By: Dr. Alexandre Ribeiro

Diplomate of American Board of Periodontology

Gum disease is mostly characterized as an infectious disease developed in the interface between tooth and gingiva. The body trying to defend itself against the infectious agents results in bone loss and formation of a pocket. This consists of a perfect environment for the further development of the disease.  Recent research has related gum disease with multiple systemic conditions including cardiovascular disease, diabetes and adverse pregnancy outcomes between others.

The most common adverse pregnancy outcome related to gum disease is preterm low birth weight.  This is characterized by a gestational period of less then 37 weeks and an infant born with less then 2500g (5.5Lbs).  Preterm birth is the leading cause of perinatal complications in the United States, accounting for approximately 6-9% of all births; these represent 70% of all perinatal depth and half of all long-term neurological complications.

There are multiple reports in the scientific literature correlating preterm low birth weight to gum disease. Research has shown that oral bacteria is capable of traveling through the body and through the placenta fetal barrier causing increased inflammation. Also, infection in the mouth will result in an increased systemic inflammation. The combination of the two will result in an increased chance of preterm low birth weight.

 The best treatment for gum disease is prevention. Any woman looking to become pregnant is advised to look for dental care before pregnancy. During an oral examination, gingival and dental health are evaluated. In case of diagnosis of gingival disease a proper treatment plan will be formulated. This could include a dental cleaning, deep cleaning, laser treatment of the gums and/or surgical therapy.  The resolution of any gingival disease before pregnancy is important not only to reduce the chances of any complications through pregnancy but also because hormonal changes during pregnancy will make the patient more susceptible to gum disease. Necessary treatment often needs to be delayed during at least the first 3 months of pregnancy contributing even more for the progression of the disease. 

 For all these reasons, women seeking pregnancy should be evaluated before becoming pregnant. In case of diagnosis of gingival disease, the patient should be referred to a Periodontist (gum specialist). Most of the cases can be resolved with non-invasive treatment and resolution of infectious condition is expected in a short period of time. Once this is verified, patient is placed in a recall schedule that will assure gingival health is maintained for the duration of pregnancy and afterwards.

 If you are pregnant and would like to have a gingival and dental health evaluation, make an appointment to see Dr. Ribeiro, please contact our office at 305.857.0990.

Dental floss is a special kind of string for cleaning between your teeth. Cleaning between your teeth by flossing is just as important as brushing. Flossing helps remove remains of food and plaque (biofilm) from between the teeth where your toothbrush cannot reach. It helps keep your teeth and gums health.

Flossing can cause a great impact in preventing cavity formation between teeth. It is a great idea for parents to start flossing their child’s teeth as soon as the teeth are in contact with one another, usually after age 2 ½. Ideally, you will floss your child’s teeth every night at bedtime.

The American Dental Association recommends that parents should be flossing their child’s teeth as soon as he or she has any two teeth that touch.

Flossing demands more manual dexterity than very young children have, and children are not usually able to floss by themselves until they reach age 10 or 11, and even then they should be supervised.

Oral hygiene measures should be implemented no later than the time of eruption of the first primary tooth. Cleansing the child’s teeth as soon as they erupt with a soft toothbrush will help reduce bacterial colonization. Tooth brushing should be performed for children by a parent three times daily (after every meal), using a soft toothbrush of age-appropriate size.

Here are some guidelines on how to properly use dental floss:

• Pull the floss snugly against the side of each tooth when curving it into the letter ‘c’ shape. This will scrub off the dental plaque (as known as biofilm) most effectively.
• Keep the pressure of the floss on the tooth, never up onto the gum line.
• Floss daily. Biofilm (plaque) forms on the teeth after 24 hours, so using dental floss at least once daily maintains good oral health.
• Without daily flossing, biofilm (plaque) can and will turn into decay and dental tartar (calculus/build ups)—which cannot be brushed or flossed away.
• Using dental floss only occasionally can lead to bleeding gums, gingivitis, and halitosis (bad breath)

Dr. Sharp oral care line of products includes a natural waxed dental tape which is flat, smooth and ideal to be used between teeth to remove biofilm (plaque) and also natural toothpastes and alcohol free mouthwash. Visit www.drsharpcare.com  for more information.

For more information on brushing and flossing techniques, visit www.ada.org.

