If you have osteoporosis, one of the drugs you may be taking is alendronate, more commonly known by the brand name Fosamax®. Alendronate is a member of the bisphosphonate drug family, which inhibit bone resorption (the loss of bone mass). While an effective treatment of osteoporosis, alendronate may cause an opposite side effect in other areas of the body, the inhibition of new bone growth. This effect on the jaw in particular could result in an adverse reaction after dental surgery.
The main concern is a condition called osteonecrosis, or literally “bone death.” Bone tissue normally goes through a cycle of resorption (the dissolving of bone tissue) and new growth to replace the cells that have been lost through resorption. Osteonecrosis disrupts the growth phase so that the bone doesn’t recover properly after resorption. This results in the bone becoming weaker and less dense.
There have been a number of cases of increased osteonecrosis in patients on alendronate after experiencing trauma to the mouth. This includes dental surgery, particularly tooth extractions. In addition, patients with certain risk factors like diabetes, tobacco use or corticosteroid therapy appear more vulnerable to osteonecrosis.
Although the risk of osteonecrosis after dental surgery is small, many dentists recommend stopping the use of alendronate for three months before the procedure if you’ve been taking the drug for more than three years. This recommendation is based on a number of studies that seem to indicate three or more years of bisphosphonates therapy makes patients especially vulnerable to osteonecrosis. These studies also indicate stopping the therapy for three months significantly reduces the risk of developing the condition.
There’s still much to be learned about this link between alendronate therapy and dental health. It’s a good idea, then, to let us know what medications you’re taking (especially bisphosphonates) whenever you visit us for an exam. Knowing all your medications will help us develop the safest and most effective treatment plan for your dental care.
If you would like more information on bisphosphonates and their effect on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Fosamax and Surgery.”
What happens if you’re right in the middle of a song, in front of an arena full of fans… and you knock out a tooth with your microphone? If you’re Michael Buble, you don’t stop the show — you just keep right on singing.
The Canadian song stylist was recently performing at the Allphones Arena in Sydney, Australia, when an ill-timed encounter with the mike resulted in the loss of one of his teeth. But he didn’t let on to his dental dilemma, and finished the concert without a pause. The next day, Buble revealed the injury to his fans on his Instagram page, with a picture of himself in the dentist’s chair, and a note: “Don’t worry, I’m at the dentist getting fixed up for my final show tonight.”
Buble’s not the only singer who has had a close encounter with a mike: Country chanteuse Taylor Swift and pop star Demi Lovato, among others, have injured their teeth on stage. Fortunately, contemporary dentistry can take care of problems like this quickly and painlessly. So when you’ve got to get back before the public eye, what’s the best (and speediest) way to fix a chipped or broken tooth?
It depends on exactly what’s wrong. If it’s a small chip, cosmetic bonding might be the answer. Bonding uses special tooth-colored resins that mimic the natural shade and luster of your teeth. The whole procedure is done right here in the dental office, usually in just one visit. However, bonding isn’t as long-lasting as some other tooth-restoration methods, and it can’t fix large chips or breaks.
If a tooth’s roots are intact, a crown (or cap) can be used to replace the entire visible part. The damaged tooth is fitted for a custom-fabricated replacement, which is usually made in a dental laboratory and then attached at a subsequent visit (though it can sometimes be fabricated with high-tech machinery right in the office).
If the roots aren’t viable, you may have the option of a bridge or a dental implant. With a fixed bridge, the prosthetic tooth is supported by crowns that are placed on healthy teeth on either side of the gap. The bridge itself is a one-piece unit consisting of the replacement tooth plus the adjacent crowns.
In contrast, a high-tech dental implant is a replacement tooth that’s supported not by your other teeth, but by a screw-like post of titanium metal, which is inserted into the jaw in a minor surgical procedure. Dental implants have the highest success rate of any tooth-replacement method (over 95 percent); they help preserve the quality of bone on the jaw; and they don’t result in weakening the adjacent, healthy teeth — which makes implants the treatment of choice for many people.
So whether you’re crooning for ten thousand adoring fans or just singing in the shower, there's no reason to let a broken tooth stop the show: Talk to us about your tooth-restoration options! If you would like additional information, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Dental Implants vs. Bridgework.”
Have you heard the news about red wine? Every so often, the fruit of the vine is touted for some potential health benefit. Several studies over the past few years have suggested that it could help prevent heart disease and even certain types of cancer — only to have their conclusions called into question by new research. Just recently, newspapers trumpeted a new study from the Journal of Agriculture and Food Chemistry suggesting that certain chemicals in the vino might one day be used to help prevent cavities!
So is red wine good for your health, or isn’t it?
The jury’s still out. But there’s one thing we do know: Regardless of whether it has any affect on cavities, red wine is one of the major culprits in tooth staining.
Of course, it’s not the only offender: Coffee and tea, tobacco in any form, certain foods and some types of medications can all cause extrinsic stains on teeth — that is, stains that affect the exterior surface of the tooth. In addition, intrinsic stain — those that arise from the interior of the tooth — may be caused by root canal problems, or by certain dental filling materials.
If you have stained teeth — whether from red wine or another cause — can you do anything to make them whiter?
