Times are Changing

I recently attended my 20th dental class reunion in San Francisco. It was great to be back in the City. It was great to see old friends, and make some new ones. While visiting my old stomping grounds, I was impressed to see how the old dental school, in Pacific Heights, was moving into a state of the art facility South of Market Street. It gave me a chance to reflect on my own journey. It made me come to the realization that we have to evolve to stay current. I think back to when we were taught to do Mercury fillings in school, and now I have not done one since 1999. I think back not so long ago we had to put a messy, runny material, in someones mouth to get an impression for a crown. We would then wait two to four weeks for it to come back from the lab. Now all we have to do is take a digital CAD photo, and we can usually make the crown in the office and have it in the mouth in a couple of hours. Dentistry is changing rapidly. We no longer use chemicals to develope x-rays, and with the introduction of digital x-rays, the amount of radiation for x-rays has gone down. The exposure is up to 90% less than the old traditional x-rays. We now use lasers in dentistry routinely for finding cavities, treating gum disease, and cavities. The materials we use now are far superior to what we had in the past. With the introduction of emax, a new super strong ceramic, we can place nice white looking crowns in all areas of the mouth, where before we were limited. I think back to some of the materials I used just 5 years ago I no longer use. Dentistry is truly evolving by helping save lives with sleep medicine and different treatments for sleep apnea. There are new breakthroughs in treating Temporomandibular joint disorder. If you are interested in seeing or learning about some of these things call us for an appointment (808-873-0707), or mention it to us on your next visit. Our office is constantly evolving so that we may take care of our clients the best way we can. Thanks, James Merrett DDS

Best Dentist in Hawaii 2012 by Honolulu Magazine

Best in Hawaii 2012
I want to thank all of you who voted for my practice in the Honolulu Magazine poll. And, I am so happy to have been voted one of The Best in Hawaii for the fourth straight year.

I am so happy to receive this award for a fourth time. With the recognition we received last year, many patients heard about us and our work with migraine and TMJ pain sufferers. It is my sincere hope that we reach more of those people this year.

I am fairly sure that offering advanced dental services such as Neuromuscular Dentistry and Cosmetic Dentistry is one of the reasons my practice was recognized for this awards. I think another reason we have won this honor four times now is how we treat people at our practice. “We see our patients as guests and we do everything we can to make sure they have a comfortable and serene experience when they see us for treatment. I think that makes a difference in patient care.

Thanks again for your support. I look forward to seeing you soon and helping you maintain excellent dental health.

What do you see on Facebook???

One power of social networking is to help people by sharing your knowledge, experience, and advice. On Facebook, Twitter,and Linked in, etc...it is not unusual for some one to complain or ask questions about a symptom. For instance, recently my own sister was having a problem with her tooth. She was unaware that it was a tooth problem. She then posted it on Facebook and her concerns. I was able to recognize that it sounded to me liked cracked tooth syndrome. I advised her to see her dentist in Colorado. Another friend told me about how one of his Facebook friends went in for an inconclusive MRI because of persistent headaches. The friend’s doctor has suggested it as a diagnostic measure because the headaches had been unexplainable.

My friend posted on their wall the question: “Do you also have jaw pain or grinding teeth at night?” My friend was wondering if the cause of her headaches may have been Teeth/muscle related (neuromuscular), a TMJ joint disorder. They knew about it from knowing a dentist who helps with these conditions… me.

This is why I think it is important to reach out to everyone I know and remind them of some important points. They are:

1) TMJ is hard to diagnose, especially for general practitioners. It is easy to prescribe pain pills for pain with diagnosis or order expensive testing which, as in this case, was inconclusive.

2) TMJ is a jaw joint disorder and pain is common in that area, but symptoms can range from migraine headaches, to shoulder pain, to back pain and more. If a head, neck or upper back pain cannot be identified, it very well might be linked to TMJ.

3) Neuromuscular dentists treat TMJ non-invasively.

4) Ask a friend who is showing symptoms to consider a visit me for an TMJ consultation. Worst case, we rule it out!

So, I encourage you to listen to what your friends are saying on social media and know the symptoms of TMJ, or other signs and symptoms they cannot figure out. If you see someone suffering and frustrated because their doctors can’t figure it out or they are struggling with unnecessary pain medications, please refer them to me. At the very least, we can rule out TMJ for them or other tooth, joint, or bite problems.

