Wednesday, March 23, 2011

Top 5 Reason for Tooth Decay and How to Stop It

It literally seems as though not a day passes that I don't hear, "Dr. Lepard, why do I have tooth decay and how do I stop it?" Tooth decay or cavities is on the rise in our culture for a number of reasons. Treatment may vary greatly according to the situation. The good news is that all of the causes of tooth decay have answers. An experienced, well educated dentists and hygienists have those answers.

Tooth decay is a disease. Disease is defined as a pathological condition due to an infection, genetic defect or environmental stress. The vehicle for this tooth disease is plaque. Plaque is the sometimes clear, sticky goo that latches onto your tooth every day. Plaque literally bathes your tooth in decay - producing acid every second it is left on the vulnerable tooth surface. It is fed especially by the breakdown of sugary food and drink sources. Some plaque sources are readily identified i.e. a chocolate bar - but there are hidden ones as well - Read on!

1. First on the list are poor oral hygiene practices. Today manual toothbrushes and floss are not the only way to remove the plaque. In fact, automated brushes are one of the most effective ways to break up the party the plaque is having on your teeth. Floss can be assisted by various oralirrigators. Styles and kinds of these devices are suggested in my office according to each individual's own unique situation. Coaching by the hygienist on follow-up visits yield the most effective way to improve your oral hygiene. And remember-plaque produces mouth odors not unlike rotten eggs!

2. Poorly formed enamel and deep tooth crevices are number 2 in causing bacteria from within. This plaque seeks to find the most accessible areas to grow and destroy enamel. Frequently I use a tiny camera, called an Intra-oral camera to show a patient where the problem is occurring or where they are most vulnerable. Educating my patients goes a long way in giving them the complete picture on what is going on. Something as simple as dental sealants can be used to prevent decay in the grooves and crevices that have NOT been infected. Fluoride is another defense mechanism in the interruption of plaque formation.

3. Poor diet and a diet high in sugar are next in the reasons for tooth decay. Some of the same practices that expand the waistlines also destroy tooth enamel. Food and drink high in carbohydrates break down quickly in the "sticky goo". Patients frequently tell me that things like candy make their teeth sensitive --- they are experiencing the acid formation in the soup of the plaque. Beware---there are hidden sugar and acids out there. Fruit juices can have as much sugar or a non-diet soft drink. And speaking of diet soft drinks - read the label - it has acid in the mix. This is not good for your teeth. Our dental hygienist can help you evaluate your diet to help you steer clear of the poor choices and make better ones.

4. Dry mouth conditions, called xerostomia, many times are produced by prescription medications. It is not uncommon for patients, especially in their 6th decade and older to be taking multiple prescriptions that inhibit or stop saliva flow. Saliva has naturally occurring components that inhibit plaque growth and adherence. Interrupting this process causes decay to appear even on front teeth and can destroy previous dental work. It is always a part of the dental exam to find these connections and halt decay. Many times the eventual outcome for the senior citizen is tooth infection and loss. Diabetes is another cause of dry mouth (xerostomia) and is on the rise with an estimated 45 to 50 million new cases by the year 2025. Many are pre-diabetic for a number of years before the frank disease of diabetes is diagnosed. Our hygienist and myself are trained to be aware of these conditions that threaten our patient's health.

5. Tooth grinding and bruxism are all too common. Environmental stresses influence tooth grinding. Tooth grinding strips away the hard outer enamel layer leaving the softer dentin exposed. Dentin, which is 600 times softer than the tooth enamel is much easier for the plaque to break down. Teeth stripped become easy victims of tooth decay/cavities. Approximately 70% of patients who GRIND their tooth have no idea that they do! Outward signs to the patient can be small chips on the edges of the top and bottom front teeth or a "flattening" of the tooth ---- they begin to look even from one corner to the other. A simple guard, called a bite guard or night guard can stop the destruction.

Today the GOOD news is that NO one should have their dental health destroyed by tooth decay. Identifying the causes and prescribing the correct therapies can give the patient a smile they can be proud of for a lifetime. White tooth colored fillings, crowns and veneers that brighten the smile or even dental implants to replace missing teeth can resolve pre-existing problems. Dental health and a great smile are available for a lifetime with correct frequency and consistency of health practices. As in sports, you need a coach; your dentist and hygienist can assist you in preserving your smile.

Original Article

Saturday, October 9, 2010

The Truth About Dental Insurance

Congratulations if you are one of the 60% of the population with the benefits of dental insurance! It is exciting when you get that dental insurance benefit-you just know that now you can get that smile you have always wanted. Dental insurance may have never been one reason you chose one job over another. It is a job perk that some receive as a addendum to their medical insurance or a separate negotiated benefit. That being said, it is not a piece of information that most people can interpret easily. Dental insurance can be like that legal-ez you and I skip over when we sign our life away for a mortgage or automobile. If any of these thoughts sounds familiar to you then read on. I am here to help you through this jungle!

