[DVY]

I've been on this forum a little while and noticed a lot of very mediocre to downright terrible advice.

I am at work now and have some down-time during the day. Ill try to answer as many questions as possible.

Heres some thoughts/pointers to maintain a "life-time of oral health"

Acidity
1) Reduce/neutralize the acidity consumed during the day. Acidity degrades teeth.

Thankfully, enamel is quite strong. Unfortunately, all of our are teeth are fully formed (crowns at least) by the age of 16. This means that you only get one chance to maintain good teeth.

Heres what soda does to a chicken bone....

Soda is very acidic usually about 2-3 on the pH scale. Granted, nobody douses their teeth is soda for a week or so straight. But adding up the times you drink soda over your life-time, one can quickly see that this is a damaging habit.

Solution- Asking people to quit soda/acidic drinks (coffee, lemon drinks, juices, etc) is impractical. Thus it becomes important to incorporate habits that minimize the damage. The body's way of buffering this acid is your saliva. Your saliva washes away the acid and helps buffer the acidity of your mouth. An artificial way of helping this buffering is swishing one's mouth w/water after a meal/coffee/soda.

For those living under a rock heres a pH scale

Next down-time- Human physiology of Saliva Buffering i.e Stephan Curve

[Bad Hussar]

Any effective home remedy teeth whiteners that actually work? Professional teeth whitening is absurdly expensive.

Would using 40 volume hydrogen peroxide diluted 50:50 with regular mouthwash whiten teeth over time? Would this concentration be harmful to the enamel?

[NuMbEr7]

Is it possible to get rid of cavities at home with things such as baking soda?

[Drazen]

How is the industry? I got into Dental School but didn't end up going because it just didn't feel like something I wanted to get into. Also got a bit scared at the costs of the education.

In retrospect, the money looks fantastic...but there is a lot of competition it seems.

[LowerCaseG]

I was born in Europe, and my mother took fluoride supplements when she was pregnant with me and my brother. Neither of us has had a cavity in our lives, although we both had poor dental hygiene habits as adolescents. Would you recommend this practice as a dentist?

Would you have any concerns about having dental work done in another country in order to save money? I was very impressed with the dentist in Thailand, not so much in the DR.

[chyamor]

whats the best way to fight gum disease / mouth cancer if you are over 30+ and already have a mouth that looks like a graveyard

[DVY]

@Bad Hussar- TBH I am against whitening teeth by chemical means. All effective "whiteners" use caustic chemicals that can cause a lot of damage. Disclaimers aside, a home remedy that seems to have some effectiveness is a baking soda+hydrogen peroxide+coconut oil paste that you just apply to your teeth w/your finger. 3% hydorgen peroxide is about as high as I would recommend you going for long periods of time.

@Number7- Cavity- a hollow space. If you have a cavity, it will remain a cavity. What you can do is slow down the progression of a cavity. There are numerous ways of doing this- 1)physical-brushing/flossing 2)chemical- chlorohexidine 3) pH- most cariogenic bacteria function best at ph <6. Thus by using baking soda, you raise the pH (make it a basic environment that kills off the bacteria). So, I guess the answer to your questions is "It depends"

@LowerCaseG- this behavior is why we got Anti-Fluoride crusaders. You shouldn't be giving pregnant women any drugs or possible toxic substances. No alcohol, antibiotics, tylenol, etc etc. All of these have potential of causing problems. Fluoride supplements from infancy to the ages of 14 i highly recommend. Fluoride incorporates w/the body- strenghtening bones and teeth.

@PartyonBro- Its still one of the better non-scalable jobs out there. Medicine- terrible minimum of 8 years extra schooling, pay is getting squeezed. Law- no chance. Engineering- starting salary is around 50k.

Outlook for the future is less than rosy. Insurance companies squeezing you from one side, inflation/poor economy squeezing you from another. And as you said, competition is heavy. That being said, most dentists are average and scared of everything under the moon. Branch out into "riskier" speciality type works, and youll start clearing more money. Also if you work in Alaska/North Dakota, youll be making fat stacks. Heard its 200k starting.

@chyamor- good hygenie/home care+ deep cleaning+ 1 round of low-dose long-term antibiotics( my favorite is doxycyline for 2-4 weeks). I really need more information. W/your description, recovery is impossible. At this course, it becomes about maintaining what you have for as long as possible.

