Do You Grind Your Teeth? Maybe Not…

Doctor KulagaWhen you crack or break a tooth unexpectedly, it can be a frustrating moment. You wonder, “how could this have happened?” your dentist may ask if you grind or clench your teeth. Most people are surprised by this question and say they do not. This can further add to the frustration. At this point you may feel it was bad dental work or something missed at your last check-up. You, as the patient, may very well be right.

You may not be grinding or clenching your teeth and something may have been missed: undiagnosed sleep apnea!

I have a personal vendetta against sleep apnea as the night my father passed away at the age of 52, my mother said he was snoring very loudly. Our dental hygienist brother in law passed away at 35 on the sofa due to sleep apnea.


A Serious Condition

In 2013 I began my studies into sleep apnea as I was looking for solutions as to why high quality dental work was breaking. What I learned was amazing. For those that are not aware of what sleep apnea is, you stop breathing while you are sleeping. Warning signs of possible sleep apnea are snoring, not feeling rested when you wake up, tired and low energy throughout the day, and even having a hard time with controlling diseases such as high blood pressure, diabetes, and heart disease. When you are in an unconscious state while sleeping, a lot of activity may be going on you are unaware of. During these episodes of apnea, your lower jaw moves around like a restless leg. Furthermore, your body is looking for oxygen and may thrust your lower jaw forward which can collide with your upper teeth.

Simply getting a night guard may help save your teeth, but it may make the underlying sleep apnea worse. Now this is where you, the patient, is correct. You are NOT grinding your teeth, but rather your teeth are hitting each other in a violent fashion during these apnea moments. As your dentist at White Wolf Dental, I am not the provider to diagnose sleep apnea, but rather the one to look for signs and symptoms. If I see signs of sleep apnea, I will refer you to one of our local sleep physicians. If you are diagnosed with sleep apnea, the standard of care is wearing a CPAP nightly. For those that are intolerant of the CPAP or have mild sleep apnea, your physician may write for a prescription for an oral appliance that we can make at White Wolf Dental.

A Solution That Works

An oral appliance has a compliance rate as high as 80%. Patients report it is much more comfortable than a CPAP and it can be easily taken when you travel. Not every dentist can make a sleep appliance, it takes many hours of training to understand not only how to make the device, but how it treats the apnea itself. Without the guidance of a highly trained dentist, oral appliance therapy may not be as effective. This is very critical as under treated sleep apnea may lead to other issues in your body, including death! As your dentist, I want to more than save your teeth for that beautiful smile, but also potentially save your life!

Oral Pathology – The Importance of Oral Cancer Screening

Doctor Kulaga

From coast to coast, thousands of patients are seen everyday in dental practices, yet oral cancer is missed. Is it because doctors are not looking? Has the doctor not been trained properly to identify a suspicious mouth sores, also known as a lesion? The answer is possibly both, and I admit as a dental profession that we must become better at being able to identify these lesions early.

Recently, Dr. Abrahams, Melissa R.D.H, and myself took a course from the University of Florida on Oral pathology. This is a course we take yearly to make sure our eyes are trained to catch the small lesions. In our practice we find approximately 250 lesions a year that need a two week follow-up to make sure it resolves. Of these 250 about 40 require biopsy. Most come back as benign lesions with nothing to worry about, but since 2012 we have diagnosed at least one case of oral cancer each year. We encourage our patients to also come in if they have any type of lesion in the mouth that does not heal in two weeks to return.

Remember, anything red or white that stays in the mouth longer than two weeks needs attention. Let me give you an example: A patient had something that looked like a cold sore on his lip and we agreed to have it looked at in two weeks. At that check it was still there with the same size and he stated he cut himself there with the razor and its why he hasn’t healed. I advised him this does not seem to be the case and we recommended a biposy. He stated it was not necessary. One month later we saw him and the lesion looked the same. After much talking, he finally agreed to the biposy. The results came back as squamous cell carcinoma and required surgery with radiation. Because he waited, the cancer had spread further under the skin and he required much more facial dissection than would have been needed if he addressed it earlier leaving him with permanent dis-figuration. Remember, any lesion that lasts more than two weeks we need to see it!