Ditch Your Tooth Brush

My wife saw this in a magazine. I thought it would great to share on the blog!! I wish i would of thought to write this all my self!!
Enjoy!!

James Merrett DDS

Ditch Your Toothbrush
Sorry, you do still have to brush, but you may be able to do more to keep your teeth clean
By Jess Levine, Women's Health

Find more

A Perfect Smile
Take Care of Your Teeth
6 Dental Problems Fixed

Yep, we said it and we’ll say it again: Ditch your toothbrush! At least ditch it every three to four months, that is, says the American Dental Association’s recommendation for toothbrush replacement. But consider replacing it today, because beyond brushing the old-fashioned way, we have six tricks, tips, and technological innovations that could keep your teeth even healthier. “There’s really nothing that can replace brushing and flossing,” says dentist Ruchi Nijjar Sahota, DDS, in Fremont, California, “but knowing how to brush and floss correctly and knowing what is necessary to keep your particular teeth healthy is very important.” She says the most important thing is visiting your dentist at least twice a year to make sure that you’re doing everything right. Here are a few things you might try in the meantime.

1. Let the brush do the work.

You have the latest HDTV, but perhaps haven’t considered going high-tech with your toothbrush. “Some people brush too hard. Some people don’t brush enough,” Dr. Sahota says. And neither are good. She says brushing too hard can actually scrub away tooth enamel. “Electronic toothbrushes can make it easier for everyone to brush in the right way, but you’ve gotta allow the toothbrush to do its thing,” she explains. “The electronic toothbrush moves on its own, so you should try to be gentle with it to allow the bristles to work.” She recommends just a gentle side-to-side motion across your teeth without applying any pressure. Your dentist will be able to tell you if, control freak, you’re trying to do too much yourself.

2. Make flossing effortless.

If flossing your teeth is one of those shoulda-wouldas that have never become routine, maybe you need some help. Flossing aids like Dentek Triple Clean Floss Picks can make the process a lot easier for some people. “It’s difficult to get to the back of your mouth sometimes,” Dr. Sahota says. “Anything that can make flossing easier is great, but you’ve still gotta make sure you’re doing it properly. If you’re not, it’s as good as not doing it.” She says to make sure you’re getting between the teeth gently, making a c-shape around each tooth, and reaching the backs of the last teeth.

3. Stop snacking.

“Eating a really balanced diet is important but the most important thing is limiting your snacking,” Dr. Sahota says. Saliva production is stimulated by chewing so during a meal, your mouth is producing enough saliva to flush sugar and the bacteria that feeds on it off your teeth, but with a sugary snack (and she points out that that can include anything from milk or crackers to fruit or sugary candy) the sugar just sits on your teeth for about 20 minutes waiting for bacteria to come get it and created the acid that causes tooth decay. “If you snack a lot between meals that bacteria sticks to your teeth and has more time to do damage because it’s just sitting there, whereas if you eat during a meal there’s more saliva release and that can help wash away the foods.”

4. Start chewing gum.

Chewing gum stimulates saliva production, which flushes food and bacteria from the surface of the teeth. And research shows the right kind of gum could be even better for your teeth. You want to go with sugarless for obvious reasons. And look especially for xylitol, a sugar alcohol that is used as a sugar substitute in candy and gum. This sweetener doesn’t attract bacteria like sugar, but actually fights it. Good ol' Trident should do the trick.

5. Take a toothbrush to go.

Let’s get real, most of us don’t have time to brush after each meal. That’s why twice a day became the standard recommendation. But with the new mini on-the-go-friendly toothbrushes like the Colgate Wisp, freshening up before that post-lunch meeting or discreetly unsticking something from between your teeth is easy. The lip gloss-size brush comes loaded with a dab of breath freshener and a soft pick on one end for unsticking stubborn food particles. And it doesn’t even require water. Just brush, pick, and feel fresh.

6. Drink up

If you do just one thing, drink more water. “Drinking as much water as possible allows you to flush bacteria and food out of your mouth,” Dr. Sahota says. “Water has a pH of 7, so it helps neutralize the environment in your mouth as well.” Since it’s the acid that the sugar-eating bacteria create that causes cavities in the first place, the simplest thing you can do for your dental health is drink more H2O.

