Pregnancy Prenatal Care and Oral Health

Can Oral Health Have an Effect on Pregnancy?
Growing evidence suggests a link between gum disease and premature, underweight births. Pregnant women who have gum disease may be more likely to have a baby that is born too early and too small.

More research is needed to confirm how gum disease affects pregnancy outcomes. But it appears that gum disease triggers increased levels of biological fluids that induce labor. Data also suggests that when gum disease worsens during pregnancy, there's a higher risk of having a premature baby.

What Can I Do to Ensure I Have a Healthy Pregnancy?
The best advice to women considering pregnancy is to visit their dentist for a checkup and to treat any oral problems before becoming pregnant.

During your pregnancy, your teeth and gums need special attention. Regular brushing and flossing, eating a balanced diet and visiting your dentist regularly will help reduce dental problems that accompany pregnancy.

What Oral Problems Might Develop During My Pregnancy?
Studies show that many pregnant women experience pregnancy gingivitis — when dental plaque builds up on the teeth and irritates the gums. Symptoms include red, inflamed and bleeding gums.

Pregnancy gingivitis occurs more frequently during pregnancy because the increased level of hormones exaggerates the way gums react to the irritants in plaque. However, it's still plaque — not hormones — that is the major cause of gingivitis.

Keeping your teeth clean, especially near the gumline, will help dramatically reduce or even prevent gingivitis during your pregnancy. And substituting sweets with more wholesome foods such as cheese, fresh fruits or vegetables is better for your teeth.

What Can I Expect When I Visit My Dentist During My Pregnancy?
First, be sure to let your dentist know you're pregnant when you schedule your appointment. It's best to schedule your dental visit during the fourth to sixth month of your pregnancy. This is because the first three months of pregnancy are thought to be of greatest importance in your child's development. During the last trimester, stresses associated with dental visits can increase the incidence of prenatal complications.

Typically, X-rays, dental anesthetics, pain medications and antibiotics (especially tetracycline) are not prescribed during the first trimester, unless it's absolutely necessary. During the last three months of pregnancy, sitting for long periods of time in the dental chair can become uncomfortable. And there is evidence that pregnant women can be more prone to gagging. Your dentist, however, is prepared for this situation.

If you need to schedule an emergency visit, let the office know about your pregnancy before you arrive. Discuss any stresses, past miscarriages and drugs you are taking as these can all have an influence on how your dentist attends your needs. Your dentist may also want to consult with your physician before any treatment is started.

If you have any doubts or concerns, insist that your dentist and physician discuss your particular needs. If your dentist prescribes medication, do not exceed the prescribed dosage. This includes aspirin.

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Your Dentist's Education

In the United States, a dentist must complete four years of dental school. This comes after college. Dental school graduates receive either a D.D.S. or D.M.D. degree. D.D.S. stands for Doctor of Dental Surgery. D.M.D. comes from the Latin Dentariae Medicinae Doctor.

Today, students in both types of programs receive similar training. One degree is not better than the other.

After receiving a dental degree, a person must pass two board exams in order to practice dentistry. One is a national exam. The other is a state or regional exam. A dentist's license to practice is granted by the state where the practice is located.

After earning a D.D.S. or D.M.D., about 1 in 3 dentists go on for more training. Additional training beyond dental school is not required in most places for a dentist to practice.

Recently, New York and Washington state have instituted a one-year training requirement beyond dental school. Dentists can get this extra training in a general practice residency program in a hospital. Another option is an advanced education in general dentistry program. These are usually located in a dental school. These programs are typically one year long. Some include a second year. This training gives dentists more experience with different types of patients and dental procedures.

A dentist who wants to become a specialist — such as a pediatric dentist, endodontist, oral surgeon, orthodontist, prosthodontist, public health dentist or oral pathologist — must train for as many as five years after receiving a D.D.S. or D.M.D. This training occurs in an ADA accredited program, which is typically sponsored by a dental school or hospital. About 1 in 5 dentists are specialists. After completing an accredited program, a dentist is deemed board eligible. This is followed by a board exam. A specialist who passes the board exam receives the title "board certified."

