Interdisciplinary Dentistry

Interdisciplinary Dentistry

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. Jason, Dr. Alex and Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell! Their commitment to excellent care will ensure you see the proper doctor for each individual procedure your treatment requires.

Can A Sinus Infection Make My Teeth Hurt?

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Can a sinus infection make my teeth hurt?

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.

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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. 

 

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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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!. 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?

Is your mouth making you sick?

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.
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  • 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!They will discuss your medical history with you and outline how it can affect your oral health and vice versa.  

Silver Diamine Fluoride

Silver Diamine Fluoride

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. Jason, Dr. Alex and Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!  They can discuss the treatment options for each tooth, including which ones could benefit from SDF. 

Pediatric Sleep Apnea

Pediatric Sleep Apnea

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. Jason, Dr. Alex or Dr. Serena 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. Jason, Dr. Alex or Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell! They will discuss the risk factors your child exhibits and the various treatment options available.

Caring for Your Teeth While in Braces

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Caring for Your Teeth While in Braces

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!

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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.

 

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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. Jason, Dr. Alex and Dr. Serena 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. Jason, Dr. Alex and Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell! 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?

Is Morning Sickness Ruining Your Teeth?

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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. 

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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.

 

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  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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell! They can help you manage the risks associated with morning sickness and help you protect your teeth.

Dental Insurance: Are You Throwing Away Money?

Dental Insurance: Are You Throwing Away Money?

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.

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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. Jason, Dr. Alex and Dr. Serena 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) or (605) 928-3363 (Parkston) 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 Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

How Implants Make Dentures Better

How Implants Make Dentures Better

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.

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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. Jason, Dr. Alex and Dr. Serena 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. Jason, Dr. Alex and Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Don't Get Tricked by Halloween Treats

Don’t Get Tricked by Halloween Treats

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.

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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.

 

 

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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.  

 

 

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

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

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

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.

 

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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.

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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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Dental Implants: Restoration of a Missing Tooth

Dental Implants: Restoration of a Missing Tooth

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:

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  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. Jason, Dr. Alex or Dr. Serena 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.

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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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell! They will discuss your treatment options in detail and help you decide if a dental implant is right for you.

Oral Cancer

Oral Cancer

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

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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.

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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. Jason, Dr. Alex and Dr. Serena. 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. Jason, Dr. Alex and Dr. Serena 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. Jason, Dr. Alex and Dr. Serena 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

 

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Crowns

Crowns

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

  • 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

  • Porcelain-fused-to-metal

    -Better cosmetic appearance

    -Very durable and strong to withstand chewing forces

  • Zirconia

-Good cosmetic appearance with no dark metal

-Strongest material available, almost impossible to break

-Can withstand heavy clenching or grinding forces

  • All Porcelain

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

    -Can achieve micromechanical bond with tooth structure

Cons

  • Gold

-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

-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

-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

-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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Hormone-Induced Gingivitis

Hormone-Induced Gingivitis

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. Jason, Dr. Alex or Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Aphthous Ulcers (Canker Sores)

Aphthous Ulcers (Canker Sores)

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. Jason, Dr. Alex and Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!  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?

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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

FAQ's for New Moms

FAQ's for New Moms

 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Back To School

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Back to School

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!  

Call our office at 605-925-4999 (Freeman) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!

Radiation Safety

Radiation Safety

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.

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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.

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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. Jason, Dr. Alex and Dr. Serena 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) or (605) 928-3363 (Parkston) to schedule your appointment today with Dr. Jason Aanenson, Dr. Alex Whitesell or Dr. Serena Whitesell!