What the floss?! Soulsmile Weighs in on Recent News

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What the floss?! Soulsmile Weighs in on Recent News

Let's Talk About Flossing

Surely you've seen the headlines - "Flossing is Nonsense and My Laziness is Vindicated" or "Flossing: Government's Latest Piece of Bad Advice". All this press about flossing stems from an article published this month by the Associated Press (Read it here). Their report points out the weak evidentiary basis for floss as a method of reducing plaque and tooth decay. The American Dental Association responded saying: Trust us, flossing helps.  

In reality, the AP article is less about floss and more about evidence-based medicine. They are correct in that the published and proven evidence for the benefits of floss is poor. One reason for this is that floss has been around since the 19th-century! Recommendations for flossing are based on pretty obvious assumptions: it removes plaque from in between teeth and because plaque leads to gum disease and decay, flossing will improve these conditions. But because our medical standards have risen so greatly in the last centuries, assumptions are not enough - and understandably so. 

Anecdotal evidence and long-standing traditions have been replaced with evidence-based medicine. This approach is dependent on well-designed, controlled studies. Thus far, nobody has tackled a flossing study with the academic rigor we now expect. Why? We can only speculate. Studies like this are expensive and there is no fame or monetary reward to be found in proving out flossing. Flossing is cheap, easy to adopt and no-risk. This leaves us with anecdotes and weak evidence. Two of our leading dental associations — the American Dental Association and the American Academy of Periodontology — cited other studies as proof, but most of these studies used outdated methods or had relatively small sample size. 

Despite our agreement regarding poor studies and evidence around flossing, this does NOT mean it has been proven ineffective either. Each of your teeth have six surfaces and brushing can only clean four of them. You simply need a method for cleaning in between your teeth to properly remove all plaque causing substances that are proven to cause decay.  

We always hoped more people would talk about flossing - but not like this! At the very least, we hope this exposure will inspire researchers to conduct better studies and counteract these claims made by the AP. Oh, and by the way - even the author of the article admits he still flosses. If you have any questions, feel free to contact us directly or leave a comment. We'd love to hear from you. 

For Further Reading

This 2006 study titled, “Dental Flossing and Interproximal Caries: a System Review,” recruited 808 children age 4-13 and split them into three test segments: kids who were professionally flossed 5 days/week; kids who were professionally flossed once every 3 months; and kids who reported self-flossing at home. The research lasts 18 months and unsurprisingly, the participants who were professionally flossed 5 days/week saw a 40% decrease in the risk of cavities. 

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Are Dental X-rays Safe and Necessary?

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Are Dental X-rays Safe and Necessary?

One of the great things about the Ashland, OR community is the level of health intelligence. Its evident by ready the local publications or driving around town and seeing the many natural food stores and health care providers. We’ve come to realize that concern around x-rays is even greater here than many parts of the country – and rightly so! We hear questions regarding the safety and necessity of x-rays on a daily basis. This is a great question and the answer differs from patient to patient. Let’s dive in a little deeper – we think you’ll be surprised to leave just how safe today’s x-ray practices are.

First of all, there is an ever-changing landscape when it comes to dental x-rays. The American Dental Association (ADA) together with the Food & Drug Administration (FDA) routinely revises their guidelines when advances in technology provide new methods of reducing exposure to radiation. In fact, today’s dental X-ray is already far superior to those of just a decade ago. This is due largely to the advent of digital technology.

The following guidelines come from the ADA and are supported by our practice:

New Patients: 

Full X-rays are generally suggested for new patients to provide us with a full history of your prior oral care and current needs. If you’ve recently had x-rays taken at another office, we’re happy to obtain those on your behalf.

Continuing Care Patient:

One set of X-rays every 6-18 months. We generally aim for 12 unless a patient is at a higher risk or is presenting with an issue.

Continuing Care Patient with Periodontal Disease: 

Dependent upon the professional judgment of Dr. DeCillis.

Patients with, but not limited to, Proposed or Existing Implants and Root Canals:

Also dependent upon the professional judgment of Dr. DeCillis.