If you are interested in having a dental consultation for your child, please contact (305) 857-0990 for an appointment with Dr. Sharp and Dr. Ravazzi.

The reality is that pain is a very valuable signal. Without pain we wouldn’t know to move our hand away from a burning stove; we wouldn’t know when a part of our body was injured and is in urgent need of treatment. The challenge is when the pain persists beyond its useful status as a signal and continues affecting us for days, weeks and many instances for years.

My name is Fabio Ortiz and I am a Clinical/Medical hypnotist based here in Miami Florida. I help people relieve their pain, heal themselves from the inside, break bad habits, and improve their lives by assisting them to tap into their own mind/body connection using hypnosis. My passion is to help people use these methods as complementary to traditional medicine.

I recently had the opportunity to use these same techniques myself, when I discovered that I needed dental implant surgery.

I have been coming to Dr. Sharp’s Dentistry since my move from Australia over 18 months ago. They were recommended for their professionalism and customer care, and I have since recommended them myself to close friends. So I knew they would be the perfect team to work with.

This was my chance to walk the walk and experience pain free dentistry without any chemical anesthesia or sedation whatsoever. I would attempt to achieve complete pain control while getting a full dental implant on my lower jaw using hypnosis techniques such as gate control theory, visualization and dissociation and a healthy belief in the power of my mind.

The whole purpose for doing the implant surgery chemical free was not to prove my tolerance to pain, but to experience what is normally a painful procedure without any anesthesia. It would also allow me to step into my patient’s shoes and understand what it is like to go through the process as a patient, so I could pass on knowledge to my other medical and dental hypnosis patient.

When I first approached Dr. Ribeiro with my request to have a full dental implant without any anesthesia, he was naturally taken aback. He very politely and professionally asked me if I understood the extent of the procedure.

Dr. Ribeiro patiently explained the full details of the operation, which would take around ninety minutes. The first step was to cut through the gum to the bone and move the gum out of the way to get access to the bone. He explained that “this, by itself, would be hugely uncomfortable without any anesthesia.” Then when the area had been treated, the drilling would begin and he would need to drill a hole in my jaw using several drill heads.

He continued, “There might be a need to augment the bone too or do some grafting that we won’t know until we are there. Then, after testing and re-testing, and only when the hole is the perfect size, will the implant be screwed in place. And at the very end of the operation a screw will be placed on top of the implant and the gum stitched up for healing.”

Dr. Ribeiro made it very clear that patient care and comfort were his number one priority and that he would do everything to accommodate my wishes—but would not compromise my safety or his standard of care. If there was the slightest sign that I needed an injection of anesthetic, he said he would not hesitate to stop the procedure, administer anesthesia, and continue after it took effect.

I knew I was in the right hands and was very happy to hear that Dr. Ribeiro would not compromise my care. I assured him that I would willingly accept the injection at the first sign of pain. For me it is very important to work alongside health care professionals and completely respect their treatment protocols. It’s about doing what’s best for the patient whether using medication or other modalities such as hypnosis or a mixture of both.

Typically, I’m the one helping a client relieve pain with hypnosis. But in this case, I was the client. This was the first time that I had attempted something of this magnitude with such a short period of time to prepare, so I asked a colleague to assist. Tamera Fontenot is an expert clinical/medical hypnosis practitioner and licensed marriage and family therapist who practices in St. Petersburg.

At the time of the operation Dr Ribeiro gave Tamera and I plenty of room and time to prepare, and he was extremely respectful of our needs. He started as he usually would, by testing the area to make sure it was fully anesthetized. Throughout the procedure, he planned to follow his usual process like all other times—there was to be no special treatment, simply because I was using hypnosis for pain control instead of chemicals.

Then came the moment of truth. I was both excited and apprehensive. At the slightest flinch of pain, Dr. Ribeiro would administer the anesthesia and the experiment would be over. When he started prodding my gum with a sharp dental probe and I felt no pain at all—nothing but gentle pressure—my mind raced with excitement. Then when I felt further pressure, followed by the warmth sensation of fluid, I knew he had begun cutting around my gum. To say that I was happy would be a complete understatement. Later I would mention this to Dr. Ribeiro and he would joke, “That’s the first time anyone has been ecstatic when they are being cut open!” All the hypnosis techniques were working. This part of the operation went easily and smoothly, Dr. Ribeiro kept communicating with me and asking me to adjust my position as necessary.

