Spring Lake Dental Group

Dental Trauma In Children

Author: Dr. Alison Vitelli, DMD, FAGD

My family and I love summertime as it brings a huge load of fun to the lives of our young ones! But what should we do as parents when the day does not go as planned and one of our kiddos suffered trauma to their teeth?

First of all, after any trauma, always evaluate consciousness and alertness status of the child. Make sure that there is no sign of a concussion. If any of these are present, please call 911 right away.  

After making sure your kid is alert, evaluate the mouth and clean it with either saline or clean water. Check for any missing or broken teeth. Sometimes, teeth can be avulsed (completely out of the mouth), intruded (pushed into the bone), or fractured (split edges). Of course, each one of these require different approaches ranging from a filling to a root canal or extraction. Each situation has to be carefully evaluated and treated for the best outcome possible.

If a tooth is avulsed, the best thing to do is to place it back in the mouth as soon as possible. But if you don’t feel comfortable doing this, place the tooth in a storing medium like sterile saline or milk then head to your family dentist to be examined. Sometimes antibiotics are recommended, but a relatively extensive follow up will be needed. Initially, we would like to see the patient every 1-2 weeks to be able to track and treat any pain or prevent infections. After the first month, we want to see the patient every 3 months during that first year, and take radiographs in order to evaluate the health status of the affected area.

We hope that you and your family always stay safe, but please know that at Spring Lake Dental Group, we are going to guide you a ease you in the event of a trauma.

COVID-19 Update

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

The Washington Post reports the Omicron sub-variant BA.5 ‘has quickly become dominant in the United States, and thanks to its elusiveness when encountering the human immune system, is driving a wave of cases across the country.” Now, “the risk of reinfections has increased because newly emergent sub-variants are better able to evade the front line defense of the immune system, and there is essentially no effort at the community level to limit transmission.”

If you have been following my posts, you probably realize that I received the initial two Pfizer vaccinations back in December of 2020 and January of 2021.  I followed with a Moderna booster later that year in August. Because I am over fifty, the next booster has been recommended for me and I was receptive until the BA.5 became the dominant sub-variant. Drug companies have stated that vaccines being developed now will accommodate for this sub-variant so my guess is that I will get vaccinated later this fall, before the winter sets in.

We have seen that Dr. Fauci has become Covid-19 positive and I suspect that this news event has caused some consternation among many of you. Viruses mutate and adapt very rapidly and science works hard to study them and determine where they are going. But notice that Dr. Fauci did not require hospitalization, ventilation or suffer death because of his infection. His age obviously puts him in a high risk group.

The line in the Washington Post that most concerns me is the comment about no effort at the community level to limit transmission. Pandemic weariness is a real phenomenon. We, at Spring Lake Dental Group, are still practicing diligent efforts to protect ourselves and our patients. While we have made some concession to “pandemic weariness”, we encourage our patients and staff to positively consider getting future recommended vaccinations, both for ourselves and our children age five and older. Practice social distancing as much as practicable and wear a mask in public.

Will we get through this?  Yes, we will.

How Does It Work?

Author: Dr. Sarah Mischo, DMD

Dr. Andrew from {PRACTICE_NAME}As a kid, I loved watching the Food Network show “Unwrapped.” This show went behind the scenes and showed how different treats such as M&M’s, Pez, and potato chips were made. I always found it fascinating to learn how the items we see on the store shelf become what they are through the manufacturing process.

Over the weekend, I was thinking about this show and how it relates to the world of dentistry. When a patient is being seen for treatment, local anesthetic is more often than not needed to get the patient comfortable so the procedure can be completed. I was thinking how often I have to give local anesthetic, and realized most people probably don’t fully understand how it actually makes them numb. Continue reading if you are the type of person who is curious and likes to know the details of how things work.

Every inch of our body is full of nerves–bundles of individual, highly-specialized cells called neurons that are responsible for sending messages to our brain regarding different stimuli. One such stimulus is pain, and specialized neurons called “nociceptive” neurons are responsible for transmitting this important signal which can help our bodies detect and avoid injury.

