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Cavities are Not Inevitable

Most people assume that certain things are inevitable as we age, including common dental problems like gum recession, gum (periodontal) disease, or cavities.  However, none of these conditions are as certain as the old adage, "the only guarantees in life are death and taxes," as proven by a gentleman who came to see us recently. 59 Years Old with No Tooth Decay or Gum Disease Richard came to see us as a new patient in early May 2016.  Before I met him, our hygienist Amber said that he had a perfectly healthy mouth, which naturally was a bit of a surprise.  It's true that you aren't guaranteed to have dental problems by 59 years old, but most people certainly do.  Upon looking in his mouth, however, I realized that Amber was correct!  He has never had a cavity, has no gum disease or gingivitis, no gum recession, and only a few crooked teeth.  His bite fits reasonably well, he has a small amount of wear showing on the chewing surfaces, and that's it.  WOW! In our office, he set a new record for making it the longest in life with such superb dental health by a long shot.  The previous best was a 43 year old man who, as far as he could remember, had only been to see a dentist 1-2 times in his whole life.  But 59 years old is a heck of alot longer than 43, that's for sure. Obviously, I couldn't tell him that he'd better come back every 6 months to stay healthy!  LOL  :-D   Since most people don't make it quite this long, if you're at all concerned about cavities, gum disease, or improving your smile, please give us a call for [...]

By | 2017-06-09T20:28:30-04:00 September 6th, 2016|Taking Care of Your Teeth|0 Comments

Smiles by Payet Dentistry is Growing!

Smiles by Payet Family Dentistry is expanding! It's been a long time coming, but it's finally here. I'll be adding photos and updates here as things progress through demolition and construction. We're Closed for Labor Day & That Week for Construction Our office will be closed from today, Friday, Sept. 2nd, and reopen with just 4 rooms operational on Monday, Sept. 12th, as construction is anticipated to last through the end of Sept. or into early October. Since we will be short 2 rooms during the time, our schedule will be more limited, but we'll do our best to ensure everyone is taken care of in a timely manner. This is Phase 1 of 3 and includes the gutting and widening of my 2 main treatment rooms. This will greatly improve comfort for our patients and increase our efficiency, making all of your appointments faster and easier (and who's going to complain about that, right? :-) ), as well as adding a new portrait/video studio. I'm so excited about once again offering Complimentary Portrait Sessions for all of our Inman Aligner, Six Month Braces, Invisalign, and Smile Makeover patients! Phases 2 and 3 of the expansion will be mostly invisible to patients, as they will give us a bigger team break room and lockers, a laundry area for scrubs, and more storage, while Phase 3 will be an expansion of our dental lab and sterilization area and a last bit of additional storage. Phases 2 and 3 won't happen for another couple of years, though. It's Been a Good Space, but Cramped So here's how this section of the office has looked for the last 6.25 years, since we moved in on March 19th, 2010. [...]

By | 2017-06-09T20:28:33-04:00 September 4th, 2016|ANNOUNCEMENTS|0 Comments

I Didn’t Know Squat about Cancer

Cancer (in general) and oral cancer were certainly topics that I learned about in our medical/dental training 18 years ago, but after reading The Emperor of All Maladies: A Biography of Cancer by Dr. Siddhartha Mukherjee, I realized just how little I actually knew.  To tell the truth, after reading the book, I now have a mere glimpse into the complex set of 100+ diseases that we call cancer. A quick reassurance: this article does NOT contain any gross pictures that might upset readers. The History of Cancer as a Readable Story   I first learned of this book as recommended reading on the Rationally Speaking podcast sometime in 2016, and I picked it up at Barnes & Noble , along with Dr. Mukherjee's newer book The Gene: an Intimate History, which I'm now starting.  I've been interested in the topic of cancer for a couple years from being involved with the Skeptical movement that debunks pseudoscience and quackery in dentistry and medicine.  Sadly, there is a lot of woo and pseudo-medicine around cancer for many reasons, and I'll address those towards the end of this article. The book, published in 2011, won the Pulitzer Prize (among many other awards) and was made into a PBS mini-series, which I haven't watched yet; it's supposed to be quite good.  The easiest way to sum it up (for those who prefer the tl;dr version) is quoted here from the back of the paperback edition: The Emperor of All Maladies is a magnificent, profoundly humane "biography" of cancer - from its first documented appearances thousands of years ago through the epic battles in the twentieth century to cure, control, and conquer it to a radical new understanding of its essence. The story of cancer [...]

By | 2017-06-09T20:28:37-04:00 August 22nd, 2016|Oral Cancer, Taking Care of Your Teeth|0 Comments

Why Can’t Dentists Cure Cavities or Regrow Enamel?

