Turn A Light On Teeth Whitening

  Teeth whitening is a popular cosmetic trend. A bright white smile makes people feel more confident and look younger. Dental whitening is an easy and rather low-cost way to a radiant smile. But there is much confusion about many different methods of dental whitening. I receive many questions from my patients regarding teeth whitening. What is it? Is it safe? Will it damage my teeth? Will it make my teeth or gums sensitive or hurt? How white can my teeth become? How long does it take? How long will it last? In this article, I hope to take the mystery out of teeth whitening.

What Is It?

Whitening lightens teeth and helps to remove stains and discoloration. Whitening is among the most popular cosmetic dental procedures because it can greatly improve how teeth look, rather cheaply, easily, and quickly.

Whitening can either be done with numerous, over-the-counter systems or professional whitening from a dental office. Over-the-counter systems are less costly, but also less effective and involve much longer treatment due to much lower concentrations of active ingredients. Professional teeth whitening can either be done with a custom take-home system or a quick in-office ‘laser’ whitening.

How Does Teeth Whitening Work?

Malkemus- Blog photos (4).pngEnamel is an extremely hard crystalline structure. On the microscopic level, there are little holes that fill in with stain over time from food and drink, such as coffee, tea, and tomato sauces. Tobacco is particularly staining. Basically, whitening sucks out all the years of deep surface staining and returns the teeth to the shade that they were when the individual was a child. If the teeth were dark when one was a young, then whitening can only do so much. But just removing the many years of constant stain will lighten the teeth to the original look. Most people have fairly light white teeth when young. For individual’s teeth that were always dark, more involved cosmetic procedures are necessary, like porcelain veneers or crowns.

Is Whitening Safe?

Whitening is safe and does not damage the teeth. Whitening just returns the teeth to there original shade when the person was a child. However, whitening can cause sensitivity if not done correctly.

The root surface of a tooth can become sensitive if exposed to whitening solution, so care must be taken if an individual has gum recession. Also if one has decay, extreme sensitivity can occur. So dental examination, cleaning and all decay removal is necessary before a whitening procedure.

Will It Last?

After whitening, the teeth will darken again over time as they re-stain from food and drink. But it will take many years to become as dark as they were before whitening. So whitening is not a one-time procedure. It will need to be repeated from time to time to maintain the brightest white shade with a quick touch-up procedure.

Over-The-Counter Systems

There are many whitening systems that can be bought at drug stores for home use. They are cheaper but take much more time and effort than professional whitening in a dental office. The systems are less effective due to low concentrations of whitening solution and poorer fitting of the systems. But over-the-counter systems can work for the right individual who perseveres and dedicates time to keep up daily treatments.

Malkemus- Blog photos (3).pngOver-the-counter systems include whitening toothpastes, whitening strips and homemade trays with gels. Whitening toothpastes rely on mild abrasion to remove surface stains and have special chemical or polishing agents that provide additional stain removal. A professional dental polish also uses slight abrasion to remove external staining. Whitening strips stick to the teeth and release low concentrations of whitening solution. They are somewhat effective when the teeth are straight, already fairly white, and used often.

Homemade trays are made using a boil and bite method of soft acrylic and then filling a gel in the tray and placing over the teeth. Due to the low concentration of active ingredients in the gel and the thin amount of gel on the tooth surface held by the tray, many applications are necessary to get any improvement.

Dental Take-Home Teeth Whitening

Whitening can be done in the dental office or at home. The first step is to have an exam, x-rays, check the shade of the existing teeth, take photos of the smile and determine the reason for the darkening of the teeth. The second step involves removing any decay and getting the gums in good shape with periodontal treatment or a basic cleaning and polishing of the teeth. Once this is done, the whitening procedure can begin.

For whitening at home, trays are made from precise impression of the patient’s teeth. Accurate models are made from the impressions. Trays are fabricated with small wells made on the fronts of the teeth that are to be whitened to hold the gel were it is needed. [One of the problems with over the counter trays is the gel solution is squeezed out of the tray.] The patient is shown how to place the home whitening gel in the tray, so little gel is wasted and washed into the mouth. Different concentrations of gel can be given, depending on the patient’s sensitivity level.

