Tuesday, December 18, 2012

Comprehensive Periodontal Examination

Evaluation of patient's periodontal status requires obtaining a relevant medical and dental history and conducting a thorough clinical and radiographic evaluation.

1. A medical history should be evaluated to identify predisposing conditions that may affect treatment, patient management and outcomes. Such conditions include diabetes, hypertension, pregnancy, smoking, substance abuse and medications and other existing conditions that impact traditional dental therapy.

2 A dental history including the reason for the visit and information about past dental and periodontal care and records will be useful.

3.TMJ and other extra oral structures must also be evaluated.

4. Intra oral tissues and structures including oral mucosa, muscles of mastication, lips, floor of mouth, tongue, salivary glands, palate and the oro pharynx should be examined.

5.  Examination of teeth and their replacements should include observation of missing teeth, condition of restorations, caries, tooth mobility, tooth position, occlusal and interdental relationships, signs of para functional habits and pulpal status.

6 Current radiographs  for evaluating status of periodontium and dental implants.

7.Determination of plaque and calculus distribution.

8. Periodontal soft tissue and peri implant tissue examination.

9. Probing depths, clinical attachment levels and bleeding on probing is evaluated.

10. Muco gingival relationships including abnormal frenulum attachments, gingival recession and deficiencies of keratinized tissue.

11. Presence, location and extent of furcation invasions.

Additional diagnostic aids like diagnostic casts, microbial and other assessments add value  to a thorough examination..

Based on the results of the examination, a diagnosis and proposed treatment plan should be presented to the patient. Patients should be informed of the disease process, therapeutic alternatives, potential complications, the expected results and the patient's responsibilities in treatment. Consequences of no treatment should be explained to the patient.

Tuesday, December 11, 2012

Classification of Periodontal Diseases

Classifications systems are necessary in order to provide  a framework to study the cause, pathogenesis and treatment of diseases in an orderly fashion. The current classification  includes a section on gingival diseases.


A Dental Plaque induced Gingival Diseases

1. Gingivitis associated with plaque only
2. Gingival diseases modified by systemic factors
3.Gingival disease modified by medicatons
4 Gingival disease modified by malnutrition

B Non plaque induced gingival lesions

1. Gingival diseases of bacterial origin
2. Gingival diseases of Viral origin
3.Gingival diseases of fungal origin
4. Gingival lesions of genetic origin
5 Gingival manifestations of systemic conditions and allergic reactions
6.Traumatic lesions
7. foreign body reactions
8. Non specified

II. CHRONIC PERIODONTITIS (replacement of adult periodontitis)
A Localized
B Generalized

A Localized
B Generalized

A Associated with hematological disorders
B Associated with genetic disorders
C Non specific


A Gingival abscess
B Periodontal abscess
C Pericoronal abscess


A.Tooth related deformities
B Mucogingival deformities around teeth
C Mucogingival deformities on edentulous ridges
D Occlusal trauma

Carefully adhering to this classification in assessing a periodontal condition  makes it easy to develop effective treatments for this complex group of infections says Dr. Cherukuri


Thursday, December 6, 2012

Dental Bone Grafting

Bone Grafting is the replacement or augmentation of the portion of the jaw bone that anchors the teeth. It's a surgical procedure that's often done to reverse the loss or resorption of bone that may have occurred due to tooth loss, trauma, disease or ill-fitting dentures, and to rebuild the bone structure beneath the gums in preparation for the placement of dental implants or other tooth replacements.

When bone graft is implanted in the jaw, it doesn't just simply fill a void in the bone; it may also help promote new bone growth in that location. When successful, bone grafting can restore both the height and width of your jaw bone
There are several bone graft options, and they differ in how they help promote bone formation. They include:
Autogenous Bone Grafts. Also called autografts, these types of grafts are made from the patient's own bone, harvested from elsewhere in the body. Typical harvest sites include the chin, jaw, bone of the lower leg (tibia), hip (iliac crest) or the skull (cranium).
Autogenous bone graft has traditionally been considered the "gold standard" as a graft material because it is "live bone" complete with the living cellular elements that enhance bone growth.
A potential downside of autogenous bone grafting, however, is that it involves a second procedure to harvest the bone, which may be painful and not in some patients' best interest, depending on their condition. It also may not be a viable option in instances where the patient's overall bone quality and/or density is poor, or when a large volume of graft material is required.

Allogeneic Bone. Allogeneic bone, also called allograft, is bone derived from a genetically unrelated member of the same species. It's typically non-vital (dead) bone harvested from a cadaver, then processed using a freeze-drying method that extracts all the water via a vacuum.
Allogeneic bone cannot produce new bone on its own – Its primary mechanism of action is that it is osteoconductive, and serves as a framework or scaffold over which bone from the surrounding bony walls can grow to fill the defect or void.

Xenogenic Bone. Similar to allogeneic bone, xenogenic bone is non-vital bone derived from another species, usually a cow. Because the potential for immune rejection and contamination by viral proteins is higher in bovine bone than in human cadaver bone, xenograft material is processed at very high temperatures (600-1,000 degrees Celsius). Xenograft's mechanism of action is similar to that of allograft – it serves as an osteoconductive framework on which bone from the surrounding area can grow to fill the void.
These grafting options are preferred by many patients and dental professionals alike because they eliminate the potentially painful second harvesting procedure. However, because allograft and xenograft lack autograft's bone forming properties, bone regeneration may take somewhat longer than it does when using the patient's own bone and the outcome may be less predictable.

Bone Graft Substitutes

Bone graft substitutes are commercially produced synthetic products that have many of the same bone forming properties as human bone, and are a safe and proven alternative to autograft and allograft.
One of the advantages of using a bone graft substitute instead of autogenous bone is that it eliminates the need to harvest the patient's own bone, thus potentially reducing the risk and pain associated with the harvest procedure.

Contact Dr Cherukuri for more information on dental bone grafting or visit www.chinosmiles.com  for more information.

Tuesday, November 27, 2012

Your Child's Teeth

Children's Oral Health Habits today will have an impact on their health as an adult.

Preventative Dental care has dramitically improved the oral health of many American children.  However, tooth deacy remains a serious public health problem and is the most common chronic disease that needs treatment to resolve.

