John F. Carpenter DMD, MAGD Family, Cosmetic & Imp

Sedation Dentistry, a Bad Case of Gum Disease and a Happy Family

bad breath, halitosisA 42 year old male patient, let’s call him “Bob”, presented to the office last month.  Bob’s main complaint was he was afraid to kiss his wife because of his bad breath.  “Our sex life is suffering because of it and my kids have been avoiding me.”

After spending time getting to know Bob, he disclosed that he hadn’t been to a dentist since he was a teenager.  “I had gone for bleeding gums, was traumatized and hadn’t been back since”.  Bob allowed us to examine him and take basic X-rays.  Heavy calculus (tartar) and bleeding gums were visible.  All the signs and symptoms of gum disease were present.

We let Bob know that he was a perfect candidate for dental sedation.  All his gum treatments, the extraction of 2 hopeless teeth and a few fillings could all be done in one visit with sedation.  He was scheduled for his sedation visit the next week and in over 3 hours, all his treatment was completed.

But the best part was when Bob returned for a 2 week follow-up.  Happy and smiling in the welcome area, he called out to me “My mouth hasn’t felt this good in years and my family loves what you did for me.”

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Difference Between Cold Sores and Canker Sores, Part III

Cold sore vs Canker soreCold sores need to be treated at the prodromal stage.  This stage is just before blisters are noted and when tingling, itching, and burning around the lips is felt.

OTC Treatment

Cold compress and lubrication are older remedies and can be effective.  Abreva is the only FDA-approved over the counter remedy.

In Office Treatment

Low-level laser treatment


Denavir (penciclovir) is an anti-viral prescription medicine.  This is my favorite treatment for patients who have recurrent episodes of cold sores.  It is best to keep this prescription handy and apply when symptoms are first noted and before the outbreak is more severe.


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The Difference Between Cold Sores and Canker Sores, Part II


Laser Treatment of Canker Sore

How do we treat canker sores (Apthous Ulcer)?

Treatment is pallative,  for comfort only.  These lesions will disappear completely in 7 – 10 days with or without treatment.  The problem is these ulcerated lesions can be quite painful!

For a Small Lesion

  • OTC topical anesthetic,  (contains benzocaine, e.g. Orabase with benzocaine)
  • A prescribed topical corticosteroid ointment

For a Larger and More Painful Lesion

  • In office treatment
  • Debacterol – applied by your dentist and it basically cauterizes the lesion
  • Low-level laser treatment.  This is my preferred method and usually provides immediate pain relief

Cold Sore Treatment, Part III


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The Difference Between Cold Sores and Canker Sores

Cold Sore (fever blister)

Cold Sore (fever blister)

Canker Sore (apthous ulcer)

Canker Sore (aphthous ulcer)

I find patients are frequently confused by these lesions and often use these terms interchangeably.  Canker Sores (recurrent aphthous ulcers) and Cold Sores (recurrent herpes labialis) are two different ailments and require different treatments.  While these conditions are usually not serious, they are very common and painful.

A Canker Sore is an intraoral sore usually located on the cheeks, tongue or floor of the mouth.  Typically it is a small, round ulcerated lesion surrounded by a red halo.  It is not contagious and its cause is usually multifactorial.  Stress, trauma such as cheek biting, some food allergies, smoking and sodium lauryl sulfate (a foaming agent in many toothpastes) all have been implicated as causative factors.

Cold Sores are extraoral lesions usually located under the nose and around the lips.  They start as tiny fluid-filled blisters which break open, coalesce and then crust over.  These lesions are contagious, especially when the blisters break open.  The cause is the herpes virus (HPV) that was contracted in early childhood.  This virus lies dormant until triggered by stress, fatigue, hormonal changes or exposure to sun or wind.  90% of the population tests positive for HPV but only approximately 20% of the population will experience a cold sore outbreak.  Cold sores have a tendency to recur in more or less the same place each time.  Such recurrences may happen often (once a month) or occasionally, (once or twice a year).

Treatment and Prevention to follow.

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Dry Mouth (Xerostomia)

imagesRQLW7GB7 imagesWMQF7T8Z imagesZQC1707SWhat is Xerostomia?  Xerostomia is a condition related to the salivary glands which keep the mouth moist.  When the glands do not work properly, the amount of saliva in the mouth decreases, causing dry mouth.  Saliva prevents tooth decay, helps us taste and swallow our food and aids in digestion.  Xerostomia affects approximately 25% of the population, although most patients do not realize they have a problem until they lose up to 50% of their saliva.  Over the past 10 years, I have seen a significant increase in the number of patients with xerostomia.  The rapid progression of dental decay caused by dry mouth is devastating and can create a “dental cripple”.

What is the cause of dry mouth?  There are several causes of dry mouth, such as radiation therapy, chemotherapy, diabetes and dehydration.  However, medicines are the most common culprit.  There are more than 400 medications that can contribute to dry mouth.  While medications are necessary to treat medical problems, it is their side effect of dry mouth that is harmful to the teeth.

How important is saliva?  Saliva is the “bloodstream of the mouth” which nourishes and protects our teeth and gums.  It’s composed mostly of water, but contains electrolytes, mucus, antibacterial compounds and various enzymes.  Without adequate saliva, patients are more vulnerable to tooth decay, periodontal disease and fungal infections.  Saliva helps food naturally be moved away from teeth.  Saliva has an important role in buffering the pH of the mouth.  After the intake of sugars, carbohydrates, soda, fruit juice and sport drinks, the mouth becomes acidic (pH 2-4) and leads to tooth decay.  The oral pH of a patient with a healthy flow of saliva returns to neutral (pH 7) in approximately 20 minutes after food and drink consumption.  The oral pH of a patient with a poor flow of saliva may take up to 2 hours to return to neutral pH.

