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March 19, 2020 By enhancedentald Leave a Comment

Temporarily Converting to Emergency Dentist Clinic During COVID-19

Enhance Dental cares for our patients and our community.

Therefore, we will be following and exceeding both the American Dental Association and CDC guidelines.

As of Thursday, March 19, 2020 we will be open as an Emergency Dentist Clinic through April 3, 2020.

Check out the Emergency page for more info. Our emergency line will be available to speak directly with Dr. Alvarez at 210-960-3642. You can also book your dental emergency appointment online.

The coronavirus guidelines and recommendations are rapidly evolving. Please check our Facebook, Twitter, and Google posts for up-to-date information.

Thank you, & stay safe.

Dr. Cedric Alvarez

May 8, 2019 By enhancedentald Leave a Comment

Vaping: Is this truly “safe smoking”?

Image courtesy of iStock

We’re seeing it everywhere these days: adults, as well as teens, have taken up the new fad of “vaping” or “Juuling.” The Centers for Disease Control found that from 2017 to 2018, e-cigarette use increased 78% among high school students and 48% among middle school students. But what is vaping, exactly? It is the process of inhaling a liquid (or “e-juice”) that has been heated to become an aerosol using a cigarette-like delivery system. These liquids can contain differing ingredients, including nicotine, cannabis products (including THC, cannabinol, etc.), and various flavorings. Some manufacturers of these products have even used the marketing angle of calling vaping the alternative for “safe smoking.” What do we know about the overall effects of vaping on our health?

Studies about the effects of vaping are still ongoing. The truth is, we still don’t know a lot of the long-term effects. What we do know is that there are some side effects, and those seem to be directly linked to certain e-juice ingredients. Of course, since we are a dental office, we want to first focus on the negative effects on the teeth, gums, and oral cavity.

A study out of UCSD School of Medicine found that the grooves and pits of teeth of those that vape had more bacteria in them. These same bacteria are responsible for cavities and gum disease. This is likely because these aerosols have some of the same chemical properties as “gelatinous candies and acidic drinks.”

Two of the main base carriers for e-juices are propylene glycol & vegetable glycerine. Propylene glycol is an FDA-approved food additive, but not one without effects on oral health. Because of its chemical nature, it affects oral health in multiple ways. It causes dry mouth, which plays a major factor in gum disease and increases your cavity risk. Not only that, but it breaks down into acidic byproducts in the mouth, which raises these risks even more. Vegetable glycerine on its own has little effect on oral health. However, when combined with the flavorings added to most e-juices, studies have shown that there is a huge increase in the number of bacteria sticking to the teeth, which also increases the risk for dental decay. Not to mention the bad breath…

One 2016 study suggests e-cigarette use triggers an inflammatory response in gum tissues. What does this mean? Those who are vaping on a consistent basis are contributing to an increased risk of periodontal and gum disease. It’s even worse when the e-juice contains nicotine or menthol. This constant inflammation also disrupts DNA repair in the cells of these tissues. While no direct link has yet been established between vaping and oral (or lung) cancer, it is known that inability for cells to repair their genetic coding leads to an increase in cancer risk.

Another important point is that of lithium battery explosion. As you may have seen in the news, there have been multiple instances of the batteries that power these vaporizers exploding or catching on fire. Some of these have occurred when the user had the vaporizer in their mouth, causing lacerations of lips, gums, cheeks, and loss of teeth. One man in Texas even lost his life when the shrapnel from the explosion sliced his jugular vein. Though this is rare, this is obviously a detrimental effect to the oral tissues.

A colleague, Dr. Scott Froum, mentions an interesting case that highlights some of these problems. He mentions a man who had gone 35 years without cavities. Once he stopped smoking cigarettes and took up vaping, he developed cavities on the front teeth within a year (see below). This is the area that the vaping aerosol hits first. He also developed dry mouth which contributed to the problem. This is not an isolated case, and we expect to see an increase of cases like these with the increase in prevalence of vaping.