Here are some simple steps to help your child enjoy a lifetime of beautiful smiles-

Prenatal care:
A balanced diet is critical for the proper development of an unborn child.  Teeth begin to form in the 2nd month of pregnancy and harden between the third and sixth month.  Adequate amounts of Vitamins A,C and D, protein, Calcium and Phosphorous help develop healthy teeth.

Birth to Six-
Primary(baby) teeth erupt during the first 3 years and are important in normal development for chewing, speaking, appearance  and hold the space in the jaws for the permanant teeth.  As the child grows, the jaws grow and make room for the larger permanant teeth that begin to erupt at age six.

-After each feeding, wipe baby's gums with a clean wet gauze or wash cloth
-Brush and floss your child's teeth until the child has developed the necessary skills
-Set a good example by cleaning your teeth every day.
-Set up a first dental visit within six months after the first tooth erupts for a well baby dental check up to assess child's risk of developing decay, evaluate and optimize floride exposure, assess growth and development of teeeth and jaws, assess oral habits, provide dietary conseling and clean teeth.

Six to Twelve-
At this stage, children begin to shed their 20 baby teeth to make room for the 32 permanent teeth.  The 1st permanent molars usually erupt at age six and are often called the six-year molars. They are specially important beacuse they help determine the shape of the lower face and also affect the health and position of the other teeth.
Professional Dental visits at this stage usually involve, application of sealants, assessing need for braces, hygeine and floride treatments. Often intervention at this stage can offset need for extensive dental treatment.

Optimal Oral health is an essential part of healthy living.

WWW.CHINOSMILES.COM  an oral health resource!!

Wednesday, November 21, 2012

Happy Thanksgiving from Dr. Cherukuri and Team

Have a happy Thanksgiving from all of us at the California Dental Association!

Thank You for Being a Part of Our Dental family!


10th Annual Free Thanksgiving Day Dinner.. Everyone invited! 11-22-12 11am - 3pm at Silverado Burgers 1091 6th Street Norco. Hillbilly Reign will be performing... No reservations needed... Just come down & join your friends & neighbors. All volunteer run - No non-profit or group involved - no politics. The mission is to have folks have a better holiday. Miracle on 6th Street believes no one should ever miss a holiday meal or be alone.

                                                      HAPPY THANKSGIVING!

Tuesday, November 20, 2012

Dental Care for Special People

The oral needs of people with special conditions like stroke, spinal cord injury, multiple sclerosis, mental retardation, Down syndrome, genetic disorders, Alzheimer's disease or Arthritis are just as critical, if not more; to maintain Healthy Mouths and Healthy Lives says Dr. Cherukuri.

A healthy mouth is an important part of total health. Healthy, strong teeth allow us to eat and chew, to speak clearly and to feel good about ourselves.

Prevention is Key to a Healthy Mouth-

Daily toothbrushing and flossing remove plaque and food particles
Flouride strengthens teeth against decay.
Sealants to protect chewing surfaces of back teeth
A Healthy, Balanced diet
Regular Dental Visits to detect early signs of disease

When assisting a child or a loved one with oral hygeine, choose a well lit location that's convenient for you.

If  the person is uncooperative or uncontrollable, try to calm him by explaining what you are about to do or schedule the task at a time of day when the person is well rested or receptive.

Some people are sensitive to having their mouth and head touched.  Try to move in a calm, slow, reassuring manner so as not to startle the person.  In addition, give verbal praise, reinforce independent attempts and take the opportunity for one on one interraction.

Consult with the dentist and physician to determine the best position to use. Not all positions are safe for all people and conditions.   Whatever position you find works best, remember to support the person's head.  Take special care to prevent them from choking or gagging when the head is tilted back.  If a person is unable or unwilling to keep their mouth open, a mouth prop will be helpful.

All denture wearers should continue regular dental visits.  Besides checking the dentures, the dentist will check for signs of oral cancer and examine the gum ridges, tongue and jaw joints.

Conditions that require use of long term medications can cause different problems like dry mouth, enlarged and bleeding gums that requires ongoing dental oversight.

For more information, visit www.chinosmiles.com

Tuesday, November 13, 2012

Smokeless Tobacco!

Smokeless tobacco, also called chewing tobacco, spit, dip,snuff or chew contains cancer causing, addictive substances.

Smokeless does not mean Harmless!

In fact, smokeless tobacco users experience a significant amount of nicotine and other chemicals that can cause cancer exposure, even though they don't "light up". The nicotine is swallowed or absorbed through the blood vessels in the mouth.  Holding an average sized dip in the mouth for 30 minutes gives as much nicotine as smoking three cigarettes. 

Smokeless tobacco is known to cause cancers of the mouth, lip, tongue and pancreas.  Users may also be at a risk for cancer of the larynx (voice box), oesophagus, colon and bladder because they swallow some of the toxins in the juice  created by using smokeless tobacco..

The risk of developing cardio vasular disease may also be increased.

Tobacco is costly and not pretty!

.There are strong reasons to avoid tobacco.  If health concern alone is not convincing, consider the expense!
Also consider the  negative consequences of smokeless tobacco on your appearance!
  • Bad breath
  • Brown stained teeth
  • Drooling saliva
Each year, more than 28,000 new cases of mouth and throat cancer are diagnosed. Only half of those diagnosed will live five years or more.

Leathery white patches, called leukoplakia and red sores are common in dippers and chewers and can turn into cancer.  A user's gums pull away from their teeth where the tobacco is held- when this happens, the gums usually do not grow back.

Mouth cancers are among the toughest cancers to treat.

 Early detection is the key.

Most routine dental recare visits include the benefit of an oral cancer screening.  It's usually not " just a cleaning"  says Dr. Cherukuri

 For questions or comments on this blog, please call 909 627 6699, email us at lovemydentist@gmail.com or visit our website at  www.chinosmiles.com/Contact.aspx. and send us your comments.


Tuesday, November 6, 2012

Radiation Treatment and your Mouth

While radiaton helps treat cancer, it also causes some harmful side effects.

Radiation is used to kill cancer cells but it can also harm normal cells causing problems with the soft lining of the mouth, glands that make saliva (spit) and the jaw bones.  These side effects can hurt and make it hard to swallow, eat or talk. Infections are likely that may require scaling back or even  suspending cancer treatment says Dr. Cherukuri.