Many states require dentists to keep learning throughout their careers. This is called continuing education. Dentists can take courses at a university or receive education credits by going to professional meetings. One example would be the annual meeting of the American Dental Association. Continuing education helps dentists keep up to date on the newest research and treatment options. Members of the Academy of General Dentistry who take these courses can become certified as a master in general dentistry.

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Illustrations: How a Tooth Decays

1. Healthy Tooth	2. White Spots
Enamel is the hard outer crystal-like layer. Dentin is the softer layer beneath the enamel. The pulp chamber contains nerves and blood vessels. It is considered the living part of the tooth.	Bacteria that are exposed to sugars or carbohydrates can make acid. The acid attacks the crystal-like substance in the tooth's outer surface. This process is known as demineralization. The first sign of this is a chalky white spot. At this stage, the decay process can be reversed. Using fluorides at home and in the dental office can help the tooth repair itself.
3. Enamel Decay	4. Dentin Decay
Demineralization continues. Enamel starts to break down. Once the enamel surface is broken, the tooth can no longer repair itself. The cavity has to be cleaned and restored by a dentist.	The decay reaches into the dentin, where it can spread and undermine the enamel.
5. Pulp Involvement

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Tooth Whitening

What Is It?

Tooth whitening lightens teeth and helps to remove stains and discoloration. Whitening is among the most popular cosmetic dental procedures because it can greatly improve how your teeth look. Most dentists perform tooth whitening.

Whitening is not a one-time procedure. It will need to be repeated from time to time if you want to maintain the brighter color.

What It's Used For

The outer layer of a tooth is called the enamel. The color of natural teeth is created by the reflection and scattering of light off the enamel, combined with the color of the dentin under it. Your genes affect the thickness and smoothness of the enamel. Thinner enamel allows more of the color of the dentin to show through. Having smoother or rougher enamel also affects the reflection of light and therefore the color.

Every day, a thin coating (pellicle) forms on the enamel and picks up stains. Tooth enamel also contains pores that can hold stains.

The most common reasons for teeth to get yellow or stained are:

• Using tobacco
• Drinking dark-colored liquids such as coffee, cola, tea and red wine
• Not taking good care of your teeth

Aging also makes teeth less bright as the enamel gets thinner and the dentin becomes darker.

It is also possible to have stains inside the tooth. These are called intrinsic stains. For example, intrinsic stains can be caused by exposure to too much fluoride as a child while teeth are developing. Other causes include tetracycline antibiotics. They can stain a child's teeth if taken by a mother during the second half of pregnancy or by a child who is 8 years old or younger. Teeth are still developing during these years. Trauma may also darken a tooth.

Tooth whitening is most effective on surface (extrinsic) stains.

Preparation

Other dental problems can affect the success of tooth whitening. For example, cavities need to be treated before teeth are whitened. That's because the whitening solution can pass through decayed areas and reach the inner parts of the tooth. If your gums have receded, the exposed roots of your teeth may appear yellow or discolored. Whitening products will not make them whiter.

If you have tooth decay or receding gums, whitening may make your teeth sensitive. Whitening also does not work on ceramic or porcelain crowns or veneers.

Whitening can be done in the dental office or at home. For in-office whitening, your dentist probably will photograph your teeth first. This step will help him or her to monitor the progress of the treatment. Your dentist also will examine your teeth and ask you questions to find out what caused the staining.

Next, the dentist or a dental hygienist will clean your teeth. This will remove the film of bacteria, food and other substances that build up on your teeth and contribute to the staining. Once this is done, the whitening procedure begins.

