Until recently, the standard treatment for tooth decay remained essentially the same for nearly a century: Remove any decayed structure, then prepare and fill the cavity. But that singular protocol has begun to change recently.

Although "drilling and filling" saves teeth, it doesn't fully address the causes of decay. In response, dentists have broadened their approach to the disease—the focus now is on an individual patient's particular set of risk factors for decay and how to reduce those.

At the heart of this new approach is a better understanding of oral bacteria, the true cause of decay. Bacteria produce acid, which can erode tooth enamel and create a gateway into the tooth for decay to advance. We therefore want to lower those risk factors that may lead to bacterial growth and elevated acidity.

One of our major objectives in this newer approach is to reduce plaque, a thin film of food particles used by bacteria for food and habitation. Removing plaque, principally through better oral hygiene, in turn reduces decay-causing bacteria.

Plaque isn't the only mechanism for bacterial growth and acidity. Appliances like dentures or retainers accumulate bacteria if not regularly cleaned. Reduced saliva flow, often due to certain medications or smoking, limits this fluid's ability to buffer acid and acid reflux or acidic beverages like sodas, sports or energy drinks can disrupt the mouth's normal pH and increase the risk for enamel erosion.

Our aim, then, is to develop a long-term strategy based on the patient's individual set of oral disease risk factors. To determine those, we'll need to examine their medical history (including family), current health status and lifestyle habits. From there, we can create a specific plan targeting the identified risk factors for decay.

Some of the elements of such a strategy might include:

• Daily brushing and flossing, along with regular dental cleanings;
• Fluoride dental products or treatments to strengthen enamel;
• Changes in diet and excess snacking, and ceasing from any tobacco use;
• Cleaning and maintaining appliances, as well as monitoring past dental work.

Improving the mouth environment by limiting the presence of oral bacteria and acid can reduce the occurrence of tooth decay and the extent of treatment that might be needed. It's a more nuanced approach that can improve dental health.

If you would like more information on tooth decay prevention and treatment, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Tooth Decay: How to Assess Your Risk.”

Patients and dentists alike love dental implants. For one, they're unique among other dental restorations because they replace the tooth root as well as the visible crown. It's actually their role as a root replacement that makes them so durable and lifelike.

But it still falls to the dentist to create as natural an appearance as possible through proper implant placement. It requires extensive technical skill and artistry to surgically place an implant in the precise location inside the jawbone to gain the best outcome. It's even more critical when the tooth is a highly visible one within the "smile zone"—the teeth others see when we smile.

With a patient's smile appearance on the line, it's important that we carefully consider a number of factors that can impact implant success and address them as needed in our treatment plan.

The gums. The gums are to the teeth as a frame is to a masterpiece painting. If the gums don't correctly cover the new implant, the final outcome won't look natural. Positioning the implant precisely helps ensure the gums look attractive. It may also be necessary to augment the gums, such as grafting surgery to encourage growth of lost gum tissue, to achieve the most lifelike result.

The socket. For simple extractions (as opposed to surgical removals), a dentist deftly manipulates the ligament holding the tooth in place to loosen and remove it. It's important to do this carefully—if the tooth's bony socket becomes damaged in the process (or because of other trauma), it can complicate implant placement in the future.

The supporting bone. Likewise, the bone in which the implant is imbedded must be reasonably healthy and of adequate volume. Besides not providing enough support, inadequate bone also makes it difficult to place an implant for the most attractive result. Bone grafting at the time of extraction minimizes bone shrinkage. If bone shrinkage had occurred, the Inadequate bone may require grafting, particularly if there is a lag time between extraction and implantation. In extreme cases, though, a patient may need to choose a different restoration.

The usual process for implants—planning, surgical placement and the healing period after surgery—can take time. Paying attention to these and other factors will help ensure that time and the effort put into this process has a satisfying outcome—an attractive, natural and long lasting smile.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Immediate Dental Implants.”

Although there are several potential problems people could encounter involving their teeth, gums or mouth, most fall into three basic categories. That's the finding of a recent survey conducted by the American Dental Association of more than 15,000 U.S. adults.

These categories are a triad of symptoms, each of which could arise from a variety of causes. If you're encountering any one of these, you should see your dentist as soon as possible.

Tooth pain. A toothache—or any form of pain from the mouth—could be sign of a number of possible issues. It could mean you have a decayed tooth, especially if the pain is sharp and localized. It could also indicate a gum abscess (accompanied by red and puffy gums), a sinus or ear infection, or inflammation of the jaw joints. The intensity, duration and location of the pain are all clues to its actual cause and what treatments it might require.

Biting difficulties. Does it hurt when you bite down? Among other things, you could have a loose tooth or one that's deeply decayed. The former could be the sign of advanced gum disease, which itself must be treated and the tooth stabilized (splinted) to other teeth. If the problem is advanced decay, you may need a root canal to remove diseased tissue from within the interior of the tooth, which is then filled and crowned to prevent re-infection.