Radiation causes:

Dry mouth resulting in rampant decay

Loss of taste

Sore mouth and gums making swallowing, eating and talking difficult


Jaw stiffness

Jaw bone changes

Seeing your dentist ahead of the start of radiation can help prevent serious mouth problems. Most side effects in the mouth following radiation happen because a person's mouth is not healthy.  You need to see the dentist at least 2 weeks before the first radiation treatment.

  • Keep the mouth moist-
                 Drink a lot of water
                 Suck ice chips
                 Use sugarless gum
                 Use saliva substitutes
  • Brush teeth, gums and tongue with extra soft bristled tooth brush to avoid any injury
  • Use fluoride tooth paste and other fluoride supplements
  • Avoid mouthwashes with any alcohol content.
  • Have ill fitting dentures adjusted.
  • Choose soft, easy to swallow foods
  • Take small bites and sip liquids with your meal.
  • Avoid crunchy, spicy, sugary and highly acidic foods that can aggravate your mouth.
  • Avoid tobacco products
  • Avoid alcoholic drinks.

For questions of this blog or for  a complimentary office consult,  call 909 627-6699 or visit our website www.chinosmiles.com


Friday, November 2, 2012

Chemotherapy and your mouth!

Chemotherapy is the use of drugs to treat cancer. These drugs kill cancer cells as well as harm normal cells, including cells in the mouth.

Mouth problems resulting from Chemotherapy include-

Painful mouth and gums
Dry mouth
Burning, peeling or swelling of tongue
Change in taste

A patient should see a dentist atleast two weeks prior to start of chemotherapy to check teeth, take the needed X rays and review oral hygeine practices to keep mouth healthy.

Once treatment starts-

 Do a self examinationation of the mouth every day.
Drink a lot of water
Suck ice chips
Use sugarless gum or sugar-free hard candy
Use a saliva substitute to misten mouth.
Brush teeth, gums and tongue with an extra soft toothbrush.
Use fluoride toothpaste
Floss gently
Regularly check ill fitting dentures
Choose easy to chew foods
Take small bites, chew slowly and sip liquids with your meals.
Avoid tobacco products
Avoid Alcoholic drinks

Side effects in the mouth can be serious. Call your dentist or Oncologist (cancer doctor)  if you notice any mouth problems.

For more information, visit www.chinosmiles.com

Tuesday, October 23, 2012

Teeth Whitening!

Everybody loves a bright white smile.  There are a variety of products and procedures available to help you improve the look of your teeth.

If you decide you would like to make your smile look brighter, you should investigate all of your whitening options.

Start by speaking with your dentist.  Although whitening  of teeth has a dramatic impact on your smile, whiteners may not correct all types of discoloration. For example, yellow-ish hued teeth will probably bleach well, brownish-colored teeth may bleach less well, and grayish-hued teeth may not bleach well at all. If you have had bonding or tooth-colored fillings placed in your front teeth the whitener will not affect the color of these materials, and they will stand out in your newly whitened smile. You may want to investigate other options, like porcelain veneers or dental bonding. Your dentist should guide you through the various options for ideal results says Dr. Cherukuri.

If you are a candidate for whitening,  there are several ways to whiten your smile:

  • In-office bleaching. This procedure is called chairside bleaching and usually requires only one office visit. The dentist will apply either a protective gel to your gums or a rubber shield to protect the oral soft tissues. A bleaching agent is then applied to the teeth, and a special light may be used. Lasers have been used during tooth whitening procedures to enhance the action of the whitening agent.

  • At-home bleaching. Peroxide-containing whiteners actually bleach the tooth enamel. They typically come in a gel and are placed in a mouthguard. Usage regimens vary. There are potential side effects, such as increased sensitivity or gum irritation. Speak with your dentist if you have any concerns.

  • Whitening toothpastes. All toothpastes help remove surface stain through the action of mild abrasives. "Whitening" toothpastes in the ADA Seal of Acceptance program have special chemical or polishing agents that provide additional stain removal effectiveness. Unlike bleaches, these ADA Accepted products do not change the color of teeth because they can only remove stains on the surface.

  • Over the counter whitening products offer limited results with concern of unmanaged side effects and sensitivity.
The right product and process can dramatically alter the shade of your teeth for a bright and confident smile! Your Dentist can help.


Tuesday, October 16, 2012

Dental Anxiety

It is estimated that as many as 75% of US adults experience some degree of dental fear, from mild to severe.  Approximately 5 to 10 percent of U.S. adults are considered to experience dental phobia; that is, they are so fearful of receiving dental treatment that they avoid dental care at all costs. Many dentally fearful people will only seek dental care when they have a dental emergency.   People who are very fearful of dental care often experience a “cycle of avoidance,” in which they avoid dental care due to fear until they experience a dental emergency requiring invasive treatment, which can reinforce their fear of dentistry.
Women tend to report more dental fear than men and younger people tend to report being more dentally fearful than older individuals. People tend to report being more fearful of more invasive procedures, such as oral surgery than they are of less invasive treatment, such as professional dental cleanings or prophylaxis.


 Direct experiences

Direct experience is the most common way people develop dental fears. Most people report that their dental fear began after a traumatic, difficult, and/or painful dental experience. However, painful or traumatic dental experiences alone do not explain why people develop dental phobia. The perceived manner of the dentist is an important variable. Dentists who were considered "impersonal", "uncaring", "uninterested" or "cold" were found to result in high dental fear in students, even in the absence of painful experiences, whereas some students who had had painful experiences failed to develop dental fear if they perceived their dentist as caring and warm.

