Let’s review what causes tooth decay in the first place. In simple terms, a balance of minerals constantly streams in and out of our tooth enamel. Healthy saliva contains calcium and phosphate, minerals that are absorbed by teeth to replenish loss due to exposure to acids in foods and beverages. Good quality, low-acid saliva can use these minerals to repair early, minor damage to tooth enamel – a process called re-mineralization. Who knew that common spit was such a powerhouse of activity?

On the other hand, if saliva contains too little or too much acid minerals leach out of our teeth causing de-mineralization. As calcium and phosphate are dissolved out of the tooth, bacteria begin to thrive in the weakened enamel. This then causes the infection we know as tooth decay.

The good news is that there are currently products available that can significantly enhance the remineralization process. We’re all familiar with fluoride – long the gold standard of treatment for remineralizing teeth – and routinely added to our water supply for over half a century. Recently, products have been introduced that increase the effectiveness of fluoride.

One of the best and easiest of these to incorporate into your daily routine is, startlingly enough, a sugar. Xylitol, a natural sugar alcohol found in tree sap, fruits, and vegetables isn’t exactly new – it was discovered as a sweetener in Scandinavia in the 1940s, rediscovered as a powerful anti-cavity agent in the 1960’s, and certified for safety in the 1990’s. Only recently has it actually become popular in the United States.

Xylitol does not actually remineralize your teeth. Rather, it prevents demineralization by inhibiting growth of streptococcus bacteria and reduces plaque by making it less sticky and easier to remove. Bacteria cannot break down xylitol into acid as they can other sugars such as sucrose, glucose, fructose or dextrose and many artificial sweeteners. Thus, when bacteria fill up on xylitol their acid production slows way down. Xylitol also helps prevent bacteria from adhering to tooth enamel, which, in turn, prevents them from multiplying. And while Xylitol can’t actually remineralize by itself, when used in conjunction with fluoride it enables fluoride to be even more effective at repairing and remineralizing teeth than fluoride alone.

In the correct daily dose xylitol has been proven to lower decay rates.  It can even be used as a safe, healthy, and effective sugar substitute. Xylitol is available in many forms, and is also widely available in health food stores as a bulk sweetener, making it easy to use.

With Xylitol the number of exposures is key; five to 10 servings a day is the optimum dosage. The good news for sugar lovers is that xylitol is available in candies that you suck on, gum that you chew for 5 minutes or more, toothpaste and mouthwash– anything that helps to stimulate saliva, wash out sugar residue, and replace that residue with xylitol.

You can easily replace products you currently use with xylitol products. Swap out your current toothpaste and mouthwash for toothpaste and mouthwash with 100% xylitol and fluoride. With each five-minute dose you’ll be accomplishing oral balance and remineralization. Here is an-easy-to follow schedule that will help you to keep conditions in your mouth optimal and make tooth decay history:

Use xylitol toothpaste, mouthwash or nasal spray upon waking

After breakfast use xylitol gum, mints or candy

After lunch (or snack attacks) use xylitol gum, mints or candy

After dinner use xylitol gum, mints or candy

Use xylitol toothpaste, mouthwash, or nasal spray before bed

At Leland Dental we carry the Carifree line of professional strength remineralization products as well as xylitol in a variety of options such as toothpaste, gels, mouthwash, gums, and mints. With its sweetness, low glycemic index, and multifaceted benefits xylitol will appeal to children and adults alike. Xylitol is also safe for diabetics. Everybody should find something to smile about when it comes to xylitol.

For more information on our new Carifree Protocol, xylitol or other remineralization products, drop in or call us at 781-826-8395

Cloned teeth may be a while in coming, but what if there was a way – today– to make tooth decay a thing of the past? Sound farfetched? Most of us would say yes. We tend to think of caries, or tooth decay, as an unfortunate but inevitable fact of life. We don’t usually view it as a complex disease yet it has all the attributes of one.

Tooth decay is an infection caused by specific bacteria in the mouth, Bacteria attach themselves to teeth, feed on sugars from food or drink you’ve consumed, and create acids. Small amounts of acid can be neutralized by saliva, a power house of minerals which can keep bacteria count to a minimum, and even repair early, minor damage to tooth enamel. When meals are frequent, however, sugars become abundant and bacteria multiply. They overpower your mouth’s defenses, producing ever larger quantities of acid as a by-product of digesting what is now their food. Eventually, acid takes over the environment in your mouth and begins to do real damage to your teeth. The result is a cavity, or two, or three, or more!