The trays should be worn for at least an hour and up to 2 hours. Longer than 2 hours, the gel does not have much effect. [Many manufacturers recommend wearing trays overnight while sleeping, implying that the gel keeps working all night long, not so.] The trays need to be worn for 10 to 20 times to be effective. Great results happen with constant use. The biggest problem with home systems is patient compliance. Many patients have good intentions, but it often becomes one more thing that time does not allow. I recommend finding a time for an hour or two to wear each day, like watching TV or reading in the evening after brushing and flossing.

Dental In-Office Whitening

In-office whitening is quick and very effective. There are many systems that use a concentrated light-activated gel placed on the teeth, a protective coating placed on the gums and an intense light source. In my office, 2 one-hour visits are set up with Phillips Zoom whitening system, which delivers maximum results, using advanced LED light-activated computer technology. Zoom has variable intensity settings to allow for adjustments to individual sensitivities. Patients have been having great results, up to eight to ten shade changes, with the system.

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The LED light is attached to a fitted mouth attachment that isolates the teeth. Coating paste is placed on the gums for protection from the concentrated gel and intense light. The patient sits for 30 mins each section while the treatment occurs usually listening to music with headphones. The light intensity is adjusted as needed. Accurate trays are given to the patient to wear at the end of the procedure with a fluoride gel to seal off the enamel and prevent sensitivity. Also, the trays can be used with touch up home whitening in the future. I have a few patients who have the in-office whitening every year or two. They like to stay super white and don’t like the hassle of wearing trays. They liken the procedure to having their hair done.

Note that fluoride gel or toothpaste should always be used after any whitening system to seal off the enamel. The teeth are easily stained after whitening, while the enamel porosities are still open, Fluoride seals off the openings and makes a protective coating over the enamel. Also, the teeth should be brushed without a fluoride toothpaste before any whitening procedure, so the whitening gel can be more effective by penetrating the enamel.

I hope that I have shed some ‘light’ on teeth whitening. A bright radiant smile helps make a wonderful first impression.


George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595




Turn A Light On Teeth Whitening

Super Heroes – Digital X-Rays

One of the most important pieces of equipment in a dental office is the x-ray machine. X-rays are like Superman. X-rays detect problems in your mouth that can’t be seen with the naked eye.
For years, conventional dental x-rays, using film, have been wonderful for detecting decay and dental problems. Now, detection has improved with the advent of the digital computer age. There is a new superhero, the digital x-ray.

Malkemus- Blog photos.pngDigital X-rays Are Like Digital Photos

Digital x-rays are replacing conventional film x-rays, much like digital cameras have replaced film cameras with many of the same advantages. Digital images allow downloading on a computer for storage with much less energy use and waste. Digital images are instantaneous, allowing immediate viewing of the image to determine if a retake is necessary. This saves time and eliminates the use of toxic chemicals for developing film.

Advantages of Digital X-rays Compared to Film X-rays

* Conventional film x-rays expose you to ten times more radiation than digital x-rays.
* Digital x-rays appear on the computer screen instantaneously. Film x-rays need extra time, both to take and then to develop the film.
* Computer storage for instant retrieval.
*Digital x-rays can be enhanced to improve the image, avoiding the need for retakes. Film x-rays can miss detail like decay due to over or underexposure of the film.
*Film x-rays use developing chemicals, which are toxic and a hazard to the environment, and so take special disposal systems. Digital x-rays use a computer sensor, so are totally clean.
*Film x-rays add more waste to landfill and use more energy in production than digital x-rays.