 Indirect experiences

  • Vicarious learning: Dental fear may develop as people hear about others' traumatic experiences or negative views of dentistry (vicarious learning).
  • Mass media: The negative portrayal of dentistry in mass media and cartoons may also contribute to the development of dental fear.
  • Stimulus Generalization: Dental fear may develop as a result of a previous traumatic experience in a non-dental context. For example, bad experiences with doctors or hospital environments may lead people to fear white coats and antiseptic smells, which is one reason why dentists nowadays often choose to wear less "threatening" apparel. People who have been sexually, physically or emotionally abused may also find the dental situation threatening.
  • Helplessness and Perceived Lack of Control: If a person believes that they have no means of influencing a negative event, they will experience helplessness. Research has shown that a perception of lack of control leads to fear. The opposite belief, that one does have control, can lead to lessened fear. For example, the belief that the dentist will stop


Treatments for dental fear often include a combination of behavioral and cognitive strategies to help patients reduce their fear.pharmacological techniques.
Many people who suffer from dental fear may be successfully treated with a combination of "look, see, do" and gentle dentistry. People fear what they don't understand and they also, logically, dislike pain. If someone has had one or more painful past experiences in a dental office then their fear is completely rational and they should be treated supportively. Non-graphic photographs taken pre-operatively, intra-operatively and post-operatively can explain the needed dentistry. Pharmacologic management may include an anxiety-reducing medication.
Most importantly is the need to provide an injection of anesthetic extremely gently. Certain parts of the mouth are much more sensitive than other parts; therefore it is possible to provide local anesthesia (a "novocaine" shot) in the less sensitive area first and then moving the injection within the zone of just-anesthetized tissue to the more sensitive area of the mouth. This is one example of how a dentist can dramatically reduce the sensation of pain from a "shot." Another idea is to allow the novocaine time (5 - 15 minutes) to anesthetize the area before beginning dental treatment.

We are a practice that specializes in patient comfort. Earning the trust of our patients by thoroughly educating them of their dental choices in a caring enviroment eases patient anxieties says Dr. Cherukuri.  "I love taking care of patients of all ages especially those with special needs or those who need an extra touch of TLC".


Tuesday, October 9, 2012

Oral Cancer Facts

 Each year approximately 30,000 Americans are diagnosed with oral cancer.  About 8,000 die from the disease each year.

The chance of a complete cure is highest when detected early. When it is detected in its precancerous stage, oral cancer can be prevented. Oral cancer screening is a routine and important segment of the regular recare visits says Dr. Cherukuri.

Oral Cancer Symptoms
- A sore that bleeds easily or does not heal.
- A color change of the oral tissues
- A lump, thickening, crust, rough spot or small eroded area.
- Pain, tenderness or numbness in the mouth or lips.

.Risk factors include smoking, tobacco chewing, drinking alcohol, repeated trauma and spicy food.  A full 25% of cases have no risk factors at all.

Regular Dental Appointments are Critical. Late stage treatment usually involves major facial surgery with only a 50% chance of survival longer than 5 years.

Early Detection is Key!!


Tuesday, October 2, 2012

"Toothbrushes Trump Seat Belts"

 As important as seat belts are as a preventative measure, toothbrushes have a far greater impact on the health and longevity of the American public.

According to NHTSA, seat belts save over 13,000 lives a year, nationwide. While few of our patients die from a car crash, many will succumb to heart attack or cancer.  Periodontal disease is a significant risk factor for heart attack, stroke, low- birthweight infants and some forms of cancer.  Estimates are that about 80% of American adults suffer either from gingvitis or periodontal disease.  Using a tooth brush and eliminating periodontal disease reduces the chances of sufferring from these life altering medical conditions.

The Oral Systemic connection has long been an established fact but it has recently been relabeled "The Theory of Focal Infection"  The bacteria  originating in mouth enter the blood stream and infect the blood vessel walls of the heart.. Bacterial products in the blood can also stimulate liver production  of C-reactive protein and fibrinogen, both directly linked to heart attacks.

Although periodontal disease is one amongst the many other risk factors like smoking, high blood pressure, obesity, high cholesterol ,stress,  lack of exercise &  genetics, the combination of these factors add layer upon layer of increased risk of suffering a heart attack.  Periodontal disease is an important risk factor for strokes. Periodontal disease increases the likelihood of a heart attack by 24-35%.

In a recent study, a direct correlation between the amount of periodontal bacteria present and blood pressure has been established.

Totally wiping out periodontal disease will eliminate 158,000 heart attacks, nearly half of which are fatal.  Add to that the thousands of lives that would be saved by reducing cancers, controlling diabetes, preamature births etc- from a public health point of view, tooth brushes save more lives than seat belts!!!

Tuesday, September 25, 2012

Dental Lasers!

Is this newer technology mandatory, elective or a hype?

While many procedures in dentistry can be accomplished with traditional methodologies, there are several instances where the use of lasers are  quicker, safer, easier and just  simply possible.

Diode or soft tissue lasers, unlike the electrosurgery units, can be used with pacemakers and used for small surgical soft tissue alterations with only topical anaesthetic.  Clinically, this feature makes use of  dental laser a very popular option with patients fearful of dental needles- says Dr. Cherukuri.

In addition, diode wavelengths are antibacterial and safe to use around metallic restorations. particularly dental implants.

Diode lasers can be safely used to remove  soft tissue around dental implants without damage to the fixtures and abutments and when used judiciously without fear of heat build up to the implants.  Simple soft tissue management to expose implant cover screws and during the final seating of implant retained crowns are much easier when a dental laser is utilized.

Laser treatment of cold sores also has significantly reduced the duration of these painful and disfiguring lesions or at times eliminated its manifestation when detected and treated early.

Lasers are an enhancement to technology today, tomorrow and beyond!!

Tuesday, September 18, 2012

Bad Breath

Halitosis, or bad breath, is a very common problem. There are both dental and medical causes for the condition. In looking for causes, I would first consider the obvious oral causes says Dr. Cherukuri. Below is a list of possible causes of halitosis:
  • Poor oral hygiene without regular brushing and flossing
  • Decay or cavities in teeth, which accumulate bacteria and cause a bad smell
  • Caps or crowns on teeth that may be losing cement ("cement washout"), which can cause a bad taste or smell
  • Eating certain foods that can lead to bad breath
  • Bacteria on the tongue, which can be cleaned with a toothbrush or tongue scraper
  • Lack of regular dental cleanings every three to six months to remove plaque buildup
  • Acid reflux disease or GERD
These are some of the more common reasons why one may have bad breath. Make sure you have a complete dental examination by a dentist and a full mouth cleaning by a competent hygienist. It is important first to rule out the obvious oral causes of bad breath. If every dental possibility is eliminated, I would then seek counseling with an ear, nose, and throat physician who can eliminate other causes like postnasal drip, diet, and acid reflux.

Tuesday, September 11, 2012

Are implants for you?

If you are self-conscious because you have missing teeth, wear dentures that are uncomfortable or don't want to have good tooth structure removed to make a bridge, dental implants could be an option for you.
Dental implants are a popular and effective way to replace missing teeth and are designed to blend in with your other teeth. They are an excellent long-term option for restoring your smile. In fact, the development and use of implants is one of the biggest advances in dentistry in the past 40 years says Dr Cherukuri.

