zero nutritional value, so eliminate them completely.  Instead of sticky candies, switch to chocolate.  Chocolate’s fat content gives it a lower risk of causing cavities.

2. Stimulate saliva – Saliva is our body’s best defense against cavities!  Saliva has a slightly basic pH, which neutralizes the acid produced by bad bacteria.  There are two great ways to stimulate saliva to fight sugar:

  • Limit simple sugars to mealtime only!  When you eat a meal, saliva production increases.  A soda with lunch is less likely to cause a cavity than a soda sipped throughout the afternoon.
  • Chew sugar-free gum.  By chewing gum after eating or drinking sugar, you stimulate saliva.  Ice Cubes is our favorite cavity-fighting gum.  Give a piece to your child after any sugary snack to lower cavity risk.

 

3. Practice great oral hygiene.  Do not let any sugars stay on the teeth.  You can greatly reduce cavity risk by removing any sugary food debris from your tooth surfaces. 

  • Brush after sticky and/or sugary snacks.
  • Floss, if possible, after snacking.  If not, floss every night before bed.
  • Use a fluoride containing mouthrinse after brushing and flossing.

 

 

 

 

Teaching Your Children to Take Care of Their Teeth

Wednesday, February 14, 2018

One of the most important aspects of parenting is teaching your children how to take care of themselves. You teach them to make good choices so that they can be healthy.  In the beginning, you do a task for them until they can do it themselves.  Then you supervise their efforts until you trust that they are competent and consistent in accomplishing the task.  At that point, you can give them the independence to take care of themselves without your intervention.

As with all issues in child development, every child grows and matures at his or her own unique pace.  Rather than looking for your child to perform certain tasks at a certain age, use milestones to tell you when it is time to move from demonstration to supervision and from supervision to delegation of independence.

In dentistry, our most common example of using a milestone is this: your child should not brush his teeth alone until he can easily tie his own shoes.

Start Early

In order to set the right expectations for your child and oral hygiene, start early. 

How early?  As soon as the first tooth appears in your baby’s mouth!

Begin brushing each tooth with an infant toothbrush or a soft washcloth.  Cleaning your child’s teeth is something he or she should expect as part of your daily routine.  The earlier you start, the easier it is for the child to accept.  The earlier you begin brushing and flossing your child’s teeth, the less likely they are to fight you and resist the process.

Easy Oral Hygiene Techniques:

One of the easiest ways to brush and floss a child’s teeth is to sit cross-legged on the floor and have the child lay down with his head in your lap.  You should be able to look straight down into the child’s open mouth.  Using a very small amount of fluoride-containing toothpaste and NO water, gently brush every exposed surface of his teeth. 

An alternative technique is to have your child stand on a small stool so that their head is just above your waist.  With both of you facing the bathroom mirror, stand behind the child and have her look up and rest her head against your stomach.  Again, you should be able to look straight down into the child’s mouth and visualize all of the teeth.

Use either of these positions to floss any of your child’s teeth that touch each other.  Teeth with small gaps do not have to be flossed. 

Make It Fun

While you are brushing or flossing, it helps to count or sing a song to entertain and/or distract the child.  The American Dental Association has several fun tooth brushing songs here.

If you have multiple children, you can make the oral hygiene routine your special one-on-one time with each child. 

With multiple children, games or competitions can make it fun.  Use plaque disclosing tablets to have a contest of who does the best job brushing.

Set a Good Example

Brush and floss your own teeth in front of your children as often as possible.  Show them that it is a normal part of your bedtime routine.  Kids are much better at following examples than strictly doing as they are told. 

It is important to teach your children to have an overall attitude toward oral hygiene that is positive and healthy.  One of the best and easiest ways to train this attitude is to model it in your actions and attitudes toward your own oral hygiene.

Unfortunately, the opposite is also true.  If your children see that you do not value your own oral hygiene, they will not believe that it is important for them either.

Don’t Make It Optional

Make every effort to never miss brushing and flossing your child’s teeth.  It is not optional.  Do not ever give your child the impression that they have a choice on whether or not to brush before bedtime. 

The problems that occur from improper oral hygiene in a child can be serious. They can also be prevented with good oral hygiene and good food and drink choices.

Need Help?

Call our office at 605-925-4999 (Freeman), 605-928-3363 (Parkston), or 605-326-5612 Viborg to schedule a consultation with one of our fabulous dental hygienists.  She will show you tips and techniques on brushing and flossing your child's teeth as easily as possible.

 

 

Baby Bottle Tooth Decay

Wednesday, February 7, 2018

Also known as bottle rot or early childhood caries, baby bottle tooth decay is a condition in which very young children experience moderate to severe cavities in their baby teeth.  As the name implies, this condition is caused by an improper use of baby bottles.

How Does a Baby Get Cavities?

Cavities are caused by bacteria.  Most children acquire cavity-causing bacteria from their parents.  Bacteria are transmitted from the parents’ mouths to the child’s by sharing a spoon and kissing.

The real danger occurs when these bacteria are exposed to sugar.  Baby bottle tooth decay arises when the baby drinks a bottle of any liquid which contains sugar.  The most common culprits are fruit juices and milk.  Even milk contains sugar.

As the teeth are exposed to sugar-containing liquids, the bacteria ingest the sugar and create a by-product that is very acidic.  The acid by-product weakens and softens baby teeth enamel.  The enamel on baby teeth is much thinner than that on permanent teeth.  This allows cavities to spread much more quickly on a baby tooth than on a permanent tooth. 

There are two important factors in the cavity process: 1) the amount of sugar the teeth are exposed to, and 2) the amount of time the teeth are exposed to sugar

  1. Amount of Sugar - Fruit juice contains the highest quantity of sugar (besides sodas) and is very damaging to baby teeth.  Soft drinks and sodas should NEVER be given to a child.  Milk contains small amounts of sugar, too.  If left in contact with the teeth long enough, even plain milk will cause tooth decay.
  2. Amount of Time - Even a small amount of sugar can cause a cavity if it stays in contact with the teeth for a prolonged period of time.  Any sugar-containing drink to which the child has continuous access (such as an overnight bottle) creates a higher risk for cavities.  

 

Upper front teeth are at the highest risk for baby bottle tooth decay because they are continually bathed in the liquid as the child drinks.  Other teeth may be affected as well.  The cavities initially appear as dark spots, small holes, or chips in the teeth. 

How Do I Prevent Cavities for My Baby?

  • Limit bottle time - A bottle’s purpose is to provide nutrition for your baby.  It is not a pacifier or soothing device.  
  • It should never be used to put a baby to sleep.  If a baby falls asleep while drinking from a bottle, remove the bottle and replace it with a pacifier.
  • Limit bottle contents – Baby bottles should contain only baby formula, breast milk, or water.  A baby bottle should NEVER be filled with fruit juice, soda, sugar water, or milk.  Not only do they all contain sugar; they do not provide the baby with any proper nutrition.
  • Water only overnight – If a bottle is given to the child overnight, water is the only liquid that will not increase the risk for cavities.  Water is the only thing that contains zero sugar and zero acid.  This rule goes for sippy cups, too.  Toddlers should never go to bed with anything except water!
  • Oral hygiene – Even babies need oral hygiene.  As soon as a tooth is visible, you should clean it with an extra-soft baby toothbrush or a washcloth.  Brush your baby’s teeth twice a day with fluoride toothpaste the size of a grain of rice.  The brushing routine teaches your child good oral hygiene practices as they learn and grow.  The fluoride strengthens their baby teeth to resist cavities.

 

What if My Baby Already Has Cavities?

Baby teeth have many important functions.  If they get cavities, they need to be treated so that your child can chew and speak properly.  Cavities in baby teeth, if not treated, will progress to abscesses, which are serious dental infections that can spread.  These infections can put your baby’s life in danger!

If you see cavities in your baby’s teeth, the first step is to schedule a dental appointment.  Your dentist will evaluate the teeth and prescribe the appropriate treatment.  Most small children with extensive decay are treated by pediatric dentists with the use of sedation. 

The most important part of this dental visit is the tips and instructions you, as the parent, will receive to help prevent any future cavities from developing.

More Questions about Baby Bottle Tooth Decay?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to schedule a consultation with Dr. Aanenson and Dr. Kuiper.  They can answer all of your questions about cavities in young children and advise you on how to proceed.

 

 

Whitening Options

January 31, 2018

A 2013 survey of 5,500 unmarried adults asked them to rank the qualities by which they judge the opposite sex on first meeting someone new.  Teeth was the highest ranked characteristic by a long shot (58% of men and 71% of women ranked it the #1 feature by which they judge a member of the opposite sex for attractiveness).  Americans spend $1.4 billion on teeth whitening products.  (Click here to see this and other interesting statistics about teeth whitening from research conducted by the American Academy of Cosmetic Dentistry.)  Globally, teeth whitening is a $3.2 billion industry.  If you are on social media, you have probably seen at least one DIY whitening trend.  Teeth whitening is one of the quickest and easiest ways to improve a smile.

What is Teeth Whitening?

Teeth whitening is any process that causes the teeth to appear whiter in color.  This can involve two different processes: 1) the removal of surface stains and polishing of the teeth and 2) chemically bleaching the teeth with peroxide agents.  The removal of surface stains and polishing of the teeth is the mechanism of action used by whitening toothpastes and all of the DIY whitening trends you see on Instagram and Pinterest.  This is accomplished by the use of abrasive compounds to polish the outer surface of enamel and remove superficial stains like coffee, tea and red wine. 

The risks associated with this type of teeth whitening is the removal of enamel or exposed root surfaces.  This risk is the main concern that dentists have with DIY whitening trends: they can cause irreversible loss of tooth structure.  Teeth will initially appear whiter, and as the abrasion continues and enamel becomes thinner, the underlying dentin will begin to show through, making the teeth look darker over time. 

The best way to lessen this risk is to use whitening toothpastes with the American Dental Association’s seal of approval because their abrasivity has been tested and confirmed to be safe for tooth structure.  Also, make sure to follow the manufacturer’s instructions when using a whitening toothpaste.  

Teeth whitening can also involve bleaching the enamel and underlying dentin tooth structure with chemical compounds containing peroxides.  Because bleaching the teeth does not remove any tooth structure, it can actually be safer for your teeth.  Many over-the-counter products contain peroxide chemicals for bleaching and are safe when used as instructed.  This blog will address the professional whitening options offered at Prosper Family Dentistry, all of which are bleaching agents containing peroxides.

Hydrogen Peroxide vs. Carbamide Peroxide

The two possible whitening ingredients in professional teeth bleaching agents are hydrogen peroxide and carbamide peroxide.  Because carbamide peroxide breaks down into hydrogen peroxide, they are virtually the same.  There are two minor differences that may factor into the decision on which product to use: 1) Hydrogen peroxide shows an initially quicker whitening effect, which then plateaus so that the final whitening result is the same for both hydrogen peroxide and carbamide peroxide.  2)  Carbamide peroxide has a slightly longer shelf life.  This is important for take-home whitening gels that you may use on a less frequent basis.

Option #1: Professional Whitening Gel in Custom Trays

Teeth whitening using custom trays and a bleaching gel is considered the “gold standard” in teeth whitening.  It is the most customizable and controlled option available in teeth whitening.  Professional Teeth Whitening Gel is available in many concentrations; we offer various concentrations in our practice.

Pros:

Cons:

Once made, the custom trays will last for years.  The only reason you would need new ones is a major change in the shape of your teeth (for example, significant dental work or orthodontics).  This allows you to purchase refill kits of bleaching gel for continued whitening at a much lower cost than the initial investment.

Impressions of your mouth are necessary to fabricate a mold of your teeth, on which the custom tray is made.

You choose which teeth to whiten and when.  Easily customized to get the best result with the least amount of gel.

About 1 week lab time before you can begin whitening.

Greater variety of concentrations of the gels = greater versatility of whitening (anywhere from 15 minutes to 9 hours/overnight).

Results are not immediate; typically, whiter teeth are noticed after 3-4 days of whitening.

Whitening can be done any time for maintenance of a bright, white smile.

Properly loading the gel into the trays requires some manual dexterity.

Carbamide peroxide is the main ingredient, which increases its shelf life.

 

Contains potassium nitrate (desensitizes the teeth) and fluoride (strengthens enamel).

 

Very inexpensive after the initial investment for the custom trays.

 

 

Option #2: In-Office Whitening

In-Office Whitening is the way to go for an instantly whiter and brighter smile.  This option gives you instant gratification and is perfect for an upcoming special event or for those people who just do not have time for at-home whitening.  In one session of in-office whitening, you will achieve the same results you would get with multiple days of whitening your teeth through the first two methods of at-home whitening.  Basically, we do all the work for you!  Most in-office whitening treatments are a high concentration of hydrogen peroxide gel, which means it is strong and works fast.

Pros:

Cons:

Instant results!  Your teeth are visibly whiter in one hour.

Most expensive option.

Customizable: Your dentist or hygienist can apply different amounts of gel to different teeth, if they are not all the same color.  They can also protect sensitive areas of gum recession and avoid using the gel on dental work.

Requires a scheduled appointment with your dentist or hygienist.

Chemically activated: no light needed.

Increased risk of irritation of the gums or tooth sensitivity due to its high concentration.

 

Some maintenance may be required if you frequently drink beverages with a high probability of staining your teeth (coffee, tea, red wine).

 

Interested in whitening your teeth?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a teeth whitening consultation with Dr. Aanenson or Dr. Kuiper.  They will discuss the various options available and help you decide which is right for you!

 

 

Is Flossing Really That Important?

Wednesday, January 24, 2017

Let’s talk about flossing.

We know.  No one wants to floss.  Recent statistics show that Americans can be roughly divided into thirds when it comes to flossing habits.  Just under 1/3 of the population floss every day.  Just over 1/3 of the population floss sometimes.  And the rest admit to never flossing.  Never.  That hurts our dentist-hearts.

Many of our patients have shared that they feel guilty when we ask about flossing.  We do not ever want to make anyone feel guilty.  We simply want to know where you stand on the flossing issue so that we can point you in the right direction.  Our goal is to encourage you to have great oral hygiene habits so that your visits to see us consist of maintenance only, not repair.

What does flossing accomplish?

A toothbrush mechanically removes soft buildup on the exposed surfaces of teeth.  The bristles have to touch the tooth to be effective.  Many areas of tooth structure are not accessible with a toothbrush, namely in between the teeth.  A toothbrush can effectively clean the cheek side, the tongue side, and the biting surface of teeth.  It simply cannot reach the side of a tooth that faces an adjacent tooth (called the interproximal surface). 

Flossing removes plaque and food debris that your toothbrush leaves behind.  By physically touching the interproximal surfaces of the teeth, floss does the job that a toothbrush cannot.

Benefits:

Increased life expectancy – Some studies claim an increase of 6.4 years for people who floss daily over those who do not.  This is likely an assumed benefit based on the reduced risk of other diseases, which itself is another benefit of flossing.

Reduces risk of heart disease, cavities, gum disease – It is no surprise that flossing reduces the risk of dental disease.  Anything that keeps the teeth and gums free from harmful bacteria will lower the risk of cavities and gum disease.

Over the last 20 years, new research has shown a significant link between oral health and systemic health.  Patients with periodontal disease are more likely to have cardiovascular disease.  People who suffer from severe dental disease are more likely to develop oral cancer.  There is a proven connection between diabetes and gum disease.  All of these associations make it clear that keeping your mouth healthy is beneficial for the whole body.

Improves bad breath – Bad breath is the product of bacteria and food debris that is left in the warm, moist environment of the mouth.  A good, but gross, analogy is that the mouth is like a kitchen trash can.  Flossing is like taking out the trash.  When you neglect it, it starts to stink.

Gives gums healthy pink appearance – A beautiful smile involves more than just the teeth.  Straight, white teeth surrounded by swollen, red, or receding gums cannot be considered beautiful or healthy.  Flossing removes the source of gum inflammation (called gingivitis), which keeps them healthy.  Healthy gum tissue is light pink in color, flat (not swollen, bulbous, or rounded), and does not bleed when brushed or flossed. 

Proper technique:

Not just any old flossing will do.  In order for the floss to actually remove buildup from the teeth, it must touch the teeth.  Simply snapping floss in between each tooth contact and hitting the gums can miss a large portion of the tooth.  For effective flossing, envision the following diagram with a triangle between each tooth.

 

  1. Holding an end of the floss in each hand, first press back with both hands to wrap the floss around the rear tooth.  Using an up and down motion, rub the floss against the side of the tooth labeled on the diagram as side #1 of the yellow triangle.
  2. Then pull forward with both hands to wrap it around the forward tooth.  Using the same up and down motion, clean side #2 of the yellow triangle.
  3. Before pulling the floss out, use a gentle sweeping motion along the bottom of the triangle (side #3 on the yellow triangle) if there is any open space between the teeth to remove large pieces of debris that may have become lodged there.  This step is necessary when the gum tissue does not completely fill in the triangular area.  If you do not have gum recession or areas between the teeth called black triangles (described below), you may omit this step.

 

Adjuncts:

In some cases of overlapped teeth or teeth with large gaps, it is necessary to use additional tools to properly clean between the teeth. 

Waterpik – A Waterpik is a tool that uses water or mouthwash at high pressure to flush out the areas between the teeth.  This is a great tool for patients with braces, large areas of “black triangles”, or problems with handling floss (such as arthritis).  Black triangles develop when the gums no longer completely fill the space between two teeth, as shown in the diagram.  This open space allows food and bacteria to collect and presents an additional cleaning challenge.  A Waterpik creates a power wash for these hard-to-clean areas.  It is not a replacement for flossing.

Interproximal brushes – Another great tool for black triangles is a small angled brush called an interproximal brush.  Brand names include Proxabrush, Go-Betweens, and Interdental brushes.  They look like tiny pipe cleaners or bottle brushes and are made to fit between the teeth and gently scrub the side of each tooth.  Please use caution with these tools.  Aggressive use of an interproximal brush could create black triangles and gum recession.  Only a light, gentle touch is necessary to remove plaque and food debris from between the teeth.

Do you have more questions about flossing?

If you have questions this blog did not answer or would like an in-person demonstration of the proper flossing technique, please call to set up a consultation with one of our doctors or dental hygienists.  They will create a customized hygiene plan for you to keep your teeth as clean as possible.

 

 

 

Interdisciplinary Dentistry

Wednesday, January 17, 2018

You’ve probably heard the saying, “Jack of all trades”; maybe you didn’t know that the rest of that phrase is “ . . . master of none”.  The theory behind this phrase is that a person can be competent in many tasks, but is usually limited to excellence in just a few.  At our dental centers in Freeman, Parkston, and Viborg, we believe that this phrase applies to dentistry.  Because our goal is for each patient to receive excellent care in every realm, we cooperate with medical and dental specialists to accomplish interdisciplinary dentistry. 

