Sometimes, too much of a good thing can be bad, even when it comes to fluoride. In this issue of Word of Mouth, we talk about the levels of fluoride in drinking water and how too much fluoride can cause a condition called fluorosis. We'll tell you how to maintain a healthy fluoride regimen.

We also reveal the sometimes ugly truth about your toothbrush. This article provides a number of tips on how to keep your toothbrush clean and in working order to keep your mouth healthy.

We're excited to keep you up-to-date more often with our e-newsletter.  If you know anyone who has yet to register for their edition of Word of Mouth, send them to our website, www.HagenDDS.com so they can receive their dose of what's new at our practice!

Once again, thanks for reading!

Dr. Hagen

In the latter part of the 20^th century, the U.S. took a huge step toward overall oral health when most communities began adding fluoride to their drinking water. In fact, The Centers for Disease Control and Prevention named community water fluoridation one of the greatest public health achievements of the 20th century.  Today, about 60 percent of the U.S. population drinks fluoridated water.

However, in recent years, instances of fluorosis have been on the rise. Fluorosis is the result of overexposure to fluoride and can lead to tooth streaking, discoloration, pitting and the eventual breakdown of tooth enamel. At very extreme levels, fluoride has been linked to skeletal bone damage and possible hormone disruption.

The final recommendation from the EPA and HHS will likely be issued sometime this spring, but the decision will ultimately fall to individual state and local municipalities as to whether they want to lower levels in their water supplies.

Many dental experts say this recommendation makes sense, because unlike years ago, most people now also get fluoride from other sources, like toothpaste and mouthwashes. Dentists prescribe fluoride supplements and apply other fluoride treatments during office visits. It's also found in infant formulas prepared with fluoridated water as well as some other beverages.

Continue to turn on the tap

This does not mean you should panic and stop drinking your tap water.  Fluorosis is rare and in most cases, subtle. At appropriate levels, fluoride is one of the most effective cavity fighters out there. The past few generations have much less tooth decay because of fluoride in drinking water. Also, while incidents of fluorosis have been on the rise, they have generally been very mild or moderate cases. Ultimately, this recommendation was issued because many people are now getting more fluoride from other sources in addition to their drinking water, not because the level of fluoride in drinking water is generally unsafe.

However, if you are concerned and would like to reduce your exposure, you can call your local water municipality, as the levels vary from city to city. If it's above 0.7 milligrams per liter, the new proposed recommendation, you could consider filtering your water. For infants on formula, consider using fluoride-free water to reconstitute their formula. And save your money! Experts suggest that bottled water is not the answer, because it often also contains fluoride.

What does fluorosis look like?

Fluorosis can be difficult to spot. Most cases are mild and will probably only be noticed by a dentist. Fluorosis can make teeth become more opaque, streaked and/or spotty. In severe cases, teeth can become stained and pitted.

Fast Fluoride Facts and Guidelines:

• Fluoridation was introduced into U.S. drinking water supplies in 1945. By 2008, 64% of the U.S. population had access to water fluoridation.
• Canada, the U.K., Australia, New Zealand and a few other countries now add fluoride to their drinking water.
• Adding fluoride to drinking water is a way to reduce the inequalities in dental disease among all Americans.
• Use small amounts of fluoride often. Frequent use of small amounts of fluoride is still the best way to reduce risk of tooth decay for all age groups.
• When using a fluoride mouthwash, use about two teaspoonfuls once a day (unless otherwise directed by Dr. Hagen), and do not swallow.
• Children younger than 6 should be monitored when using fluoride
  • They should only a use pea-sized amount of fluoride toothpaste.
  • Frequently, fluorosis occurs in young children who are just learning to brush because they swallow too much toothpaste, or in many cases, mouthwash. So be sure to supervise small kids when they brush and/or rule out the fluoride mouthwash until they get a bit older. There are also toothpastes available that do not contain fluoride.

Resources:

http://www.npr.org/2011/01/07/132743634/Officials-Say-Kids-Getting-Too-Much-Fluoride

http://www.webmd.com/oral-health/news/20110107/us-wants-to-reduce-fluoride-in-drinking-water

http://www.webmd.com/oral-health/guide/fluoride-treatment

http://www.scientificamerican.com/article.cfm?id=second-thoughts-on-fluoride

The American Dental Association recommends that you replace your toothbrush every three to four months, not a couple of times a year, as many people do.  Reasons to replace your toothbrush are simply normal wear and tear, bristle damage, and of course, health and hygiene.

