Saturday, January 23, 2016

Why Does My Dentist Shake My Cheek? The Painless Injection Technique.


CrossKeys Dental Always Strives for a Painless Injection

Focus on the results. Allow CrossKeys Dental keep you at ease during your visit. 

At CrossKeys Dental we realize that one of the most common causes of anxiety in the dentist’s office is the process of getting numb. Comfort is the most important goal in my chair, and keeping the patient from feeling the work is at the top of the list, but the tools we use to keep you comfortable may make you feel uneasy.  In fact, I’ll try not to use the “N” word in this article as it might make a few of you shudder…

The dentists at CrossKeys Dental make it a point to make the injection as easy as possible for the patient. I use a technique that I have found to yield happier patients and Dr. DuPre՛ uses a similar process and has kept his patients comfortable for almost 30 years! Before anything else, the doctors and the staff make an effort to maintain a relaxed atmosphere and we try to gauge the comfort level of each patient so that we can help ease them through the process.

·      A topical anesthetic is always applied prior to the injection. I like to place the gel on a cotton roll to keep it from spreading. This helps to ensure that only the injection site is numbed and not your tongue, cheeks and lips! I also like to leave it at the site for a few minutes to allow maximum diffusion into the tissue so that there is deeper anesthesia, even before the injection.
·      This is not a race! I think the most important aspect of the “painless” injection is to take it slowly. Most of the discomfort is due to the fluid pressure filling the space in the soft tissue. Slow delivery accomplishes 2 things: decreased pressure, and the ability to numb the tissue immediately ahead of the needle (I know I said I wouldn’t write it, but I needed it there…) to try to keep the patient from feeling the movement.
·      Did you know that Novocain is a thing of the past? Most (almost all?) dentists stopped using it years ago. The anesthetics that we now use have a much quicker onset and last long enough to finish the procedure comfortably.

So, how does gently shaking your cheek fit into the equation? Many dentists, including me, will often use this a distraction during the injection. While it definitely helps the patient take their mind off of the process, it is also rooted in neuroscience through a phenomenon called the gate control theory. This theory proclaims that non-painful stimulation of a site can help to “close the gate” on painful stimulation. The nerve fibers that carry touch, pressure and vibration sensation are thicker than those that transmit pain, and when they are stimulated their cells may actually inhibit transmission through the thinner, pain-carrying nerve fibers.

Think of a highway onramp. Now picture the highway as the thicker nerve fibers that carry the non-painful sensation and the onramp as the thinner, pain-carrying fibers. At 10:00 AM when most people are at work there is very little traffic and it’s easy to get onto the highway from the onramp. In this situation the pain wins out. But think of all of the traffic on the highway at 5:15. At that time it’s much harder for the cars (pain) to use the onramp to get onto the highway. So, when the dentist is shaking your cheek, he or she is trying overload the “highway”, thereby blocking the pain of the injection from reaching your central nervous system. Think about it: have you ever rubbed your elbow after you bumped it? You were putting the gate control theory into action!

We realize that most people don’t look forward to their trip to the dentist’s office, but you can rest assured that CrossKeys Dental understands this and is hard at work trying to make your visit a pleasant one. To me, after I give an injection, it always makes me feel great to hear “Did you give me the shot yet?”


CrossKeys Dental is located at 110 CrossKeys Office Park in Fairport. Dr. DuPre and Dr. Badali provide comprehensive family dentistry and are always welcoming new patients. Visit us at for more information. 
Written by Vincent Badali, DDS

Monday, December 7, 2015

Doesn't Everyone Eventually Loose Their Teeth?


What are the best ways to avoid tooth loss as we age?

Tooth loss doesn't have to be a part of aging.

If you've ever considered the prospect of living without teeth as you age, it's probably caused you considerable amount of distress just thinking about it. Multiple tooth loss can indeed be traumatic and costly, and, for some, the remedies are less than ideal. That said, you'll be pleased to know that aging itself isn't much of a contributor to tooth loss, and that many people live their entire lives with nearly all of their natural teeth intact. So what's the best way to ensure you're among this coveted group?

