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Porcelain Restoration–Is it Right For Me? An Interview with Dr. Brunacini

We love helping our patients achieve the smile of their dreams!  Many dental issues can be corrected through cosmetic dentistry and the first step for any cosmetic procedure is a simple consultation with Dr. Brunacini or Dr. Karagiorgos.  They are here to discuss your dental health goals and help you find the right fit for your needs. A question we often get from patients is if they should replace old metal crowns and bridges with porcelain.  There are many advantages to replacing your old crowns, but the reason to replace them isn’t one-size-fits-all. To learn more about porcelain restoration and who could benefit from this procedure, we spoke with Dr. Brunacini.

1. What is porcelain restoration? 

Dr. Brunacini:  Porcelain is the material that is used to give crowns and veneers the esthetic properties–color, luster, and a tactile sense.  Porcelain restoration provides you with the translucency and shine of your natural teeth—you’d never be able to tell there was a need for a crown—and the texture of the polished porcelain is very similar to that of enamel.  It is a restoration that needs to be fabricated in a lab, and requires taking an impression to send to the lab. We are now doing crowns that are metal-free. By doing so, we can create highly esthetic AND very strong restorations with minimal risk of chipping or breaking. It is a great option for patients!

2. Why would I need to replace a metal crown or bridge?

Dr. Brunacini:  There can be numerous reasons for patients to need to replace their metal crowns.  The most obvious one is when a new area of decay develops under an existing crown or bridge.  This is one reason we do regular x-rays; they are very important to discover any changes underneath crowns before they become loose or problematic.  

Also, for some patients, they find it unsightly to have metal show, so replacing a metal crown with a porcelain crown is a good solution for their needs.  For many years, dentists placed crowns with a metal substructure and porcelain overlayed on top of the porcelain. Over time, the porcelain can chip, which may lead to poor esthetics or difficulty cleaning the crown.  The only way to fix this situation is to replace it with a new crown.  

If you have questions or concerns about your metal crowns, schedule a consultation with me or Dr. Karagiorgos.  We are here to help you achieve your dental goals!

3. I’ve heard porcelain crowns can cause more wear and tear on my other teeth.  Is this true?

Dr. Brunacini:  With newer types of porcelain, there is less concern with wearing down opposing teeth.  Of course, it is very important to finely adjust the bite on crowns to be sure they function well with the other teeth. This is why when we fit a porcelain crown, we sculpt and shape the porcelain to fit perfectly with your existing bite.

4. Are there any special care instructions for porcelain crowns and bridges?

Dr. Brunacini:  There really isn’t much “special” care needed. For patients who grind their teeth, a night-guard may be indicated to protect the porcelain from chipping.  However, most patients can simply stay on top of their regular home care, such as brushing twice daily and flossing daily. This should be sufficient enough to maintain porcelain crowns for many years! 

 

Thank you, Dr. Brunacini!

Whether your reason is cosmetic, physical, or a bit of both, our team of caring dental professionals is here to help you find the right path toward a better smile.  If you have more questions about porcelain restoration or would like to schedule a consultation with Dr. Brunacini or Dr. Karagiorgos, call our office at 207.781.5900 today.

I Have a Microbiome…in My Mouth?

Not all bacteria are bad!  Our bodies also host a range of good bacteria that help keep us healthy.  They are part of your body’s microbiome, which is defined as a community of micro-organisms (such as bacteria, fungi, and viruses) living on or in the human body.  There is an emerging field of medical research on our microbiomes and how the bacteria that live on and in our bodies affect our health. Perhaps you’ve heard of the microbiome in your gut and how it can impact your health ranging from mental well-being to digestion, but did you know there is also a microbiome in your mouth?  Fascinating, right!? We’ve discussed how our oral health impacts our overall health before, now let’s zoom in to the microscopic level and learn about the microbiome in our mouths.

Your Oral Microbiome

You swallow about 1 trillion bacteria each day (!!!) and have a unique community of bacteria that live in your mouth known as your oral microbiome.  Your oral cavity has different habitats, from your tongue to your teeth to your tonsils where some 700 different bacteria exist and help perform vital functions such as transporting ionic minerals and carrying molecular oxygen.  There is a symbiotic relationship between us and the microbes that live within us…they help us stay healthy and thrive! You’re probably familiar with one of the most famous symbiotic relationships: E.T. (everyone’s favorite cinematic extra-terrestrial) and the little boy Elliot.  In the movie when E.T. was healthy, so was Elliot. When E.T. got sick, so did Elliot. Don’t be afraid to make friends with your microbiome!   

