Why Should I Care About Geriatric Dental Care?

The World Health Organization defines the population between 65 and 75 as “elderly”. The term “old” is used for people between 76 and 90 and “very old” for those people over the age of 90. In general, older adults severely underutilize dental services. Less than 1/3 of the elderly population sees a dentist regularly, and almost 50% haven’t visited a dentist in over 5 years. Practicing in the Palm Beach area, many of my patients maintain their active and healthy lifestyles, so consequently they are living longer today. So what does that mean when it comes to the oral health of this segment of the population? And why should you care about this topic if you’re younger than 65? Let me tell you why!


Years ago, and still today, many people believe the myth that tooth loss is caused by old age. In fact, the most common reason for tooth loss is active, untreated periodontal disease. This happens across all ages. Infection in the gums is the major reason why people experience tooth loss. Gum disease is easily treatable and preventable with regular visits to the dentist and proper oral hygiene care at home. That is why it is vital that people over the age of 65 continue to keep regular dental maintenance visits every 3 months.


With increased age there is an increased risk of staining, chipping and cracking and this age group is more at risk for fractures. This means that there is an increased need for continued maintenance and replacement. This means that if we keep on eating all foods with different textures – i.e. hard, crunchy veggies or nuts – then naturally we will see more wear and tear on our dentition – whether it is our natural dentition or a denture. This means that replacement of old, existing restorations, dentures and crowns are to be expected. Just like you take your car in for regular maintenance, it’ll be up to you to visit the dentist regularly to make sure everything is in proper working order and make any replacements necessary before the teeth become hopeless and require removal. If you do this from a young age, then you’ll be sure to have the least amount of dental treatment necessary to keep your mouth healthy for a lifetime.


Recurrent decay – (under existing crowns and fillings) – and root surface decay – (where the root is exposed due to gum recession from gum disease and/or malaligned bite) account for the most common type of cavities in the older population.

Older adults typically don’t feel pain when it comes to cavities because the pulp (nerve) shrinks as we age. When you’re young, a small cavity is much closer to your nerve, so you feel the discomfort sooner and are more apt to visit the dentist for treatment. However, the older population usually will complain about food getting caught in the cavity, and sometimes by the time they decide to seek dental care, the cavity is deep below the gum line, that the tooth is now hopeless and requires extraction. This is why it’s so important that older patients seek routine maintenance dental care to avoid preventable tooth loss.


Older patients are generally on multiple medications due to various systemic diseases. Many medications cause dry mouth as a side effect. Also, head and neck radiation treatment for patients with cancer in that region of the body, almost always have loss of function of their salivary glands, leading to dry mouth. Patients with xerostomia, or dry mouth, are at an increased risk for decay and must be specially monitored to prevent tooth loss. Possible dental treatments to help prevent decay include fluoride treatments, both daily and in-office, as well as artificial saliva products and medications.


As people age, physical and cognitive problems arise. Arthritis typically sets in and causes a significant decrease in manual dexterity. However, there are people of all ages with physical disabilities that may affect their oral hygiene. There are many options to practice good oral hygiene for someone with physical issues, including electric toothbrushes, tennis balls (YES! I said tennis balls! Don’t worry, I’ll probably write a blog on this topic alone.) and other unique tools. If cognitive issues, such as Alzheimer’s or dementia exists, then the task of oral hygiene falls to the caregiver. If there is no caregiver, there’s even a higher chance of it leading to poor oral hygiene practice at home, therefore increasing the on-set of decay and gum disease in the aging population. For this segment of the population, it is especially important to see the dentist even more often, perhaps even as often as every 1-2 months.

These are a few of the issues that afflict our brilliantly aging population. So if you know someone who has a lot of life experience, but hasn’t been to the dentist lately, then give them a call and tell them to visit the dentist TODAY!


Dr. Meli


BOUNTY OF BOTOX®: Make sure the only one at the Thanksgiving table this year with Wrinkles is the Turkey

Have you ever wondered what Botox® is all about? Do you want to look more relaxed and healthier before you have to face the in-laws this Thanksgiving? Then let me welcome you to the world of facial rejuvenation and one of its stars: Botox®!

So what exactly is Botox®? Botox® is a prescription medicine that is injected into the muscles and used to temporarily improve the look of both moderate to severe crow’s feet lines and frown lines between the eyebrows in adults. It is the only FDA-approved prescription medicine for this purpose.