The drilling was a very interesting part of the operation; Dr. Ribeiro had mentioned that there would be heavy vibration while drilling, so this added another dimension to the procedure. I was in constant communication with Dr. Ribeiro and by this time I knew there would be no need for anesthesia, but it was good to know he was prepared should anything unforeseen happen.

Dr. Ribeiro is a perfectionist and drilled and adjusted my jaw until it was just right for the implant. So by the time he said that we were on the home stretch I knew the rest would be easy. We had done it!

Immediately after the operation we talked about the healing process. Dr. Ribeiro was about to ask me whether I wanted pain killers—then he realized they wouldn’t be necessary. I told Dr. Ribeiro that I was giving myself suggestions for rapid and comfortable healing. I used hypnosis to make sure that the comfort would stay for the rest of the day and the next, and I didn’t have any discomfort whatsoever or needed to take pain medication.

Around a few days later, I returned to the surgery for my checkup. Dr. Ribeiro examined the implant as was surprised to see how quickly it was healing, faster than the majority of patients.

Clinical/Medical hypnosis can be used for many purposes from managing stress and anxiety, weight management, stop smoking, enhance sporting performance, clear fears to name a few. For me helping people with chronic pain and discomfort is very close to my heart. So I want to thank all at Dr. Sharp Dentistry who were supportive and specially Dr. Ribeiro for working with me to achieve this amazing milestone.

If you are interested in hypnosis for any of your dental procedures, please contact our office at (305) 857-0990.

You can watch the video interview here:

Gum disease is an infection of the gingiva that is primarily caused by biofilm (bacterial dental plaque) accumulated on the teeth around the gums. In an attempt to protect itself against the insult caused by the bacteria in the biofilm, the body will initiate an immune response resulting in loss of supporting bone around the dentition.  This process may progress differently in individuals but will ultimately result in loss of proper bone to support the dentition therefore causing teeth loss. Recent research has demonstrated that the bacteria circulating in the gingiva may also be found in different parts of the body; also, the inflammation generated by the activation of the immune response will circulate through the role body resulting in an increase of systemic inflammation. This condition has been associated with many diseases such as heart disease, diabetes, pre-term low birth weight, Alzheimer’s, erectile dysfunction and others.

This year the American Heart Association has established gum disease is associated with heart disease as a Level A evidence independently of known confounders. This means that there is data that supports the treatment of gum disease will result in a significant improvement of health and the benefit of treatment substantially outweigh the risk of harm. Gum disease can participate in the process of heart disease in different ways but mainly by the interaction of pro-inflammatory factors and oral bacteria in the formation and rupture of atherosclerotic plaque. This may result in a heart attack and/or stroke.

Other known risk factors for heart disease include:

Uncontrollable risk factors:

• Male sex
• Older age
• Family history of heart disease
• Post-menopausal women
• Race (African Americans, American Indians (or Native Americans?), and Mexican Americans are more likely to have heart disease than Caucasians)

Controllable risk factors include:

• Smoking
• High LDL, or “bad” cholesterol and low HDL, or “good” cholesterol
• Uncontrolled hypertension (high blood pressure)
• Physical inactivity
• Obesity (more than 20% over one’s ideal body weight)
• Uncontrolled diabetes
• High C-reactive protein
• Uncontrolled stress and anger

It is well established that the best treatment and most cost effective way of treating any type of disease is prevention. The prevention of gum disease can be achieved in most of the population by regular visits to the dental professional and regular cleanings that should be done every 3-6 monthS depending on the individual conditions. For people that have active gum disease a proper treatment plan and maintenance schedule has to be established to control the disease process and correct some of the deformities caused by the disease. This treatment is usually established by the dentist or in more advanced cases by the periodontist (gum specialist).

If you have any questions regarding your gingival health set up an appointment with Dr. Sharp, Dr. Ravazzi or Dr. Ribeiro for a comprehensive evaluation by calling 305.857.0990.

Our office has the most advanced modalities of treatment for gum disease including: non-invasive gum treatment, laser treatment of the gums, and regenerative therapy for reestablishment of proper bone support and local delivery antibiotics for treatment of sites of infections.

From morning to night, your mouth is exposed to lots and lots of different bacteria as a result of your food, beverage and medication consumption. What you don’t know is that most of the bacteria can harm your teeth and gums.

