Tag Archives: oral hygiene

The Lifesaving Power of Preventative Dentistry: A Comprehensive Guide

Posted by Genny Skrobanek on April 23, 2024

In the realm of healthcare, the significance of preventative measures cannot be overstated. From routine check-ups to healthy lifestyle choices, proactive interventions play a pivotal role in safeguarding our well-being. However, when it comes to dental health, the importance of preventative dentistry often flies under the radar. In this comprehensive guide, we delve deep into the transformative power of preventative dentistry, exploring how prioritizing oral health can not only preserve your smile but potentially save your life.

Understanding Preventative Dentistry

At its core, preventative dentistry encompasses a range of proactive measures aimed at maintaining optimal oral health and preventing dental problems before they escalate. From regular dental cleanings and examinations to education on proper oral hygiene practices, these interventions form the cornerstone of preventative care. By identifying potential issues early on and implementing timely interventions, preventative dentistry seeks to mitigate the risk of dental diseases and their associated complications.

The Oral-Systemic Connection

Emerging research has shed light on the intricate relationship between oral health and systemic well-being, highlighting the interconnected nature of the human body. Indeed, the health of your mouth can exert profound effects on various aspects of your overall health. Gum disease, for example, has been linked to an increased risk of systemic conditions such as cardiovascular disease, diabetes, and respiratory infections. By addressing oral health issues proactively through preventative dentistry, individuals can potentially lower their risk of developing these serious medical conditions.

Gum Disease: A Silent Threat

Among the most prevalent oral health concerns is gum disease, a chronic inflammatory condition that affects the tissues surrounding the teeth. Despite its prevalence, gum disease often progresses silently, with symptoms such as redness, swelling, and bleeding gums going unnoticed until the advanced stages. Left untreated, gum disease can lead to irreversible damage to the gums and supporting structures of the teeth, eventually culminating in tooth loss. Moreover, the systemic inflammation associated with gum disease has been implicated in the development of various systemic conditions, underscoring the importance of early detection and intervention.

The Role of Routine Dental Examinations

Regular dental examinations serve as a cornerstone of preventative dentistry, providing an opportunity for early detection of oral health issues. During these appointments, dental professionals conduct a comprehensive assessment of the teeth, gums, and oral tissues, using advanced diagnostic tools to identify any signs of disease or abnormalities. By detecting problems such as cavities, gum disease, and oral lesions in their infancy, dentists can initiate prompt treatment, preventing further damage and preserving oral health.

Embracing Proper Oral Hygiene Practices

While routine dental visits are essential, the foundation of preventative dentistry lies in daily oral hygiene practices. Brushing twice a day with fluoride toothpaste, flossing daily, and using antimicrobial mouth rinses are integral components of a healthy oral care routine. Additionally, adopting a balanced diet low in sugary and acidic foods can help protect against cavities and gum disease. By prioritizing these simple yet effective habits, individuals can fortify their defenses against dental diseases and promote long-term oral health.

The Impact of Lifestyle Factors

Beyond oral hygiene practices, lifestyle factors play a significant role in determining oral health outcomes. Tobacco use, for instance, is a major risk factor for gum disease and oral cancer, highlighting the importance of smoking cessation efforts in preventative dentistry. Similarly, excessive alcohol consumption can contribute to a host of oral health problems, including tooth decay and gum disease. By addressing these modifiable risk factors and adopting healthier lifestyle choices, individuals can bolster their oral health and reduce their risk of dental diseases.

Early Intervention: The Key to Success

In the realm of dentistry, early intervention is paramount to achieving favorable outcomes. Whether it’s addressing minor tooth decay or treating early-stage gum disease, prompt action can prevent the progression of dental problems and preserve the integrity of the teeth and supporting structures. Through techniques such as dental sealants, fluoride treatments, and non-surgical periodontal therapy, dental professionals can effectively halt the advancement of oral diseases, sparing patients from the potential complications associated with untreated conditions.

Beyond the Mouth: A Holistic Approach to Health

As our understanding of oral health continues to evolve, so too does our appreciation for its far-reaching implications. By embracing a holistic approach to health that encompasses both oral and systemic well-being, individuals can unlock the full potential of preventative dentistry in preserving their overall health and longevity. From reducing the risk of chronic diseases to enhancing quality of life, the benefits of prioritizing oral health extend far beyond the confines of the mouth, underscoring the profound impact of preventative dentistry on our lives.

For the Sake of Your Health, Schedule Your Dental Exam

Preventative dentistry stands as a powerful ally in the pursuit of optimal health and well-being. By embracing proactive measures such as routine dental examinations, proper oral hygiene practices, and lifestyle modifications, individuals can safeguard their smiles and potentially save their lives. Through early detection, timely intervention, and a holistic approach to health, preventative dentistry empowers individuals to take control of their oral health destiny, paving the way for a brighter, healthier future. So, let us embark on this journey together, as we strive to unlock the lifesaving power of preventative dentistry one smile at a time.

Dr. Gary P. Skrobanek is a dental implant dentist and his experienced, friendly team at GPS Dental offer affordable family dentistry and gentle dental care in the San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at (210) 633-3477 to make an appointment.

Oral Health: Wishing You & Your Little Goblins a Cavity-Free Halloween

Posted by Genny Skrobanek on October 18, 2022

Halloween is the scariest holiday — for your teeth. During this holiday season, it might feel impossible to keep your kids (and yourself … I know it’s impossible for me to stay away from my favorites) away from the sweets. Use these tips to limit candy consumption and keep your kid’s teeth healthy and happy for a cavity-free Halloween.

Many people know that eating too much of anything is a bad idea, especially during the Halloween and Holiday Seasons! Cutting down on sugary snacks is one way to keep your pearly white smile healthy. Unfortunately, sometimes it can go sour and tooth decay can happen. Do you know how?

Your Sweet Tooth and Decay

When you eat sugar, there is a series of events that begin to happen as soon as you pop that sweet treat in your mouth; however, sugar alone does not cause tooth decay. If your teeth are not properly cleaned, the tooth enamel can begin to wear down and cavities can form.