What Botox® does is temporarily relax the muscles of the face that cause these moderate to severe wrinkles around the eyes and in between the eyebrows (also known as 11s). It can also be used to improve the appearance of wrinkles on the forehead, nose (aka bunny wrinkles when you laugh), lips and elsewhere.

Typically, men and women with fine, moderate or severe wrinkles on their face come to me for facial rejuvenation treatment. Botox® is the choice of treatment to smooth lines on the face and even give a slight eyebrow lift to open the eyes and face up, thereby giving a more youthful appearance. Also, many patients who have severe headaches and/or migraines, will get great relief using Botox® treatment as an adjunct to other therapies. The same thing goes for TMJ issues.

What can you expect when getting Botox® treatment?

  • You may get noticeable results with the first 48 hours, but typically its full effect will be seen within 7-10 days. These results will last up to 4 months.
  • Most patients say that getting injected with Botox feels like a tiny pinch and that’s it! Some patients don’t even feel the injections since I use ice beforehand to numb the area being treated.
  • The total injection time itself takes around 10 minutes. First I do a facial rejuvenation consultation with each patient. I analyze their facial musculature and we determine together what treatment is appropriate to reach his/her desired result.
  • I tell my patients “You’ll look like yourself, but like you’ve been on vacation!” People won’t know what is different about you. They might ask if you’ve had your hair done, or if you’ve lost weight. But you’ll just look refreshed and well-rested like you’ve been on vacation – that’s it!
  • There’s basically no downtime or recovery period. You may experience some redness and swelling at the injection sites, but it’ll dissipate within a half hour typically.
  • Cost consideration – be aware that you are not only paying for the cost of materials when it comes to Botox® treatment. You are also paying for the skill of the individual practitioner, and his/her expertise.

Also, be aware that “discounted” or “cheap” Botox® is most likely highly diluted, so it won’t last as long, and you’ll be going back to get injections more times throughout the year. Do you want to get injections in your face more often? I think not! My patients typically see me 3-4 times per year in order to maintain the well-rested look they desire. That’s it!

You may wonder about going to the dentist to have Botox® treatment. But let me tell you something, the day I graduated from the University of Pennsylvania School of Dental Medicine, I was a head and neck specialist – unlike MD (medical doctors) who have to further specialize. In fact, while I was still in school many years ago, I had medical doctors who were just learning how to do Botox® and dermal fillers asking me about the anatomy and nerves of the face because they weren’t familiar with it. For over 12 years now, my patients have been trusting me with their Botox® treatment, and everybody keeps on coming back for more!

So I hope you enjoyed this quick rundown of what Botox® is and what it can do for you. And be sure to get your Botox® treatment this month if you want to ensure that the only one with wrinkles at the Thanksgiving table this year is the turkey! Gobble, Gobble!


Dr. Meli

Which Mouthwash is Right for Me?

Let’s talk mouthwash! I know it’s always so confusing when you’re standing in the oral health care aisle at a store and you look at the myriad of bottles of colorful mouthwash, wondering which one is right for you. Let me break it down so you can get a better understanding of what is available OTC.

Manufacturers divide OTC mouthwashes into three main categories:

1.) Fluoride

2.) Antiseptic

3.) Whitening

Fluoride Mouthwashes:

Fluoride mouthwashes, which are usually purple in color, are also known as “anti-cavity” because they usually contain 0.02% sodium fluoride. Yes, fluoride is good for your teeth and prevent cavities if you are cavity prone. However, in order to get this super low concentration of sodium fluoride into your teeth, the mouthwashes are super acidic, meaning they have a low pH. Over the long term, this can damage your enamel on your teeth. In fact, one of the ingredients they use is phosphoric acid, which is what we use to etch the teeth when we do bonding on teeth. So you can imagine how strong of an acid that is!

However,the fluoride treatment that you get at a dental office usually has 10 times higher concentration of fluoride, and it usually has a neutral pH. This way right after your dental hygiene maintenance, when there is no plaque or tartar present, the fluoride has it’s best chance of permeating your enamel and strengthening your teeth, and even your gums. If I had to recommend an OTC fluoride mouthwash, it’d be the ACT mouthwash. Why? Because it has a neutral pH and has 0.05% sodium fluoride in it, almost three times that of the rest of them. Also, it has a unidose measuring system at the top of the bottle, so you can never use too much and get an overdose of the mouthwash or fluoride in it. So if you like Berry Blue, Bubblegum or Fruit Punch flavor, then go for it!

