Even Procter & Gamble, maker of Crest toothpaste, is launching a charcoal whitening toothpaste soon. Patients say the black charcoal toothpaste makes a mess and adds an extra step to the morning routine, and despite add dirtiness to teeth, some people think it makes their teeth whiter. Charcoal has been used on teeth for centuries, and while there is no evidence of any danger, there is also no evidence of any benefit. Dentists are concerned with the abrasiveness that wears away teeth.  However, charcoal has been all over social media lately in terms of beauty products- from makeups and hair colors to masks. If nothing else than a great selfie, go ahead and try some charcoal toothpaste. 


Source: https://www.wsj.com/articles/the-latest-fad-in-tooth-whitening-is-to-turn-them-black-1534096646?mod=hp_featst_pos3

Enamel, the outer surface of teeth and the hardest substance in the body, can be damaged by acidic foods or liquids over time. The wear of enamel due to acid is called erosion. 

Acid commonly comes from foods, drinks, acid reflux, or vomit. Eating acidic fruits multiple times per day and drinking soda or sports drinks daily contributes to acid erosion. 

How can you notice acid erosion? Front teeth may appear short, yellow, and thin. Teeth can become sensitive so you may feel pain when your teeth are touched or you drink hot/ cold beverages. You may notice pits on the chewing surfaces of back teeth. 

What can be done? Enamel cannot be restored but there are some steps to prevent or stop dental erosion. Drink water or milk while eating, avoid acidic foods, use a straw if you do drink something acidic. Make sure not to swish around soda or other acidic beverages and wait at least 30 minutes to brush your teeth after acidic intake. 

Here are some other tips-

• Chew sugar free gum
• Use a soft tooth brush with fluoride toothpaste
• Look for dental products with the ADA seal

As bad as snoring can be for the person with sleep apnea, snoring can cause martial problems and lead to insomnia, headaches, and daytime fatigue for the partner. Snoring can lead to obstructive sleep apnea- the collapse of the upper airway that disrupts breathing and can lead to decreased blood oxygen. Sleep apnea is associated with depression, heart attacks, and diabetes. 90% of people with sleep apnea aren't even diagnosed. Many people may not realize they have sleep apnea, but eventually the symptoms will eventually become noticed.  The definitive diagnosis requires a sleep study by a physician. 

There are treatments- surgery, continuous positive airway pressure (CPAP) machines, oral appliances, and even oral laser treatment. As dentists we can fabricate oral appliances and perform oral laser therapy. For patients who are reluctant to try CPAP, dental treatments are a worthy option. 

Source: https://www.nytimes.com/2018/06/25/upshot/i-learned-i-have-sleep-apnea-its-more-serious-than-many-people-realize.html

Certain questions are asked by patients on a daily basis. We thought we would put together a list of some of these frequently asked patient questions. 

1) What's the best way to whiten teeth?
There are many ways to whiten teeth from over the counter products such as whitening toothpastes, Crest Whitestrips, hydrogen peroxide rinses or coconut oil rinses. Professional dental whitening products include hydrogen peroxide and carbamide peroxide gels applied either in the office or with the aid of custom trays worn at home. One thing to keep in mind is that whitening toothpastes whiten by polishing via an abrasive action. Our suggestion is to try over the counter/ home remedies and if you aren't satisfied we can come up with a home or in-office gel whitening plan. 

2) What is the best type of toothbrush to use?
First and foremost patients need to have good brushing form (Modified Bass Technique), which consists of soft brushes held at a 45 degree angle to the teeth with tiny circular motions. Hold the brush vertically for the insides of the front teeth. It is recommended to brush twice a day and about 20 minutes after you eat (especially if the food was acidic). Studies show that electric toothbrushes may enhance plaque removal, clean better between teeth, and show improved patient compliance. If you are more likely to brush well with an electric toothbrush it may be worth the investment. 

3) What are the benefits of flossing?
Flossing removes plaque (food and bacterial biofilm) between teeth and under the gums between teeth. Removing plaque decreases the amount of bacteria that cause cavities and gum disease. Interdental brushes, picks, and Waterpik accomplish the same goal. 