Cavities can Develop

Your mouth is filled with hundreds of bacteria, many of which benefit the health of your teeth; however, some are harmful. These harmful bacteria feed on the sugars that are left on your teeth when they are not brushed after that sugary snack. They create acid that destroys your tooth enamel. Your tooth enamel is the shiny, outer layer that protects your teeth; if this layer becomes compromised, decay and cavities can form and leave tiny holes in your teeth. If the cavity isn’t treated properly, additional issues, such as gum disease and tooth loss can occur. See how your sweet tooth can go sour, quickly?

Preventing Cavities is Pretty Simple

Brush your teeth regularly, especially after sweet treats and before bedtime
Avoid sugar when possible (this includes snacks, gum and beverages)
Eat healthy foods that are rich in fiber
Make regular trips to visit your dentist

Have a Cavity-Free Halloween

With Halloween just around the corner, which for most children means bags of free candy and easy access to all kinds of sweets. It’s also a pretty tempting holiday for adults. Here are 5 ways everyone can stay mouth healthy during your cavity-free Halloween and every day.

Stay away from things that stick

Besides how often you snack, the length of time sugary food is in your mouth plays a role in tooth decay. Unless it is a sugar-free product, candies that stay in the mouth for a long period of time subject teeth to an increased risk for tooth decay. The stickier candies, like taffy and gummy bears, also take longer to get washed away by saliva.

Think twice before picking hard candies

Besides how often you snack, the length of time sugary food is in your mouth plays a role in developing cavities. Unless it is a sugar-free product, candies that stay in the mouth for a long period of time subject teeth to an increased risk for tooth decay.

Try and eat candy with meals

We know candy can be hard to resist, especially after all that hard work trick or treating for it! If you can, try and eat Halloween candy and other sugary foods with meals or shortly after mealtime. That’s because saliva production increases during meals and helps cancel out acids produced by bacteria in your mouth and helps rinse away food particles.

Avoid beverages with added sugar

When teeth come in frequent contact with beverages that contain sugar, the risk of tooth decay is increased. Drinking water can also help prevent tooth decay and who needs extra calories from sugary sweet drinks?!

Chew Gum that has the ADA Seal

Instead of candy, consider gum. Studies show that chewing sugarless gum for 20 minutes after meals helps reduce tooth decay, because increased saliva flow helps wash out food and neutralize the acid produced by dental plaque bacteria.

Remember, Candy Causes Tooth Decay

Here’s the recap: The outer layer of our teeth is called the enamel. It’s a resilient and shiny substance on the surface of your teeth that keeps the inner layer of your teeth, the dentin, safe from damage. But when sugars mix with bacteria in our mouths, an acidic environment leaves enamel vulnerable to harm and decay.

Remember, Not All Candy is Created Equal

What are the worst and best to give Trick-or-Treaters to preserve the health of their teeth for a cavity-free Halloween?

WORST:

Gummies, Taffy, and Caramels: Anything containing chewy or sticky ingredients is harder to remove from teeth and can easily lead to cavities
Hard Candy: Like chewy candy, they are hard to fully clean off of teeth
Sour Candy: As it is highly acidic and can erode the enamel of the teeth

BEST:

Sugar-Free Candy: While it’s less fun, you can rest assured knowing that damage won’t be done to teeth
Sugar-Free Gum: A great way for older kids to keep breath fresh and teeth clean
Chocolate, especially DARK Chocolate: It’s the most easily removable of all sugary candy, but remember the extra ingredients, like caramel, may cause problems!

Handy Halloween Candy Facts

With Halloween comes a ton of parties, trick or treating, and, of course, sweets. 4% of all candy consumption occurs on this spooktacular holiday. We’ve gathered up some fun facts in our “Halloween Candy Facts” below.

Consider our tricky tips below for a safe and healthy Halloween season:

Only 4% of candy consumption occurs on the day of Halloween
Almost 3 out of every 4 households will be handing out Halloween treats in the U.S. this year!
Experts estimate that $3.1 Billion will be spent on Halloween candy this year
25% of the candy industry’s revenues come from Halloween-related sales
The average household will spend $44 just to purchase Halloween candy
Consumers are seeing a price increase of around 13% over their bulk candy purchases for Halloween 2021
76% of households serve Hershey’s Kisses at Halloween
Candy corn is the most popular candy-related search for search engines
3 out of 4 households will put the purchased Halloween candy in-sight at home
From a health standpoint, it’s actually better to eat more candy at once than spread it out during the day; because the added saliva cancels out the acids that can ruin teeth
Many candies have more than 15 ingredients in them, with many of them being different types of sugars
Pro Tip: Freeze It!! Chocolate can last up to 6 months in the freezer

Sorting after Trick or Treating

Many families return home with their sweet loot and start a sorting ritual. If you don’t typically do this, consider it this year. Throw out any candies or treats that aren’t properly wrapped. Recent articles are pointing more and more toward drugs being presented as candy. Protect your family by making sure anything they consume won’t hurt their mouth. Remember, if your goal is a cavity-free Halloween and your haul is excessive, consider putting some of your chocolate in the freezer. It will keep nicely for up to 6 months.

Battling Decay After All the Sweets

If you want to be sure you or your family members’ teeth don’t suffer extreme consequences for all that Halloween candy consumption, then encourage and increase these healthy oral habits even more than you already do to ensure a cavity-free Halloween:

Be sure you are brushing your teeth for 2 minutes twice daily. Around Halloween, it might even be worth it to brush after eating the candy, or a third time midday.
Increase flossing from 1 to 2 times daily for the week following Halloween.
Even if you don’t normally choose to use mouthwash, doing so around Halloween and throughout the holidays is a great idea. It can keep sugars at bay and strengthen teeth with the fluoride often included in it.
Drinking lots of water can help keep your mouth flushed out and sugars to a minimum.
Eating healthy foods to balance out sugar intake is a wonderful way to keep blood sugar from spiking and your teeth free from decay. Munching fresh apples, carrots, celery, and other fibrous produce can actually scrub away plaque buildup and sugars in your mouth, and offer hydration that has been depleted.
Consider scheduling teeth cleaning after Halloween or in January following all the major Holidays of the year. If any damage is done, we’ll be sure to find it and prevent it from getting any worse.