The Wow Factor

There is something about this time of year that makes people get motivated. The holidays are behind us and the summer is only a few months away. And, a lot of people are either waiting on their tax refund or know what the damage is there, so the pressure is off. In general, as we swing into April, it‘s a time when people start thinking about doing what’s next.

If you have considered cosmetic dentistry in the past, you might be thinking about it now. There are many great reasons to improve your smile. Sure, you can look at it from the viewpoint that a perfect smile can help with your career or give you an added edge socially. Or you can look at cosmetic dentistry as a way of giving yourself something long lasting, like the confidence to express your true self.

A lot of people have healthy teeth but they just do not like how they look. These people tend to shy away from smiling or being too expressive. And, it’s a shame when we don’t get to see their full personality because of this inhibition.

Cosmetic dentistry changes all that. The most common comment we hear following cosmetic dentistry is that the patient feels a new sense of confidence. They feel like they are free to smile because they know their teeth and smile are beautiful. And, when that happens, they let their whole personality out. Cosmetic dentistry is as easy as changing out that old dark filling on your front tooth, or a complete smile makeover. Just a small rejuvenating touch can make the world of difference. Recently, we have had many people who have had braces as adolescents get in to invisalign to straighten up those crowded lower teeth that could be affecting their overall health.

If you have had a desire to feel better about yourself, why not contact me today to discuss what cosmetic dentistry can do for you?

Mahalo,
James Merrett DDS

Oral Health: Don’t Brush it Aside

I saw this article on MSN.com and thought I would share.
James Merrett DDS

Oral Health: Don’t Brush it Aside
Your mouth is trying to tell you something.
By Rich Maloof for MSN Health & Fitness
What motivates you to visit the dentist: A sore molar? Time for a cleaning? A crush on the hygienist? These are all (or nearly all) sound reasons for keeping your semi-annual appointment. But there’s a significant link between your smile and your overall health that has recently come to light.

Dental experts and medical physicians are learning to recognize striking correlations between oral hygiene and serious diseases, providing all new incentives to take excellent care of your teeth and gums.

Try a little tenderness

Unless you floss every day—and only 10 percent of the population does, according to the American Dental Association (ADA)—chances are good that your gums swell and bleed during a dental cleaning. A little inflammation and tenderness is normal and can be brought under control.

“If your gum is tender, it’s because you have inflammation caused by bacterial plaque,” explains Dr. Kimberly Harms, consumer adviser for the ADA. “There are toxins in the bacteria that are sitting between your tooth and gum. That bacteria is already at work in those little pockets if your gums are bleeding.”

About 70 percent of adults over 35 have some form of gum disease. Gingivitis, or inflammation of the gums, is reversible; floss regularly and your gums will regain resilience and a health pink hue. However, unhealthy gums that remain sensitive and inflamed can lead to far more trouble than a little discomfort in the dentist’s chair. When moderate to severe inflammation sustains for a period of time, the bone that holds your teeth in place begins to decay.

“Once you have bone loss, that’s not reversible. You can’t bring that bone back,” says Dr. Harms.

Bone loss (periodontal disease) can in turn cause loss of teeth—which is bad enough in its own right. But at least that condition is confined to the mouth. Growing evidence indicates that chronic gum inflammation is associated with life-threatening inflammations deeper in the body.


Tracing the pathway

Jonathan B. Levine, DMD, PC, is an associate professor at the NYU School of Dentistry and has a degree from Cornell University in microbiology, so he’s acutely aware of the damage unchecked bacteria can wrought on the body. He explains here the pathway bacteria takes from the mouth to critical systems.

“When there’s chronic gum inflammation, bacteria byproducts start accruing around the roots of the teeth,” Dr. Levine describes. “If the wall of the gum tissue gets too inflamed, it can thin to a point where it’s permeable. There are these micro-cuts in the gum lining, almost like tiny cuts on your finger. With the gum opened, there’s a pathway — a portal of entry for bacteria to get into the bloodstream.”

The current thinking is that when these bacterial byproducts enter the bloodstream, they end up nicking the walls of the arteries. As the immune system dispatches its cellular soldiers to heal the nicks, there’s a cascade of inflammation that eventually leads to clot formations and plaque buildup in the arteries.