Leland Dental has now incorporated a system called CariFree, which diagnoses and treats risk factors for decay. This system signals a radical change in the way we view tooth decay. CariFree treats decay as an infectious disease that is not only curable but preventable. It strikes tooth decay proactively – and early, before it has had time to break down healthy tooth structure. CariFree marshals a complex assault on tooth decay. When used regularly, it helps establish a healthy balance between the bacterial acids and conditions that produce cavities, and the protective factors that prevent them.

The CariFree system of care is simple. As with any preventative protocol, it requires your commitment to a regular routine of maintaining and protecting your teeth. Wait a minute, you’re probably thinking, I already do that with brushing and flossing. True enough, those trusty mainstays of dental prevention can clean the surfaces of teeth, but neither process can neutralize acid or combat caries infection once it has gained control. Practiced consistently, CariFree can restore a healthy balance in the mouth, so that early-stage decay can be detected, and often healed by the mouth’s natural defenses – possibly eliminating the need for invasive restorations.

The team here at Leland Dental is delighted to announce that we are initiating this state-of-the-art protocol into our practice. CariFree can be easily incorporated into your regular schedule of cleaning and examinations. In addition to checking your teeth, gums and bite during the exam, we’ll add a ten-second swab test to determine the level of decay-causing bacteria in your mouth; and a brief questionnaire documenting the habits – good and bad – that will help measure your risk (low, moderate or high) for future decay. Then, we’ll develop a treatment plan tailored to the unique conditions of your mouth and teeth. If necessary, we’ll stabilize any current decay until we develop a healthy balance in which to proceed with restorations or elective procedures.

The standard of medicine is “First, do no harm.” CariFree advances prevention, a principle that has been a central goal of treatment at Leland Dental for 35 years. With the CariFree protocol we use risk assessment and caries management, early detection of tooth decay, and buttressing of the natural process of remineralization to minimize the need for drilling and filling. When restorations are necessary to treat active decay, we’ll utilize procedures that are as minimally invasive as possible to achieve the best long-term results. Our goal for the child born today is a lifetime free from tooth decay.

Call Leland Dental at 781-826-8395 or contact us online at LelandDental.com for more information on CariFree or to book an appointment

By Robert S. Leland, DMD

Nature originally designed our teeth to come in subtle milk and cream tints. Currently, however, the trend for smiles is to flash ultra bright teeth. You may not pine for the blindingly white teeth of toothpaste commercials, but even attractive natural teeth can darken over time, and you may be wondering whether whitening would improve your smile. Here are a few things to consider.

Healthy young teeth are most often naturally white without artificial brighteners. I don’t recommend whitening of any kind for patients less than 16 years old. Permanent teeth will always be slightly darker than baby teeth, but youthful permanent teeth generally need nothing more complicated than regular brushing and flossing to maintain brightness. And that would be fine if we all lived on baby food and spring water throughout our lives. But teeth are porous, and can be stained by the foods and beverages that we favor – and by smoking, which can actually blacken teeth over time.

At first, discoloration is superficial and can usually be polished away. Over-the-counter whitening toothpaste will usually do the trick – just don’t overuse it. Over time, however, regular exposure to staining can cause darkening of the internal tooth structure. Physical trauma to teeth and certain medications can cause this discoloration as well. In these cases, stronger whitening methods may be called for.

A word of caution: Your smile may not be enhanced by whitening of any kind if you have had restorations placed in your front teeth. Whitener will not lighten these materials, and they will stand out in your newly brightened smile. Replacing these later with lighter shaded restorations can be an expensive proposition. In these cases, dental bonding or veneers may be attractive and cost-effective alternatives to whitening.

I advise all patients considering this level of whitening to come in for an exam that will match the current shade(s) of their teeth against a dental shade guide, and determine the level and causes of staining. We look for recurring problems, such as irritated gums, that must be resolved before whitening. If all is well, we’ll offer advice on whitening options tailored to each patient’s unique needs and expectations.

If your teeth are not as white as you would like, but still even-toned, and on the bright side of the guide, a home whitening system might be an option. I don’t

recommend many over-the-counter whitening kits, however. Some are effective, but many are unregulated, so can vary widely in strength and safety; some concentrations on the market are just too strong and acidic for the surface of your teeth. One-size-fits-all trays don’t always whiten uniformly, and may push excess whitener up into the gum area, causing irritation and sensitivity to delicate tissue.