Preventing Tooth Decay:

Preventing the unhealthy aftermath of your sweet tooth is important and the best way to do that is to take proper care of your teeth and have a cavity-free Halloween. Limiting the sugar intake in treats and snacks is obvious, but when we talk to our patients, we find out that sometimes the sugars sneak up on them (and they don’t even realize it)! That’s right, gum and beverages are just as guilty at leaving their marks on your teeth. If you drink soda, it doesn’t make any difference whether it’s sugar-free or not because these drinks will leave acid on your teeth that begin to wear down the enamel too. Opting for healthy choices, like water or milk are always better options for your oral health (just make sure they’re not “flavored water”… see how sneaky??)

Brushing and flossing away the plaque (twice each day) will make it harder for a cavity to develop because you are strengthening your enamel at least twice every day. By adding regular visits to your dentist for thorough dental exams, you’re well on your way to preventing cavities and keeping your mouth healthy.

GPS Dental Wishes You a Cavity Free Halloween

With these tips, you’re sure to have a wonderful time this Halloween Weekend without compromising on the health of your mouth. We hope everyone has a safe and wonderful Cavity-Free Halloween!

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers affordable dental care for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at 210-633-3477 to make an appointment.

Breast Cancer Oral Health Link: Does Gum Disease Increase the Risk?

Posted by Genny Skrobanek on October 4, 2022

Postmenopausal Women with Gum Disease Seem to Have Higher Breast Cancer Risk

Research suggests that postmenopausal women with gum disease are more likely to develop breast cancer than postmenopausal women who don’t have gum disease. Why? Let’s discuss the breast cancer oral health link.

If a woman has a history of smoking, the risk of breast cancer may be even higher

Gum disease, also called periodontal disease, can range from simple inflammation of the gums, called gingivitis, to periodontitis, when the gums pull away from the teeth leaving open spaces that become infected. The bacteria causing the infection and the body’s response to the infection can break down the bone and connective tissue that hold your teeth in place. If periodontitis isn’t treated, the teeth may become loose and must be removed.

Gum disease can be prevented by regular tooth brushing and flossing.

Gum disease has been associated with several other diseases, including heart disease, stroke, and diabetes. Past research has found links between gum disease and oral, esophageal, head and neck, pancreatic, and lung cancer

So … are there any links between gum disease and breast cancer?

A study has found that postmenopausal women with gum disease were more likely to develop breast cancer than postmenopausal women who didn’t have gum disease.

If the women had a history of smoking, the risk of breast cancer was even higher.

The study was published online on Dec. 21, 2015 by the journal Cancer Epidemiology, Biomarkers & Prevention. Read the abstract of “Periodontal Disease and Breast Cancer: Prospective Cohort Study of Postmenopausal Women.” The research is part of the very large Women’s Health Initiative Observational Study, commonly called the WHI. The WHI is looking for links between health, diet, lifestyle, and genetic factors and health problems, such as cancer.

In this study:

the researchers monitored 73,737 postmenopausal women in the WHI who had never been diagnosed with breast cancer.
About 26% of the women told the researchers they had gum disease.
After about 6.5 years, 2,124 women had been diagnosed with breast cancer.
Overall, the risk of breast cancer was 14% higher in women who had gum disease compared to women who didn’t have gum disease.
So, if average breast cancer risk is about 12%, a woman with gum disease had about a 13.5% risk of breast cancer.

“We thought that periodontal bacteria — either the bacteria themselves or the inflammation that’s part of having periodontal disease — has an effect on other parts of the body, including breast tissue. We know there are bacteria in breast tissue, and we know there are bacteria in mother’s milk. Women who had periodontal disease had a small increase in the risk of breast cancer overall,”
said Jo Freudenheim, Ph.D., distinguished professor of epidemiology and environmental health at the University of Buffalo and lead author of the study.

Does Smoking Have an Effect?

Because earlier studies have shown that the effects of gum disease can be more severe if a person smokes, the researchers also grouped the women by smoking history:

Among women who had quit smoking within the last 20 years, women with gum disease had a 36% higher risk of breast cancer than women who didn’t have gum disease.
Among women who had never smoked, women with gum disease had a 6% higher risk of breast cancer than women who didn’t have gum disease.
Among women who had quit smoking more than 20 years ago, women with gum disease had an 8% higher risk of breast cancer than women who didn’t have gum disease.

“There’s been an explosion of information recently that makes it clear that many different parts of the body that were thought to be sterile contain bacteria and other microbes,” Dr. Freudenheim said. “These bacteria may influence diseases that were previously thought to have no infectious component.”

Gum Disease and Breast Cancer

The researchers said there are several possible reasons for the association between gum disease and breast cancer:

Bacteria in the mouth can get into the bloodstream through tooth brushing, flossing, and chewing. Even though the bacteria are cleared out of the body quickly, the cumulative exposure to tissues can be considerable. It could be that these bacteria affect breast cancer.

Inflammation in one part of the body, such as the gums, may have an impact on other diseases.

Other Factors Increase the Risk

There may be other factors that increase the risk of both gum disease and breast cancer.

“This is a new area, so we have to be careful in how we interpret our findings,” said Dr. Freudenheim. “We can’t say, ‘if you treat periodontal disease it will reduce cancer risk.’ There are new methodologies that allow us to measure things we weren’t able to before. We are now beginning to understand how much the interaction of the microbiome affects our health both in terms of acute infections and chronic diseases.”

Decrease Your Risk for Breast Cancer

Now that you know of the breast cancer oral health link. Doing all that you can do to keep your breast cancer risk as low as it can be makes good sense.

Here are steps you can take to control several risk factors:

exercising regularly
eating a healthy diet
maintaining a healthy weight
not smoking
avoiding alcohol
taking good care of your teeth and gums

Decrease Your Risk for Gum Disease

Decreasing your risk is important because we know about the breast cancer oral health link, where gum disease increases breast cancer risk. According to the Centers for Disease Control, gum disease can be kept in check by:

Brushing and flossing your teeth every day to remove the bacteria that cause gum disease
Seeing a dentist at least once a year for a checkup, or more frequently if you have any of the warning signs of gum disease:
- red/swollen gums
- tender/bleeding gums
- loose teeth
- bad breath or a bad taste in the mouth that won’t go way
- gums that have pulled away from your teeth
- sensitive teeth

Learn more: Avoid Gum Disease: What You Need to Know

Making a Difference One Dental Exam at a Time

Now you understand why keeping your gums healthy is such an important task – the breast cancer oral health link where gum disease increases breast cancer risk! AND you know what to do to help keep you and your smile in the best possible health and avoid Gum Disease. Why almost half of Americans suffer some form of gum disease, why wait??