Antiseptic Mouthwashes:

The next category is antiseptic mouthwashes. These are the most commonly used, and typically you’ll feel a burning sensation when rinsing with these due to the high level of alcohol. The alcohol is in fact antiseptic, but it indiscriminately kills all bacteria in our mouth, leaving it unbalanced and therefore more susceptible to a yeast or fungal infection. Also studies have definitively shown that alcohol is a huge risk factor for oral cancer. So these mouthwashes usually have 25-27% alcohol content. This is 2-3 times what we find in a glass of wine or beer. And when you drink a glass of wine or beer, you’re simply sipping it and swallowing it. Whereas with an antiseptic mouthwash, your swishing it for 30 seconds straight, twice a day, pushing it into your oral mucosa of your cheeks and gums. Over time it’s going to cause cell mutations and then lead to oral cancer. Alcohol also has a drying effect, and a dry mouth is more prone to cavities, so be aware!

Also, another popular ingredient in antiseptic mouthwashes is Cetylpyridinium Chloride, aka CPC. This has antiseptic properties, but will stain your teeth brown. And the Eucolyptol and Thymol commonly found in antiseptic mouthwash will stain your teeth yellow. Now, these stains can be removed with a professional dental cleaning, but do you really want to be walking around with severely stained teeth from a mouthwash?

Which OTC antiseptic mouthwash would I recommend? Only one that is alcohol free for sure, but overall I don’t recommend them to my patients. If they want some fresh breath and that’s about it, then I tell them to dilute it with water, this way they get the freshening effect without the harmful side effect of the alcohol contained within. In fact this is what we do in the office to give a better flavor to the water our patients rinse with while in the dental chair.

Whitening Mouthwashes:

The final category of OTC mouthwashes is whitening. These generally have hydrogen peroxide as a whitening agent. Usually you’ll see the bottles are opaque, not translucent, so that that hydrogen peroxide doesn’t disintegrate. The level of hydrogen peroxide is minimal, but it can still be damaging to your gums. Over the years, I’ve seen so many patients who’s cheeks were peeling away on the inside of their mouths due to using a whitening mouthwash. As soon as they discontinued use of the whitening mouthwash, the pain and discomfort and peeling stopped. I do not recommend anyone use a whitening mouthwash, even if it says “Pre-brushing whitening rinse” on the bottle. These only cause sensitivity and are not as effective as you might think, especially if you have plaque and/or tartar buildup on your teeth. And for patients for have any recession, the sensitivity can be especially high. If you really want whiter teeth, then be sure to floss and brush them!

So I hoped this helped open your eyes to what’s available when it comes to OTC mouthwash. I’ve also got a Mouthwash Review video on my YouTube channel, so be sure to check it out.

Next time, I’ll discuss Natural Mouthwashes and what I recommend when it comes to that category.


Dr. Meli

Is Chewing Ice Bad for my Teeth?: YAAAAAASSSSSS!!!!

This is a question I get asked quite often by my patients. “Is chewing ice bad for my teeth?”

The definitive answer is: YAAAASSSS!!!! Let me tell you about why people chew ice, and how in fact it can severely damage your choppers.

You probably started chomping on ice cubes in your drink when you were a kid and your mom had to tell you stop doing it because it was rude to make so much noise at the dinner table. Well, not only that, but you were consciously chewing on super cold and super hard stuff. Our teeth are not meant to handle so much stress when masticating (that’s the technical term for chewing). So as you can imagine, what happens over time if you continue to chew on ice, is that your teeth start to wear down and over time your bite gets all out of whack. Also, the severe cold temperature of the ice will cause the enamel on your teeth to expand and contract. Not only that, if you have any type of fillings, the material of your fillings will expand and contract at a much faster rate that the enamel of your tooth, thereby causing teeny tiny cracks in your enamel. Just like you see the cracks in the asphalt after years of winter and summer seasons passing, the same thing happens to your teeth. And eventually these micro cracks will turn into large cracks and you’ll simply break your teeth off!

Pagophagia is a form of the disorder pica and it involved the compulsive consumption of ice or iced drinks. Typically, it has been associated with iron deficiency anemia. However, once iron levels are increased, most people stop the ice chewing habit. It is purported that people with iron deficiency chew ice constantly in order to soothe the pain associated with glossitis ( an inflamed tongue) which is a symptom of iron deficiency. Usually the tongue is super red and irritated and can become painful. So the super cold ice numbs the pain, and hence leads to pagophagia .