We understand that, as a patient, it is more convenient to have all of your dental care performed in one location.  However, when it comes to a choice between convenience and excellence, we will always choose excellence.  When Dr. Aanenson and Dr. Kuiper create a customized treatment plan for their patients, they considers what type of practitioner will best perform each individual procedure.  These decisions are made on a case-by-case basis, much like a primary care physician may treat a case of high blood pressure in his or her office, but refer out a complicated cardiovascular issue to a cardiologist.

Dental Specialties

The American Dental Association recognizes nine dental specialties in dentistry.  These specialties are characterized by residency programs, which add several years to their education, and certifying boards, which recognize their limitation of practice to a specific specialty.  The nine recognized dental specialties are:

  1. Dental Public Health – promotion of oral health and disease prevention
  2. Endodontics – root canals and surgeries related to infections originating within the tooth
  3. Oral & Maxillofacial Pathology – diagnosis of abnormal lesions and diseases of the oral cavity
  4. Oral & Maxillofacial Radiology – interpretation of images of the head & neck complex, including x-rays and cone beam computed tomography
  5. Oral & Maxillofacial Surgery – surgical intervention ranging from simple extraction of teeth to complex realignment of the upper and lower jaws
  6. Orthodontics – realignment of teeth and bite relationships
  7. Pediatric Dentistry – dentistry for children
  8. Periodontics – treatment of diseases and conditions of the supporting structures of the teeth: bones, ligaments, and gum tissue
  9. Prosthodontics – restoration of missing tooth and jaw structures

Many people are surprised to learn that there are currently no recognized specialties for TMJ, cosmetic dentistry, and dental implants.  Advertising claims can be misleading in these areas. 

Why Do Some Dentists Pull Wisdom Teeth, Place Implants or Do Root Canals?

Many general dentists have practiced long enough to determine which procedures they are able to perform with excellence, rather than just being competent.  They will spend more time in continuing education learning the procedures that they love, and will consistently improve their skill in specific techniques.  This is why some general dentists are able to provide excellent treatment in areas another general dentist would refer to a specialist.

On the other hand, you may find that a dentist who used to do root canals in his office no longer does.  It is likely that this dentist has found he is not able to efficiently provide the very best root canal for his patients, and they will receive a more positive long-term success rate by seeing an endodontist for that specific procedure. 

Medical Specialists

As we discussed in a previous blog on how oral health affects your overall health, there are many connections between the mouth and the rest of the body.  As we continue to gather more information about your head & neck with the 3D imaging and continued learning in dentistry, we are better able to recognize these connections and advise you to see the appropriate medical specialist.

The Importance of the General Dentist

In cases where interdisciplinary dentistry is necessary, the general dentist plays an important role.  In addition to performing certain procedures in the care of the patient, the general dentist is instrumental in organizing and coordinating the flow of communication and treatment among the various specialists.  

If you have a complicated dental history and think you need interdisciplinary dentistry, call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to schedule a consultation with Dr. Aanenson and Dr. Kuiper.  Their commitment to excellent care will ensure you see the proper doctor for each individual procedure your treatment requires.

 

 

Energy Drinks

Wednesday, January 10, 2018

Are Energy Drinks Bad For Your Teeth?

Red Bull gives you wings, but it may also give you cavities.  Energy drinks are defined as “any of various types of beverage that are considered a source of energy, especially a soft drink containing a high percentage of sugar and/or caffeine or other stimulant”.  The most common brands of energy drinks sold in the U.S. are Red Bull, Monster, and RockStar.  In 2015, Red Bull had $4.55 billion in sales.  While the soda industry is noticing a slow, steady decline in sales, the energy drink industry is steadily climbing.  

What is in an Energy Drink?

 

  • Caffeine – Energy drinks contain a varying amount of caffeine, some as high as 160mg, which is equivalent to a Starbucks coffee.  If you would not let your child drinks a strong coffee at Starbucks, you should not let them drink energy drinks.
  • Taurine – Taurine is an amino acid, present in most energy drinks, that shows no actual evidence of providing any energy at all. 
  • Guarana – A plant native to the Amazon region, guarana berries contain a very high concentration of caffeine.  Guarana is an ingredient in both Monster and Rockstar energy drinks.  If you see both caffeine and guarana listed as ingredients in your energy drink, it’s a double whammy, and you should proceed with caution.
  • Lots and lots of sugar -  An 8-oz serving of Monster energy drink contains 27g of sugar, which is the exact amount of sugar in an 8-oz serving of CocaCola.  The important thing to remember is that most people buy both energy drinks and sodas in 16-oz bottles or cans.  If you drink a 16-oz energy drink, the amount of sugar is doubled to 54g, which is far higher than anyone’s recommended daily allowance. 

 

How Do Energy Drinks Cause Cavities?

Energy drinks cause cavities in the same way sodas cause cavities: high sugar content, and very acidic pH.  It is important for both parents and children to understand that energy drinks offer no health advantages over sodas; in fact, they are more harmful due to the high levels of caffeine they provide.

  1. Sugar – The bacteria which is naturally present in mouths ingests (eats) sugar, and the by-product is an acid.  When this acid stays in contact with the enamel surface, it begins to etch or weaken the outer layer of enamel.  This process is the beginning of a cavity.  The more sugar you drink, the more you are feeding the bacteria in your mouth, enabling them to cause damage to your enamel.
  2. pH – All energy drinks, even the sugar-free versions, have a very low pH.  Rockstar Sugar Free has a pH of 3.15, Red Bull Sugar Free is 3.39, and Monster Low Carb is 3.60.  These pH measurements are well below (more acidic than) the threshold of 5.5, at which enamel begins to soften and become susceptible to decay.  Consistently drinking very acidic drinks predisposes you to a high risk for cavities.

 

What if I Can’t Give Up My Energy Drink?

As with sodas and sparkling waters, you can minimize the damage to your teeth by high sugar, acidic drinks if you limit them to mealtime only.  Drink them quickly and while you are eating.  The saliva stimulated by your chewing and tasting food will counteract the acid in the energy drink. 

If you have a dry mouth, you are at a much higher risk for developing cavities from energy drinks.  Please ask Dr. Aanenson and Dr. Kuiper how you can address your dry mouth issues and still enjoy an energy drink from time to time.

After having your energy drink, chew sugar-free, xylitol gum for 20 minutes.  Chewing gum stimulates saliva production and can bring the pH in your mouth back up to neutral more quickly than it can without chewing gum.

Know your cavity risk.  Unfortunately, some people are much more prone to cavities than others.  You should know your risk and take the necessary steps to lower that risk as much as possible.  If you do not know your level of cavity risk, call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

New Year, New Smile

Tuesday, January 2, 2017

It is that time of year when people around the world are resolving to make changes for the better.  A common theme in many New Year’s resolutions is improved health.  One of the great perks of improving your health is that it usually involves improving your appearance, too!  If you are exercising to enhance your health, you may also be losing weight or toning muscles.  If you resolve to get more sleep, you will lose those dark circles under your eyes.

The same applies to taking care of your teeth.  The steps you take to make your mouth healthier will make your smile prettier.  Here are a few ways you can improve the health and appearance of your smile.

Brush Up on Your Oral Hygiene Regimen

Keeping your teeth free from plaque reduces your risk of unsightly cavities and gum disease.  Here is the most effective way to keep your pearly whites pearly and white.

Brush twice a day, preferably after breakfast and before bed.  Make sure you are using a soft-bristled toothbrush at a 45 degree angle to the edge of the gums.  Make sure you touch every surface of every tooth.  This should include the cheek side, tongue side, and biting surface.  The most commonly missed area is the inside (tongue side) of the lower teeth.  Do not go to bed without brushing!

Floss nightly!  Brushing alone is not enough to ensure proper plaque removal.  The toothbrush bristles cannot reach in between the teeth; therefore, they leave harmful plaque, bacteria, and food debris on the teeth.  Flossing is absolutely mandatory to keep your teeth and gums healthy and beautiful.

Use a mouthwash.  Swishing mouthwash is a great way to flush out unhealthy bacteria from the various nooks and crannies of the oral cavity.  If you are cavity prone, use a mouthwash containing fluoride to strengthen your enamel and fight cavities.  If you have a dry mouth, stay away from mouthrinses containing alcohol.  For someone with red, swollen gums, a whitening mouthwash containing hydrogen peroxide is a great tool for reducing gum inflammation.

Treat Yourself to Teeth Whitening

There are many ways to improving your smile.  Whitening your teeth is one of the quickest ways to give your smile a boost.  At the dental centers in Freeman, Viborg and Parkston, we are proud to offer KöR professional teeth whitening.  With both in-office and at-home whitening products, we can help you find the type of whitening that most easily and quickly meets your needs. 

Another way you can achieve a brighter smile is by using an electric toothbrush and whitening toothpaste.  This works to polish off surface stains accumulated by years of drinking coffee or tea and using tobacco products.  Ask our dental hygienists about the other benefits of an electric toothbrush.  Most patients find that once they begin using an electric toothbrush, they cannot return to a manual toothbrush.  Electric toothbrushes truly give a cleaner, smoother, shinier appearance to the teeth.

Straight Teeth are Healthy Teeth

Many people consider crooked teeth to be a cosmetic issue.  In addition to an improved appearance, straightening your teeth actually creates a healthier oral environment.  A research experiment was conducted in which plaque was collected from both patients with straight teeth and those with crowded teeth.  This study concluded that not only do crooked and crowded teeth harbor a greater quantity of plaque; they actually harbor more dangerous bacteria than straight teeth.

Closing gaps between the teeth helps prevent food impaction, which leads to cavities and periodontal disease.  Aligning crooked teeth makes brushing flossing easier to accomplish.  Ask us how Invisalign® can make your mouth healthier!

Full Smile Makeover

Perhaps you have always wanted a full smile makeover, and 2018 is your year.  Missing teeth can be replaced with dental implants.  Broken teeth can be restored crowns.  Cavities can be repaired with cosmetic tooth-colored fillings.  

You can even get a beautiful, straight, white smile with veneers.  A veneer is a covering of at least one full surface of the tooth.  Veneers are made from porcelain or composite (an in-office dental restoration).  They can be contact lens thin for minor corrections and refinements.  Or they can be several millimeters thick to correct misalignments and dark discolorations.

The possibilities are almost endless!  To get started on your full smile makeover, schedule a consultation with Dr. Aanenson and Dr. Kuiper.  They will evaluate your current situation and discuss the treatment options available to meet your cosmetic goals.

Happy New Year!

Whether 2018 is the year for minor improvements or major life changes for you, there are two things that will always be a great idea: 1) Make healthy choices.  2) Smile! 

If you’d like help improving that smile, we are here for you.  Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

Can a sinus infection make my teeth hurt?

Tuesday, December 26, 2017

Winter is here.  And with it come colds, sinus infections, and the flu.  It is very common for dentists to see an increase in “toothaches” during this season.  We put “toothaches” in quotes because while the tooth definitely aches, it is not a tooth problem.  Many patients will call us with a toothache and come in for an evaluation, only to be told that the tooth is perfectly fine. 

Why does sinus pressure make my teeth hurt?

The natural anatomy of our upper teeth, jawbones and sinus cavities predisposes us to this problem.  The maxillary sinus cavities are large, air-filled spaces located just inside our cheekbones.  They extend inward toward the nose and downward toward the upper teeth.  Often the jawbone separating our upper teeth from the above sinus cavity is extremely thin. 

The sinus cavities are supposed to be empty.  These air-filled spaces allow for the passage of air as we breathe and lighten the weight of our skull so that we can hold our heads up.  Anyone who has ever experienced sinus congestion knows that it can be hard to breathe and make your head feel heavy.

When the sinuses are filled instead of empty, pressure is created in that bone-encased space.  Many people feel this pressure inside their cheekbones or under their eyes.  Many also feel this pressure on their upper molars and premolars.  The nerves that supply sensation and feeling to our teeth enter the tooth at the very tip of its root.  Many upper molars’ roots protrude up into the sinus cavity.  When there is an increase in pressure in the sinus, it can cause sensitivity, soreness or just a plain old toothache.

 

What symptoms are commonly associated with sinus pressure toothaches?

 

  • Because the toothaches associated with sinus cavities are caused by an increase in pressure, anything that changes the pressure would change the pain in the tooth.  Things like the impact of running or jumping and tossing your head upside down to blow-dry your hair will affect the pain of a toothache caused by sinus pressure. 
  • Because of the pressure on the tooth’s nerves, the teeth may be more sensitive to cold air or liquids. 
  • The increase in pressure on the roots of the teeth also causes a soreness or tenderness when chewing, grinding, or tapping on the side of the tooth. 

 

What can I do about it?

First of all, you should rule out any problems with your teeth.  If you haven’t seen a dentist in a while, you should schedule a visit to have the tooth or teeth evaluated. 

If you have been seen regularly by your dentist and know that you have no cavities or other problems with your teeth, you may want to begin by treating your sinus pressure.  Take over-the-counter decongestants and antihistamines.  If these do not help, you should see your medical doctor to treat your sinus condition, allergies, cold or flu. 

Many patients have experienced this multiple times and are able to recognize it as a sinus problem and not a tooth problem.  If you’re not sure, come see us anyway.  When in doubt, rule a real toothache out!

Have a toothache that could be from sinus pressure?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper. They will do a thorough evaluation of the area that is bothering you and distinguish between a tooth problem and a sinus problem.

 

 

Is your mouth making you sick?

Tuesday, December 19, 2017

How Oral Health Impacts Systemic Health

At our Dental Centers in Freeman, Parkston and Viborg, we take healthcare seriously.  While we are specifically concerned with our patients’ oral health, we acknowledge its role in a person’s overall health.  Unfortunately, the mouth has always been treated by a realm of healthcare (dentistry), which has historically been kept separate from general medicine.  For this reason, some people are under the impression that the mouth is therefore independent and unrelated to the rest of the body. 

This is a dangerous myth!

What systemic issues are connected with the mouth?

In 2000, the surgeon general released a report called “Oral Health in America”.  The purpose of this report was to inform and educate the nation about oral health, its prevalence in our nation, and how it affects a person’s overall health.  This report was based on a review of published scientific literature and is still considered the authority on the link between oral health and systemic health.

There are many links between the mouth and the rest of the body.  In this article, we will limit the discussion to the most harmful health conditions that are affected by the health of your mouth.

  • Osteoporosis – Osteoporosis is a condition of decreased bone density and often brings to mind a picture of a frail old lady whose bones break easily.  Osteoporosis can affect any bone in the body, even the jawbones.  This is especially important in patients who have lost teeth and wear dentures.  The jawbones in a patient with osteoporosis will diminish much more rapidly than in a patient with healthy bones, causing the denture to become loose and uncomfortable.  
  • In a patient with all of their teeth, osteoporosis causes an increased risk for periodontal bone loss.  It has even been suggested that bone loss around the teeth could be a warning sign of osteoporosis.
  • Immunosuppression – There are many different diseases, disorders, and conditions that suppress the immune system, including HIV, autoimmune diseases, organ transplants and cancer treatments.  A suppressed immune system makes any type of infection worse because your body cannot fight it naturally.  This puts a person at higher risk for periodontal disease and dental abscesses.  Because these infections also affect other areas of the body, the impact on the overall health is much greater in an immunocompromised patient.  
  • Anyone who has a problem with their immune system should keep to a strict oral hygiene routine and continuing care schedule with their dentist.
  • Some people with a weakened immune system will suffer from persistent mouth sores and ulcers that do not heal.  Often a dentist is the first person to catch these signs of a suppressed immune system.
  • Pulmonary Disease – Because the bacteria in the mouth have a quick pathway to the lungs, there is a link between oral disease and pulmonary disease.  COPD (chronic obstructive pulmonary disease) is associated with poor oral health, and patients with periodontal disease are at a higher risk of developing bacterial pneumonia.
  • Diabetes – The link between periodontal disease and diabetes is considered a two-way connection: meaning diabetes makes periodontal disease worse, and periodontal disease makes diabetes worse.  Diabetes worsens periodontal disease through its affect on blood flow, inflammation and healing ability.  Periodontal disease worsens diabetes by contributing to hyperglycemia and complicated metabolic controls.  This association is thought to be true of diabetes with any chronic infection in the body.
  • Heart Disease – The bacteria present in the mouth of a patient with periodontal disease can contribute to heart disease through a few different mechanisms of action: 1) small localized infections of blood vessel walls, which leads to plaque formation, atherosclerosis, and in severe cases, a heart attack,  2) an influence on platelets causing them to aggregate and form clots in the bloodstream, which could block a coronary artery, leading to heart attack.  People with periodontal disease have a 25% higher risk of heart disease than people with healthy gums.
  • Stroke – The increased risk of a stroke in patients with periodontal disease is based on the same mechanism of action noted above: increased risk for clot formation, which can travel to the brain and occlude a cerebral artery, blocking blood flow to brain tissues.
  • Adverse Pregnancy Outcomes – There is a correlation between periodontal disease and low birth weight infants.  The mechanism is in need of more scientific research.  At this time, it is thought to arise from two possible consequences of periodontal disease:  1) The bacteria present in periodontal disease produce toxins that could enter the blood stream, cross the placenta, and cause damage to the fetus.  2) The maternal inflammatory response to these toxins could interfere with fetal growth.

 

How do I reduce my risk of health problems?

All people should be aware of the health risks associated with dental diseases.  Because most oral health problems are preventable, you can be instrumental in lowering your risk for systemic health problems.

 

  1. See your dentist and dental hygienist at their recommended intervals for cleanings and oral evaluations.
  2. Practice good oral home care with regular brushing, flossing, and rinsing with the proper mouthwash.
  3. Treat dental problems as they arise.  Do not wait until something hurts!  Periodontal disease is often called a “silent” disease because it rarely causes pain.
  4. See your medical doctor to be as preventive as possible with conditions like diabetes and cardiovascular diseases.

 

I am concerned that my mouth is affecting my overall health.  What now?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.  They will discuss your medical history with you and outline how it can affect your oral health and vice versa.  

 

 

Silver Diamine Fluoride

Tuesday, December 12, 2017

What is SDF?

Last June, the New York Times published an article on a new dental material called Silver Diamine Fluoride (SDF) that excited all of its readers and everyone who saw it shared on Facebook!  (New York Times article) Correction: it is not new.  SDF has been used in Japan for decades (approved by their ministry of health in the 1960's), but it is new to the United States. 

This material, which is a clear liquid that looks like water, can stop tooth decay in its tracks.  That is an exciting material!

The Food & Drug Administration has classified SDF as a fluoride treatment and has only cleared it for use as a desensitizing agent.  This means that when dentists use it to stop cavities, it is being used "off-label".  The evidence is compelling enough that Dr. Aanenson and Dr. Kuiper have begun offering this "caries arrest" treatment to its applicable patients. 

Caries arrest, simply put, means stopping a cavity.  Caries is the scientific word for tooth decay or cavities.

Who is a candidate for SDF? 

The most common application of SDF is in young children because it prevents them from having a dental appointment involving local anesthetic, drilling and filling.  It takes about 5 minutes to isolate the affected tooth and apply the colorless liquid SDF to the site.  It is also a great option for treating cavities on elderly patients with a very high risk for decay, patients with dementia or Alzheimer's disease, and patients with special needs.  It can be used to stop the progression of decay for a patient who has need of extensive dental treatment and is unable to proceed for financial or medical reasons. 

