Dental Blog

Mouth Acids

Your Dentist can help to diagnose systemic problems by looking in your mouth and should examine your mouth every six months, it is not money wasted! Usually during cleaning visits I will complete our Periodic Oral Evaluation. During this cleaning visit, I also look at the tissues of the mouth; gum tissue, teeth, and the tongue are all under great scrutiny. I look for any type of oral change. 

In this post I want to show you the changes that alerted me to my patient's case of GERD- Gastro-Intestinal-Reflux-Disease. 

He had not been in for some time but when I saw the back of his teeth I knew right away that he had some extra 
acid in his mouth. After asking the right questions, he did mention that he had excessive indigestion. 


Enamel loss, seen above, usually arises through one of two conditions: GERD or excessive vomiting. While the vomiting associated with morning sickness is not usually enough to damage teeth, excessive vomiting can cause this type of erosion. This is often associated with Bulimia and is a change that is visibly apparent to a dentist. 



When to Treat a Cavity

"My dentist told me my tooth has a dark spot. It feels fine. It doesn’t hurt when I chew and it doesn’t hurt to sweets. Why should I fix it?"

Many times I hear the same thing…"but it feels fine…can I wait".

I have here photos of someone that had a cavity. It seemed small but when we opened up the tooth it was quite large. The problem with decay is that it usually does not hurt until it touches a nerve. The problem with treating a cavity once it starts to hurt is that it treatment now requires a root canal. 

The photo on the left shows a tooth with a small dark spot. What I was most concerned with is the grayish areas around those small spots. That tells me that there is a hollow “cavity” below the surface. As you follow to the right you will see how the decay is still in the dentin of the tooth until it is quite deep. If we had been allowed to treat this tooth much sooner we would have preserved much of the patient’s tooth structure. This tooth might need a root canal in the future. Small fillings are less likely to hurt the patient and last longer.



When Should I Replace My Toothbrush

When should I replace my toothbrush head / toothbrush.

Firstly a manual toothbrush is fine HOWEVER any electric toothbrush will do a better job of brushing.

I personally prefer the Sonicar brushes in electric and Oral b Cross Action for manual brushes.

That said it does depend on you as to when you replace your brush. If you brush aggressively you will wear the bristles out faster and thus replace the brush faster. With normal use I usually suggest 3-4 months. Above is a photograph of normal brush use at 6 months. One can readily see that the bristles loose their ability to spring back and in turn wipe away plaque. The above photo also shows why I like the Sonicare brush. It has a wonderfuls shape that fits into the spaces in our teeth. The blue band in the front is supposed to show us when to change the brush head. When the blue band is down to the final 1/3 replace the brush. Many brushes have such technology and can be a good guide as well. Do pay attention to these details when selecting a brush. A brush that is more efficient in cleaning is more efficient in removing bacteria and in turn keeping your mouth healthy.



Welcome Sunlight

Recently I had my anual physical. Reading my bloodwork I realized I had less than HALF the amount of Vitamin D than I should have. We all learn in school that lack of Vitamin D during development can lead to poor bone formation, even Rickets. I personally cannot drink much milk, and even I read people I am not still growing so should I be concerned? YES.

Vitamin D is essential in proper immune system function (infact I believe I read 70% of people that develop a cancer had low Vitamin D levels). In addition to poor bone formation and osteoporosis, low Vitamin D levels can lead to depression, infections, cancer, heart disease and muscle weakness. Vitamin D is similar to a hormone and helps to regulate our absorbtion of calcium, iron, phosphate, zinc.

Interestingly I had been experiencing lower energy levels (though I did not even realize until after supplementing that I had this). My blood levels of Phosphate were off, and I had gotten a nasty cold (also odd for me).

Other than supplementation the only way we can get adequate vitamin D is though exposure to sunlight. You can see how working indoors and "wanting to avoid skin cancer" would allow our bodies (as a society not just me) to become deficient.