However, if you’ve not been diagnosed with iron deficiency anemia, then why are you still chewing on ice? For some it may be generally soothing habit to calm them down in a stressful situation, much like biting your nails or gnawing on a pencil. For others they just love to visit the dentist so much that they try as hard as possible to do severe damage to their teeth so they can rack up some more dental chair time…..said no one ever! But it has been documented that due to peer pressure, children will grind and chew on hard things like ice to self-mutilate teeth because they are teased for having crooked and uneven teeth. So be sure to check up on your children and make sure they’re actually doing irreversible harm to their teeth.

Remember, our teeth are not meant to constantly chew on hard, cold chunks of ice! If you think you might be doing it because you have an underlying systemic disease like iron deficiency anemia, then call your medical doctor or your dentist to get checked out asap! And if you just can’t kick the habit then suck on the ice cubes instead – you’ll still get the pleasant cooling sensation you love without the long-term damage to your teeth.


Dr. Meli


So I’ve written about how chronic headaches affect our daily life in Part 1 of this series, and also about minimally invasive treatment options your dentist can offer you in Part 2. Here in Part 3, my aim is to clue you into a few simple things you can do on a day-to-day basis to manage your headaches.

ERGONOMICS: Work smarter, not harder. It’s my mantra and I am conscious of it on a daily basis. It is well known that people who work in the dental field have a high prevalence of neck and back pain. IMG_8861Dentistry is a profession that has many physical demands. Yes, I am a scientist, an artist, a psychologist, a salesperson and a doctor. But I am also called upon to treat my patients in reverse, looking upside down in a mirror, into a dark, wet, tiny space with saliva spraying all over and a tongue that just won’t stay still! So I use every tool at my disposal in order to do so ergonomically. From my stool that positions my body, head and neck into a comfortable position, to the comfortable clothes I wear and magnifying loupes with high power LED lighting I am always cognizant of the fact that if I want longevity in my profession, I need to work ergonomically. The same thing applies to everybody else as well. Studies show that a proactive approach to ergonomic workspace, reduces musculoskeletal pain and eye strain, and increases work productivity. Maybe put your computer screen on an elevated platform directly in front of your face, or hold your smartphone in front of your face instead of turning your head downwards to look at it. Position your seat, with lumbar support, so that your spine is aligned. All of these simply ergonomic positions will be sure to help you avoid headaches and other aches and pain in future.

GET YOUR EYES CHECKED: Although you may not need special magnifying loupes to see the computer screen or your smartphone, be sure that you are not squinting all of the time. Get your vision checked by an ophthalmologist or optometrist and be sure to get fitted for glasses or contacts. Also think about getting a larger computer screen to work on. What may seem like a nuisance now – like squinting because your computer screen is blurry – can become a severe pain in the neck literally! And headaches are sure to follow.

WOMEN – WEAR A SUPPORTIVE POSTURE BRA: If you’re a woman and well endowed, then you’re causing extra stress on your upper back, neck and shoulders. Be sure to find a brassiere that not only fits you well, but is supportive to help relieve the strain. To see if you’re bra is supporting you properly, a simple trick is to place your fingers underneath your bra strap and see if that relieves the pressure on your neck and shoulders. If it does, than you’re not wearing the correct bra. The posture bra is designed to hold the weight of your breasts in the band and the back, not the straps themselves. So if you have marks on your shoulder from digging bra straps then you’re more likely to experience the neck and shoulder strain associated with not wearing the correct bra. Posture bras are designed specifically to support the weight of breasts and provide relief from neck strain, shoulder strain and muscle tension headaches.

USE THE CORRECT PILLOW WHEN YOU SLEEP: Support from pillows is essential in getting a good night’s rest. If you sleep on your back, your side or your stomach be sure to find the pillow that will give you the best support for your head and neck. This way your neck and shoulder muscles won’t be straining to support you while you rest. You can also try a pillow between your legs if you sleep on your side, or under your knees if you sleep on your back, as well as a rolled up towel under your lower back to ensure proper support during slumber.

I know my patients are generally nervous when they come to see me for dental treatment. So in order to relieve their stress and make them as comfortable as possible, I give them a leg support pillow, a lumbar pillow and a neck pillow to support them. This way their experience is less stressful. In fact most of my patients tend to fall asleep and even snore while laying back in my chair, that’s how relaxed they are!