We can provide a custom home-whitening system, a 10% to 16% carbamide peroxide gel kit that is American Dental Association-approved. More importantly, we custom-fit a gel tray for your teeth to insure that teeth are uniformly whitened and gums protected. You can always call our office with any questions or problems that may arise. Depending on the current shade of your teeth and how diligent you are about following directions, you can expect whiter, even-toned teeth from a custom home system in one to two weeks and at reasonable cost. Home whitening works best on healthy, but moderately yellowed teeth – and on patients who are conscientious about follow-through.

Professional, in-office whitening is a better option for patients who are less than meticulous about following directions or are looking for immediate results. It’s also a better option for gray, brown or black shades that are more difficult to whiten and which may require several sessions to reach optimal color.

If you are a candidate for in-office whitening, we customize a plan that factors in unique concerns such as color goal, current alignment, structure and condition. The in-office procedure takes about 90 minutes. To protect lips, mouth and gums and reduce sensitivity, we apply a protective shield. Then we apply a whitening agent to teeth. As the agent breaks down, oxygen enters the enamel and dentin, whitening stained or discolored areas. The structure of the tooth is left unchanged. In-office whitening is a custom procedure; whatever your whitening goals may be, we take the time to insure that you are delighted with the results.

At Leland Dental, we believe that professional whitening unquestionably produces the highest return on investment. If you are interested in exploring options for a brighter smile, please call us at 781-826-8395 to make an appointment for a free exam and consultation.

Proms, graduations, vacations and other photo-op moments are on the horizon for you – and spurring you to consider a smile makeover. Whitening today is easier than ever, and you may be motivated by those brilliant smiles on magazine covers and even on your friends and schoolmates.

If you’ve mentioned the idea of having your teeth whitened to your parents, you’ve probably heard this question: Is it safe? You may have wondered about it yourself. So is it?

The straightforward answer: It depends. Although teeth whitening solutions can produce good to excellent results, they can also produce side effects, and may not always give you the outcome you expected. Here are some things to consider when making a decision.

You can be too young – and the issue isn’t safety, it’s appearance. According to the American Academy of Pediatric Dentistry, younger teens who don’t yet have all their permanent teeth (unusual, but it does happen) risk whitening that mix of permanent and primary teeth and ending up with mismatched teeth —artificially whitened next to newer arrivals that are naturally colored. Matching them later can be tricky and expensive.

Also, permanent teeth in younger teens often have not fully emerged from the gums. So you could end up with teeth that are noticeably whiter near the biting surface than near the gum line – not an attractive look. Another concern is that whitening kit instructions need to be carefully followed. If you are not fond of reading directions closely, or tend to use whitening treatments more often than directed, you could cause irritation, painful tooth sensitivity—or even damage to the enamel or pulp of a tooth.

For the most part, these problems are usually resolved by the time you are 16 to 18. So, I generally recommend that you wait until that age before deciding whether or not to whiten. I urge my teen patients who are considering whitening first to come in for a brief (and free) exam. During the exam, our team checks the maturity of teeth; looks for problems, such as irritated gums, that should be resolved before whitening; and offers advice on whitening options.

Healthy young teeth are most often naturally white (emphasis on natural) without artificial brighteners. The friends and schoolmates whose smiles you’ve been studying may be doing nothing more complicated than regular brushing and flossing to maintain those bright healthy smiles. At your next dental exam, ask to check your smile against your dentist’s shade guide. You may be surprised to find that your teeth are naturally right up there on the whiteness scale. If beverages or foods that you favor have actually stained your teeth, try giving them up temporarily. After a week or two, if regular brushing hasn’t brightened your smile, try over-the-counter whitening toothpaste, preferably one recommended by the American Dental Association.

Most importantly, be aware that whitening is not a replacement for brushing and flossing. The same habitual care that keeps your hair shiny and your skin glowing works wonders on your teeth. Here is a routine that will keep your newly whitened teeth healthy and sparkling:

• Clean your teeth well twice a day, after breakfast and last thing before you go to sleep at night
• Use a small toothbrush with soft bristles to protect enamel from scratching and dulling, and gums from damage
• Use fluoride toothpaste. Spit, don’t rinse to keep protection working
• Cut back or cut out enamel-staining drinks
• Choose water as your main drink. Tap water is best because it contains fluoride to harden and repair enamel
• After eating, rinse your mouth with water to stop plaque build-up.
• Definitely don’t smoke! It darkens and stains teeth.

Next Time: Professional Whitening

Last January the team attended the New England Region Yankee Dental Convention in Boston.

We have always strived to learn and grow in order to provide you, our patients, with the latest and greatest dentistry. There are literally hundreds of courses offered. Some very technical, some motivational, some involving personal growth, communication, exercise, nutrition, and so on.