Basically, SDF can be used to buy some time when it comes to "fixing" your teeth.

What are the pros?

  • No local anesthetic = no injections
  • No drilling
  • No filling
  • Much shorter treatment (about 5 minutes compared to 30+ minutes)
  • Decreased cost (about 10% of the cost of a filling)

 

 What are the cons?

  • The biggest con is that the silver particles in SDF stain the tooth black in areas of decay.  The amount of staining depends on the amount of decay in the affected tooth.  There will be some temporary staining of the gums near the treatment area, which will resolve over a few days. The gum staining is similar to a henna tattoo, reddish brown in color and lasting for several days.
  • It tastes awful.  We do our best to keep it away from your tongue, but we cannot guarantee you won't taste it.
  • SDF is not 100% effective.  There are some cavities SDF will not stop.  So it requires follow-up x-rays to confirm that the SDF did its job and that the cavities have not grown since being treated with SDF.
  • It must be reapplied at your next cleaning appointment for maximum efficacy.
  • It does not fill in any holes created by the cavity, so you still get food impaction in the treated area, which can lead to gum disease or decay on other teeth.  This means it is not a good option for normal permanent teeth on a healthy adult.

 

Is SDF Right for You or Your Loved One?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.  They can discuss the treatment options for each tooth, including which ones could benefit from SDF. 

 

 

Pediatric Sleep Apnea

Tuesday, December 5, 2017

Why Is My Dentist Asking If My Child Snores?

Some of you may have noticed that when you bring your child in for their professional cleaning and periodic evaluation, Dr. Aanenson or Dr. Kuiper asks questions about your child’s sleep patterns.  “Does your child snore?  Does he grind his teeth?  Does she wake up with a raspy voice or a sour stomach?”  We treat adults who have obstructive sleep apnea with an oral appliance.  After much study and continuing education on the subject, it was only natural that we continue our learning with research into pediatric sleep apnea.  Because we have a chance to look inside their mouths (and inevitably, down their throats) a few times a year, we are in a perfect position to evaluate their airway on a regular basis. 

Refresher: What is Sleep Apnea?

An apnea occurs when breathing stops for a period of time.  It is generally caused by an obstruction or blockage in the airway, which causes a disruption of normal breathing.  Snoring is an important warning sign because it indicates that there are excess tissues vibrating in the airway.  These same excess tissues can collapse and block the airway, causing apneas to occur.

Why Is Pediatric Sleep Apnea an Important Issue?

According to a 2002 study, children with obstructive sleep apnea consume 226% more health care services than children without.  According to a 2007 study, these children have 40% more visits to the hospital than children without OSA, as well as higher consumption of anti-infective and respiratory system drugs.  The risks of undiagnosed sleep apnea include problems with behavior, learning and development, and in severe cases, failure to grow, heart problems and high blood pressure.

 What Causes Pediatric Sleep Apnea?

Obstructive sleep apnea can be caused by anything that makes the opening of the airway (through either the nose or the mouth) smaller than it should be.  Some children have very large tonsils or an enlarged tongue that blocks the opening at the back of the throat.  Some may have a jaw that is smaller than normal or a palate (roof of the mouth) that is very long and hangs down into the back of the throat.  Even a deviated nasal septum or an enlarged turbinate can cause a decreased amount of airflow.  The shape of the upper and lower jaws are important in shaping the airway.  Certain growth patterns make some children more susceptible to airway problems than others. 

What Warning Signs Should I Look For?

 

  • Snoring, snorting, gasping or squeaking sounds during sleep
  • Restless sleep, nightmares, sleep walking or bedwetting
  • Sleeping in abnormal positions with the head in unusual positions
  • Heavy, irregular breathing or mouth breathing
  • Grinding teeth
  • Difficulty waking up in the morning

 

Where Do We Go From Here?

If your child exhibits several of the warning signs and has any narrow airway risk factors, Dr. Chowning will discuss the next step in diagnosis of sleep apnea.  It may involve treatment in our office as well as referral to several different doctors, including a sleep physician, an ENT, an orthodontist, an allergist and possibly 3D imaging to visualize the child’s airway.  In certain cases, your child may be treated with an oral appliance that opens and shapes the airway as the child sleeps.  A sleep physician conducts a sleep study to gather all the data needed to diagnose or rule out a sleep-disordered breathing problem.  If your child is diagnosed with pediatric obstructive sleep apnea, it is possible that an adenotonsillectomy (surgery to remove the adenoids and tonsils) could be recommended, and you would be referred to an ENT for that procedure.  Because the shape of the jaws can affect the breathing space, orthodontic treatment may be necessary to change the shape of the jaws, thereby increasing the airway space.  An allergist can be helpful in decreasing the size of inflamed tissues through allergy therapy.

 Do you think your child may have sleep apnea?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.  They will discuss the risk factors your child exhibits and the various treatment options available.

 

 

Caring for Your Teeth While in Braces

Tuesday, November 28, 2017

Best Day Ever

The day you get your braces off should be the best day ever. After months, maybe even years, of hiding your metal mouth and constantly digging food out of the brackets and wires, you will feel a newfound sense of freedom and won’t be able to pass a mirror without smiling at yourself. The end result of orthodontics is always worth the time, money, and effort you put into it. Not only are straight teeth beautiful; they are actually healthier than crooked teeth.

There are two reasons straight teeth are healthy teeth: 1) Many people understand that crowded and crooked teeth allow more plaque accumulation because of the various nooks and crannies created by overlapping and rotated teeth. 2) Research studies have shown that the types of bacteria collecting on crooked teeth are different than the bacteria typically found on straight teeth. They are more periodontopathogenic - more likely to cause periodontal disease!

How the Best Day can become the Worst Day

If the braces come off, and instead of exposing a beautiful, straight smile, a mouth full of discolored and decayed teeth is revealed, the Best Day has now become the Worst Day. Braces create a dental hygiene challenge that many people, especially preteens and teenagers are not aware of or prepared for. The extra apparatuses on the teeth are havens for plaque, bacteria, and food debris, causing a person’s risk for gum disease and cavities to sky-rocket.  The most common problem we see after braces is a phenomenon called "white spot lesions" that outline where the bracket was.  The white spots are areas of demineralization or weakening of the surface enamel where plaque was allowed to linger for too long and damaged the tooth structure surrounding the bracket.

 

How to Lower Your Risk for Cavities & Gingivitis

  • Don’t miss a single dental visit! While you are busy seeing your orthodontist every 4-6 weeks, it is easy to forget your need for dental cleanings and checkups while in braces. Dr. Aanenson and Dr. Kuiper will be able to reassess your risk for both gum disease and cavities and make recommendations to help you lower your risk. This may include more frequent dental cleanings, a prescription toothpaste, a professional fluoride application, and adjunctive oral hygiene tools for you to use at home.
  • Additional oral hygiene tools - Braces take cleaning your teeth to a whole new dimension. A manual toothbrush usually will not adequately do the job, and traditional floss is virtually impossible to use alone.
    • Brushing - An electric toothbrush is a must because it can remove more plaque and bacteria around the brackets more effectively than a manual toothbrush.
    • Flossing - Using traditional floss requires the addition of something called a floss-threader, which is like a large plastic needle that can be inserted underneath the wire in order to floss between the teeth. An alternative to this is using small pre-threaded floss picks that will fit underneath the wires, called Platypus flossers.
    • Waterpik - Some people choose to add a Waterpik tool to their oral hygiene regimen. It is an effective way to remove food debris from underneath the orthodontic wires.
  • Additional oral hygiene products - The specific type of oral hygiene products you use matters when you have orthodontic appliances. There are many products available that can strengthen enamel and make it more resistant to damage from plaque and bacteria.
  • A prescription fluoride toothpaste or gel - Dr. Aanenson and Dr. Kuiper will give you recommendations based on your specific risk levels. If they determine that you are high risk for cavities, you may be given a prescription for a special toothpaste or gel to use on your teeth. Make sure to carefully follow the instructions and store any of these products out of the reach of small children.
  • Mouthwash - A mouthwash is a great way to flush out food debris from around the brackets and wires before you begin the flossing and brushing process. Any alcohol-free mouthwash is appropriate for pre-brush rinsing. Before bed and after brushing and flossing, you should swish with a fluoride-containing mouthwash. Do not rinse your mouth after using this one because the fluoride should stay in contact with your teeth for as long as possible. Our favorite fluoride mouthwash for patients in braces is Phos-Flur.

Questions about Your Risk (or Your Child’s Risk) While in Braces?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper. They will assess your risk for gingivitis and cavities while in braces and make the appropriate recommendations for your specific risk.

 

 

 

Is Morning Sickness Ruining Your Teeth?

Tuesday, November 21, 2017

What is Morning Sickness?

Morning sickness is a commonly used term to describe the nausea and vomiting that affects many women during pregnancy.  It’s a bit of a misnomer, as most women who experience this phenomenon say it actually happens throughout the entire day and not just in the mornings.  Morning sickness affects between 70-85 percent of pregnant women!  While most women experience morning sickness in the first 16-20 weeks of pregnancy, some of the unlucky ones have symptoms throughout the entire pregnancy. 

Morning sickness affects a person’s ability to work, perform necessary tasks around the home, and/or care for children or other dependents in the household.  Many women state that morning sickness forced them to reveal their pregnancy earlier than they would have preferred. 

How Does Morning Sickness Affect My Teeth?

The reason morning sickness is damaging to teeth is that the nausea and vomiting brings acid from the stomach up into the mouth.  Healthy stomachs are filled with acid, which breaks down food as an important part of the digestion process.  However, that acid is supposed to stay in the stomach.  Stomach acid has a pH of 1.5-3.5. 

In contrast, a healthy mouth has a pH that is slightly above neutral, in the range of 7.1-7.5.  Teeth can stay strong at this pH.  The enamel covering our teeth begins to weaken when the pH drops to 5.5 or below.

When someone vomits, the acid in the stomach is pulled up the esophagus and into the mouth.  This stomach acid is far below the pH threshold for enamel damage.  When the mouth is subjected to this strong acid with such a low pH repeatedly, the enamel is weakened and may begin to erode. 

Enamel erosion is the gradual degradation of the enamel surface of teeth caused by exposure to acids.  This includes any acid, like sodas, lemon juice, and any carbonated drink.  Because stomach acid is more acidic than these things, it can cause more damage in a shorter amount of time.  The photos below show examples of severe enamel erosion.  The enamel becomes thinner and is even missing in some areas.  On front teeth, this can cause the teeth to appear translucent or “see-through”.  On back teeth, the enamel can erode away from a filling, leaving the filling taller than the tooth surface. 

Because enamel is a tooth’s defense against decay, anything that weakens enamel makes a tooth more likely to get a cavity.  Loss of enamel also causes tooth sensitivity. 

  

How Do I Protect My Teeth From Morning Sickness?

There are several steps you can take to protect your teeth if you are suffering from morning sickness.

 

  1.  After vomiting, do not immediately brush your teeth.  Rinse your mouth thoroughly with water, wait 30 minutes and then brush.
  2. Use an over-the-counter mouthrinse that contains fluoride before bed each night.  Fluoride can strengthen the enamel and protect it against acid.
  3. Chew sugar-free gum throughout the day.  This stimulates your natural saliva production, which raises the pH in your mouth.
  4. See your dentist.  If you are suffering from morning sickness, let Dr. Aanenson and Dr. Kuiper know.  They can assess your risk for enamel erosion and make specific recommendations for you.

 

What Else Can Cause Acid Erosion of Teeth?

GERD – Severe acid reflux can keep the pH in the mouth much lower than normal.

Bulimia – As with morning sickness, consistent vomiting causes enamel erosion.

Lemon juice cleanses – Lemon juice is as acidic as stomach acid and should never touch the teeth.

Are You Suffering With Morning Sickness?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.  They can help you manage the risks associated with morning sickness and help you protect your teeth.

 

 

Dental Insurance:

Are You Throwing Away Money?

Tuesday, November 14, 2017

Some of the most common questions we answer in our dental offices are about dental insurance.  Dental insurance plans and the benefits they provide can be very confusing.  There are thousands of different plans, and many of them even share the same name.   So just knowing that you have Blue Cross Blue Shield won’t get you very far when it comes to figuring out your dental benefits.

The front office staffs in each of our locations have been working with our patients for decades to help them get the most out of their dental insurance.  We have  noticed some trends in recent years that may affect your dental care.  While insurance premiums have stayed the same or increased, the provided benefits have actually decreased.  This means that even though you or your company may be paying the same amount or more, you are receiving a lower dollar amount of dental benefits. 

How Do Dental Insurance Benefits Work?

Dental insurance is not like medical insurance at all.  If required, dental insurance deductibles are usually under $100, and are collected at your first dental visit of the insurance plan year.  Most insurance plans follow a calendar year; some use a different fiscal year, like August-to-August, which is important to know.   This matters when it comes to maximizing your benefits.

Dental insurance plans always have a “maximum”.  These range from $1000-2500.  There are a few great plans that offer higher maximums, but they are rare.  Dental insurance benefits pay up to their stated maximum, and then the patient is responsible for 100% of any fees that accrue past that. 

The important thing to understand about a benefit maximum is that any benefits you do not use during the plan’s year are not carried over to the following year.  They are simply lost.

How Can I Maximize My Benefits?

Do not wait until the end of the year!  Many people forget about their dental insurance until December and then attempt to get all of their dental work done in a short amount of time.  In order you get the most out of your insurance plan, we need to see you as soon as possible.  Our experts will help you with the following things:

Know your plan’s benefit calendar.  If your benefits renew in August instead of January, that may change the timing of your treatment. 
Know your maximum.  If your plan offers $2000 in dental benefits, and you are in need of treatment, you should proceed with treatment before the end of the plan’s calendar.  Otherwise, those benefits are lost.

 

Your care at our dental centers is always based on what is best for your health, and our doctors will treat you with excellence and compassion regardless of the presence or absence of dental insurance benefits.  In all cases, Dr. Aanenson and Dr. Kuiper create a customized treatment plan for each person’s specific dental needs.  Only then will our insurance experts help you prioritize the timing and financing of each prescribed procedure so you get the most out of your dental insurance. 

How Can I Find Out What Benefits I Have?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to speak with one of our insurance experts about your specific plan.  They can answer all of your questions and set you up to see Dr. Aanenson and Dr. Kuiper as soon as possible.

 

 

How Implants Make Dentures Better

Tuesday, November 7, 2017

The History of Dentures

More than 36 million Americans do not have any teeth.  Unfortunately, this state, called edentulism, is nothing new.  Teeth have been removed due to decay and gum disease for thousands of years.  People have also been attempting to replace those missing teeth for thousands of years.  There is historical evidence that dentures were made as far back as 700 BC!  Contrary to popular belief, President George Washington’s dentures were not made from wood, but from a combination of carved ivory, human teeth and animal teeth.

The history of dentures has been a long, ever-changing one.  Man has been attempting to improve “false teeth” for thousands of years.  Most of these changes have been in the materials and techniques by which the dentures are made.  In general, dentures have relied on the remaining jawbone for their only structural support.  And as the jawbone continually changes in response to the absence of teeth, maintaining a proper fit with full dentures is a constant battle.  Only in recent decades have we been able to give a full set of dentures something to anchor onto: Dental implants!

The Trouble With Dentures

A traditional full set of dentures has a large acrylic base that holds the false teeth.  This base simply rests on the gums and jawbone remaining in the mouth after all of the teeth have been extracted.  The gum and jawbone remaining after the teeth are pulled are called the alveolar ridge.  The upper and lower jawbones are unique in that their only purpose is to support teeth.  Once teeth are removed, the bone shrinks and recedes because it no longer has anything to hold onto.  This process happens slowly over a period of years.  As the ridge shrinks, there is less and less for the denture to sit on, so dentures become increasingly loose and difficult to wear.  Some people are able to adapt to full dentures and use the muscles in their cheeks, lips and tongue to hold them in place while eating and talking.  However, many people are not able to achieve that level of muscle control and struggle to keep their dentures in place, often suffering difficulty chewing, and embarrassment when talking or laughing.

Better Dentures 

The solution for this worsening problem with ill-fitting dentures is dental implants.  Dental implants improve dentures in two different ways.
The root form: Dental implants are placed into the jawbone and function similarly to a natural tooth root.  The jawbone responds to an implant the way it would to a tooth root and does not shrink in height or width.  The dental implant acts to maintain the jawbone, giving the denture more surface area of the alveolar ridge to rest on, which is less likely to shrink and change over time.
The abutment: The abutment is the portion of the dental implant system that projects out of the gum tissue.  Abutments come in many shapes in sizes, depending on their purpose.  For the purpose of denture retention, a locator abutment is placed into the implant root form.  The denture contains a cap set into the denture acrylic base for each locator abutment in the jawbone.  There is a range of caps available, giving you and your dentist flexibility in how tightly your denture locks onto the locator abutment.  Because of this locking action, the dentures do not move when you chew or talk! 


This is a vast improvement from traditional dentures, which depend on a person’s muscles to hold them in place.  In this scenario, rather than having an acrylic denture base which simply fits over the gums, there are interlocking pieces on both the implant and the denture, creating a secure connection.  This connection eliminates the embarrassment and fear that plagues traditional denture wearers.

Implant-Supported Dentures 

Dental implants, used to support dentures, employ the same technology used for a single-tooth replacement implant.  It begins with 3D imaging for preoperative planning.  Dr. Aanenson and Dr. Kuiper will work in close collaboration with your oral surgeon to plan the position of the implants for the most optimal support of dentures.  Once the surgical phase is complete, and the implants have achieved adequate stability to withstand chewing forces, Dr. Aanenson and Dr. Kuiper will fabricate dentures with appropriate attachments to connect securely with your implants.  With implant-supported dentures, any adjustment period is much shorter due to the security and stability of the implant-denture connection.  This creates a level of function far superior to any achieved by traditional dentures.  Patients are more comfortable and more confident with implant-supported dentures.

Do You Have Poorly Fitting Dentures? 

If you are interested in implant-supported dentures, call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

Don’t Get Tricked by Halloween Treats

Tuesday, October 31, 2017

Halloween: Making Good Decisions for Your Teeth

Halloween is almost synonymous with candy, and most people know that candy can cause cavities.  What many people do not know is that some candy is worse and more likely to cause cavities than other types of candy.  As dentists, it is easy to be a killjoy on Halloween.  Since we know kids are going to load up on candy at Halloween, we are not going to tell you not to eat it.  We’re going to give you information that will help you make better decisions about Halloween candy.

All Candy is Not Created Equal

The cavity risk associated with candy is based on two factors: 1) the amount of sugar in the candy, and 2) the amount of time the sugar from the candy is exposed to the teeth.  This blog will give you tips to help address both of these factors so that your risk of a Halloween cavity is minimal.