Can your toothbrush make you sick?

Probably not, but it is important to remember, "The bottom line is, there [are] hundreds of microorganisms in our mouths every day," says Gayle McCombs, RDH, MS, associate professor and director of the Dental Hygiene Research Center at Old Dominion University. "That's no big deal. Problems only start when there is an unhealthy balance of bacteria in the mouth."

"It's important to remember that plaque-the stuff you're removing from your teeth-is bacteria," says dentist Kimberly Harms, DDS, consumer advisor for the American Dental Association. "So you're putting bacteria on your toothbrush every time you brush your teeth."*

So naturally, changing your toothbrush regularly helps reduce the redundant and increased amount of bacteria that can build up on your toothbrush, and can help remove a potential health issue.

Other tips for tip-top brush maintenance include:

• Store your toothbrush upright so it will dry better
• Keep it rinsed, and rinse it thoroughly after every use
• Keep it dry; bacteria thrive in a moist environment
• Keep it to yourself (no matter how close you are to who you share your home with); this is one time when it's OK to be selfish!
• Lastly, don't brush where you flush! Most bathrooms are small, but keep your toothbrush away from the toilet, and close the lid when you flush to avoid unseen splashes that can and do land anywhere in your bathroom.

Following these simple tips will help you take care of the tool that helps to take care of your teeth. But remember, it's OK to not get too attached to it.

* Web MD- Facts About your Toothbrush

In this issue, we shared a lot information about how to maintain your toothbrush. So, for this issue's contest question, we thought we would ask you...

How often should a toothbrush be replaced with normal use?

• A-Once a year
• B- Every leap year
• C- Every 3-4 months
• D-Every 6 months

The winner of this issue's contest will receive a Sonicare electric toothbrush.

Please submit your answer by June 6, 2011. Visit www.hagendds.com and submit your answer via our website. Just click on "News," and you'll see the "Our Patients are the Best" section and an easy-to-submit form. You can also drop off  your entry in person during your next office visit or mail your answer to Hagen Dental Practice, 4998 Glenway Avenue, Cincinnati, OH 45238. If you win, we will notify you by phone or e-mail.

In this issue of Word of Mouth, we take a close look at dental bonding and veneers. If you have a broken or chipped tooth, or another aesthetic issue that has been bothering you, bonding or veneers could be the dental solution you’re looking for. We talk about the difference between the two, what types of dental issues are right for bonding and veneers, the procedure and finally how to maintain bonding and veneers once they are in place so you will have a lasting, healthy, good-looking smile.

We will also discuss digital radiography and its many benefits. At Hagen Dental Practice, we feel that going digital goes a long way in improving the patient experience. It helps us be more efficient, accurate, and finally and most importantly, spend more time with you!

In our patient profile, you will get to know Gil Born, who is a retired University of Cincinnati DAAP professor, as well as a talented painter. Gil has been a loyal patient at Hagen Dental Practice for about 20 years. Know of a Hagen Dental Practice patient with an interesting story to tell? Let us know, and we might feature them in a future edition! Email us at info@hagendds.com.

Finally, I want to announce that this will be our last printed edition of Word of Mouth. Starting with our next edition, you can enjoy Word of Mouth as an e-newsletter! You will be able to easily access our articles and stay up-to-date with all the new developments at Hagen Dental Practice. Also, going paperless helps us do our part for the environment. So, be sure to register your email at www. HagenDDS.com to receive future editions of Word of Mouth and other important updates! And please call us at 513-251-5500 with any questions or to let us know if you do not have an e-mail account.

Thank you for taking time to read this edition of Word of Mouth. Don’t forget to “fall” into an appointment with Hagen Dental Practice

These types of dental issues can range from serious problems, such as gum recession and tooth decay, to the purely cosmetic, like stained teeth. In any case, these problems can leave your teeth looking unsightly, affecting the brightness of your smile and your self esteem. Bonding or veneers might be the dental solution you are looking for. With these procedures, you can gain a bright, white, healthy looking smile in just a few visits. Now, that should give you something to smile about!

