What is Air Abrasion in Dentistry?

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Air Abrasion is an alternative to a drill in preparing a tooth for a filling. We have been using this alternative procedure for some time and with many patients. We have never received a complaint about the process. Our patients find it a delightful alternative to drilling.

Air Abrasion works like a tiny sandblaster. It is used to remove decay in small areas of a tooth. It directs a slender stream of particles at the decayed portion of the tooth. The particles are typically a composite of silica, aluminum oxide, or baking soda. They are propelled by compressed gas or air. When the spray comes into contact with the tooth, it removes the particles of decay from the tooth. These particles are removed with suction.

Air Abrasion is safe for you and for your dental team. We wear protective eyewear, and we will ask you to do the same to prevent any irritation from the spray. To protect the teeth and mouth areas around the tooth we are treating, we surround the target tooth with a “rubber dam” (a rubber sheet that fits around the tooth) or with a protective resin that we apply to surrounding teeth and gums. Use of suction during the procedure prevents you from breathing in any of the particles. In fact, air abrasion is considered a form of “conservative dentistry.”

Here are the key facts you may want to know about using air abrasion.

  • Unlike a drill, air abrasion creates no heat, pressure, or vibration.
  • Use of air abrasion typically reduces the number of cases with the need for numbing or anesthesia.
  • Air abrasion can remove the decay while protecting the surrounding healthy tissue.
  • Air abrasion reduces the risk of fracturing, chipping, or otherwise damaging the tooth. It is widely believed that this extends the life of the filling.
  • It may take a little bit longer to remove decay with air abrasion, but the process is quite simple.
  • The procedure is not always completely free of pain or sensitivity, but this is typically relatively minor.
  • Air abrasion is not recommended for deep cavities or for cavities between teeth.
  • Air abrasion cannot be used to remove hard enamel.
  • Air abrasion cannot be used to prepare teeth for crowns, onlays, and inlays.
  • The process if ideal for children and for people who are fearful of dental procedures and have minimal shallow decay.

In addition to this primary use of air abrasion, it can also be used to remove old composite restorations, to prepare the surface of a tooth for the application of a sealant or for bonding, and to remove discoloration of teeth due to damage or stains.

At Complete Dental Care of Salem, VA, we are pleased to offer air abrasion as an alternative to drilling in many cases. It is always our goal to preserve as much of the natural tooth as possible and to cause as little stress and pain as possible for our patients. If you have a child with an early-stage cavity or if you (or your child) are fearful of dental procedures, air abrasion might be the best approach to preparing your tooth for a filling. Ask me about air abrasion. I will be happy to explain why it may or may not be the best option for you. If appropriate, we are happy to use this process. 

Metabolic Syndrome and Oral Health

There is a clearly documented connection between metabolic syndrome and oral health. This connection is important in treating the condition, and you might find it helpful to have your primary care physician and your dentist working together to some extent. Metabolic syndrome affects approximately 23 percent of American adults. It is more prevalent as people age. Every year three million new cases of metabolic syndrome are diagnosed in the U.S.

Incidence of metabolic syndrome in Americans has been studied, resulting in the following findings:

  • 40% of people over age 40
  • 37% of all women
  • 50% of people over age 60
  • Incidence in the pediatric population is increasing.

What is Metabolic Syndrome?

Metabolic syndrome is a convergence of several conditions: high blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels. When several of these conditions are found together (metabolic syndrome) you are at increased risk of heart disease, stroke, sleep apnea, neuropathy, some cancers, kidney disease, fatty liver disease, and diabetes. Any one of these conditions in isolation does not indicate metabolic syndrome. It can, however, increase your risk of developing it. Having more than one of the conditions, further increases your risk.graphicstock-belly fat SmMdHxnL

Metabolic Syndrome is also called:

  • Dysmetabolic syndrome
  • Hypertriglyceridemic waist
  • Insulin resistance syndrome
  • Obesity syndrome
  • Syndrome X. 