Dental implants are made up of titanium and other materials that are compatible with the human body. They are posts that are surgically placed in the upper or lower jaw, where they function as a sturdy anchor for replacement teeth.

Most patients find that a dental implant is secure, stable and a good replacement for their own tooth. There are generally three phases to getting an implant:

  • First, the dentist surgically places the implant into the jawbone. Your dentist may recommend a diet of soft foods, cold foods and warm soup during the healing process.
  • Next, the bone around the implant heals in a process called osseointegration. What makes an implant so strong is that the bone actually grows around it and holds it in place. Osseointegration means “combines with the bone” and takes time. Some patients might need to wait until the implant is completely integrated, up to several months, before replacement teeth can be attached to the implant. Other patients can have the implants and replacement teeth placed all in one visit.
  • Finally, it’s time for the placement of the artificial tooth/teeth. For a single tooth implant, your dentist will customize a new tooth for you, called a dental crown. The crown will be based on size, shape, color and fit, and will be designed to blend in with your other teeth. If you are replacing more than a single tooth, custom-made bridges or dentures will be made to fit your mouth and your implants. (Note: The replacement teeth usually take some time to make. In the meantime, your dentist may give you a temporary crown, bridge or denture to help you eat and speak normally until the permanent replacement is ready.)
If you are interested in dental implants, it's a good idea to discuss it carefully with your dentist first. If you are in good general health this treatment may be an option for you. In fact, your health is more of a factor than your age. You may be medically evaluated by a physician before any implant surgery is scheduled.
Chronic illnesses, such as diabetes or leukemia, may interfere with healing after surgery. Patients with these issues may not be good candidates for implants. Using tobacco can also slow healing.

Call 909 627-6699 for a complimentary implant consultation.!

Friday, September 7, 2012

Dental Emergencies

Accidents happen, and knowing what to do when one occurs can mean the difference between saving and losing a tooth.

Here are some tips for common dental emergencies:

  • For a knocked-out permanent or adult tooth, keep it moist at all times. If you can, try placing the tooth back in the socket without touching the root. If that’s not possible, place it in between your cheek and gums, or in milk. Get to your dentist’s office right away.
  • For a cracked tooth, immediately rinse the mouth with warm water to clean the area. Put cold compresses on the face to keep any swelling down.
  • If you bite your tongue or lip, clean the area gently with water and apply a cold compress.
  • For toothaches, rinse the mouth with warm water to clean it out. Gently use dental floss to remove any food caught between the teeth. Do not put aspirin on the aching tooth or gum tissues.
  • For objects stuck in the mouth, try to gently remove with floss but do not try to remove it with sharp or pointed instruments.

For all dental emergencies, it’s important to visit your dentist as soon as possible.

There are a number of simple precautions you can take to avoid accident and injury to the teeth:

Wear a mouthguard when participating in sports or recreational activities.

Avoid chewing ice, popcorn kernels and hard candy, all of which can crack a tooth.

Use scissors, NEVER your teeth, to cut things.

 In Dr. Cherukuri's office, most emergencies are handled within the same day.

Tuesday, August 14, 2012

The Mouth is the Mirror to your Body

Oral Health: The Mouth-Body Connection

Years ago, a physician who suspected heart disease would probably not refer the patient to a gum specialist. The same went for diabetes, pregnancy, or just about any other medical condition. Times have changed. The past 5 to 10 years have seen ballooning interest in possible links between mouth health and body health.
"Physicians are taking a more holistic approach to their patients’ overall health," says Sally Cram, DDS, PC, consumer advisor for the American Dental Association. And for good reason. In one recent study, people with serious gum disease were 40% more likely to have a chronic condition on top of it.

What Your Dental Health Says About You

It's easy to ignore the effects of poor oral hygiene because they're hidden in your mouth. But gum disease may point to problems with diabetes and heart disease and loose teeth could be a sign of osteoporosis. Could it be that a healthy mouth means more than just a sparkling smile? And what could your dentist learn about you the next time you open wide?
Additional Links:
In this article, WebMD answers two questions about the mouth-body connection. Why can the health of your mouth affect your whole body? And why are simple habits like daily brushing and flossing more important than you might think?

Your Mouth, the Gateway to Your Body

To understand how the mouth can affect the body, it helps to understand what can go wrong in the first place. Bacteria that builds up on teeth make gums prone to infection. The immune system moves in to attack the infection and the gums become inflamed. The inflammation continues unless the infection is brought under control.
Over time, inflammation and the chemicals it releases eat away at the gums and bone structure that hold teeth in place. The result is severe gum disease, known as periodontitis. Inflammation can also cause problems in the rest of the body.

Oral Health and Diabetes

The working relationship between diabetes and periodontitis may be the strongest of all the connections between the mouth and body. Inflammation that starts in the mouth seems to weaken the body’s ability to control blood sugar. People with diabetes have trouble processing sugar because of a lack of insulin, the hormone that converts sugar into energy.
"Periodontal disease further complicates diabetes because the inflammation impairs the body’s ability to utilize insulin," says Pamela McClain, DDS, president of the American Academy of Periodontology. To further complicate matters, diabetes and periodontitis have a two-way relationship. High blood sugar provides ideal conditions for infection to grow, including gum infections. Fortunately you can use the gum disease-diabetes relationship to your favor: managing one can help bring the other under control.

Oral Health and Heart Disease

Though the reasons are not fully understood, it’s clear that gum disease and heart disease often go hand in hand. Up to 91% of patients with heart disease have periodontitis, compared to 66% of people with no heart disease. The two conditions have several risk factors in common, such as smoking, unhealthy diet, and excess weight. And some suspect that periodontitis has a direct role in raising the risk for heart disease as well.
"The theory is that inflammation in the mouth causes inflammation in the blood vessels," says Cram. This can increase the risk for heart attack in a number of ways. Inflamed blood vessels allow less blood to travel between the heart and the rest of the body, raising blood pressure. "There’s also a greater risk that fatty plaque will break off the wall of a blood vessel and travel to the heart or the brain, causing a heart attack or stroke," Cram explains.

