Are Wisdom Teeth Wise? Sunday, 28 May 2017

Known in dentistry as “third molars”, they are often called “wisdom teeth” in society.  These teeth arrive in the mouth sometime during high school or early adulthood – at a time when many parents believe that their kids need a bit more wisdom!  Only once the jaw has reached full maturity, there might be space for them.  There are pros and cons about third molars.  They provide additional chewing surfaces.  Some erupt slowly, with a gum tissue “flap” over the chewing surface for months on end.  It is hard to keep the teeth clean until this tissue flap recedes, if it does, and the areas are tender if crunchy foods venture back that way.  At times, third molars never move up into position, that is, aligned with the biting surface of all the other teeth.  Many times, they are tipped forward.  Both are problematic because food accumulates, creating a cavity, bad breath, and sometimes gum disease.  Our hygienists take the time to show patients how to adapt their toothbrush to clean this space, sometimes suggesting a site-specific brush.  Therefore, we would be wise to heed their suggestions.

The other concern about wisdom teeth is whether the jaw will eventually grow enough to make room for a late arrival.  An orthodontist is trained to take specific x-rays that are precisely measured, to determine the growth pattern of children. Only then can one make a calculated guess whether the four wisdom teeth will fit or, potentially, erupt and force existing teeth crowd together.

Should an adult dislike the appearance of their crowded teeth, or find it difficult to keep them clean, sometimes a combination of minor orthodontics and capped front teeth can rectify the problem. Ask me if you’re a candidate for coordinated care between two professionals with specialty training!

Contact Winterset Dental today to find out which treatment is right for you.

One Tooth that Doesn’t Like Cold Food or Beverages Thursday, 25 May 2017

This subject often comes up, only after a long pause from a patient, in response to my question, “Have any teeth been bothering you?” They’ve taken the time to think about subtle pain that occurs infrequently, an annoyance, often dismissed. But when someone answers with, “One tooth aches occasionally when I eat cold food”, I launch into Detective Agarwal mode. There are several reasons that a specific tooth might ache, but one that is cold sensitive alerts me to look diligently for decay.  Should that tooth already have a filling, it may indicate that a cavity has started underneath the filling, something I cannot see without an x-ray. Depending on the location of the decay and the type of filling material, sometimes even an x-ray isn’t sufficient. This tooth often needs urgent treatment to prevent the decay from reaching the nerve, which is then only cured by a root canal or extraction. 

Should most of the teeth experience cold sensitivity, this is usually related to a different, but treatable, issue. More on this later.

The bottom line is that sensitivity to cold is often a strong indication of bigger problems ahead.  Schedule an exam today. 

Contact Winterset Dental today to find out which treatment is right for you.

Receding Gums (Gingiva) Monday, 22 May 2017

When teeth appear to “grow longer” over time, it doesn’t mean that they actually do.  Teeth erupt in a certain shape and size.  They are only able to wear down, chip, or have a portion crack off. The illusion of growing longer occurs when the gum tissue moves away from its original position, exposing more of the root surface of the tooth.  There are three reasons why this occurs.  First, there’s subtle changes during the aging process.  Second, there’s vigorous, improper brushing techniques.  Third, there is periodontal disease. This disease affects the bone support which holds teeth in place.  When there is less bone support, the gums recede and expose more root surfaces of the teeth, so they look longer.

Apart from their appearance, receding gums also expose the less-resistant root surfaces to the sugars in food and drink. Root surfaces do not have a protective enamel coating, so are more prone to decay.  Add to that sugar-free soda. While missing sugar, all soda is very acidic, which brings about “hypersensitivity” to cold foods and drink, or even winter conditions, when a patient consumes these regularly.

Contact Winterset Dental today to find out which treatment is right for you.

The Expertise for Dental Implants Tuesday, 23 May 2017

Today, every budding dentist is trained to place implants when completing their graduate education.  But it wasn’t always like this.  When I was in dental school at Northwestern University, this procedure was just starting to enter the curriculum.  It was “Love at First Sight” for me! I went on to become a member of the founding team to start an Implant Center at Northwestern. This team conducted three-day Seminars several times a year, for many years.  And I chose to focus my private practice on a specialized field of dentistry, known as Prosthodontics, in which dentists design individualized structures for the mouth that improve function for patients with a complicated problem that needs a long-term solution.

Because placing implants is very technique sensitive and requires considerable evaluation of the bone density and implant position, my experience has allowed me to share this knowledge with those choosing dentistry as a profession, be they advanced courses for dentists or hands-on techniques for lab technicians. As time allows, I also work with current seniors to prepare them to accurately place implants and other forms of prosthodontics, such specialized dentures.

My family claims that I still have a good case of “Love at First Sight”, as evidenced by dinner table conversation, and I believe that I’ve never actually worked a day in my life. What a Blessing!

Contact Winterset Dental today to find out which treatment is right for you.


