Building Kindness...One Smile at a Time

If Your Teeth Could Talk

2012-01-25T09:22:00.000-08:00

This is an article Dr. Bhatia read, and wanted to share, about clues the mouth offers to disorders and disease. Straight teeth are NOT only for looks!

HEALTH JOURNAL

The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole.

Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue—sometimes long before a patient knows anything is wrong.

There's also growing evidence that oral health problems, particularly gum disease, can harm a patient's general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications.

"We have lots of data showing a direct correlation between inflammation in the mouth and inflammation in the body," says Anthony Iacopino, director of the International Centre for Oral-
Systemic Health, which opened at the University of Manitoba Faculty of Dentistry in Canada in 2008. Recent studies also show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes.

Such findings are fueling a push for dentists to play a greater role in patients' overall health. Some 20 million Americans—including 6% of children and 9% of adults—saw a dentist but not a doctor in 2008, according to a study in the American Journal of Public Health this month.

"It's an opportunity to tell a patient, 'You know, I'm concerned. I think you really need to see a primary care provider,' so you are moving in the direction of better health," says the study's lead researcher Shiela Strauss, co-director of statistics and data management for New York University's Colleges of Nursing and Dentistry.

George Kivowitz, a restorative dentist with offices in Manhattan and Newtown, Pa., says he has spotted seven cases of cancer in 32 years of practice, as well as cases of bulimia, due to the telltale erosion of enamel on the back of the upper front teeth, and methamphetamine addiction. "We call it 'meth mouth,' " he says. "The outer surface of teeth just rot in a way that's like nothing else."

Some of the most distinctive problems come from uncontrolled diabetes, Dr. Kivowitz adds. "The gum tissue has a glistening, shiny look where it meets the teeth. It bleeds easily and pulls away from the
bone—and it's all throughout the mouth."

An estimated six million Americans have diabetes but don't know it—and several studies suggest that dentists could help alert them. A 2009 study from New York University found that 93% of people who have periodontal disease are at risk for diabetes, according to the criteria established by American Diabetes Association.

It's not just that the same lifestyle habits contribute to both gum disease and high blood sugar; the two conditions exacerbate each other, experts say. Inflammation from infected gums makes it more difficult for people with diabetes to control their blood-sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation.

Diabetes also complicates dental-implant surgery, because it interferes with blood vessel formation and bone growth. "When you put a dental implant in, you rely on the healing process to cement it to
the jaw, so you get a higher failure rate with diabetes," says Ed Marcus, a periodontist in Yardley, Pa., who teaches at the University of Pennsylvania and Temple University dental schools.

Dr. Marcus notes that about 50% of periodontal disease is genetic—and even young patients can have significant bone loss if they have an unusually high immune response to a small number of bacteria. Giving such patients a low dose of doxycycline daily can help modify the immune response. "It doesn't really control the bacteria, but it helps reduce the body's reaction," he says.

There's also growing evidence that the link between periodontal disease and cardiovascular problems isn't a coincidence either. Inflammation in the gums raises C-reactive protein, thought to be a culprit in heart disease.

"They've found oral bacteria in the plaques that block arteries. It's moved from a casual relationship to a risk factor," says Mark Wolff, chairman of the Department of Cariology and Comprehensive Care at NYU College of Dentistry.

Bacteria from the mouth can travel through the bloodstream and cause problems elsewhere, which is why people contemplating elective surgery are advised to have any needed dental work performed first.

The American Heart Association no longer recommends that people with mitral valve prolapse (in which heart values close abnormally between beats) routinely take antibiotics before dental procedures, since it's now believed that oral bacteria enter the bloodstream all the time, from routine washing, brushing and chewing food.

But the American Heart Association, the American Medical Association and the American Orthopedic Association all urge people who have had a full joint replacement to take an antibiotic one hour before any dental visit for the rest of their lives to reduce the risk of post-surgical infections. "I have my guidelines taped to the door in my hygienists' room," Dr. Kivowitz says.

Dentists say they also need to stay up to date with all medications, supplements and over-the-counter drugs their patients are taking. Blood thinners can create excess bleeding in the mouth. Bisphosphonates, often prescribed forosteoporosis, can severely weaken jaw bones. Both should be stopped temporarily before oral surgery.

Antihypertensive drugs, calcium-channel blockers and some anti-inflammatory drugs can cause painful ulcerations of the gums. Many medications, from antidepressants to chemotherapy drugs, cause dry mouth, which can cause cavities to skyrocket, since saliva typically acts as a protective coating for teeth. Additional fluoride treatments can help.