Think of your mouth as a garden. There are good bugs in the garden that put the bad bugs in check. If you consume foods and beverages that contain too much bad bacteria and the good bacteria has been killed, then there isn’t anything to buffer out the bad bacteria. This may be the exact opportunity for bad bugs to gain an advantage and cause harm to your mouth. Removing mass numbers of bacteria in your mouth with an alcohol-based mouthwash is the equivalent of killing weeds and bugs in the garden with pesticides. What then comes forth from the garden can have some repercussions and same goes for your mouth when swishing around the typical mouthwash.

Many mouthwashes on the market can contain benzalkonium chloride, calcium, cetylpyridinium chloride, chlorhexidine gluconate, domiphen bromide, enzymes, eucalyptol, fluoride, hexetidine, hydrogen peroxide, menthol, methylparaben, methyl salicylate, and thymol. Sweeteners such as sorbitol, sodium saccharine, sucralose, and xylitol are usually included to give flavor. Some of these contain as much as 27% alcohol. (Note: Beer and wine only come in at about 10 -15% total alcohol content.)

If you want to continue to use mouthwash, we suggest trying natural alternatives. There are many ingredients that will provide the fresh breath affects you are looking to achieve. Dr. Sharp’s Natural Alcohol-Free Fresh Mint Mouthwash is a great choice. It contains witch hazel, which can soothe sores on the inside of the mouth, and sage extracts, which have whitening properties. The aromatic mint flavor, rooted from natural mint oils, naturally freshen breath and make this a wise choice for your mouth.

If you have a favorite dentist, nominate them for America’s Top Dentist here: http://betasurvey.com/TopDentists/C3/

The One-hour in-office teeth whitening (also known as chairside-whitening) procedure is designed to lighten the color of your teeth in one single visit. Significant lightening can be achieved in the vast majority of cases. One session usually radically whitens your teeth although some patients may require an additional session. A before and after teeth color chart comparison will be able to clearly show results of the one-hour teeth whitening treatment.

Anatomy, calcifications, age, teeth condition, hygiene, among others, determines the result each patient will attain. Teeth with yellow and brown stains will achieve greatest success while those with grey shading from tetracycline or other medications may experience less dramatic results but should improve. Crowns and other tooth-colored restorations will not whiten, to maintain uniform color; tooth-colored restorations may require replacement following whitening procedure.

Patients with known dental hypersensitivity, untreated caries, exposed root surfaces, defective restorations, oral tissue injuries and untreated periodontal (gum) disease should address these issues prior to whitening treatment otherwise may not qualify for this treatment. A consultation with the dentist is recommended.

During the first 24 hours following whitening treatment, some patients experience transient sensitivity. It is usually mild if your teeth are not normally sensitive. It usually subsides in 1-2 days.

Steps for in-office teeth whitening:

- Dental shade prior to whitening

- Clean teeth with pumice

- Application of lip moisturizer

- Proper retraction of cheeks and tongue

- Gum protection with dam barrier

- Eyewear protection

- Application of whitening gel

- Light activation with Zoom® or Rembrandt® system

- Final shade after whitening procedure

- Post care instructions and maintenance

For maximum results, patients are strongly advised not to consume coffee, tea, red wine, tobacco, colored juices (natural and artificial), green leaf vegetables, beets and any strong color drink or food that may stain your teeth for 48 hours after dental whitening procedure.

Our office provides the most efficient teeth whitening systems: Zoom® and Rembrandt® in-office and take-home trays.

If you would like to know if an in-office teeth whitening is right for you, call Dr. Sharp and Dr. Ravazzi for an appointment at (305) 857-0990. For more information visit our website www.sharpdentistry.com

Teaching your children proper oral care is essential for a healthy life. Brushing and flossing their teeth is very important and should be done three times a day after every meal. Just a simple routine of brushing and flossing, in addition to regular dental checkups, can be enough in most cases to help prevent tooth decay, gum disease and bad breath. A balanced diet is also essential for your child to develop strong, resistant teeth.

As we start this new school year remember to pack nutritional lunches packed with vitamins and essential nutrients and remember to follow these simple oral care tips and techniques for optimal dental care.