Digital X-Ray Procedure

With a digital x-ray, a small, flat plastic sensor is placed in your mouth, and—presto—in a few seconds a picture of your teeth displays on a computer screen. It takes only seconds to re-take an x-ray—if necessary—and the radiation is 90 percent less than conventional x-rays. Digital technology produces sharp images, showing great detail. The quality of the image can be instantly enhanced and the image can be magnified for more detailed viewing with just a click of the computer mouse. With increased resolution, cavities and other problems can be detected early on.

The Digital Pan – Big Daddy Super Hero

Malkemus- Blog photos (1)The digital panographic x-ray called a pan for short, is a machine that shows your entire mouth in just one image. The name comes from the word panoramic, a full view. With normal individual x-rays, many x-rays need to be taken to view the entire set of teeth. The pan shows all the teeth, both jaws and other important items like the sinuses in one full image. With the pan, the need for a traditional full mouth series of x-rays is eliminated.

My office has been using digital x-rays for over 15 years with great results. About 10 years ago, I purchased a digital pan. It’s an amazing machine. It uses even less radiation and is more comfortable. The machine rotates around the patient’s head without the need for film or sensor placement in the mouth.

Major Benefits of The Digital Pan

*High-resolution technology provides crystal clear images.
*Better patient education-Patients gain a better understanding of their mouth and needs with a full view of their mouth.
*Patient comfort – Patients love it. No more gagging or discomfort from film rubbing on soft tissues.
*Quicker – It’s fast! Only 5-10 secs.
* Zoom and enhancement capabilities show detailed information.
* Less radiation exposure.
* Best image for planning dental implants, extractions and wisdom teeth removal.
* Best image for finding cancer or abscess in the jaw.

Cone Beam Computed Tomography [CBCT] – New Super Hero

CBCT is an amazing technology that allows a 3-dimensional computer image of the jawbones and teeth. CBCT is an important tool in determining jawbone height, width, and density, as well as, nerve location and position of other structures such as the sinuses. This helps safely determine implant placement and need for additional bone placement during surgery. CBCT is also helpful when treating cancer or extreme bone infections. CBCT is not needed for routine dental treatment, but definitely has a place for many surgical related treatments, especially implant placement.

No matter the type of x-ray, it is important to have regular dental visits to maintain an x-ray image history of the changes in your mouth. Early detection is the key to identifying potentially harmful changes. Digital x-rays are the latest development to improve early detection. I usually recommend yearly 4 digital x-rays to determine decay between the teeth and digital pan every five years to check changes in the jawbone and roots of the teeth. For patients with rampant decay, I will up the frequency as needed.



George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595



Super Heroes – Digital X-Rays

How Dry I am – Dry Mouth

Normal saliva formation in the mouth is vital to good oral health, keeping the mouth moist and clean.  Reduced saliva flow in the mouth causes a common problem called xerostomia.  Dry mouth can lead to tooth decay, gum infection, fungal growth, mucosal inflammation and bad breathe. Many medications, certain diseases, stress, dehydration, and radiation therapy for head and neck cancer causes reduced salivary gland function leading to the dry mouth problems.

The Importance of Saliva

Saliva coats and lubricates tissues in the mouth.  Saliva helps cleanse the mouth and begins the digestive process with chewing.  A healthy mouth produces about three pints of saliva every day to begin the digestive process on the food that is eaten, to prevent fungal [candidiasis] growth, and to help prevent harmful bacterial growth, which can cause decay and gum disease.  Saliva constantly bathes your teeth and washes away the sugars and food particles to help prevent tooth decay and gingivitis. Saliva also helps to replace minerals in the tooth enamel to strengthen the enamel against cavities.

Note: salivary flow stops during sleep [otherwise, we would wake up in a pile of drool on our pillow], so it is particularly important to brush and floss before bedtime to prevent decay.  And sipping and swishing a little water during the night if awaken can help moisten and clean the mouth as well.