In conclusion, it’s important to realize that exposure to all sources of radiation - including the sun, home appliances, minerals in the soil, X-rays - can damage the body's tissues and cells. Fortunately, the dose of radiation you are exposed to from dental X-rays is tremendously small, especially with our use of digital x-rays. Our recommendation is to follow the ADA guidelines. This is because allowing a major dental issue to go undiagnosed can be much more damaging to your health than a small amount of radiation. Please feel free to ask us any questions or voice your concerns regarding x-rays and we will do what we can to accommodate your preferences.

You can also check out our great FAQ Page on Digital Xrays.
 

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#RideMyRoad

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#RideMyRoad

Lauren Trantham

Lauren Trantham

Our patient and friend, Lauren Trantham, is about to embark on the adventure of a lifetime with a project called RideMyRoad. Soulsmile is proud to be a sponsor as she rides around the United States on her motorcycle photographing survivors of sex trafficking. She will be telling their stories, raising funds and promoting awareness. Many of the photos will be available for viewing on her website. Her goal is to make women feel beautiful, empowered, and worthy. 

Come out to the starting point of Lauren Trantham's 9k solo motorcycle journey to raise awareness and funds for survivors of Human Trafficking. She'll be starting here in Ashland, Oregon and traveling clockwise around the entire country. 

Kick Off Details

Where:  Schneider Museum of Art  1250 Siskiyou Blvd, Ashland, Oregon 97520
When: September 2, 2016 @ 7pm
Stay up to date with the Facebook Page
Follow Lauren on Instagram: ridemyroad 

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Gum Disease? Meet Your New Best Friend: Arestin®

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Gum Disease? Meet Your New Best Friend: Arestin®

Regular brushing and flossing are essential parts of oral home care. But gum disease won’t go away on its own. Because it’s an infection, it needs to be treated professionally. In our office, we often combine scaling and root planing (SRP) with application of an antibiotic medication called Arestin®.

Because of the way gum disease progresses, the longer you wait to take action, the greater the chance you may need painful and expensive surgery to get it under control. Arestin® is a locally administered antibiotic (LAA) in powder form that we place directly into the infected areas—or pockets—in your gums. Arestin® powder is made up of 100,000 tiny microspheres, invisible to the eye. These microspheres contain the antibiotic drug minocycline, which is released over time into the infected pocket. This means Arestin® keeps working to kill bacteria long after you’ve left our chair. 

Moft of the time, our patients are pleasantly surprised to find that their medical insurance's prescription coverage applies to Arestin®. It is typical that a $30 copay will enable our patients to receive $1,000 worth of this medicine. 

How Arestin + SRP Works:

01. Your dental professional removes plaque and tartar above and below the gumline with SRP. 

01. Your dental professional removes plaque and tartar above and below the gumline with SRP. 

 02. ARESTIN® microspheres are placed into infected pockets using a special plastic applicator. 

 02. ARESTIN® microspheres are placed into infected pockets using a special plastic applicator. 

  03. The antibiotic is released over time, helping to reduce bacteria as your gums heal.

  03. The antibiotic is released over time, helping to reduce bacteria as your gums heal.

If you have any questions regarding gum disease or how Arestin® can help, let us know! We're happy to share some insights or schedule an appointment to help evaluate your unique needs and oral health. 

Images and content courtesy of Arestin®.

 

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Q&A Spotlight: Periodontal Maintenance vs. Prophylaxis

Often times, we get asked by patients, “What’s the difference between a normal cleaning a periodontal maintenance, and why does it cost more?” This is a great question and the answer has a few parts to it. 

First, let's establish that a “normal” cleaning (prophylaxis) is for a healthy mouths. This includes procedures that address plaque, calculus and stains on the coronal portion of the tooth. “Coronal” means relating to the crown of the tooth, above the gumline. The typical patient who should receive prophylaxis comes to routine (every 6 months) hygiene appointments, exhibits excellent home care habits and has healthy tissues with no bleeding when probed or flossed. When they have a periodontal evaluation and charting session, probings are measured at 4mm or less. 

Next, let’s cover periodontal maintenance and scaling. This is an ongoing therapeutic procedure to treat periodontitis, which is a chronic and incurable (but controllable) bacterial infection. The primary objective is below the gumline - removal of dentin that is rough and/or permeated by calculus and contaminated with toxins and microorganisms. Some soft tissue removal also occurs. This type of procedure requires more skill and expertise than a prophylaxis. 