STRETCHING EXERCISES: I try to do these on a daily basis, especially during a long case. I get up for a couple of minutes in the middle of a long treatment with a patient, and this allows me to get my stretches in as well as allows the patient to rest their jaw for a bit. This way we both feel better after a short break. I like to stretch my neck, arms and shoulders. #11 in the diagram below is one of my favorites. And I do it at shoulder height, above my shoulders and below to thoroughly stretch my entire shoulder muscle. Try doing these a few times a day during working hours, and you’ll see how refreshed you’ll feel afterwards!


I hope these 5 tips were helpful. You’ll see that if you incorporate these into your daily rituals, you will have less headaches and feel better overall!


Dr. Meli



In my last blog, I talked about the consequences daily headaches have on our daily lives, such as decreased productivity at work, and increased dependency on pharmaceutical remedies. Wouldn’t it be great if there were other, more conservative treatment options available to us?

Good news! There are many things you can do to start treating the cause of the headache, and not just its symptom of pain.

STRAIGHTEN/ALIGN YOUR TEETH: As I mentioned in my previous blog, aligning your teeth will not only ameliorate your headache issue, but it will help you in other numerous ways. You will be able to chew your food better. Maybe you’ve been unable to bite into a hearty sandwich until now because your front teeth had a huge open space (open bite). Or you were scared to eat that crusty French bread because you couldn’t incise it due to your open bite. Once your teeth are properly aligned, you’ll be able to eat anything you want to again!

Also, you’ll be able to preserve any past and future dental restorations (crowns, fillings, bridges, partial dentures) for much longer. If your teeth hit in a malaligned position, then you concentrate the forces in a pinpoint area and the you’ll wear away your enamel or filling material much faster. You’ll also start to break the porcelain off your crowns and bridges. However, when your teeth are aligned in a healthy position, you’re causing less wear and tear, and your teeth in general will last much longer!

Finally, you’ll decrease your risk of getting gum disease (periodontitis). If your teeth are crowded and malaligned, then they essentially become food traps. This food that gets trapped there, feeds the naturally occurring bacteria in your mouth, which then turns into plaque and tartar. Also, it’s much tougher for your to keep clean with flossing and brushing alone. Once tartar has formed, it travels down the root, underneath the gums. This is a chronic infection that doesn’t really cause any pain, but it eats away at the bone that houses your teeth. Also untreated gum disease is directly linked to high blood pressure, atherosclerosis, diabetes, pancreatic cancer, Alzheimer’s disease and angular glaucoma.

BOTOX TREATMENT: Although not many dentists offer this treatment option, it is a very valuable one. After all, we are responsible for your head and neck health, and that includes the oral cavity as well.

It is a non-invasive, quick treatment that can have tremendous effects on your headaches. Botox allows us to relax your muscles, so if you clench or grind your teeth, it will minimize the effects of your habit. Also, if you are a migraine sufferer, who pays up to $300 per pill in order to get migraine relief, then this treatment will definitely minimize the number of days you’ll experience migraines. And instead, you may only experience a small headache instead, or no pain at all! I have patients that were paying thousands of dollars a month to take a single pill for each chronic migraine episode. Now instead, they only use it a few times a month if at all.

ORAL APPLIANCES: Once your teeth have been aligned, be sure to complete any necessary dental restorations, and then use a custom made oral appliance, such as a retainer or occlusal guard to maintain your bite in it’s correct position. If you’re planning on having any cosmetic dentistry done, such as porcelain jacket crowns or veneers, then having an oral appliance that you use at night is imperative! All of my patients that have cosmetic dentistry completed, are always prescribed and oral appliance in order to maintain the investment they made in themselves.

So, as you can see, there are various, truly minimally invasive treatment options that, as a dentist, I can and do offer my patients. Ultimately you’ll get a straight smile and wrinkle-free younger looking appearance overall – but that is just the icing on top. My main goal is to give my patients a healthy, functional smile; and if I can help them make feel better about themselves along the way, then it’s all the more fulfilling for me.

Don’t forget to check out Part 3 of this series coming next!


Dr. Meli



We all get headaches, and as a population we are experiencing them with more severity and frequency than ever before. The stresses of life have increased exponentially over the years. Many of us sit in front of computers for work, look at our tablets and smartphones non-stop, and are on the go constantly.

So then we turn to pharmaceuticals, prescribed and over the counter, to help relieve the discomfort. But in doing so we are only treating the symptom, not the cause. Studies show the increased use of anti-migraine medications like triptans and ergot alkaloids. Although preventive therapies such as the use of anti-convulsants, anti-depressants, beta blockers and calcium channel blockers have increased in usage as well, they remain pharmaceutical solutions to an ever growing ubiquitous problem.