You may see at other practices that they use special lights or solutions to find these oral lesions, but there is usually a charge for their oral cancer screening. At our most recent course, two instructors from the University Of Florida Pathology department stated these devices do not lead to a better exam and actually return more false positive results. Their recommendations is to do a high quality oral soft tissue exam looking at all aspects of the mouth, including the back of the throat. At White Wolf Dental, we include a high quality oral cancer screening as part of our new patient comprehensive exam. Not only do we complete a high quality oral exam, we also take a 3D scan that allows us to see pathology in the bone and sinus that traditional x-rays would miss. As of this writing our exam is $99, but at other offices an exam of this caliber would be over $569! We want to take care of our patients and want to make access to high quality care more affordable.

So the next time you go in for your yearly dental exam, make sure your dentist does a high quality oral exam. It doesn’t matter if you come to our office, one in Aspen Colorado, or anywhere in the heartland of America, make sure your dentist pays close attention to not only your teeth, but the whole mouth.

~Dr. K

Unhappy with your smile? You are not alone!

Doctor Kulaga

“I have lost all confidence in my smile.”

Has this statement ever crossed your mind? If so, you are not alone! In our office, we often see patients who want to regain confidence in their smile and repair the function of their teeth so they can chew even simple foods. A big part of life is enjoying laughter with friends over a good meal, so, when your teeth keep you from socializing due to embarrassment, it now goes beyond just “I can’t eat”. The good news is, we are here to help! We have many options in our office to help our patients and each procedure has its pros and cons. In this article, we go into great detail about what to expect from your transition of broken teeth to a smile you can be proud of!

At White Wolf Dental, we never judge our patients and will do whatever it takes to make you comfortable. We will listen compassionately to your needs, wants, and desires. This article describes the most severe situations: When teeth cannot be saved.

All of our doctors are firm believers that dentistry is second to mother nature and try everything to keep dental work to a minimum. We all believe the best dentistry is preventative or no dentistry at all. Unfortunately, many people have circumstances beyond their control, such as their daily medications, underlying illnesses, or even fear of seeing the dentist, that cause their teeth to fail.

Now, let’s talk about what we can do to repair your smile:

We can do standard dentures for both the top and bottom
We can do implant dentures that are removable but snap into place
We can make a fixed hybrid prosthesis that is screwed down and only removed in office

While there are many options on how to sequence these procedures, we have developed a remarkable formula that gives our patients the most predictable results. I will say this now, in dentistry, slower is sometimes faster and I’ll explain more later.

The most affordable option is to do conventional dentures. The majority of people do very well with their upper denture as it has a lot of surface area to create suction, and very few people require implants on the upper arch to stabilize the denture. The lower denture, however, is much different as people have difficulty with the looseness and sores created. Why is the lower so much harder to deal with? You have a strong tongue, chewing muscles, and less gum to attach to. All of these factors lead to patients not being very satisfied with the bottom denture. Patients will only have approximately 30% chewing function of natural teeth with conventional dentures. Here’s a list of the pros and cons:

Pros: Lowest cost, easily repairable, can be relined to fit better, fastest solution
Cons: May need to use adhesive, feels the largest in the mouth, teeth can wear prematurely from a harder food diet, teeth can crack, teeth may come off, food tastes different with roof of mouth being covered, cannot bite corn on the cob or bite into an apple

Our second option is doing implants with dentures. This is a very popular option as you do not use adhesive, the upper denture does not cover the roof of the mouth, and the lower denture is much more stable. Patients will have approximately 45% chewing function of natural teeth. Here’s a list of the pros and cons of implant dentures:

Pros: Do not need to use adhesive, roof of mouth is not covered, feels less bulky, more comfortable due to smaller size, lower denture does not fall out, stronger denture base with custom metal framework.
Cons: Nylon snaps need to be changed every 12-18 months (usually 6 to change out at around $25 each as of this writing), relines maybe needed at year 5 or so, teeth can wear prematurely from a harder food diet, teeth may come off, lower denture with 2 implants still has a slight forward rocking