Oral Health and Pregnancy

Babies born too early or at a low birth weight often have significant health problems, including lung conditions, heart conditions, and learning disorders. While many factors can contribute to premature or low birth weight deliveries, researchers are looking at the possible role of gum disease. Infection and inflammation in general seem to interfere with a fetus’ development in the womb.
Though men have periodontitis more often than women do, hormonal changes during pregnancy can increase a woman’s risk. For the best chance of a healthy pregnancy, McClain recommends a comprehensive periodontal exam "if you’re pregnant or before you become pregnant to identify whether or not you’re at risk."

Oral Health and Osteoporosis

Osteoporosis and periodontitis have an important thing in common, bone loss. The link between the two, however, is controversial. Cram points out that osteoporosis affects the long bones in the arms and legs, whereas gum disease attacks the jawbone. Others point to the fact that osteoporosis mainly affects women, whereas periodontitis is more common among men.
Though a link has not been well established, some studies have found that women with osteoporosis have gum disease more often than those who do not. Researchers are testing the theory that inflammation triggered by periodontitis could weaken bone in other parts of the body.

Oral Health and Smoking

Not smoking is one of the most important things you can do for your mouth and your body. According to the CDC, a smoker’s risk of severe gum disease is three times higher than someone who does not smoke.
"Nicotine in cigarettes causes blood vessels to constrict," McClain tells WebMD. This interferes with your gums’ ability to fight infection. Not only that, smoking interferes with treatment -- gum surgeries tend to be more complicated and recovery more difficult.

Oral Health and Other Conditions

The impact of oral health on the body is a relatively new area of study. Some other mouth-body connections under current investigation include:
  • Rheumatoid Arthritis. Treating periodontal disease has been shown to reduce pain caused by rheumatoid arthritis.
  • Lung Conditions. Periodontal disease may make pneumonia and chronic obstructive pulmonary disease worse, possibly by increasing the amount of bacteria in the lungs.
  • Obesity. Two studies have linked obesity to gum disease. It appears that periodontitis progresses more quickly in the presence of higher body fat.

The Bottom Line on Oral Health

One thing is clear: the body and mouth are not separate. "Your body can affect your mouth and likewise, your mouth can affect your body," says McClain. "Taking good care of your teeth and gums can really help you live well longer." This means brushing twice a day, flossing once a day, and going for regular dental cleanings and check-ups.
Cram stresses the importance of letting your dentist know your full family medical history. And, she adds, "if you have periodontal disease, make sure you see your dentist frequently and get it treated promptly, before it progresses to the point where you begin losing teeth or it starts to affect your overall health.

Call Dr. Cherukuri for more information on the Mouth Body Connection 909 627 6699 or visit us at www.chinosmiles.com

Tuesday, August 7, 2012

Dry Mouth (Xerostomia)

Dental Health and Dry Mouth

We all need saliva to moisten and cleanse our mouths and digest food. Saliva also prevents infection by controlling bacteria and fungi in the mouth. When we don't produce enough saliva, our mouth gets dry and uncomfortable. Fortunately, there are many effective treatments for dry mouth.

What Causes Dry Mouth?

There are several causes of dry mouth, also called xerostomia. These include:

What Are the Symptoms of Dry Mouth?

Common symptoms of dry mouth include:
  • A sticky, dry feeling in the mouth
  • Frequent thirst
  • Sores in the mouth; sores or split skin at the corners of the mouth; cracked lips
  • A dry feeling in the throat
  • A burning or tingling sensation in the mouth and especially on the tongue
  • A dry, red, raw tongue
  • Problems speaking or difficulty tasting, chewing, and swallowing
  • Hoarseness, dry nasal passages, sore throat
  • Bad breath

Why Is Dry Mouth a Problem?

Besides causing the aggravating symptoms mentioned above, dry mouth also increases a person's risk of gingivitis (gum disease), tooth decay, and mouth infections, such as thrush.
Dry mouth can also make it difficult to wear dentures.

How Is Dry Mouth Treated?

If you think your dry mouth is caused by certain medication you are taking, talk to your doctor. He or she may adjust the dose you are taking or switch you to a different drug that doesn't cause dry mouth.
In addition, an oral rinse to restore mouth moisture may be prescribed. If that doesn't help a medication that stimulates saliva production, called Salagen, may be prescribed.
Other steps you can take that may help improve saliva flow include:
  • Sucking on sugar-free candy or chewing sugar-free gum
  • Drinking plenty of water to help keep your mouth moist
  • Protecting your teeth by brushing with a fluoridetoothpaste, using a fluoride rinse, and visiting your dentist regularly
  • Breathing through your nose, not your mouth, as much as possible
  • Using a room vaporizer to add moisture to the bedroom air
  • Using an over-the-counter artificial saliva substitute

Tuesday, July 31, 2012

Oral Longevity Initiative

Oral Longevity

Help Nursing Home Residents Pay for Care

Help Nursing Home Residents Pay for Care
A How-To Guide
Find out more about how Incurred Medical Expense regulations can help most nursing facility residents who are enrolled in Medicaid pay for dental care.
Oral Longevity
The OralLongevity™ initiative is designed to increase awareness about the oral health needs of older Americans. Specifically, the OralLongevity program encourages patients to visit the dentist where they can receive information and guidance from trusted professionals. Launched in September 2007, the program aims to create a dialogue among dental professionals, mature consumers and caregivers across the U.S. For more background information, read How the OralLongevity Initiative Evolved (PDF).
OralLongevity educational materials explore the link between oral health and general health and discuss ways to keep your teeth for life. By tackling oral health problems that impact adults over 60, the information and resources help dentists and consumers work together to maintain and preserve oral health, a healthy body and a great look throughout life.
The cornerstone of the OralLongevity outreach effort is a brochure and educational DVD that is formatted in searchable chapters on a variety of oral health topics. Dental professionals will be able to use the DVD in their office to educate patients and caregivers. Consumers can also access the information based on their individual needs. Topics in the brochure and addressed on the DVD include:
  • Dry Mouth
  • Cavities after 60
  • Oral Cancer
  • Dentures & Implants
  • Daily Mouth Care
  • The Effect of Diabetes, Arthritis and Medications on Oral Health
Additional OralLongevity information prepared for patients, such as helpful tips, questions and answers, fact sheets and more can be found in the Consumer Resources section.
For OralLongevity resources and materials to assist dental professionals, please visit the Dental Resources section. Dental professionals can find literature reviews, clinical publications, and case studies. This section also contains assistance on reaching out to older adults who may be living independently, in assisted living facilities or in nursing homes.