What can I do to prevent dry mouth?  Treatment involves identifying correctable causes and removing them if possible.  Hydration is important, drink plenty of water.  Eliminate drying alcoholic mouth washes, and avoid a diet high in sugars and sticky carbohydrate-rich foods.  Many over-the-counter dry mouth products exist to help lubricate and neutralize the mouth.  Vigilant home oral hygiene, a careful evaluation by your dentist and a customized dry mouth plan will also help.


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Root Canal vs Implant Treatment

Infected Tooth

Infected Tooth

Root Canal Treatment

Root Canal Treatment

3 Components of a Dental Implant

3 Components of a Dental Implant








Of course no one looks forward to a Root Canal, but should a tooth be extracted and an implant placed?  This all depends on the restorability of the existing tooth.  If the tooth is not extremely broken down, then it’s best to save the tooth with a root canal followed by a post and core and crown.  A root canal performed on a tooth can prevent the tooth from extraction.  The infected tissue is removed from the internal chambers of the tooth and filled with a biocompatible filler.

If damage to the tooth has been caused by extensive decay and fracture, and there is insufficient tooth structure to attach a crown to, then it is best to remove this tooth and place an implant.  This decision is sometimes one of the most difficult decisions a practitioner must make.

Remember, each situation is different and time must be taken to fully evaluate each individual’s case.  Root canal treatment is fairly conservative with a good long-term prognosis.  However, if a root canal has been attempted and failed, or if the tooth is fractured, it’s often best to extract the offending tooth and place an implant followed by an abutment and crown.  The cost of both treatments is very similar.

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The Mouth and Heart Connection

Artery Plaque

Artery Inflammation

Do you have gum disease?  Did you know gum disease is the leading cause of tooth loss and has also been associated with heart disease, low birth weight, diabetes and other health problems?  According to the Center for Disease Control, 50% of US adults have some form of gum disease (periodontal disease).  Major risk factors for periodontal disease include a generic predisposition, smoking, lack of routine home care, diet, certain systemic diseases, and various medications.

Early inflammation of the gums is called gingivitis.  The signs and symptoms of gingivitis include red, swollen, bleeding gums and bad breath.  Gingivitis is most often caused by inadequate oral hygiene.  Plaque accumulates around your teeth and can become mineralized, forming tartar (calculus).  With the removal of calculus and improvement in oral hygiene, gingivitis is reversible.  However, gingivitis, if left untreated, can advance to chronic periodontitis, a more serious infection.  Plaque and associated bacteria penetrate deeper and eventually destroy bone and tissue that hold your teeth in place.

How are periodontal disease and cardiovascular disease connected?  The first evidence linking periodontitis to heart disease was in a 1989 study conducted in Finland.  Patients who had experienced heart attacks often had advanced periodontal disease.  Several studies since 1989 have shown patients with periodontal disease have an increased risk for heart attack or stroke.  Research suggests that inflammatory proteins and bacteria associated with gum disease enter a person’s blood stream and cause thickening of the blood vessel walls, typically seen in heart disease.

Treating gum disease and its associated inflammation is not only important to your teeth, it may help in managing other diseases and chronic inflammatory conditions.

What can I do to keep my gums and body healthy?  It is important to practice proper oral hygiene, visit your dentist regularly for check-ups and teeth cleanings to remove plaque and tartar deposits.

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Reliability and Advantages of Dental Implants

3 Components of a Dental Implant

3 Components of a Dental Implant


Dental Implants are among the most successful procedures in dentistry.  Studies have shown a five year success rate of 95%.  With proper care, dental implants can last a lifetime.

A single tooth dental implant is made up of 3 components.  There’s a titanium screw that fuses to the jaw bone, an abutment (post) on top and a crown which is fitted onto the abutment.  A single dental implant offers many advantages when replacing a tooth.

Before the invention of dental implants, a fixed bridge was used to replace a missing tooth.  The disadvantages of a fixed bridge include:  1.  necessary reduction of the adjacent teeth  2.  it is less natural and life-like, 3. root canals are often required for the adjacent teeth being crowned and 4.  it is not uncommon for decay to form under the crowns, leading to an early demise.

Regain your ability to eat anything and smile with confidence.  Call our office at 561-2330 for a consultation.

Conventional Dental Bridge

Conventional Dental Bridge

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Halitosis or Bad Breath

Halitosis, Bad breathHalitosis affects more than 80 million people in the US.  In most cases people are unaware they have a problem.

What causes bad breath?

Typically bad breath originates around your teeth and on your tongue.   It is caused by bacteria in the mouth, decaying food particles and bad oral hygiene.  The bacteria and decaying debris produce an unpleasant odor (think sulfur smell).  Dry mouth (xerostomia), stress, smoking, snoring, sinus problems and other medical conditions can all worsen the problem.  Saliva helps by washing away odor-causing bacteria and food particles.  When you sleep, saliva glands slow down causing the dreaded “morning breath”.

How can I control bad breath?

tongue cleanerGood oral hygiene and cleaning visits with the hygienist are No. 1.  More advanced periodontal conditions often require root planing with anesthesia.  I find regularly cleaning your tongue with a specialized tongue scraper is extremely helpful.  It is necessary to clean between teeth with floss or specially designed brushes, such as “Soft Pics”.  In addition, drink plenty of H2O and try chewing sugar-free gum that contains Xylitol.  This will help inhibit bacteria and stimulate saliva production.  Yes, watching your diet can help.  Avoid spicy foods, garlic, onions and coffee.  These foods and drink linger for up to 12 hours.

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