The first two options have a similar beginning and processing so we will walk you through what to expect if you choose either of these denture options. I will be frank and honest here and not sugar coat the process as we want all of our patients to make the best decision for themselves. First, you will visit us for xrays, photos and records. At this appointment, you will tell us which option you would like . Since this is a complex procedure, we almost always ask our patients to return for a complimentary consultation to go over costs and time frames. We feel an appropriate plan can not be made in 10-15 minutes while you talk with the Doctor during this initial exam. Following your initial exam, your team of Doctors plan your case together to make the most predictable outcome. We will schedule you to take models, pick the color, shape and size of your teeth and coordinate with our lab to make your new smile. Since we do not have the ability to test-fit your teeth before surgery, your cosmetics and bite may not be perfect, but I would say we get 80% of the way there. Even for your temporary dentures, we use a high quality local laboratory giving you the best possible result. On the day of your surgery, your natural teeth are extracted and we place your prosthesis. We want you to wear your prosthesis for 24 hours. Many people return to work in three days after surgery. For the first week, your dentures will be the most loose as your gums need time to heal before pressure can be applied to them. One week after your surgery, we will place a soft liner to tighten up your dentures. Week two is when things start to get better and you begin to learn how to use your new teeth. During the first three weeks, you will likely need the most adjustments for sore spots. In our office we never charge for denture adjustments as we want you to wear them and be comfortable. If we see you 3 times in a month or 20, it’s okay! Everyone is different and healing can be variable. This is also something to take into consideration when thinking about the overall cost of your denture. In some practices, not all the costs are upfront costs. By week four, things are usually smooth sailing.

In our office we usually make two sets of teeth, your temps which were described above, and a final set. Why two sets? Since we did not have the ability to try in your teeth before surgery, the cosmetics and size of the denture is not ideal. With the second set, we are able to customize the teeth to a more ideal form and fit. We usually start making the second set around month four and we will take what is called a final impression on month six. I know what you are thinking: Why do you wait six months for a final set when other offices do it all in a day or six weeks? We have found if you move too quickly, the patients need a hard reline of their denture within a year because we have not allowed the bone and gum to adequately heal. Hard relines can be a costly and unexpected expense that we try to get in front of. This is where slower is faster! By allowing you to heal more, your final denture fits much better and the risk of relining your new denture is minimized. Sometimes, the patients are so happy with their temporary dentures and do not have the budget for a second set, we can turn the temporary dentures into your final dentures by doing a hard reline at month six instead.

If you want to achieve results most like your natural teeth, our teeth in just a day procedure will be the best option. The name, “ teeth in just a day”, is slightly deceiving because, while you do get a new set of teeth on the day of surgery, these will be your temporary teeth. We usually complete the process with your final set around month six. Again, we want to make sure your bone is stable, your gums are stable, and your implants have achieved osteointegration (your body has attached to the implants)with no bone loss. Your final set of teeth will be made from a zirconia with a layered porcelain which has a 3 year warranty or a monolithic zirconia that has a 6 year warranty. We no longer offer weaker plastic or composite teeth, however, the higher quality teeth we do offer are priced very similar to them. Please read our blog with Ms. Smith story to see the “teeth in just a day” transformation from start to finish. With “teeth in just a day”, you get strength, beauty, confidence, and 95% function of your natural teeth. Here’s a list of the pros and cons of “teeth in just a day”:

Pros: It is screwed in place, can brush and eat like normal teeth, minimal chance of failure, minimal chance of teeth wearing out, you can bite into an apple and corn on the cob, smallest fitting of all three and closest to natural teeth, get cleanings every 4 months like natural teeth, at least a 15 year lifespan
Cons: Difficult to repair, must be removed every 18 months to clean underneath, can sound loud if you bite too hard, most expensive option

Wow! I know that was a lot of information but, believe it or not, there is still more we could cover. We hope this helps you make the best choice, whether it’s with our office or another. I’m sure you have more questions so remember, we always offer a complimentary consultation to speak with us in person to discuss your dental needs further. During this complimentary consultation, we will talk about what may be best for your smile and, after visually examining your mouth, the Doctor will determine if you are a candidate for the proposed procedure. If you need, or want, a more detailed examination, we have a $95 charge for xrays, 3D scan, and photos, however, we will always credit this back to you when you start treatment at our office. There is no pressure to take xrays during our complimentary consultation and you can take them whenever you are ready. If you bring xrays, there is no cost at all. At White Wolf Dental, we are here to help and will do whatever it takes for you to be happy, be confident, and smile again!

~Dr. K

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LANAP – A Safe, FDA-Approved Laser Gum Therapy

Doctor Abrahams

LANAP vs Laser Periodontal Surgery

We had a long time patient come into the office recently asking about the varying results he had read about online concerning laser gum therapy. He told us that he had searched “Laser gum surgery” on his web browser and the results were so confusing that he came to talk with us directly.