We take off time from work when we go to numerous doctor appointments, get myriad of tests, and they continue to all show no conclusive results as to the why we keep feeling so bad. We go to the chiropractor, the physical therapist, the masseuse, but achieve only temporary results. A study, which reviewed over 144 million patient visits, shows a persistent overuse of low-value, high-cost services, such as advanced imaging (i.e. CAT scans, MRIs) and the prescription of opioids and barbiturates.

So, we have decreased productivity not only from missing work, but also due to the constant pain we experience while at work. How can we stop this vicious cycle and actually get to feeling better and being more productive?

I recommend a visit to the dentist! The majority of headaches, and head and neck pain in general, is directly linked to your bite (occlusion). Not only can we alleviate the discomfort, but also fix the root of the problem – how your teeth come together.

If teeth are misaligned, then the forces from regular everyday chewing, as well as grinding and clenching (bruxism) will exacerbate those forces and how they affect the longevity of your teeth. When your teeth are not aligned in a healthy position, it will cause your enamel to wear and break off. Also, your facial musculature and temporomandibular joint (TMJ) will adjust to an malaligned occlusion, and that’s why you feel tightness in the muscles, and pain. This pain then radiates down into the neck and shoulders, as well as up to the head thereby causing headaches and/or migraines.

So don’t just treat your headaches by popping some pills, or getting a massage. Get dental care to align your teeth into their proper healthy position, then get an oral appliance to ensure that they stay that way and to protect your teeth for the future. Including a daily head & neck stretching routine, as well as limiting your time in front of the computer, or looking down at your smartphone or tablet, will greatly decrease your risk of getting a headache.

Be sure to check out the next installment in my series of how to conservatively treat headaches and neck pain without popping pills regularly. I’ll include other treatment options, as well as tips as to what you can do on a daily basis to keep yourself headache free!


Dr. Meli

Oral Cancer: 7 Easy Ways to Prevent Oral Cancer


Did you know: One person in the United States dies every hour from oral cancer? That’s a staggering amount if you think about it! Here’s some information about oral cancer including risk factors and what you can do to make sure you catch it in time before it becomes too late.


450,000 people are diagnosed with oral cancer worldwide. Around 50,000 people will be diagnosed with oral or pharyngeal cancer in the United States this year. That means that 11% of oral cancer cases in the world occur in the U.S. It will cause around 10,000 deaths, meaning 20% of those diagnosed will die. Of the 80% that survive, only approximately 57% will be alive in 5 years.

Thankfully the survival rate of oral cancer has gone up from 50% to around 57% over the past few decades. But this increase is not due to early diagnosis, but rather from an increase in the effectiveness of treating HPV. This is because the newest risk factor linked to oral cancer is the HPV16 (Human Papillomavirus).


Historically, major risk factors have been age: anyone over the age of 40 is more likely to get oral cancer. Also lifestyle risk factors like tobacco use (smoking, chewing tobacco, cigars) and alcohol use (drinking wine, beer, liquor & oral rinses containing alcohol) increase your likelihood of getting oral cancer. If you have a history of any other type of cancer, then you’re at a higher risk as well. Also exposure to radiation, like the sun, increases the risk of cancer of the lips, especially the lower lip since that is the one that usually juts out the furthest on the face.

So, how can we decrease the risk of being diagnosed with oral cancer? Here are a few tips:

VISIT YOUR DENTIST REGULARLY. Make sure you get an annual oral cancer screening including the head and neck. This includes a visual examination of the oral tissues, underneath the tongue, back of the throat, the inside of the cheeks and lips, roof of the mouth, sides and back of the tongue. Also palpating around your jaw, beneath the ears and the lymph nodes in your neck.

I do one of these regularly once a year for all of my patients, but I do a visual screening every time I see a patient as well. My patients usually tell me “Doc, you ask me about the same area in my mouth every time I see you!” They seem annoyed, because I ask them the same questions every time I see something suspicious, but that’s simply my protocol!

STOP USING TOBACCO. Smoking cigarettes, cigars, marijuana or using chewing tobacco severely increases your risk of oral cancer, especially if you’ve been doing it for years. The physical damage of the heat from smoking damages your gums. This includes trendy vaping. The chemicals and toxins in a cigarette transform your saliva into a deadly cocktail and damages your cells, leading to oral cancer.

STOP DRINKING ALCOHOL. This one can be tough, I know. But moderation is key. Although drinking a glass of wine with 12% alcohol doesn’t seem harmful, when you add up the number of times that alcohol has passed through your lips and hit the tissue of your mouth, it adds up.