As we’ve noted before, the mouth is a great window into the body, often reflecting systemic disease before it can be determined by other means.  This is why we do a thorough examination of your whole mouth when you come in for a routine cleaning. When your oral microbiome is healthy and balanced we see that reflected in your mouth.  For example, when the plaque (or oral biofilm) in your mouth is healthy, it forms a clear, odorless, protective film. Your teeth feel clean and your gums look healthy and pink. When imbalanced, the plaque becomes sticky, white, has an odor, and over time contributes to tooth decay and gum disease.  You may notice symptoms such as bad breath and bleeding gums with an imbalanced microbiome. What’s interesting to note is that a number of bacteria associated with tooth decay and gum disease still exist in mouths with a healthy microbiome, but do not have the same adverse effects. Keeping the environment in your mouth healthy through routine oral health care is what’s important for maintaining a healthy oral microbiome.  So keep on brushing and flossing!

The Mouth-Body Connection

Your oral microbiome’s impact extends beyond your teeth and gums.  Research has shown that oral microbiomes have a link with gastrointestinal diseases such as inflammatory bowel disease, nervous system diseases such as Alzheimer’s, and endocrine system diseases such as diabetes.  We’ve discussed some of these correlations, such as your oral health and diabetes, on the blog before, and cannot stress enough how important dental care is to your overall health.  Here are some examples of the link between these health conditions and your oral microbiome:

  • Gastrointestinal Diseases:  People with gastrointestinal diseases, such as inflammatory bowel disease (IBD), often have correlating oral symptoms like dry mouth and mouth ulcers.  People with IBD routinely have an imbalance of oral bacteria in the gut. It has also been found that people with advanced gum disease and tooth loss have an increased risk for gastrointestinal, pancreatic, and liver cancer.   
  • Nervous System Diseases:  Researchers have been studying the gut-brain axis and its connection to disease and have found that a healthy gut biome is integral to decreasing the development of diseases such as Alzheimer’s, depression, and anxiety.   Given the close connection between the oral microbiome and the gut, oral health plays a role here as well. In fact there was a ground-breaking study from 2019 that showed bacteria responsible for gum disease also appeared in Alzheimer’s patients’ brains.
  • Endocrine System Diseases:  We know that diabetes increases your risk of dental diseases and oral symptoms such as dry mouth and gum disease.  However, it has also been found that  people with periodontitis, or gum disease, have an increased risk of developing diabetes. It’s unclear which exactly happens first, the development of the disease or an imbalanced oral microbiome, but researchers continue to study the correlation and relationship between the two areas. 

We find it compelling to learn more and more about how our oral health is linked with our overall health.  We always like to say that we are part of your healthcare team: our goal is to keep you informed and to help you make the best choices for your health.  If you ever have any questions about how we can help you, please don’t hesitate to ask any of our team members!

Oral Care with Your Oral Microbiome in Mind

So, what can you do to keep your oral microbiome and your whole body healthy?  We can never say it too much: maintain your oral health care routine of twice daily brushing, daily flossing, and regular visits to our office for check-ups.  As part of this, we also recommend avoiding oral-care products that have harsh detergents or mouthwash with alcohol as part of their ingredients. These products may destroy the microbiome–the good bacteria along with the bad.  Look for alcohol-free mouthwash and toothpaste without sodium laurel sulfate (SLS) or triclosan.

Diet is also a big part of maintaining a healthy oral microbiome.  We often talk about the importance of a healthy diet for the health of your mouth, and this is just another reason to stress the importance of approaching your oral health holistically.  Keep your diet rich in vegetables, high-calcium dairy products, protein, and omega-3s, and avoid excess sugar and complex carbohydrates. There are lots of ways to do this…loading up on dark leafy greens, yogurt, strawberries, eggs, and sardines, for example. Your mouth and your whole body will thank you! 

Your mouth is an extraordinary place and we love helping you take care of it!  We are here to provide you with the best care possible…from the tiny micro-organisms in your mouth to your whole body.  Please let us know if you have any questions about your oral health care or if you need to schedule your next appointment by calling our office at 207.781.5900.

 

 

*Image courtesy of www.askthedentist.com

An Interview with Dr. Karagiorgos on Antibiotic Prophylaxis

Antibiotic prophy….say what?! For most of our patients, antibiotic prophylaxis is something they’ve never heard of and don’t need to worry about.  However, for some of our patients, particularly with heart conditions, it can be an important part of their oral health care. In short, antibiotic prophylaxis is the use of antibiotics before a dental procedure to prevent a bacterial infection elsewhere in the body.  It is a treatment that may be recommended for you after talking with your physician and Dr. Brunacini or Dr. Karagiorgos. There are side-effects and risks to taking antibiotics, so antibiotic prophylaxis is only used when the benefit outweighs the risk for you. To learn more, we talked with Dr. Karagiorgos.

1. What is Antibiotic Prophylaxis?

Dr. Karagiorgos:  Antibiotics usually treat bacterial infections, but sometimes physicians or dentists recommend antibiotics prior to a treatment, such as a teeth cleaning or root canal, to reduce the risk of infection.  This is because during some dental treatments, bacteria from the mouth can enter the bloodstream and cause infection elsewhere in the body. We only recommend this for certain patients, which is why it’s important to have a conversation with us and your physician.