One of the most common diseases in America is gum disease. 8 in 10 Americans have some sort of gum disease, yet only 3% will ever seek any type of treatment. Signs of gums disease could include red gums, bad breath, gums that seemed to have pulled away from teeth and even loose teeth – just to name a few. Technology has given us a few options to treat gum disease that is in the later stage, including laser technology.

Not all lasers used in dentistry are the same!

There are many different types available in dentistry that can each be used for different treatments from cutting bone and teeth to removing excess gum tissues to periodontal therapy. Some dentists out there will state that they use a laser to treat GUM DISEASE, despite their particular device’s lack of research papers that confirm its ability to kill bacteria while activating healing processes in the teeth and gums.

At White Wolf Dental, we use a device called The Millennium Periolase to perform a procedure called the Laser Assisted New Attachment Procedure (LANAP). This is the ONLY FDA approved laser-utilizing periodontal therapy that can create new attachment when there is a weak attachment to the teeth. In the dental world we call this the absence of long-junctional epithelium. This laser is the ONLY device we use at White Wolf Dental to perform LANAP on our patients.

Sounds Complicated?

It’s really simpler than you think. “Long-junctional epithelium” is a weak attachment of the gums to the teeth. We don’t want that. We want a STRONG attachment similar to the original one present when your teeth were first made. In a healthy environment, the strong attachments can be help support bone growth and healing around a tooth.

Long story short, the LANAP procedure with the specific Millennium Periolase Laser is the only FDA approved laser therapy for the regeneration and recreation of bone around teeth! That’s why it is the only procedure of its kind that White Wolf Dental offers to our patients. Ask your dentist if they have a Millennium Periolase or if they are just hoping for a good outcome!

~Dr. A

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Keep on Flossing!

Jeanie at White Wolf Dental in Port Orange, FL
Does the latest news about flossing have you confused or even happy? Don’t toss your floss just yet! Our government has endorsed flossing since 1979 when the Surgeon General and then later in the report Dietary Guidelines for Americans stated that daily flossing reduces both dental caries (cavities) and periodontal disease.
The problem with this latest news from US Health and Human Services is that there is not enough long term, evidence based studies. The report that just came out only looked at 10 years of data and did not find enough adequate studies to confirm nor deny that this practice is helpful. This does not mean that flossing does not work!

The bacteria that live in our mouths are live and make a substance called plaque biofilm. Daily flossing does two things for our mouths:
1. Mechanically removes millions of bacteria
2. Disturbs the biofilm.

If left untouched, this plaque biofilm is allowed to grow and multiply, causing an overgrowth of bad bacteria in our mouths. If we are not removing the bacteria, this overgrowth activates the immune system and causes chronic inflammation that can further damage our health. When our immune system is activated, it sends inflammatory and chemical mediators to the area, such as white blood cells. These mediators can cause inflammation and bone loss. Some of the mediators are inflammatory chemicals such as C- reactive protein which is a marker for inflammation that causes coronary artery disease. This is just one of the inflammatory markers our bodies make when under attack! It’s imperative that we disturb this biofilm so that bacteria is not allowed to flourish and trigger these reactions.

It is our stance that everyone should continue to floss for health and wellness! If you are having trouble with your flossing technique, see our dental hygiene department for tips and tricks to make flossing more comfortable and effective. Happy flossing!

-Jeanie Grondzik RDH COA

Not all Dental Cleanings are Created Equal

Doctor Kulaga

“I just want my regular 6-month cleaning”

It’s a phrase we hear from time to time when we tell a patient that a routine cleaning won’t be enough. It’s understandable that these folks may not want to spend extra time in the chair, make a necessary follow-up visit, or spend the money for the cleaning procedure they really need. But the truth is, sometimes a routine cleaning simply isn’t enough to stave off periodontal disease.

80% of Americans have some form of gum disease and this is why we have a Periodontist on staff. Even I, your dentist, have periodontal disease. Ask my hygienist, Melissa, at your next visit and she will tell you from time to time I will develop some 5 millimeter pockets. How do I, a dentist, have gum issues? I floss 4 times a day, I brush 3 times a day and yet I am still getting pocketing. More than likely my cause is genetics, the type of bacteria I have in my mouth, and the fact I am a clencher. My father’s side of the family does have a history of tooth loss from periodontitis and the type of bacteria I have in my mouth is more aggressive. We have tools to check your bacterial levels when needed and a wide range of treatment options from scaling and root planing to LANAP to help control the bacteria. LANAP is a very technologically advanced procedure that it has even been granted approval by the FDA to state that the procedure can regenerate some amounts of lost bone. Never in dentistry has this been possible until now.