I've previously discussed why you can't cure cavities, but recent research sounds promising, so it's a good time to review.  In addition, there were some good points raised in the comments of the previous article that deserve more attention.  Be warned: lots of bullet lists ahead as I break it down.  :-D Recap: Why We Currently Can't Grow Dentin or Enamel A small-looking cavity that was actually quite big, cleaned out with a laser and filled with composite resin. You can't cure cavities like this. Let's briefly summarise the difficulties that must be overcome in order to cure cavities, whether naturally or artificially: Once the cells that form dentin (odontoblasts) and enamel (ameloblasts) finish forming teeth, they die.  Some odontoblasts remain in the tooth pulp, but they are stuck inside and can't get out. We currently have no way to grow and transfer dentin- or enamel-forming cells into a tooth with a cavity and survive, much less grow new tooth structure. The dentin-forming cells in the pulp can't grow outwards, just inwards, which shrinks the pulp chamber.  This is a normal response to stress from cavities, bruxism, trauma, and aging. If you already have a cavity, we still have to get rid of the bacteria, which usually means drilling out the infected tooth structure. If we don't want to drill, but just put a miracle gel on the tooth, it has to do 3 things: Stay in place for a long enough time to strengthen the enamel and soak way in for deep cavities It has to kill the bacteria inside the cavity It can't negatively affect the rest of your mouth. If we have to drill out the cavity, then place the miracle gel, we still [...]

“If You Don’t Floss, You’ll Die,” Says One Charlotte Dentist

Oh ok, sue me for the clickbait headline....you'll die if you do floss, too.  :-D The Story: Does Flossing Even Work? Obviously, since I'm a dentist and have many dentists friends, one of the most commonly shared and widely discussed news stories this week has been about whether or not flossing is any good for you.  Naturally, because science journalists need traffic for their websites, too, there have been plenty of outrageous headlines: It all started with this Associated Press story: Medical Benefits of Floss Unproven Wait, Does Dental Floss Even Work? (Gizmodo) No Need to Floss, US Health Department Says (NY Daily News) Feeling Guilty about Not Flossing? Maybe There's No Need (The NY Times) And naturally, just as I've discussed in a number of other articles over the years, the science journalists have taken a story about the weak scientific evidence for flossing and suddenly turned it into "OMG FLOSSING IS USELESS!! DENTISTS HAVE BEEN LYING TO US FOR DECADES!!!!"       Ummmmm........no. Just......no.  /facepalm/       The Real Story: There Truly Isn't Much Good Research So here's the crux of the story as quoted from the Associated Press report that set the storm in motion: The AP looked at the most rigorous research conducted over the past decade, focusing on 25 studies that generally compared the use of a toothbrush with the combination of toothbrushes and floss. The findings? The evidence for flossing is "weak, very unreliable," of "very low" quality, and carries "a moderate to large potential for bias." Let me be perfectly up front and honest here, because I have to be, given how much I've harped on the importance of critically evaluating and understanding scientific research and [...]

By | 2017-06-09T20:28:43-04:00 August 3rd, 2016|Cavities, Gingivitis, Taking Care of Your Teeth|0 Comments

Replacing Veneers after 15 Years

There are a number of important questions to ask when considering cosmetic dentistry, including porcelain veneers: How many veneers do I need? What can (and can't) you change about my smile with veneers? When are veneers better than braces? How much do veneers cost? How long do veneers last and what happens when they need replacing? Recently, we saw a patient for whom I did 8 porcelain veneers in 2001, and his case illustrates all of these questions, so without further ado, let me introduce Steve's teeth.  (He's a rather private person and prefers not having his portrait used, and this is something that we always respect.) Please forgive the varying levels of photography you see through this article; the first photos were originally slide film that were scanned from negatives, then they move through a series of progressively better cameras and a progressively improving photographer (me). :-)  I've tried to even them out with Photoshop, but rest assured, absolutely nothing else has been done to the photos. 8 Porcelain Veneers in 2001 Steve originally came to us because he was getting ready to attend a big high school reunion, if I recall correctly.  It was on kind of short notice, too, as in he was catching a flight the next day.  Yikes!  But we arranged to see him later that day and started him on 8 veneers to lengthen his worn-down teeth.  He looked pretty good with the temporary veneers for the reunion, and we saw him a few weeks later to bond in the real porcelain veneers.  So back in 2001, the first set of 8 veneers took Steve's smile from here: Fast Forward to August 2015 & 2 Cracked Veneers Given that Steve [...]

Dental Cavities: How Fast Can They Grow?

How fast dental cavities grow may sound like a simple question, but it's actually rather complicated.  I decided to write about it, though, after seeing a patient recently to treat a cavity that went from just beginning to an almost-root-canal-sized cavity in just 14 months.  It's a good example of why most dentists still recommend dental bitewing x-rays every 12-18 months. Is the Cavity There or Not? Here's the starting x-ray, taken on Dec. 14, 2014.  If you look at the circled area, it looks fairly normal.  Unfortunately, there was a slight overlap of the teeth in the x-ray, as the digital sensor was angled ever-so-slightly, and the overlap may have masked the area of concern, preventing an earlier diagnosis.  Since the patient had few fillings, though, indicated a low risk of cavities overall, we didn't retake the x-ray to avoid unnecessary exposure.  Nevertheless, there's really nothing there that caused me any concern. 14 Months Later, the Cavity is Obvious & Deep Check out the circled area this time, eh?  I've outlined the nerve chamber in the tooth on the x-ray in red and the cavity in green, but it's important to know that a cavity is never sharply defined like this.  There are several zones identifiable in cavities, highlighted in the next image.  We also know that cavities are typically about 20-30% bigger than can be seen on an x-ray, which is due to 2 reasons: The human eye can only distinguish about 60% of the shades of grey as a computer monitor can project, so there is simply detail that the eye can't detect, and The deepest zone of decay has not yet softened enough to be less dense enough for x-rays to detect it, [...]

