November 22nd, 2016
The most important part of oral health is attending to your oral microbiome. Achieving oral health is really about promoting balance among the bacteria in your mouth. And contrary to popular belief, antimicrobial agents and alcohol mouthwashes designed to "kill bad bacteria" may actually do far more harm than good.
The oral microbiome, while connected to the gut microbiome, is quite unique. Most importantly, it has a protective component that protects you from deadly viruses and bacteria in the environment. The second function of the oral microbiome is the beginning of digestion. When we look at the oral microbiome, it's an essential component of the salivary immune system; it aids in digestion, and it even makes vitamins. We are looking at ways to promote oral microbiome homeostasis.
Interestingly, probiotics do not work in the mouth, so it's not as simple as adding more beneficial microbes. As an initial step, you need to cease killing all the microbes in your mouth with alcohol mouthwashes. In the mouth, you don't want to have a 'scorched earth policy' or nuking all the bacteria and hoping the good bugs come back.
Instead, we recommend *effective removal* of the "food source" of these bacteria: plaque and food particles. This involves careful home care each day and regular dental cleanings to clean beneath the gums. Brushing of the tongue to remove the film can also aid in the balance of good and harmful bacteria. Plant based diets and lean proteins aid in the minimization of harmful mouth bacteria. Avoidance of processed food, which contain vastly more sugars, is also an important goal.
From a systemic point of view, minimizing the use of systemic antibiotics can help improve the gut and oral microbiome. Unless there is a clear diagnosis of infection, routine use of antibiotics may also kill off many of the beneficial bacteria in a person's mouth.
The secondary benefit from improved oral microbiome health is less odors and halitosis. The very products we are using to improve our breath, by masking the odor or killing all the bacteria in our mouths, may not be as effective as better daily home care to manually remove the food particles and film from our mouths.
Instead of banishing bacteria in our mouths, which is impossible anyway, let's think of it as limiting the buffet of food that we provide when we forget to floss or brush our teeth, or put off professional cleanings.
Come see Hasiba and Brooke for the "best cleaning of your life". It's a comment we often hear and we thought you should know.
June 8th, 2016
I have often had the conversation with my patients whether or not a dental implant is necessary. Too often, people believe that an implant to replace a missing tooth, is frivolous or just for cosmetics. This belief couldn't be further from the truth. Teeth, all 28-32 of them, are designed to function as a whole. When there are teeth missing, besides the wisdom teeth, changes may occur that weaken the other remaining teeth. Besides the obvious extra chewing forces that would be placed on the teeth adjacent to the missing tooth, these teeth will often shift and move into the newly formed space. As the teeth shift- and depending on the number of teeth missing- this can result in a collapse of a patient's bite. In other words, the teeth move and the jaw now "over closes" to accommodate to the new shifted tooth position. This can lead to jaw pain and problems with the TemporoMandibular joint (TMJ).
Shifting of teeth into the space of a missing tooth can also lead to irregular gums that become difficult to clean and can often develop into periodontal disease. Once this occurs, the bone becomes diseased and can lead to more tooth loss. As more and more teeth are lost, it becomes a slippery slope of dental problems that can result in more tooth loss. Therefore, replacing a tooth, whether with an implant or a bridge or a partial denture, depending on the situation, is important to stopping the progress of these problems.
All forms of tooth replacement have their pros and cons, but dental implants have proven to be the most predictable, long term tooth replacement option in healthy, non-smokers. The value of knowing that there are no "missing teeth" can improve one's self esteem and of course, make a smile look great, but there are other important reasons to replace a missing tooth. Implants are just one way to do this.
May 3rd, 2016
Dentistry is an art. As with any art, it takes training to see the nuances of a person's teeth, gums, lips, nose and eyes. I enjoy looking at proportions and symmetry, and comparing that to what our society considers to be a "pretty smile". When patients ask me about cosmetic dental procedures, I don't just look inside their mouths, but consider the whole picture. Sometimes, it can be as simple as some tooth whitening and replacing an old silver filling, but sometimes great care can take multiple steps.
I am proud to be a comprehensive dentist that can deliver this care. This is often when I discuss phasing of treatment with my patients. Phasing is when you take a step by step approach, with the overall goal in mind. Phasing allows dentistry to become more predictable and affordable. Setting goals, which are unique to each patient, is the most important step. I let patients co-diagnose with me and take ownership of their care.
For example, a patient might have crooked teeth with old, mismatched dental work. The first phase would be to straighten the teeth with Invisalign. Later, the old fillings or veneers could be replaced to make the teeth look brighter and more natural. When teeth have been crooked for many years, often the gums are irregular. Laser gum sculpting could balance the smile and frame the teeth.
Nothing makes me happier than to see a patient with a huge smile and speaking with confidence. I also love to empower patients and let them help design their smiles, so we can both work toward this common goal over several months, or even years. Comprehensive dental care is something we can all smile about!
Dr Kristen Donohue
February 9th, 2016
This exquisite image is from researchers with the Marine Biology Lab at Woods Hole. Multi-colored probe molecules were used to identify and view the microbacteria in dental plaque. The long magenta filaments (trunks) are Corynebacterium with green Streptococcus spheres (leaves) on the ends. The bacteria are clearly quite organized with the Corynebacterium adhering to the enamel and fanning out from the tooth. It creates a "canopy" and provides a framework for the rest of the bacterial community.
Not to get too technical, but the Streptococcus (green spheres) at the surface of this biofilm consume sugars and oxygen to produce lactate and hydrogen peroxide—substances that can cause cavities. Streptococcus also release carbon dioxide, which a type of bacteria called Capnocytophaga need to grow (shown above as yellowish filaments). This is why Capnocytophaga lives in the zone just below the canopy, nestled within the trunks. This zone, being low in oxygen thanks to Streptococcus, is also home to anaerobic species like the gum disease causing: Fusobacterium.
In other words, plaque is not some random blob of bacteria. It's layered with zones of oxygen and chemicals that can attract and repel various types of bacteria within it's complex form. The structure is more elaborate and involved than anything scientists thought possible. To put it simply, plaque is less like a random mixture of bacteria and more like a tissue; organized into sub-structures with specific functions.
This beautiful picture, as part of a feature by National Geographic, illustrate the complexity of the microbiome within our mouths. It also gives us insight as to why the biofilm of bacteria in our mouths is so darn hard to remove! The next time you are getting your teeth cleaned and polished, ponder the microbiology going on inside your mouth.
Sorry to "geek out" on you... I just had to share this cool photo!