Some proactive dentists have glucose monitors for another check on blood-sugar levels if they suspect diabetes. Somealso take patients' blood pressure and hold off on invasive procedures if it's extremely high.

The Centers for Disease Control and Prevention recommends that dentists offer HIV testing, because some of the first symptoms appear in the mouth, including fungal infections and lesions. Dentists can do the HIV test with a simple mouth swab and get results in 20 minutes.

Breaking the bad news is often more difficult. "I went into oral surgery because I didn't think I would have to deliver that kind of news to patients," says Clifford Salm, an oral and maxillofacial surgeon in Manhattan who has found leukemia, lymphoma, AIDS and metastatic breast cancer after performing biopsies on suspicious spots. "It can be adifficult conversation," he says, "but most patients are very grateful."

Don't Be Fooled by White, Shiny Teeth

A gleaming, white smile is a sign of a healthy mouth, right? Not necessarily.

"Whiteness and the health of your teeth are totally unrelated," says Mark Wolff, an associate dean at New York University College of Dentistry.

In fact, many dentists worry that people who whiten their teeth may have a false sense of complacency, since their teeth can still be harboring tooth decay and serious gum disease.
Even people who have no cavities can still have inflamed and infected gums. It could be that their saliva is particularly protective of their tooth enamel, while their brushing and flossing habits, needed to keep gum tissues healthy, could be lax.

"I get these patients in their mid-30s who don't have cavities, so they haven't been to a dentist in 10 years. But they have full-blown periodontal disease," says George Kivowitz, a restorative dentist in Manhattan. "They are losing all the supporting structure, and I have to tell them that these gorgeous teeth will fall out of your head if we don't turn this around."

Using whitening products more often than recommended can erode some of the enamel and cause teeth to appear translucent. But whether that actually harms teeth is controversial. "No one has really shown that it's damaging, but no one knows the long-term results," says Dr. Marcus, the periodontist in Yardley, Pa.

This article was found at WSI.com, The Wall Street Journal

Bite Problems Linked to Headaches in Children and Adolescents

2011-11-02T12:37:00.000-07:00

Headaches are frequently the most reported symptoms of TMD (temporomanibular disorder) in children and adolescents. The correlation between recurrent tension-type headaches, TMD, and tenderness to palpation of the jaw muscles has been well established. This supports the theory that recurrent headache disorders in children and adolescents are most often of the muscle tension/contraction type.

Studies have shown that Overbite, overjet, and posterior crossbite showed significant associations with increased risk for headaches. The combination of all three of these occlusal (bite) factors increased the risk even more.
After excluding patients with known migraine headaches (diagnosed), neurological disorders, trauma-related conditions, and other possible disorders related to the head and neck, the recurrent, tension-type headache was targeted in children and adolescents. The occlusal factors found to have a statistically significant relationship to headaces are similar to those for TMD. These include:

• unilateral posterior crossbite

• anterior open bite

• overjet greater than 6 mm.

Headaches have also been strongly correlated to oral functional habits such as clenching, grinding, nail biting, and lip or cheek biting.

The tension type of headache is the most common, and it has the most damaging socioeconomic effect on the general population of any health disorder and also has a profound impact on the quality of life for children and adolescents.

The American Association of Orthodontists recommends an initial screening by age seven. This gives Dr. Bhatia the best chance to guide jaw growth and correct harmful oral habits.

Halloween Fun!

2011-10-31T13:02:00.000-07:00

It's that time of the year.... broken brackets and extra pokey wires due to all the sticky sweet treats!

In honor of this day full of gooey goodness we're posting a BRACE-FRIENDLY recipe from Got Braces? The Braces Cookbook by Pamela Waterman and Brenda Waterman, Recipes You and Your Orthodontist Will Love

Fudgy Cocoa Bites
Using cocoa powder instead of melted baking chocolate is one of the secrets to baking soft cookies (another is using shortening instead of margarine or butter). If you're looking for a change from brownies, this is a great melt-in-your-mouth alternative.

1 cup shortening
1 cup sugar
2 Tablespoons water
1 teaspoon vanilla
2 eggs
2 cups all-purpose flour
1/2 cup cocoa
1 teaspoon salt
1/2 teaspoon baking powder

Preheat oven to 375 degrees. Bake for 9 minutes.

In a large bowl, combine shortening, sugar, water, and vanilla, using an electric mixer and beating until smooth. Add eggs and mix until blended. Mix flour, cocoa, salt and baking powder slowly into shortening mixture, using low then medium speed.