[slubu]

How often do I need to actually go to the dentist to get my teeth cleaned? Do I really need to floss everyday? Why does OJ taste like shit after I brush?

[DVY]

Human Physiology of Saliva

Dental Erosion- Damage to teeth caused by chemicals.

pH of the mouth runs from 6.2 to 7.2. This fluctuates throughout the day and night. Enamel demineralization starts around 5.7 and accelerates exponentially (according to log-scale of pH). Saliva is generally right around 6.1 on the pH scale.

So when you have a coffee, you go into slight demineralization. When you have a soda, a lot of demineralization. Check the pH scale. Each point drop from 7 to 6 is a 10x increase in acid (H+). That means a soda pH of 2 (coca-cola) is 1000x more acidic than coffee (ph 5)

Thankfully we have saliva which helps buffer your mouth's pH and save your teeth. The Stephan Curve (blue) helps describe a normal interaction after a meal/drink/soda. This will be adjusted based on the altering pH.



As you have add more acid, it takes longer to buffer the pH. This extends the demineralization period. Side-note, as you decrease saliva flow you decrease buffering.

This phenomenom is why dentists recommend xylitol gum after a meal. The chewing action releases more saliva.

*Helpful tip- anything sour is acidic. This means fruit juice, oranges, applesauce, yogurt (esp greek yogurt).

Stephan's curve helps explain why it is so crucial to brush your teeth at night. When you sleep, your saliva function/output drops dramatically. This means that your teeth are under more potential danger when sleeping.

[Kickb]

Let's say one of my fillings crumbles due to me eating ice. Now i have a slight hole in my molar and everytime I drink a cold liquid I get an annoying (But easily manageable) pain.

Do I need to visit my dentist and get a new filling? Will the pain eventually get worse? Will my molar rot out of my head if I don't have it refilled?I've been living with this for a few months now and I've gotten used to the pain. I'm more concerned about the long term effects of not having my tooth completely filled.

Also, something I have wanted to know. These health care industries (Dental and Eye Care) make money from people that have problems with their mouth/eyes. Do Dentist and Optometrist always give good advice to clients? Sometimes I get the feeling that we are given bad advice to keep us coming back.

[el mechanico]

I need a crown. My sis got one and said it was fast because they had a "cerac" machine. My cousin who works a dental lab said it's obsolete.

What shit does the dentist need to have there to make my visit be a in and out deal?

[DVY]

@kickboxer- go in and get it filled. Sounds like the pain is short and goes away suddenly. This leads me to believe its just a filling and not a RCT.

Its should be around 100-150 dollars in the US. Maybe bring cash and plead w/him a bit saying your not flush (from your prior posts, I suspect you are young and not 100% financially stable). Cash discount =). Most private dentists will give you some leeway w/ cash.

Anyways, and extraction costs about the same price, and a RCT/post and crown is around 2k. Go do it. You are probably coming out ahead by filling it.

[Kickb]

Last question. How often do dentists bang the cute assistants/receptionists?

[DVY]

@el-mech- Cerec is a POS. Dont do it.

The longevity/strength is shit compared to traditional PFM (porcelain fused to metal) crowns. Granted this takes 2 visits, because the dentist needs to send it to the dental lab, but WTF you are spending at least 500 buxs. Why not make sure itll last you for at least 5+ years. Plus the 2nd visit is only 20-30 mins to seat the crown and makes adjustments.

Cerec is all porcelain crown milled from a 3D machine. Long-term studies show its longevity at 87% for 5 years compared to PFM at 94%. At 10 years, I think the statistic was 30% of CEREC crowns have catastrophic failure and need to replaced compared to 10% failure of PFM, of which only 3% were catastrophic failures.

Keep in mind this, failure rates for molars (esp 2nd molars) are probably double that.

CEREC is what I call a good idea, terrible execution. Sounds good on paper, but falls way short IRL.

Dentist who do CEREC are doing a tremendous dis-service to their patients.

Edit- In-n-out visit not recommended. PFM crown should be about 500- 750 dollars. Maybe less, since your in Florida.

[stoney]

haha great new thread, lots of good questions off the bat...i'll be back to keep up on this. bamp.

[DVY]

@ kickboxer- not sure. I only keep ugly/older ones around. This is a purely business relationships. I try not to sleep w/patients either. It can cause a lot of problems.

Top 3 reason for dental license suspension
1) Fraud
2) Substance Abuse- Alcohol (DUI), pills, etc etc
3) Sexual relationships/abuse- lawsuits galore if you want to fire a staff (especially if you started sleeping with her after you hired her). Not a position I would like to be in. Patients can sue you too for this.

