Dr. Graef's Blog

As a successful author, interior design guru (with 127 makeovers in eight years on The Oprah Winfrey Show), and host of his own television program, The Nate Berkus Show, Nate Berkus understands the important role a beautiful smile plays in one's life and career. In a recent interview with Dear Doctor magazine, Nate discussed his oral health history. Berkus credits his all natural smile — no cosmetic dentistry here — to the treatments he received as a child from his dentist. “I'm grateful for having been given fluoride treatments and sealants as a child.” He then added that, “healthy habits should start at a young age.”

Dental sealants are important because they help protect developing young teeth until the enamel has matured. Without dental sealants, the newly erupted immature enamel of teeth is more permeable, meaning that the acids produced by bacteria in the mouth can damage these teeth more easily. This makes the teeth less resistant and thus more susceptible to tooth decay.

Regardless of how much your children brush their teeth, the reality is that toothbrush bristles cannot reach down to clean out the crevices found in the deep grooves (“pits and fissures”) of teeth. And if not removed, the bacteria found in these grooves produce decay-causing acids as a byproduct of metabolizing sugar. However, when sealants are used in combination with fluoride, good hygiene and nutrition (including lower sugar consumption), the odds of having tooth decay is dramatically reduced.

We refer to dental sealants as “pit and fissure” sealants because they protect the grooves found in the top of back teeth and the back of front teeth. Sealants also may reduce the need for subsequent treatments as your child grows older — just as it did for Nate Berkus. For these reasons, sealants are definitely something that all parents and caregivers should consider for their young children.

To learn more about dental sealants, contact us today at (248) 589-2021 to schedule an appointment so that we can conduct a thorough examination, discuss any questions you have as well as what treatment options will be best for you or your child. Or to learn more about sealants now, you can continue reading the Dear Doctor magazine article “Sealants for Children.” And to read the entire interview with Nate Berkus, please see the Dear Doctor magazine article “Nate Berkus.”

Recent research has revealed a relationship between overall general health and proper care for your dentures. The evidence shows that oral bacteria have been implicated in bacterial endocarditis (“endo” – inside; “card” – heart), chronic obstructive pulmonary (lung) disease, generalized infections of the respiratory tract and other systemic diseases. This proves what you might not suspect — you need to pay attention to the care of your dentures to achieve optimal health. For this reason, we have put together this list of five great tips for caring for your dentures.

1. Daily cleaning at home: It is critical that you thoroughly remove the bacterial biofilm in your mouth and on your dentures. This one tip alone will help minimize the likelihood of your developing inflammation (denture stomatitis) under your dentures.
2. Don't boil your dentures: While cleaning is important, you should NEVER place your dentures into boiling water because it can damage and warp them.
3. Don't wear your dentures 24/7: To help reduce or minimize denture stomatitis, you really should not wear your dentures 24/7. It is important to thoroughly clean them each night along with your mouth (as noted above), and then leave them out while you sleep. This will also slow down the bone loss that naturally occurs from the pressure caused by wearing dentures.
4. Always store your dentures immersed in water: This tip is so important because it helps prevent your dentures from warping. And do not forget to change the water each day, as well as to clean the container in which you store them.
5. Annual professional cleaning: Even though you may do an excellent job cleaning your teeth at home, you still need to come to our offices at least once a year for an examination, fit and function check, as well as a professional cleaning. During this cleaning, we will use our ultrasonic cleaners to minimize the biofilm that accumulates over time.

To learn more, contact us today at (248) 589-2021 to schedule an appointment.

Protecting your children is one of your most important roles as a parent or caregiver. Dental sealants are one way you can protect your children's teeth from the ravages of tooth decay, drilling and fillings — and they can be applied simply, comfortably and quickly right here in our office.

What is a dental sealant?

A dental sealant is a thin, plastic film that is painted onto the tiny grooves on the chewing surfaces of the back teeth (usually the premolars and molars) to prevent caries (cavities) and tooth decay. And by allowing us to use sealants to seal these little nooks and crannies where your child's toothbrush can't reach, you will dramatically reduce their chances for developing tooth decay. This one, simple and quick office visit could save you both money and time with fewer dental visits and healthier, cavity-free teeth.

So will sealants guarantee no (or no more) cavities?