I decided to take a course that mirrored my personal passion of creating a more sustainable world. “Greening Your Dental Practice” was right up my alley!

After hearing the startling statistics of material use and waste, we broke down our office into departments to see how we could best save resources, reduce waste and save money while still maintaining our high level of quality care and sterilization practices for you, our patients.

First some statistics:

100 million trees are forested every year- not all are replanted.

One half of the world’s forests are gone.

25 countries have no forest left at all.

We started our “greening” efforts with our paper consumption.  We only buy office paper with a minimum of 30% recycled content.  When purchasing paper, we look for the highest recycled content possible.  Instead of buying paper for interoffice notes, we cut up sheets of used paper, use it again and then recycle that!  We also recycle all catalogs, magazines and paper scraps.

We also discontinued using paper covers on instrument trays and countertops.  Previously, after each patient we just threw away the paper and sterilized the trays. We save about 70 sheets of paper a day and now wonder why we ever used the covers in the first place!

We recycle all of our empty glove boxes as well as the other boxes supplies come in. We must use 10 boxes of gloves a day. Previously, these were going in the regular trash.  We also recycle all the corrugated cardboard boxes used to ship us our supplies. Most weeks we receive 10-20 boxes. Previously when I went to throw something in our dumpster, it was full of just cardboard boxes.

AbitibiBowater, Inc. collects recyclable materials in many communities with its Paper Retriever^® dumpsters and makes many products with the recycled paper and different community organizations get some income. We use the Paper Retriever^® at the YMCA adjacent to our office.

The sheer volume of materials our office uses is staggering. By recycling at the level we do, the cost savings in trash removal and landfill space is significant.

(Our office complex does not provide recycling, so several team members take our recyclables home where we have recycling pickup).

   Most people don’t even think about what happens to trash (or items that can be recycled) when they are disposing of materials from their home or office. Out of sight, out of mind! We are making every effort to combat this mind-set, while still providing our patients with top-level care.  If everyone were to do a little, it ends up being a lot!  We are trying to do our part.

I have had a number of questions of late regarding mouthrinses, when to use them and what type to use.  Here’s my take on mouthrinses:

Mouthrinses are used for a variety of reasons: to freshen breath, to help prevent or control tooth decay, to reduce plaque, to prevent or reduce gingivitis, to reduce the speed that tartar forms on the teeth, or to produce a combination of these effects. Most mouthrinses are available without a prescription.

What ingredients are commonly found in mouthrinse?

Basic ingredients include water, alcohol, cleansing agents, flavoring ingredients and coloring agents. Active ingredients vary depending on the type of mouthrinse, but they can be placed into four general groups:

• Antimicrobial agents act directly on oral bacteria to help reduce plaque, decrease the severity of gingivitis and control bad breath.
• Fluoride helps reduce tiny lesions (tooth decay) on tooth enamel and make teeth more resistant to decay.
• Astringent salts can serve as temporary deodorizers that mask bad breath.
• Odor neutralizers act by chemically inactivating odor causing compounds.

What’s the difference between cosmetic and therapeutic?

Cosmetic mouthrinses may temporarily control or reduce bad breath and leave the mouth with a pleasant taste. But they don’t deal with the causes of bad breath. They don’t kill the bacteria that cause bad breath or chemically inactivate odor causing compounds. Also, none of the cosmetic mouthrinses helps reduce plaque, gingivitis or cavities.

Therapeutic mouthrinses, on the other hand, can help reduce plaque, gingivitis, cavities and bad breath. Some fight the bacteria present in plaque, a sticky film that forms on teeth and gums. Plaque bacteria create toxins that can damage the gums. Plaque that is not removed with daily brushing and flossing can cause gingivitis, an early stage of gum disease. If plaque is allowed to continue to accumulate, gingivitis can progress to advanced gum disease, called periodontitis, which only a dentist can treat. Plaque can also turn into tartar (or calculus), a hard substance that can only be removed during a professional cleaning. Some therapeutic mouthwashes contain agents that either fight bad breath bacteria or that chemically inactivate odor causing compounds. Some therapeutic mouthrinses that contain fluoride help prevent or reduce tooth decay.

Do I need a mouthrinse?

We can advise you whether you need a mouthrinse depending on your oral health needs. Rinsing helps remove debris from the mouth. It can be done before or after brushing, but it is not a substitute for brushing or flossing. You may consider using a mouthrinse with fluoride or antimicrobial agents as part of your daily oral hygiene routine.