Regular dental exams and cleaning is wonderful preventative care. Although you may be brushing and flossing really well at home, tartar and plaque is impossible to remove with regular brushing and flossing, and can build-up over time. Dentists are able to use specific tools to remove that plaque and tartar, keeping our mouth cleaner and our chances of other complications much lower.

When almost half of Americans suffer some form of gum disease, why wait?

Now you understand why keeping your gums healthy is such an important task – they keep your teeth in place! AND you know what to do to help keep you and your smile in the best possible health and avoid Gum Disease.

At GPS Dental, we take your oral health seriously and want to help you avoid gum disease by checking your oral health and every scheduled cleaning. We are also happy to answer any gum disease questions you have. Take the time to be extra diligent in your normal oral health routine to reduce your risk for gum disease.

If you have questions or concerns about your gum health, please give us a call, Dr. Skrobanek and his experienced team at GPS Dental in San Antonio will be happy to schedule your dental appointment and help you keep your gums, teeth and mouth healthy. Please call our office at 210-633-3477 to schedule your dental appointment.

Dr. Gary P. Skrobanek’s experienced and friendly team at GPS Dental offers affordable dental care for all ages in San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we promote dental health awareness to our patients and provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at 210-633-3477 to make an appointment.

The information in this blog has been provided by Breastcancer.org. For more information on breast cancer risk and other steps you can take to minimize your risk, visit the Breastcancer.org Lower Your Risk section.

Avoid Gum Disease: What You Need to Know

Posted by Genny Skrobanek on September 25, 2022

You may not have heard of Periodontal Disease, if you visit your dentist regularly and you haven’t – that’s probably a good sign! Poor dental hygiene can lead to problems that are more severe than the average cavity or case of bad breath. Periodontal Disease is also known as Gum Disease and almost 50% of adults have some form it.

Gum disease is most commonly the result of poor dental hygiene and is the inflammation of the tissue around the teeth, according to www.medicinenet.com. Here’s the scary part – if left untreated, it can lead to even more serious problems, ranging from tooth loss to heart disease. Knowing the signs, symptoms, and treatment for various stages of gum disease can set you on a proactive path to avoid gum disease and a disappointing trip to the dentist.

Signs & Symptoms of Gum Disease

Do your gums bleed when you brush your teeth? If so, you can assume your gums are sick. Symptoms are key … if you are experiencing ANY gum bleeding, notice any gum pain or mouth sores, and/or pick up on a sour taste in your mouth, do not hesitate – it’s time to schedule a visit to your dentist! Remember, you can avoid gum disease and even reverse the early stages of Gum Disease, but the only way to keep Gingivitis from progressing into Periodontal Disease and other problems is dental treatment.

Someone with gum disease may have the following symptoms/signs:

White spots on the gums
Gums that are pulling away from the teeth or receding gums
Painful to chew
Sensitive teeth and gums
Loose teeth
Bright red, swollen, tender gums
Gums that bleed easily – even during normal daily cleaning
You may have a bad taste in your mouth or bad breath
Uneven bite
Ill-fitting dentures

If you are unsure if your symptoms are caused by gum disease, consult your dentist for clarification and make sure to stay on top of regular scheduled professional dental cleanings to reduce your risks.

Related Article: The Dangers of Gum Disease

Stages of Gum Disease

Early Stage: Gingivitis – this early stage of gum disease is characterized by the inflammation of the gums and is usually caused by an abundance of tartar or plaque in the mouth. Often, swollen gums bleed easily when brushing or flossing and this beginning stage of the disease is a warning sign to a more serious condition, Periodontitis.
Progressed Stage: Periodontitis – If Gingivitis progresses, plaque will extend from the gums to the bone. Once the bone gets the infection, they can form deep gum pockets and collect even more bacteria and plaque and can lead to bone loss or even tooth loss. However, there are different forms of Periodontitis and it is more serious than it may seem at first.
- Aggressive Periodontitis:
  - rapid gum recession
  - occurring during a period of growth in young people
  - due to vitamin depletion, not bacteria
- Chronic Periodontitis:
  - periods of rapid progression and then periods of remission
  - can happen on its own or in response to dental treatment

Periodontal disease starts with a sticky film of plaque bacteria that forms on your teeth, just like tooth decay (when you’re getting a cavity). If plaque is not removed, it will collect around your gum line and they’ll become inflamed and irritated. This early stage of gum disease is called Gingivitis. The good news is that you can avoid gum disease and it can be reversed easily with consistent and thorough brushing and flossing.

However, if it is not removed regularly, this plaque will harden into tartar. Your gums become increasingly red, swollen, and inflamed as tartar builds up around the gum line and they will eventually pull away from the tooth, forming a loose pocket. As more bacteria and tarter accumulate in these “pockets”, the destructive toxins begin to infect and destroy the gums, bone and ligaments that support your teeth. This advanced phase of Gum Disease is called Periodontitis, or Periodontal Disease. If left untreated, periodontal disease can lead to tooth loss, because the gums can no longer hold your teeth in place.

Tooth Loss Statistics

Here are a few staggering statistics we’d like to share with you:

Missing 1 tooth: the average person age 20-39
Missing 3+ teeth: the average 40-49-year old
Missing 8 teeth: the average 60+ person

We know what you’re thinking … I had my 4 wisdom teeth pulled!! No wonder these numbers are so high!!

Bad News: These statistics do NOT include wisdom teeth that have been removed AND this tooth loss is typically caused by gum disease. Now you understand why it’s our goal to help you AVOID Gum Disease!

Prevention Methods and Treatment

Gum disease is extremely common among adults, but the good news is that it can be easily prevented with good, daily dental care. Hygiene within your mouth is linked to your overall wellbeing, so the importance of preventing gum disease is high. You can avoid gum disease by simply brushing and flossing daily, as well as getting regular professional cleanings from your dentist are all it takes to heavily reduce your risk for gum disease.