Circled areas are cavities. Picture courtesy of Dr. Scott Froum

With the legalized marijuana movement growing in this country, the rise of cannabis (THC) cartridges (or “dabs”) has risen also. But make no mistake – this is not the “weed” of the 70’s. A recent study out of Johns Hopkins found that the THC concentration within the blood was higher in those that vaped with THC cartridges compared to those that smoked marijuana. This leads to a higher level of intoxication at school, at home, behind the wheel of a vehicle, etc. Also keep in mind that many of these products are much easier to inhale and hold, and are often flavored like “creamsicle” or “cotton candy” – you can see the problem. Though advocates for these vaping products say this is better for those who want a more controlled dose of THC, this makes these products incredibly dangerous for our young people. I have a family member who is a high school administrator, and they have personally seen a large increase in the number of kids high at school due to vaping THC cartridges. Parents and teachers have a hard time detecting this other than behavior due to the lack of scent. Let’s not forget to mention that within many states, it is illegal (in Texas it is a felony) to be in possession of these cartridges. With the lack of studies on this age group, I believe it is only a matter of time before we start to see a health crisis on our hands.

It may not be all bad though for one particular group of individuals: current tobacco smokers. One 2016 study found that switching to vaping from tobacco cigarettes was associated with overall improvement in oral health, including decreased plaque levels and gum bleeding. One 2018 study compared three groups: one who smoked cigarettes, a group who vaped, and a group who did neither. Those that smoked tobacco cigarettes were more likely to have higher levels of inflammation during their dental hygiene appointment than those who vaped or did neither.

Ultimately, we are in a a similar situation that was seen in the 1930’s and 40’s. Back then, the long term effects of cigarette smoking were unclear. They were even touted as being healthy by physicians. But eventually, the science caught up with the marketing, and we now know the truth. As the science begins to catch up, I believe we will see the evidence of the detrimental effects grow. Unfortunately, until then, I believe we will continue to see the increase of use, especially amoung younger populations, and the cases of side effects will increase as well. We did not even touch on the negative effects to the throat and lungs…

I do not personally recommend vaping to anyone other than long-term smokers who are trying to eventually quit smoking altogether. Even with this group, we bring them in more often to monitor their oral health more carefully. I encourage anyone out there who is vaping to first – quit. Second, If you choose not to, you definitely need to let your doctor and your dentist know you are vaping in order to make sure you are more carefully monitored. Please contact our office by phone, e-mail, or FB messenger if you would like to discuss further.

Yours in better dental health,

Cedric Alvarez, DDS

All links contained within the article link to the published article or webpage used to obtain info for this blog. Works cited contained within each article.

February 8, 2018 By enhancedentald Leave a Comment

What is Tartar

What Is Tartar? A Common Problem For Your Teeth

Tartar on teeth is a common problem that dentists and hygienists see every day, but few people know what it is or why it is a problem. The truth is tartar is not only a sign of poor hygiene habits but also the beginning stage of other more severe problems, like gum disease.

What is Tartar?

Tartar (sometimes called calculus) is a rough, porous mineral buildup that forms on your teeth at or below the gum line. Tartar forms when plaque stays on your teeth and hardens due to the salt and minerals in our food. But unlike plaque, which is soft and can be hard to see, tartar takes on a yellowish or brownish color.

Roughly 70-80% of all adults have tartar to some degree. Younger children and older adults are more at risk, as are smokers, people with braces or fixed retainers, and people with dry mouth.

Why Tartar is an Oral Health Problem to Take Seriously

While tartar is not immediately harmful or dangerous, it can create a number of problems down the road if you do not take care of it:

Tartar gives dental plaque more surface area on which to stick, which in turn gives bacteria a nice place to grow.
That same bacteria can, in turn, cause cavities and irritate your gums, eventually leading to gum disease.
Because tartar is porous, like a granite counter top, it absorbs stains easily. Coffee, tea, and cigarette smoke will be the most noticeable.
Tartar can make it harder to brush and floss like you should. This can lead to even more cavities and tooth decay.

What Can You Do About Tartar on Teeth?

Most people can feel or see tartar on their own teeth when it’s getting pretty bad (like the picture above), and if they take the time to find it. You’ll notice a chalky white or yellowish-white substance on your teeth that does not come off easily, and usually on the bottom front teeth. More often, people find out about tartar from their dentist during a regular check-up. The same goes for finding out about tartar on children’s teeth.