STOP USING LISTERINE.  Listerine actually as more than twice the amount of alcohol that wine does (26.9%). It also has other chemicals and coloring in it. Think about it: You rinse with Listerine, for 30 seconds straight, twice a day, for years, pushing those chemicals and alcohol straight into the cells of the tissue in your mouth. Of course your cells will be adversely affected! Studies have shown the link to long-term Listerine (and other alcohol based rinses) use and oral cancer. I tell my patients they can use Listerine if they dilute it with water, simply for the taste. But at that point its antibacterial property has been lost. So, my patients use only one mouth rinse with alcohol, that I prescribe to them if needed, for short-term use only. After that they use an alcohol-free herbal tooth & gums rinse that is all natural. This way I am able to eliminate one risk factor for oral cancer, while keeping my patients’ gums healthy!

WEAR SUNSCREEN & A HAT. I live in Florida, so I know my patients are outdoors for much of the year. Even just walking to and from our cars in the parking lot, we get a lot of radiation from the sun. And since our lower lip usually juts out the furthest on the face, I tell my patients to use a lip balm with sunscreen as well as wear a hat when they are outdoors. Also avoid indoor tanning beds!

GET YOUR TEETH STRAIGHTENED. If you have malocclusion – a bad bite – then you could be causing repeated trauma to an area in your mouth like biting your cheek or tongue. This constant trauma to the tissue, will cause the cells to change and can lead to oral cancer. So if you get your teeth aligned – straightened with Invisalign® – to a healthy bite, then you will decrease your chances of getting oral cancer.

DO A MONTHLY CHECK INSIDE YOUR MOUTH. Just like women do a monthly self breast exam, I recommend you check out the inside and outside of your mouth once a month. Look for any unusual lesions, bumps or lumps or discolorations, and don’t forget your lips!. Especially if you have a sore area that won’t go away or get better after 14 days, then visit your dentist immediately. You may need a biopsy to see if there is anything out of the ordinary.

So, the key to avoiding oral cancer is to modify your lifestyle and try to catch it early on. Usually by the time oral cancer is seen by the naked eye alone, it is in the late stages already. If it’s caught in the late stages, then it can require disfiguring surgery in order to save your life. That’s why I recommend a more detailed oral cancer screening, like Vizilite or Velscope – both of which allow us to see any changes in your oral tissues before it becomes too late. We have the tools to catch oral cancer early on, and although very few dental insurance companies will pay for this special examination, it’s worth your peace of mind to pay for it out of pocket on an annual basis. Your life may be saved by your dentist!

Melisande J. Wolff, DMD

5 Benefits of Straighter Teeth with Invisalign®

The most common orthodontic problem is called malocclusion, or ‘bad bite’, and is often times a genetic problem. A bad bite can also be caused by thumb or finger-sucking, mouth breathing, dental disease, abnormal swallowing, poor dental hygiene, the early or late loss of baby teeth, accidents or poor nutrition. Malocclusion, if untreated, leads to various other health issues and dental problems.  Here are some benefits of treating malocclusion with Invisalign that you probably didn’t know about!

Avoid Gum Disease (Periodontitis) and other Health Problems:

If your teeth are not straight, they are more likely to build up plaque and tartar deposits. Why? If your teeth are crowded or have open spaces between them, they act as food traps. These food deposits then give nutrition to the naturally occurring bacteria in our mouths, thus forming plaque and tartar and leads to gum disease. Gum disease is a constant infection underneath your gums, which dissolves the bone in which your teeth are housed. So the more bone you lose, the higher risk of losing your teeth.  And untreated gum disease is linked to heart disease, diabetes, high blood pressure, pancreatic cancer, Alzheimer’s disease and angular glaucoma.

Avoid Extra Dental Treatment like Crowns & Root Canals & Extractions:

When your teeth are straight, and they hit each other while you chew, the forces go directly down the straight axis of the root and cause no problems. However, if they are rotated, pushed out or crowded, then your teeth are hitting in the wrong place, and the forces of chewing aren’t absorbed down the root. Instead, your teeth hit  in pinpoint areas that they aren’t meant to hit, and this causes you to wear away and fracture the enamel off of your teeth. Then you’re looking at crowns, possible root canal treatments or even tooth loss requiring extractions that you wouldn’t have needed if your teeth were properly aligned.