No, just like life, there are few guarantees. Your child's oral hygiene, regular dental visits, fluoride, sugar consumption and genetics are the other important factors that will determine to what degree your child experiences tooth decay. However, research shows that pit and fissure (chewing surface) decay accounts for approximately 43% of all decayed surfaces in children aged 6 to 7, even though the chewing surfaces (of the back or posterior teeth) constitute only 14% of the tooth surfaces at risk. This demonstrates the vulnerability of the chewing surfaces of the posterior teeth to decay. By placing a protective seal over the areas of teeth at risk, you can effectively and proactively protect your children's teeth.

How long do sealants last?

Research has shown that some sealants can last up to 10 years. However, if you opt for sealants for your children's teeth, we will closely monitor them with each office visit to ensure that they are still doing their job. As needed, we can apply more sealant. Contact us today at (248) 589-2021 to schedule an appointment to discuss any questions you may have regarding dental sealants.

Your son just crashed his skateboard and cracked a tooth, or maybe your daughter fell off the monkey bars at school and now has a chipped front tooth. For children, and some adults, repairing chipped or damaged teeth with tooth-colored restorative materials directly bonded to the teeth may be the perfect solution to restore their smiles.

What is Involved: Composite bonding is a technique that has been developed to correct chipped teeth and other minor dental imperfections. It may also be used to correct mild crookedness or gaps between teeth. The procedure requires the application of a tooth-colored composite resin material to the surfaces of teeth, which is then sculpted to the desired shape. It can be performed in a single visit for one or multiple teeth. The procedure usually takes between one and two hours, and the end result is a beautiful, natural-looking smile.

Advantages for Kids and Adults: Composite resin bonding is a good choice for kids and teens since their jaws are still growing and developing, and they may still be engaged in high-risk activities. After your child's teeth and jaws are fully developed, we can discuss options for more permanent restorations such as porcelain veneers or crowns. These require removal of more tooth structure, which could compromise the long-term health of your child's teeth if done too soon. Composite resin restorations, which bond straight to the teeth and require little to no tooth preparation or drilling are therefore a good option for fixing chipped teeth, and they're less expensive than choosing veneers.

Disadvantages: The longevity of composite resin restorations is related to how well you maintain your teeth. Many people can go for ten or fifteen years before they need to have the bonded resins repaired or replaced. Others will tend to stain and wear after only one or two years and will need some touch-up work.

Contact us today at (248) 589-2021 to schedule an appointment to discuss any questions you may have regarding dental bonding. Read more about this topic in the Dear Doctor magazine article “Repairing Chipped Teeth.”

If you've lost one or more of your teeth due to tooth decay, trauma, gum disease or a failed root canal, there are a variety of ways that our office can help you to restore your smile and increase your confidence. Crowns, conventional bridges and dentures aren't your only options for replacing missing teeth. Dental implants, surgically placed below the gums, are another alternative for replacing missing teeth.

Getting Started: If you would like to explore the option of having dental implants to replace one or more teeth, you will first need a comprehensive exam. The ideal candidate for implants is in good general and oral health. Adequate bone in your jaw is needed to support an implant. Smokers and those with uncontrolled chronic diseases like diabetes may not be good candidates for dental implants because healing may be impaired or slow. In addition, dental implants aren't appropriate for children or teens until their jaw growth is complete.

The Process: Dental implant surgery can be performed in our office using either a local or general anesthetic. The implants actually replace tooth roots; they are placed into the bone surgically. Generally made of commercially pure titanium, this metal has the remarkable ability to fuse with the bone as it heals forming a union known as osseointegration (“osseo” – bone; “integration” – to fuse with). This process takes two to six months depending upon many factors of which bone quality is the most important.

The next step is to place an abutment (a small connector) which attaches the implant to the crown. The crown is the part of the tooth that is normally seen in the mouth above the gums.

Assessment of your individual situation and deciding if dental implants are right for you takes knowledge and experience. Contact us today at (248) 589-2021 to schedule an appointment to discuss any questions you may have regarding dental implants. Read more about this topic in the Dear Doctor magazine article “Dental Implants: Options for Replacing Missing Teeth.”

Let's talk about oral cancer. Yes, it's a scary subject — but the truth is, the more you know about it, the better able you are to protect yourself.