Dealing with tartar, then, requires two strategies: removing existing tartar, and preventing future tartar and plaque buildup on teeth.

Removing existing tartar on teeth is best done by a dentist or dental hygienist. He or she will use special instruments to remove the tartar from your teeth both above and below the gum line. This process is called scaling. What you see in the “after” side of the photo above is what the teeth look like after scaling.

Preventing future tartar and plaque buildup on teeth is easy if you adopt good oral health habits:

Brushing at least twice a day removes the plaque that creates tartar. Be sure to brush those hard-to-reach places behind your teeth and on your rear molars.
Try an electronic or powered toothbrush. This was a game-changer for me. I am especially a fan of sonic toothbrushes. These can provide a bit more power behind the bristles, and are especially good options for older adults and young children who might not have the full strength to brush well.
Use a toothpaste with tartar control (with fluoride). These are readily available in most stores that sell toothpaste. The ingredient pyrophosphate helps to prevent plaque formation on the teeth. However, it can cause gum irritation in some people, so stop using it if you feel a burning or itching sensation after use, or if you develop inflamed gums you didn’t have before.
Use a rinse. A good rinse will help kill the bacteria in plaque, especially in hard-to-reach places. Look for a rinse that says “antiseptic” on the label. Listerine, Crest Pro-Health, ACT, and Rejuvenate are all proven to improve oral health.
Floss. Yes, it can be time-consuming, but you’ll be amazed at the food and bits of tartar you remove. Water-piks have been shown in some studies to do a better job at cleaning in between teeth than traditional floss.
Watch those snacks. The bacteria in your mouth thrive on sugary and starchy foods; this is how plaque starts. So, try to cut down on the sugar, and get in the habit of brushing after these kinds of snacks.
Visit a dentist regularly. A dental visit can reveal tartar build-up, which can give you clues as to how to brush better to prevent future tartar.

Enough with Tartar

Now you should be able to easily answer ‘what is tartar’ and better understand the risks it plays in your oral health. By removing it, your oral as well as overall health will benefit, as multiple studies have shown that periodontal (gum and jaw bone) disease increases the risks for stroke, heart disease, respiratory disease, osteoporosis, and even some types of cancers. This is due to the chronic (or constant) inflammation that is occurring in your mouth when tartar is present, and bacteria that can enter into your system when this inflammation occurs. Tartar is unhealthy and, frankly, kind of gross. Take steps to prevent its growth, both for yourself and your loved ones.

Yours in bettter dental health,

Dr. A

some content from happytoothnc.com and popcorndaily.com

July 18, 2017 By enhancedentald Leave a Comment

History of the Tooth Fairy

As we all remember, one of the great joys of childhood was finding that coin under your pillow after you lost a tooth. The Tooth Fairy had visited you during the night! I cherished those quarters (if I was lucky, a 50 cent piece) and would, of course, made sure I picked up a piece of candy on the next trip to the store! I had a friend ask recently where the tales of the Tooth Fairy come from, and truth be told, I was unsure. I did a little research (okay, I did a Google search), and found this nice information from our friends over at 1 2 3 Dentist. The history of the Tooth Fairy has shown changes in the myth over time, and continues to evolve even today. Anyways, I thought I’d share this with you, and if you find that the Tooth Fairy is leaving more bills than coins nowadays; no worries. That’s just inflation. 🙂

A Brief History Of The Tooth Fairy

The tooth fairy is an iconic symbol of childhood, the same way we fondly remember Santa Clause or the Easter Bunny, we look back on the Tooth Fairy with fond memories. Unlike the other two mythological heroes of modern folklore, the Tooth Fairy exists across religion and culture in many anglo-based societies. But where did this sprightly sprite originate, and just how long have we believed in her magic? 123 Dentist decided to dig into the history of the Tooth Fairy and provide you with some much needed answers. With any luck, we’ll learn something together and satisfy our fascination with folklore at the same time!

Ancient Tooth Related Myths

The Tooth Fairy as we know it is a relatively recent creation, like other myths, evolved over time. There are traditions, legends and myths dating back millennia with regards to loosing your baby teeth.