If you have difficulty brushing and flossing, a mouthrinse may provide additional protection against cavities and periodontal (gum) disease. Anti-cavity rinses with fluoride help protect tooth enamel.

The bottom line with these whitening kiosks is that they are not staffed or overseen by anyone trained in the dental health field.  These services are administered without examination to determine if the person receiving the treatment is even a candidate for whitening, or has underlying oral health issues that make whitening ill-advised or even potentially harmful to the patient.

Don’t get me wrong, I believe in the safe administration/application of whitening products where it is deemed appropriate.  That is why it is best to consult a trained dental health professional before embarking on a quest for a whiter, brighter smile.  That being said, if whitening is appropriate, here is a little background about whitening materials and processes and ways to safely and effectively whitening your smile:

Nearly all whitening products will whiten teeth to a certain extent because they all have the same active ingredient, either carbamide or hydrogen peroxide. However, the percentage of the active ingredient in whitening products varies between what a dentist uses and what is contained in over-the-counter products.

Over-the-counter products (Crest White Strips, for example) contain about 5 percent or less of active whitening ingredients, whereas a dentist will use products that have 10 to 35 percent of active whitening ingredients. Because of this, store-bought whitening products may not be as effective and could take a longer time and require a larger quantity to achieve any significant results.

There are two different whitening systems used by a dentist.  In-office whitening takes roughly 60 to 90 minutes per visit. A chemical solution is applied to the teeth and a special light may be used to help activate the bleaching agent. To complete the process, multiple visits may be required.

With at-home whitening, we produce a custom-fitted mouthguard that holds whitening gel. The mouthguard is worn during the day or at night, and the treatment period varies (generally 4-6 hours per day/night for 2-3 weeks).

Those who use the store-bought kits lose the benefit of a custom-made mouthguard to apply the gel, and results may not be uniform. Therefore, anyone with moderate to severe discoloration could be disappointed with the results of the store-bought kits.  Patients with only mild, yellowing teeth, either due to age or food and beverage stains, may benefit from diligent use of a store-bought product.

Teeth may often be sensitive during the period when any type of whitening solution is used. In most cases, this sensitivity is temporary and should lessen or disappear once the treatment is finished.

Those who are thinking about whitening their teeth should understand that only natural enamel will whiten. This means that if you have had any type of restorative procedures done—such as tooth-colored fillings, bonding, crowns, or veneers on your teeth—those particular teeth will not whiten. Plus the restorations, which used to blend in very nicely with the previous shade of your teeth, will now appear much darker and distinct. This could result in additional dental work to fix the problem.

Basically, check with us before you decide which whitening product or system is right for you.

It’s here!  For years, Dr. Brodil and I have talked about how great it would be if, after completing a procedure, we could make the numbness disappear.  Well, we are now using a product that can indeed reverse the effects of a local anesthetic!

OraVerse^TM is now available at our office.  This is an agent that accelerates the return to normal sensation and function for patients who want to avoid the unwanted and unnecessary lingering soft tissue anesthesia (numbness) after routine dental procedures.  The anesthetic we typically use contains vasoconstrictors (epinephrine).  This part of the anesthetic produces prolonged loss of oral sensation and function. On average, it takes 3-5 hours to recover from soft tissue anesthesia, thus the hours of post-procedure numbness.  With the administration of OraVerse^TM, patients can return to normal sensation and function in about half that time.

There are no contraindications for OraVerse^TM. In nationwide comprehensive clinical trials OraVerse^TM was tested in patients able to receive routine dental restorative and periodontal maintenance procedures involving a local anesthetic with vasoconstrictor.  Tests, however, were not conducted with pregnant patients, so Dr. Brodil and I will refrain from using OraVerse^TM with pregnant women.  OraVerse^TM is not indicated for use in individuals less than 6 years of age or weighing less than 33 pounds.

We administer the OraVerse^TM in the same manner, at the same site as the original anesthetic.  The bonus is that the area is already numb, so no injection is felt.

Unfortunately, the cost of OraVerse^TM, as with many new medications when they come on the market, is still quite expensive; for this reason, we charge a modest fee for the use of OraVerse^TM for the time being. 

For many, I can imagine this product will make dental procedures, and the lingering effects, much more tolerable.  We often hear that it’s as much the numbness after the procedure as the procedure itself that is the most uncomfortable.  With OraVerse^TM, we hope to minimize or eliminate one of those aspects of a dental visit. 

Please ask any member of our team for more information about this wonderful advancement in dental pharmacology.