Drop by tablespoons onto ungreased cookie sheets. Makes about three dozen. Store in a covered container to keep the softness.

Impression-Less Options at Bhatia Orthodontics

2011-10-31T11:23:00.000-07:00

We are excited to offer our patients the very latest advancements in orthodontic technologoy with the introduction of the iOC Digital Impression Photo Scanner.

- Eliminates messy gooey impression material that can cause gagging

- The accurate images are used to create much better fitting appliances, ensuring shorter treatment times and better results

- Faster turn around time from the lab for appliances, Invisalign, and Invisalign Teen

ENT and Orthodontics???

2010-09-02T13:43:00.000-07:00

This may sound like an odd combination, but should your child primarily use their mouth for breathing your Orthodontist may advise that you take your child for an evaluation with an ENT (Ear, Nose, Throat) doctor. Mouth breathing can influence how the teeth develop.

Breath to humans is as similar in necessity as sunlight to a tree. But, if a tree receives sunlight from only one direction, the trunk and branches grow toward the light source, and the tree will become permanently deformed. If a child is unable to maintain a consistent, healthy nasal airway, the body will automatically program the system to take breaths through the mouth. Whenever a child cannot breathe through the nose, a mouth-breathing mode of breathing occurs.

When the change is made from nasal to mouth breathing some unhealthy things can occur:
~ Chronic middle ear infections
~ Sinusitis
~ Upper airway infections
~ Decrease in oxygen intake into the lungs, which can lead to lack of energy
~ Abnormal swallowing pattern

In adapting the mouth for breathing, two basic changes takes place; the upper lip is raised and the lower jaw is maintained in an open posture. The tongue, which is normally placed near the roof of the mouth, drops to the floor of the mouth and protrudes to allow a greater flow of air into the back of the throat. This alters the normal muscular activity of the face and jaw during critical developing years.

The largest increments of growth occur during the earliest years of life. By age four, the facial skeleton has reached 60% of its adult size, and by 12, when most parents think of orthodontic treatment, 90% of facial growth has already occurred. Consequently, if a child has chronic untreated nasal obstruction during the early critical growing years, facial deformities result... some subtle, some more noticeable.

We CAN help influence proper facial growth and maximize quality of life for a child. How your child breathe should not be taken for granted. When parents take early orthodontic action, not only can the existing problems be corrected, the physical and emotional pain the child may experience is prevented.

Tools for a Healthy Smile:

2010-07-15T14:28:00.000-07:00

~ Limit snacking to less than three episodes a day

~ Offer your child a nutritious, balanced diet that includes a variety of foods to give their body all the nutrients it needs

~ Remind them to brush thoroughly twice a day with fluoride toothpaste and clean between teeth with floss or inter-dental cleaner once a day to remove plaque

~ Make sure you child has regular dental checkups and teeth cleanings

~ If teeth are crowded, crooked or overlapping it is harder to clean between the teeth resulting in increased chance of decay. Straight teeth are not just for looks but for good health as well. Therefore....

~ Have your child evaluated by an Orthodontist between the ages of 7 and 9 as recommended by the American Association of Orthodontists (www.braces.org)...timely intervention may provide advantages that are not available later.

Do You Like Your Smile ?

2010-06-23T14:10:00.000-07:00

It seems like an easy question. How many of you are truly 100% satisfied with the smile you face the world with? Beautiful, healthy smiles are only the most obvious benefit of orthodontics. Another outcome--increased self-confidence--may be less evident. But orthodontics can be credited for dramatic improvements in the careers and personal relationships of millions of people in the United States according to the American Association of Orthodontists (AAO).

the aesthetics of your smile has a tremendous effect on the perception others have about you, and even affects our outlook about ourselves. There are several key components to a dazzling smile; it is a mixture of personal appeal, a healthy appearance of the teeth and face, and a positive outlook that comes from within the individual. In a recent survey by Harris Interactive, the following results were found concerning smiles:
*94% said that a smile is the first thing they notice when meeting someone.
*71% believe people with a nice smile make friends more easily then people with crooked teeth.
*75% of adults believe that an attractive smile is important for succeeding at the workplace.
*45% believe that bad teeth are a sign of bad personal hygiene.
*Over 1/3 of people polled agree that bad teeth overshadow the rest of a person's appearance.
*86% think people with good teeth are more attractive to the opposite sex.

The photos below are an outstanding example of the tremendous impact orthodontics can have on your smile, and your life. This patient started treatment at 21 and finished a little more than a year and a half later with an entirely different smile, face and attitude.