Periodontal disease is very serious as it slowly leads to tooth loss. It can be difficult for the patient to understand a recommendation we make when the disease is present as many times the symptoms are not. This is why every once in a while we will have a patient leave our practice due to us not performing a regular cleaning because periodontal disease has been diagnosed. This can be a frustrating moment as many of these patients do not feel pain, do not see any issues, have been coming every 6 months for cleanings, and usually have good home care. So how did this problem all of a sudden show up? Well the answer is it has always been there in some form, but unfortunately many dental practitioners ignore it until its too late. Here at White Wolf we will always inform our patients of their oral health in an honest manner.

Now it is time to share a story. About once a month we will have a patient return that left our practice due to us not performing regular cleanings on them due to being diagnosed with periodontal disease. They usually will find another dentist that will perform regular cleanings. After 3 or 4 years pass by they start to develop symptoms such as sensitive teeth due to receding gums, teeth looking longer in appearance, or teeth beginning to move. Here is an xray of a patient that left our office about 4 years ago. The black arrows on the first image is where the bone was in 2012. The second image has black arrows showing the height of the bone in 2012 and the red arrows showing the current level in 2016.

Periodontal Disease

Notice how much bone loss has occurred; all the way around the root tip! Believe it or not this patient did not have any pain on this tooth even though there was no bone around it. The main complaint was that her partial denture did not fit anymore. This inability to be put the partial denture back into the mouth was due from to the teeth moving from due to the lack of bone support. Many patients will even state to me “Well isn’t doing 6 -month cleaning (prophylaxis) better than nothing?” Unfortunately, as you can see in the example above, doing the incorrect treatment can have very negative effects.

I do not like seeing this situation as to and recovering from it is very difficult. We now have to discuss extractions and tooth replacement options such as implants and partials. All of this adds further frustration, cost, and possible decreased function than if we would have done periodontal therapy to control the disease from the start.

Please notice how I said ‘control the disease’ not eliminate it. Periodontal disease is like high blood pressure, once you have it there is no way to cure it, but you can control it. With high blood pressure you take a daily medicine and your blood pressure stays in a normal range. With periodontal disease, after the initial therapy you will be on a 3-month periodontal maintenance program to keep bacterial levels lower. Also, the periodontal maintenance cleaning at each recall appointment is more thorough than a regular cleaning as the hygienists do go under the gums more aggressively to wipe out the bad bacteria.

So the next time we recommend a cleaning other than your regular cleaning, we are not trying to up-sell you, but rather we are trying to help by preventing bone loss, eventual tooth loss and the future heart ache and expense of replacing lost teeth. Periodontal disease is a very slow process and I do not want to see another patient return and say “Doc you were right 4 years ago and now I need help!”

Dr. K

Can sleeping be hazardous to our health?


As if heart disease, diabetes and cancer are not bad enough, do we really have to worry about going to sleep each night? If you think you have sleep apnea, you likely do. Sleep apnea is caused by complete or partial airway obstruction. Despite the effort to breathe, its characterized by repetitive episodes of short or paused breathing during sleep and can cause a reduction in blood oxygen saturation. These apneas can last 10 to 40 seconds each. This can happen hundreds of times each night and interferes with the ability to enter into the deepest stage in the REM sleep cycle that is required for the physically restorative effects of sleep. Common signs and symptoms for sleep apnea are having day time fatigue, waking up and not feeling rested, snoring loudly. Feeling irritable, depressed or anxious.

There are a few things that make people at risk for sleep apnea. The most common is being overweight. Having a large neck circumference, a narrow airway, being male, being older and snoring loudly. Also use of alcohol, tranquilizers, using pain killers such as opiates or narcotics and smoking can also be other significant risk factors for developing sleep apnea. Unfortunately this disorder is one of the most misdiagnosed by doctors, and can result in serious health complications. High blood pressure or heart disease, type 2 diabetes, metabolic syndrome, complications from surgeries or medications are just some of the health complications.

It can also be fatal.

This fact hit home this past March when my 38 year old brother-in-law died in his sleep from sleep apnea. He left behind his young wife, Brooke, and two little girls ages 3 and 7. A successful business owner, loving husband and father, he died in the prime of his life. He had some of the risk factors like being overweight and enjoying his beers on Friday night. Brooke had often said he snores like a freight train, but had been snoring for many years. He never got a chance to be diagnosed and was found dead in the spare room (because he kept Brooke up at night snoring) one beautiful spring morning this past March by his youngest daughter, 3 year old Brackey. It seems such a senseless passing especially since there are many options a person with sleep apnea has for this condition.