For whitening at home, your dentist can make trays to hold the whitening gel that fit your teeth precisely. Home whitening gel usually needs to be applied daily for two to three weeks. Over-the-counter kits also are widely available for home use. They provide trays to hold the gel, or whitening strips that stick to your teeth. Talk to your dentist if you want to use these home products. Be sure to follow directions to avoid overuse and possible damage to your teeth and mouth.

How It's Done

There are two main types of whitening procedures. Non-vital whitening is done on a tooth that has had root-canal treatment and no longer has a live nerve. Vital whitening is performed on teeth that have live nerves.

Non-Vital Whitening

Vital whitening may not improve the appearance of a tooth that has had root-canal treatment because the stain is coming from the inside of the tooth. If this is the case, your dentist will use a different procedure that whitens the tooth from the inside. He or she will place a whitening agent inside the tooth and put a temporary filling over it. The tooth will be left this way for several days. You may need this done only once, or it can be repeated until the tooth reaches the desired shade.

Vital Whitening

The most common type of vital tooth whitening uses a gel-like whitening solution that is applied directly to the tooth surface. This product contains some form of hydrogen peroxide.

Tooth whitening can be done in the dentist's office or at home. In-office (chairside) whitening allows your dentist to use a more powerful whitening gel. A specialized light or laser activates the gel and allows bleaching to happen faster.

In-office whitening usually takes 30 to 90 minutes. You will need one to three appointments. The number will depend upon the method used, how severe your stains are and how white you want your teeth to be. Different types of stains respond differently to the treatment.

First, your dentist will apply a substance that covers and protects the gums around the teeth. Then, the whitening agent, usually hydrogen peroxide, will be placed on the teeth.

Some whitening agents are activated by a laser light, special lights or by the heat from these lights. After the whitening agent is applied, the dentist will shine the light on your teeth. If your teeth are badly discolored, your dentist may suggest that you continue the bleaching process at home for a few days or weeks.

For in-home whitening, your dentist will take impressions of your upper and lower teeth and will make custom mouthpieces to fit you. The mouthpiece needs to fit well. A close fit helps the whitening agent remain in contact with your teeth.

At home, you will fill each mouthpiece with a whitening gel your dentist provides. You will wear the mouthpiece for several hours every day. Many people achieve the amount of whitening they want within a week or two. However, you may need to wear the mouthpiece for four weeks or longer.

You also can buy whitening products over the counter. They contain a weaker whitening agent than the products you can get from your dentist. Therefore, whitening may take longer. The whitening agent is applied as a gel placed in a mouthpiece or as a strip that sticks to your teeth. Over-the-counter mouthpieces fit less securely than the kind you get from your dentist.

Whitening toothpastes are available as well. They contain abrasives that remove stains on the enamel. They do not actually change the overall color of your teeth.

Follow-Up

If you find that your gums are white or sore, follow up with your dentist.

Whitening is not a permanent solution. The stains will come back. If you smoke or consume a lot of staining foods or drinks, you may see the whiteness start to fade in as little as one month. If you avoid these sources of staining, you may not need another whitening treatment for 6 to 12 months.

Re-whitening can be done in the dentist's office or at home. If you have a custom-made mouthpiece and whitening agent at home, you can whiten your teeth as frequently as you need to. Discuss your whitening schedule with your dentist. You can talk about what whitening products would work best for you.

Risks

Whitening is unlikely to cause serious side effects, although some people's teeth may become more sensitive for a short while. You may get mild gum irritation as well. Women should not have their teeth whitened while pregnant. The effect of the whitening materials on the development of the fetus is not known. Since the procedure is cosmetic, it should be postponed until after delivery.

When To Call a Professional

If you feel your teeth would benefit from whitening, contact your dentist to discuss the procedure.