Let's face it. We all want to keep our natural teeth. Here are a few ways to ensure you do just that as you move along in years. And remember, there is no defined age where problems start to arise, so thinking ahead regardless of your current age is always a good idea.
  • Periodontal Disease: Without a doubt, gum disease is the number one destroyer of smiles. When thinking of dental problems, most people think of cavities, but tooth loss is more often related to periodontal (gum and bone) issues. Gum disease starts with gingivitis, which is the inflammation of soft tissue that makes you gums red and swollen. If this goes unchecked you will progress into periodontal disease, which involves the loss of attachment of the teeth to the surrounding gums and bone. In advanced stages teeth loosen and may be lost. There is no cure for this leading cause of adult tooth loss in North America, and once it begins, it can only be proactively and professionally managed. When caught early, periodontal disease may not become a problem, but that means you must maintain your regular visits, and you may be placed on a periodic maintenance routine where you visit your dentist more than twice a year. Be sure to keep those appointments - they will help you keep your teeth.
         Although the onset of periodontal disease is related to many factors (ask your dentist            at CrossKeys Dental), the best way to avoid problems is good home care. I always say          that the best (and cheapest!) dental insurance is a toothbrush and floss...
  • Systemic Disease: There are a host of diseases that can adversely affect oral health. For decades diabetes & heart disease have been studied, and even recently the link between these diseases and periodontal disease has been found to be stronger than ever before. It is important to be mindful of this connection, and maintaining an open door of communication with your doctor and dentist while undergoing treatment may help you minimize the effects these diseases can have on your teeth.
  • Poor Habits: We all know a diet high in sugar, starch and acid will harm your surface enamel and lessens a tooth's ability to protect itself from decay. You may not know, however, that smoking and excessive alcohol consumption can also do significant harm. For example, both cigarette smoke and alcohol rob gum tissue of the moisture needed to keep it healthy, leaving it acidic and prone to decay, and smoking can interrupt the mouth's natural healing mechanisms. More benign habits can also damage teeth. For instance, consistently gnawing on objects not designed to be in the mouth all day, like pencils, pipes, paper clips and ice cubes, are not good habits to pursue. Additionally, using your teeth as a vice to open bottles and rip apart bags is best left to those among us committed to losing teeth, not keeping them.
  • Prescription Medication: Lastly, certain medications can dry out the mouth in ways similar to smoking and alcohol.  Many of our patients are regularly taking prescription drugs. A growing number of people, especially the older population, are prescribed two or more drugs for various ailments. This can often cause a compounding effect, causing a greater feeling of dryness. This is where communication with your physician is key. Let your dentist know what you are taking so that we can set up a game plan that may involve medications that are still beneficial without the drying effect. Also, be sure to keep your hydration in check as per your doctor’s recommendations, or use chewing gum or lozenges with Xylitol to help maintain saliva production throughout the day. Other products and techniques are also available, so if you feel like your mouth is dry lets us know!

So, as you can see, allowing your “permanent” teeth to live up to their name really isn't that difficult. The old TV image of every grandpa throughout the land dropping his teeth into a bedside jar at the close of the day is far from a reality for the majority of today's seniors, and it doesn't have to be for you either. Maintain a solid oral care routine, and ask your care providers about keeping a healthy mouth throughout your years, and you'll be well on your way to ensuring your teeth stay just where you want them to be – in your mouth.

CrossKeys Dental is located at 110 CrossKeys Office Park in Fairport. Dr. DuPre` and Dr. Badali provide comprehensive family dentistry and are always welcoming new patients. Visit us at for more information. 

         © 2015 Patient Connect 365 - modified for CrossKeys Dental in Fairport, NY by Vince Badali, DDS

Tuesday, November 24, 2015

Why Do We Take Digital Dental X-Rays?


 Why Has CrossKeys Dental Transitioned to Digital X-Ray Technology?

Color enhancement made possible with digital technology helps your dentist with diagnosis.

Most of you have already experienced the new state of the art imaging systems we employ in our practice at CrossKeys Dental in Fairport, NY. Many of us are old enough to remember having the dental staff put little film packets in our mouth and take pictures that the dentist would look at to detect cavities and other problems. From those tiny films, the diagnosis and treatment decisions were decided upon. Now, the images are displayed on a huge monitor where we can all see them together and share in the decisions. That alone is worth the change from film to digital systems, but there is much more.

We can now enhance the images, magnify them, highlight areas of concern, make measurements, send images directly to specialists while you are still there for consultations, and even use the images to help with your insurance claims. Due to the high sensitivity of the newest capture devices that have taken the place of the film we can now render images using far less radiation than was necessary to properly expose the film that was previously used.

