Merwe Castle and the Origin of My Name

The Merwede, Merwe in medieval Dutch, is a river in the Netherlands. It flows from  a branch of the Rhine to the sea and has changed course several times due to huge floods. So Van de Merwe means from the Merwede River.

In 1015 Count Dirk III of Fresia founded the city of Dordrecht, now in the Netherlands, and built a castle on the bank of the Merwede. The knights of Merwede fought in the first four crusades and brought back many relics. A Lord Daniel took the first tower of Constantinople. When he returned he commenced building a second castle outside the City of Dordrecht. Lord Daniel V built an expansion of the castle in 1335. Daniel VII died without a male heir in 1403 ending the direct line. 

The castle was partially destroyed during a siege in 1418 in a war over the Countship of Holland. Later that year a huge flood devastated the countryside. Three years later the St. Elisabeths flood caused massive destruction in South Holland, 72 villages were submerged. The strong ice of that winter cracked the castle walls which eventually collapsed. The people of Dordrecht took bricks fallen from the castle to build their cathedral and restore the city walls. Only a remnant of the keep facing the city remained standing. The ruins stood in water for the next 600 years until the area was reclaimed in the early 20th century. In 1940 archeological excavations began, and in 1971 the remaining walls were stabilized.

You Don't Need to Floss?!

OK, when the media reaches the conclusion that studies show that you don't need to floss, I need to comment. The conclusion is wrong, but it's actually accurate to say a study has never proved that flossing reduces decay.

The problem is with the difficulty of dental hygiene studies. If you try to do a double blind study, as soon as people know the study is about flossing- they floss! Even if they otherwise never would. If they know it's about brushing, they brush better. Almost no one will brush for a full 2 minutes without a timer. The average American brushes for more like 20 seconds. If you try to do a retrospective study and ask people how much they flossed 10 years ago, the answers are garbage! People don't remember, and they almost always give themselves more credit than is due. It's like asking people to write down everything they eat, most lie! At best people don't report actual portion sizes.

So it hasn't been proved in a study that flossing prevents decay. It has been shown that it reduces gingivitis and gum disease. And science has shown that you must "disrupt the biofilm" on teeth or it caused problems. That means you must disrupt the organization of the bacterial plaque. It's not technically about removing food, or even "cleaning" the teeth. You must prevent the bacteria from building a more solid structure of plaque- the junk on the teeth. That's when the damage occurs. This must be done between the teeth, too.

Flossing is not the only way to "clean" between the teeth. A water pick can do it. I like this one. A tooth pick can do it, if you're really good at it. An African chew stick can do it. Something has to get in between the teeth every day. Studies have shown that is the interval required for "biofilm organization disruption." That just isn't as snappy a headline as  "You don't need to floss now!"

Dry Mouth?

   A dry mouth can be miserable. Saliva also has several important functions.

• Lubrication- it makes you feel better, makes it possible to swallow food, and speak.
• Digestion- it actually has enzymes that start digestion.
• Cleaning- it helps to wash away food debris. It chemically buffers acid attacks from plaque or from acidic food or drink (Diet Coke!) Decay rates can skyrocket without enough saliva.
• It somehow helps keep the 1,000 different kinds of bacteria in your mouth in balance. Yeast infections and bad breath can result from imbalances.

Causes of dry mouth

• The most common cause in younger people is a medication side effect. This is possible with many medications.
• Sometimes the salivary glands just don't work like they used to.
• Detergents in toothpaste are drying.
• Diseases like Sjogren's.
• Radiation and other medical treatments can harm salivary glands.
• Lifestyle- smoking, mouth breathing due to tonsils, congestion etc.

Solutions (or at least aids)

• Water, sips all day long, a sip with every bite at meals, carry a bottle (or a flask!)
• Use a toothpaste without detergent. Detergents make the toothpaste foam. Americans like foaming cleaners, scrubbing bubbles! It's usually listed on the ingredients as a laureth sulfate. It's great for cleaning grease but not really helpful for toothpaste. Almost all of them have detergents. One that doesn't, and is widely available, is biotene. 
• biotene has other products like sprays, mouthwash, rinses and gum. They all contain helpful lubricants and enzymes.
  
• Mints and gum will stimulate saliva production. For heaven's sake, sugarless! 
• Oramoist is a long lasing patch that sticks to gums. It gradually releases lubricants and stimulates salivation.
  
