Most childhood sicknesses are highly treatable and quickly fade from memory afterward. But there's one viral infection that can reappear years later, albeit in a different form and this time it might not be as forgettable. It could even impact your dental care.

Varicella, more commonly known as chicken pox, is a viral infection that mainly affects children. Fortunately, the itchy blisters and other symptoms associated with it usually clear up on their own. But the virus itself, varicella zoster virus (VZV), can remain behind and become dormant.

Fast-forward a few decades, and the child once with chicken pox is now an adult, usually over 50. In 20-30% of former chicken pox patients, the virus reactivates as a new infection known commonly as shingles.

Shingles often begins with an itching, burning or numbing sensation on the skin that develops into a severe rash. Because of its effect on surface nerves, the rash often takes on a striped or belt-like pattern on the skin. A shingles outbreak can also cause fever, fatigue and pain, the latter of which in rare cases can be quite severe.

Shingles in its early stages is also highly contagious, transmitted easily through either physical contact with the skin lesions or through airborne secretions. This is especially troubling for certain groups: pregnant women, patients undergoing cancer or other serious disease treatment, or those with compromised immune systems. For them, shingles can pose a significant risk for complications.

Because of its easy transmission, and the danger it can pose to certain groups, dentists typically postpone treatment—even routine dental cleanings—for patients experiencing a shingles outbreak, especially a facial rash. Once their outbreak subsides, those procedures can be rescheduled.

If you develop what you think is shingles, you should seek medical attention as soon as possible. Certain prescribed antiviral medications can ease the symptoms and hasten recovery, but they're most effective if started within three days of the onset of the disease. There's also an effective vaccination for shingles recommended for people over 60 to help avoid the disease altogether.

One other thing! If you do develop shingles and have an upcoming dental appointment, let your dentist know. Better to reschedule your visit after you've recuperated than to put others' health at risk.

If you would like more information on shingles and dental care, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Shingles, Herpes Zoster.”

Inauguration night is usually a lavish, Washington, D.C., affair with hundreds attending inaugural balls throughout the city. And when you're an A-List celebrity whose husband is a headliner at one of the events, it's sure to be a memorable night. As it was for super model Chrissy Teigen—but for a slightly different reason. During the festivities in January, Teigen lost a tooth.

Actually, it was a crown, but once she told a Twitter follower that she loved it “like he was a real tooth.” The incident happened while she was snacking on a Fruit Roll-Up (those sticky devils!), and for a while there, husband and performer John Legend had to yield center stage to the forlorn cap.

But here's something to consider: If not for the roll-up (and Teigen's tweets on the accident) all of us except Teigen, her dentist and her inner circle, would never have known she had a capped tooth. That's because today's porcelain crowns are altogether life-like. You don't have to sacrifice appearance to protect a tooth, especially one that's visible when you smile (in the “Smile Zone”).

It wasn't always like that. Although there have been tooth-colored materials for decades, they weren't as durable as the crown of choice for most of the 20th Century, one made of metal. But while gold or silver crowns held up well against the daily grind of biting forces, their metallic appearance was anything but tooth-like.

Later, dentists developed a hybrid of sorts—a metal crown fused within a tooth-colored porcelain shell. These PFM (porcelain-fused-to-metal) crowns offered both strength and a life-like appearance. They were so effective on both counts that PFMs were the most widely used crowns by dentists until the early 2000s.

But PFMs today make up only 40% of currently placed crowns, down from a high of 83% in 2005. What dethroned them? The all-ceramic porcelain crown—but composed of different materials from years past. Today's all-ceramic crowns are made of more durable materials like lithium disilicate or zirconium oxide (the strongest known porcelain) that make them nearly as strong as metal or PFM crowns.

What's more, coupled with advanced techniques to produce them, all-ceramic crowns are incredibly life-like. You may still need a traditional crown on a back tooth where biting forces are much higher and visibility isn't an issue. But for a tooth in the “Smile Zone”, an all-ceramic crown is more than suitable.

If you need a new crown (hopefully not by way of a sticky snack) or you want to upgrade your existing dental work, see us for a complete exam. A modern all-ceramic crown can protect your tooth and enhance your smile.

If you would like more information about crowns or other kinds of dental work, please contact us or schedule a consultation. To learn more, read the Dear Doctor magazine article “Porcelain Crowns & Veneers.”

Your child's dental development is in overdrive between birth and early adulthood. The rapid growth of the teeth, gums and jaws occurs mostly on its own—but tooth decay could significantly derail it.

Although most cases of dental disease occur in adults, tooth decay is a major problem for children, particularly involving primary teeth. These teeth are much more important than they seem given their short lifespans: Because they help incoming permanent teeth to align properly, their premature loss due to decay can create future bite problems.

To prevent this from happening, taking steps to prevent tooth decay in young children is well worth the effort. The best strategy is a double-pronged approach. You'll first want to address certain areas that directly contribute to tooth decay. You'll then want to add measures that strengthen the teeth themselves against the disease.

In regard to the former, reducing the levels of harmful bacteria in the mouth tops the list. These bacteria produce acid as a byproduct that in turn softens and erodes enamel, the teeth's natural barrier against decay. We reduce bacteria by eliminating dental plaque, a film of built-up food particles that feeds and shelters bacteria, through daily brushing and flossing.