Both Dr. Badali and I believe that proper diagnosis is possibly the most important thing we do for the people who entrust their care to us. The quality and the precision of the images we now have makes an accurate diagnosis more possible than ever before. If you have seen these images for yourself, you can attest to the remarkable level of detail we now have at our disposal. We continue to train our staff regularly on proper technique for capturing and interpretation of the images. We call our method "Co-Diagnosis." This involves participation of the doctors, the staff and the patients themselves, all looking at, and making decisions regarding what is displayed on the monitors. In the process, the patient becomes much more educated about their own body and how they can take steps to maintain it in optimum health. Being able to show you the images first hand allows us to take time to teach you how to examine the images and what all the detail means.

One of the most important things you will soon realize is how relevant areas other than the teeth are. We carefully examine all of the bony areas of the head and neck in order to detect anything unusual which may be the beginning of something much more serious than tooth decay. You can see the details yourself as we point out the anatomical landmarks, so you know what is considered normal and what is not. Our favorite thing to tell our patients is that there is nothing on their X-ray study that is out of the ordinary. However, you can imagine how powerful the information is if we do in fact see something. We all know that as we age, things happen and that early diagnosis is the key to successful treatment. Just as important as the other tests that we all go through, such as colonoscopy, mammogram, blood tests, etc, a properly exposed and carefully evaluated dental X-ray scan could not only find cavities, it could actually save your life!

One of the operatories at CrossKeys Dental with the patient's HD monitor on display.

So for those of you who have already seen the system in action, I think you will agree that times have changed. For those who have not, we invite you to inquire of anyone on our staff about it. We have made it a priority to update our patient's charts using all available state of the art diagnostics so we will probably bring this topic up with you at your next cleaning appointment. If you wish to have a full series done prior to that time, please call our office and we will be happy to do so. We will provide you with both the images as well as some time with one of the doctors to review the scan with you.

CrossKeys Dental is located at 110 CrossKeys Office Park in Fairport. Dr. DuPre` and Dr. Badali provide comprehensive family dentistry and are always welcoming new patients. Visit us at for more information. Written by Robert DuPre`, DMD

Tuesday, November 17, 2015

What Exactly is a Dental Cavity?


So, what is a cavity anyway? 

Where do we find them? Where do they come from and how can they be prevented?
Your dentist calls them dental caries and we spend our careers trying to stop them from spreading. Think about it: have you ever been to a visit with the dentist without them and the hygienist reviewing proper oral hygiene. It's the sound of a constant drumbeat - brush twice a day for 2 minutes... make sure you floss daily… do you use a fluoride rinse?… and on and on and on. I often joke with my patients that we must be the only professionals that are trying to put ourselves out of business!
Let's face it, most of us have had at least one cavity, even those that heed our warning and follow a good home-care regimen, but following your dentist's recommendations will vastly reduce your risk and keep us from having to pick up our drill.
Here are 5 facts about cavities that you may not have known:

1. A cavity is a bacterial infection

On the most basic level a cavity is simply an acid burn. You may have heard that sugar causes cavities, and that is indirectly very true. The direct cause is the production of acid from bacteria that we all have in our mouths. The main culprit is one call streptococcus mutans, but there are others, and depending on the patient they play different roles. This acid begins to erode the enamel, which is the hard outer layer of your tooth. This small hole that starts becomes more difficult to clean, which starts a downward spiral of greater collection of bacteria and deepening of the cavity. Where does this acid come from? It's the byproduct of the sugars and other carbohydrates that are eaten by the oral bacteria after you have your meal or snack.

These bacteria form colonies that build up to form plaque. Dentists call this a biofilm, which is nothing more than a huge group of bacteria held together by their own sheer will and a few other main ingredients, often produced by the bacteria themselves. So imagine the number of bacteria that needs to be present for you to be able to see it! These microorganisms reproduce very quickly (some create an entirely new generation in about 20 minutes!), so brushing twice and flossing once daily helps to reduce these numbers, allowing you to contain their spread.