Need a dentist to answer your Oral Health Questions? Call Dr. Cherukuri

Tuesday, July 24, 2012

Stress and Oral Health

How Stress Affects Your Oral Health

Excess stress may give you a headache, a stomachache, or just a feeling of being "on edge." But too much stress could also be doing a number on your mouth, teeth, gums, and overall health.
The potential fallout from stress and anxiety that can affect your oral health includes:
  • Mouth sores, including canker sores and cold sores
  • Clenching of teeth and teeth grinding (bruxism)
  • Poor oral hygiene and unhealthy eating routines
  • Periodontal (gum) disease or worsening of existing periodontal disease
So how can you prevent these oral health problems?

Mouth Sores

Canker sores -- small ulcers with a white or grayish base and bordered in red -- appear inside the mouth, sometimes in pairs or even greater numbers. Although experts aren't sure what causes them -- it could be immune system problems, bacteria, or viruses -- they do think that stress, as well as fatigue and allergies, can increase the risk of getting them. Canker sores are not contagious.
Most canker sores disappear in a week to 10 days. For relief from the irritation, try over-the-counter topical anesthetics. To reduce irritation, don't eat spicy, hot foods or foods with a high acid content, such as tomatoes or citrus fruits.

Cold sores, also called fever blisters, are caused by the herpes simplex virus and are contagious. Cold sores are fluid-filled blisters that often appear on or around the lips, but can also crop up under the nose or around the chin area.
Emotional upset can trigger an outbreak. So can a fever, a sunburn, or skin abrasion.

Like canker sores, fever blisters often heal on their own in a week or so. Treatment is available, including  laser therapy, over-the-counter remedies and prescription antiviral drugs. Ask  Dr. Cherukuri about faster healing with laser treatment.. It's important to start treatment as soon as you notice the cold sore forming.

Teeth Grinding

Stress may make you clench and grind your teeth -- during the day or at night, and often unconsciously. Teeth grinding is also known as bruxism.
If you already clench and grind your teeth, stress could make the habit worse. And, grinding your teeth can lead to problems with the temporomandibular joint (TMJ), located in front of the ear where the skull and lower jaw meet.
Ask Dr Cherukuri about what can be done for the clenching and grinding. She may recommend a night guard, worn as you sleep, or another appliance to help you stop or minimize the actions.

For more information, visit www.chinosmiles.com

Tuesday, July 17, 2012

Dental Emergencies

Accidents happen, and knowing what to do when one occurs can mean the difference between saving and losing a tooth. Here are some common dental emergencies and how to deal with them. For all dental emergencies, it’s important to visit your dentist as soon as possible. Most dentists reserve time in their daily schedules for emergency patients so be sure to call your dentist and provide as much detail as you can about your condition. If the accident occurs when your dental office is not open, visit your local emergency room.
Question: What do I do if I knock out my tooth?
For a knocked-out permanent or adult tooth, keep it moist at all times. If you can, try placing the tooth back in the socket without touching the root. If that’s not possible, place it in between your cheek and gums, or in milk. Get to your dentist’s office right away.
Q: What if I crack my tooth?
For a cracked tooth, immediately rinse the mouth with warm water to clean the area. Put cold compresses on the face to keep any swelling down. See your dentist as soon as possible.
Q: If I bite my tongue or lip, how do I treat it?
If you bite your tongue or lip, clean the area gently with water and apply a cold compress. See your dentist or go to the emergency room as soon as possible.
Q: How do I treat a toothache?
For toothaches, rinse your mouth with warm water to clean it out. Gently use dental floss to remove any food caught between your teeth. Do not put aspirin on your aching tooth or gums; it may burn the gum tissue. If the pain persists, contact your dentist.
Q: What if I think my jaw is broken?
If you think your jaw is broken apply cold compresses to control the swelling. Go to your dentist or a hospital emergency department immediately.
Q: How do I remove an object that’s stuck in my mouth or teeth?
For objects stuck in the mouth, try to gently remove with floss but do not try to remove it with a sharp or pointed instrument. See your dentist or go to the emergency room as soon as possible.
Q: How can I avoid a dental emergency?
There are a number of simple precautions you can take to avoid accident and injury to the teeth:
  • Wear a mouthguard when participating in sports or recreational activities.
  • Avoid chewing ice, popcorn kernels and hard candy, all of which can crack a tooth.
  • Use scissors, NEVER your teeth, to cut things.
Visit our website www.chinosmiles.com or call 909 627 6699 for more information.

Tuesday, July 10, 2012

Preventative Dental Care for Children

Preventive Dentistry for Children
Photo Credit brush teeth image by Marjan Veljanoski from Fotolia.com
 Dental exams and treatment should start from an early age, according to the American Academy of Pediatric Dentistry, or AAPD,


Preventative dentistry for kids means dental care designed to maintain healthy teeth and prevent problems. The AAPD explains that children should receive regular check-ups, cleanings and preventative treatments. Dentists and oral hygienists can also educate them on how to take care of their teeth through brushing and flossing.


Preventative dentistry for children has many benefits, according to the AAPD. Oral problems can inhibit eating and keep youngsters from getting proper nutrition. They can also interfere with speech. The AAPD warns that kids with painful dental problems like cavities may be unable to concentrate properly in school. They are at risk for low self-esteem if crooked or damaged teeth are visible. Early dental care prevents these negative effects. It also potentially saves money because uncorrected dental issues often cost more to fix later in life.

Time Frame

Children should be treated by a dentist within the first year after their first teeth erupt, the AAPD recommends. A professional can catch and treat problems early and prevent issues like cavities that badly damage teeth. Parents should also practice preventative care by cleaning their children's teeth daily until they are old enough to handle the task themselves. The Consumer Guide to Dentistry advises using a cloth or gauze to clean baby teeth until they come in fully and can be brushed.


Dentists use various techniques to take care of children's teeth, according to the AAPD. Preventative dentistry includes fluoride treatments and sealants to prevent decay, cleaning and polishing. Dentists can recommend injury-preventing mouth guards for kids who participate in sports and prescribe night guards for youngsters who grind their teeth overnight. They can also perform screenings for orthodontic issues and provide referrals to specialists if needed.

Summer is a great time to schedule dental exams for children. Click here to schedule an appointment.