Here’s To Good Health Saturday, 20 May 2017

It was tough for my children to grow up with a dentist in the home.  They’ve gone on to make it tough for my grandchildren, and I’m thrilled.  Since the second semester of dental school, I saw firsthand the damage caused by snacking on salty snacks or processed food lunches.  I could look at a patient’s x-rays and ask them how many soft drinks they drank daily, without flossing before bed.

Our family allowed snacks, but only “detergent foods”.  These were whole foods, like carrots, apples, and celery, that only had natural sweetness and sort of scrubbed plaque off tooth surfaces when chewed.  Candy was one piece for a special occasion, not a daily delight.  Any chip, pretzel, or “ito”, as we nicknamed them, was never allowed in the house, because they all wedged in the biting surface of teeth – for hours.  Though tasting salty, they all broke down to sugar in the mouth, then expensive cavities on permanent teeth.

Similarly, soda pop is basically acid, sugar, and flavoring, in water. Powdered lemonades are only one step better.  The acid in soda pop allows the sugar to act even faster to destroy the tooth surface. Sipping soda over an hour makes the process last even longer!  I don’t recall how long it took to dissolve an extracted tooth completely, once submerged in soda pop, when I was in dental school.  It would certainly be an experiment worth conducting for a science fair. 

One of the added advantages of health snacking was the savings in our food budget.  Convenience foods have always been expensive for the serving size.  Chip bags look full because they are filled with air, but they actually cost a lot per piece – for empty calories.  In contrast, a whole apple can fill someone until dinner time.  With unsweetened peanut butter, they stay content even longer! Canned fruit, with no sugar added, is as convenient and transportable as chips. A bag of carrots and a glove-compartment peeler always saves the day (and time, when kids perform the peeling) if stuck in traffic.  Start thinking of snacks differently and watch your grocery bill and, perhaps, your dental bill go down.


Contact Winterset Dental today to find out which treatment is right for you.




Weight Changes Friday, 05 May 2017

Most new patients who currently wear a full denture look at me oddly when I ask them if they’ve lost or gained a significant amount of weight over the past year to eighteen months.  They usually hesitate, then ask “how did you know?” Because their denture told me.  Substantial changes in weight make changes in mouth musculature and the amount of tissue lining the bone, among other structures.  When someone loses weight, a denture often feels loose so the patient relies on adhering paste to hold it in place, when speaking and chewing. If not, intraoral sores form. A similar process occurs when the elderly loose body mass.

That is one of the reasons that I am such a proponent of dental implants.  Attached directly to bone, they never move when soft tissues change in size or shape.  They never feel loose, requiring a paste to hold them. They feel like teeth you can trust.

I have been placing dental implants for 32 years, having followed the technological advances in shape and design that allow successful placement in almost every situation today.  But the actual development of modern-day implants occurred before I even graduated from dental school. According to the International Congress of Oral Implantologists, the discovery of what makes current dental implants successful was serendipitous.  In 1952, an orthopedic surgeon noted that he could not remove a small titanium cylinder he had placed in a bone to study how bone healed. The special property that titanium has of fusing to bone, called “osseointegration”, is the biological basis of modern implants’ success.

I’d say that implants have a pretty great track record, wouldn’t you?

Contact Winterset Dental today to find out which treatment is right for you.


Party People Friday, 05 May 2017


I attended a wedding reception several weeks ago and sat at a table with strangers.  The topic of back pain gave way to various home remedies, which expanded to back surgeries and their related rehab.  After 40 minutes of discussion, the topic closed with the summation, “Well, you just have to fix it because you can’t live without a back or in chronic pain”. No one at the table knew my profession, so I added, “the same goes for your teeth”.  I was astounded that many at the table just admitted, to complete strangers, that they just deal with the pain for as long as they can and then have teeth removed.  They quipped that, after all, they started out with so many that they can live without a few, especially in the back.

 Vanity aside, there are five strong reasons for replacing teeth.  Each person at the table would probably prioritize the reasons differently, and none would have thought through the consequences of removing an occasional tooth.  The most obvious one is under-chewed food, which makes swallowing more difficult and doesn’t introduce enough digestive enzymes from the saliva, necessary for proper digestion.  Now, the stomach, and related passageways, must work harder – three times a day. This is related to bone deterioration in the jaw, because the absence of sturdy teeth that used to absorb a chewing load means that the jaws take the abuse. I have x-rays of patients who have 25% of the original bone density remaining in their lower jaw.  These patients are at risk of breaking their jaw when in a car crash, playing with kids, or petting a happy dog.  Further complicating this is the fact that teeth no longer “stand up” in the U-shape of the jaw, touching each other at 2 points, when even one is removed (unless it is a wisdom tooth). Some tip, some rotate, and some drift away from the U-shape.  Patients start telling me that food “gets stuck” between teeth. Patients over 40 attribute their age to their “sagging” cheeks, when they often just lack the teeth to fill out the bottom half of their face.  And finally, patients who lose teeth and don’t replace them upset the function of the jaw joint, known as a temporal mandibular joint. These muscles are meant to keep the jaws aligned but, when missing teeth force people to alter their chewing patterns for years, an imbalance is created.  Pain results.  Now they need surgery to correct the imbalance, not to mention the discomfort from surgery and the urgent need to do something in the mouth to restore balance.