Dry mouth. We're not talking about that "cotton mouth" feeling we all get now and then. This is a chronic condition known as xerostomia in which the mouth feels dry all the time. Xerostomia has several causes including smoking or treatments for cancer or other serious diseases. It might also be a medication you're taking, which has reduced your mouth's saliva production. Because dry mouth could lead to dental disease, you should take steps to relieve it.

Even if you're not having symptoms like these, there may still be something going on in your mouth that needs attention. That's why you should see your dentist on a regular basis, besides when you notice a problem, to keep your oral health in tip-top shape.

If you would like more information on potential teeth and gum problems, please contact us or schedule an appointment for a consultation.

Buffalo Bills wide receiver Stefon Diggs wrapped up the NFL regular season in January, setting single-season records in both catches and receiving yards. The Bills handily beat the Miami Dolphins, earning themselves the second seed in the AFC playoffs, and Diggs certainly did his part, making 7 catches for 76 yards. But what set the internet ablaze was not Diggs' accomplishments on the field but rather what the camera caught him doing on the sidelines—flossing his teeth!

The Twitterverse erupted with Bills fans poking fun at Diggs. But Diggs is not ashamed of his good oral hygiene habits, and CBS play-by-play announcer Kevin Harlan expressed his support with “Dental hygiene is something to take note of, kids! There's never a bad place to floss” and “When you lead the NFL in catches and yards, you can floss anytime you want.”

We like to think so. There's an old joke among dentists:
Q. Which teeth do you need to floss?
A. Only the ones you want to keep.

Although this sounds humorous, it is borne out in research. Of note, a 2017 study showed that people who floss have a lower risk of tooth loss over periods of 5 years and 10 years, and a 2020 study found that older adults who flossed lost an average of 1 tooth in 5 years, while those who don't lost around 4 teeth in the same time period.

We in the dental profession stress the importance of flossing as a daily habit—and Stefon Diggs would likely agree—yet fewer than 1 in 3 Americans floss every day. The 2016 National Health and Nutrition Examination Survey (NHANES), conducted by the CDC's National Center for Health Statistics, revealed that only 30% of Americans floss every day, while 37% floss less than every day and 32% never floss.

The biggest enemy on the football field may be the opposing team, but the biggest enemy to your oral health is plaque, a sticky film of bacteria and food debris that builds up on tooth surfaces. Plaque can cause tooth decay and gum disease, the number one cause of tooth loss among adults. Flossing is necessary to remove plaque from between teeth and around the gums where a toothbrush can't reach. If not removed, plaque hardens into tartar, which can only be removed by the specialized tools used in the dental office. Regular professional dental cleanings are also needed to get at those hard-to-reach spots you may have missed.

If Diggs can find time to floss during a major NFL game, the rest of us can certainly find a couple minutes a day to do it. While we might not recommend Diggs' technique of flossing from one side of the mouth to the other, we commend his enthusiasm and commitment to keeping his teeth and gums healthy. Along with good dental hygiene at home—or on the sidelines if you are Stefon Diggs—regular professional dental cleanings and checkups play a key role in maintaining a healthy smile for life.

If you would like more information about keeping in the best dental health, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Daily Oral Hygiene.”

If you think brushing and flossing and regular dental visits are all you need to do to avoid dental disease, you're missing a key component in your prevention plan. What you eat could also help close the door on tooth decay or gum disease—or open it even wider if you're eating nutritionally deficient foods.

Let's look first at the latter scenario. Like us, the oral bacteria most responsible for dental disease also have to eat to survive and thrive. And, often like us, they have a favorite food—provide them ample amounts of that and they'll continue to multiply and raise your risk of disease.

That favorite bacterial food is simple carbohydrates, particularly refined sugar. A diet heavy in added sugar can increase oral bacteria, which in turn elevates your chances of a gum infection. Bacteria's main by-product, acid, may also increase. That's bad news for your teeth. At high levels, acid contact softens and erodes enamel, the precursor to tooth decay.

Obviously, then, a "tooth-friendly" diet should be low on sugar and other simple carbohydrates like refined breads, pasta or pastries. Soda, energy and sports drinks high in both sugar and acid should also be avoided or restricted to mealtimes. You should also be careful with how much fruit you're eating as their natural sugars can also feed bacteria.

A well-rounded diet, however, isn't simply about avoiding foods—you'll also want to include foods that help you build and maintain healthy teeth and gums. That includes:

• Fiber-rich plant foods: Their fiber reduces the effects of any carbohydrates and they're packed with nutrients;
• Whole grains: Whole grains don't promote decay as refined products do, and chewing them stimulates saliva flow for neutralizing acid;
• Fresh fruits: Eaten in moderation, fruits can provide a bevy of vitamins and minerals. But avoid dried fruits as their sugars are more concentrated;
• Dairy: Milk-based products, particularly cheese, contain nutrients like Vitamin D, calcium and phosphorus, which strengthen teeth against dental disease.

For the most part, a diet that promotes overall well-being will also provide optimum benefits for your dental health. Along with your dental hygiene efforts, eating the right foods can help protect your teeth and gums from both tooth decay and gum disease.

If you would like more information on how better nutrition can boost your dental health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Nutrition & Oral Health.”