4) What causes gum recession?
The most common causes of gum recession are 

1. Overly vigorous toothbrushing (especially with a stiff brush)
2. Grinding teeth/ bite problems
3. Gum disease

More common questions and answers to come!

Dr. Gary Pearl was recently in Miami, FL for the Neoss Symposium on "Advancing Implant Dentistry from Ordinary to Extraordinary." Dr. Pearl learned about new techniques and materials in the rapidly evolving field of implant dentistry. There have been huge advancements in making gums look better, implants last longer, and dentures more secure. Dr. Pearl can't wait to apply the new knowledge to his patients. 

Pulpdent's ACTIVA BioACTIVE-Restorative improves the quality of Pearl Dental Care's crowns, onlays, bridges, and fillings. Drs. Gary and Scott Pearl are amazed by the improved quality of their restorations with the help of ACTIVA. What is ACTIVA and why does it matter?

Nearly everyone has or has seen old silver colored amalgam fillings. Amalgam fillings have served patients well for decades, but the poor esthetics and requirement for excessive tooth removal for placement are severe disadvantages. The 1980's to mid 2000's saw the introduction and advancement of tooth colored composite fillings. Composite fillings have gotten stronger and more beautiful over the years, but they still have limitations in biocompatibility. 

ACTIVA is a breakthrough product for patients. Unlike amalgam or composite, ACTIVA chemically bonds to teeth, releases calcium, phosphate, and fluoride, and is bioactive. ACTIVA is strong, shock absorbent, and mimics the properties of teeth. As patients brush their teeth the ACTIVA filling material gets recharged with fluoride. The long-term benefits for our patients are exactly what we look for when choosing our materials. 


​https://www.pulpdent.com/shop/category/activa-bioactive-restorative/

A recent article in the Wall Street Journal explains the deadly hospital-acquired infection, pneumonia, and how the best way to prevent it may be with a toothbrush. Contracting pneumonia is a significant risk for patients in a hospital, especially those undergoing surgery. Pneumonia is the number 1 hospital-acquired infection in America. The sad truth is that hospitals are not doing enough to prevent hospital-acquired pneumonia. Patients can catch pneumonia from bacteria in their breathing tubes and those bacteria may very well likely originate from the mouth.

Experts recommend patients are elevated in their beds, move and walk around so air moves through their lungs and don't settle in, and deep breathing exercises. "At NYU Langone Health in New York City, patients- whether having complex surgery or an outpatient procedure- brush their teeth and gargle before going under anesthesia and throughout their hospital stay." Patients go to the operating room within 20 minutes of brushing their teeth. At Sutter Medical Center in Sacramenton, researchers foundn that hospital-acquired pneumonia cases were down by 70% after toothbrushing policies were instituted. Investing in toothbrushes is certainly much more affordable for the health care system than managing pneumonia. 

Source: https://www.wsj.com/articles/in-hospitals-pneumonia-is-a-lethal-enemy-1518868800

As dentists, we see patients with dental fears every single day. Here are some strange and wonderful medically verified dental phobias! Hopefully we can overcome these phobias!

Odontophobia- the fear of dentists
Odontarrupophobia- the fear of toothbrushes
Arachibutyrophobia- the fear of peanut butter sticking to the roof of your mouth
Queunliskanphobia- the fear of saliva (usually other people's)
Cibophobia- the fear of choking on food
Touloungeaphobia- the fear of tongues- commonly, the fear of swallowing your tongue
Dipsophobia- the fear of drinking alcohol

With 2017 nearing an end it's a great time to use up remaining dollars in your flexible spending account (FSA). FSA's allow you to pay for IRS-qualified health care expenses with pretax dollars you save in a special account all year. The discount can be more than 30% depending on your tax bracket. Eligible expenses include co-pays, co-insurance, deductibles, prescription drugs, and even dental care.

The IRS limit on FSA contributions for 2018 is $2,650, $50 more than the limit this year. 

The problem with FSA's is that in most cases you must spend the money you put aside in an FSA account in the prescribed time period, often the calendar year. Don't waste any of your saved FSA dollars! 