Teethbusters: How Concession Snacks Damage Smiles
AACD Dentists offer advice on summer movie munchies
MADISON, Wis. (7/2/12) – For many, the movie theater experience isn’t complete without a trip to the concession stand. But those sugary, sticky, and butter-laden snacks are scarier than a blockbuster horror flick and play a big role in tooth damage, staining and cavities, according to the American Academy of Cosmetic Dentistry (AACD).

Here’s a round-up of the best and worst theater snacks for your teeth from a panel of AACD dental experts including AACD President Dr. Ron Goodlin, DDS, from Toronto, Ontario, Dr. Colleen Olitsky, DDS, from Jacksonville, Fla., and Dr. Kellee N. Stanton, DDS, from St. Paul, Minn.

“Crunching down on an un-popped popcorn kernel is a common cause of painful dental fractures,” the panel points out. Each dentist noted that they have treated patients for broken teeth from popcorn. “Popcorn husks can also become lodged between the back teeth and gums, often requiring a course of antibiotics to clear up the resulting infection after removal.”

While candy is an obvious offender, some choices are better than others for teeth. The panel reviewed a variety of favorite movie sweets:
  • Sour Candies (Sour Patch Kids and War Heads) – These candies cause the most damage because they contain high amounts of citric, fumaric and malic acids, all which cause damage to tooth enamel.
  • Caramels (Milk Duds and Sugar Babies) – The caramel in these treats is super sticky enabling it to remain on teeth for a long period of time. Also, its stickiness can enable crowns or fillings to be pulled out.
  • Fruit and Nut-based Candies - (Raisinets and Boston Baked Beans) –While these may seem like a healthy choice, they are also sticky, allowing sugar to stick on teeth.
  • Candy Coated Chocolates (M&Ms and Reese’s Pieces) — While not as sticky as other sweets, the colored candy shell stains teeth.
Acid-Packed Drinks
Soda is another concession culprit and carries a one-two punch, according to the AACD expert panel. First, there’s the high sugar content. Next, and even worse, is the high acidity level which wears down tooth enamel. Acid levels are ranked on the pH scale where the lower the number, the more acidic the substance is. Whereas battery acid ranks at 1.0 on the scale, soda ranks near or below a 3 compared to water which ranks at 7.0 (neutral). It’s not surprising that AACD experts recommend bottled water or club soda or even opting for a small soda to reduce the damage.
Snacks for Your Smile
There’s no need to avoid movie candy and snacks altogether when heading to the movie theater say AACD experts, but look for better alternatives.
  • Dark chocolate is the least processed and closest to the cocoa bean, which contain tannins, polyphenols, and flavonoids. Each of these offers a strong antioxidant that benefits the mouth and teeth.
  • Pixie Stix are a candy option the panel agreed on is because they are poured directly on the tongue, thus avoiding chewing altogether.
  • Cheese Nachos – From a purely oral health perspective, nachos are a reasonable choice because the sugar content isn’t high, they aren’t hard to chew and there’s not much acidity.
“The reality is that most people will continue to enjoy their favorite snacks at the theater,” says Dr. Ron Goodlin, AACD president. “Do yourself a favor and rinse your mouth with a glass of water after indulging in sweets to wash away excess sugar and acids; and don’t forget to bring your dental floss.”

Tuesday, July 3, 2012

Happy July 4th!

Oral Cancer

Cancer is defined as the uncontrollable growth of cells that invade and cause damage to surrounding tissue. Oral cancer appears as a growth or sore in the mouth that does not go away. Oral cancer, which includes cancers of the lips, tongue, cheeks, floor of the mouth, hard and soft palate, sinuses, and pharynx (throat), can be life threatening if not diagnosed and treated early.

What Are the Symptoms of Oral Cancer?

The most common symptoms of oral cancer include:
  • Swellings/thickenings, lumps or bumps, rough spots/crusts/or eroded areas on the lips, gums, or other areas inside the mouth
  • The development of velvety white, red, or speckled (white and red) patches in the mouth
  • Unexplained bleeding in the mouth
  • Unexplained numbness, loss of feeling, or pain/tenderness in any area of the face, mouth, or neck
  • Persistent sores on the face, neck, or mouth that bleed easily and do not heal within 2 weeks
  • A soreness or feeling that something is caught in the back of the throat
  • Difficulty chewing or swallowing, speaking, or moving the jaw or tongue
  • Hoarseness, chronic sore throat, or change in voice
  • Ear pain
  • A change in the way your teeth or dentures fit together
  • Dramatic weight loss
If you notice any of these changes, contact your dentist or health care professional immediately.

Who Gets Oral Cancer?

According to the American Cancer Society, men face twice the risk of developing oral cancer as women, and men who are over age 50 face the greatest risk. It's estimated that over 35,000 people in the U.S. received a diagnosis of oral cancer in 2008.
Risk factors for the development of oral cancer include:
  • Smoking. Cigarette, cigar, or pipe smokers are six times more likely than nonsmokers to develop oral cancers.
  • Smokeless tobacco users. Users of dip, snuff, or chewing tobacco products are 50 times more likely to develop cancers of the cheek, gums, and lining of the lips.
  • Excessive consumption of alcohol. Oral cancers are about six times more common in drinkers than in nondrinkers.
  • Family history of cancer.
  • Excessive sun exposure, especially at a young age.
It is important to note that over 25% of all oral cancers occur in people who do not smoke and who only drink alcohol occasionally.

What Is the Outlook for People With Oral Cancer?

The overall 1-year survival rate for patients with all stages of oral cavity and pharynx cancers is 81%. The 5- and 10-year survival rates are 56% and 41%, respectively.

How Is Oral Cancer Diagnosed?

As part of your routine dental exam, your dentist will conduct an oral cancer screening exam. More specifically, your dentist will feel for any lumps or irregular tissue changes in your neck, head, face, and oral cavity. When examining your mouth, your dentist will look for any sores or discolored tissue as well as check for any signs and symptoms mentioned above.
Your dentist may perform an oral brush biopsy if he or she sees tissue in your mouth that looks suspicious. This test is painless and involves taking a small sample of the tissue and analyzing it for abnormal cells. Alternatively, if the tissue looks more suspicious, your dentist may recommend a scalpel biopsy. This procedure usually requires local anesthesia and may be performed by your dentist or a specialist. These tests are necessary to detect oral cancer early, before it has had a chance to progress and spread.