Tooth brushing tips and technique:

Here are a few tips to help you develop a good brushing routine:

- Use soft or extra soft toothbrush when brushing your teeth. Small-headed brushes are recommended since they can better reach all areas of the mouth, including hard-to-reach back teeth.

- Brush three times a day (ideally after every main meal).

- Proper brushing takes at least two minutes. Time yourself when doing your tooth brushing.

- Use a gentle touch – it doesn’t take much pressure to remove the biofilm (bacterial plaque) from your teeth, and a forceful brushing could irritate your gums.

- Electric toothbrushes can aid in applying an adequate amount of pressure when brushing, particularly for those who have difficulty doing it, who are wearing braces and who have limited manual dexterity.

- Brushing your tongue gently can help remove bacteria that cause halitosis (bad breath) by using a tongue cleaner.

- Toothbrushes should be replaced every 3 months since the bristles wear away.

Brushing technique:

- Clean the outer surfaces of your upper teeth, then your lower teeth.

- Clean the inner surfaces of your upper teeth, then your lower teeth.

- Clean the chewing surfaces.

- Place your brush at a slight angle toward the gums when brushing along the gum line.

- Concentrate on cleaning all the surfaces of the teeth.

- Make sure to brush your tongue.

The importance of flossing:

Cleaning between your teeth is every bit as important as brushing.

- Since brushing can’t effectively clean between teeth, it’s important to use floss to get to those areas in order to mechanically remove the biofilm (bacterial plaque) that forms in between your teeth.

- Flossing removes food particles and biofilm (bacterial plaque) between teeth that brushing misses. You should floss for your children beginning at age 4. By the time they reach age 8, most kids can begin flossing for themselves. (American Dental Association)

- Floss your teeth at least once a day.

- As with brushing, use a gentle touch to avoid injuring your gum tissue.

Dr Sharp Natural Oral Care Products include soft and extra soft toothbrushes, a tongue cleaner, green tea mint dental tape, fresh mint mouthwash, green tea and fresh mint whitening toothpastes, and a strawberry cream kids toothpaste.

For more information about brushing/flossing techniques visit the American Dental Association website www.ada.org or call (305) 857-0990 for a consultation with Dr. Sharp and/or Dr. Ravazzi.

Watch Food Types: There are great foods to help your teeth, and there is also a lot of things that will hurt them. It’s important to know the difference. Stay away from sugars and carbohydrates, which and leave deposits on teeth causing cavities. Dairy products, like cheese and milk are not just great because they provide calcium needed for strong bones, but they also aide in saliva production. The more saliva, the easier it is for their mouth to self-clean itself.

Go Fluoride-Free: Many people believe that using fluoride on all children is the best way to avoid cavities, but some research shows that there are harmful risks caused not only by ingesting these products, but they can also be a trigger for discoloration of the teeth leaving stains, or possibly cracks. To counter act it, try Dr. Sharp’s Strawberry Cream Kids Toothpaste, or his Natural Alcohol-Free Fresh Mint Mouthwash. These products are free of fluoride, synthetic colors and detergents. Both of these items will help to keep your children’s teeth clean, and healthy at the same time.

Limit snacks: It’s not just about skipping the soda, and sugar. If your kids are snacking a lot, it is actually not the amount of food that’s worrisome for their teeth, but how often they put it in their mouth. The more time in between eating, allows their mouths to produce saliva and get rid of particles of food stuck between their teeth.

Don’t use a bottle to help the little ones sleep: While falling asleep nursing a bottle might comfort your baby to close their eyes, it’s awful for their teeth. The liquids in the bottle, milk, juice, etc all form puddles around their teeth, and mixing with saliva not only leaves deposits in your baby’s mouth, but creates an acid that sits there all night. The official name for this problem is Baby Bottle Tooth Decay or BBTD. Try singing them a song, or gently rocking them to alleviate the need for the bottle.

Visit a dentist: The American Dental Society recommends that children first visit the dentist after they turn six months old, and before their first birthday. They should then get their mouth and teeth examined twice a year after that first appointment. Just like adults, the more consistent the visits, the better it is for their teeth. Getting their mouth checked out early, even for children who do not have teeth yet, also establishes a level of comfort with the dentist. Children that have a good relationship with their oral care office will be less likely to develop a dental phobia.

This post was provided by Shoshana Davis, contributor at Top Dentists and Everyday Health.