However, if gum disease is found, usually the treatment method is simple and your dentist will usually recommend upping your normal hygiene routine at home; making sure you are following the recommended daily guidelines. If Periodontitis is found, a deeper cleaning may be needed to remove the high levels of plaque and bacteria that has infiltrated your gums and bone. This treatment is often called Scaling or Root Planing.

Related Article: Gum Disease Treatments by WebMD

Gum Disease Can Affect More Than Your Smile

Cosmetic: It’s a well-known fact that people with a healthy smile tend to look younger. However, Periodontitis affects much more than the aesthetic look of your pearly white smile and is important for more than cosmetic reasons.

Function: It’s also easy to understand that it’s easier to talk and chew when your teeth are functional and it’s less costly to keep all of your own teeth.

Overall Health: Gum disease is also a systemic disease that is related to the body’s reaction to bacteria that can have far-reaching effects on your overall health. By completely avoiding periodontal disease or treating it, you’re helping to protect your body from other systemic inflammatory conditions, such as heart disease, diabetes, and autoimmune conditions. As well as, osteoporosis, respiratory disease, and cancer.

Gum Disease and Stress: You may think about stress being a factor behind many health problems, but the truth is, stress can also have a negative effect on your oral health as well. Stress can make it harder for our bodies to fight viruses and other harmful bacteria in the body, leaving you more vulnerable to infections. This means that if you’re dealing with gum disease, your body will have a harder time dealing with it and healing.

Teeth grinding, gum disease, and bruxism can all be results from too much stress in your life. Also, if stress is causing you to grind your teeth, smoke cigarettes, or clench your jaw, then it could contribute to gum disease as well. Stress can also make us forget to brush and floss as often as needed, so remember to stay on top of your oral health and self-care routines at home.

What do Healthy Gums Look Like?

Healthy gums are pink, firm, and they do not bleed.

Avoid gum disease by keeping your gums firm, pink and healthy isn’t difficult, but it does require consistent healthy oral care habits. Your main focus is to always keep the harmful oral bacteria to a minimum!

Daily Tips & Tricks for Healthy Gums:

Use a soft-bristled toothbrush and fluoride toothpaste to brush thoroughly at least twice a day.
Replace toothbrushes every 3 months; frayed bristles don’t clean as well (and old toothbrushes can store bacteria).
Flossing once a day is a must.
Rinse with an antimicrobial mouthwash to reduce bacteria in the mouth.
Fight dry mouth by sipping water throughout the day, chew sugarless gum or suck on sugarless lozenges. Dry mouth creates an environment where bacteria can thrive. Numerous medications and certain illnesses can cause dry mouth.
Schedule routine dental appointments every 6 months that include a professional cleaning.
Stop Smoking! Tobacco, of any kind, increases the risk of gum disease and makes it harder for gums to heal.
DO NOT VAPE! Vaping is not an alternative, even if you’re not using nicotine.
If you are Diabetic, you need to be diligent about keeping your diabetes under control, since high sugar levels can increase your risk for gum disease.
Opt for healthy snacks. Healthy foods can help lower the risk of gum disease. Bacteria love sugar, so as an alternative, consume water, milk, yogurts, apples, and other healthy options.

If you have children, take this opportunity to review their dental care routines and emphasize the importance of daily tooth care. A clean mouth can´t get sick!

When almost half of Americans suffer some form of gum disease, why wait?

Oral Health: Coping Methods for Easing Dental Anxiety

Posted by Genny Skrobanek on July 26, 2022

Easing Dental Anxiety

If you’ve ever dealt with nerves, the jitters, or anxiety about visiting your dentist, know that you are not alone … let’s talk about easing dental anxiety.

According to article, Why Are People Afraid of the Dentist? Observations and Explanations,

“Dental anxiety, or dental fear, is estimated to affect approximately 36% of the population, with a further 12% suffering from extreme dental fear. This anxiety can have serious repercussions in terms of an individual’s oral health, and it is considered to be a significant barrier to dental attendance resulting in poor attendance.”

Downside of Avoiding Dental Offices

Seeing your dentist for routine checkups and maintenance is too important to your health and wellbeing to skip. When you don’t see your dentist, you’re at a much higher risk for:

Cavities
Bad breath
Tooth loss
Infection
Gum disease
Discolored teeth
Plaque and tartar

More Tips from the American Dental Association: Coping with Dental Anxiety

Easing Dental Anxiety: Tips and Tricks

Rather than postponing or cancelling visits, let’s look at some of the coping mechanisms for dental anxiety.

Psychological Coping Mechanisms

Meditation
Deep breathing
Guided imagery – visualizing happy thoughts, nostalgic thoughts
Distraction (tv, music, stress ball, etc.)
Using a weighted blanket

Bring a Friend

Ask your dentist if a relative or a friend can accompany you to your dental appointment. Having a familiar person nearby may calm nerves and make you feel safe.

Medication

In some cases, medication may help with dental anxiety. Analgesia is an over-the-counter medication that are sometimes used to reduce pain and anxiety, or sometimes, dentists will use laughing gas to ease anxiety.

Make Sure to Speak Up

Let our dental office know beforehand that you experience dental anxiety. It can make a world of difference if Dr. Skrobanek and his Team are aware of your anxiety and can be prepared prior to your appointment. You can also agree on a signal with Dr. Skrobanek if you ever need to take a break. Don’t be afraid to ask questions, sometimes knowing exactly what will happen, and when, can alleviate some nerves.

A Few More Tips

Avoid caffeine and sugar before any appointments – these can make you jittery and more anxious. Instead, eat a high protein snack or meal.
Choose an appointment time that is the least stressful for you.
Arrive on time for your appointment – try not to arrive too soon.

Easing Dental Anxiety at GPS Dental

The mouth is a great window to the rest of your body, so when you visit us at GPS Dental, we can take a peek into your overall health during your regular dental cleanings and exams. This could save you money, time, and protect your health down the road. Learn how HERE.

When your Dr. Skrobanek catches a problem early, there’s a much better chance of figuring out what’s going on and treating it early, with a higher success rate. Oftentimes, dentists can detect warning signs before we experience any symptoms. Actually, oral health is an easy way to boost your immune system, learn more HERE.

Luckily, when depression or anxiety takes a toll on oral health, there are ways to fight back. The simplest step in easing your dental anxiety that you can take is to maintain your oral health by brushing twice a day, flossing daily and scheduling regular dental appointments with Dr. Skrobanek and his team at GPS Dental. Keeping up these basic oral health habits can go a long way to keeping your mouth in tip-top shape.