Moderation and Timing is Key

In order the address the amount of sugar in Halloween candy, it is important to exercise moderation.  Try not to binge on Halloween candy, and don’t let your kids do it, either.  Eating large amounts of candy fuels the cavity-causing bacteria in our mouths with unlimited sugar.  Limiting your candy intake to “dessert” (with a meal) also reduces cavity risk by counteracting the high amount of sugar with a high volume of healthy, cavity-fighting saliva.

Make Good Choices

 

  • 1.  Sort through all your Halloween candy.  Make three piles: 1) Sticky, gooey candy like caramels, Starburst, any kind of taffy, anything “gummy”.  2)  Hard candies or anything that is held in the mouth for a long period of time like a jawbreaker or any kind of sucker (lollipop).  Even mints fall into this category.  3) Chocolates or candy bars containing fat, anything that would be eaten quickly.
  • 2.  Now throw away piles 1 and 2.  These sticky and hard candies have a high risk for causing cavities because they expose the teeth to sugar for a long period of time.  The sugar in sticky candies will adhere to the tooth, especially in deep grooves, and provide fuel for bacteria for as long as the candy is stuck to the tooth.  You also fuel those bacteria by sucking on a piece of candy for an extended length of time.
  • 3.  Eat your chocolates and candy bars in moderation as explained above.

 

Feel Bad Throwing Candy Away?

We want to make Halloween as fun as possible while still encouraging good habits.  Consider offering your child a trade-in for his or her Halloween candy.  You can “buy” the candy back at $1 per pound, and then allow then to purchase a non-candy treat with the money, like a Hot Wheels car or sheet of stickers.  You can also use the Halloween candy as an opportunity to teach your child about sharing and giving to others.  Many local shelters and food pantries accept donations of any kind, and they would be happy to receive sweet treats at this time of year.  

 

 

Pizza Burns, Popcorn Shrapnel, and Tortilla Chip Daggers: Soft Tissue Injuries in Your Mouth

Tuesday, October 24, 2017

Have you ever been so excited for your pizza that you just could not wait for it to cool down?  You are starving.   You cannot wait one more second.   So you take a big bite of piping hot pizza, only to feel the searing pain of a tomato sauce burn on the roof of your mouth instead of the simple gustatory satisfaction of bread, tomatoes, cheese and {insert your favorite topping here}. 

Maybe Mexican food is your weakness.  The chips and salsa start calling your name as soon as you walk in the door.  You toss the whole chip with its twists and turns into your mouth, but when you bite down, a shard stabs into your gums. 

At the movie theater, you eat hot, buttery popcorn by the giant handful.  When one shell of a kernel finds its way between your teeth, you spend the entire movie contorting your tongue to try to work it out and curse yourself for not carrying floss with you at all times.

Most everyone can relate to these slightly over-dramatized examples.  In some cases, the damage is very minor and only bothers you for an hour or two.  In other cases, the injury leads to a painful ulceration or a localized gum infection if not handled correctly.  Here is what you need to know about reducing your risk for these types of injuries and how to handle them when they inevitably happen.

How to Reduce the Risk of Injury

Slow down!  Many of these injuries happen because someone is eating too quickly, not allowing food to cool properly, or taking bites that are too large.  In order to lower your risk of these types of injuries, always wait for your food to cool to a manageable temperature.  Only take bites that are appropriate for your mouth, and chew slowly.  When teeth are aligned properly and chewing is performed at a normal rate, the anatomy of the mouth provides protection for the gum tissues, lips, cheeks and tongue as you chew.

How to Handle a Soft Tissue Injury

Keep your mouth as clean as possible!  The initial injury, whether it is a burn, laceration, or impacted food, can quickly progress to an inflammation or infection if not cleaned properly.  Our mouths are full of bacteria, and it is imperative to keep sores clean until they heal.  Gentle swishing of warm salt water or over-the-counter Peroxyl® mouthrinse can keep the injured site clean and promote rapid healing.

Use mild oral care products.  The injured site can be very tender and overly sensitive.  If you find that your normal mouthrinse and toothpaste cause a stinging or burning sensation to the injured area, you should switch to mild, hypoallergenic products like those made by Biotene.

Alter your diet.  Areas of ulceration or inflammation are easily irritated by very hot temperatures, very spicy foods, and acidic foods and beverages.  In order to keep the injured site as soothed as possible, you should avoid drinking hot coffee or tea.  Do not eat food that is extremely hot; allow it to cool down before taking a bite.  During the healing period, eat a mild diet that is not spicy or acidic.  Steer clear of foods high in tomato or citrus content until the area has resolved.

Avoid toothpicks.  If you feel that a popcorn kernel or other food debris is lodged between your teeth and gums, do not use a traditional wooden toothpick to attempt retrieval.  Ironically, we have removed more fragments of wooden toothpicks from patient’s gum tissues than popcorn kernels.  Only use dental floss or small interdental brushes (like a Proxabrush) to remove the embedded food particles.

Be careful when flossing.  It is possible to floss too aggressively and cause damage to your gum tissue.  When you floss with the intent to remove a popcorn kernel or other food particle, it is important to be gentle and monitor your progress.  Ideally, you want the floss to reach under the foreign body and pull it out.  If you feel that your flossing is actually pushing the material further into the gum tissue, stop immediately! 

Come see us.  If you are unable to remove a piece of food or debris, it is important to see your dentist sooner rather than later.  The longer the irritant stays in place, the more likely it is to cause inflammation and can lead to infection.  If you have a painful burn or ulceration, we can prescribe a prescription mouthrinse and/or topical ointment to alleviate the painful symptoms and promote healing.

Have You Injured Yourself?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

Dental Implants:

Restoration of a Missing Tooth

Tuesday, October 17, 2017

A Missing Tooth 

In dentistry, we use the term prognosis to describe how long a tooth will continue to function properly.  That term also encompasses any treatment done on a tooth as a predictor of how long the treatment itself will last and keep the tooth in proper function.  Giving a prognosis of a tooth or treatment is a little like predicting the future.  We are not giving an exact timeline; we are making an educated guess.  We want your teeth and the work we perform on them to last as long as you do!

When a tooth has a hopeless prognosis, the only treatment option is removal of the tooth by extraction.  When a tooth or the proposed treatment to save a tooth has a poor long-term prognosis, we will always give you the option to remove the tooth.  Once the tooth is removed, you will have several options for replacing it.  We believe that your time, effort and money are best invested in something that will last.  The treatment option with the highest success rate for replacing a missing tooth is a dental implant.

Anatomy of a Dental Implant 

One of the reasons a dental implant has such a high success rate is that its anatomy mimics a natural tooth more closely than any other treatment option available in dentistry.  This configuration allows a dental implant to stand alone; it does not anchor or rest on any other teeth the way a bridge or a removable partial does.

A dental implant consists of three parts:

  1. Implant body - The implant body is the root replacement. It is made from titanium, like implants and prostheses used in other parts of the body.  This titanium root form comes in many different sizes, and using our 3D image of your jawbones, we will select the proper size for your specific missing tooth.  In some cases, the implant can be placed at the time of extraction, called an immediate implant.  In other situations, it is necessary to allow the jawbone to heal for several months between the extraction and the placement of the dental implant. Once the implant has been placed into the jawbone, it must heal for several months, allowing the bone to grow into the threads of the implant form, which is a process called osseointegration.  After a minimum of 3 months of healing, we assess the level of osseointegration of the implant to ensure that the implant is stable and ready to withstand chewing forces.
  2. Abutment - The abutment is the connector between the implant root and the dental crown. An abutment can be made from several different materials, as needed for appearance.  The abutment is affixed to the implant root with a small screw, and it protrudes from the gums, providing the core structure for a crown.
  3. Abutment-supported crown - An abutment-supported crown is very similar to a traditional dental crown. It covers the entire abutment form to the gumline and restores the natural anatomy of the tooth, enabling you to return to normal function in this area.

 

What Is the Process for Replacing a Missing Tooth with a Dental Implant? 

Visit 1:  Implant Planning

  

At this visit, images are taken of the proposed implant site, including photographs, dental x-rays, and a 3D CBCT image.  Dr. Aanenson or Dr. Kuiper will determine the best treatment to restore your missing tooth and discuss the details of the upcoming surgical visit.  They will refer you to a skilled oral surgeon for the surgical placement of the dental implant.

Visit 2: Surgical Placement of the Implant

During the surgical visit, you have the option to be sedated, and if you desire this, please discuss it with your surgeon BEFORE this visit.  You can also elect to have the procedure done with local anesthetic only, meaning you are awake throughout.  Implant placement is a relatively quick procedure and usually causes less discomfort than a tooth extraction, so many people choose to remain awake for this visit.  You should feel only vibration as the site in the bone is being prepared and the implant placed.  You will be given very strict post-operative instructions regarding your stitches, care of the surgical site, and oral hygiene to follow.

Visit 3: Post-operative evaluation

Between one and two weeks later, you will return to the oral surgeon for the removal of any stitches and a post-operative evaluation of the surgical site.  This is typically a very quick visit, and most, if not all, post-operative pain or discomfort has subsided by this time.

Visit 4: Uncovering and Testing Implant

At three months post-op, the implant will be exposed to the mouth (if it is not already) by removing the gum tissue over it with a dental laser.  If the implant shows the correct amount of stability, we can proceed with visit 5.

Visit 5: Impression for Abutment and Crown 

This visit may be done in combination with visit 4 if the implant has osseointegrated.  An impression is taken of the implant site and the surrounding teeth. The abutment and crown are designed and fabricated by a dental laboratory.  A healing cap may be placed to maintain the position of the gum tissue while the abutment and crown are being made.

Visit 6: Final Placement of Abutment and Crown

When the abutment and crown are completed, the healing cap is removed from the implant, and the abutment and crown are placed.  The abutment is attached to the implant via a small screw, which is torqued to the appropriate tightness.  Dental x-rays confirm the fit of the crown.  Once the crown meets our standards and feels perfect to you, it will be cemented and cleaned.

Do You Have a Missing Tooth that You Would Like Restored with a Dental Implant?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.  They will discuss your treatment options in detail and help you decide if a dental implant is right for you.

 

 

 

Oral Cancer

Tuesday, October 10, 2017

Cancer is a disease caused by uncontrolled growth of abnormal cells in a part of the body.  Oral cancer is a type of cancer in which these abnormal cells originate in the mouth.  Cancer is classified by the original site of abnormal cells.  Oral cancer kills approximately one person every hour in the United States.  About 50,000 new cases of oral cancer are diagnosed each year. 

What are the different types of oral cancer?

The most common type of oral cancer is squamous cell carcinoma, and it occurs in the tissues lining the inside of the mouth or on the lips.  Squamous cell carcinoma makes up over 90% of all oral cancer.  A much smaller percentage of oral cancers develop in other types of tissue in the mouth, like the salivary glands causing adenocarcinoma, the lymph nodes or lymph tissue like tonsils causing lymphoma, or in pigmented tissue causing melanoma.

What are the risk factors for oral cancer?

The risk factors most closely associated with oral cancer are:

 

  • Tobacco use of any kind
  • Alcohol consumption
  • Infection with human papilloma virus (HPV)
  • Chronic oral infections
  • Persistent trauma to oral tissues
  • Poor oral hygiene, lack of dental care
  • Poor nutrition

 

Who is most likely to get oral cancer?

  • People who work outdoors and have a large amount of sun exposure on their lips are at a high risk for developing cancer on their lips.
  • People who smoke, use smokeless tobacco and/or drink alcohol have a high risk for oral cancer inside the mouth.  Tobacco use combined with alcohol consumption creates a risk level that is higher than either one alone because they act synergistically together. 
  • People infected with the human papilloma virus (HPV) have a higher risk for developing oral cancers at the back of the throat and base of the tongue.  Certain strains of the virus have a higher risk than others.  HPV is the newest known cause of oral cancers and accounts for the changing demographics of oral cancer.  Historically, oral cancer was a disease of old men who smoked and drank alcohol a lot.  The average age of oral cancer has dropped in the last two decades, and it now affects more women than in the past.
  • People with chronic infections and persistent trauma in their mouths have an increased risk for developing oral cancers.

 

What can I do to lower my risk for oral cancer?

 

  • Limit sun exposure and use SPF chapstick!
  • Stop ALL tobacco use, both smoking and smokeless tobacco!
  • Limit alcohol consumption.
  • Practice good oral hygiene.  Treat any persistent infections in the oral cavity including cavities and periodontal disease.
  • If you have an area of your mouth that is prone to trauma (cheek biting, a sharp tooth cutting your tongue), see your dentist to discuss treatment options to reduce the occurrence of this trauma.
  • See your dentist for regular oral cancer screenings.  At the Dental Centers in Freeman, Parkston, and Viborg, this is included in every comprehensive and periodic oral evaluation you have with Dr. Aanenson and Dr. Kuiper.  In its initial stages, oral cancer is typically painless and easily goes unnoticed without a visual evaluation.  This is why consistent oral cancer screenings are so important.  Early detection is key!
  • Perform a self-screening exam once every month.

 

What should I look for in my mouth?

Any ulcer, sore, blister, lump or abnormal tissue that does not heal within 14 days needs professional evaluation by a dentist.  A very common presentation for oral cancer is an overgrowth of white tissue on the sides of the tongue or the floor of the mouth.  Cancerous lesions can also be bright red in color.  As you are screening yourself, simply search for anything that does not blend in with the surrounding tissue both by look and by feel.  Because of some locations in your mouth being difficult to see, you may be able to feel something unusual without seeing it.  Remember, oral cancer rarely causes any discomfort or pain in its early stages, so you have to be looking on a consistent basis to catch it early.

What do I do when I find something in my mouth that could be oral cancer?

Monitor it closely, noting what date you first saw or noticed the lesion.  Take photos of it, if possible.  Any sore, ulcer, or bump that does not heal within 14 days needs professional evaluation by a dentist.  Make an appointment with Dr. Aanenson or Dr. Kuiper for an evaluation as soon as possible.

What is the treatment for oral cancer?

Treatment for oral cancer depends on the stage of cancer diagnosed.  Early detection is the most important factor in beating oral cancer!  The first step is always a biopsy of the abnormal tissue.  Depending on the location of the tissue, this will be done either by a periodontist (gum specialist), oral and maxillofacial surgeon, or an ENT (for lesions on the tonsils or throat).  Once biopsy results confirm a diagnosis of cancer, treatment will commence with the surgeon working in coordination with an oncologist and can include surgical removal of cancerous tissue, chemotherapy and radiation.  Dr. Aanenson and Dr. Kuiper will work in cooperation with your doctors to ensure that the rest of your mouth stays as healthy as possible throughout treatment.

More information on oral cancer can be found online at The Oral Cancer Foundation and the American Association of Oral and Maxillofacial Surgeons.

 

 

Crowns

Tuesday, October 3, 2017

Most people have heard of the terms “crown” and “cap” in regard to dentistry (they are interchangeable, and dentists prefer the term crown), but few actually understand what a crown is.  This blog will explain this, along with why they are necessary, what types of crowns are available in modern dentistry, and what to expect if you are in need of one.

What is a crown?

There are actually two meanings of the word “crown” in dentistry, which can sometimes make things confusing.  We will define both here, and the rest of the blog will pertain only to the second definition.

  1. Crown – the portion of a tooth exposed to the mouth, which excludes the roots (even any root structure that is visible through gum recession).  This definition describes an anatomical portion of a tooth.  The crown is covered in enamel.  Under this definition, every tooth has a crown.
  2. Crown – a dental restoration of a tooth in which all of the enamel has been removed and replaced with a new material.  Crowns can be made out of metals, ceramics, or temporary materials.  A crown should completely cover the entire exposed portion of the tooth, and the edge (margin) of the crown typically rests near the gum line of the tooth.

 

Why do certain teeth need crowns?

  • Very large cavities – In some cases, the integrity of the tooth is undermined by a very large cavity.  Once all of the decay has been removed from the tooth, there must be an adequate amount of solid, healthy tooth structure to support a filling.  If there is not enough tooth structure remaining to hold a filling, then the entire tooth must be covered by a crown in order to restore it to its proper shape for chewing.  In this situation, if a filling were placed instead of a crown, it could only be considered a short-term solution at best. 
  • Fracture – The enamel covering a tooth is one solid, continuous layer.  A visible fracture or crack means that the enamel is no longer able to do its job of protecting the tooth from bacteria, food, and chewing forces.  Interestingly, cracked teeth do not always cause pain.  A crown’s role in “fixing” a cracked tooth is the total replacement of the enamel layer with a new solid, continuous material, which splints the underlying tooth structure together.
  • Lack of adequate coronal tooth structure – Just as a very large cavity can deprive a tooth of the necessary amount of tooth structure, a large filling or even missing tooth structure can do the same.  The crown restores the tooth to its original shape, size and strength to provide proper function.
  • Root Canal Treatment – When a tooth has had a root canal, the nerves and blood vessels have been removed from the inner, hollow chamber of the tooth.  They are replaced with a filling material called gutta percha.  Because the tooth no longer has a blood supply, it no longer has a source of hydration and becomes dried out and brittle.  This brittleness makes the tooth high risk for cracking.  A crown is placed over a tooth that has had a root canal in order to prevent such cracking so that you can keep the tooth for a long time.  A root canal is a significant investment in the life of a tooth.  If the tooth is not properly covered and protected with a crown, that investment could be wasted.

What are the different types of crowns?

There are many different materials available for crowns today. Each material has pros and cons, listed below. What is most important is that your dentist select the proper material for each individual tooth. At our Dental Centers in Freeman, Parkston, and Viborg, we prioritize each patient as an individual with distinct and specific needs. You will never get a “one size fits all” recommendation. Our doctors take all of the pros and cons of each material into consideration when selecting the right crown for your particular needs.

Material

Pros

Cons

Gold

-Requires minimal removal of tooth structure

-Least damage to the opposing tooth

-Studies show best longevity and lowest chance of developing new cavities underneath

 

-Metallic appearance, not cosmetic

-Can wear down over time and can develop holes in its surface when worn too thin

-Can cause a reaction in patients with metal sensitivities or allergies

Porcelain-fused-to-metal

-Better cosmetic appearance

-Very durable and strong to withstand chewing forces

-Not cosmetic enough for front teeth due to opaque appearance and possible gray line at the gums

-Porcelain can fracture away from the metal

-Porcelain biting surface can damage the opposing tooth

Zirconia

-Good cosmetic appearance with no dark metal

-Strongest material available, almost impossible to break

-Can withstand heavy clenching or grinding forces

-Can sometimes appear opaque

-Require more removal of tooth structure

-Very abrasive and damaging to opposing teeth

-Higher incidence of long-term post-operative discomfort

All Porcelain

-Best cosmetic appearance, most like a natural tooth with translucence and shading

-Can achieve micromechanical bond with tooth structure

-Requires most removal of tooth structure

-Most likely to crack or chip

-Porcelain biting surface can damage the opposing tooth

 

What can I expect at my dental appointment for a crown?