Some truisms about dental insurance you need to know:
  1. Dental insurance is capped at a yearly maximum. For about all policies this is $1,000-$2,000 per year. It has been this way since the 1960's.
  2. Dental Benefits paid for procedures vary greatly from company to company and even policy types within companies. It becomes a function of what your individual employer is willing to pay for. This is why it is very difficult for you and your neighbors to compare coverage "over the fence."
  3. It's best and most effective use for most consumer is as a maintenance tool. It would be like you getting your oil changes paid for or most paid for, but major maintenance on your car is an out of pocket expense.
  4. Some dental insurance policies give you the choice to see who you would like. Others give you a list to follow. By and large if you are restricted to a list the relationship with your dentist will be minimal at best.
  5. Your dental insurance company will likely try to influence your decision about dental care you receive. Many times clerks who are giving you information have less dental knowledge than you. Yet they will give you opinions that should come from your dentist. Find a dentist who treats you like they would a family member and listen to them. You will win in the end.
  6. Never base your dental appointment frequency on whether you have insurance. Keeping consistent hygiene maintenance appointments will save dollars and your smile in the long run.

All of this being said, the success of a dental relationship can have dental insurance as an aid. I espouse helping anyone get all of the benefits they are due-that's how I would like to be treated as well. However be aware of the fact that dental insurance can get between you and your dentist. The relationship that Dr. Richard Lepard strives to create is medicated on trust and integrity between us and the patient. I believe that will give me the ability to help my patients achieve their dental goals. Health, function, and appearance are the primary reasons my patients seek my advice.

Tuesday, May 11, 2010

Local Anesthesia Technique by Dr. Richard Lepard

One of the most frustrating aspects of dentistry for even the most experienced of practioners is difficulty attaining local anesthesia with the mandibular teeth. It is commonly known that, according to the study you read, only 80 - 85% of mandibular blocks are successful.

When they are not it:

  1. creates anxiety in the patient
  2. frustrates the dentist
  3. puts undue pressure on the daily schedule of the patient and the dentist due to "having to wait on it".
  4. requires the dentist to try to achieve the required level of comfort by the addition of much more medication which is not helpful to the patient. I have actually had patients come to me with stories of the dentist dismissing the patient to reappoint to another day due to the patient not getting "numb".
  5. gives additional risks of increased heart rate due to inadvertent arterial infection or paresthesia from mandibular nerve trauma.
  6. increases the risk of a hematoma.

Advantages of the "spot on technique" are:

  1. instant anesthesia, therefore you can begin treatment immediately.
  2. less medication is administered to the patient.
  3. it is more comfortable than the mandibular block. Many times a patient will ask "Did you give me a shot?"
  4. a more profound anesthesia. Many times patients will exclaim that this is the first time they have been truly numb on that side. I commonly hear that a previous dentist had told them that "it is just them, and that they are hard to numb."
  5. fewer traumas than intraosseus techniques. I have seen tissue sloughing with this route.


  1. an intraligamentary syringe. My choice is the style that is index finger activated vs. the pistol grip. It tends to be easier to control and seems to be easier to get the "clicks" indicating doses administered.
  2. A 30 gauge extra short needle
  3. 4% Articaine with 1:100,000 epinephrine
  4. 4% Prilocaine HCl plain
  5. A standard syringe with a 30 gauge short needle
  6. Possibly most important is a compounded triple topical anesthetic mix of benzocaine, lidocaine and tetracaine.
  7. A carpule warmer

The Technique is as follows: Give five minutes to allow the topical to do its job. Apply to the vestibule as well as the entire buccal gingival margin of the tooth. With the Standard syringe, slowly inject 4% prilocaine plain in the vestibule. This should be practically imperceptible to the patient. Next slide the 30 gauge needle under the free gingival margin. The idea is literally to drip the anesthetic into the area with a slight pressure. Increase this action to moderate pressure going from line angle to line angle of the buccal of the tooth. Be sure to keep aspiration active the entire time as leakage will occur and to avoid the bitter taste. Copious water rinses help here as well. Next using the intraligamentary syringe with 4% Articaine with 1:100,000 epinephrine slowly engage the bifurcation on the buccal. The feeling you should have is moderate pressure or squeezing that is required to force the solution into the space of the periodontal ligament. You should get a click as each dose is administered. Normally 4 to 5 clicks per site are sufficient. It is very important to get the feel as the technique requires you to get into this specific area. Anatomical differences in the height of the furcation relative to the free gingival margin can require you to adjust the angle to approximately 45 degrees. Picture the needle as sliding into the area. I prefer to repeat the process at the line angles in a similar fashion. Again, if done properly, with lighter pressure to start increasing pressure in the last couple of clicks the patient should have little difficulty noticing any of the traditional feelings of a "shot". On rare occasion, the tooth may require the same process on the lingual repeating the steps outlined above.

It is a wonderful feeling to be able to achieve patient comfort without their lips and tongue feeling swollen for 3 to 4 hours. We all dislike hearing our patients say "I just hate that numb feeling". The majority of the time our patients are referring to the after effects of the traditional mandibular block - and it may have been only 90% effective! It is a difficult process to get a referral from one of our patients who had to endure pain of any kind during dental treatment.

In summary the Dr. Richard Lepard Spot-On Local Anesthesia Technique gives you profound anesthesia with less medication, freedom from anatomical areas of complication, i.e. hematomas or parathesis in the mandibular nerve complex. It further removes the variance of the angle of the mandibular as influence of "missing the block." It is a way to WOW your patients and de-stress your day with another successful local anesthesia experience.

Friday, May 7, 2010

What Patients Really Want From Their Dentist

I trust you will truly find our Rockwall Office unique. It is designed to be frank and based on my experience of thirty-plus years in dentistry, thousands of hours of continuing education through conventions, seminars, webinars, CD's and study clubs. I am always learning and most importantly, listening to my patients.