Dr. Gary P. Skrobanek and his experienced, friendly team at GPS Dental offer affordable family dentistry and gentle dental care in the San Antonio, TX area. Our Brooks City Base dentist office is conveniently located and offers early morning appointment times Monday through Friday to meet your needs. At GPS Dental, we provide most dental services, from family and general dentistry to dental implants, sleep apnea, TMJ / TMD Treatment, cosmetic dentistry and much more. We accept most dental insurance plans and offer affordable financial solutions for any budget. Call us at (210) 633-3477 to make an appointment.

Staying Hydrated is beneficial to your Oral Health and Your Body

Posted by Genny Skrobanek on July 12, 2022

You’ve probably heard that drinking water can help clear up your skin, keep your body healthy, rejuvenate your muscles, get rid of waste, etc. There are so many benefits to staying hydrated and many of them are widely known. Essentially, there’s no better drink than water, and it makes sense with our bodies being 60% water. What sometimes isn’t known is how great drinking water is for your oral health. A simple and easy way to help keep your teeth healthy and strong is to drink more water!

Learn more about The Best Beverage

Staying Hydrated: The 4 Major Oral Health Benefits of Drinking Water

Strengthens Teeth. In the United States, fluoride is added to our water and it’s a huge contributor to your oral health. Fluoride is often known nature’s cavity fighter and that’s exactly what is does for us when you drink water with fluoride. It blends with your teeth’s enamel and can even prevent tooth decay and plaque.
Cleans and Keeps Your Mouth Clean. When you drink something after you consume food, it helps to wash away leftover food in your mouth, and water is the best option for this. When you consume drinks filled with sugar, your tooth enamel suffers and gets worn down due to a build-up of bacteria from all the sugar. With water, there’s no sugar involved, and it can wash down the food you eat, dilute the acid in your mouth, and also clean up any debris in your mouth so bacteria have less to cling to. That fluoride we talked about earlier will also coat your teeth and defend your teeth against any harmful acids. Watch this quick video: Drinking Water for Good Oral Health
Keeps Dry Mouth Away. Surprisingly, tooth decay loves a dry mouth and this is because saliva is our biggest defender against tooth decay (which makes staying hydrated even more important). So, when your mouth is dry, you’re fighting against more and more bacteria. Drinking water helps keep the dry mouth away by creating more saliva in your mouth.
Fights Bad Breath. You might think that a swish of mouthwash is the only way to curb a case of bad breath, but water comes to the rescue again. In the morning, we’re essentially dealing with dry mouth after sleeping for hours, and our bad breath is a result of that. Bacteria has been working hard overnight to give us bad breath, and drinking water when we wake up can help with the dreaded morning breath smell, and, of course, contribute to good oral health.

The reasons to drink water are plenty, and knowing how big of an effect water can have on our oral health makes it even more imperative to staying hydrated by drinking water every day.

GPS Dental Wants You to Have a Healthy Smiles

As you know, it’s important for everyone to have a solid foundation of oral health habits. Not only does that include brushing and flossing daily, but also having healthy habits — including drinking water! Why is drinking water important for you and your family? I hope we answered that question in this blog. Dr. Skrobanek and his Team love to talk about dental health and look forward to answering any of your questions during your next dental appointment.

Life Saving Preventative Dentistry Helps Diagnose Disease & Cancer Early

Posted by Genny Skrobanek on April 26, 2022

What is Life Saving Preventative Dentistry and how can it save your life? In simple terms, your dental exam can expose and help diagnose gum disease and oral cancer early. Let’s discuss.

Your Dentist is a Super Hero

You know that seeing your dentist is important and helps keep your mouth healthy and clean, but did you know that getting regular dental checkups is the most important procedure against oral cancer? Your dentist is doing a lot more than just checking up on your smile and cavities.

Dr. Skrobanek is a Super Hero. The preventative dentistry he provides can detect early signs of cancer, gum disease, and other major health problems; not to mention the little problems that can be treated. All in all, preventative dentistry could just save your life.

The Test of Time with Life Saving Preventative Dentistry

Your smile was meant to last a lifetime. That’s why it’s so important to take care of your teeth, so they can function well and last as long as they’re supposed to. Ultimately, the best thing you can do for your teeth’s durability is seeing your dentist for life saving preventative dentistry that includes regular dental exams, cleanings, and oral cancer screenings.

According to the Oral Health Foundation, “Dental appointments shouldn’t just be made when you have a problem that needs to be addressed. Prevention is always better than needing a cure and there are plenty more reasons why it’s important to maintain regular visits to your local dental practice.”

Some of these reasons include:

Prevention of plaque, tartar, decay
Helps keep gum disease away
Checking for oral cancer and other health issues
Getting advice on your specific needs/oral health goals

Preventative dentistry focuses on dental care practices, good oral health, oral hygiene education, and early detection – which is what’s happening during your routine dental exam. So, your dentist may talk with you about what steps to take to avoid cavities, tooth decay, best oral health practices, and so on.

Oral Cancer Screenings

When your dentist does an oral cancer screening, they’re looking for abnormalities in the mouth tissue. This can be lumps, pimples, patches that are rough, or teeth placement changes. This is done both visually and by feeling around the mouth. Diagnosing oral cancer in its very early stages is critical because each year, over 7,500 deaths are caused by oral cancer alone.

The screening will be painless and easy, and it could be the difference of early detection or not. If something looks like it may be oral cancer, your dentist may suggest a biopsy of some tissue. Early detection can significantly increase the chances for a full recovery and can make treatment easier as well.

Learn more from The American Dental Association about Detecting Oral Cancer Early.

Your mouth is the gateway to your entire body and its health determines your overall health. We believe that brushing and flossing daily, and regular dental exams and cleanings are key to a beautiful smile and a happy, healthy you!

Overall Checkup and The Importance of Oral Health

Oftentimes, we don’t notice some oral health problems unless they cause us pain or discomfort. Maybe we have a signs and symptoms of a problem that we never would’ve noticed until later on, when issues have progressed.