Periodontal disease overwhelms a patient’s defenses and spurs the immune system to initiate a breakdown of supporting tooth structures (bone loss). It is also episodic. These type of destructive episodes can be triggered by stress, disease or other problems unbeknownst to the patient. The three-month interval recommendation for perio maintenance is not arbitrary. It is based on the behavior of the bacteria. After periodontal maintenance therapy, periodontal pathogens aggregate on the biofilm and become the predominant species of bacteria again in three to 12 weeks. This means that by the 12th week, or 3 months, the periodontal “bugs” are flourishing again. That’s when we should reduce their numbers again. After discovery of periodontal disease, it is important to stay vigilant in controlling and monitoring through periodontal therapy. 

To value a periodontal maintenance it is necessary to understand that it is different from a regular cleaning because you are controlling disease with therapy versus simply cleaning teeth. 

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Dental Care: Under the Microscope

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Dental Care: Under the Microscope

The introduction of microscopes has revolutionized dental care. A microscope is the best visualization tool available in modern medicine. This advanced machine allows Dr. Kivel to work under a magnified scope of up to 20x that of normal vision.

The benefits of dental procedures completed with a microscope include:

Magnified Image: With the simple turn of a dial, microscopes offer a deeper and wider field of view than traditional dental loupes.

Conservative Treatment: Increased magnification allows better precision and access into small, narrow openings without unnecessary removal of tooth structure.

Illumination: Typically, when magnification is used, the light is spread out and an image field would appear darker. Mounted to our microscope is an integrated, through-the-lens, fiber optic light. This light source completely eliminates shadows because it incorporates a coaxial (line of sight) light path.

Ergonomics: With a microscope, it is no longer necessary for dentists to contort and bend their bodies to obtain proper visualization, enabling more comfortable operation for longer periods of time. This efficiency also means more treatment can be provided in fewer visits for the patient.

Imaging: With an added camera (even a cell phone camera!), a scope can fulfill the purpose of an intra-oral camera mid-treatment. With a scope, there’s no stopping in the middle of the procedure to get a wand, find the area, focus, and capture the image. It’s there already!

How Much Extra Does it Cost?

We charge no additional cost to perform treatment using a dental microscope. A microscope is simply the best modality for accurate visualization and diagnostics and we believe this is essential to providing the best care possible for our patients.
 

A Different Kind of Dental Experience

Overall, microscopes give Dr. Kivel increased precision and a higher level of confidence that all decay has been removed. Most importantly, however, the microscope enables us to better diagnose problems early, and in turn, communicate these issues to patients so that they are better informed in making decisions related to their care.  

Please let us know if you have any questions about dental microscopes or are interested in becoming a patient of our Ashland dental office and experiencing the difference yourself! 

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The Importance of Athletic Mouth Guards

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The Importance of Athletic Mouth Guards

The benefits of sports and athletic activities are numerous – they improve strength, coordination and reduce stress. Many of these activities also carry with them a bit of physical risk – including potential damage to your mouth. When we think of protective gear, items like helmets and shin-guards come to mind, but athletic mouth guards are just as important when it comes to negating physical risk.

The Journal of the American Dental Association (JADA) reported that as many as 39% of all dental injuries are sports-related, resulting in nearly $500 million spent on replacing teeth due to injury each year. We encourage you to evaluate your sports activities and related risks and consider having a mouth guard made.

The American Dental Association recommends mouth guards for the following sports:

Peter helping create custom mouth guards for our SOU Women's Wrestling team members!

Peter helping create custom mouth guards for our SOU Women's Wrestling team members!

  • Acrobatics
  • Football
  • Martial Arts
  • Skiing
  • Volleyball
  • Basketball
  • Gymnastics
  • Racquetball
  • Skydiving
  • Water Polo
  • Boxing
  • Handball
  • Rugby
  • Soccer
  • Weight Lifting
  • Discus Throwing
  • Ice Hockey
  • Shot Putting
  • Squash
  • Wrestling
  • Field Hockey
  • Lacrosse
  • Skateboarding
  • Surfing

This list is not exhaustive – in fact, we feel that Mountain Biking is an obvious one to add to the list. The point is that many of the sporting activities we all enjoy should be included. Studies show that athletes are at a much higher risk of sustaining orofacial injuries when not wearing a mouth guard. These type of injuries are not just cosmetic. Injuries to the teeth and soft tissue can be very serious, whether it’s nerve damage or eventual periodontal disease.