Source: https://www.cbsnews.com/news/fsa-money-its-time-to-use-it-or-lose-it-for-2017/

The ADA does not officially support the use of activated charcoal products in dentistry. A fad these days is the use of charcoal for whitening. Some people are even brushing their teeth with charcoal. Many brands claim that activated charcoal results in whiter teeth. Does it actually work? Is the water-charcoal slurry mixture worth it?

The Oral Health Foundation in the UK says there is no research or evidence to support the claims by activated charcoal products. In addition, many of the charcoal toothpastes contain less than the 1,250 to 1,500 parts per million of fluoride needed to actively protect teeth from tooth decay. Some of the products can be overly abrasive and can wear away the enamel on teeth. The roughened enamel can make it easier for bacteria to stick to the surface of teeth. 

The bottom line is that there isn't any proof that charcoal is safe and effective for your teeth. Until we learn more, stick to the products your dentist recommends. 

Source: https://www.menshealth.com/health/activated-charcoal-toothpaste

Dr. Gary Pearl proudly announces the joining of his son, Dr. Scott Pearl, to the Pearl Dental Care team in Hamden. Dr. Pearl attended dental school at UConn School of Dental Medicine and completed his residency training at Montefiore Medical Center in Bronx, NY. While patients may have seen Dr. Pearl around the office since he was a child performing such tasks as filing charts, gardening, or doing computer work, he will now be providing dental care to children and adults full-time. Congratulations to Dr. Pearl in this exciting time!

For more information about Dr. Pearl click here. 

A recent study published in the Journal of Oral Microbiology examined the effect of the bacteria Porphyromonas gingivalis on conception in women. According to the Global Burden of Disease Study, severe chronic periodontitis is the sixth most common medical condition. Periodontal disease has been associated with cardiovascular disease, diabetes, respiratory infections, and premature birth. The systemic effects may be related to bacterial lipolysaccharide (LPS) and a pro-inflammatory state. The gram-negative bacteria Porphyromonas gingivalis and Aggregatibacter actinomycetemcomitans have been implicated in periodontal disease and systemic disease. 

Infection and inflammation are related to fertility due to an affect on the ovary, uterus, embryo, and implantation. Another study has associated periodontal disease and endometriosis. Periodontal disease and infertility share common risk factors including age, obesity, and smoking, but the association needs further clarification. 

An observational study was performed in a prospective setting with a cohort of young women trying to get pregnant. The mean age was 29.2 years with a range from 19-42 years from Finland. The main finding of the study was that detection of P. gingivalis in saliva and elevated salivary antibodies against this bacteria resulted in a significantly increased risk for unsuccessful conception. The results were independent of age, smoking status, socioeconomic status, and previous deliveries. P. gingivalis very well may delay conception or at least be a marker of this association. 

http://www.tandfonline.com/doi/full/10.1080/20002297.2017.1330644

A recent article was published in The New York Times which tells the story of the letters the founder of WM. Wrigley Jr. Co. wrote to young children to entice them to chew gum. William Wrigley Jr., the founder of the Wrigley Company, wrote direct letters to every child he could find turning 2.. "In the early 1900s, he actually shipped free sticks of gum to every address in the U.S. phone book, and that is thought to be the first national direct marketing campaign." Wrigley often mailed sticks of Juicy Fruit, Wrigley's oldest product, glued to his letters. Juicy Fruit was created in 1893 a few months before Spearmint. 

Wrigley writes that chewing gum is good exercise for children's teeth. The irony is that Wrigley chewing gum contained sugar which promoted dental cavities. There is no evidence to support that chewing gum in the 1920's or 1930's had any beneficial effect on children's teeth due to any ingredient in the gum. But maybe people knew that the extra saliva produced from chewing gum and the gum rubbing across the teeth had beneficial cleansing effects. The American Academy of Pediatrics now considers gum a choking hazard for children younger than age 5. 

Interestingly, the recipient of the above letter, Henry Trombley, grew up to be a dental technician, making dental crowns and bridges. 

Does swallowed gum stay in your stomach for seven years?
No, while the digestive system is unable to break down the synthetic gum base, the gum moves through the intestines and passed into the stool normally. 