You Can Eat Anything You Want Again:

Do you have an open bite and can’t bite properly into a sandwich? Are you afraid to order the steak when you’re on a date because it’s difficult to eat since your teeth don’t come together in the back of your mouth? Do you avoid hard and crunchy foods like nuts? If the answer is yes, then aligning your teeth will open up a whole new world of culinary options for you! Order and eat to your heart’s content whatever you want once your teeth are properly aligned again!

Avoid Oral Cancer:

If you are constantly wounding the inside of your cheek(s) or lip(s) because you “accidentally” bit into it again, you must realize that it’s NO “accident”. It is because your bite is off and you have what’s called a cross-bite, where the lower teeth overlap the upper teeth. It is considered malocclusion because your bite is out of whack. In healthy, properly aligned teeth, it is the upper teeth that overlap the lower teeth (not the other way around). Constant long-term trauma like that is a risk factor for oral cancer. So if you straighten your teeth, your risk for oral cancer will decrease.

Worry Less, Smile More & Take Better Selfies:

If you’ve got an overbite, an open bite, gap between your front teeth, buck teeth or crowded teeth, then you’re probably hiding your smile without even realizing it. By aligning your teeth, it naturally boost your self-confidence. You’ll want to show off your new, gorgeous smile to the entire world!

Hope this information was helpful! If you’ve read this, and said, “Wow…that’s exactly my situation!”  Then feel free to give us call and set-up a consultation to find out how Invisalign can benefit you.


Dr. Meli

8 Common Mistakes you make when Brushing your Teeth


TOOTHBRUSH: You tend to brush in all sorts of ways, and our gum tissue is fragile. Be sure to pick up a toothbrush with SOFT or EXTRA SOFT BRISTLES only – this way you won’t damage your gums. If you’re having trouble keeping your mouth open while brushing, then look for a toothbrush with a smaller head on it. If your arm hurts after brushing, or you have manual dexterity issues or you’re just lazy, then get an electric or ultrasonic brush that’ll do most of the work for you.

METHOD: You want squeaky clean teeth, so you think brushing harder is better. WRONG! You should hold the toothbrush at a 45 degree angle, so you feel the bristles going in between the teeth and up underneath the gums. Then, brush in a compact circular motion and sweep away from the gum. Do this with gentle pressure on both the inner and outer surfaces of each individual tooth. Then you can brush the biting surfaces at the end. This method applies to both manual and electric toothbrushes.

TOOTHPASTE: So you think using a whitening toothpaste is going to make them sparkly white, right? WRONG! Whitening toothpastes have tons of abravises and are way too harsh for your gums, and can wear away enamel over the long term, so avoid using them. Instead, use a regular toothpaste with fluoride, or an herbal dentifrice, without any sodium lauryl sulfate, which is what causes the foaming action.

TIMING: You need to brush for at least TWO FULL MINUTES for the fluoride to be activated in your toothpaste. Plus it takes at least two minutes to really cover all of the surfaces of your teeth while brushing. First set your timer on your cell phone for 2:00 minutes. Then, divide your mouth into four quadrants – upper right, upper left, lower left and lower right – and work your way from quadrant to quadrant as you watch the timer. Spend at least 30 seconds brushing the teeth in each quadrant.

LONGEVITY: You think it’s ok to keep using your toothbrush forever and ever and ever. WRONG! Bristles get broken and splayed and they are totally ineffective. Be sure to get rid of your toothbrush every 3 months, and get a new one that’s strong enough to stand up to the task!

FREQUENCY: You think brushing more often is better. WRONG! Brushing more than 3 times a day can be damaging not only to your gums, but your enamel as well. Keep your brushing frequency to no more than 3 times a day to avoid undue damage to your smile while maintaining its health!

AREAS: You think it’s ok to just brush your teeth. WRONG! Don’t forget to brush your tongue as well every time you brush your teeth. Tons of bacteria lurk amongst your tastebuds so you can use a special tongue brush, or gently use your toothbrush to brush the top of your tongue as the final step before you rinse out.

FLOSS: You brush before you floss. WRONG! You must floss first, then brush your teeth. Why? Imagine if you vacuumed the floor, then dusted and all the dust fell on the floor and you’d have to vacuum the floor again. That is exactly what you are doing when it comes to your mouth if you brush before flossing. The toothpaste is not effective if you haven’t flossed first to remove the funk that’s sitting in between your teeth and just underneath your gums on the surface of your roots. So FLOSS and then BRUSH your teeth!

Hope this has helped you with your daily oral hygiene routine. And remember, a healthy smile is always in style!


Dr. Meli