The first thing you should do if you have even one of these symptoms, is have a sleep study done. Contact our office and we will set up a sleep study with Florida Hospital. Our own sleep apnea expert Dr. Matt Scarpitti will evaluate you and refer you as necessary. Treatment for sleep apnea is achieved by using a CPAP machine. Its called a continuous positive air pressure machine and hooks to a mask you wear on your face that provides you with oxygen even during apneic moments. We also make a customized mouth guards for patients who cant tolerate the CPAP machine. In hind sight, I should have talked more about this to him. We may have been able to save his life. If I can educate our patients about this potential life saving information, I will feel as if his death was not in vain.

Don’t ignore these symptoms! Get it checked out!


Top 3 Questions About Dental Implants

Doctor Kulaga

In today’s world, there is a lot of information available very quickly and easily. A quick search on
the internet will reveal more results than most people can process in a day. For this reason, looking up medical or dental procedures can become confusing as sometimes it is difficult to determine what is opinion or what is fact. To help make things a little simpler, will go over the three most common questions we are asked by patients looking at dental implants as an option.

What is the difference between a no charge consultation and comprehensive exam?

After you do your research, you can come to us with questions and we will be your guide on your journey to a perfect smile. We will answer all your questions and get a better understanding of what your wishes, wants and needs are. Once all of your questions are answered and you feel implants are a good choice for you, we will do a comprehensive exam for $99 to determine your specific needs. This includes our 3D scan, photos, bite­wing x­rays and a doctor exam. Implants need to be placed in a very precise manner so we spend extra time to plan your case. Both the surgical and restorative doctor utilize the 3D scan as a template of your mouth and it allows us to place digital implants in exact areas for optimal implant placement and success. Both doctors work as a team to utilize this technology to make the smile of your dreams as flawless as possible. Everyone’s anatomy is different and just placing an implant in bone and not understanding the space requirements for the implant crown can lead to early failure or an implant crown that always becomes loose. This is why we use the team approach to implant planning as we utilize each doctors area of expertise and bounce ideas off each other. Sometimes a patient may not have adequate bone height or width for implants, so we can plan to do bone rebuilding to make the area ideal for an implant. By doing this careful planning, we can usually avoid anatomy, such as nerves, to prevent long term harm and have a prosthesis that fits well. Once this very detailed planning process is complete, we will have you come back for a no charge sit down review of your treatment plan, time frame, and cost of your ideal treatment.

How much do implants cost?

This is a difficult question to answer as every patient is unique. What most people can compare is the cost of what is called the implant body or more commonly called the “screw”. At our practice as of Spring 2016 the implant body is $1900 and if you have our QDP membership it is $1520. Once an implant is placed there are many things you can do with it, such as attach to a tooth or a denture so we will not go over those costs here as it can be variable. Moreover, we offer something called a bundle fee so that if you are doing a lot of work, we can lower your cost-per-implant as ours goes down also. As an example of our New Teeth in Just One Day bundle fee, we only charge four implants (screws) to the patient, but if the bone allows and we can do five or six, we will at no additional cost.

Will I be comfortable during treatment?

The next step in creating your ideal smile is ensuring you are at ease during your treatment. It is not just about the planning or cost to us, it’s making sure you are as comfortable as possible with the doctors and staff. We try our very hardest to make your experience a positive one. If there is something you need or prefer, always let us know so we can make each visit as comfortable as possible. Our office has many sedation options to help those that need dental work, but are too fearful to receive treatment. Nitrous oxide or laughing gas, helps relax you. I would relate it having a glass of wine. Oral sedation is the next option. It is a form of conscious sedation similar to IV sedation but in pill form. You are never “knocked out” and are always able to respond to us. Most people are so comfortable they do fall asleep, but not from a too high dose of medicine. This is a great option for procedures up to 3 hours. Our final option is IV sedation. This form of sedation gives us the most control and allows us to keep you in a more comfortable state. You will still be able to respond to questions, and you will not be “knocked out”, but you may be so comfortable you catch up on your beauty sleep. The greatest advantage of oral and IV sedation is that most people do not have a memory of their experience.