Symptoms of Metabolic Syndrome

Several indicators of metabolic syndrome have been identified. They are:

  1. Abdominal Obesity. Specifically, a large waist circumference is a highly visible indicator. Large, in this connection, is 35 inches or more for women and 40 inches or more for men. The larger the circumference of the waist, the greater the likelihood of having metabolic syndrome.
  2. Insulin Resistance. Insulin resistance is a condition I which your body cannot use blood sugar or insulin. Untreated, this can lead to pre-diabetes or type 2 diabetes. This is the body’s response to its own inability to respond to the body’s increased need for insulin. Without sufficientinsulin, excess glucose accumulates in the bloodstream.
  3. Abnormal levels in the blood. Several abnormalities can be identified in blood tests.
    1. Elevated levels of C-reactive protein in the blood.
    2. High blood pressure (above 130/85 mmHg.
    3. High triglycerides (150 mg per deciliter or 1.7 millimoles per liter or higher).
    4. Reduced high-density lipoprotein (HDL) cholesterol. (Atherogenic Dyslipidemia)
    5. Elevated fasting blood sugar.
  4. Fatigue or Tiredness. This is particularly important if fatigue is experienced after eating a meal 
  5. Brain fog. This is an inability to focus on something or a specific task appropriately.
  6. Acanthosis Nigricans. This refers to a browning in the folds of your skin, particularly on your neck, armpits or groin and between butt cheeks.
  7. Other physical changes, including frequent urination, abnormal thirst, frequent feelings of fatigue, and blurred vision. 

If you begin to experience one or more of these symptoms, it might be time to visit your physician 

Risk Factors

Diabetes test SM- storyblocks DSC 0777Metabolic syndrome is linked with obesity and inactivity. Certain risk factors raise the chances of developing or having metabolic syndrome. These include:

  • Age. Risk increases with age.
  • Race. In the U.S., Mexican-Americans appear to be at greatest risk of developing the condition.
  • Obesity.
  • Diabetes.
  • Other diseases: cardiovascular disease, nonalcoholic fatty liver disease, polycystic ovary syndrome 

The Oral Health Connection

A clear connection between metabolic syndrome and oral health problems has been documented. Key points in this regard are:

  1. Periodontal disease is an early warning sign for metabolic syndrome.
  2. In one study, untreated periodontal disease was linked to a 3-fold increase in mortality from heart and kidney diseases.
  3. Periodontal disease elevates HBA1C markers and may contribute to the onset of diabetes.
  4. Periodontal therapy can reduce markers of inflammation, preventing heart complications.
  5. Periodontal therapy reduces HBA1C levels, and promotes blood sugar control in diabetics.
  6. Reducing HBA1C levels reduces the risk of death and serious complications from diabetes and heart disease.

Many people, including many dental patients, tend to separate oral health from overall general health. This is not a bad thing, and it is not uncommon. It simply suggests a need for additional information nor education and a shift in perception. At Complete dental care - pixabay cco free commercial use-842314 640Dental Care of Salem, VA, we strive to help every patient understand this broader perspective. We want our patients to think about more than the whiteness of their teeth and the appearance of their smile. We are committed to helping each patient appreciate how oral health affects their overall health. 

We will ask you about risk factors and symptoms of metabolic syndrome, just as we inquire and maintain records regarding sleep apnea and other sleep disturbances. We evaluate patients with risk factors for metabolic syndrome or any of the component conditions in terms of the aggressiveness of each individual’s care plan. All members of our team understand metabolic syndrome and each of us are happy to discuss your health with your primary care physician upon request. 

We know that our patients trust us to identify and understand their needs and to provide the appropriate levels of care to promote both oral health and overall health. We are always eager to answer your questions. The more honest and open you are with us about your general health issues and concerns, the better our responses to your needs will be. 

What You Can Do About Metabolic Syndrome

There are a number of steps you can take to prevent and control the component conditions of metabolic syndrome or metabolic syndrome itself. Among the most important are:

  1. Healthy diet. Two “diets” have been found to be particularly helpful for those with metabolic syndrome: the dietary approaches to stop hypertension (DASH) diet, and the Mediterranean diet.
  2. Lose weight. Reducing body weight is one way to reduce the weight carried around the waist. Maintaining a healthy weight also reduces insulin resistance, blood pressure, and risk of diabetes.
  3. Physical activity. Many physicians recommend 30 minutes or more of moderate exercise each day. This could be something as simple as a 30-minute walk.
  4. 4.Stop smoking. Smoking exacerbates the health effects of metabolic syndrome.
  5. 5.Manage stress effectively. The effects of stress are harmful to overall health and to oral health. Managing stress through exercise, meditation, or other programs will improve your outlook, your energy, and your health.