My personal rule, since it is an anonymous forum,- dont hire black people. Racist or not, black people have uber-power esp. in California Police State. You basically cant fire them for any reason. Youll get sued for racial discrimination.

[Giovonny]

I hear dental hygienists conventions are full of horny chicks?

Do you ever go there to chase pussy? I hear the ones in Vegas are fun.

(04-11-2013 03:07 PM)DVY Wrote:  

dont hire black people.

wtf???

I'll have Athlone give you a call.

[MikeCF]

Are gold fillings the best?

What's your take on the view that mercury in "silver" fillings is toxic?

[thegmanifesto]

What is the best commercial toothpaste?

Best floss?

[DVY]

@Gio- Thats life in the CA police state

Funny enough I have a distant family acquaintance who owns a large dental group practice. He hired a black dentist to be lead dentist and do all diagnostics (money-making part).

Hes been audited multiple times for suspected shady practices (big hint-all giant group practices are borderline unethical scumbags) , and sued sucessfully for "racial discrimination".

Dental hygenists are cute. I ran through a couple in undergrad. A+ feminine sweet girls. These girls know its 3 years of school (edit- and have a job to serve other people, similar to nurses) and have good chairside manners. Its a good combo.

[DVY]

@MikeCF- Best is a subjective term. Yes, Gold is the best dental material, but it has a couple drawbacks- Expensive, not aesthetic, time-consuming. It also may be inferior in certain cases to white/silver, at least for fillings.

Gold foil (99% of dentists dont even offer this) is expensive, time-consuming and marginally better than white fillings.

Gold inlays are great, but overly expensive and take 2 visits. 1 visit to prepare the tooth and take final impression. 2nd visit to deliver.

Gold Crowns- more expensive, not aesthetic.

Porcelain-Fused-Gold Crowns- best option for people who have nickel allergies. People who have metal allergies should switch to gold. Sadly, "metal-free crowns" are being sold. This is a giant dis-service to patients. Anecdotally, they break ALL the time.

Heres the benefit- gold is bacteriostatic, few people have allergies to gold

Overall, I would say for fillings "No". For crowns, I would recommend full gold crowns or PFG (porcelain fused to gold). In fact, on all our implant crowns, we only do PFG.

For fillings, do a white filling or amalgam (mercury) w/spherical high copper content. The new amalgam fillings today are a huge upgrade on the 1970s mercury fillings that were dripping wet w/mercury. Elemental mercury which is the dangerous mercury HG0 is all bound up in less reactive forms HG1 and HG2.

Overall, I am not convinced that amalgam fillings are that bad from the research shown to me. What I am sure of is that the process of removing amalgam fillings to replace for white/resin releases more mercury than leaving them be. Mercury fillings are basically inert when set.

Edit- I dont want go super-technical. But white fillings have their own drawbacks. The big one is that they are highly moisture senisitve. For posterior teeth, moisture control can be a huge issue. One little drop of saliva basically ruins a white filling. Amalgam doesn't have this problem. The old joke is that you can fill teeth underwater w/amalgam w/your thumb.

[Screwston]

I brush 2-3 times a day and try to floss/rinse with hydrogen peroxide daily. This is the toothpaste I use with a dollar store soft toothbrush (my gums bleed easy). I buy packs of toothbrushes from the dollar store and use a new one every few months. Should I switch anything up? I like to keep it simple.

[iknowexactly]

If whiteners suck, what should I do? Get veneers or crowns on badly yellowed front teeth? It seems too bad to leave alone.

I'm guessing crowns or veneers on an otherwise intact tooth traumatizes it even more than whitening....
I had mechanical problems with a couple front teeth and had quite white crowsn put on with the idea I will finish the other fronts with vanity crowns or
veneers.

[POHammer]

Why are you against tooth bleaching?
There are published studies that show no damage to enamel.

Furthermore, the bleaching agent is applied to the front of teeth...not the chewing surface where cavities are more likely to form.

I am not sure if it really is bad for teeth, but white teeth are very important for being perceived as good looking, and the more extreme white the better. Perhaps veneers are good, but seem pricey.


Also, what is your take on xylitol chewing gum for reducing tooth decay?

[Parlay44]

Which countries would you recommend visiting for dental tourism? No offense but dental work costs a fortune in the US.