I have been encouraging patients of mine that have complaints of muscle cramps, fatigue, weakness / tiredness, sickness to have their blood analyzed by their physician.

After just a week of supplementation I do feel different. Just a week. I am a believer. (and I probably will try to get a bit more sun this summer :) )



Thank You Notes for CityDentist

Dr Stange,

My husband and I have elected you to the doctors hall of fame! We both feel very lucky to have found you. (Thank you ## and ## !)

You got me through a process today that I've been fearing in a deep way. I'm very grateful to you. Your commitment to your work reminds me why people who care about their profession can make an enormously meaningful difference in peoples lives.


Again I thank you so much.

Your new patient,


Thank You Note To CityDentist

Need We Say More?!!!!

This is a thank you note from one of our patient's. She lost a front tooth and we not only restored that tooth but created a new smile for her!!


Odd Bleaching Recommendations from the Internet

Recently I found a few bleaching recommendations on the internet. I was both amazed and frightened by what was apparently written by non Dental personelle. I wrote replies to each of these below. Hopefully you will understand both what TO do and what NOT to do. As well I hope to convey that "Just because it is on the internet does not make it true". Please read aware of the SOURCE of this information. UNDERLINED COMMENTS ARE THE COPIED INFORMATION.

> Foods that naturally whiten your teeth:>
> Strawberries - bc they contain malic acid, which is also found in whitening toothpastes

Even with the malic acid however that is not the whitening ingredient is a preservative for the paste. It is not helpful and actually damaging on its own. While very nutritious too many strawberries can help form cavities. The acid and sugar combined are enemies of the teeth. The red coloring is also going to stain a tooth because acid makes a tooth porous and more likely to absorb stains. I say no on the strawberries as whitening.

> Apples, celery, carrots - natural stain removers

Each of these foods requires extra chewing. Because they are fibrous they will naturally scrub the tooth structure with each bite.

> Lemon Juice - mix half water, half lemon juice once or twice a week bc it will naturally "bleach" your teeth - (think about how we used to use lemon juice in our hair to lighten it) - but don't overdo it by using straight lemon juice bc it will be too acidic (harmful) for enamel.

NO NO, Lemon Juice acid will lighten hair because hair is Collagen. Acid breaks up the collagen structure and changes the color. Enamel is irreversibly damaged by the acid if in excess. Dringin lemon juice is ok but the mixture here is WAY too concentrated. Citric Acid is very potent and dissolves enamel in seconds. Eat lemons sparingly for flavor NOT for bleaching teeth.

> Yogurt, milk and cheese - lactic acid,

Yogurt (plain not with added colored fruits) and cheese (and not with artificial or natural dyes) help NOT to stain the teeth but will not inherently whiten. Yogurt does have the added benefit of adding GOOD bacteria to the mouth and GI tract. These good bacteria will actually benefit the mouth by competing for the same food that bad bacteria need to live. Less bad bacteria leads to less stain. The foods themselves do not bleach they just do not harm.

> Oranges and pineapples -

Same as lemons Good to eat but not for prolonged contact with teeth.

> Chocolate - an antibacterial because of the cocoa bean husk?

Interestingly enough. I read a research article years ago, I believe it was from the late 1930s or 40s, it did state that the cocoa is actually antibacterial. The problem is that we are not going to find much cocoa in chocolate these days. I find more and more soybean fillers and sugar than actual cocoa. I believe cocoa that is unrefined is quite bitter and not as palatable as we might think. The dark coloring of cocoa will not be beneficial to the color of teeth. 