Metabolic syndrome is pervasive in the U.S. It is a condition that affects millions of people and one that brings serious consequences if not treated appropriately. Oral infections and bacteria contribute to the severity of metabolic syndrome and its component illnesses. Aggressive dental and periodontal treatment and management can help you and your primary care physician manage the condition and improve your quality of life.

If you have metabolic syndrome or one of its components, or if you have risk factors for the condition, please notify us immediately. We will work aggressively with you and your physician to treat any oral health issues that may contribute to or result from the condition. Together, we can make great progress in improving your quality of life and extending your life.  

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Dental Care for the Middle Aged

A recent study of dental care of the middle aged (age 50 – 64) presents a disconcerting picture. Their needs and expectations after age 65 are very uncertain. This study was conducted by the University of Michigan Institute for Healthcare Policy and Innovation and supported by AARP. The current state of dental care and oral health among the middle aged is a surprise to many. We know that older Americans find it difficult to pay for dental care. This study casts light on the challenges faced by thosesm graphicstock cbi-0216-038 013 220614 approaching retirement.

  • “One in three . . . say they’re embarrassed by the condition of their teeth.”
  • A slightly larger percentage of middle aged Americans report dental problems that cause pain, difficulty eating, missed work, or other health problems in the last five years.
  • And, 40 percent don’t get regular cleanings or other preventive care that could help to prevent problems in the future.
  • 28 percent of those in the study reported having no dental insurance coverage.
  • Among those who seek care only for serious dental problems, 56 percent are without dental insurance.
  • 28 percent of those surveyed have no dental insurance.
  • 56 percent see a dentist only for serious dental problems.

In terms of current oral health there is a serious divide among middle aged adults around those who have insurance and good dental care (including prevention) and those who do not. Thus, the cost of preventive dental care (with or without insurance) is a significant barrier for many middle-aged Americans. Other reasons for not visiting a dentist regularly include being afraid of the dentist, could not find time to visit a dentist, or could not find a dentist.


More than one in 4 have no dental insurance now. Without preventive care and regular treatment of emerging problems, their oral health is likely to decline.


As middle-aged Americans look to the future and their dental care needs

  • 51 percent said they don’t know how they will get dental insurance after age 65.
  • 13 percent expect to count on Medicare and Medicaid for their dental needs.
  • Medicare pays nothing for dental care; Medicaid coverage is very limited.

Despite the fact that most of the participants in this study understand and agree with the importance of preventive dental care, and understand the link between dental health and overall health, those who are currently middle-aged face a very challenging landscape for receiving appropriate dental care after age 65.


We know the number of Americans now over the age of 65 who face challenges in obtaining and paying for dental car. This study indicates that we can only look forward to a worsening situation as those currently middle-aged also face the same challenges in obtaining and paying for dental care. The question is what we can do and what we will do to improve the dental health of our seniors and how they can be expected to pay for treatment? The solution probably lies in some combination of changes and improvements that will address this issue. Some elements of a solution would seem to be to (1) improve the coverage offered in dental insurance and (2) find ways to make dental insurance either more affordable for all or available to all as part of Medicare. Finding a workable solution to the problem and improving the dental health and overall health of aging Americans is one that we must face as a nation. Good dental health improves both life expectancy and the wellbeing of every person. 

Posture and Your Teeth


Do you have problems with balance or posture? How do your teeth come together when you close your mouth? There is a connection between the two.

In two recent studies, it has been demonstrated that malocclusion (teeth that do not come together perfectly) typically parallels balance - pixabay cco free commercial use - jump-863058 640balance and posture challenges. The evidence suggests that correcting your #occlusion will contribute to improvement in your posture and balance.

Why is this important? It seems particularly important to three groups of people.