Each individual neuron transmits signals up and down its length through the use of microscopic gates or “channels” that allow different electrolytes (salt ions) to flow into and out of the neuron. One of the most important of these channels are sodium-potassium voltage gated channels. Pumps within the wall of each neuron maintain lots of sodium on the outside of the cell and lots of potassium on the inside when the neuron is inactive. But when there is a stimulus, the neuron opens these sodium-potassium gates, allowing sodium to rush into the cell an action potential or “signal” results. This signal tells the brain “Hey!! There is something going on here.” Local anesthetics block this sodium influx into the cell preventing that “signal” or action potential from being sent to the brain, causing the patient to feel calm and comfortable instead of feeling pain or discomfort during a procedure.

So, while, your dental visit and the production of your favorite potato chips might not have too much in common, now you know that salt is an important part in both processes!

Tykes, Trauma, Teeth

Kids are pretty resilient. Bumps and bruises are normal and often in school, on vacation, or summer break. During one of their rumbles, kids can hurt their teeth or even lose them. In the event that a primary (baby) tooth falls out due to trauma, it is not recommended to replant it. The soft tissue such as the gums, tongue, cheeks, roof of the mouth should be evaluated. The hard tissue such as adjacent teeth and sockets should be assessed clinically and radiographically.  A space maintainer may be needed to preserve space for eruption of the permanent tooth. It is important to be able to identify permanent teeth from baby teeth as permanent teeth can be reimplanted. There are 20 primary teeth which will remain in the mouth until about 33 months. Compared to permanent teeth, baby teeth are whiter and smaller.  The permanent anterior (front) teeth have ridges on the chewing surface called mamelons, not present on baby teeth. Under ideal situations, if a permanent tooth is avulsed, hold the tooth by the crown, quickly rinse with cold water if soiled, correctly insert in socket and add biting pressure, and seek dental care immediately.

Understanding Your Treatment Plan

Author: Dr. David Dickerhoff, DDS, MAGD, FOCOI

It was reported in The Academy of General Dentistry Today  that “four out of ten Americans say that they are saddled with active debt from medical or dental bills according to a new survey. The poll, “published on Thursday, fount that 24% of those surveyed said that they had medical or dental bills that are past due or haven’t been paid, while 21% of respondents said that they have medical or dental bills that they are paying off over time directly to their provider. Becker’s Dental Review reports, “Of adults with health care debt, 49% say dental bills account for some of that amount.” According to Kaiser Health News, the investigation reveals the problem is “far more pervasive than previously reported’ since “much of the debt that patients accrue is hidden as credit card balances, loans from family, or payment plans to hospitals and other care providers.”

As I watch this week’s Consumer Price Index rise from a quarterly report of 8.3% to 8.8% and much talk of inflation and a looming recession, I cringe at the thought of decisions we must make as money gets tighter and tighter. The price of a barrel of gas will probably rise from its current $122.00 to something around $140.00 as long as tensions continue in the Ukraine. The price of gas here in North Carolina is better than other parts of the US but will hover around five dollars per gallon. Energy costs will affect the entire spectrum of goods and labor shortages compound the problem.

Which brings me to my message for today,  I urge you to have a great discussion with your care provider at the first opportunity to talk about the best way to attack your individual treatment plan. Many recommendations that we make to our patients are made to enhance quality of life or esthetics. Many other recommendations are made to correct disease, pathology or defective restorations. Learn what recommendations are made that need to be addressed immediately and what care can be deferred without a poor outcome eventually. Just like any maintenance program you ascribe to, the cost of replacement is always greater than the cost of maintenance.  Ignoring a dental problem only makes it worse and sometimes those decisions lead to a significant health problem or a decrease in quality of life.

We love talking with our patients at Spring Lake Dental Group.  Our tenet of “never treating a stranger” allows us to give you a professional opinion. Engage with us so as to achieve your best outcome in these trying times.

Checking In

Author: Dr. Sarah Mischo, DMD

Dr. Andrew from {PRACTICE_NAME}I am not a mental health professional. I have no formal training in counseling, cognitive behavioral therapy, psychopharmacology, or any other behavioral health discipline. The last time I sat in a classroom and discussed human psychology was my freshman year of college, almost a dozen years ago. So I’m definitely not an expert on mental health, but I do have a lifetime of experience living with, growing with, and loving, wonderful friends and family who happen to live with various mental health conditions.