Let's say you have a dental emergency. Do you go to the hospital or to Pearl Dental Care? Where you go for treatment will depend on the type of emergency and where the problem area is. Accidents such as jaw fractures, major lacerations to the face, trouble breathing or swallowing, or jaw dislocation require immediate attention at a hospital emergency department. For dental emergencies involving broken teeth, missing teeth, abscess, oral wounds, or other emergencies that are not considered life-threatening you should see your dentist for immediate care. 

There are several situations the American Dental Association recommends patients become familiar with. 

1. If a tooth is knocked out, hold the tooth by the crown and rinse it if it is dirty. Do not scrub it. Place the tooth back in the socket if possible or in a cup of milk. Go to your dentist ASAP. The tooth can often be re-implanted if within 1 hour. 
2. If you break a tooth, rinse your mouth with warm water. Apply pressure to any bleeding areas with gauze. Apply a cold compress to the outside of the mouth , cheek, or lip, near the broken area. See your dentist ASAP. 
3. If you bite your tongue or lip clean it gently with a cloth and apply cold compresses to reduce swelling. If the bleeding is heavy or doesn't stop see your dentist ASAP. 
4. If you have a toothache rinse your mouth with warm water and floss the area to remove any trapped food. Apply a cold compress to the outside of your mouth and see your dentist ASAP. 
5. If you wear braces and a wire is sticking out and poking your cheek, tongue, or gum, use a pencil eraser to push the wire into a more comfortable position or cover the wire with wax until you can get to your dentist. 

If it hurts, it's an emergency. Treatment provided sooner increases the odds of a good prognosis. Don't be afraid to contact us no matter how big or small your problem may seem. 

Bicycling Magazine recently published an article listing 20 easy ways to help your heart. Some of the recommendations include eating calcium rich foods, filling up on antioxidants, and treating high blood pressure. Number 8 on the list is "Go to the dentist."

The tip references a Taiwanese research study which showed that people who had their teeth cleaned twice per year for the past 2 years had a 24% lower risk of heart attack and a 13% lower risk of stroke compared with people who did not have a cleaning. Professional cleanings reduce inflammation and bacteria in the mouth, which lowers inflammation in other areas of the body such as the blood vessels. 

According to a recent article in The Wall Street Journal, genetics may increase your chances of getting cavities and even inheriting a sweet tooth. Some patients with average to poor oral hygiene rarely if ever get cavities. Other patients with diligent home care who floss and brush regularly are often told by their dentist that they have cavities. Dr. Michael Glick, a professor at the School of Dental Medicine at the University at Buffalo and editor in chief of the Journal of the American Dental Association, explains how genetics may increase your chances of getting cavities in baby teeth by up to 64%. Genetics affect the way tooth enamel is formed. Different variants of enamel may be better or worse at resisting acid erosion. 

Dr. Glick says "(i)t's hard to separate a high-sugar diet that will predispose one to develop cavities from a genetic predisposition." Community trends in cavities are usually a result of dietary habits but current research is nevertheless showing a genetic component. 

Even if someone is genetically susceptible to cavities, the fact remains that you need sugar in your diet to get a cavity. You cannot get a cavity without sugar. Avoiding sugar products that cling to teeth is the best preventative measure you can take. If you think you are more susceptible to cavities make sure you follow hygiene recommendations- brush twice a day, floss regularly, rinse with mouth wash, and see a dentist at least twice a year. "Don’t sweat the genetics, he says. “See your dentist often, brush regularly and get your cavities filled quickly,” whether your parents had lots of cavities or not."

You and your dentist have a range of options for relieving dental pain. It's most important to determine the cause of the pain and if any treatment is necessary. This blog post will discuss medications that are available for mitigating dental pain. When choosing a pain medication you might consider:

• the pain intensity you have or might have
• whether the pain is acute (will last for a short period) or chronic (will last for an extended period)
• past and current medical history
• all other medications you are taking 

OTC Drugs
OTC (over the counter) drugs are medications that you can buy at a pharmacy without a prescription. The two general types of OTC pain relievers are non-steroidal anti-inflammatory drugs (NSAIDs) and acetaminophen (Tylenol). Examples of NSAIDs include ibuprofen (Advil of Motrin), naproxen (Aleve or Naprosyn), and aspirin. Some of these drugs have different maximum dosages and indications. Research has shown that NSAIDs are just as effective as narcotics for relieving most dental pain. 
People with asthma, kidney disease, and gastric ulcers should not use NSAIDs. In addition, patients on blood thinners should not use NSAIDs. For these patients Tylenol is a better choice. 