Whether you are a teenage boy competing in high school, a college graduate about to begin your professional career, a young executive striving to establish your position in the business world, a young mother attempting to create an ideal image of your children, a child standing on the threshold of a lifetime or whether you are a grandmother who is enjoying a senior position of respect and dignity within the family circle...a beautiful, healthy smile translates into happiness, invites communication, and opens the doors to success and fulfillment. At Bhatia Orthodontics we believe that a warm smile is the universal language of kindness and so our credo is "Building kindness...one smile at a time!"

Why Age 7 ???

2010-05-06T12:52:00.000-07:00

Your child should have their first orthodontic screening between the ages of 7 and 9. At this time a panoramic x-ray will be taken to allow us to see if the child is crowded or not. If the child is not crowded we will continue to monitor their growth and once their permanent teeth have exfoliated we will begin traditional braces to better align the teeth. Should the child be crowded we are able to intervene and treat the patient without having to remove permanent teeth and a more aesthetic and stable result is accomplished.

You might be wondering how we are able to achieve this with crowding. What the x-ray shows us is the bone size is smaller than what is required by all the permanent teeth. Fitting all the permanent teeth onto the bone requires increasing the size of the bone. This orthopedic change requires a degree of force to the bone that braces alone cannot do. This may sound frightening, but it is a simple appliance placed on the roof of the mouth attached to the molars. In the middle of the appliance is a small jack-screw that will gradually be turned over time prescribed by the orthodontist to accumulate the space required for the permanent teeth. Braces can only tip the teeth out to make space, but in order to have a stable bite it is necessary for the teeth to sit as close to the middle of the bone as possible. Extractions of permanent teeth to resolve the crowding can be avoided by increasing the total width of the bone with an Expander. Studies have shown that treatment with an Expander, in addition to braces, results in a significantly favorable long-term increases in upper and lower arch measurements.

Medical Reasons for Adult Orthodontics

2008-08-14T08:31:00.000-07:00

There are plenty of medical reasons for adult orthodontics. Crowded, excessively spaced or misaligned teeth can wear unevenly over time and, in some people cause the teeth to weaken and fall out. Other problems associated with misaligned teeth include headaches, jaw pain and difficulty in cleaning and maintaining the teeth, possibly resulting in more decay and gum disease.

Research has found that people with periodontal (gum) disease are almost twice as likely to suffer from coronary artery disease, than those without periodontal disease. The theory is that the bacteria that form periodontal disease can trigger white blood cells to release chemicals in the blood known as pro-inflammatory mediators that may lead to heart disease and stroke. Another theory is that bacteria from the mouth attach to fatty acid plaques in the coronary arteries and contribute to clot formation. These clots can obstruct normal blood flow and also lead to strokes and heart attacks.

STRAIGHT TEETH allow for proper oral hygiene by providing easier access to the areas between the gums
Reduce the accumulation of tartar and plaque on the teeth thereby reducing the total bacterial count in the mouth.

INVISALIGN is the latest alternative to conventional braces and most adults can be treated with this modality. Invisalign is a set of clear aligners that straighten the teeth gradually until the intended results are achieved. I have been awarded the distinction of being a Premier Provider for Invisalign three years in a row. This is based on over 200 cases diagnosed and treated. Click on the "Bhatia Orthodontics" link to view before and after photos of some of the cases treated with Invisalign. You can also visit the Invisalign website from the link at the left.

Straight Teeth, No Braces!!

2008-07-30T07:18:00.000-07:00

Invisalign is a virturally invisible solution so you can smile during as well as after treatment. In fact,virtually no one will know you're wearing them unless you tell. By using a series of clear, removable aligners, Invisalign straightens your teeth right before your eyes. Change them about every two weeks and your teeth will move toward the smile you have always wanted.

Invisalign is a Tecnique

Although it could be viewed as a product that can be purchased, it is actually another way to
apply orthodontic forces to teeth.
Therefore….. Technique is Important!

Every appliance has it’s strong points and weak points, and it is the experience of the treating Orthodontist that maximizes the strong points to achieve the desired result.

Signs the bite is not right

2008-07-15T14:32:00.000-07:00

•Early or late loss of baby teeth
•Difficulty in chewing or biting
•Breathing through the mouth
•Thumb sucking
•Crowded, misplaced or blocked out teeth
•Jaws that are too far forward or back
•Biting the cheek or biting into the roof of the mouth
•Protruding teeth
•Upper and lower teeth that don’t meet, or meet in an abnormal way
•An unbalanced facial appearance
• Grinding or clenching of the teeth