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San Francisco, CA, 94108

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Second Opinion: The Delta Dilemma

Second Opinion: The Delta Dilemma
Dr. Robert G. Griego, former Delta Dental board member, takes issue with the current goings-on at the insurance company.
The Delta Dilemma– Robert G. Griego, DDS Second opinions are common in health care; whether a doctor is sorting out a difficult case or a patient is not sure what to do next. In the context of our magazine, the first opinion will always belong to the reader. This feature will allow fellow dental professionals to share their opinions on various topics, providing you with a "Second Opinion." Perhaps some of these observations will change your mind; while others will solidify your position. In the end, our goal is to create discussion and debate to enrich our profession. — Thomas Giacobbi, DDS, FAGD, Editorial Director, Dentaltown Magazine Delta of Washington made the decision to cut reimbursements to member dentists across the board.This has caused an uproar with Washington dentists.What has happened in Washington is nothing new though. In one form or another across the country and finally even here in Arizona, Delta has compromised the best interests of dentists for years. My experience with Delta is vast. I served on the Delta board from 2003 through 2010. I was board chair from 2006 to 2010. As a historical review, Delta was started by dentists more than 50 years ago. This first occurred in the states of California, Oregon and Washington. The goal for Delta was to be an option to the new types of dental insurance that were being developed. Delta was to be owned and managed by dentists to insure quality plans for the patients. The Arizona State Dental Association (AzDA) incorporated Delta in the mid-70s as the Arizona Dental Insurance Service. Years later because of anti-trust issues, all state dental associations except for Oregon divested themselves from Delta. This was not necessary to do as proven by Oregon who maintained their ownership and have thrived as a subsidiary of the Oregon State Dental Association. Oregon has managed the anti-trust issues very well. My involvement started in 1990 when Arizona Delta attempted to market PPO-type discounted plans as most other Delta chapters were doing. I led a movement of Arizona dentists to oppose this and we prevailed. This again occurred in 1994-95. This time it was a bitter yearlong battle but again dentists prevailed. The CEO resigned as we re-established our influence with the insurance company that we started. We honored our mission of promoting only quality insurance products. This set the stage for our incredible run of glory years for Arizona Delta. We were the envy of many dentists from other Delta chapters in the country. I stand behind this statement because at that time we were a small fledgling company. However by taking the position for quality insurance for the patients we serve and fair reimbursement for our dentists, we were able to develop our niche which was desired by patients. We became the number-one dental insurance company in the state and held that ranking for at least 12 consecutive years. Sad to say, the board and I fell prey to a takeover. Currently here in Arizona, even under the leadership of dentists, PPO-type plans are being marketed statewide for the first time in our long history of Arizona Delta! It is unbelievable to me that some long time AzDA leaders would permit this. Prior to this sad turn of events, only the premier plans were allowed to be sold under our leadership. History repeats itself and this will eventually cause the premier plans to be greatly compromised here in Arizona. I have attended numerous Delta national meetings on issues such as limitations on non-covered services to marketing steeply discounted PPOs. Usually the dentist's interests are low on Delta's list of priorities. The common denominator in each state that has slashed payments to dentists are people who sell the notion there are absolutely no other options left. Dentistry, at least here in Arizona, is in a negative freefall. Some factors are an oversupply of dentists and the full impact of two new dental schools here in Phoenix yet to be felt. Corporate dentistry has entered the Phoenix market and around 65 dental centers have opened. I do not know the quality of their services, but I understand fees are discounted which will inevitably attract certain patients. Of course, the economy remains a negative factor as well. Now Delta, the company dentists started, as the last bastion of hope and influence for dentists here in Arizona, is promoting the notion that because the economy is awful we need to bear the sacrifice to keep Delta highly profitable. Why would a board dominated by dentists allow this? I ask the question: Why is organized dentistry not in this battle? I cannot speak for Washington but here in Arizona, AzDA has remained silent toward Delta's actions. Every AzDA member should be demanding a strong position against Delta on this issue. AzDA appears to be more interested in fostering an environment of cooperation with Delta. Since when do the best interests of dentists parallel those of insurance сompanies? As the economy continues to struggle, will similar actions to Washington take place here in Arizona? Will this continue to spread to other states? In many states, the premier plan is already an insignificant part of Delta's business. Be prepared to hold your state dental associations accountable for fighting for the dentists, of course, within applicable anti-trust laws. The Delta Board of Directors must also be held accountable. Do not fall for decisions that do not protect the best interest of our patients. In my opinion, in these times, quality leaders in the dental profession are hard to find but this wonderful profession of dentistry is worth fighting for, so get involved. Author’s Bio Dr. Robert G. Griego graduated from Creighton University School of Dentistry in 1969. Dr. Griego was honored with Creighton's School of Dentistry National Alumni merit award in 2006. He has held many positions throughout his career, including president of the Arizona Dental Association and president of the Central Arizona Association. He brings 40 years of experience to his private practice in Phoenix, Arizona. Dr. Griego has been chosen AzDA's Dentist of the Year twice and is in AzDA's Hall of Fame. He has served on numerous civic organizations including The West Valley Child Crisis Center serving as Board Chair. Call Now San Francisco Dentist Request for appointment at: (415) 391 - 7751 450 Sutter street, Suite 1905 San Francisco, CA, 94108 http://malidds.com/