• There are prescription medications, such as Salagen, that can stimulate salivary glands. Of course it won't work if the glands don't work at all.
• If the cause is a medication, sometimes a different one can be tried, or the dose adjusted.
• Use a vaporizer to humidify bedroom air. 

    Don't ignore a dry mouth. The dental consequences can be severe, and some of the treatments are pretty easy.

What is a crown?

   A crown is replacement for the enamel, the outer layer of the tooth. A crown is used when the enamel is broken, stained, misaligned or weak. The crown, or cap,  provides strength and protection for the underlying tooth.

   Crowns used to be made of metal alloy, porcelain, or a combination of both. Modern crowns are usually made from high strength, tooth colored ceramic. See  our video for a demonstration of their strength- search YouTube for "Doctor Adrian crown strength.”

   The procedure takes two appointments. First the tooth is shaped and an impression and temporary are made. In 3 weeks we place the final crown.

   How long a crown lasts depends on 3 factors:

          How good is the dentist

          How good is the lab

          How good does the patient take care of it

A case of a cracked tooth. Biting caused pain.

The light makes the cracks more apparent

The ceramic crown

 Inside

 A new tooth

Grinding, or "Lips Together, Teeth Apart."

     It seems like I give this speech several times every day. Now I can just refer to this blog post!

     If everything is working correctly, you shouldn't even be aware of your teeth or bite. If your bite bothers, your jaw joint hurts, or I complain about tooth wear- we have a problem.

     If you grind, usually the front teeth wear. Clenching wears the back teeth. Either one can bother the joint.

     The normal wear rate for enamel is about 30 microns per year, so 1 mm in 30 years. If you have worn 3 mm off your teeth, not uncommon, you have the teeth of a 100 year old! I used to tell patients, you have the teeth of a __ year old, but the girls made me stop. It sounded too mean.

     If you have any of these issues, your teeth should never touch. Really, never! The teeth touching is what has caused the problem, so it just needs to stop. When you chew, food is between the teeth so that doesn't count. Most of us clench with stress- when freeway traffic is bad, when a child throws a fit, or when we have a dental appointment coming up. During the day, it's a matter of becoming aware of your clenching. I have seen hypnosis therapy used. The post-hypnotic suggestion is, "Lips together, teeth apart."

     Grinding at night obviously can't be stopped consciously. It is usually stress related. Many people start grinding in college, then it becomes a firmly entrenched habit. The solution is a bite guard. They can be smaller than the NFL style. The guard will prevent tooth wear, and usually stops the grinding. 20% of patients still grind, but at least it's acrylic that grinds away, not enamel.

     Children often grind their baby teeth. It's not stress, the cause is actually unknown. Many kids grind their teeth so flat that only a little disc is left when the tooth comes out. Only a small percentage of kids keep grinding when their permanent teeth come in. If the grinding continues, then it's a problem, we don't want wear on those teeth. I know how terrible it sounds, but ignore it. Close the bedroom door.

     The TMJ is a ball and socket joint. Instead of being a simple hinge, the joint can slide around so you can chew. A disc in the joint enables the sliding. The disc is held in place with ligaments. The most common TMJ problem is when the ligaments are damaged and the disc pops out of position. It makes a popping noise, sometimes makes it hard to open or close, and hurts. The first thing to do for TMJ is to be nice to the joint. If your knees hurt, it's time to stop running and do a different excercise. With TMJ, it's no more hard food like beef jerky or sourdough bread. Be careful not to open too wide. Don't clench or grind, don't even let your teeth touch in the daytime. At night wear a bite guard. If you are in the 20% that still grinds with a guard, it should still help. It holds your jaw down and forward and only touches in the front. That minimizes the pressure you can put on the joint. If it still hurts after (1) being nice to the joint and (2) wearing a nightguard, it's time to see a TMJ specialist.

    Give us a call if your bite needs to be evaluated.

New Dry Mouth Treatment

This is a new treatment for a miserable problem. It's a medicated patch that sticks to your cheek. We have seen some good results. It only costs about 50 cents per patch. It's available at Walgreens or online. Here's their info-

OraMoist dry mouth treatment is a small, tablet-sized patch that adheres easily and comfortably inside the mouth and then slowly dissolves. It releases ingredients that lubricate and moisten the mouth, and other ingredients that stimulate natural saliva production. Just hold the patch to the roof of the mouth or inside of the cheek for 10 seconds to get it to adhere. OraMoist works extremely well as a dry mouth treatment at night - often all night. During the day, the patch lasts up to 4 hours.