Prescription Drugs
Prescription drugs include higher dosage NSAIDs and narcotics. For nearly all patients, a higher dosage NSAID works just as well if not better than narcotics and has less side effects. Narcotics are often combined with an OTC medication. For instance Vicodin is a combination of hydrocodone and acetaminophen. Narcotics can make people sleepy and there is a risk for addiction, so NSAIDs or Tylenol are usually a better initial choice. . 

Taking Prescription Drugs Safely
Take your medication exactly as directed. Remember, it is for your use only. It can be harmful or fatal when used by someone else. Make sure you tell your dentist if you are taking other medications (even OTC medications) because some combinations can be dangerous. 

Talking To Your Dentist About Pain Medication
When you talk to your dentist about pain relief make sure you tell him or her about your past history with pain, past use of OTC and prescription pain medications, and your full medical history. Are there certain drugs that made you feel poorly? Are there certain drugs you know you can't take? Be sure to ask questions about when to take your pain medication (for example, whether you should take the medication after a meal). 
If you find that the medication is not improving your pain, call your dentist. Since there are so many pain medications available today, he or she will be able to recommend a different option. 

In the past several months there has been a lot of chatter about the benefits of flossing. An Associated Press report stated that flossing does not add any benefit over brushing. Many people are confused and skeptical about what is being reported. The main point from the Associated Press report is that since there is no randomized control trial (RCT) to prove the benefits of flossing, then we shouldn't floss. RCT's are the gold standard in scientific study. However, it's unethical to enroll subjects in an exerpiment where half of the subjects are instructed not to floss- for potentially years. 

The truth is that dentists every day see the benefits of flossing. In fact, when performing crown, bridge, and filling procedures, we almost always use floss to check contacts and clean under the gums. We do this because flossing works. Floss cleans debris and bacteria where a toothbrush can't reach. There are other interdental cleaning tools on the market such as proxy brushes and wood picks. These work similarly as floss and can often be used in place of floss. An RCT isn't necessary to prove the benefits of flossing because the benefits are obvious!

For the people who hate to floss and finally thought they could no longer feel guilty about not flossing, we're sorry! We really love the WaterPik. It's fun to use and a great flossing alternative. 

A recent FOX News Health article discussed 10 holiday foods and drinks your dentist might not be happy about. We all tend to let loose around the holidays and recklessly consume cakes, candies, cookies, beverages and more. Here are 10 holiday season staples that may make you think twice before indulging. 

1. Bourbon- A tasty addition to eggnog but it can dry the mouth increasing the risk for cavities
2. Candy Canes- Not only are they packed with sugar but their hardness can result in cracked teeth
3. Citrus fruits- While they can have many health benefits, the acid content is not beneficial to teeth as it can cause enamel erosion
4. Coffee- Not only is coffee acidic and potentially full of sugar (don't add sugar!) but it can decrease salivary flow
5. Corn on the cob- A disaster for those with braces, but corn on the cob can also crack a filling. It's definitely better to remove the corn from the cob before eating
6. Dots and jujubes- While they are great for decorating ginger bread houses, chewy candies are not only sugary but can aggravate the TMJ due to chewing fatigue
7. Dried fruit- Dried fruit are good sources of fiber and nutrients but the high sugar content makes them a cavity risky food
8. Eggnog- Eggnog is one of the worst beverages for your teeth due to the sugar, alcohol (sometimes), and dairy, The sugars in dairy are easily digested by oral bacteria producing tooth decay
9. Fruit cake- The sugar content and sticky nature of fruit cake make it risky for dislodging crowns and causing cavities
10. Hot chocolate- As much as we love hot chocolate, the high sugar content makes it another risky holiday beverage. 

After consuming sugary items it's best to brush and floss. Waiting half an hour or so is a good way for the body to naturally neutralize acids and cleanse the teeth. We also recommend xylitol chewing gum and plain water. 