It just makes sense to protect your teeth. But not all mouth guards are created equal. There are three main types:

1. Stock

These mouth guards are non-custom. They can be purchased at a store for immediate use. For most patients, they feel bulky and uncomfortable, which can affect the willingness of a patient to wear the guard.

2. Boil and Bite

Just as the name implies, these guards can be purchased at a store, then boiled in hot water (to make it more malleable) and then fit into the mouth and bitten down on to form. These guards are usually more comfortable than a stock guard, but they can be hard to get just right. 

3. Custom

Custom mouth guards are creating by a dentist to fit the unique shape of your teeth, which makes them most comfortable and most effective. Even if a patient is in braces, these guards can be formed to fit comfortably around orthodontia. The process is quick, easy and inexpensive.

If you are a patient or a parent of a child involved in any activity with the potential for injury, let us know. We’re happy to create a custom mouth guard to keep those pearly whites protected! Contact us to book an appointment for your fitting. 

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Insurance Update

Today's blog post is brought you by a special quest author, our office coordinator, Nikki Kirkland, to keep you updated on our insurance information. Here's Nikki ... 

As a service to our patients, we are happy to submit dental claims and maximize insurance benefits to reduce out-of-pocket expenses.  Our office accepts all major insurance carriers, including most employer-sponsored group plans and many individual plans. Currently, we are a Delta Premier Provider, which means our Delta Dental and MODA subscribers benefit from our in-network agreement and fee schedule. We are also a participating provider with Regence Blue Cross Blue Shield, which includes LifeMap, HMA and RGA dental plans. To better serve our patients and community, several additional carriers are being considered for our participation.

As the end of the year approaches, it is important to keep in mind that most dental plans renew on January 1. Dental insurance is unique in that patients have an annual maximum allowed, and any unused benefits at the end of the year are lost. Now is an ideal time to schedule pending treatment and use those remaining insurance dollars. The same concept applies to flexible spending and healthcare savings accounts.

Many of our patients do not have dental insurance, but will still benefit from fair and competitive fees, treatment plan discounts and monthly payment plan options. Our experienced and knowledgeable staff is here to assist you with any questions you may have.

> Please don’t hesitate to contact our Office Coordinator, Nikki with any financial or insurance related concerns.

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Toothbrush Selection

There are so many toothbrushes on the market – how do you choose? Angled heads, electric brushes, ergonomic handles, biodegradable, etc. All these choices can make it tough to decide which brush is right for you. In this article, we’ll decode some of these options and help steer you in the right direction.  

What’s the Difference Between Hard and Soft?

When we talk about “hard” or “soft” toothbrushes, we are referring to the stiffness of bristles on a toothbrush. In theory, stiffer bristles are designed to better remove plaque, food bits and staining. However, our recommendation is to always go for a softer brush. This simple fact is that most people actually brush too hard! Brushing too vigorously is compounded when using a hard-bristled brush and can cause damage to sensitive gum tissue - especially near the gum line.

So next time you come across a hard toothbrush, save it for cleaning the kitchen grout instead!

Natural or Synthetic Bristles?

Most toothbrushes are made from a synthetic material. However, recent advances have been made to promote the production and usage of natural material toothbrushes – for both bristles and handles. Popular materials for these types of brushes are plant or wood fiber. In our opinion, either is fine for your pearly whites, but we love the idea of toothbrushes which are better for the environment! Try a natural toothbrush out when you have the opportunity.

Heads and Handles

There are almost infinite possibilities in brush and head styles. Rather than take too much time describing them all, we’ll get down to business. Here’s what you need to know: It doesn’t matter much. Instead of getting weighed down by the choices, just choose one that’s comfortable to use and inspires excellent hygiene (cheetah print anyone?).

Electric or Manual?

This is where we’ll make our strongest recommendation. We are huge fans of electric toothbrushes! They are powerful and easy to apply the right pressure with. Another great benefit is that many models come with a timer, encouraging people to brush for a full two minutes more often than they normally would. A study by the American Dental Association found that most people brush for only a minute and half.

In addition, the sonic waves emitted by the vibrating brush are proven to be more effective at loosening food and plaque. We had a patient in Invisalign treatment compare brushing her aligners with a manual toothbrush after forgetting her electric brush on a two week vacation. After the experiment, she claimed she would never use a manual toothbrush again! She said the difference, when she could actually see what she was brushing (opposed to the teeth in your own mouth), was an obvious one.