At our Dental Centers in Freeman, Parkston, and Viborg, crowns are made in a dental lab by a professional, certified dental lab technician. In order for a crown to be properly fabricated for your specific needs, you will experience a two-appointment process. At the first appointment, the tooth is prepared for the crown under local anesthetic. You should be numb and experience no discomfort during the preparation process. Once the doctor has achieved the proper preparation for your tooth based on the crown selected, either an impression or a 3D scan is taken. Both of these serve to communicate the exact shape of the prepared tooth from the doctor to the lab. The lab uses this to fabricate the prescribed crown. The process typically takes 2-3 weeks. During that time, you will wear a provisional or temporary crown to replace the enamel and cover the tooth. The temporary crown and your bite should feel comfortable after the initial post-operative sensitivity has worn off (on average, a few days). You will return for your second appointment after we have received your crown from the dental lab. At this visit, the temporary crown is removed, the underlying tooth structure cleaned, and the new crown fitted to your tooth. An x-ray is taken to confirm that the crown fits properly and allows no leaking of saliva or bacteria under the crown. The bite is adjusted, if necessary, and then the crown is cemented onto the tooth. You need to have a little caution when eating and cleaning the new crown for the first 24 hours. Afterward, you return to business as usual, eating and cleaning it like you would a natural tooth.

Want more information about crowns?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

 

Hormone-Induced Gingivitis

Tuesday, September 26, 2017

What is hormone-induced gingivitis?

Hormone-induced gingivitis is a type of gingivitis that occurs specifically during changes in hormonal levels .  It is a very common condition that we see frequently in our office.  Hormone-induced gingivitis causes a patient to have gums that are swollen, red, tender, and bleed easily.   The tenderness and bleeding often make oral hygiene routines uncomfortable, and patients sometimes avoid proper brushing and flossing techniques because it hurts.  Healthy, natural gum tissues are light pink, relatively flat and tightly adhered to the teeth.  The appearance of bright red, puffy gums is unsightly, giving a diseased look to the mouth, and may cause embarrassment. 

What causes hormone-induced gingivitis?  

The name says it all: it is induced by hormones.  Rapid swings in hormone levels (most notably estrogen, progesterone, and chorionic gonadotropin) can have a profound effect on gum tissues.  Research has shown that these hormone levels cause two important changes to occur:

  1. Hormone changes affect the tiny blood vessels in the gum tissue, increasing the blood flow in this area (which can cause swelling) and changing the permeability of the blood vessels (which makes the tissue bleed more easily).
  2. Hormone changes also affect the types of bacteria present in gum tissues.  Research shows that gum tissues in patients with hormone changes such as pregnancy or taking birth control pills have more dangerous bacteria than patients without hormone changes.  By “more dangerous”, we mean stronger and more likely to cause gum disease.


Who is at risk for hormone-induced gingivitis?
 

Hormone-induced gingivitis is common in children going through puberty, both girls and boys.  It is also prevalent in women at various stages of hormone changes, including menstrual cycles, the use of birth control pills, pregnancy, and menopause.  This higher risk for gum disease makes oral hygiene even more important than it already is.  People with poor oral hygiene are more likely to experience hormone-induced gingivitis than those with good plaque control and consistent oral hygiene habits.  People who have infrequent and inconsistent dental cleanings are also at an increased risk.

 

What can you do about hormone-induced gingivitis?

 

  • Practice perfect oral hygiene.  Do not miss a single day of flossing!  Use an electric toothbrush; they are shown to effectively remove more plaque than a manual toothbrush.
  • Add a mouthwash to your oral hygiene routine, and use it twice daily.  In addition to an over-the-counter alcohol-free mouthwash, you can swish with warm salt water throughout the day.  Some patients require a prescription mouthwash to get the inflammation under control. 
  • Stay on schedule with professional dental cleanings.  Your dental hygienist is able to remove bacterial buildup from areas you might be missing, even with good oral hygiene. 
  • Consider increasing the frequency of professional dental cleanings.  Many of our patients with severe gingivitis during puberty or pregnancy have their teeth cleaned every 3 months, instead of every 6 months.  This reduces the severity of gingivitis by reducing the amount of bacterial buildup accumulated between cleanings.
  • Talk to Dr. Aanenson or Dr. Kuiper about other recommendations they may have to improve your gingivitis.  There are many additional oral hygiene products available to help reduce gum inflammation.  They will determine which one will be most beneficial for your unique situation.

 

Think you or your child may have hormone-induced gingivitis?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

Aphthous Ulcers (Canker Sores)

Tuesday, September 19, 2017

If you have never had a mouth ulcer, thank your lucky stars!  They are terribly painful and interfere with eating, speaking, and brushing your teeth.  The most prevalent type of mouth ulcer is an aphthous ulcer, and it is commonly referred to as a canker sore.  Aphthous ulcers are unusual in that, even now in 2017, we still do not know exactly what causes them.  There are many studies showing correlation between certain diets, vitamin deficiencies, hormone changes, and stress levels with the occurrence of aphthous ulcers.  But correlation is not the same as causation. 

What are aphthous ulcers?

There are three main types of aphthous ulcers: 1) minor, 2) major, and 3) herpetiform.  They all the share similar appearance of a round or oval-shaped ulcer with an inflamed red border around a yellowish-white film that covers the deeper ulceration.

  1. Minor aphthous ulcers are the most common and least painful.  They typically are less than 1 cm in diameter and last for 7-14 days. 
  2. Major aphthous ulcers are much larger, up to 3 cm, and can last over a month.  Due to their increased size and duration, they are much more painful.
  3. Herpetiform aphthous ulcers take their name from herpes lesions (also called cold sores) caused by a Herpes Simplex Virus, which occur in clusters.  Herpetiform aphthous ulcers also occur in clusters and can easily be misdiagnosed as viral sores.  Herpes viral sores and aphthous ulcers differ in cause and location.  There is no virus associated with aphthous ulcers, and they only occur on freely movable mucosa.  This includes the inner lining of the lips, cheeks, tongue, floor of mouth and the soft palate.  Herpes lesions, or cold sores, occur on the outside of the lips or any attached gum tissue like the hard palate or gums covering the teeth.  When herpetiform aphthous ulcers form in a cluster, the ulcers often coalesce or blend together to form one very large, very painful ulcer. 

 

What causes aphthous ulcers?

There is currently no scientific data identifying one specific cause of these ulcers.  The research studies have shown a correlation in the occurrence of aphthous ulcers with certain predisposing factors, listed here.

 

  • Genetics – Some studies suggest a genetic component because children are much more likely (90%) to experience aphthous ulcers if both of their parents have had them.
  • Certain GI problems – There is a high correlation between patients who experience aphthous ulcers and those with gastrointestinal issues like ulcerative colitis, Crohn’s disease and Celiac Disease.
  • Vitamin deficiencies – Some studies show a correlation between patients with aphthous ulcers and low levels of iron, vitamin B12, and folic acid.
  • Hormone levels – Many women experience aphthous ulcers at regular intervals correlating to their menstrual cycle.
  • Stress – Because stress cannot be quantitatively measured, this one is difficult to prove scientifically.  But it’s no surprise to people who suffer with these ulcers that stress can make them more likely to appear.
  • Trauma – This is likely the most common cause of aphthous ulcers.  Trauma can range from anything as simple as accidentally biting the inside of your lip or hitting your gums with the toothbrush to routine dental treatment or a complicated oral surgery procedure.

 

How are aphthous ulcers treated?

There are many ways to treat the painful symptoms of aphthous ulcers, but there is no cure to prevent them from recurring.  There are many options available, and it is best to discuss them with Dr. Aanenson and Dr. Kuiper to figure out which one is best for your specific ulcers.  Some of the possible treatment options are listed here.

  • A topical gel or paste – Usually a prescription product, this is applied to the ulcer with a Q-tip or clean fingertip multiple times a day.  It typically contains a steroid, which reduces the severity and duration of the ulcer, but does not change the frequency of occurrence.
  • A prescription mouthwash – Also used to alleviate symptoms only, this can contain an antibiotic, antifungal, steroid anti-inflammatory, antihistamine (like Benadryl), and antacid (which creates a thick coating over the oral lining).  When used 4-6 times per day, it can reduce the symptoms of the painful ulcers.
  • Laser treatments – A laser can be used to treat the ulcer, which reduces inflammation and speeds up the healing process by making changes to the surface of the ulcer. 
  • Dietary changes – Patients who are afflicted with frequent or multiple aphthous ulcers and have celiac disease or a 
  • gluten intolerance show a marked reduction in ulcer occurrence when gluten is eliminated from their diet.  A very recent study has also shown an improvement in occurrence of ulcers when a dairy-free diet is observed.  This is based on a new study showing a higher level of antibodies to cow’s milk proteins in patients who have aphthous ulcers.  
  • Vitamin therapy – In patients who do show deficiencies in iron, vitamin B12, and folic acid and experienced frequent aphthous ulcers, the ulcer occurrence rate decreased after vitamin therapy to treat those deficiencies.

 

What can I do about aphthous ulcers?

The most important step you can take is contacting your dentist as soon as you notice the lesion.  All of the above treatment modalities are most effective when started early in the life of the ulcer.

Ulcers are aggravated by acidic foods, spicy foods, and hot temperatures, so avoid them in order to reduce your painful symptoms.  Use caution when eating and talking so that you do not reinjure the area and cause the ulcer to last longer.  Cold can temporarily alleviate symptoms, so we do recommend drinking ice water and holding a piece of ice against the ulcer until you see the dentist for other treatment options.

Do you think you have an aphthous ulcer?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to see Dr. Aanenson and Dr. Kuiper for an evaluation.  They will help you get started on the best treatment to reduce the pain and length of your ulcer.  

 

 

Do I Really Need to Have My Wisdom Teeth Removed?

Tuesday, September 12, 2017

Does everyone need to have their wisdom teeth removed?  Not necessarily.  There are many criteria that dentists evaluate to determine whether or not a patient’s wisdom teeth need to be removed.  There are also different criteria that we use to determine when they should be removed.  As with any type of medical procedure, there are risks and benefits, and we always weigh the risks vs. benefits to determine if the procedure is right for each specific person.

What are wisdom teeth?

Wisdom teeth are the third set of permanent molars in an adult mouth.  The first molars come in, or erupt, at about age 6-7 years, so they are also referred to as 6 year molars.  The second molars erupt at about 12 years of age and are also called 12 year molars.  If third molars erupt at all (many do not; instead they stay hidden under the gums), it’s typically between ages 18-25, so they’ve earned the nickname “wisdom teeth”.

Who can keep their wisdom teeth?

Unfortunately, not many people fall into the category of those who can keep their wisdom teeth with minimal risk of future problems.  In order to keep wisdom teeth with the least risk of cavities and gum disease, people need to have:  1) very large jaws with enough room for the wisdom teeth to fully erupt (come through the gums into the mouth), 2) wisdom teeth that are erupting in the correct alignment with the rest of the teeth, and most importantly, 3) great oral hygiene.  The average adult jaw does not have enough space behind their second molars for another molar to naturally reach the correct position for chewing and proper cleaning.

What are the risks of keeping wisdom teeth?

Assuming wisdom teeth have enough space and do come into their correct position behind the second molars, they are located in an area that is very difficult to keep clean.  Even the best brushers and flossers have trouble reaching the back of a wisdom tooth.  This leads to an accumulation of plaque and bacteria and food debris, which in turn, leads to tooth decay and gum disease.    This accumulation of bacteria also predisposes the adjacent second molar to both cavities and gum disease. 

When wisdom teeth do not have enough space to fully erupt into the appropriate location, several problems can occur.  If the location of the tooth causes it to be partially covered by gum tissue, there is a very high risk of pericoronitis, an inflammation of the gum tissue that surrounds and often lays over the top of the tooth.  Because this partial covering creates a pocket where plaque and food can collect, painful inflammation easily develops, and can even lead to an infection.

When wisdom teeth are positioned at an angle, they are unable to erupt into the mouth (this is referred to as “impacted”) and can damage the adjacent jaw structures, as well as any adjacent teeth.  When this occurs, often both the second and third molars have to be extracted. 

Why take wisdom teeth out preventively?

If your dentist determines that you are at risk for any of the problems noted above, she will recommend preventive extraction of the wisdom teeth and refer you to an oral surgeon.  This prevents potential pain and suffering from problems with the wisdom teeth themselves, and also protects the second molars from the higher risk for cavities and gum disease associated with the presence of wisdom teeth.

Why so young?

Teeth form from the biting surface down toward the roots.  At age 18, a wisdom tooth is much smaller than it is at age 25.  Earlier extraction of wisdom teeth means the removal of a much smaller tooth.  This results in smaller surgical site, smaller extraction sockets, quicker healing, and lowest risk of future infections.  Later extraction, after the tooth has fully formed roots, leaves the patient with a larger surgical site, a larger socket, and longer healing time.

Still have questions about your wisdom teeth?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

FAQ's for New Moms

Tuesday, September 5, 2017

 When do the teeth break through the gums (erupt)?

Normal eruption of the first tooth is generally around 6-7 months of age +/- 6 months.  This means that it is normal for a baby to be born with teeth (6 months old minus 6 months = birth) or to have no teeth until they are 1 yr old (6 months old plus 6 months = 1 yr old).  You can see that “normal” encompasses a pretty wide range.  If your baby’s first tooth is later than the average, you can expect them to also lose teeth later than most of their peers.  This is still considered normal. 

Teething: What can be done, and when will it end? 

Teething causes intermittent discomfort, irritability and excessive salivation as new teeth are erupting in your baby’s mouth.  It can be managed with over-the-counter analgesics, such as Tylenol Infants’ Drops, or allowing the baby to chew on a soft, chilled teething ring.  Use of teething gels containing topical anesthetics such as benzocaine is NOT recommended due to potential toxicity of these products in infants.  Teething happens intermittently as teeth are erupting, so you may notice that it is off-and-on until the child is around 2 years of age or until all the teeth have erupted.

When should I start cleaning my baby’s teeth? 

As soon as a tooth appears!  The American Association of Pediatric Dentistry recommends that you use a smear of fluoridated toothpaste on a soft, infant-sized toothbrush twice a day.

Wait a minute! I thought I wasn’t supposed to use fluoride until the child is old enough to not swallow it? 

Yes, that used to be the case.  However, the recommendations were changed due to research showing that the benefits of fluoride, preventing devastating dental disease, far outweigh the risks.  Fluoride has been deemed safe and effective by both the American Dental Association and the American Association of Pediatric Dentists.  It should always be stored out of the reach of young children and should be used under adult supervision for children under age 5.

What kind of toothbrush should I use? 

There are many products available to clean your baby’s teeth.  You may have to try out a few different types to see which you like the best.  As the teeth first erupt, a soft wet washcloth is adequate to remove the soft buildup that accumulates on the teeth and gums.  There is a type of “toothbrush” for infants that includes a sleeve that fits over the parent’s finger with small rubbery bristles to clean the teeth.  An infant toothbrush is simply much smaller in size with very soft bristles.  Do not ever use a medium or hard toothbrush on your baby!

What about baby bottles or sippy cups? 

Baby bottles are a great way to nourish your child.  Once your child has moved on to a sippy cup and is no longer receiving all of his or her nutrition via bottle, the sippy cup should contain only water.  Anything else that your child sips throughout the day and/or night can greatly increase his risk for tooth decay.  A common cause of cavities in very young children is having a bottle or sippy cup in bed with milk or juice.

What about pacifiers and thumb-sucking? 

These habits constitute a behavior known as non-nutritive sucking because it stems from the sucking reflex babies have and does not provide any nutrition.  Pacifiers and thumb-sucking are a common method very young children use to self-soothe.  Please read our earlier blog on pacifiers and thumb-sucking below to learn more about these habits.

When should my baby visit a dentist?

The American Association of Pediatric Dentists recommends that every child should see a dentist by his or her first birthday or when the first tooth comes into the mouth.  This will enable the dentist to give you, the parent, valuable information and education regarding how best to care for your child’s teeth.  It will also familiarize your child with the dental office.  You will be shown how to properly clean your child’s teeth and given tips on how to best accomplish this as your child grows and becomes more mobile.

 Do you have other questions about your baby’s teeth?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

Back to School

 Tuesday, August 28, 2017

For many people, this time of year is more than just back to school.  It is back to daily and weekly routines, back to bedtimes and alarm clocks, and back to good habits that may have gone by the wayside in the easygoing days of summer.  Add this to your list of daily activities as you get back into the swing of things: taking great care of your teeth!  There are many things involved in pursuing a healthy mouth.  Here are some tips to getting that oral hygiene routine back on track.

 Brushing

  • In order to properly remove plaque (the soft, sticky substance that causes cavities and gum disease), it is necessary to brush your teeth twice a day with a soft or extra-soft bristled toothbrush.              
  • The most commonly missed area in brushing is at the gumline, so make sure the bristles of your toothbrush are gently touching the gums as you brush.   
  • Check the bristles of your toothbrush often.  The American Dental Association recommends replacing toothbrushes every 3-4 months or sooner if bristles are splayed and worn (like the photo shows).  A worn toothbrush cannot do a thorough job of cleaning teeth.   
  • Please remember: never share a toothbrush with anyone, especially your child.  
  • If you or your child is sick with any type of infection, replace your toothbrush or run it through your dishwasher’s “Sanitize” cycle.   
  • Supervise your children’s brushing.  They should only be brushing their own teeth if they can tie their shoelaces or write their name in cursive.  Otherwise, you should still be brushing their teeth for them.                                                                                                                                  

 Flossing

Brushing alone cannot quite get the job done when it comes to removing all of the plaque from your teeth.  The nooks and crannies between your teeth are havens for clumps of bacteria where even the best brusher is not able to reach.  Flossing removes this plaque and reduces your risk for cavities and gum disease.  When you skip flossing, you miss over 35% of the surface of a tooth.  Studies have shown that flossing every day can prolong your life by six years.  

Because flossing is a more difficult skill to master, you should floss your children’s teeth until they show they can properly do it on their own.  The easiest way to floss your child’s teeth is to sit on a bed or the floor, and have the child lay down with his head in your lap.  Have the child tilt his head up so that you can look straight down into his mouth.  This gives you the simplest access for flossing (also good for brushing).  The earlier you start this process, the easier it is to accomplish. 

