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900 E. Bidwell St. #400
Folsom, CA 95630
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By Drs. Jeff DiMariano & Shaina DiMariano
April 14, 2015
Category: Oral Health
Tags: oral health   oral hygiene  
OvercomingDentalCareObstaclesinChildrenWithChronicDiseases

All children encounter sickness as they grow; thankfully most of these conditions are relatively mild and fade away in short order. But some children endure more serious, longer lasting conditions. The health of children with chronic diseases can be impacted in numerous ways, including the health of their teeth and gums.

Unfortunately, dental care is often pushed to the side as caregivers understandably focus on the primary disease. In addition, many chronic conditions involving behavior, such as autism, attention deficit and hyperactivity disorder (ADHD) or intellectual disabilities, may inhibit the child’s ability to cooperate with or even perform daily oral hygiene. Many special needs children have an acute gag reflex that makes toleration of toothpaste, spitting matter from the mouth, or keeping their mouths open more difficult. However difficult it may be, though, it’s still important to establish daily hygiene habits to reduce the risk of tooth decay and gum disease.

There are techniques for building a daily routine for children with physical and behavioral limitations. For example, using “modeling and shaping” behavior, you (or perhaps a sibling) brush your teeth with your child to demonstrate how it should be done. If there’s a problem with cooperation, you can also position the child “knee to knee” with you as you brush their teeth. In this way you’ll be able to meet their eyes at a level position and lessen the chance of a confrontation.

We encourage all children to have their first dental visit before their first birthday. This is especially true for children with chronic conditions. The Age One visit helps establish a benchmark for long-term care; it then becomes more likely with regular visits to discover and promptly treat dental disease. This is especially important for special needs children who may have congenital and developmental dental problems, like enamel hypoplasia, a condition where the teeth have not developed sufficient amounts of enamel.

Teeth are just as much at risk, if not more so, in children with chronic diseases. Establishing daily hygiene and regular checkups can reduce that risk and alleviate concern for their long-term oral health.

If you would like more information on oral healthcare for children with chronic diseases, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Managing Tooth Decay in Children With Chronic Diseases.”

By Drs. Jeff DiMariano & Shaina DiMariano
April 06, 2015
Category: Oral Health
EatingDisordersMayContributetoDamagedTeethandGums

While most dental problems are caused by disease or trauma, sometimes the root problem is psychological. Such is the case with bulimia nervosa, an eating disorder that could contribute to dental erosion.

Dental erosion is the loss of mineral structure from tooth enamel caused by elevated levels of acid in the mouth, which can increase the risk for decay and eventual tooth loss. While elevated acid levels are usually related to inadequate oral hygiene or over-consumption of acidic foods and beverages, the practice of self-induced vomiting after food binging by bulimic patients may also cause it. Some of the strong stomach acid brought up by vomiting may remain in the mouth afterward, which can be particularly damaging to tooth enamel.

It’s often possible to detect bulimia-related erosion during dental exams. The bottom teeth are often shielded by the tongue during vomiting, so erosion may be more pronounced on the unshielded upper front teeth. The salivary glands may become enlarged, giving a puffy appearance to the sides of the face below the ears. The back of the mouth can also appear red and swollen from the use of fingers or objects to induce vomiting.

Self-induced vomiting may not be the only cause for dental erosion for bulimics. Because the disorder causes an unhealthy focus on body image, bulimics may become obsessed with oral hygiene and go overboard with brushing and flossing. Aggressive brushing (especially just after throwing up when the tooth enamel may be softened) can also damage enamel and gum tissue.

Treatment must involve both a short — and long-term approach. Besides immediate treatment for dental erosion, a bulimic patient can minimize the effect of acid after vomiting by not brushing immediately but rinsing instead with water, mixed possibly with a little baking soda to help neutralize the acid. In the long-term, though, the eating disorder itself must be addressed. Your family doctor is an excellent starting point; you can also gain a great deal of information, both about eating disorders and treatment referrals, from the National Eating Disorders Association at their website, www.nationaleatingdisorders.org.

The effects of bulimia are devastating to mental and physical well-being, and no less to dental health. The sooner the disorder can be treated the better the person’s chance of restoring health to their mind, body — and mouth.

If you would like more information on the effect of eating disorders on oral health, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Bulimia, Anorexia & Oral Health.”

By Drs. Jeff DiMariano & Shaina DiMariano
April 03, 2015
Category: Dental Procedures
Tags: dentures  
NewPartialDenturesMoreComfortableandDurableThanOlderModels

While dental implants are the preferable choice for teeth replacement, your life circumstances may cause you to postpone it or some other permanent restoration. In the meantime, you need a temporary solution for your tooth loss.

Removable partial dentures (RPDs) have met this need for many years. RPDs are traditionally made of rigid, acrylic plastic resin and fasten to existing teeth with metal clasps. While effective as temporary tooth replacements, RPDs do have their drawbacks: they can be uncomfortable, develop a loose fit and are prone to wear and staining.

Recently, though, new RPDs made of a flexible type of nylon are addressing some of these drawbacks. Because the nylon material is thermoplastic (able to change shape under high heat), it can be injected into a cast mold of a patient’s mouth to create the denture base, to which life-like replacement teeth are then attached. And rather than a metal clasp, these RPDs have thin, finger-like nylon extensions that fit snugly around existing teeth at the gum line.