Bonding

Bonding is typically the procedure dentists use if you have teeth that are cracked, chipped, stained, discolored or decayed. Dentists also use bonding to close gaps between teeth, make teeth look longer and finally to protect a tooth’s root that has been exposed due to gum recession. Dental bonding is relatively inexpensive and can typically be completed in one office visit, unless several teeth are involved. Each tooth usually takes 30 to 60 minutes.

To begin the process, the dentist will carefully match the resin color to your tooth. Then, the tooth will be roughened and a conditioning liquid applied to help the resin properly adhere to the tooth. The resin will then be applied and smoothed to the correct shape. The dentist will then use a special light to harden the resin material. Finally, after the resin material has hardened, the dentist will further shape and polish the tooth so it matches the shape and shine of the rest of the tooth surface. After the procedure, teeth do not require special care; you just need to continue to brush and floss regularly.

Bonding is generally considered to be best for small cosmetic changes and to improve minor aesthetic issues with your overall smile. Also, while dental bonding can be great for small issues, it isn’t as strong and doesn’t last as long as veneers or crowns. Bonding materials are not as stain resistant as crowns and can be subject to eventual cracks and chips. So, it is important to continue to maintain your oral health and schedule regular visits with Dr. Hagen. However, if you have a small dental issue like a chip or a stain, this procedure could do wonders for your smile.

Veneers

Dental Veneers are custom-made, ultra-thin shells of tooth colored material designed to attach to the front surface of the tooth. Veneers can change the size, length, color or shape of a tooth. They are typically used to correct the appearance of teeth that are worn down, chipped or broken, discolored, irregularly shaped, or with gaps in between them. They are a good choice for individuals who want to change the appearance of their teeth, more so than what bonding can provide, but not as drastically as a crown.

Veneers usually require three trips to the dentist—one for the initial consultation and two to make and attach the veneers. During the planning stage, dentists will determine if veneers are an appropriate choice. Initially, the dentist will take some X-rays and make impressions of your teeth.

Unlike the bonding process, veneers have to be made in a laboratory based on the molds from your first visit. The dentist will numb the area, remove about half of a millimeter from the enamel of the tooth, make an impression and send it off to the lab. When the veneers arrive from the lab, the dentist will make sure that the fit and color match the tooth and then make any other necessary alterations to the veneer by removing and trimming it. Next, the tooth will be cleaned and polished. Then, the tooth will be prepared to allow for a strong bonding process. A special adhesive is placed on the tooth, and then the veneer is attached. After the veneer is in place, a light is used to activate the adhesive, causing it to harden quickly. Veneers are popular because they give a natural tooth appearance. Furthermore, porcelain veneers are stain resistant, don’t require as much shaping, and gums tend to tolerate them well. Keep in mind that the process is not reversible, and veneer color cannot be altered once they are in place. So, if you whiten your teeth, do it before you get veneers. Even with veneers, your teeth are still prone to decay.

While bonding and veneers can solve some dental neglect or serve as cosmetic upgrades to the overall appearance of your smile, remember that practicing good dental habits, like brushing and flossing daily, scheduling regular check-ups and cleanings with Dr. Hagen, and eating healthy foods that promote healthy teeth, are even more important to maintaining proper dental health.

Resources:

• http://www.ada.org/sections/scienceAndResearch/pdfs/patient_38.pdf
• http://www.webmd.com/oral-health/guide/dental-bonding
• http://www.webmd.com/oral-health/repairing-a-chipped-or-broken-tooth
• http://www.webmd.com/oral-health/veneers
• http://www.webmd.com/oral-health/slideshow-cosmetic-dentistry

In this issue, we shared a lot of information about dental bonding and veneers. So, for this issue’s contest question, we thought we would ask you...

How long does a bonding procedure usually take?

• A - 15 minutes per tooth
• B - 30 to 60 per tooth
• C - As long as Dr. Hagen wants it to
• D - Three Office Visits

The winner of this issue’s contest will receive a $50 gift certificate to Applebee’s to help break the stress of the work week.

Please submit your answer by November 22, 2010. Submit your answer via the comments section below. You can also drop off your entry in person during your next office visit or mail your answer to Hagen Dental Practice, 4998 Glenway Avenue, Cincinnati, OH 45238. If you win, we will notify you by phone or e-mail.

These dedicated servicemen and women have continued to answer the call and selflessly serve their country, and we want to show our appreciation for their sacrifices. We have seen firsthand the generosity of all of our patients and neighbors, and know we can continue to exceed our level of giving as a practice.