 Preventive Dental Care

  • Professional cleanings – So let’s say you’re not a perfect brusher and flosser; no one is.  We all have areas that we may miss with our toothbrush or floss.  What happens when sticky, soft plaque is not removed from our teeth?  In 24 hours, it begins to harden into tartar (also called calculus).  Once it has hardened, it cannot be cleaned off with a toothbrush or floss.  It has to be removed by your dentist or dental hygienist.  Tartar buildup that is not removed on a regular basis leads to painful, chronic conditions that require more extensive and more expensive dental treatment.
  • Dental evaluation and x-rays – A dental evaluation by your dentist can uncover problems that can be treated in the early stages, when damage is minimal and restorations may be small.  Dental x-rays show how the teeth are developing and hidden decay that develops between the teeth.  X-rays also allow us to monitor the jawbones for any changes, including cancer or abnormal growths.  These important steps, taken on a regular basis, can help prevent painful, chronic conditions and save money.  Untreated tooth decay is a serious infectious disease for which there is no immunization. 
  • Fluoride application – Cavities used to be a fact of life.  Over the past few decades, one thing has been responsible for a dramatic reduction in the prevalence of cavities: fluoride.  The U.S. Centers for Disease Control says that water fluoridation is “one of 10 great public health achievements of the 20th century”.  Fluoride in your water supply is integrated into children’s teeth as they are forming, adding strength and cavity resistance to their enamel.  Teeth can also be strengthened and protected with topical fluoride.  Topical fluoride includes many products you may already use at home (toothpaste, mouthwash and gel), and it can be professionally applied in your dentist’s office.  Your need for professional fluoride treatment should be assessed by your dentist and is based on your cavity risk level.
  • Sealants Another common area that toothbrush bristles miss is the deep pits and grooves on the biting surfaces of your back teeth.  These types of cavities can be prevented by applying dental sealants over the pits and grooves.  A dental sealant is a thin coating that goes on in a liquid form, flowing into the pits and grooves and then hardening to form a smooth, flat surface that prevents the accumulation of bacteria and food particles.  Sealants are most effective when applied as soon as a back tooth enters the mouth.

 

If you missed getting in to our office this summer for your preventive care, take a look at your school calendar.  School holidays are busy in our office, and appointments go quickly! Pick the next school holiday for your dental visits and call us today to get on the books for the day you want!  

 

 

Radiation Safety

Tuesday, August 22, 2017

We are often asked by our patients about the safety of dental x-rays.  Many people are concerned about the radiation they are exposed to when diagnostic x-rays are taken.  Since exact measurements are difficult to obtain, this article will use averages and comparisons to help you understand the radiation dose you receive from dental x-rays.

Understanding Dose from X-rays

A set of four bitewing x-rays, which is typically taken once per year, delivers an average effective dose of 0.005 milliSievert (mSv). Effective dose is not measured. Effective dose is calculated by taking the dose delivered to the specific organs exposed during an x-ray and accounting for the sensitivity of the tissues exposed. Those values are then summed over all of the tissues in the human body to calculate an effective dose, which allows us to compare doses delivered in different ways to one another.

 

Comparing the dose from a set of four bite-wings to other doses we are exposed to daily is a useful way to understand dental x-ray doses in context. In the graphic below, dental bitewing x-ray dose is shown in comparison to other medical exposures and different sources of naturally occurring background radiation. Naturally occurring background radiation is exposure that each of us gets every day, and some of us more than others depending on the location in the world in which we live. In the chart below, the average US doses are shown. The total US average natural background dose from all sources per year is right around 3 mSv, or 600 times greater than the dose from one set of four dental bitewing x-rays, so you would nearly need to have bitewing x-rays twice a day for a year to equal the dose you receive annually just from living on the planet.

  

Risk from Dental Exposures

What most people worry about when they hear the word “radiation” is whether or not it can cause cancer.  The likelihood of an adverse effect (cancer) given an exposure to radioactivity is also known as risk. The delivery of radiation dose to the head and neck area during a dental x-ray does come with some associated risk.  According to the World Health Organization (WHO)’s publication, Communicating radiation risks in paediatric imaging: Information to support healthcare discussions about benefit and risk, the increased risk of cancer incidence from various types of diagnostic x-rays can be compared with baseline lifetime cancer risk.  This publication focused on risk to children because: “children are more vulnerable than adults to the development of certain cancer types, and have longer lifespans to develop long-term radiation-induced health effects.” Basically, kids are more susceptible than adults to cancer from radiation because they will live longer from time at exposure than their adult counterparts and their bodies are still growing and developing, so their organs are more vulnerable to exposure.  WHO’s studies showed that the increase in cancer incidence, or risk, for children aged 1-10 years from dental x-rays is <1 in 500,000.  That risk would be even lower in an adult. Levels of risk are generally considered to be “acceptable” among agencies that regulate radiation exposures to the public if they are in the range of 1 in 10,000 to 1 in 1,000,000. The cancer incidence risk from dental x-rays to children reported by WHO falls directly in this range of acceptable risk.

 

Benefit

The benefit of dental bitewing x-rays is the early detection of multiple types of oral disease, including cavities, gum and bone infections, and oral cancer.  As with any disease, the earlier it is detected, the less invasive treatment can be and the better the long-term prognosis.  The risk of these diseases going undetected is the progression of disease, spread of infection, loss of teeth, loss of bone in the jaws, and in severe cases even death.


Risk vs. Benefit

Due to the prevalence of oral diseases and the risks associated with those diseases, it is the opinion of our practice, as well as that of the American Dental Association, that the benefits of early detection with diagnostic x-ray imaging far outweigh the risks associated with the x-rays.  The risk of adverse consequences from undetected dental and oral diseases is significantly greater than the risk of increased cancer incidence due to dental x-rays.  Because each patient has different risk factors, the number of x-rays and the frequency at which they are taken can vary widely and is always determined on a case-by-case basis with the utmost respect for balancing patient concerns with positive outcomes.  For example, a patient with a higher risk for cavities or periodontal disease would benefit from more frequent dental x-rays than a patient who has a very low risk for either cavities or periodontal disease.  The more aggressive a dental condition is, the more frequently dental x-rays are needed to provide the best preventive and interceptive dental care.


X-rays and Pregnancy

The American College of Obstetricians and Gynecologists Committee on Health Care for Underserved Women reaffirmed its committee opinion in 2015: “Patients often need reassurance that prevention, diagnosis, and treatment of oral conditions, including dental X-rays (with shielding of the abdomen and thyroid) … [is] safe during pregnancy.”  Dr. Aanenson and Dr. Kuiper typically postpone any dental x-rays during a patient’s pregnancy until after the baby is born unless the patient has a very high risk for disease, which could affect the patient’s overall health and that of the pregnancy.

 

Concerned about Radiation from Dental X-rays?

The number and type of dental x-rays taken on every patient is customized for his or her specific needs.  Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

Tuesday, August 15, 2017

What is Invisalign®? 

Invisalign® is a method of straightening teeth that does not require metal brackets or wires.  It consists of a series of removable clear plastic aligners (or trays) that are custom made for each individual’s teeth.  When a patient decides to straighten their teeth with Invisalign®, Dr. Aanenson or Dr. Kuiper makes a personalized treatment plan for his or her orthodontic needs.  This unique plan is communicated to the AlignTech® laboratory, where each aligner is fabricated via CAD/CAM technology.  The aligners are virtually invisible, and it is one of the most esthetic ways to straighten your teeth.

What are the advantages of using Invisalign® to straighten teeth?

Aside from the obvious cosmetic advantages, Invisalign® provides the patient with the ability to clean the teeth much more easily than in traditional braces.  Because the aligners are removable, they are simply removed for a normal, good oral hygiene routine that includes mouthwash, brushing and flossing.  With traditional braces, adjunctive products such as special flossers, interdental brushes or picks or Waterpik tools are often needed to keep the teeth free of food debris and bacterial plaque.  The Invisalign® aligners make perfect custom whitening trays, so you can whiten your teeth while you straighten them.  The aligners can also be removed for special occasions like weddings, photo sessions, speeches, etc…

What are the disadvantages of using Invisalign® to straighten teeth?

Like the advantages, the disadvantages also stem from the fact that the aligners are removable.  Unlike braces and wires, which cannot be removed by the patient, Invisalign® aligners can be taken out at any time.  This means that the success of treatment depends on patient compliance.  If the aligners are not worn for at least 22 hours per day, the teeth will not move as prescribed by your dentist.  There are times when the orthodontic movement of teeth can cause discomfort or tooth pain.  This makes it very tempting to remove the aligners for relief from the pressure being put on the teeth.  There are many people who do not achieve a successful result with their Invisalign® treatment because they do not wear the aligners as prescribed.

How does it work? 

Through the use of its patented design, Invisalign® aligners move your teeth through the appropriate placement of controlled force.  To put it simply, Invisalign® moves teeth by pushing them into the desired position.  Invisalign® not only controls the amount and direction of force, but also the timing of the force application.  This means that your dentist can prescribe exact movements for each individual tooth, including which teeth not to move, like implants or teeth that are part of a cemented bridge.  Certain teeth can be held in place while others are being moved.

Why do some people get Invisalign® and others get braces? 

There are some limitations to the type of tooth movements Invisalign® can accomplish, and not every patient is a candidate for straightening their teeth with Invisalign®.  An orthodontic evaluation of your teeth is necessary to determine if your goals will be met by using Invisalign®.   

What is the cost?

For Invisalign® treatment, the cost varies depending on the length of treatment and is similar to the cost of traditional orthodontics.  Once Dr. Aanenson or Dr. Kuiper have done a thorough orthodontic evaluation, he will estimate the length of treatment and number of aligners required to meet your goals. 

Does my dental insurance cover Invisalign®? 

Many dental insurance companies do provide coverage for Invisalign®.  It is claimed as a benefit for Adult Orthodontics and typically ranges from $1500-2500.  To find out if you are covered, you can call your dental insurance company and ask if you have adult orthodontic coverage.  Teenagers are often covered under their insurance plan’s orthodontic benefits, up to a certain age limit, which varies depending on your specific insurance plan.

How long will it take to straighten my teeth?

Treatment time varies based on how much movement is required to achieve your goals and how compliant you are with wearing the aligners for at least 22 hours per day.  New studies suggest that each aligner may be worn from 7-14 days.  This range means that some patients may achieve quicker results than others.  Average treatment time for an adult is about 12-18 months. 

How often do I have to see the dentist during treatment?

After treatment has begun, your dentist will typically see you every 6 weeks, which means you will wear three sets of aligners between each visit.  Sometimes more frequent appointments are required to monitor the progress of the teeth.

What are the eating and drinking restrictions during Invisalign® treatment?

Because aligners can be removed for eating and drinking, there are no restrictions to what you can eat or drink when the aligners are not in your mouth.  You can eat with the aligners in, and the chewing force actually contributes to tooth movement.  It is important that you do not drink anything besides water with the aligners in.  Because the aligners keep your saliva from properly bathing the teeth, any acid or sugar from a beverage could be trapped under the aligners and increase the likelihood of cavities. 

Why now?

 There is no better time to straighten your teeth than now!  Over time, teeth continue to shift and move, and most problems are aggravated as we age.  Spacing between teeth continues to increase so gaps get noticeably larger.  Crowding on upper and lower front teeth typically gets worse so teeth appear more and more crooked.  Straightening teeth earlier, rather than later, allows for shorter treatment time and more time to enjoy your new, beautiful smile. 

Interested in learning more about Invisalign®?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an Invisalign® consultation with Dr. Aanenson or Dr. Kuiper.

 

 

 

TMJ Disorder and Dysfunction

Tuesday, August 8, 2017

What is TMD?

TMD stands for TemporoMandibular Disorder or Dysfunction. People commonly refer to this as "TMJ". TMJ actually means TemporoMandibular Joint, and we all have two TMJ’s. TMD is what dentists refer to when the joint has a problem. There are many different types of problems and different levels of severity of these problems.

What is TMJ?

TMJ is the TemporoMandibular Joint, which connects your lower jaw to your upper jaw. It is a ball and socket joint, and it is the most complex joint in the body because it is the only joint in which the ball comes out of the socket during normal function. Anytime you open to speak, yawn, chew or laugh the joint must move within the socket and many times out of the socket. The joint involves two bones (the ball and the socket, anatomically named the condyle and the fossa) separated by a cartilage disc. The disc is held in place by ligaments and muscles.

 How does TMD happen?

There are many reasons for TMD to happen. One of the most common reasons is damage to the muscles and ligaments that hold the disc in position. The muscles and ligaments work to maintain the disc’s position within the joint space during function. If the muscles or ligaments are put under pressure or torqueing forces, damage to the joint can occur. These pressures can develop from many causes; some of these include trauma to the head and/or neck, functional habits like clenching or grinding of the teeth, or posturing the jaw into abnormal positions.

What does it mean to be high risk?

If you are high risk, you show signs that the muscles, ligaments, or disc may be in a vulnerable state or have suffered damage in the past. When there is vulnerability and/or damage, it is necessary to diagnose and stabilize or treat the joint and supporting structures, including the teeth. Some of the risk signs include, but are not limited to:

 

  • Flat spots on the teeth (wear facets)
  • Enlarged jaw muscle size
  • Presence of a line on the inside of the cheek (linea alba)
  • Joint sounds, including popping or crunching/gravel-like noise with or without pain
  • Asymmetry of the face structures or asymmetry during opening or closing
  • Scalloping of the tongue
  • Tenderness of the jaw muscles
  • Headaches in the temples
  • Tenderness in the ear, ringing of the ear
  • Gum recession or tooth notching at the gum line
  • Anterior open bite; the front upper six teeth do not overlap the lower front six teeth

 

What can I do about it?

Diagnosis for TMD is similar to diagnosis for any other joint problem. It is essential to acquire radiographic images of the bones and MRI images of the soft tissue and disc in order to determine the condition of the joint. These images need to be interpreted by a radiologist trained in TMD. In addition to 3D imaging, we use models and photographs of the teeth to aid in the diagnosis of the joint condition and how it has affected your bite. This allows us to correlate the 3D images with the evidence in your mouth.

What treatment will I need?

Treatment for TMD varies greatly. Like damage to the knee, some injuries require surgery. More moderate injuries and concerns can sometimes be treated with oral appliances, orthodontics, physical therapy and/or medication. In order to determine what treatment best suits you, a proper diagnosis with radiographs, MRI, models and photographs is the key.  Without the correct diagnosis, it is impossible to determine what treatment is right for your joint condition.

How do I get started?

If you would like to get a complete diagnosis of your TMJ condition, you will need to complete three steps:

 

  1. Photos, dental models and MRI bite registrations completed.
  2. CBCT radiographic image taken in our office and interpreted by our doctors.
  3. MRI imaging with bite registration. Referral to an imaging center and interpreted by a medical radiologist.

 

What if I don’t do anything?

Without treatment, a very high percentage of high-risk joints progress to a degenerative state over time. This can include loss of the disc (similar to a slipped disc in the back), arthritis, and changes in the occlusion of the teeth (bite). Many people without treatment develop chronic neck and jaw pain.  Other patients will adapt to the dysfunctional joint.  It is impossible to predict how TMJ dysfunction will affect a person over the course of his or her life. 

Need more information?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a TMJ consultation with Dr. Aanenson or Dr. Kuiper.

 

 

High Risk for Teeth Grinding 

Tuesday, August 1, 2017

What is bruxism? 

Bruxism is the medical term for the grinding of teeth or the clenching of jaws. Bruxism often occurs during deep sleep or while under stress.  Clenching and/or grinding the teeth can be a subconscious act, meaning you are unaware that you are doing it.  Many people clench or grind their teeth when they are concentrating, driving or working out in addition to while they are sleeping.

What are the causes of bruxism?

Bruxism can have several different causes.  Some people have irregularities in the way the teeth come together (occlusion) that cause increased muscle activity.  Other people clench or grind their teeth when they are under stress.  Often, bruxism is a sign of a sleep-disordered breathing problem, like sleep apnea.  It can also be a side effect of certain medications, including some antidepressants and ADHD medications.

 

What does it mean that I am high risk? 

There are multiple factors that can show your dentist that you are at high risk for clenching or grinding your teeth.

  •        Wear facets – damage to the biting surfaces of  teeth that looks like flattened areas
  •        Tightness or soreness in the muscles of the jaws
  •        Excessive muscle force – evidenced by large facial muscles
  •        Recession – loss of gum attachment, teeth appear longer
  •        Abfractions – notching of enamel at the gumline
  •        Potholes on the biting surfaces of back teeth – the enamel is completely worn away, and the underlying tooth structure becomes deep and concave, just like a pothole in the road
  •        Linea alba – white callous line on inner cheeks
  •        Scalloped tongue – the outer edges of the tongue become shaped like the inner edges of the teeth

 

What can I do about it? 

You can prevent some of the damage to your teeth and gums by having a dental nightguard custom made for your mouth.  When you sleep in a protective nightguard, you decrease the stressful forces applied to the teeth as you sleep and protect them from further breakdown.  If you find yourself clenching during the daytime, talk with Dr. Aanenson or Dr. Kuiper about techniques to help break that habit.

What if I don’t do anything?

Bruxism can lead to multiple complications of your oral health.  Inside the mouth, bruxism can cause cracked teeth, loss of tooth structure, shortened teeth, gum recession, abfraction or notching of the teeth at the gumline.  These complications can result in many different types of damage to the teeth and an increased cost of dental care over your lifetime.  Outside the oral cavity, bruxism can cause problems in the chewing muscles or in the jaw joint itself.  Muscle tension can lead to facial pain or headaches.  Problems in the joint can lead to arthritis and slipped disks within the jaw joint.  This all can lead to pain, limited function, and decreased overall quality of life.

How do I find out if I am grinding my teeth?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up a consultation with Dr. Aanenson or Dr. Kuiper.

 

 

 

Athletic Mouthguards

Tuesday, July 25, 2017

People say that having children involved in sports is expensive.  In dentistry, we commonly see one of  thmost expensive aspects of sports: injuries.  The bad news is that the injuries themselves are sometimes unavoidable.  The good news is that the damage to the teeth, gums, lips, cheeks and jaws associated with sports injuries is largely preventable by wearing an athletic mouthguard.

Sports injuries to the face are very common and very expensive.  A research study on the use of athletic mouthguards cited some interesting statistics.

“The U.S. surgeon general’s report on oral health identified sporting activities as one of the “principal causes of craniofacial injuries.” Studies have linked sporting activities to nearly one-third of all dental injuries, and approximately one in six sports-related injuries is to the craniofacial area.”

Who needs an athletic mouthguard?

Most people associate sports injuries to the teeth with contact sports like football and hockey.  Interestingly, even non-contact sports such as baseball, gymnastics and cycling have a high incidence of injuries to the mouth.  If there is any chance you could be hit in the mouth by another person, a ball, or the ground, then you need an athletic mouthguard.

How do athletic mouthguards work?

Mouthguards work to prevent or lessen the severity of many types of damage to the mouth that can occur during a sports injury to the face and jaws.  They function by covering the teeth, separating the lips and cheeks from the teeth, and separating the upper and lower teeth from each other.  These three mechanisms of action are listed below with which types of injuries they can prevent or lessen the severity.

1.  Covering the teeth - This covering prevents or lessens the severity of various injuries to teeth.  Examples of injuries to the teeth during sports include:

  • Chipping
  • Luxation (forced movement of the tooth out of its natural position)
  • Root fractures
  • Avulsion (a tooth is knocked completely out with the entire root)
  • Intrusion (a tooth being forced into its socket so that it looks shorter than normal)
  • Necrosis (death of the nerves and blood vessels inside a tooth from blunt force)

 

2.  Separating the lips and cheeks from the teeth – This separation prevents or lessens the severity of various injuries to the soft tissues of the mouth. 

  • Cuts or lacerations to gum tissue, lips, cheeks, and intraoral muscle attachments

 

3.  Separating the upper and lower teeth from each other - This separation prevents or lessens the severity of various injuries to the teeth and jaw joints by preventing a harsh impact of upper and lower teeth and jaws.