How to Choose a Dentist

Everyone would like to have a straight, white smile. Dentists know this. Dentists would love to do more cosmetic dentistry. Today, most dentistry should be some form of cosmetic dentistry. But, with so much choice out there, how do you choose a cosmetic dentist right for you?

Remember that you are placing your aesthetic future in someone else's hands—literally. You want to make sure that this person is qualified, experienced, and able to meet your specific needs. So shop around. Many cosmetic dentists offer free consultations. Take advantage of these offers. Visit a few different cosmetic dentists. As you do your research, consider the following things:

Training and education. It's pretty safe to assume that most dentists have a fair bit of dental education. But how much do they really know about cosmetic dentistry? Dental school training is at an introductory or general level. Many dentists never attend further training beyond reading "What's New" columns. To stay at the top level, dentists must constantly attend workshops and seminars and, especially, attend hands-on training to keep up with rapidly evolving materials and technology. A dentist who invests time, money and energy to his or her own continuing education demonstrates a commitment to achievement, and to patient satisfaction.

Honesty. A good cosmetic dentist will be upfront about what he or she can do for you, how much time it will take, and how much post-treatment maintenance you will have to do. Anyone who tells you about "quick and easy" fixes is trying too hard to sell you his or her services.

Communication. You want what's best for your teeth. So, too, should your cosmetic dentist. Choose one who listens and makes sure he or she really understands your needs. Remember, you're looking for a course of treatment tailored to your specific aesthetic goals, so seek a cosmetic dentist who will customize a plan for your teeth. Conversely, make sure you understand your dentist. Go for someone who describes in detail what he or she proposes to do, and clearly answers your questions.

Artistic Eye. Remember, these are your looks at stake. Make sure your cosmetic dentist considers not only what will work best for you, but what will look best for you as well.

Experience. Practice makes perfect in cosmetic dentistry, just like anywhere else. The more experience a dentist has had performing various cosmetic tasks, the better he or she will be at it. Ask potential cosmetic dentists how much experience they've had in the type of procedure in which you are interested.

Before and After Photos. Every good cosmetic dentist has a collection of these photos available for patient viewing. Look at them, and pay special attention to cases similar to yours. The photos should be high quality and show amazing detail. Careful, some dentists might have purchased a photo set containing generic photos of cosmetic dentistry success stories. Be sure that the photos you see depict actual clients of your dentist.

References. Ask other patients about their experience with a potential dentist. A Google search can reveal a lot. Google reviews can be a good resource. It's not perfect, it is possible to cheat the system, at least for a while. I think a bad review or two is a good thing.  It shows that the reviews aren't totally rigged, and no business can please everyone. I believe that before any medical practitioner treats you, you should check Google and online reviews. Also, you can phone the State Licensing Board to inquire if any complaints have been filed against the dentist. You can check for disciplinary actions at www.dopl.utah.gov.

Tour of the Facilities. Finally, have a look around the office. This is your opportunity to see the equipment, ask questions about available technology and procedures, and check out the sterilization areas.

Other things to watch for. The dentist should listen to what you want. It’s not, “yes doctor, whatever you think is best,” anymore. The days of the guy down the street making crowns in his basement are over, too. Ask which lab will be used and check their website. Ask to see lab work of a similar case. The lab work should be neat and polished, not sloppy.  The dentist should have nice teeth. They should be white and probably have no silver fillings. It shows if he really believes in cosmetic treatment. The office should run smoothly, there shouldn't be too many miscommunications or too much employee turnover. There should be enough assistants. Modern techniques require more hands than the dentist and one assistant. The dentist should be interested in conservative treatment. If the recommendation is a crown for every tooth that has a filling- red flag. Long appointments for extensive work are not easy. The dentist should be experienced with a variety of drugs to make the appointment easier. The dentist should be very concerned about your comfort, remember special requests and not be rough or heavy-handed.  Attention should be paid to the health of your gums, your jaw joint and bite.  Cosmetic dentistry is not a “recognized specialty.” If a dentist claims to “specialize” in cosmetic dentistry, they are guilty of poor use of the lingo at least, deception at most. 

   There are dentist's out there who are caring , honest, and talented- choose one of those!