  • First, it is important to persons with physical disabilities. Improvement of balance could significantly improve mobility, reduce fear, and improve state of mind.
  • Second, it is important to older adults. Many older people develop posture and balance issues as they age, particularly in connection with other conditions. The number one cause of emergency room visits for older adults is falls. If something as simple as correcting malocclusion would improve stability for these people, their general health and their enjoyment of life would be enhanced.
  • Third, it is important for athletes. Correcting a malocclusion to improve balance and posture could significantly enhance athletic performance.

If a dentist can improve your life in so many ways, isn’t it worth discussing malocclusion? Ask me about it when you come in for your next appointment.  

Clear Tooth Aligners: Are They Right for You?

As an alternative to traditional braces, clear tooth aligners have become very popular in recent years. They might be the right choice for you or for your child. These plastic aligners (or series of aligners) accomplish the same goal of straightening and properly aligning teeth as traditional braces, but with several advantages. Unfortunately, these are not the best choice for everyone.

Advantages of Clear Tooth AlignersClear tooth aligners - Are they right for you - Caroline Wallace DDS

  1. Appearance. Clear aligners are almost invisible, making them a good choice for those who are concerned about the appearance of their teeth during the alignment process.
  2. Removable. Clear aligners can be removed as you choose.
  3. Eat what you want. Some foods should not be eaten when wearing conventional braces because they can become caught in the hardware and cause pain or damage. Clear aligners allow you to eat whatever you want.
  4. Fast results. Clear aligners are one of the fastest and easiest ways to straighten and align teeth.
  5. Minimal pain. Clear aligners correct tooth alignment continuously and gradually as opposed to the periodic adjustment of braces, which can be painful or irritating.
  6. Less frequent dental appointments. Clear aligners require a visit to the dentist only once every 6 to 8 weeks. Many people find this preferable due to busy schedules.
  7. Better oral health. Unlike the tendency of traditional braces to trap food particles that are difficult to remove, tooth aligners are simply removed while you brush, easily cleaned, and replaced.

Answers to Most Common Questions

Most people have questions about clear aligners. We believe you should have every opportunity to ask all of your questions and receive thoughtful and helpful answers before you decide to use them. The following are responses to the most commonly asked questions.

  • What should I expect during treatment? You may experience some occasional minor pain for a day or two at a time because the new aligners are moving your teeth. People might ask why your teeth look different. You can expect your “bite” to feel different during the process. You may have a lisp during the early days of using aligners.
  • How comfortable are the aligners?  Although you may experience some irritation or sores in your mouth while using clear aligners, they tend to become more comfortable as you wear them. The devices may cause some increase in salivation or in dry mouth.
  • How are they cleaned? Proper oral hygiene is important when using aligners to prevent damage to your teeth or gums. The devices can be cleaned with a toothbrush and cool water.
  • What are the bumps on some aligners? The bumps are called “engagers.” These may be attached to facilitate difficult tooth adjustments. They are made of a composite material that matches the color of your teeth.
  • How long does the process take? The duration of the process varies depending upon the amount of realignment needed, your health, and the rate of bone and tissue adjustment. Your dentist will review this with you before beginning the process.
  • Do I wear the aligners all day? We recommend that you wear the aligners for 22 hours every day. They should be removed for eating and cleaning. Failure to do so will slow down the entire process.
  • How often are the aligners changed? Typically, you will move from one aligner to the next every 1 to 3 weeks. However, frequency depends upon the amount of change needed and your willingness to diligently follow instructions.
  • What happens when the whole process is finished? You will be given a retainer and instructed how long to wear it to maintain the realignment.
  • What material is used to make the clear aligners? Aligners are made of a polyurethane resin that has been extensively tested. The resin contains no BPA or phthalates.
  • Can I use clear aligners when pregnant? The materials contain nothing harmful, but you should discuss your health with your dentist.
  • Are aligners covered by my insurance? You will need to ask your insurance company about your coverage. Some policies cover clear aligners and others do not.

Most people are familiar with the brand name Invisalign. When their patent expired, others began to make similar products. At that time, we switched to Clear Correct. It is less expensive and equally effective.


Clear tooth aligners are a wonderful option for many people (though not all). It is a beautiful thing when appropriately used. If you have additional questions, please ask. 


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