2. Your teeth may be constantly under attack

Since we covered the bacterial production of acid with respect to the foods we eat, we can take that a step further. To get you up to speed without giving you high school chemistry nightmares – a greater acid concentration means a lower pH. Each time we eat, the acid content increases and therefore the pH in our mouth falls. People that eat more often, especially those that frequently snack on sugary foods, will have their oral pH in the cavity-producing danger zone more frequently. This has been found through research to be below a pH of 5.5. This fluctuation is know as the Stephan Curve, which is seen below. It is best controlled with proper, brushing, flossing and rinsing habits to reduce the sugars and bacteria that may have collected. 

A Stephan Curve -

There are some foods and beverages, usually taken in between meals, that are tooth killers. These will ensure that your teeth spend overtime below the safe pH level: Soda (or any type of carbonated drink), sports drinks, energy drinks, juice (especially citrus), sugary chewing gum, and, of course, candy. At CrossKeys Dental, we don't ask that you change your life, but that you understand how Stephan's Curve works and realize the importance of oral hygiene.  

So, a nutritionist and a dentist have different opinions with regard to timing. When looking at Stephan's Curve, it makes more sense to eat all of your food in fewer sessions. For instance: Halloween just passed. From a dentist's view, your teeth would be safer if you ate the entire bag of candy in one sitting rather than spreading it over several days. Of course, you might end up with a stomach ache... but the acid attack on your teeth would be limited to one event rather than many.

3. Cavities are contagious

Like any infection, dental caries can be spread from person-to-person or tooth-to-tooth. Just like when you pass a cold virus to your coworkers, you can pass your oral bacteria to other people. This can happen easily if you are not taking good care of your mouth. It even means that sharing a spoon or licking a baby's pacifier can be bad news. In the image below, you will see what many dentists call “kissing caries”. It sounds a lot cuter than it is... It's actually the spread of the dental infection, or cavity, from one tooth to another. Here you see it happening several times.

"Kissing Caries" - Farida et al, 2012

4. Dental caries is the most prevalent childhood disease

As reported by the Centers for Disease Control and Prevention, “Although dental caries are largely preventable, they remain the most common chronic disease of children aged 6 to 11 years and adolescents aged 12 to 19 years. Tooth decay is four times more common than asthma among adolescents aged 14 to 17 years. Dental caries also affects adults, with 9 out of 10 over the age of 20 having some degree of tooth-root decay”. This was reported in the CDC's Vital and Health Statistics report in 2007. Here are some key facts to consider:
  • By age 15, approximately 60% of all adolescents will have experienced tooth decay (CDC, 2007)
  • An often cited study estimated 51.7 million school hours are missed annually by school-aged children because of a dental problem or visit (Gift, 1992)
  • In 2009, the total dental expenses for U.S. children aged 5–17 years were approximately $20 billion (US Department of Health and Human Services; 2013), accounting for 17.7% of all health-care expenses among this age group (US Department of Health and Human Services; 2012)

It does not have to be this way. Dental cavities are largely preventable with good education leading to proper hygiene.

5. A cavity doesn't usually hurt.

I will often reveal to someone that they have a cavity, and I will show it to them on our HD monitor, and I hear “But I don't feel anything”. It takes a long time for a tooth to start bothering you due to a cavity. In fact, if you have a toothache due to a cavity (lots of things can cause your teeth to hurt), it's probably too late for a simple filling. When you have spontaneous pain or sensitivity to temperature, especially heat, it's likely time for a root canal. It is recommended to have your cavities repaired when they are small so that you can avoid additional, costly fees to save the tooth.

As an old professor in dental school used to say: We need 4 things to cause a cavity– teeth, carbohydrates, time and bacteria. Of course, getting rid of your teeth isn't the solution, we can't stop eating and we have yet to figured out how to stop time. The only factor that can be controlled is the bacterial load. So why are you still reading this? Have you brushed your teeth yet?


CrossKeys Dental is located at 110 CrossKeys Office Park in Fairport. Dr. DuPre` and Dr. Badali provide comprehensive family dentistry and are always welcoming new patients. Visit us for more information. Written by Vince Badali, DDS

Tuesday, November 3, 2015

Are Brushing Habits Learned as a Child Wearing Away Your Enamel?


How Can a Few Simple Tooth Brushing Mistakes Make a Good Habit Go Bad? 

Are Your Child's Brushing Habits Wearing Away Their Enamel?

Back’n’forth, back’n’forth – scrubba’ scrubba’ scrubba! Get those teeth clean! Yes, get ‘em clean … but, if your child’s method of brushing more resembles a lumberjack sawing trees in half than it does a gentle massage, they might be in for a lifetime of sensitive teeth, bonding treatments and receding gums. With this in mind, we thought we’d offer our top five tips for avoiding enamel loss when brushing.