Oftentimes, the answer is yes — but finding the best way to do so can be challenging. You can begin by identifying habits and dietary factors that could cause staining. Then, reduce or eliminate the stain-causing factors, and enhance the beneficial ones. For example: stop smoking, modify your diet, practice regular, effective oral hygiene… and come in to the dental office twice a year for a professional cleaning and check-up. In addition, check whether any of your medications could cause staining or reduced saliva flow — a major contributor to the problem.
If making these changes isn’t enough to control teeth staining, the good news is that a number of treatments are available that can help bring your teeth back to a pearly shine — or even give you the “Hollywood white” smile you’ve always wished for. Depending on the cause of your teeth staining, and your desired level of brightening, these treatments can range from professional bleaching to porcelain veneers.
If your smile needs a little help to look its brightest, contact us or schedule an appointment to find out what we can do. For more information, see the Dear Doctor magazine articles “Tooth Staining” and “Important Teeth Whitening Questions Answered.”
She received an academy award for best supporting actress in Chicago (2002); she regularly stars in big Hollywood films like Oceans Twelve and Side Effects. And she’s been named one of People magazine’s “most beautiful people” of the year… a total of five times so far. According to big-screen heartthrob Antonio Banderas, “She has one of the most beautiful close-ups in cinematography today.”
So would it surprise you to learn that Catherine Zeta-Jones had a little help from cosmetic dentistry along the way? In her childhood, the actress said, “I was teased because I had a really flat-looking nose, and before I got braces, my teeth used to stick out a bit.” According to press reports, she has also had various dental treatments to make her teeth look whiter and more even.
Because she’s been in the spotlight since a young age, Zeta-Jones had her cosmetic dental treatments performed over a number of years. But if you’re unhappy with your smile right now, there’s no need to wait: Getting a complete “smile makeover” starts with a consultation at our office. How does it work?
We begin with a thorough dental exam to check for any underlying issues, and some basic questions, including: What do you (and don’t you) like about your smile? Are your teeth as even and as white as you’d like them to be? Is your smile too “gummy”, or do the teeth seem too large or small in proportion to your facial features? Do gaps, chips or cracked teeth detract from your appearance?
Next, working together with you, we can develop a plan to correct any perceived problems in your smile. We’ve already mentioned two of the most common ways to enhance a smile that’s less than perfect: orthodontics for straightening crooked teeth, and whitening treatments for a more brilliant smile. If your teeth are otherwise healthy, both treatments can be performed at any time — in fact, more and more of today’s orthodontic patients are adults.
Other treatments that are often used include cosmetic bonding to repair small to moderate chips or cracks in teeth; crowns (caps) to restore teeth with more extensive structural damage; and veneers to remedy a number of defects — including discoloration, small irregularities in tooth spacing, and even teeth that appear too long or too short. Plus, we have even more procedures designed to remedy specific dental issues.
Will having a better smile get you on the “most beautiful people” list? We can’t say for sure. But we think you’ll feel better about yourself… and people will notice.
If you would like more information on smile makeovers, please contact us or schedule an appointment for a consultation. You can learn more in the Dear Doctor articles “The Impact of a Smile Makeover” and “Great Expectations — Perceptions in Smile Design.”
We’ve all heard about potentially negative health effects from the sugar that’s added to many of our favorite foods. So these days, lots of us are trying to cut down on our consumption of sugar — not only to lose weight, but also to help prevent maladies like diabetes and heart disease. We can’t help noticing those pastel-colored packets — pink, yellow and blue — on the rack of our favorite coffee shop. But now we’re wondering: Are those sugar substitutes a good alternative to natural sugar? And which one should we choose?
Artificial sweeteners have been around for decades. Six different types (including the ones in the colorful packets) are currently approved as safe by the Food and Drug Administration; a couple of older ones (notably cyclamates) have been banned for many years. In addition to those zero-calorie sugar substitutes, low-calorie sweeteners called sugar alcohols (for example, mannitol and xylitol) are often used as food ingredients. So what’s the difference between them — and which one is best?
That’s not so easy to answer. If you have a rare genetic condition called phenylketonuria, you should avoid aspartame (the blue packet), because your body can’t process the substance. Otherwise, the choice may come down to a matter of taste. Even though they are FDA-approved, some controversy (both fact-based and far-fetched) remains about the long-term safety of sugar substitutes, and their usefulness in preventing obesity and other diseases.
Yet it’s clear that for some people, the consequences of consuming too much sugar could be much worse. So if you’re at risk for diabetes or certain other diseases, sugar substitutes can be an important tool in maintaining a healthier diet. They also have another health benefit: sugar substitutes don’t cause cavities. Further, some sugar alcohols (xylitol in particular) have the property of stimulating saliva flow, and have been shown to actually impede the formation of cavities. Oral health is an important (if sometimes overlooked) component of your general well-being, and several studies have pointed to a link between oral and systemic diseases — for example, diabetes and heart disease.
As with so many aspects of our health, there seems to be no “magic bullet” to cure all our diet-related problems. But used in moderation, artificial sweeteners can be a valuable part of the effort to improve our overall health and well-being. For more information on this topic, see the Dear Doctor article “Artificial Sweeteners.”
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