The new RPDs are lightweight, resistant to fracture and offer a more comfortable, snugger fit than the older RPD. And because the nylon material can be made to closely resemble gum tissue, the base can be designed to cover receding gum tissue, which may further improve the appearance of a patient’s smile.

On the downside, these new RPDs are difficult to reline or repair if they’re damaged or the fit becomes loose. And like all RPDs, they must be regularly removed and cleaned thoroughly to prevent any accumulating bacterial biofilm that could increase the risk of gum disease or tooth decay (the attachment extensions are especially susceptible to this accumulation). They should also be removed at night, since the reduction in saliva flow while you sleep can worsen bacterial buildup.

Still, the new flexible RPD is a good choice to bridge the time gap between lost teeth and a permanent restoration. They can restore lost function and improve your smile during the transition to implants or a fixed bridge.

If you would like more information on temporary tooth replacement, please contact us or schedule an appointment for a consultation.

By Drs. Jeff DiMariano & Shaina DiMariano
March 26, 2015
Category: Oral Health
TheScareThatMadeIronChefCatCoraBelieveinMouthguards

Cat Cora, philanthropist, author, chef, restaurateur and the first female chef on the Food Network's hit series Iron Chef America is a dynamo driven by a desire to change people's lives for the better. And she is no different when it comes to tackling her most challenging role: caring for the needs of her four active young sons. This includes monitoring the food they eat, their oral hygiene habits and protecting their teeth from injuries.

During an interview with Dear Doctor magazine, Cat describes a backyard accident in which one of her boys, Zoran, was accidentally knocked in the mouth by another child while jumping on the family's trampoline. While her son was not seriously injured, it did cause her to take proactive steps to avoid future injuries. She had her dentist make a custom-fitted mouthguard to protect his newly erupted adult teeth. He now wears the mouthguard while on the trampoline and when playing soccer.

If you and/or your children routinely participate in contact sports — boxing, football, hockey, lacrosse, soccer, water polo, rugby and basketball, for example — or other forms of vigorous physical activity, you too should consider getting a professionally made mouthguard. A properly fitted mouthguard can help prevent injuries to the jaws, lips and teeth. And unlike those cumbersome “boil and bite” mouthguards you can purchase at a drugstore, the ones we make will stay in place, making it easier for you to breathe and talk.

If you are still not convinced, consider these facts: According to the American Dental Association, an athlete is 60 times more likely to suffer harm to the teeth when not wearing a mouthguard. And the US Centers for Disease Control reports that sports-related dental injuries account for more than 600,000 visits to the emergency room each year. Furthermore, people who do not have a knocked out tooth properly reserved or replanted may face a lifetime cost of $10,000 to $20,000 per tooth, according to the National Youth Sports Foundation for Safety.

To learn more about mouthguards, continue reading the Dear Doctor magazine article “Mouthguards.” Or if you are interested in obtaining a mouthguard for yourself and/or your child, contact us today to schedule an appointment. And to read the entire interview with Cat Cora, please see the article “Cat Cora.”

By Drs. Jeff DiMariano & Shaina DiMariano
March 18, 2015
Category: Oral Health
Tags: oral hygiene  
DailyHygieneTasksPerformedProperlyHelpEnsureGoodOralHealth

Daily personal care is essential for optimal oral health. Brushing and flossing in particular keep bacteria and acid, the main causes of dental disease, at manageable levels. But to gain the most benefit from your personal care, you need to perform these tasks effectively with the proper techniques and equipment.

For most people brushing begins with a soft-bristled, multi-tufted toothbrush with fluoride toothpaste that helps strengthen enamel. You should hold the brush at a slight angle and brush with a gentle motion to remove plaque, the main cause of gum disease and tooth decay — if you’re too aggressive by brushing too hard or too long, you could damage the gums. You should brush no more than twice a day for two minutes, and at least thirty minutes to an hour after eating to allow saliva time to neutralize any remaining acid and help restore minerals to enamel.

Although some people find flossing difficult to perform, it remains an important component of daily care. Flossing once a day removes plaque from between teeth where a brush can’t reach. If you need help with your technique using string floss, we’ll be glad to provide instruction at your next visit. If you have bridges, braces or other dental restorations or appliances that make string flossing difficult, you might consider other options like floss threaders or a water flosser.

There are also dietary and lifestyle choices you can make to enhance your daily care: limit sugary or acidic foods to mealtime and avoid between meal snacks to reduce bacteria and acid in the mouth; drink water to keep your mouth moist, which will inhibit plaque buildup; and stop tobacco use, excessive alcohol consumption and chewing habits like clenching or biting on hard objects. Above all, be sure to visit us at least twice a year for cleanings and checkups, or when you notice abnormalities like bleeding gums, pain or sores.

Keeping your teeth and gums healthy can be done, but it requires a daily care commitment. Performing these hygiene habits in an effective manner will help preserve your teeth for a lifetime.

If you would like more information on effective oral care, please contact us or schedule an appointment for a consultation.





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