Early norse and European traditions suggest that when a child lost a baby tooth, it was buried to spare the child from hardships in the next life. A tradition of the tand-fe or tooth fee originated in Europe for a child’s first tooth, and vikings used children’s teeth and other items from their children to bring them good luck in battle.

There’s also the more general tradition of a good fairy in Europe that was birthed out of fairy tales and popular literature in more recent times. Ultimately the most popular version of a ‘tooth deity’ is the image of a mouse, who would enter children’s rooms and remove baby teeth. This tradition is prominent in Russia, Spain and many asian countries like China.

Tooth Fairy Traditions Around The World

More recently, when the 6th tooth fell out, the child was rewarded with a gift in many northern European countries. In France, a mouse or rabbit dating to the 17th century mentioned a La Petite Souris. In Latin countries the most well known character is Ratoncito Perez. Perez has become a pop symbol in his own right, appearing in cartoons and he even has a museum dedicated to him in Madrid, Spain. Perez is used to market dental products to children much the way the tooth fairy is in Canada or the US.

The reason for the mouse being synonymous with so many culture’s tooth fairy tradition is the fact that rodents continue to grow their teeth their entire lives. Anthropologists consider a type of ‘sympathetic magic’ a way for believers to transfer good luck or traits to the child who lost the tooth.

In other cultures, the legend varies to include beavers, cats, dogs or even squirrels. Other traditions of the tooth fairy include rituals dating back thousands of years in almost every culture. Traditions like:

(1) thrown into the sun.
(2) thrown into the fire.
(3) thrown backwards between the legs.
(4) thrown onto or over the roof of a dwelling.
(5) placed in a mouse hole.
(6) buried in the ground.
(7) hidden out of site of animals.
(8) put inside a tree or on the wall.
(9) swallowed by mother, the child or a pet.

The Many Faces Of The Tooth Fairy

Unlike the counterparts of Santa Claus or The Easter Bunny, which have been branded in large part by companies like Coca Cola and Cadbury, the Tooth Fairy has not been associated with one specific look. The most common rendition was inspired by other fairies in pop culture, but the tooth fairy has appeared in countless shapes and sizes, from young to old, human to sprite, even animals and birds have inspired the look of the fairy.

The All-American Tooth Fairy

The tooth fairy as we know her was inspired by the legend of the mouse mentioned earlier and the good fairy myth. In 1927 or so, a book popularized what would consider to be the modern tooth fairy. The legend was obscure for a while, but with the popularity of Walt Disney’s fairy characters, the tooth fairy gained popularity and quickly became a presence in most households.

A recent survey by Visa found that the average child in the United States receives $3.70 per tooth, which is considerably more than what we used to get as children. Some parents offer more money for bigger teeth or for the first or last tooth, also inspired by European tradition.

Tooth Fairy In Popular Culture

To this day, the tooth fairy legend has appeared in hundreds of plays, books, cartoons and feature films. Some of these films are more or less what you’d expect from a female fairy character. The Tooth Fairy has featured in other lore about fairies, too. In recent films, the Tooth Fairy appeared in:

Rise of the Guardians
An almost superhero version of mythological characters have to join together to save the world and the Tooth Fairy is a key part of the group, presented as likeable, and almost bird like. The film is well animated, but a bit silly, even for a kids film.

The Tooth Fairy
If you could choose the least tooth fairy like actor in Hollywood today, at the top of the list you’d find Nicholas Cage or The Rock. In this modern take on the legend, a pro-sports star becomes the tooth fairy and has to get in touch with his sensitive side. Best avoid it unless you have small children.

Darkness Falls
One of the most recent takes on the Tooth Fairy myth re-imagined it for the horror genre and melded it with other folklore. If you like a good scare and a classic good vs. evil horror romp, check it out, but leave the kids watching something else.

Toothless
A lot of people don’t remember Toothless, Kristie Alley’s take on a dentist who becomes the next tooth fairy. The film was born out of the success of Tim Allen’s Santa Clause movie, another connection for the two closely related characters. It’s hard to find but it was fun for a family audience.