How Do I Maintain Good Oral Health in My Senior Years?

How Do I Maintain Good Oral Health in My Senior Years?

Your teeth can last a lifetime with proper home care and regular dental checkups. No matter what your age, you can keep your teeth and gums healthy by brushing twice a day with a fluoride toothpaste, flossing daily and seeing your dentist regularly for professional cleanings and checkups.

What Special Oral Health Issues Should I Know About as a Senior?

Even if you brush and floss regularly, you may face certain issues in your senior years when it comes to your oral health. Wearing dentures, taking medications and general health conditions are some of the issues many seniors face. Luckily, your dentist and physician can help you meet most of these challenges quite successfully.

• Cavities and decay on the root surfaces of the teeth are more common in older adults. So it's important to brush with a fluoride toothpaste, floss daily and see your dentist regularly.
• Sensitivity can be an increasing problem as one ages. Your gums naturally recede over time, exposing areas of the tooth that are not protected by enamel. These areas are particularly prone to pain due to cold or hot foods or beverages. In severe cases cold air, as well as sensitivity to sour and sweet drinks and foods, can occur. If you experience sensitivity, try an anti-sensitivity toothpaste. If the problem persists, see your dentist, as the sensitivity may be an indication of a more serious condition, such as a cavity or a cracked or fractured tooth.
• Dry mouth is a common condition in seniors, and one that may be caused by medications or certain medical disorders. Left untreated, dry mouth can damage your teeth. Your dentist can recommend various methods to restore moisture in your mouth, as well as appropriate treatments or medications to help prevent the problems associated with dry mouth.
• Existing health conditions such as diabetes, heart disease, or cancer, can affect your oral health. Be sure to let your dentist know of any general health issues you're facing, so that he or she understands the whole situation and can help you meet your special requirements.
• Dentures can make life easier for many seniors, but they require special care. Follow your dentist's instructions carefully and see your dentist if any problems arise. An annual checkup is recommended for long-term denture wearers.
• Gum disease is a potentially serious condition that can affect people of all ages, but especially people over 40. A number of factors can increase the severity of gum disease, including:

• Bad diet
• Poor oral hygiene
• Systemic diseases, such as diabetes, heart disease and cancer.
• Environmental factors such as: stress and smoking
• Certain medications that can influence gum condition

Because the earliest stages of gum disease are reversible, it is important to spot it early on. Regular dental checkups can insure early detection and treatment of gum disease. Best of all, it is easy to prevent gum disease from developing in the first place, by practicing proper oral hygiene.

• Crowns and bridges are used to strengthen damaged teeth or replace missing ones. A crown is used to entirely cover or "cap" a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space.

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How do I Best Care for My Teeth as an Adult?

How do I Best Care for My Teeth as an Adult?