Certain dietary choices may also contribute to bacterial growth. Refined sugar is a prime food source for bacteria, so limiting it in the diet will help reduce tooth decay. Furthermore, a diet rich in whole, unprocessed foods and dairy provide nutrients strengthen teeth against decay.

The other prong in defeating tooth decay mainly involves protective measures provided by your dentist. Sealants applied to the chewing surfaces of a child's teeth help protect the enamel from the buildup of bacteria in these highly susceptible areas. An occasional direct application of fluoride to teeth further strengthens their enamel, and makes them less susceptible to decay.

This approach can minimize the chances of tooth decay, but it won't eliminate the risk altogether. If it does occur despite your best efforts, prompt treatment can limit the damage and preserve the teeth. Working with your dentist, you can help ensure your child's teeth are protected from this damaging disease.

If you would like more information on best dental care practices for children, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Dentistry & Oral Health for Children.”

Besides straight and translucent teeth, an attractive smile has another important component: balance. In a great smile, the visible areas of the teeth and gums are in balanced proportion to one another.

But what is the ideal proportion between teeth and gums? Although aesthetic appeal is largely “in the eye of the beholder,” dental professionals typically consider a properly sized tooth to be around 10 mm in visible length. As for the upper gums, no more than 4 mm of tissue should show when smiling. Teeth appearing shorter than 10 mm or the gums displaying more than 4 mm can create an effect called a “gummy smile.”

Fortunately, there are different approaches for correcting a gummy smile, depending on what's causing the appearance of gumminess. Not only are there different causes, but they can be diverse in nature.

Obviously, an actual excess of gum tissue can cause a smile to look gummy—but so can shortened teeth. One possible solution called crown lengthening could help correct either possibility. During the procedure, we remove any excess gum tissue or reposition the gums after reshaping the underlying bone to reveal more of the tooth crown. Worn or shortened teeth can also be made to look longer with porcelain veneers.

A gummy smile could also be caused by a hypermobile lip, in which the lip rises higher than normal while smiling. We may be able to prevent this temporarily by injecting Botox into the lip muscles, which paralyzes them and inhibits their ability to move upward. A more permanent approach is to surgically restrict the upward movement of the lip muscles.

The gums may also seem too prominent if the upper jaw is longer in proportion to the face. One way to correct this is orthognathic surgery, a procedure that moves the upper jaw to a higher position on the skull. This can reduce the jaw profile with the face and subsequently affect how much of the gums show while smiling.

These solutions range from relatively minor to significantly invasive. The first step, though, is to find out what's really behind your gummy smile before taking the next step to make it more attractive.

If you would like more information on improving a gummy smile, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Gummy Smiles.”

October 20th is World Osteoporosis Day, putting the spotlight on this degenerative bone condition and the impact it has on millions of people. Not only does it significantly increase the risk of potentially life-threatening fractures, but it can also indirectly affect dental health.

This connection arises from the use of certain treatment drugs that ultimately could lead to complications following some forms of dental work. These particular drugs, mainly bisphosphonates like Fosamax™ and RANKL inhibitors like Prolia™, destroy bone cells called osteoclasts, whose function is to clear away worn out regular bone cells (osteoblasts). With fewer osteoclasts targeting them, more older osteoblast cells survive longer.

In the short-term, a longer life for these older cells helps bones afflicted by osteoporosis to retain volume and density, and are thus less likely to fracture. Long-term, however, the surviving osteoblasts are less elastic and more brittle than newly formed cells.

In the end, these longer living cells could eventually weaken the bone. In rare situations, this can result in parts of the bone actually dying—a condition known as osteonecrosis. The bones of the body with the highest occurrences of osteonecrosis are the femur (the upper leg bone) and, of specific concern to dental care, the jawbone.

The effect of these medications on the jawbone actually has a name—drug-induced osteonecrosis of the jaw (DIONJ). Fortunately, there's only a 1% risk of it occurring if you're taking these drugs to manage osteoporosis. It's also not a concern for routine procedures like cleanings, fillings or crown placements. But DIONJ could lead to complications with more invasive dental work like tooth extraction, implant placement or periodontal surgery.

It's important, then, that your dentist knows if you're being treated for osteoporosis and the specific drugs you're taking. Depending on the medication, they may suggest, in coordination with your physician, that you take a "drug holiday"—go off of the drug for a set period of time—before a scheduled dental procedure to ease the risk and effects of osteonecrosis.

Because infection after dental work is one possible consequence of osteonecrosis, it's important that you practice thorough oral hygiene every day. Your dentist may also prescribe an antiseptic mouth rinse to include with your hygiene, as well as antibiotics.

You may also want to talk to your doctor about alternative treatments for osteoporosis that pose a lower risk for osteonecrosis. These can range from traditional Vitamin D and calcium supplements to emerging treatments that utilize hormones.

Osteoporosis can complicate dental work, but it doesn't have to prevent you from getting the procedures you need. Working with both your dentist and your physician, you can have the procedures you need to maintain your dental health.

If you would like more information about osteoporosis and dental care, please contact us or schedule a consultation.