A New Smile with Porcelain Veneers for a Wedding

As a cosmetic dentist, one of the absolute most satisfying parts of my job is the ability to give someone a new smile.  Especially when it's because the person has an important event coming up, like getting married!  And that's just what happened recently with our patients Michael and Becky.  :-)  Scroll beyond the photo to read their story. A New Smile In Just 4 Weeks With Veneers Becky referred her fiancé Michael to us in early March because they had planned their wedding for early April.  While Michael was being your kind of typical guy ("Hey, I think my smile's ok, right?"), Becky was hoping that we could brighten and straighten up his smile for their wedding pictures.  And because Michael obviously loves Becky, he wanted to make her happy. Which we all think is really sweet of him.  :-D  And to tell the truth, I totally get that!  After all, I got 8 veneers bonded in just 4 days before my wedding in 2006. So after some discussion, we agreed that veneers were also the best choice for Michael.  Due to time constraints, they were really the ONLY option.  Thankfully, we work with an absolutely superb dental lab based out in Oregon named Disa Dental Studio, with a true artist and ceramist, Bill Marais.  Bill is quite literally known and respected for his work around the world, and we're very fortunate to work with him.  Even though the pressure was on, with less than 5 weeks from the time Michael first came in, Bill delivered a phenomenal work of art.  We bonded in Michael's veneers on Tuesday, and the wedding was the very next Saturday.  Obviously, Michael had a lot more to smile about [...]

By | 2017-06-09T20:28:51-04:00 April 14th, 2016|Cosmetic dentistry, Porcelain Veneers|0 Comments

We Do NOT Discriminate

Let me start off by saying that, while I’m not a native North Carolinian, I have lived here for almost 26 years and have deep family roots in the state, as my Mom was born in Lewisville and grew up in Albemarle (most of our extended family still live in the state, too), and my parents met in Chapel Hill during college.    I chose to start my practice here and live here with my wife and daughters.  Charlotte, NC has been my home for the last 18 years & will probably be our home until we die. However, since the passage of House Bill 2 by the NC Legislature and Governor McCrory’s signature on Wednesday, March 23rd, 2016, I am now deeply ashamed to say that I am from North Carolina.  And while I generally try very hard to avoid discussing politics within our practice, in person or in writing, I believe this is a time to stand up for what I believe is right, both personally and professionally.  The following article will describe why I believe that HB 2 is wrong and the NC Legislature should repeal HB2 immediately: Repeal HB2: It is Immoral & Discriminatory First and foremost, I believe that our state legislature and Governor have now signed into law a measure that makes North Carolina among the most discriminatory and anti-LGBT in the nation, and that is wrong.  The United States Constitution and long legal precedents have determined that ALL people are deserving of equal rights, not just the ones approved of by any single constituency or any religion.  As is often said, “Rights can’t be voted on; that’s why they’re called RIGHTS.”  But the NC Legislature and Governor have [...]

By | 2017-06-09T20:28:53-04:00 April 4th, 2016|ANNOUNCEMENTS|0 Comments

Charlotte Dentist Google+ Collections: Like Pinterest but Better

One of my favorite new(er) features on Google+ (yes, I'm still a huge fan of it and you can Circle or Follow us here: Smiles by Payet Dentistry) is Collections.  So what are Collections?  Easy: they're a way for users to organize their posts by topics.  This means that you can Follow either a Person (everything they share) or just certain Topics, so if you want to keep up with one person's photography but not their politics, you can just follow the person's Photography Collection (that's a link to my personal Photography Collection) rather than everything.  If you're the person creating a Collection, you can set it to either Private (just people in your Circles), Public (everyone can see it), or Custom (you pick who sees it).  So it's a very fun way of organizing your own content (makes it easier to find stuff later on for sure) or following specific topics from others.  And naturally, we have a bunch of them for our Page: Smiles by Payet Dentistry Collections.  But I'd like to feature a few specific ones. Foods to Make You Smile Hey, who doesn't love food, right?  As a dentist, there are things I recommend you avoid or minimize, like excess sugar and acidic drinks.  Other than that, no crazy fad diets or recommendations here, just photos of, and recipes for, yummy food that I like and that you might, too.  Want us to share your favorite recipe?  Send it to us and we'll add it! Kids' Dental Care Need tips on taking care of your kids' teeth?  When should you start a fluoridated toothpaste?  Are electric toothbrushes for kids good? How long should they brush?  Do amber necklaces help with teething? (Ummmm, NO, [...]

By | 2017-06-09T20:28:57-04:00 March 10th, 2016|ANNOUNCEMENTS|0 Comments