Ultimately, the reason the tooth fairy legend continues to grow and evolve across cultures is that it provides a level of comfort to children. As you grow, your body undergoes many changes, but arguably the first and most traumatic for children is the loss of a tooth or two. The tooth fairy and the mouse legends like Parez help bring comfort and excitement to a traumatic experience.

Today dentists use the tooth fairy to encourage dental health, even encouraging parents to propagate the legend with the notion that a tooth that is cleaner receives a larger reward. This kind of encouragement and the notion of a tooth fairy makes dental work easier for children, and that’s a very good thing!

February 3, 2017 By enhancedentald Leave a Comment

Safety of Dental X-Rays

I’m often asked as a dental practitioner, “Are dental X-rays necessary?” Often, I’m even told by my patients that they aren’t necessary; or worse, I hear whisperings of the belief that practitioners are just “running up the insurance” by taking them.

There is a fear inherent with the “R” word : radiation. A colleague of mine wrote a short, informative piece on the safety and necessity of dental x-rays that I would like to share with our Enhance Dental family. Please pass the link on if you feel this would benefit them!

Yours in better dental health,

Dr.A

by Jacquelyn Do, DDS

X-ray technology has provided immeasurable diagnostic benefits to the medical and dental community. Doctors can now identify and prevent the progression of disease at earlier stages. With the development of digital imaging technology, the amount of radiation exposure in routine dental x-rays are now considered negligible.

A comparison of our daily natural environmental radiation exposure with the amount of radiation in dental x-rays will help in understanding the risks and benefits encountered during your child’s routine dental check-ups.

According to the National Council on Radiation Protection and Measurements, the average American receives an effective dose of 3 millisieverts (mSv) per year from naturally occurring radioactive materials and cosmic radiation from outer space. Naturally occurring radioactive materials can be found in the air that we breathe and the food that we eat. Cosmic radiation is that which we receive from the sun in the form of UVA/UVB wavelengths.

For a child who is in their primary dentition and has not yet lost their first baby tooth, the dental x-rays indicated to be taken by the American Academy of Pediatric Dentistry (AAPD), are two bitewings and two periapicals. The total amount of radiation for this set is 0.008 mSv. If a child has one or more adult teeth then a panoramic x-ray is indicated in addition to the bitewing and periapical x-rays. The amount of radiation exposure in a single panoramic x-ray is 0.007 mSV.

Following are comparisons of effective radiation dose with naturally-occurring environmental radiation exposure:

Procedure/source of exposure	Approximate radiation dose	Comparable to natural environmental radiation for:	*Additional lifetime risk of fatal cancer

CT Head Scan	2 mSv	8 months	Very Low
Mammography	0.4mSv	7 weeks	Very Low
Chest X-ray	0.1 mSv	10 day	Negligible
Coast to coast flight in a commercial airplane	0.03 mSv
2 bitewing and 2 periapical dental x-rays	0.008 mSv	1 day	Negligible
Panoramic X-ray	0.007 mSv	1 day	Negligible

Depending on your child’s dental health and history, the AAPD recommends that children have dental x-rays taken as soon as their teeth touch and proximal services cannot be visualized or probed. Then, once every 12-18 months, thereafter, and more frequently when there is a past experience of tooth decay or an increased risk for tooth decay. Examples of factors that increase the risk for tooth decay are poor oral hygiene, inadequate fluoride exposure, prolonged nursing, and frequent high sugar content in the diet.

Tooth decay left undiagnosed and untreated can often times lead to dental pain or emergency. With the help of your child’s pediatric dentist you can gain the information and tools vital to keeping your child cavity-free. Schedule your child’s first dental check-up by their first birthday and every 6 months following. Prevention and early diagnose is key to a healthy dental home.

* LEGEND
Risk Level	Approximate additional risk of fatal cancer for an adult from exposure

Negligible:	Less than 1 in 1,000,000
Minimal:	1 in 1,000,000 to 1 in 100,000
Very Low:	1 in 100,000 to 1 in 10,000
Low:	1 in 10,000 to 1 in 1,000
Moderate:	1 in 1,000 to 1 in 500