Personal Wellness Thursday, 11 May 2017

I’ve been in a dentist for over 43 years, sometimes treating patients with a damaged self-image.  They lack confidence, do not take pride in their accomplishments, or avoid social interactions. Some do all three!  Addressing how teeth might contribute to their situation is complicated.  The topic is often considered taboo - patients are sometimes hesitant to discuss it and dentists are afraid of offending. There are several studies to indicate that a damaged self-image leads to depression.

 At Winterset Dental Care, our motto is “We not only treat teeth but we treat people”.  A good example is Mary whose sister was already a Winterset patient.  A week earlier, her sister had stated that Mary never smiled because she was embarrassed by her ugly teeth.  She went on to admit that Mary avoided family functions and had few friends. During my medication review on Mary, as a new patient, I noticed that she listed an antidepressant on her medical history form. She estimated taking this for over 5 years.

After an exam and a couple visits, with conversation, we created a Digital Smile for Mary before doing anything significant.  When Mary saw the potential in her smile, her first reaction was tears of joy!  She went through a Smile Makeover and gained the confidence to step out of her comfort zone.  Moreover, she then worked on her image, changing the style of her clothing and embracing opportunities to try something new.  I have treated many people and firmly believe that improving a patient’s smile gives them the mental boost necessary to think far beyond their current perception of reality.

Contact Winterset Dental today to find out which treatment is right for you.




Flattened Molars Monday, 08 May 2017

Last week, I saw new patient, Maggie, for a toothache.  Her tooth had cracked in half, right down the middle and required extraction. Maggie claimed that she has been grinding her teeth together for almost 30 years, a noise so distinctive that she also claimed that family members couldn’t sleep in the same room with her.  Many of her teeth were flat on the chewing surface and the front ones looked shorter than normal.  In dentistry, this is labelled “bruxism”. Though only 42 years old, Maggie looked at least 10 years older, with sagging cheeks and frown lines at each corner of her mouth.  Essentially, the distance between the tip of her nose and the bottom of her chin was now almost a quarter of an inch shorter, when her mouth was closed, because her flattened molars allowed her lower jaw to move further up than it did 20 years earlier!

Working alongside other dental specialists to restore the proper function of her Temporal Mandibular Joint (TMJ), it is my hope that Maggie will be able to eventually have her natural teeth “built up” with crowns that restore her natural smile and original chewing surfaces.  The wrinkles will soften, and she will swallow well-chewed bites.

Bruxism is often eliminated when family members take it seriously, rather than dismissing it as a “phase” or annoyance.  Orthodontists are trained to study the teeth and muscles, then work with an interdisciplinary team to create healthy function.  Another option might be a custom-made Night Guard, molded from acrylic, that is worn while sleeping so opposing teeth cannot grind together.


Contact Winterset Dental today to find out which treatment is right for you.





Mighty Muscles Of Mastication Friday, 05 May 2017

“Mastication” is the term used for the process of chewing food. The amount of force used to chew varies, but research has demonstrated that between 16-34 pounds of force is created when opposing teeth close on a carrot.  Note that certain items, like popcorn kernels and ice, create significantly more force and have been known to crack teeth. The maximum force of the jaw ranges from 110-160 pounds of force (  Amazingly, dental professionals are brave enough to put their hands in the mouth! 

No matter the amount of force involved, it is distributed over many teeth when chewing food – unless some of the natural teeth are missing.  Remaining teeth then take on more force because it can’t be distributed over a large surface area, so teeth wear out more quickly.  Sometimes they crack or chip.  Sometimes they tip and cause defects in the surrounding bone.  Sometimes the filling in them wears away more quickly. And sometimes the nerve inside dies. In my years of practicing dentistry, I honestly believe that ignoring the damage caused by the improper distribution of force has caused patients to spend more money to fix the problem later than it would have cost when I first detected the problem.

How do I restore the proper distribution of chewing force? Sometimes, by “bridging” 3-4 teeth together so they work together to create stability.  When this isn’t possible, I may fashion a “partial” that fills in gaps with acrylic teeth and gums, hooking to several strong teeth nearby, for support.   The optimum solution is the placement of dental implants, if the damage to bone isn’t severe.  In all cases, x-rays and specific measurements within the mouth help me determine the best choice for treatment, and any choice is better than doing nothing.

Contact Winterset Dental today to find out which treatment is right for you.