  • Condylar fractures – The condyles are the “balls” of the ball-and-socket jaw joints.  A sharp impact between the upper and lower jaws can cause a fracture of the jaw bone just underneath the condyle. 
  • Dislocation of TMJ (jaw joint) disc – The jaw joints each contain a small cartilage disc that separates the ball from the socket.  When the lower jaw is hit with an impact, it can force the condyle (ball) off its correct position on the disc.  This leads to TMJ dysfunction and may require surgical intervention to repair.
  • Broken back teeth – Any time the upper and lower teeth are forced together with high forces, the back teeth can crack and break.  Sometimes, they can be repaired through dental restorations; in other cases, the tooth has a hopeless long-term prognosis and must be extracted.

 

An important thing to note is that these problems can have long-term consequences requiring dental treatment for decades after the injury. 

What types of athletic mouthguards are available?

There are three main types of mouthguards: stock, boil-and-bite, and custom.  The stock and boil-and-bite type mouthguards are available over the counter, and a dentist makes the custom mouthguard.  Because a custom mouthguard is made from a model of a patient’s teeth, it will have a better fit and should be very comfortable.  There is typically a direct correlation between cost and comfort; i.e. a stock mouthguard will be very inexpensive and very uncomfortable.  The more comfortable a mouthguard is, the more likely the athlete will be to wear it regularly. 

How do I take care of my athletic mouthguard?

Do not clench on the mouthguard or chew it while you are wearing it.  This will speed up the normal wear and tear and cause you to need a replacement much sooner than average.

After every use, rinse it.  The best thing to do is to clean it with a soft toothbrush and cold water.  You can use liquid hand soap if necessary. 

When not in use, store it in its vented case in a cool, dry area.

Do not allow it to get hot because it will lose its shape.  This includes leaving it in your car!  

Do you or your child need an athletic mouthguard?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

 

Thumb sucking and Pacifiers

Tuesday, July 18, 2017

Parents of our littlest patients frequently ask us about oral habits such as thumb sucking and pacifiers.  These perfectly normal behaviors in an infant can become damaging to an older child’s facial growth and development.  There are many different opinions and treatment options, and this blog will give you a general overview as to the most widely accepted philosophies and treatments for prolonged habits.

Non-Nutritive Sucking Behaviors

Both thumb sucking and pacifier use are classified as “Non-Nutritive Sucking Behaviors” or NNSB.  All infants exhibit sucking behaviors because it is necessary for their nutrition, through either breastfeeding or a bottle.  Non-nutritive sucking behavior is performed with the same sucking motion, but no nutrition is received.  Its purpose is solely comforting or soothing.

What is “normal”?

Any non-nutritive sucking behavior in infancy is considered normal.  There are ultrasounds showing babies sucking thumbs or fingers in the womb.  Over 90% of children exhibit NNSB at some point during the first 2 years of life.  Researchers differ on what age at which NNSB is considered “prolonged”.  Most agree that by age 4 years, any NNSB should have naturally stopped.  On average, most children will discontinue thumb-sucking or pacifier use on their own at some point from ages 2 to 4 years.  Prolonged thumb-sucking or pacifier use is anything past 4 years of age. 

Why is prolonged thumb sucking or pacifier use bad?

Short explanation: It causes improper development of the jaws and positioning of the teeth that can only be corrected with orthodontics.

Long explanation: During growth, the jaws are very susceptible to outside influences.  The suction forces can distort the shape of the upper jaw and the position of the teeth causing an incorrect bite (malocclusion).  The pressure of a thumb or pacifier on the roof of the mouth can increase the height or vault and narrow the dental arch, which reverses the proper bite relationship between the upper and lower teeth (a posterior crossbite).  The constant presence of a thumb or pacifier in between the upper and lower teeth pushes them into a position that accommodates the habit and leaves an opening (called an anterior open bite) rather than allowing the upper and lower front teeth to contact in the appropriate way.  This open bite can lead to tongue thrusting and lisping, as well as not being able to bite into foods with the front teeth. 

 

What should a parent do about prolonged NNSB?

The first step to take in aiding your child to discontinue sucking thumbs or using pacifiers is talking to him or her about the negative effects of the habit.  Your child thinks the habit is a good thing because it makes him feel good, and he may not be able to understand the cause and effect relationship between the habit and the consequences to their teeth, jaws and face.  Children who verbalize that they are ready to stop the habit will have the quickest success.

 

  • Gently discourage the habit and use positive reinforcement when he or she is successful. 
  • Start small with goals that are easier for him to meet, such as watching a movie without sucking his thumb.
  • Do not punish the child for continuing the habit.  Negative reinforcement is not recommended as a technique because the habit is something that comforts or soothes him.  Shaming or scaring him will only cause him to feel a greater need to suck his thumb or use his pacifier.
  • Because stress or anxiety can increase the child’s need to self-soothe by thumb sucking or pacifier use, try to identify situations that make him feel anxious and address them as needed.
  • If possible, gently and quietly remove the thumb or pacifier from his mouth after he has fallen asleep.

 

Pacifiers have one benefit over thumbs: they can be taken away or made dysfunctional (cutting the tip off a pacifier renders it useless).  If the child claims he is ready to stop, simply remove any pacifiers from his possession and go “cold turkey”. 

Thumb sucking is a bit more difficult because the thumb is always available.  Because of this, thumb sucking typically persists longer than pacifier use.  Some try applying bitter-tasting nail polish or wrapping the thumb in a Band-Aid or covering the entire hand with a sock. 

Ask your dentist and pediatrician for their input on the habit.  There are many different techniques used to help in stopping the habit before it causes long-term damage.

As a last resort, a dentist, pediatric dentist or orthodontist can fabricate a dental appliance that prevents the habit by removing the ability to create a suction and impeding the insertion of the thumb or pacifier.  The appliance does not contain sharp spikes or anything that would harm the child’s tongue or fingers; it simply prevents them from being able to enjoy the sensation of the habit.

Concerned about your child’s thumb-sucking or pacifier habit?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

Product Highlight: Xylitol

Tuesday, July 11, 2017

What is xylitol?

Xylitol is a natural sweetener derived from the fibrous parts of plants, and it a healthy substitute for sugar. Xylitol is not an artificial substance, but a normal part of everyday metabolism.  It is widely distributed throughout nature in small amounts. It does not break down like sugar (which turns into acid when the bacteria in the mouth digests it) and can help keep a neutral pH level in the mouth. It also prevents bacteria from sticking to the teeth, increases saliva flow, and is shown to stimulate remineralization of teeth. Research studies have shown a reduction in the levels of Streptococcus mutans (the bacteria that causes cavities) in plaque and saliva with a consistent daily dose of xylitol chewing gum. All of these factors promote good oral health.

Who could benefit from xylitol products?

High risk for cavities - Because it helps reduce the levels of cavity-causing bacteria, patients who have a high risk for cavities will benefit from xylitol products.  In addition to reducing bacteria, it also increases the flow of saliva, which is the body’s natural defense against acid, which causes cavities.

Plaque control - Because it helps reduce plaque formation, it is very helpful for patients who lack the manual dexterity to properly brush and floss their teeth.  This includes young children, elderly people, people with special needs or those affected with arthritis.

Dry mouth (or xerostomia) - Due to its salivary stimulation, xylitol chewing gum is a great product for anyone suffering from dry mouth.  It will cause the mouth to naturally produce saliva and alleviate the symptoms of dry mouth.

How can I use it to improve my oral health?

You may see xylitol as an ingredient in many over-the-counter products such as gum and mints. It is also available as a sugar substitute, found at most health food stores.  Read the label to find out how much xylitol is present. Research studies vary in their conclusions as to how much xylitol is necessary to prevent cavities. An average recommended xylitol intake for reducing your cavity risk is 6-10g per day.   Studies have also shown that chewing xylitol gum has a greater anti-cavity effect than sucking on xylitol mints because the chewing motion also increases your saliva production, which helps neutralize the pH in your mouth.  Ice Cubes gum by Ice Breakers has over 1.5g of xylitol per piece!  It comes in many flavors and is available at most grocery stores, including Walmart.  The only patients that should not use xylitol chewing gum are those with TMJ problems.  If you suffer from clicking, popping or locking of the jaw joints, chewing gum could aggravate your symptoms and cause joint pain.  Ask your dentist if chewing gum could be problematic for you.

IMPORTANT!  Xylitol is toxic to dogs!


Make sure you keep any xylitol products out of reach of your pets.  Xylitol is highly toxic to dogs.  It can cause low blood sugar, seizures, liver toxicity and even death.  If you find that your dog has gotten into a container of any xylitol product, call your veterinarian immediately. 

Want to find out if xylitol is right for you?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

 

Crest Sensi-Stop Strips

Wednesday, July 5, 2017

Who needs Crest Sensi-Stop Strips?

Sensitive teeth can be annoying, causing you to avoid certain foods or drinks, changing the way you chew or swallow, and even interrupting a conversation because you are in discomfort.  This blog highlights one of our favorite over-the-counter products that can help alleviate this common problem.

 {Disclaimer: Sensitivity to hot and cold temperatures or sweets can sometimes indicate that a tooth has a cavity or a crack.  It is important to see Dr. Aanenson and Dr. Kuiper to confirm that this is NOT the case before proceeding to over-the-counter relief products.  Please scroll down to read our previous blog about Sensitive Teeth.}

How are Crest Sensi-Stop Strips different from other products?

There are many over-the-counter products available, mostly toothpastes like Sensodyne, which contain the ingredient potassium nitrate. Potassium nitrate is an effective desensitizer in some cases and must be applied to the teeth regularly to achieve the desired desensitizing effect.  In most cases, you need to use the sensitivity toothpaste twice daily for at least two weeks before you will notice any relief in sensitivity.  Crest Sensi-Stop Strips are unique in their active ingredient, the method of application, and the length of sensitivity relief they provide.

 

How do Crest Sensi-Stop Strips work?

Most tooth sensitivity is caused by gum recession, which exposes the roots of teeth. Tooth roots should be covered by gum tissue and insulated against the hot and cold temperatures of food and drinks that we consume.  When gums recede, the root structure is exposed to those temperatures, and in some cases become very sensitive.  The active ingredient in Sensi-Stop strips is oxalate, a chemical that has been proven to fill in the open tubules (pores) on exposed root surfaces, thus eliminating the transmission of hot or cold temperatures to the nerve inside the tooth.

They also use a unique delivery method: the same type of strip everyone knows as Crest Whitestrips. Instead of a whitening gel, the strips are coated in an oxalate-containing gel.  This allows them to be effectively applied directly to the area of sensitivity.  They cover about three teeth and should be left in place for 10 minutes.  For the best results, they are applied to the sensitive teeth for 10 minutes per day, 3 days in a row.  This technique has been shown in clinical studies to provide at least a month of relief from sensitivity to hot and cold temperatures, sometimes even longer!  When you notice the sensitivity returning, simply use the strips again.

 

When should I use Crest Sensi-Stop Strips?

You can use them anytime you feel sensitivity on your teeth.  Make sure to follow the instructions.  You should not use them more than 3 times on the same site in less than 1 month.  If you did not experience any relief of the sensitivity in that area, you should contact Dr. Aanenson and Dr. Kuiper to discuss the issue.

These can be especially useful for people who dread getting their teeth cleaned because of the sharp pain caused by cold air or water used by your dental hygienist. If you have experienced this, try using a Sensi-Stop strip over the sensitive area 1-3 days prior to your dental cleaning.  Let your dental hygienist know that you have tried them and whether or not you notice a difference.

 

Need more information?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

Dental Sealants

Tuesday, June 27, 2017

What are dental sealants? 

Dental sealants are a protective barrier, covering the most vulnerable surface of the teeth and shielding them from cavity-causing bacteria. The sealants are most commonly applied to the chewing surfaces of the back teeth (premolars and molars) where decay occurs most frequently.  They can also be applied to any deep pit or groove that is high risk for decay, including the back of upper front teeth.

How does a sealant help prevent decay?

A sealant is a dental material that is applied to the chewing surfaces of the back teeth—premolars and molars. This material has a micromechanical bond to enamel in the deep pits and grooves of the chewing surfaces of back teeth. The sealant acts as a barrier, protecting enamel from plaque, bacteria and acids.

Thorough brushing and flossing help remove food particles and plaque from smooth surfaces of teeth. But in some cases, toothbrush bristles cannot reach the depth of pits and grooves to extract food and plaque. Sealants protect these vulnerable areas by filling in the grooves to prevent any accumulation of bacteria, plaque or food, and by creating a shallower, more cleansable surface for the toothbrush.

Is sealant application a complicated procedure?

Sealants are easy for your dentist or dental hygienist to apply, and it takes only a few minutes to seal each tooth. The teeth that will be sealed are cleaned. Then the chewing surfaces are roughened with an etching solution to help the sealant adhere to the tooth. The sealant is then “painted” onto the tooth enamel, where it bonds directly to the tooth and hardens. Sometimes a special curing light is used to help the sealant harden.

The only difficult aspects of sealant application are the bad taste of the materials used and the need to keep the tooth dry.  If a child is very cooperative, the sealant can be applied without his or her ever tasting the materials.  There is no pain associated with the application of a sealant.  

Sealants are just for kids, right? 

The likelihood of developing pit and fissure decay begins early in life, so children and teenagers are obvious candidates. Children typically do not have the manual dexterity necessary to adequately clean their teeth, so they are at a higher risk of developing cavities.  Adults can benefit from sealants as well.  An easy way to determine where a sealant would be most beneficial for an adult is to look for dark stains in the pits and grooves of the teeth.  A deep crevice that is accumulating stain which cannot be removed by brushing is a high-risk area for a cavity to start.  If it is collecting stain, it is also collecting bacteria.  Over a period of time, the bacteria is very likely to start damaging the enamel surface, leading to a cavity. 

“CDC Promotes Dental Sealants in New Report

According to a new U.S. Centers for Disease Control and Prevention (CDC) Vital Signs report, dental sealants are an extremely effective intervention for preventing most of the cavities children get in their permanent back teeth, but the majority of children still don’t have them. The report also found that children from low-income families, who are at increased risk for cavities, are less likely than children from higher-income families to have dental sealants. Increasing sealant use prevalence could substantially reduce untreated decay, associated problems, and dental treatment costs, the CDC report concludes.

Additional findings of the report include:

  • School-age children (ages 6-11) without sealants have almost three times more first molar cavities than those with sealants.
  • Although the overall number of children with sealants has increased over time, low-income children are 20 percent less likely to have them and two times more likely to have untreated cavities than higher-income children.”

 

Sounds great! Can I have dental sealants on all of my teeth?

Once a tooth already has decay, it cannot be sealed.  The decay must be removed and restored with a filling.  A one surface filling to fix this type of cavity costs over $200.  Placing sealants can prevent this type of decay, decreasing your costs for dental care in the long run.  A thorough evaluation of all of your teeth should be performed by your dentist to determine which teeth could benefit from sealants. 

Do sealants last forever?

As long as the sealant remains intact, the tooth surface will be protected from decay. Sealants hold up well under the force of normal chewing and usually last several years before a reapplication is needed. They can be damaged by habits such as teeth grinding and chewing ice.  During your dental evaluations, Dr. Aanenson and Dr. Kuiper will confirm the effectiveness of the sealants and reapply them when necessary.

Need more information?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

 

Periodontal disease:

What does it mean to be high risk?

Tuesday, June 20, 2017

What is periodontal disease? 

Periodontal disease is a disease that affects the structures supporting the teeth, including both the gums and the jawbone.  Its primary cause is bacterial buildup on the teeth, and some people have a higher risk due to genetic factors, systemic disorders (such as diabetes), and habits (such as smoking or oral tobacco use). 

What are the stages of periodontal disease?

The earliest stage of periodontal disease is called gingivitis, which means inflammation of the gums.  Inflammation can involve one or more of the following:

  • A bright red color to the gums
  • Swollen or puffy gums
  • Gums that bleed easily when brushing, flossing or having teeth professionally cleaned

 

 

 How does periodontal disease happen?

Periodontal disease begins with the accumulation of bacteria and plaque on the teeth.  This can be due to poor oral hygiene, and it can also be due to the presence of very difficult-to-clean areas on your teeth.  When teeth are crooked or rotated, they collect more bacteria.  We all have different types of bacteria in our mouths, and some types are more destructive than others, meaning they are more likely to cause disease.  Research studies show that the types of bacteria that gather on crooked teeth are more likely to cause periodontal disease than the types of bacteria that collect on straight teeth.  Periodontal disease progresses as the bacteria and plaque harden on the teeth into tartar, which can only be removed with a professional cleaning.  If no professional dental care is completed, the tartar accumulation will grow, causing more inflammation and more serious damage to the gum and bone.  In severe periodontal disease, the supporting structures have become so damaged that they can no longer hold the teeth, which become loose and have to be extracted.

What does it mean if I am high risk?

If, during your evaluation, you presented with some signs of gingivitis, you would be classified as high risk for periodontal disease.  As stated earlier, gingivitis is the first step to periodontal disease, and if left untreated, it can lead to a progression of disease.  The good news is that in the early stages, periodontal disease is completely reversible!

Risk factors noted during a clinical evaluation:

  •        Pockets measuring ›3mm
  •        Poor oral hygiene
  •        Crowded teeth
  •        Prior periodontal disease
  •        Bone loss
  •        Mobility (loose teeth)
  •        Gum recession
  •        Mucogingival defect (gum tissue that is not attached to the bone underneath it)
  •        Abnormal frenum attachments

What can I do about it?

  1. Have a professional dental cleaning.  This removes the bacterial accumulation from the teeth, essentially giving you a “clean slate”.
  2. Change your oral hygiene routine as directed by your dentist or hygienist.  This may involve different toothbrushing techniques, an electric toothbrush, consistent flossing, interdental brushes, etc . . .
  3. If prescribed by your dentist, begin an antibiotic mouthrinse daily.  The more bacteria you kill, the less there are to accumulate on your teeth.
  4. Return for a follow-up professional cleaning in 6-8 weeks.  This allows us to assess the home care, suggest any positive changes to be made, and again remove bacteria that have accumulated.

 

What if I don’t do anything?

Without treatment, bacterial levels will increase, causing more accumulation of plaque and tartar.  More plaque and tartar causes more inflammation and response from the gums and bone.  As the bone migrates away from the tartar buildup, which it considers a foreign substance, the support for the teeth is slowly lost.  In a worst case scenario, untreated periodontal disease eventually leads to loss of all teeth and loss of the underlying jawbone, which makes future treatment with either dentures or dental implants less predictable.

Need more information?

Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

Sensitive Teeth

Tuesday, June 13, 2017

 Many people experience sensitive teeth, and not everyone has the same symptoms.  You can have one sensitive tooth, or a mouth where every single tooth feels sensitive.  You can have sensitivity to cold and/or hot temperatures and sweet and/or sour flavors.  However you experience it, it is no fun!