Before embarking on his career as a professor, Gil served in the United States Air Force for four years through the ROTC at Homestead Air Force Base in Florida. He says that wouldn’t be very noteworthy, except for the fact that he was there during a particularly tense moment in American history—the Cuban Missile Crisis.

“We were on high alert during that time, but it wasn’t very stressful.” He joked, “I like to tell people I fought the Cold War, and we’re safe because of it.”

After his military service, Gil became a professor in UC’s DAAP program. For more than 40 years, he was a professor and advisor in the Industrial Design program. He served as department chairman for 12 years, and taught Visual Communication courses and Experimental Design studios. As an educator, he benefited from UC’s world renowned co-op system in which students alternate between school quarters and full-time work assignments in their professional fields throughout the U.S., and occasionally in foreign countries. He says it was “a very gratifying teaching lifestyle. After gaining a few quarters of work experience, the students felt more like colleagues. In studios, it would feel like, ‘OK we’re a team. I’ll guide and work with you.’” One of nine kids, Gil has painted all his life, and credits a lot of that interest to his mother, who was very talented and artistic. He said he gravitated towards industrial design because of his interest in painting and art. “Visual communication stems from art; I was interested because industrial design is artistic skill assigned to practical problems. Industrial design is applied art.”

Gil originally worked in watercolors, and 25 years ago began painting in oils. Now, even in his “retirement,” he continues to work as an educator. He is an instructor at the Art Academy of Cincinnati, where he teaches courses in oil painting, and often shows his work in faculty art shows. He says some of his favorite subjects to paint include landscapes, seascapes, human figures, portraits and still lifes. “Like many realistic painters, I admire the work of John Singer Sargent, who provided great examples in all of these categories,” said Gil.

As for dental work, he says he has had his share over the years. According to Gil, “my mouth is like a museum of modern dental history. I’ve had crowns, fillings, root canals and implants.” Gil has been a patient at Hagen Dental Practice for about 20 years. “The Hagen staff is so talented and very professional.” He says it’s the constant level of professionalism at Hagen that has impressed him most and kept him coming back over the years.

Gil lives in Clifton with his wife, Carol.

X-rays are an essential part of modern dentistry, and are used to detect problems that are not evident with a visual examination. They are commonly used to detect tooth decay, damage to the bones supporting the teeth, dental injuries and other problems where symptoms are not yet present. Digital radiography has streamlined the X-ray process, making it much more efficient and ultimately safer for patients.

Most dentists across the country agree that digital radiography has greatly improved their practices. Digital radiography saves time and money and improves diagnoses, bringing more flexibility to offices around the country. With digital X-rays, doctors and hygienists are able to immediately capture an image, examine the image, or delete and correct the image if the first one didn’t come out exactly as needed. In essence, digital radiography is identical to the transition from film to digital cameras. This technology maintains the quality of the X-ray, but allows you to easily enhance the image. Dentists and hygienists can enlarge images, make them lighter or darker, make color enhancements or superimpose certain colors.

Digital radiography is perhaps most beneficial to patients. Digital X-rays are safer and more convenient. They dramatically reduce the high intensity radiation exposure of conventional film X-rays. They generally emit 70% to 80% less radiation than conventional film X-rays. Other studies have even reported emissions to be as much as 90% fewer. Also, your X-ray images can be easily sent to another doctor and saved to your medical record in a matter of seconds, saving time, reducing errors, and improving your diagnosis.

Most importantly, digital X-rays can improve the doctor-patient relationship. They take much less time to produce, making for a shorter appointment while allowing dentists and hygienists to spend more time with their patients explaining the states of their dental issues and the appropriate courses of treatment. And enlarging the picture not only helps the dentist see the patient’s problem; it allows them to easily point it out to patients, as some dental problems on conventional X-rays are not easily discerned by the untrained eye.

So, the next time you find yourself in the office with a dental problem, you can thank digital radiography for a speedy diagnosis and more quality time with Dr. Hagen.

Resources:

• http://jorthod.maneyjournals.org/cgi/content/full/29/1/66
• http://jada.ada.org/cgi/content/full/135/10/1437
• http://www.dexis.com/index.php?option=com_content&task=view&id=49& Itemid=65
• http://www.dentequip.com/Digital/X-Ray/WhyGoDigital/