2. Who Could Benefit from Antibiotic Prophylaxis?

Dr. Karagiorgos: With a few exceptions, most patients who require antibiotic prophylaxis before a dental visit will need it for one of two major reasons:

  • Risk of infection to replacement (artificial) joints–commonly the hip, knee, or shoulder.
  • Risk of infection in the heart.

The American Heart Association recommends antibiotics before dental procedures only for individuals with the highest risk of infection. This includes patients who have:

  • A prosthetic heart valve or who have had a heart valve repaired with prosthetic material.
  • A history of endocarditis (heart infection).
  • A heart transplant with abnormal heart valve function.
  • Certain congenital heart defects, including:
  • Cyanotic congenital heart disease (birth defects with oxygen levels lower than normal), which has not been fully repaired, including in children who have had surgical shunts and conduits.
  • A congenital heart defect that has been completely repaired with prosthetic material or a device (for the first six months after the repair procedures).
  • Repaired congenital heart disease with residual defects, such as persisting leaks or abnormal flow at, or adjacent to, a prosthetic patch or prosthetic device.

If you’re not sure what these guidelines mean for you and your particular heart condition, make sure to ask your cardiologist; “Do I need to take antibiotics for dental work?”

3. What if I’ve had Hip Surgery or a Joint Replacement?

Dr. Karagiorgos:  For many years, people that had undergone surgery for replacement of a joint (most commonly hip or knee joints) had to take antibiotics before any dental procedures. While this is generally still required for patients with two or more replacement joints, the American Dental Association no longer recommends routine antibiotics prior to dental procedures to prevent prosthetic joint infection.

Many orthopedic surgeons have their own criteria for deciding which of their patients might be at risk of joint infection with dental procedures (even cleanings). That is why in most cases I defer to a patient’s orthopedic surgeon to decide and prescribe prophylactic antibiotics for dental visits. 

If you have any questions about your particular situation, make sure to discuss them with me or Dr. Brunacini, as well as your orthopedic surgeon or physician.  This is especially important if you have a significant immunodeficiency or previously suffered an infected prosthetic joint. We are part of your health care team and will work together to determine if you have a need for antibiotic prophylaxis. 

4. What Else Should I Know?

Dr. Karagiorgos:  Good oral health and good general health go hand in hand.  So, keep up with your regular oral care routine of brushing twice a day, flossing at least once a day, and seeing your dental team with us for regular cleanings.  

At Falmouth Dental Arts you will notice that we ask you about any changes to your health history at every visit.  This includes medications that you are taking and any allergies you may have. It is important for us to know what medications that you take, and in what dosages and frequency. If you take many medications and it becomes difficult for you to remember them, then you can ask your physician to give you a current list that you can carry with you.  This information is important for us to know when determining the best course of treatment and care for you.

Also, I find it fascinating that the turnover of new tissue in the oral cavity is one of the fastest in the body!  Ever notice how a pizza burn in your mouth heals in a matter of days? The mouth is a great window into the body, often reflecting systemic disease before it can be determined by other means.  This is why we thoroughly examine all of the mouth, not just the teeth. We want to help you be healthy in your mouth and your whole body!

 

Thank you, Dr. Karagiorgos!

If you have questions about antibiotic prophylaxis or about how your health issues may impact your dental care, please give us a call today at 207.781.5900.  We are here to be your healthcare partner and provide you with the best oral care possible!

 

*Image courtesy of www.medlineplus.gov

Tips for a Tooth-Friendly BBQ

Summer is in full swing which means long days, trips to the beach, and, of course, busting out the BBQ!  It is always a treat to be outside celebrating the season with family and friends, and if you’re like us, you like to look for ways to make your outdoor meals both delicious and healthy.  However, perhaps you haven’t always thought about the ways you can make your gathering tooth-friendly, too…well, we’ve got you covered! Since it’s July, a quintessential BBQ month, we decided to share some of our tips for keeping your mouth healthy while you enjoy this beautiful season in Maine.

Kick Things Off with a (Healthy) Crunch!

At many BBQs, the crunch usually comes in the form of a potato chip.  These starchy snacks can be just as bad for your teeth as sugary sweets as they tend to stick in your teeth, giving cavity-causing bacteria a chance to go to work.  Include a healthy crunch at your next meal by putting out a platter of fresh fruits and veggies. Having apples, carrots, and celery to munch on is not only healthy for your body, but it’s great for your mouth, too.  Those crisp fruits and veggies will help stimulate saliva and keep your teeth clean…kind of like brushing your teeth!  

Say Cheese…Please!