1. Who is more likely to get oral cancer? Because of your genetic disposition — heredity — men are twice as likely to develop oral cancer as women. African-Americans have a higher incidence than Caucasians. The disease is also related to aging, although in recent years many young people have been diagnosed with this disease.
2. Are some habits related to development of oral cancer? Risk factors include use of tobacco in any form, both smoking and chewing, chronic exposure to sun, and consumption of alcohol. Moderate to heavy drinkers have a three to nine times greater risk than non-drinkers. Tobacco smokers are at five to nine times greater risk than non-users, and users of snuff or chewing tobacco are at four times greater risk than non-users.
3. Where do most oral cancers occur? The most common areas are in the mouth itself, the lips, the tongue, and the pharynx (back of the mouth and throat).
4. What are the statistics for survival after treatment for oral cancer? Conquering cancer depends most on early detection. Since most cases of oral cancer are discovered at a late stage, survival is poor, with less than 60% surviving five years after treatment. When oral cancers are detected early, the survival rate is more than 80%.
5. What are some of the symptoms of oral cancer? Most oral cancers are “squamous” (small scale-shaped) cell carcinomas in the lining of the mouth. Signs of these cancers can be seen as white or red patches in the early pre-cancerous stage. These develop into an ulcer that does not heal.
6. When should you seek medical help? If you notice color changes (white or red patches) or sores or ulcers anywhere in your mouth that do not heal within two or three weeks, go to your dentist for a checkup right away. Sometimes the sores resemble cold sores. A definitive diagnosis requires a tissue biopsy, in which a small piece of tissue is removed under anesthesia and taken to a lab for microscopic examination.
7. What about regular routine examinations? An oral cancer examination should be part of your visit to our office. We will inspect your face, neck, lips and mouth for signs of cancer, feel the floor of the mouth and sides of the neck for any lumps, examine your tongue and the back of your throat. The American Cancer Society recommends a cancer related check-up annually for all individuals aged 40 and older and every three years for those between 20 and 29.

Contact us today (248) 589-2021 to schedule an appointment to discuss your questions about oral cancer. You can also learn more by reading the Dear Doctor magazine article “Oral Cancer.”

If you have ever had tooth decay, you should know:

1. Tooth decay is one of the most common of all diseases, second only to the common cold.
2. Tooth decay affects more than one-fourth of U.S. children ages two to five, half of those ages twelve to fifteen, and more than 90 percent of U.S. adults over age 40.
3. Tooth decay causes pain, suffering and disability for millions of Americans each year — even more disturbing, tooth decay is preventable.
4. If it is not treated, in extreme and rare cases tooth decay can cause death. Infection in an upper back tooth can spread to the sinus behind the eye, from which it can enter the brain and cause death.
5. Tooth decay is an infectious process caused by acid-producing bacteria. Your risk for decay can be assessed in our office with a simple test for specific bacterial activity.
6. Three factors are necessary for tooth decay to occur: susceptible teeth, acid producing bacteria and a diet rich in sugars and refined carbohydrates.
7. Babies are not born with decay-causing bacteria in their mouths; they are transmitted through saliva from mothers, caregivers, or family members.
8. Fluoride incorporated into the tooth structure protects teeth against decay by making the enamel more resistant to acid attack.
9. Sealants — sealing the nooks and crannies in newly erupted teeth, stops bacterial collection where a toothbrush can't reach. Teeth with sealants have been shown to remain 99 percent cavity-free over six years.
10. Restricting sugar intake is important in preventing tooth decay: your total sugar intake should be less than 50 grams a day (about ten teaspoons) including sugars in other foods. A can of soda has up to six teaspoons of sugar — or more!

Contact our office at (248) 589-2021 to schedule an appointment to discuss your questions about tooth decay. You can learn more by reading the Dear Doctor magazine article Tooth Decay.

Nightly snoring can be a sign of a dangerous condition called sleep apnea (from “a” meaning without and “pnea” meaning breath). When someone snores the soft tissues in the back of the throat collapse onto themselves and obstruct the airway, causing the vibration known as snoring.

If the obstruction becomes serious, it is called obstructive sleep apnea, or OSA. In such cases the flow of air may be stopped for brief periods, causing the person to wake for a second or two with a loud gasp as he attempts to catch his breath. This can cause heart and blood pressure problems, related to low oxygen levels in the blood. The obstruction and mini-awakening cycle can occur as many as 50 times an hour. A person with this condition awakens tired and faces the risk of accidents at work or while driving due to fatigue.

Studies show that sleep apnea patients are much more likely to suffer from heart attack, congestive heart failure, high blood pressure, brain damage and strokes.

What can be done to treat OSA?
Snoring, apnea, and OSA occur more frequently in people who are overweight. So start with losing weight and exercising.

At our office, we can design oral appliances to wear while sleeping that will keep your airway open while you sleep. These appliances, which look like sports mouth guards, work by repositioning the lower jaw, tongue, soft palate and uvula (soft tissues in the back of the throat); stabilizing the lower jaw and tongue; and increasing the muscle tone of the tongue.