The key to keeping a bright, healthy smile throughout adulthood is to practice proper oral hygiene. Even adults can get cavities, as well as gum disease, that can lead to serious problems. Throughout your adult life, it's important to continue to:

• Brush twice a day with a fluoride toothpaste to remove plaque-the sticky film on your teeth that's the main cause of tooth decay.
• Floss daily to remove plaque from between your teeth and under your gumline, before it can harden into tartar. Once tartar has formed, it can only be removed by a professional cleaning.
• Limit sugary or starchy foods, especially sticky snacks. The more often you snack between meals, the more chances you give the acids in plaque to attack your tooth enamel.
• Visit your dentist regularly for professional cleanings and checkups.

What Special Dental Issues Should I Be Aware of as an Adult?
Even if you brush and floss regularly, you may face certain oral health issues as an adult. Luckily, your dentist can help you meet most of these challenges quite successfully.

• Gum disease begins as gingivitis, which in this early stage is still reversible. Symptoms of gingivitis include red, swollen or tender gums that tend to bleed when you brush them. If you notice any of these symptoms, see your dentist before serious problems develop. Advanced stages of gum disease may lead to tooth loss.
  
  The health of your gums can also affect your overall health. Recent studies have shown a possible link between periodontitis (a gum disease) and other diseases, such as diabetes, heart disease and a possible link to premature births. To prevent gum disease from getting started in the first place, be sure to brush twice a day, floss daily and schedule professional cleanings every six months.
• Cavities around existing fillings (called recurrent decay) and decay on the root surfaces of the teeth become more common as we age. So it's important to brush with a fluoride toothpaste, floss daily and see your dentist regularly.
• Sensitivity can be an increasing problem as one ages. Your gums naturally recede over time, exposing areas of the tooth that are not protected by enamel. These areas are particularly prone to pain due to cold or hot foods or beverages. In severe cases cold air, as well as sensitivity to sour and sweet drinks and foods, can occur. If you experience sensitivity, try an anti-sensitivity toothpaste. If the problem persists, see your dentist, as the sensitivity may be an indication of a more serious condition, such as a cavity or a cracked or fractured tooth.
• Crowns are used to strengthen damaged teeth. A crown entirely covers or "caps" a damaged tooth. Besides strengthening a damaged tooth, a crown can be used to improve its appearance, shape or alignment. Implants and bridges are used to replace missing ones. Dental implants replace one or more teeth or are used to attach full or partial dentures. Consult with your dentist to see if implants are right for you. Bridges are commonly used to replace one or more missing teeth. They span the space where the teeth are missing. Bridges are cemented to the natural teeth or implants surrounding the empty space.

How Can I Help Make My Teeth Look Whiter?
Thorough cleanings by a dentist or hygienist will remove most external staining caused by food and tobacco. Using a whitening toothpaste can also help remove these surface stains between dental visits. If stains have been present for years, you may need to have your teeth professionally whitened to remove these more stubborn external stains.

Internal stains can be bleached, bonded or capped (crowned). While each of these methods is safe and effective, your dentist will recommend which treatment is appropriate for you depending on the state of your teeth and the results that you wish to achieve.

What Effect Does Diet Have On My Oral Health?
In addition to greatly affecting your overall health, proper nutrition is necessary for healthy teeth and gums. Eating a well-balanced diet gives your gum tissues and teeth the important nutrients and minerals they need to stay strong and resist infections, which can contribute to gum disease. In addition, firm, fibrous foods such as fruits and vegetables tend to help clean the teeth and tissues. Soft, sticky foods tend to remain on the grooves and between teeth, producing more plaque.

Each time you consume foods and drinks that contain sugars or starches, the bacteria in plaque produce acids that attack your teeth for 20 minutes or more. To reduce damage to your tooth enamel, limit the number or between meal snacks and drinks. And when you do snack, choose nutritious foods such as cheese, raw vegetables, plain yogurt or fruit.

Call Now San Francisco Dentist
Request for appointment at: (415) 391 - 7751
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