At White Wolf Dental, we feel strongly that answering your questions up-front and honestly helps you make the best decision. We want you to  know what you are getting into and how we can make the experience a positive one. Our team of doctors and staff will always work our hardest to give you the smile you deserve.

-Dr. K

Sleep Apnea and Dentistry

Doctor Scarpitti

When most people visit their dentist they don’t typically think of having a conversation with them about their sleep. However, did you know that dentists can help treat a sleep condition known as sleep apnea? While it may seem unconventional, sleep dentistry is becoming a major part of improving quality of life for our patients. So what exactly is sleep apnea?

Sleep apnea is a diagnosis given by a certified sleep physician in which people repeatedly stop and start breathing during sleep. It can be a potentially life threatening condition as it can affect weight gain, increase the risk of heart disease, stroke, diabetes and can also be very serious for people who are constantly fatigued, especially while operating a motor vehicle.

So how do we as dentists help treat sleep apnea? With the help of a board certified sleep physician we can screen patients and refer them to have a sleep study performed. The sleep study is ordered by the physician to determine if a patient has obstructive sleep apnea or central sleep apnea. Depending upon the diagnosis and treatment recommendations by the sleep physician, the dentists can help treat obstructive sleep apnea with an intraoral appliance.

Typically, the first line of defense to treat obstructive sleep apnea is the CPAP machine. This machine works by creating a constant flow of air to open a patients airway and allow for unobstructed breathing. If you have previously been diagnosed with OSA and are currently using but struggling with the CPAP, a viable alternative is also an intraoral appliance made by a dentist.

An intraoral appliance is different from the CPAP machine in a couple of ways. It works by moving the lower jaw forward in order to manually open the airway. One analogy I like to give my patients is to think of a garden hose with a kink in it. The hose would be the airway, the water the air, and the kink the obstruction preventing air/water flow. The CPAP works the same way as increasing the water pressure in the hose by opening up the water faucet which then increases flow to overcome the kink/obstruction. The intraoral appliance works manually in this analogy. It would be as if you grabbed the hose and manually relieved the kink in the hose to increase flow and allow for the passage of water.

A few common signs/symptoms of sleep apnea:

  • Frequent waking during the night
  • Dry mouth, grinding of the teeth known as bruxism
  • Feeling groggy upon waking
  • Consistently tired through out the day
  • Trouble concentrating at work/school
  • Snoring
  • Increased weight gain

If you suspect you have sleep apnea consider seeing your dentist or family practice physician for a screening and referral to the appropriate sleep physician. See this atricle from the Mayo Clinic for more information.

Dr. S

The Right Tool for the Job – The Sonicare Difference

Doctor Kulaga

Benjamin Franklin said it best; “An ounce of prevention is worth a pound of cure.” In oral health, this saying goes a long way. Even though our current dental materials are far superior to what we had even 10 years ago, they are still second best to your natural tooth structure. At White Wolf Dental, we pride ourselves on patient education which includes preventative care to keep your natural teeth healthy for a lifetime.

One of the simplest ways we can improve our oral health is to be more thorough with the way we brush our teeth. Brushing our teeth is one of the easiest activities we do each morning, but most people when asked about their technique describe very inefficient ways of brushing. Here comes technology to the rescue! The Sonicare electric toothbrush is my personal recommendation to achieve the best results for plaque and tartar removal.

Sonicare Electric Toothbrush by Phillips

With the bristles moving in rapid vibration, the Sonicare brush creates millions of tiny bubbles that are able to increase the surface area of your toothpaste and clean areas your normal toothbrush could not even come close to reaching. This activity also helps clean out the bacteria underneath your gums that can cause gingivitis. Up to 80% of Americans have gingivitis. If you poked your arm with your finger and it started bleeding you would be worried. Having bleeding gums should be as much of a worry. The Sonicare gives you the ability to reach bacteria that cause inflammation, which is the underlying cause of bleeding gums.

Sonicare removes up to four times more plaque than a manual toothbrush after four weeks of use.
Sonicare removes up to 4X as much plaque as a manual toothbrush.

This clinical study published by Phillips summarizes the difference between Sonicare and manual brushing.

As fancy as this technology is, you still need to floss! Between flossing and use of a Sonicare, Americans can prevent thousands of dollars in dental work.

Not every member in your home needs a Sonicare handle. You can save money by buying one handle and other family members can have their own brush head that attaches to this handle. This way everyone benefits from the brush and minimizes overall cost.

Happy Brushing!

-Dr. K