Another approach is to use a Continuous Positive Airway Pressure (CPAP) bedside machine. These machines send pressurized air through a tube connected to a mask covering the nose and sometimes the mouth. The pressurized air opens the airway so that breathing is not interrupted.

Much less frequently, jaw surgeries may be recommended to remove excess tissues in the throat. These would be done by specially trained oral surgeons or ear, nose and throat specialists.

Diagnosis and treatment of OSA is best accomplished by joint consultation with your physician and our office. Contact our office at (248) 589-2021 to schedule an appointment to discuss snoring and OSA. You can learn more by reading the Dear Doctor magazine article “Sleep Disorders and Dentistry.

When you have your teeth bleached in a dental office, the results almost seem like magic. Let's push aside the magician's cape and see what is really happening in professionally-applied, in-office tooth whitening.

How do teeth become discolored?
A tooth's enamel covering is mostly composed of mineral crystals. At a microscopic level, you can see a framework or matrix of organic (living) matter interspersed between the crystals of enamel creating a very irregular surface capable of retaining stains. Chromagenic (color generating) organic compounds can become part of this organic matrix resulting in tooth staining. They can be bleached without affecting the mineral structure of the tooth's enamel.

As people get older and their teeth wear, the enamel loses its youthful translucency and the underlying layer, called dentin, thickens and becomes more yellow. Such changes to the actual tooth structure are called intrinsic staining. Other causes of intrinsic discoloration are exposure to high levels of fluoride or tetracycline antibiotic administration during childhood, tooth decay, or root canal problems, among others. Discoloration can also be caused by external staining from certain foods, drinks, or tobacco products. Such surface stains are called extrinsic staining.

Behind the Magic
Materials used for tooth bleaching are hydrogen peroxide and carbamide peroxide. Peroxides are commonly used as bleach, and you may have seen them used as hair bleaches, for example. Hydrogen peroxide is a strong oxidizing agent that attacks the organic molecules responsible for tooth discoloration, bleaching them until they lose their color. Carbamide peroxide also contains urea, which is a compound that permits the peroxide to remain in contact with the teeth for longer amounts of time without harming them.

Often called power bleaching, the in-office technique uses a high concentration of peroxide solution (35-45% hydrogen peroxide), placed directly on the teeth in the form of a gel. A heat or light source may enhance the peroxide release. The gel is applied with trays custom fitted to your mouth, and specific barriers are applied to protect sensitive gum tissue from the solution. Results show teeth becoming up to ten shades lighter in about an hour.

In-office bleaching under the supervision of my staff and me is recommended if you have severely stained teeth, and particularly if you are about to have veneers or crowns made. It's a way to rediscover the pearly translucency of your youthful smile.

Contact our office at (248) 589-2021 to schedule an appointment to discuss your questions about tooth bleaching.

One topic we are often asked about is finger or thumb sucking and/or pacifier use — a challenge that most parents or caregivers will likely face with at least one of their children. The first and perhaps most important thing to remember is that it is totally normal for babies and young children to suck their fingers, thumb or a pacifier. It only becomes a problem when it continues as the child ages or if you unnecessarily make it a problem.

For most children, the sucking instinct starts in the womb before birth. This fact is evident, as many expectant mothers are shown their child sucking fingers or a thumb during a mid or late-term sonogram. Once the child is born, the habit may continue because it provides the child with a sense of security. Other research indicates that some babies start sucking habits as a way to make contact with, test and learn about their new world outside the womb. It is interesting to note that most children typically tend to stop finger or thumb sucking habits on their own and without much intervention between the ages of two and four. However, for others it can continue much longer. And that is the scenario that parents and caregivers need to be aware of so that they can monitor sucking habits.

Children who suck their thumbs or a pacifier after the age of two have a higher risk of developing some long term negative effects from the habit. This includes but is not limited to upper jaw development issues and “buck” teeth (upper front teeth that protrude forward out of a natural position towards the lips). For this reason, some researchers feel that children should cease thumb or finger sucking and/or pacifier use by 18 months of age. However, the Academy of Pediatric Dentistry recommends that parents and caregivers encourage children to cease this habit by age three.

If you feel your child is at risk due to his/her age and habits, please call our office at (248) 589-2021 to schedule an appointment for your child. After a thorough exam, we can work with you to create a strategy for helping your child overcome finger, thumb or pacifier habits.