First Visit to the Dentist

I feel the most important thing to consider for any child is if they have spaces in their baby teeth or not.  Children that have spaces in their teeth ( which is supposed to be the case ) have teeth that are more  "self cleaning". Minimal care from the caretaker will keep the teeth healthy. I recommend starting with a flexible finger cot that is sold in most pharmacist / baby store infant oral care sections. It helps keep the hands close to the child and offers more control. As the infant grows accostomed to this habit switch to the brush.  Wiping the teeth clean before bedtime is important and early on you may or may not use toothpaste. I recommend start one thing at a time, finger cot, toothbrush, then toothbrush and paste. Never allow a child with teeth to fall asleep with a milk or juice bottle in their mouth. Sugar that will remain in the mouth overnight will cause baby bottle decay. This usually starts in the front teeth and turns the teeth dark. It can be easily prevented by our mentioned steps above. The toddler with spaces in their teeth toddlers usually have their molars by the time they are 2 years old. This is a good time to bring them to the dentist. At this point it is important to have a professional evaluation.

The second situation is a child that has teeth without spaces. If this is the case it is much more important to clean this child's teeth. Just like an adult the touching teeth allow plaque and bacteria to grow between their teeth. The children I see with little to no space between their teeth are usually the ones with decay. These children should be evaluated by a professional around 1 year or when you can see 8-12 teeth in their mouth.
Preparation for a toddlers first dental visit starts at home. If this is the first time anyone is looking in their mouth the new experience with a stranger will most likely not be received well.
I especially tell parents not to threaten their child with the dentist. children have good memories and the first description of the dentist should not be: "If you don't brush your teeth you will have cavities and the dentist is going to have to pull all your teeth ". When they arrive in the dental office guess what they feel we are going to do to them. Use positive reinforcements at times when the childs behavior of brushing is correct. I have my 4 month old daughter hold and explore her little toothbrush already. It does not become something forced into their mouth but something akin to their pacifyer that is accepted as normal. I also would recommend brushing the teeth while the child is in a playful and inquisitive mood. Right before bed while your child is tired and fussy is probably not the time to try to brush the teeth. I recommend after dinner and or after breakfast. Remember that the cavity and odor causing bacteria are always growing in our mouth. We are controlling their population by brushing them away. It is not as much about brushing at 9:04pm and again at 7:56am as it is about removing bacteria twice a day. It is ok to brush and have one more bottle as long as again we don't fall asleep with that bottle. Bushing effectively while a child is accepting is much better than fighting that cranky child at 11pm. Ultimately it is best to brush then go off to bed, and in the morning after breakfast would be best as well.
The first visit to the dentist should be a quick and pleasant one. I tell patients to bring their toddler to watch while they have a cleaning. They Hygientist will be the first person to touch them one day and so they should see that touching mom dad or the caretaker is acceptable. 
If you are not hurt in the chair and they have watched that then most likely they will at least let us look in their mouth.
At home in preparation you can have your child open wide, show them a small flashlight and make a game of opening so you can see inside their mouth. Have them stay open enough so to can count their teeth. Also you can have them do the same to you. If they are in control and understand the situation you have removed the fear.
I say start as young as you can and "desensitize" the child in a non-combative constructive way.
If they see it is easy with you then it will be easier to relate to the dentist. We find ways to have our children enjoy reading or coloring we should also find ways to learn oral health. Again these times are best timed with your child's moods. we usually don't ask them to wait till bedtime to start reading playing or learning so my recommendation is make oral hygiene a part of the day.

Breast Cancer Awareness All Year

In memory of my Mother Patricia:

To all our patients their extended families and friends. Please be sure that you and your loved ones have annual breast cancer screenings. If you are opposed to mammograms at least have physical examinations. Anything that can be detected while small is MUCH more treatable. 

 Your choices not only effect you but those who love you as well.

5 Tips to Avoid Cavities

Dentists say that limiting consumption to one sweet food per day lowers risk of cavities and improves oral health. Cavities. We all fear them. Those little black spots look harmless, but they can permanently damage teeth. In order to have a healthy, shining smile the team at our Midtown Manhattan dental office offers five helpful tips to keep your ivory digits sparkling.

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Fred Stange, DDS

Fred Stange, DDSWe deliver personalized cosmetic dental care.

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