Recently, a friend of mine shared an article from the National Alliance on Mental Illness (NAMI) titled “What Mental Health Care Can Learn from Dental Health Care Strategies” that really hit home for me. I won’t try to summarize the whole article here (I highly encourage you to read it for yourself at the link below), but it does a wonderful job outlining the ways in which dentistry has pivoted over the last several centuries from a “problem-based” to a “prevention-based” profession that highlights healthy habits, routine checkups, and early intervention to address most dental problems before they ever cause serious symptoms (and often before a patient even fully realizes there is a problem occurring).

As mental health care becomes more available and less stigmatized, our nation’s behavioral health system is undergoing a similar transition, moving toward a future where routine mental health checkups are just as common as an annual physical or biannual dental cleaning. For now, however, the average time between a person’s first mental health symptoms and their first mental health care intervention is an astounding 11 years, which is far too long.

So, to anyone who is facing mental health challenges of any sort, please reach out early to friends and family, but also to a mental health professional. And, for everyone, if you happen to have three extra minutes on your hands, give “What Mental Health Care Can Learn from Dental Health Care Strategies” a read here.


Author: Kimberly N. Powell, DDS, MS, FAGD

It seems that the needs of others will always come before yours. It happens so routinely that we fail to recognize it. In order to be the best for the people in our lives…our family, staff, employees, employer, students, patients, we have to carve out time to be the best to ourselves. A bit of time to reenergize, to pause, to worship, to workout, to take a mental health break, to mend our bodies is needed. When you think about it, we can replace cars, houses, jobs, but we were given one body, I guess it was meant to last a lifetime…let’s take care of it.

Whitening Options

Author: Dr. Alison Vitelli, DMD, FAGD

Woman Smiling with Clear Braces onA very common comment we get from our patients is that they would love for their teeth to be whiter but, is everyone a good candidate for whitening?

The answer is: No. Not every patient is a good candidate for teeth bleaching right away. There are several factors we need to consider before moving forward with whitening treatment.

We always need to make sure our patients are free of cavities before we whiten. The presence of untreated decay can cause extreme sensitivity and pain. Recession of the gums can be a potential cause of sensitivity if directly exposed to bleaching material without properly desensitizing the teeth prior to the procedure. We also need to consider the presence of previous fillings, crowns or veneers, and understand that the only structure that changes shades is the natural tooth. Any material like resin, porcelain or zirconia will not change the already selected shade. Younger patients are not the best candidates for whitening since their enamel is still being reinforced by the action of the fluoride in the toothpaste and dental cleanings.

Today’s market provides an overwhelming amount of options for whitening your teeth. Most products are based on hydrogen peroxide at different percentages. For example, the professional products used at dental offices will contain a higher concentration of the hydrogen peroxide when compared to over-the-counter whitening strips, or whitening toothpaste. Each patient is very unique, and that’s why when we are being asked about whitening, we look and take into consideration all the factors that will be involved in the final outcome of the treatment. Next time that you come to our office, feel free to ask about our whitening options and we will be more than happy to let you know when would whitening be good for you!

What, When, How to Eat

Stay away from the cookies, candies, sweet tea! This has been a persistent thought amongst many to prevent cavities. It has been reported that it’s the frequency of exposure to any carbohydrate that can cause tooth decay. Oral bacteria that causes decay does not discriminate from the source of the carb, it could be candy or bread. It has also been reported that one should limit carb-centric snacking and snacking throughout the day even on healthy foods like dairy, whole grains, and fruit. To help control caries and erosion risks, limiting snacking, having brief mealtimes, rinsing with water after meals, using straws with sweetened and acidic drinks, and chewing sugar-free gum can help. Watching what you eat, when you eat, and how often you eat are very important. We encourage brushing twice a day, flossing, and using a mouth rinse to ensure that 100% of the oral cavity is clean, but “you can brush five times a day, and it will still be tough to compete with that constant bathing of your mouth in carbs”-Amr Moursi, DDS, PhD.

Information in this article relating to nutrition was obtained from AGD Impact, May 2022, vol. 50, no. 5