The best part is, even parents can benefit from these tips as well! In fact, one of the most prominent dental problems that we see at CrossKeys Dental is recession of gums in adults, which leads to difficulties with root cavities and tooth sensitivity. This is often directly related to brushing a technique that was developed as a child.
  1. Brushing too frequently: Taking to the toothbrush three times a day may be ideal, particularly if it is done after meals. More than that, though, and you or your child might end up doing more harm than good. Teenagers might have a particular desire to clean more frequently if they wear braces, but it’s really not necessary. If your teen snacks frequently, or uses sport beverages, encourage them to rinse their mouths with water afterwards instead of constantly brushing throughout the day. The same advice applies to those that drink coffee, juice, soda or other sugary drinks. Often, brushing twice a day is recommended (think the ADA's 2X2MIN campaign). A third brushing, after school as an example, is especially beneficial for those with a high or recent cavity risk. Ask your dentist at CrossKeys Dental if this applies to you or your child. 
  2. Brushing too vigorously: The number one self-inflicted cause of worn enamel is brushing too hard. In a race to get through the boredom of brushing their teeth, so they can dive into bed (or back to Minecraft...), many children pick up the bad habit of brushing with a back'n'forth saw-like motion. Does this sound like you too? Well, this habit likely started when you were a child. It also “sounds” effective, and if you’ve ever seen a character brush their teeth in a cartoon, or in the movies, that’s how it’s done – so you can’t blame ‘em, really. However, the continual friction this causes along the gumline wears away not only the enamel, but also gum tissue, and that’s not good. If you spy your youngsters brushing this way, correct the behavior by illustrating the correct way, which is to brush gently and in a circular motion, aiming the head of the toothbrush at a 45 degree angle toward the base of the gums. We like to teach children (and adults) to treat each tooth as an individual. This may help you stay on track in small, circular motions rather than taking brushing an entire quadrant at a time. And, most importantly, LIGHTEN UP! You don't have to grip it and rip it like you're teeing off at Oak Hill. Your job is to clean up a buildup of very soft material, which means you only have to gently grip the brush as you would when you hold a pencil. 
  3. Using an ill-fitting toothbrush: If your child is using a toothbrush with bristles just a hair shorter than the ones on their hairbrush, a change to a smaller one is probably in order. The toothbrush we use should always fit our mouths, and for the growing mouths of children, that brush size is going to change until they reach adulthood. Try out different sizes. Smaller is often better. And, if you’re at all uncertain, ask us the next time you’re in for a visit. We can help you make sure that the brush your child is using is one that fits just right. 
  4. Using a toothbrush with bristles that are too stiff: Just as the dimension of a toothbrush matters, so does the stiffness of the bristles. Bristles that are too firm can be damaging to enamel and gum tissue in much the same way as brushing too vigorously. This is why most dentists will recommend either soft or extra-soft bristles on a toothbrush because it’s the technique (see tip #2) that really matters not the force of the brushing, nor the firmness of the bristles. Again, if you’re not sure, ask us for advice specific to you or your child!
  5. An electric toothbrush may make a difference: It may seem counter-intuitive. How can something that moves the bristles so rapidly be more gentle? Think about the ability to treat each tooth as an individual as I mentioned above. These brushes are made to do the work, allowing you to move from tooth-to-tooth and surface-to-surface without using that learned "sawing" motion. Also, you don't have to break the bank to buy and maintain one of these brushes. The next time you visit CrossKeys Dental ask Dr. DuPre or Dr. Badali to give you a few suggestions.   Plus an electric toothbrush may be a great way for those with dexterity issues to brush more effectively without extra effort. 
Saving your enamel and gums from slowly “disappearing” from your teeth is often simple to avoid by changing some habits likely developed as a child.  Anyone can benefit from the above tips, but as a parent you can teach good habits that can help save your child a lifetime of dental problems.

CrossKeys Dental is located at 110 CrossKeys Office Park in Fairport. Dr. DuPre` and Dr. Badali provide comprehensive family dentistry and are always welcoming new patients. Visit us at for more information. 

         © 2015 Patient Connect 365 - modified for CrossKeys Dental in Fairport, NY by Vince Badali, DDS