Finding “The One”

Still wondering which toothbrush is best? Don’t worry about it too much. Consistency in your dental hygiene makes a bigger impact on your dental health than any style of toothbrush. Brush two times a day, floss daily and keep your regular hygiene appointments.

If you still have questions about choosing a toothbrush or any other dental care topics, feel free to drop us a line. 

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You Can See What We See: Digital Dental Intraoral Cameras

We have a special post this week, written by our fantastic hygienist, Pam. Over to her ...

You’ll love our intra-oral camera!  You will now get to see up close and in detail, the state of your teeth. Our intra-oral camera is a small pen-like device that connects to our computer and a large monitor so that you can see what we see as we check out your teeth.

Benefits to you –

The intra-oral camera makes going to the dentist easier, provides patients with a greater understanding of their dental health and allows patients to be more interactive.

Early Detection of Dental Health Problems

The intra-oral camera enlarges your teeth to almost 40 times their actual size on a color screen display. By zooming in on problems we are able to see more than we could with the human eye alone. Often we can find the beginnings of dental disease (like decay and periodontal disease) that may have otherwise gone undetected.

Positive Patient Interaction

The intra-oral camera isn’t just a diagnostic instrument, but a great educational one as well. Most people cannot see into their own mouths, but with the camera we can point out areas of concern and the patient can see exactly what we see. This allows for a better understanding of oral conditions and creates an opportunity to ask questions and become part of the discovery process.

Great Record Keeping

The intra-oral camera helps make record keeping simple. The camera can take pictures of decay or the beginning of an oral condition and save images to a patient’s file. We can accurately track the progress of treatment or problems for years. In addition, we can print and send images to specialists and insurance companies.

The Intra-Oral Camera 

Because it is so small, the camera can reveal images of your teeth and tissues from angles previously unseen. Using the intra-oral camera is completely sanitary, as we use a different disposable camera cover for each patient every time. All images can be digitally stored, printed or discarded following an exam.

- Pamela Philips, RDH

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October is National Dental Hygiene Month

This October marks the sixth straight year that the American Dental Hygienists’ Association (ADHA) is presenting National Dental Hygiene Month (NDHM), with the Association and the Wrigley Oral Healthcare Program (WOHP) working collaboratively to increase public awareness about the importance of maintaining good oral health.

This year's focus is on the four components of good oral care maintenance: brushing teeth twice a day, flossing every single day, rinsing with antimicrobial mouthrinse and chewing sugar-free gum (optional). We'd like to take this opportunity to remind our wonderful patients to "do the daily 4". During your next visit with Pam, let's start a conversation about how to integrate good oral health habits into your own daily routine. This practices will not only lead to a healthy mouth, but also contribute to improved overall health. 

“Each and every day, dental hygienists educate patients of all ages and walks of life on the value and importance of good oral health habits. The Daily 4 regimen is a great habit to implement, and talking to patients about brushing, flossing, rinsing and chewing sugar-free gum to stimulate saliva production in between brushings is a great way to open a conversation before discussing patient-specific oral care needs,” said ADHA President Jill Rethman, RDH, BA. “The Daily 4 is simple and effective and can help patients have a bright smile, fresh breath and healthy gums. The ADHA is grateful to the Wrigley Oral Healthcare Program for their commitment to help dental hygienists have this conversation with patients — a conversation that can have a huge impact on their oral and overall health. ”

If you want to check out some of the festivities going on this month, use the hashtag #NDHM2015 online to find pictures and stories. 

 

 

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The Link Between Gum Disease and Prostate Issues

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The Link Between Gum Disease and Prostate Issues

Ashland, OR – For many years now, we’ve known about the unique link between gum disease and other ailments such as increased risk of heart disease. A new discovery points to the likelihood that treating gum disease may also lessen symptoms of prostate inflammation.

“Western Reserve University School of Dental Medicine recently released research that this may be the case,” says Ashland dentist Dr. Aron Kivel. “In the report, participants who suffered from prostatitis experienced fewer symptoms while also seeking periodontal (gum) treatment.” 