“There have been studies showing that the plaque from periodontal disease is the same plaque that builds up on the carotid artery,” says Dr. Levine. “So now you’re at risk for cardiovascular disease, or CVD. And if the plaque gets dislodged, you’re looking at the potential for a stroke.”

Dentists as detectives

Research confirms a connection between oral and arterial plaque, though no one would claim that gum inflammation is as much a risk factor as smoking or obesity. For cardiologists and dentists, though, an understanding of the link can quite literally be a life-saver. CVD and stroke, two of the nation’s leading killers, are not the only systemic conditions that have been related to oral bacteria, either. A 2008 study from Dr. Levine’s own institution provided evidence that gum inflammation contributed to brain inflammation and resulted in threefold memory loss. The NYU study supported a long-held hypothesis about the link between periodontal disease and Alzheimer’s.

All of these connections to oral hygiene position the dentist as a first line of defense against disease. The reality is, people see dentists a lot more often than they see internists.

“We’re the dental detectives,” says Dr. Levine. “When there’s no obvious cause of chronic inflammation, we have to move into risk assessment. Is the patient on medication? Some meds can cause inflammation. But so can diabetes. Diabetics have a much higher percentage of periodontal disease.”

Thanks to advances in technology, dentists today are also better equipped to detect oral cancers. Using a device called the VELscope, Dr. Levine can identify classic warning signs in the tissues of the mouth. Every visit to his office is a de facto cancer screening.

About that “apple a day”…

So, what can you do to improve your oral hygiene? A healthy lifestyle in the broadest terms contributes to a healthy mouth, and it all begins with nutrition. Dr. Levine notes that Americans favor a diet of high-protein meats and a lot of sugars—both of which make for an acidic oral environment in which damaging bacteria thrive. Adding more fruits and vegetables, which are alkaline, to the diet balances the pH and gives the gums a fighting chance against bacterial invaders.

The ADA also recommends brushing three times a day for two minutes each time (that’s 30 seconds in each quadrant of the mouth) and flossing every day. But you knew that already. If it seems like too much time to commit, consider how long it took to eat that cookie after lunch, or how long you chew on one piece of gum. Most of the damage we do to our mouths can be undone in a fraction of the time.

Be sure to catch your dental checkups and cleanings twice a year. You may be too old for a pat on the head and a free toothbrush on the way out. But when your dentist leaves you with a clean bill of health, it’s one gift you are sure to appreciate.


Rich Maloof is a regular contributor to MSN Health & Fitness. He specializes in health as well as technology and music. Rich has also written for CNN, Yahoo!, Women's Health, Billboard and the “For Dummies” book series.

Is your mouth trying to tell you something???

I see many mouths everyday and fortunately most mouths I see are healthy.

However,here is a list of general health-related conditions that show warning signs in your mouth. Sure you want to keep your dental health strong and many people know that gum disease is connected with heart disease. I encourage you to have more awareness of your dental health and that includes these warning signs.

Flat, worn teeth and headaches are signs of TMJ. People often grind. This stress level, left unchecked, can lead to other physical and emotional issues. It can also lead to TMJ… you’ve seen plenty about TMJ treatment on my blog. If you have worn teeth and bruxism (grinding), please see me for a TMJ evaluation

Cracking teeth is a warning sign for Gastroesophageal Reflux Disease (GERD). You may also have something we call erosion. This is when the stomach acid erodes the tongue side of the teeth. Of course not brushing away sugars will cause your tooth enamel to erode, too. But if you take good care of your mouth with brushing and flossing and you still have tooth erosion, you may want to look for treatment for GERD.

A mouth sore that don’t heal is a sign of oral cancer. An oral cancer screening is part of your regular checkup and it is a good reason to keep your appointments for cleanings and check ups.

Gums that grow over teeth are a sign of issues with prescription medication. Your medication for seizures, heart disease or autoimmune diseases could be causing this reaction if the medication is not adjusted properly.

And, a dry mouth is a sign of diabetes. There are many early warning signs of diabetes and one small tip that you might need to see a doctor for a diabetes screening is a persistent lack of saliva. We have also seen with some of the newer medications being prescribed that they are causing dry mouth. This is leading to a high degree of decay in some of our patients.

Watch for these warning signs as you manage the home care of your dental health. Please see me regularly for check ups this year as well, so we can make sure your dental health is at its peak.

Thanks,
James Merrett DDS