The good news is, your dentist can look for multiple signs and symptoms that show in our mouths – such as oral cancer, Crohn’s Disease, and other serious health problems. So, when you get your regular dental exam, you’re doing so much more for your overall health and wellbeing than just getting your teeth cleaned. How amazing is that?

Early diagnosis through dental exams can sometimes determine health issues such as:

Crohn’s Disease
Diabetes
Oral Cancer
Anemia
GERD
Intense stress
Osteoporosis
Dementia
Rheumatoid Arthritis
Heart Disease

As you can see, Dr. Skrobanek offers life saving preventative dentistry each time you visit his office. That’s one of the main reasons we schedule your next appointment after your dental exam and cleaning, so we can help you manage your oral health and stay healthy.

10 Easy Steps to Improve Your Smile

A healthy smile isn’t always achieved overnight, but takes a variety of methods to help create and maintain. Here are 10 easy steps you can take to help improve the appearance and health of your teeth, mouth, and gums.

Brush your teeth twice a day
Floss every day
See your Hygienist twice each year
Stop Smoking
Drink plenty of water
Buy a quality toothbrush
Limit coffee, tea, and red wine
Choose whitening products carefully
Improve other health conditions
Get dental treatment in a timely manner

It can take some time before you start to notice changes from whitening or improved oral hygiene. While these changes don’t come overnight, they are certainly worth the time and effort, both for the sake of your smile and your overall health. You should also have regular dental checkups and cleanings. Why? Read more about “Why it’s important to schedule your dental exam twice a year”.

A Healthy Smile Can BOOST Your Immune System

You may not realize that a healthy smile can boost your immune system and don’t forget about the importance of healthy gums! They may not seem like the star of the show, but they’re just as important as every other part of your mouth, and have to be taken care of to maintain a bright and healthy smile. Even if you take care of your teeth and don’t have any cavities to worry about, you’re not immune to gum disease.

To learn more about Gum Disease, enjoy our blog: BOOST Your Immune System thru Oral Care and Gum Health

GPS Dental Offers Life Saving Preventative Care

That’s why our expert team at GPS Dental strives to educate our patients on healthy habits that can do more than keep your smile bright. Life saving preventative care is one of the main reasons it’s always important to see Dr. Skrobanek every 6 months for proper checkups at GPS Dental, so your he can check for all the signs of a healthy mouth. A healthy mouth, teeth and gums has all the makings for a beautiful smile!

Thyroid Disease: Link Between Hashimoto’s and Gum Disease

Posted by Genny Skrobanek on April 12, 2022

Link between thyroid disease, Hashimotos, and Gum Disease

You may have heard the common phrase, “all disease starts in the gut.” A phrase that was coined over 2,000 years ago, which has been attributed to Hippocrates, the Greek founder of medicine. While that phrase is true, it’s also true that the mouth is often the window to the entire body. Meaning that if something isn’t right in your system, it’ll show signs in your mouth.

This means that your mouth is connected to more than just your teeth or even your gut – it’s connected to your thyroid, liver, kidneys, and all other parts of your body. In the past few years, the scientific community has determined the link between thyroid disease, and Hashimoto’s, with gum disease. According to Dr. Izabella Wentz, a doctor of pharmacy, “the same bacteria that contribute to gum disease or periodontitis produce an inflammatory response associated with Hashimoto’s thyroiditis—the underlying cause of hypothyroidism.”

Learn more from Dr. Wentz: Periodontitis, a Trigger for Hashimoto’s?

Gum Disease/Periodontitis

Gum disease, also known as periodontitis, happens when your gums become inflamed from bacteria in the mouth. This can lead to:

Loose teeth
Receding gum line
Bone loss in the jaw
Tooth loss

Gum disease is common and effects up to half of Americans over the age of 30, according to the Centers for Disease Control. If you’re seeing blood when brushing or flossing your teeth, it could be the first sign of gum disease, so it’s important to stay on top of your oral health routine and to see your dentist regularly for checkups and cleanings. So, what’s the link between Hashimoto’s and gum disease? The proof is in the bacteria.

Case Study:

Please read the below clinical case report of Hashimoto’s thyroiditis and its impact on the treatment of chronic periodontitis (link below):

https://www.njcponline.com/article.asp?issn=1119-3077;year=2012;volume=15;issue=1;spage=112;epage=114;aulast=Patil#:~:text=The%20strongest%20type%20of%20causal,the%20outcome%20of%20periodontal%20therapy.

Linking Bacteria to Thyroid Disease and Hashimoto’s

According to Dr. Wentz, the link is in molecular mimicry. While that may sound confusing, let’s break down the basics of it all:

The bacteria in our mouth, which is causing gum disease, is also causing inflammation in the rest of our body.
People with Hashimoto’s often have gum disease. When they experience flare-ups in their disease, they also experience flare-ups in their gums – showing a connection.

“Molecular mimicry is an autoimmune theory suggesting that bacterial cells or other proteins (such as food proteins) have a similar appearance to the cells that make up parts of the human body, or “self-antigens.”, says Dr. Mentz.

So, when bacteria are around, our body is not only attacking the bacteria, but also parts of our body that have similar proteins. Meaning our body could be attacking the bacteria in our gums, and also the proteins in our thyroid.

The relationship from the National Library of Medicine: Relationship between hypothyroidism and periodontitis: A scoping review

Gum Disease is linked to other diseases. Learn more:

Protect Your Thyroid and Your Mouth

The evidence for good dental hygiene is stronger than ever. Regular brushing and flossing are essential for not only good oral health, but good overall health. The thyroid can have huge impacts on all aspects of your body, and your mouth could very well be impacted through gum disease. If you’re concerned about signs of thyroid or Hashimoto’s, speak with your doctor about testing your thyroid.

GPS Dental Offers Help

Now that you understand a little more about the link between Hashimoto’s and Gum Disease, GPS Dental can help. At GPS Dental, we offer treatment for our patients with Gum Disease with thorough dental cleanings that you may not find through other dental offices. Call 210-633-3477 to schedule your dental exam and cleaning, remember it can lead to early detection and diagnosis of disease. Make sure to mention any changes in your health, new medications, and especially if you are seeing blood after brushing or flossing your teeth.

Dr. Skrobanek and his team at GPS Dental are accepting new patients and look forward to meeting you and your family.