Whether it’s enjoying a cheeseburger, a zesty yogurt dip for your veggies, or putting together an epic cheese platter, incorporating dairy into your next summer soiree is a smart choice.  Dairy products are rich in tooth-strengthening calcium and phosphorous, and there is research that suggests that eating more dairy may lower your risk for developing gum disease.  

Skip the Soda

We all know how unhealthy soda is, but on a hot summer day a cold drink really hits the spot.  Here’s a fun way to avoid the empty calories and cavities at your next gathering: serve water infused with your favorite fruits.  Think cucumber and mint, or strawberry and lemon…the possibilities are endless! Infused water is low in sugar, looks pin-worthy, and is oh, so refreshing.  So, hydrate smart and in style this summer!

Ketchup with the Sugar Content of Condiments

Did you know that ketchup is 25% sugar and a typical BBQ sauce can have 5 grams of sugar and 22 grams of carbohydrates in one teaspoon!  By adding so many sugary sauces to your BBQ plate, you can easily reach your recommended intake of sugar for the day before you even think about dessert!  Limit the unnecessary sugar in your next BBQ where you can by providing sliced tomatoes, onions and pickles for flavor enhancement. If you’re feeling bold, you can make your own ketchup without so much sugar.  Your teeth will thank you.

 

We hope you are enjoying these amazing Maine summer days and that these tips help keep your teeth in good shape while you indulge in the treats of the season.  Let us know if you have any favorite infused water recipes, and, please call us with any questions or concerns at 207.781.5900. We are here to help you have a smile that is healthy and happy!

 

*Image courtesy of www.familycorner.blogspot.com

An Interview with Dr. Brunacini on Oral Cancer Screening

Did you know that your routine dental check-up could save your life?  Dentists are on the front lines of a growing health concern: oral cancer.  Oral cancer is the uncontrollable growth of cells that invade the oral cavity (mouth) and the oropharynx (part of the throat at the back of the mouth).  According to the Oral Cancer Foundation, approximately 53,000 people will be newly diagnosed with oral cancer in 2019; that means 145 people each day.  Prevention and early detection is one of the most effective strategies for treating oral cancer, as when it is caught early there is an 80-90% survival rate.  Oral cancer screenings are an important part of our regular dental exams and something we want to help create more awareness about for our patients. To learn more about this critical health topic and the resources we have at FDA, we talked with Dr. Brunacini.

1.  Why is oral cancer screening an important part of care at FDA?

Dr. Brunacini:  As dentists, we are part of your health care team.  A lot of what is seen in the mouth can be an indicator of overall health and a lot of patients see their dentist more frequently than their physician.  That makes an oral cancer screening at the dentist extremely important for early detection of any changes in the mouth which can be the key to easier treatment options for oral cancer, as well as a rapid recovery, and a prolonged life.

2.  What happens during an oral cancer screening?

Dr. Brunacini:  A lot of the oral cancer screening is simply examining the soft tissues with our eyes.  We examine the gum tissue, lips, cheeks, and tongue. We also palpate areas of the face and neck to check for any nodules or lumps.  If there is an area of concern, we also offer to do a VELscope screening. VELscope is a non-invasive oral cancer screening device that emits a safe blue light that provides earlier detection of abnormal cell growth that could be cancerous or precancerous.  

3.  What are some risk factors for oral cancer?

Dr. Brunacini: The most common risk factors include tobacco, alcohol, and sun exposure.  Cigarettes and other forms of tobacco account for most cases of oral cancer and lip cancer is often caused by excessive sun exposure.

Also, another risk factor, although less known, is HPV (Human Papillomavirus).  It is a very common virus that most of us get exposed to throughout our childhood.  There is now a vaccine that can be given, which could help decrease the risk for oral cancer.  

Please let us know if you have any questions or concerns about these risk factors and your health.

4.  Are there any warning signs or symptoms for oral cancer?

Dr. Brunacini:  Yes, patients should be aware of any white patches or areas that bleed more easily, as these can sometimes be a sign of oral cancer.  If there is a noticeable and recent change in your mouth, such as tenderness or a change in the way your teeth fit together, it is always a good idea to let us know.  We will assess and address the issue and make sure that you are equipped with the information you need to make the best decisions for your well-being.

5.  If you find something during a screening, what are the next steps?

Dr. Brunacini:  Generally, if there is an area of concern, the next step will be a referral to an oral surgeon.  The oral surgeon will perform a biopsy of the area to determine the diagnosis. A lot of times, the biopsy determines that the area is not of concern.  However, when the biopsy is positive for cancerous cells, then further treatment may be indicated. Throughout this process, we are here to support our patients with the follow up care they need.

Thank you, Dr. Brunacini!  

We strive to be your dental care partner for a healthy life and always want to make sure you have information about how we can help you achieve that.  If you have any questions or concerns about your oral health or would like to schedule an appointment with an oral cancer screening, please call us at 207.781.5900.