In a recent article published by The Washington Post the relationship between gum disease and various others diseases was discussed. "Open wide. There’s a host of researchers peering inside your mouth, and you may be surprised at what they hope to find. They’re looking for a connection between gum disease and illnesses such as breast cancer and even dementia."

Is gum disease related to diabetes, pancreatic cancer, and heart disease? There certainly seems to be more and more evidence of a relationship. It could be possible that one disease exacerbates another or gum disease could be a symptom of other diseases. "In the meantime, extra dental care for those with gum disease and certain at-risk conditions has become common, pragmatic practice."

Gum disease, also known as Periodontitis, is an inflammatory condition in the mouth. Signs of gum disease include bleeding gums, swollen gums, bad breath, and loose teeth. Left untreated, gum disease can result in tooth loss and can increase the risk and severity of other diseases. 

"While not definitive, the links between gum disease and diabetes, at-risk pregnancy, heart disease and stroke have been so consistent that some insurers offer extra preventive periodontal care at little or no cost to people with those conditions."

For more information on periodontal therapy visit us here. 

Oral cancer, most commonly squamous cell carcinoma, is associated with a history of smoking and alcohol use. According to a new study report by Oncology Nurse Advisor, poor oral health is associated with oropharyngeal squamous cell carcinoma. As opposed to oral squamous cell carcinoma, oropharyngeal (involving the throat) is often associated with HPV. The new study was recently published in the journal Cancer.

The results of the study showed that routine dental examinations were associated with a 48% reduced risk of HPV-negative oropharyngeal squamous cell carcinoma and a 45% reduced risk of HPV-positive oropharyngeal squamous cell carcinoma. 

The study researchers found that the prevalence of periodontal disease increased the risk of HPV-negative oropharyngeal squamous cell carcinoma by 70% and HPV-positive disease by 45%. 

Further investigation is necessary, but periodontal disease is increasingly found to be involved with many systemic diseases. 

Dental sealants are one of the best ways to lower the chances of getting a cavity. Sealants are recommended for children as soon as their teeth are fully erupted into the mouth. Sealants protect the teeth from developing occlusal cavities. Occlusal means the biting surface of the tooth. By penetrating the pits and fissures (grooves) of the teeth, the sealant material is a physical barrier against cavities because it prevents food and bacteria from getting trapped. Sealants can also help arrest the early stages of an existing cavity. 

The evidence shows that dental sealants are safe and very effective at protecting teeth from occlusal decay in both baby teeth and adult teeth. 

Many people believe that getting your wisdom teeth removed is a necessary rite of passage. Is this true and why do so many people have their wisdom teeth removed?

Wisdom teeth (third molars) usually erupt into the mouth between the ages of 17 and 21. They are called wisdom teeth because they come through at a more mature age. Some people have enough room in their jaws for the wisdom teeth to erupt normally and function properly like their other teeth. However, if there isn't enough space wisdom teeth can lead to problems. If the wisdom teeth are impacted it means they are trapped under the gums or in the bone. If this is the case the following can happen:

• Food can get trapped increasing the chance of a cavity
• Flossing can become more difficult increasing the chance of gum disease
• Neighboring teeth can get crowded or damaged
• An impacted tooth can result in a cyst that can damage bone 

Every patient is different, but in general, wisdom teeth may need to be removed if there is evidence of the following changes in the mouth: 

• Pain
• Infection
• Cyst
• Tumor
• Cavities
• Gum Disease

Just because 1 wisdom tooth is causing a problem does not mean that all of them need to be removed. Regular dental visits allow your dentist to evaluate your wisdom teeth and overall oral health. 

Research from Taiwan has showed that frequent and regular dental scalings (cleanings) are associated with a decreased risk of infection after total knee arthroplasty (TKA). The data analysis showed that patients who received dental scaling had a 20% lower risk for infection than patients who did not get scaling. The more frequently patients got scaling the lower their risk for infection. 

Source: http://www.ada.org/en/science-research/science-in-the-news/frequent-dental-scaling-was-associated-with-decreased-risk-of-periprosthetic-joint-infection