Oral Health: Protect Your Teeth and Smile Over the Holidays

Posted by Genny Skrobanek on December 7, 2021

At every turn there seems to be a plate of cookies, a tray of chocolate, or visions of sugar plums dancing in our heads. Christmas season is in full swing and the sweet treats and sugary concoctions are upon us! While holidays can bring us so much joy, some stress, and confections, a little bit of effort in your oral health care routine can make all the difference for your smile and dental health. Here’s how to stay on top of your dental care and protect your teeth this holiday season.

Learn More: Have You Been Naughty or Nice to Your Teeth?

Sweet Alternatives – Try a Cheese and Meat Tray

Sweets can not only wreck some havoc on our teeth, they can also bother our stomachs and cause a buildup of harmful bacteria in our mouths. While it’s certainly okay to indulge in a few sweet holiday treats, keep in mind that meat and cheese trays are a much healthier snack option to protect your teeth. If you’re drinking soft drinks or any alcoholic beverages, cheese can also neutralize the acid in these drinks and are also a good source of calcium.

You can also enjoy:

Fruit trays – Apples, strawberries, and kiwis can actually help scrub your teeth when you eat them. The natural fibers in these fruits, combined with your saliva, help wash away harmful bacteria.
Vegetable trays – Carrots and broccoli are packed with Vitamin A, which helps strengthen your teeth’s enamel.
Sugarless gum – Since you may not be able to sneak away to brush your teeth at a holiday party, chewing sugarless gum increases saliva production, which helps wash away any leftover food bits and bacteria.

Stick to Your Daily Oral Health Routine

Routines are so helpful at keeping us feeling normal. Holidays can really interrupt our normal schedules and daily activities, so keeping to your daily oral health routine can become more difficult than ever – but it’s also more important than ever.

With an influx in sweets, alcohol, and other holiday goodies, our mouths can take a toll. Keep the bacteria at bay and strengthen your immune system by brushing twice a day and flossing once a day. If you’re traveling, remember to pack your essentials to make your routine easy and protect your teeth!

More Tips to Protect Your Holiday Smile

Add in More Water

Water is really the best thing you can drink. It helps hydrate us and give us glowing skin, but it also helps keep our mouths cleaner as well. Just like how saliva washes away bacteria, water also does this. It cleans away bacteria, freshens breath, and helps with digestion. All good things. Remember, if you’re going to enjoy a treat, eat it either with your meal when you have a lot of saliva production, or drink lots of water after to wash out any lingering bacteria.

Related Article: Why Water is the Best Beverage

Are You Stressed and Grinding Your Teeth? Mouthguards are a Solution

Dr. Skrobanek can help prevent cracked and fractured teeth by designing a mouthguard or oral appliance to wear at night to keep you from clenching and grinding your teeth. We know there’s a dental health mental health link and thankfully, mouthguards are a wonderful way to protect your teeth at night. They can also help with sleep apnea and snoring. Each mouthguard will be custom-made by Dr. Skrobanek to fit your mouth comfortably and will keep your teeth separated so they don’t grind together.

There’s more good news: Custom mouthguards or oral appliance therapy is covered by many insurance plans and the team at GPS Dental can help answer any questions you may have about your coverage. Learn More HERE.

See Your Dentist ASAP

Many of us will lose our dental benefits come December 31, so it’s time to use them or lose them! Make an appointment today if you’re in need of a checkup or cleaning. The absolute best way to stay on top of your oral health is to see your dentist regularly.

GPS Dental Can Help You Protect Your Smile

Know you know more about how to protect your teeth and smile! It’s also important to stay up to date on your cleanings and routine visits with Dr. Skrobanek. In the meantime, having a strong and steady oral health routine – brushing twice a day and flossing once – is the best thing you can do for your oral health!

Dr. Skrobanek Works to Save Your Tooth, Not Pull It

Posted by Genny Skrobanek on January 19, 2021

Do you need a tooth extraction or can Dr. Skrobanek save your tooth?

Although we hope our natural teeth will last us forever, sometimes life throws a wrench in our plans and a tooth extraction is necessary for our oral health. However, at GPS Dental, we always do our best to provide you with the best dental care and make sure an extraction is the last option. If we can save your natural teeth, we will, every time. Still, let’s take a look at why a tooth extraction may be necessary and what you can expect.

Learn More from WebMD about Pulling a Tooth

Reasons for a Tooth Extraction

Damage – probably the most common reason for a tooth extraction is a damaged tooth that’s beyond simple repairs. Damage can often occur from:

Decay or infection: If a tooth’s decay penetrates the inside (pulp) of a tooth, then a root canal is often the first step to restore the health of the tooth. However, if antibiotics don’t cure the infection, then an extraction may be the next step. This is necessary for the health of your mouth. Periodontal disease will sometimes cause the loosening of a tooth, and the tooth may need to be pulled if it’s extremely loose, or if the tooth is at risk for infection.
Crowded mouth: Sometimes we have to pull teeth to make room in the mouth. This happens sometimes with wisdom teeth to eliminate crowding. Or, if a tooth cannot break through the gumline, it will be best to pull it.

Related Articles:

What to Expect

Once a tooth extraction is decided as necessary and we cannot save your tooth, there are a few steps for a successful extraction. A thorough examination will be performed and X-rays will be taken. Dr. Skrobanek wants to make 100% sure that your tooth must be pulled before performing an extraction. If your tooth can be saved by other methods, then those will definitely be looked into instead.

There are two types of extraction – simple and surgical. Simple extractions involve a local anesthetic to numb the area. We then use a tool called an elevator to loosen the tooth and extract it. Surgical extractions are what they sound – surgical. You will be unconscious during the procedure and the tooth will be extracted surgically. A small incision will be made around the tooth to remove it. Recovery often takes a few days.

Learn More on What to Expect from a Tooth Extraction.

Dr. Skrobanek at GPS Dental Wants to Save Your Tooth

As you can see, there are many reasons your tooth may need to be pulled; however, one thing that can help you keep all of your natural teeth healthy and in place is prioritizing your dental health. (Learn how GPS Dental is Keeping You Healthy with Extra Safety Precautions.) Brush and floss daily and make sure to visit your dentist every 6 months for a dental exam and cleaning. Dr. Skrobanek will help treat any cavities or decay, before your tooth runs out of options and needs to be pulled.