 

Teeth are not supposed to be sensitive, and if they are, it is a symptom you should share with your dentist.  She will discuss your specific issues and try to isolate the cause of your sensitivity so that you can remedy the situation. 

What Causes Tooth Sensitivity?

 There are three main causes of tooth sensitivity.  In order to understand these, let's cover a little dental anatomy first.  Teeth are hollow, and the hollow space inside teeth contains a nerve that sens signals to your brain telling you when something is not quite right.  The part of the tooth you can see is called the crown.  The crown is covered in enamel, which is the hardest substance in the body, even harder than bone.  Enamel is made to be a solid coating over the crown of the tooth, protecting it from the sensations we expose our teeth to when we eat and drink.  The part of the tooth you cannot see because it is hidden in the jawbone and gums is the root.  The root of the tooth is not covered in enamel because it is meant to be encased in bone and gums. 

 

 1.  The first possible cause of tooth sensitivity is when there is a problem with the enamel coating of the tooth.  This includes cavities and cracks which disrupt the solidarity of the enamel and provide an opening for those sensations to reach the nerve inside the tooth. 

 2.  The second most common cause of tooth sensitivity is exposure of the root caused by gum recession.  When gums and bone recede, it exposes the root to the mouth and all the subsequent sensations associated with eating and drinking.  Because the root does not have enamel, it does not have the same protection as the crown of the tooth.  This means the nerve inside the tooth can feel temperatures and flavors more than it is supposed to.  (Gum recession does not always cause tooth sensitivity.  Dr. Aanenson and Dr. Kuiper will evaluate the area where you feel sensitivity to determine if this is the cause.)

 

3.  The third most common cause of tooth sensitivity that we see in our office is bruxism (clenching or grinding your teeth).  This can cause individual tooth sensitivity or an entire mouth full of sensitive teeth.  The cause of bruxism-related tooth sensitivity is hypersensitivity of the nerve inside the tooth because it is being subjected to abnormally-strong biting forces. 

 These causes can become interrelated because bruxism often leads to tooth cracks and gum recession.  But let's say cavities, cracks and gum recession have all been ruled out, and your teeth are still sensitive.  Now it's time to evaluate your whole mouth for signs of bruxism.  The hypersensitivity of the nerve caused by the heavy forces of bruxism can affect different teeth at different times or all the teeth at once and often is inconsistent.

 What Can I Do About Tooth Sensitivity?

 The very first thing to do is have a dental evaluation to rule out cavities and cracks.  Either of those conditions will require dental treatment to fix the problem.  Once the cause of the sensitivity is treated, it should subside.  It's not always an immediate cure; it can take a few weeks after treatment for the nerve to settle back to normal.  If you experience sensitivity more than a few weeks after treatment, you should have the tooth evaluated again. 

 If cavities or cracks are ruled out, then the cause of tooth sensitivity is likely a gum recession problem.  There are many ways to treat hypersensitivity from gum recession including (but not limited to) fluoride treatments, over-the-counter sensitivity toothpastes and strips, fillings to cover the exposed root surface, or gum grafting to return the gums to their proper position. 

If bruxism is determined to be the cause of your sensitivity, the simplest way to treat it is by wearing a mouthpiece (night guard) while you sleep that keeps the teeth separated and reduces the biting forces put on the teeth.

 

Tooth sensitivity can be treated relatively easily.  The most important factor in treating it is accurately diagnosing the cause, which is your dentist's job. 

 Need more information?

 Call our office at 605-925-4999 (Freeman), (605) 928-3363 (Parkston), or (605) 326-5612 Viborg to set up an evaluation with Dr. Aanenson or Dr. Kuiper.

 

 

 

Do I Really Grind My Teeth?

June 6, 2017

Some of our patients are surprised when we inform them that we see evidence in their mouths of teeth grinding, or bruxism.  Many people have no idea that they are grinding their teeth.  And what happens very frequently is they come back in six months and say, “You know . . . I think I might be grinding my teeth.  Ever since you told me that six months ago, I’ve been noticing {insert symptom here}.” 

Signs vs. Symptoms

In order to explain this phenomenon of a dentist telling the patient about something they are doing which they are unaware of, it is important to understand signs and symptoms.  Signs are objective, observable facts.  This means they are not swayed by opinions or feelings, and they can be shown by a photograph, an x-ray or other type of image, a lab result, etc…  Signs are noted by the dentist during an evaluation of your mouth.  Signs can exist without any symptoms, so it is possible that a dentist can inform you of the signs of a condition without your being aware of any issues.

Symptoms are subjective evidences of a condition or disease of which the patient is aware.  For instance, pain is a symptom because it cannot be observed, and the patient must describe it to their doctor for it to be properly documented and used to aid in diagnosis.  Other examples of symptoms include anxiety, fatigue, or muscle tension.

Bruxism (Teeth Grinding)

Bruxism is a very common condition in which a person closes the upper and lower jaws, creating high pressure on the teeth, gums, supporting jaw bones, facial muscles and jaw joints.  It can include hard squeezing called clenching, or a side-to-side or back-and-forth movement called grinding.  When bruxism occurs, it will manifest in one or more clinical signs and possibly some symptoms. 

Signs of Bruxism

  • Attrition – the flattening of the biting surfaces of teeth and loss of enamel caused by clenching or grinding
  • Potholes – a specific type of attrition where the enamel has been worn through, and the underlying dentin is exposed and worn down into a concavity
  • Gum Recession – movement of the gum attachment away from stressful biting forces on the tooth to a position further toward the root, can cause exposure of the root and tooth sensitivity

 

 

  • Tooth Abfraction – a loss of tooth structure at the gumline causing a notch or concavity
  • Facial Muscle Enlargement – as with any other muscle in the body, when exercised frequently, they will enlarge
  • Linea Alba – Latin for “white line”, this is a visible line on the inside of your cheeks caused by friction against the grinding teeth, like a callous
  • Scalloped Tongue – the sides of your tongue can be pressed against the inner surfaces of the teeth when clenching or grinding, causing it to conform to the shape of the teeth and have a scalloped appearance

 

Symptoms of Bruxism

  • Facial pain, including headaches – constant clenching of muscles can create muscle soreness in the cheeks, temples, forehead, and the neck
  • Muscle tightness – a tight or tense feeling in the muscles of the cheeks and temples
  • Joint pain or sounds – the jaw joints, located in front of your ears, can be tender to touch, have sharp shooting pains, or make popping, clicking, or crunching sounds
  • Generalized tooth pain or sensitivity – the pressure of clenching or grinding can cause all of the teeth to be sore or sensitive to temperature

 

Not everyone who clenches or grinds his or her teeth will exhibit all of these signs or symptoms.  It is important for the dentist to get the whole picture and put together each patient’s specific signs and/or symptoms in order to accurately diagnose the condition of bruxism.

What Can I Do About It?

The most common treatment for bruxism is a hard, custom-made nightguard to protect the teeth, gums, bone, muscles and joints at night.  People who clench during the day can follow some habit-breaking techniques to prevent daytime damage.  If extensive damage is present, you will probably need some dental work to repair it before moving on to the preventive phase. 


Will an Over-the-Counter Nightguard Work?

OTC nightguards are typically made of a soft, thermoplastic material that you can heat and shape to fit your teeth.  This material is not great at preventing the damage from bruxism because the soft, squishiness actually increases muscle action and deteriorates very quickly.  The best protection for your teeth, gums, bone, muscles and joints is a hard nightguard that is custom-made for you by your dentist.  These will actually reduce muscle force and provide real protection.

Need More Information?

If you think you may exhibit one or more of the listed signs and symptoms, please don’t hesitate to discuss it with Dr. Aanenson or Dr. Kuiper.  You can also call the office at 605-925-4999 to set up a consultation.

 

 

Root Canal Treatment

Tuesday, May 23, 2017

What is a root canal? Teeth are hollow, and the hollow space contains the nerves and blood vessels of the teeth, also called the pulp.  The internal chamber or hollow space containing these nerves and blood vessels inside the tooth is the root canal. 

What is root canal treatment?  Root canal treatment is a dental procedure that involves removing the nerve tissue and blood vessels from the root canal inside the tooth and sealing the cleaned space with a root canal filling material. 

 

Why is it necessary?  A root canal is necessary when the pulp becomes inflamed or infected. The inflammation or infection can have a variety of causes: deep cavities, repeated dental procedures on the tooth, faulty crowns, or a crack or chip in the tooth. In addition, trauma to a tooth may cause pulp damage even if the tooth has no visible chips or cracks. If pulp inflammation or infection is left untreated, it can cause pain or lead to an abscess.   

Why might I be referred to a specialist?  Dr. Aanenson and Dr. Kuiper will closely evaluate the affected tooth to determine which treatment will give the best long-term prognosis.  In some cases, root canals should be performed by an endodontist (root canal specialist) with the aid of an operating microscope, which allows them to visualize the internal surfaces of the roots.  These are especially important in the diagnosis of root fractures, which can cause root canals to fail in the future.  Left undiagnosed, a root fracture can lead to repeated treatment on a tooth that has a poor or hopeless long-term prognosis.


 Is a crown necessary to cover the tooth after root canal treatment?  

Yes.  A root canal treatment removes the nerves and blood supply from the internal chamber of the tooth.  With no blood supply, teeth become brittle and can easily fracture.  A crown is necessary to protect the tooth.  If the tooth is not adequately covered, it could crack and need extraction despite having the root canal treatment.  Ideally, the crown should be placed within 30 days of the root canal treatment.

 What is an alternative to root canal treatment?  If the nerve inside a tooth is irreversibly inflamed, infected, or dead, the only alternative to a root canal treatment is extracting the tooth.  Most teeth can be restored with a dental implant after extraction if the proper planning is done before the tooth is extracted.  Please ask Dr. Aanenson or Dr. Kuiper for more information if you do not wish to save the tooth with a root canal treatment.

 

 

Sports Drinks

Tuesday, May 16, 2017

Sports drinks make up a multi-billion dollar industry ($6.8 billion in 2014 according to the Wall Street Journal), and the growth of sports drinks is outpacing the growth of soft drinks.  Many analysts think this trend is due to an improved awareness of the health risks associated with the consumption of soft drinks. 

Most people know that a Coke is not good for you.  There is a mindset, encouraged by the sports drink industry in its advertisements, that sports drinks are healthier than soft drinks and even better for you than water.  They spend a lot of money to make people think that if you’re going to be a real athlete, you have to drink Gatorade. 

Unfortunately, sports drinks are not quite the “healthy” option they claim to be.  This blog will address the dental consequences of sports drinks.  Click HERE to read about the general health consequences according to some 2012 studies published in the British Medical Journal

Sports drinks have two characteristics that make them bad for teeth: 1) high sugar content, and 2) very low pH.  You can see from the following table that the sugar content varies pretty widely, but the pH is consistently as low as a soft drink.

Most people know that sugar causes cavities.  What you need to know is that a low, or acidic, pH makes it much easier for cavities to start.  In the same way that acid etches glass, acid also softens and weakens enamel.  Enamel, which is the hardest substance in the human body, is damaged when the pH of its environment drops below 5.5.  All of these drinks fall far below that threshold. 

So if you know you are a cavity-prone individual, or your teenage athlete has a bunch of new suspicious areas on his or her teeth (called incipient lesions by your dentist), it’s time to trade the Gatorade for good old-fashioned water. (Freeman, Parkston, and Viborg all have drinking water that is above neutral on the pH scale, so stick with tap water!)

A few things to remember when considering a sports drink:

1)      Always look at the serving size when assessing the nutritional facts.  If the serving size is different than the size of the bottle, you’re going to have to do some math.  Gatorade labels have nutritional information for a 12 fl. oz. serving.  This means if you drink the whole 32 oz. bottle, you need to multiply those grams of sugar by 2.66 to get the true amount of sugar you just ingested. 

2)      Think about the volume you actually drink.  Most people drink much larger amounts of a sports drink than they ever would of a soda.

3)     Pay attention to the length of time it takes you to drink your sports drink.  Sipping on a sports drink throughout a long sporting event is much worse for your teeth than quickly guzzling 32 ounces at the end of a game or practice.

 

 

 

 

 


 

 

Why is my dentist asking how I sleep?

Tuesday, May 9, 2017

Patients at our offices in Freeman, Parkston and Viborg may be accustomed to the dentists, hygienists, and assistants asking about their quality of sleep, but this is usually something new or surprising for patients who are new to our practice.  There are a few reasons dentists are involved in the recognition and treatment of sleep-disordered breathing:

  • Dentists are in a unique position to recognize a potential problem with sleep-disordered breathing.
  • Sleep-disordered breathing often causes dental signs and symptoms that your dentist will notice during an evaluation.
  • One of the treatment options for a patient who has been diagnosed with mild or moderate obstructive sleep apnea is a dental appliance to position the lower jaw and open the airway.

 

Recognizing airway risk

Dr. Aanenson and Dr. Kuiper have been trained to recognize patients with high risk for a possible sleep-disordered breathing issue.  Obstructive sleep apnea happens when the upper airway is partially or completely obstructed (or blocked) during sleep, which causes a disruption in breathing.  There are two ways that our doctors evaluate the upper airway on our patients.  The first is through an intraoral evaluation, which allows them to visualize the opening into the upper airway at the back of the mouth.  The anatomy of this area (the oropharynx) varies widely among patients, and certain anatomical variants cause a very high risk of airway obstruction during sleep.  The second way the upper airway is evaluated during a dental visit is with 3D imaging.  At our practice, we have the ability to obtain a 3D image of the head and neck, which allows us to take a measurement of the airway and determine a patient's anatomical risk for sleep-disordered breathing.

The dental signs and symptoms

One of the body's responses to a reduction in oxygen levels is to grind the teeth in a protrusive motion, pushing the lower jaw forward to open the airway.  This can lead to noticeable attrition (surface wear) on the upper and lower front teeth.  An example of severe attrition is shown in the picture below.  This makes the teeth look like they are getting shorter.  Some dental symptoms patients may experience are facial muscle pain or tension, jaw discomfort, and sensitive teeth.  Patients with sleep apnea often also experience GERD (acid reflux), which brings the pH level of the mouth down and can lead to acid erosion of the teeth.

A dental treatment option

A dental appliance is an alternative to breathing machine treatment options.  Obstructive sleep apnea is a medical condition that must be diagnosed by a medical doctor, and it may be treated with a dental appliance, which must be fabricated and overseen by a dentist.  Our practice has been treating sleep-disordered breathing for over 13 years and understands this relationship well.  An oral appliance is not the best treatment for everyone, and it’s important to evaluate the severity of sleep-disordered breathing and whether or not a dental appliance would adequately treat it.  Your dentist needs to evaluate the health of your teeth, their supporting gums and bone, and your temporomandibular (TMJ or jaw) joint to make sure a dental appliance will be properly supported and do no harm.

 

How can I get started?

The first step in treating sleep apnea is having it diagnosed by your physician.  Our practices offer a home screening monitor that can be used to evaluate the quality of your sleep.  It gathers several types of data while you sleep, including whether or not you grind your teeth.  Our doctors will advise you based on the preliminary data reported by the home sleep screening monitor.  You may be referred to your physician for a more in-depth evaluation of your sleep prior to treatment.  If you have already been diagnosed with sleep apnea and have not had success with previous treatment options, we can help discuss options that might be available to you with oral appliances.

Some great resources for information on sleep-disordered breathing:

American Academy of Dental Sleep Medicine

Narval Oral Appliance

 

What does it mean to be high risk for cavities?

Tuesday, May 2, 2017

What is a cavity? 

A cavity is the destruction of tooth structure caused by a combination of bacteria, sugar and acid.  When bacteria in the mouth digests sugar, acid is produced.  The acid destroys enamel, just like it etches glass, and this process is called demineralization.  Once a cavity has grown through the outer layer of enamel, it cannot be reversed.

 What are the different types of cavities?

Cavities can form on any surface of the tooth, including the pits and fissures on the biting surface, smooth surfaces and any exposed root.  Pit & fissure cavities are the type that can be prevented by placing dental sealants before a cavity has formed.  Smooth surface cavities, most commonly in between the teeth, are discovered with bitewing x-rays, typically taken by your dentist once a year.  Root cavities can be seen on visual examination, or on an x-ray if they are large.

Caries_picture_1.png

 How do cavities happen?

 Four things are required for a cavity to form: 1) acid,  2) sugar, 3) bacteria, and 4) time.  The bacteria present in the mouth thrive on simple carbohydrates, the sugars in most crackers, cookies, candy, soda, sports drinks, and most juices.  The more bacteria you have in your mouth, the more likely you are to get a cavity.  This factor emphasizes the importance of daily home care and regular dental cleanings.  The more sugar your teeth are exposed to, the more likely you are to get a cavity.  This factor emphasizes the importance of your diet.  The longer your teeth are exposed to sugar or acid, the more likely you are to get a cavity.  This factor emphasizes the importance of your habits (i.e. sipping on sugary or acidic beverages for long periods of time).  The more acidic your mouth is, the more likely you are to get a cavity. This factor also emphasizes the importance of diet, specifically acidic beverages like sparkling water, sports drinks, juices, and sodas.

Caries_picture_2.jpg

What does it mean to be high risk? 

There are multiple factors that can make you high risk.  You may present with one or more of these factors:

·       Poor plaque control
·       High risk diet
·       Multiple existing restorations (like fillings or crowns)
·       Fractured teeth
·       Decreased salivary flow or dry mouth
·       Systemic condition
·       Active decay
·       Unsealed grooves and pits
·       In orthodontic treatment, either braces or Invisalign

 What can I do about it? 

By altering the four factors in the diagram, you can reduce your cavity risk.

  1.  Acid – Reduce your intake of acidic foods & drinks (this includes DIET SODAS, coffee and tea), drink plenty of water, use sugar-free gum or mints to stimulate salivary flow, and control any acid reflux problems.  Neutralizing the pH in your mouth may involve using recommended mouthrinses or gels.
  2. Sugar – Limit sugar intake, especially in between meals.  Cut back on sodas, sweetened coffee or tea, sports drinks, or juices.  Don’t chew sugar-containing gum, mints or other hard candy.
  3. Bacteria – Reduce the bacterial levels in your mouth by having your teeth professionally cleaned on a regular basis, and performing good oral hygiene at home.  FLOSS!
  4. Time – Limit the length of time that your teeth are exposed to acid or sugar.  Sipping on an acidic or sugary beverage is one of the most common causes of cavities.  You may only drink one soda per day, but if you sip on it for several hours, you are increasing your cavity risk exponentially.

 

What if I don’t do anything?

Untreated cavities expand toward the nerve inside the tooth.  Large cavities can cause nerve irritation and sensitivity to hot and cold.  If the cavity reaches the nerve, causing it to become infected with the cavity’s bacteria, a severe infection and toothache can ensue. Not all tooth infections hurt, so evaluation of teeth with dental x-rays is important!   Tooth infections can extend through the root and into the surrounding jaw structures, and worst-case scenario, end in death by closing off the airway or spreading into the brain.

 
 
 
Freeman Dentist | Blog. Jason Aanenson is a Freeman Dentist.

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