This isn’t the first time the correlation between the two have been studied. Previous research also proved the link between prostatitis and gum disease, but this new study shows proves the effectiveness of treatment in helping patients with prostatitis.  For those with inflammation of the prostate, urinating can be painful and laborious.  27 men with both prostate inflammation and gum disease were studied and after gum disease treatment. Even though these men received treatment for their gum disease only and not for their prostate issue, most showed significant improvement. Specifically, 21 of the 27 participants displayed decreased prostate specific antigen (PSA) levels, which indicate a lessened likelihood of inflammation. Men with the highest levels of inflammation also exhibited the most improvement following periodontal treatment.

So How are the Two Linked?

Gum disease develops when plaque and calculus isn’t properly removed and with time, the bacteria can spread and grow below the gum line. This toxic bacteria can then stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. If left untreated, the bacteria can also spread to the bone, causing further infection and possible bone loss.

Our bodies’ systems are intimately related. The bacteria that cause periodontitis can travel to other organs of the body. While a definitive answer has not been reached for why gum disease is linked to so many other issues, inflammation is the strong common denominator.

Research continues to be conducted around the world exploring the link between gum disease and other serious medical issues, but the consensus is obvious – even without an exact reason why, the evidence points to the fact that periodontitis has an effect on your body as a whole. Undergoing proper treatment for gum disease can very well improve people’s overall health and well-being.

You can prevent gum disease before it becomes and issue by following a thorough home hygiene routine which includes daily brushing and flossing, and regular check ups at your dental office. Because periodontitis is often painless, you might not even be aware you have it until it is too late. By discovering and treating gum disease as soon as possible, your dentist can lessen its effect on your gum health as well as the rest of your body. If you’d like a thorough evaluation of your own gum health, make an appointment with us today. 

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Electronic Cigarettes and Oral Health

Ashland, OR – Since their introduction to the market in 2004, electronic cigarettes have seen significantly increased popularity. E-cigarettes are battery-powered devices that convert nicotine into vapor. Publicized as a “healthier alternative” to regular cigarettes, many users have switched to help them quit smoking. The negative health effects of traditional cigarettes are well-know, but many people are now wondering what risks might be posed by e-cigarettes.

ecigarette

The main issue is electronic cigarettes have not been fully studied. “E-cigarettes are so new that long-term effects of their use are not yet know,” says Ashland dentist Dr. Aron Kivel. “Recent research does show that el- cigarettes can negatively impact oral health due to the presence of nicotine. Another concern is that they aren’t regulated by the FDA. “

The products are sold over the counter and are not subject to the same regulation as actual cigarettes. In fact, the FDA does not regulate them at all. Studies have shown that nicotine, delivered by traditional cigarette or other, does harm to the gums, mouth and tongue.

A report published by the Journal of the Indian Society of Periodontology stated that nicotine may contribute to the development of gingivitis and periodontitis, which can cause inflammation and bad breath. Nicotine is a vasoconstrictor, meaning it narrows the blood vessels and reduces the amount of blood that can flow. Without proper blood flow, the gums do not get the enough oxygen.

This constricted blood flow can also hide the symptoms of gum disease, making it harder to be diagnosed. When gum disease is present, it’s the increased blood flow to the gums that alerts your dentist or hygienist to the fact. Diseased gums are irritated and typically swell with blood, and when brushed or flossed, they bleed. This false positive caused by nicotine can fool you into thinking that things are going better than they are.

Nicotine can also be detrimental to people who grind their teeth as it is a stimulant. This fires up the muscles, which makes you grind your teeth more intensely. It may even prompt non-grinders to start grinding their teeth. 

The vaporizing liquid used in these cigarettes contains dangerous chemicals, restricts vital blood flow and more studies need to be conducted to further study the implications of e-cigarettes. Our final verdict? It is safe to say that the only safe alternative to smoking is quite simply not to smoke at all.

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Introduction

Welcome to our first blog post! Our goal for this blog is to share some insight and opinions on dental topics that are most important to our patients.

Often times, dental stories or "DIY" at-home tricks make it into the news and leave people wondering what the professionals think. We're here to weigh in. Other patients may be considering their options ("Should I get a bridge or have an implant placed?"). We want this blog to also serve as a place to address these common questions we hear from patients everyday.

If you have any questions or topic ideas, feel free to email us at hello@ashlanddentists.com. 

Be well!

 

 

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