The term xerostomia (zero-sto-me-uh) comes from the Greek words “xeros” meaning dry and “stoma” meaning mouth.  Dryness of the mouth results from an inadequate flow of saliva. Drying irritates the soft tissues in the mouth, which can make them inflamed and more susceptible to infection.  Severe dry mouth can promote the growth of harmful organisms.  Without the cleansing and shielding effects of adequate salivary flow, caries [tooth decay] and periodontal [gum] disease become much more common.  Constant dryness and the lack of protection provided by saliva contribute to bad breath.  Dry mouth also causes dentures to become less comfortable because there is no thin film of saliva to help them adhere properly to oral tissues.

Aging Problem?

It is a common misconception that xerostomia is an “old folks” disease. Dry mouth can occur at any age.  It is true that many older adults have xerostomia, but it is not a normal part of the aging process, but rather related to certain diseases and certain medications. Dry mouth is found in anxiety disorders, diabetes, diet deficiencies, stroke, Parkinson’s disease, Alzheimer’s disease, Sjogren’s disease, HIV-disease, Hepatitis C infection and as a result of radiation therapy. Occurrence of dry mouth is also caused by stress, when an individual is excessively nervous or upset.

Malkemus- Blog photos (19).pngDehydration

Xerostomia can also occur from dehydration, when not consuming enough water.  Dehydration is a common problem with individuals who suffer from incontinence and drink too little water to try and manage the problem.  Excessive use of caffeine or alcohol, which both act as diuretics, causes a net loss of fluid and can lead to dry mouth.  Snoring or breathing with one’s mouth open, and during a fever with excessive sweating can cause dehydration as well.


The most common cause of xerostomia is medication use, both prescribed and over-the-counter. Those wonderful meds that are taken to ease allergies [systemic antihistamines], to relieve pain [NSAIDS, anti-inflammatory meds], to reduce obesity, to thin the blood [daily aspirin], or to lower blood pressure [antihypertensives and diuretics] are just a few of the many medications taken that cause dry mouth. Xerostomia is a side effect of over 400 known medications!

Symptoms of Xerostomia

Perhaps you are having trouble chewing, tasting and swallowing or difficulty speaking, a hoarse voice. You might have sores in your mouth, or a rough fissured tongue. Perhaps your denture is difficult to wear, or your mouth feels sticky from thick, stringy saliva.  Your tissues could be dry to touch.  You may have many recurring cavities, especially along the gumline with heavy accumulations of plaque and tartar.  Halitosis [bad breath] is constant and strong.

What Can Be Done?

There are numerous saliva substitutes on the market that can be prescribed, but artificial saliva is not a perfect substitute for natural saliva, which is complex physically and chemically.  Most patients prefer sipping water to using a saliva substitute, since artificial saliva’s benefits are short lived.  Not only is water sipping the most cost-effective means of improving oral moisture in the short-term, it has the added advantage of contributing to improved hydration.

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The good news is that there are several easy things that can be done at home to improve a dry mouth, including:

* Sip water continually during the day. [Having a water bottle with a straw-type top is ideal].

* Avoid sugared drinks and eating sweets.

* Suck on ice chips.

* Chew sugar-free gum [Gum sweetened with xylitol has been shown to reduce cavities].

* Suck on sugar-free candy.

* Eat foods with a high liquid content.

* Avoid alcoholic beverages and drinks that contain caffeine.

* Avoid dental mouth rinses that contain alcohol.

* Use a mist humidifier while you sleep.

* Don’t smoke or chew tobacco.

* Brush 2–4 times a day and floss once or twice each day.

*Use a fluoride rinse daily to prevent decay.

*Use fluoridated toothpaste that is free of sodium lauryl sulfate [a detergent used as a foaming agent in most commercial toothpastes].

*Use a prescription-strength topical fluoride [which may be delivered in custom fluoride trays or in a brush-on preparation].

Dry mouth is a common problem, but with early and ongoing treatment, serious dental and oral disease can be prevented.  I have had many patients with severe xerostomia who have stayed in excellent oral health by using the above tips, particularly regular water sipping and good oral hygiene habits.  The most important thing you can do for yourself is to get regular dental checkups and cleanings. The earlier dental problems are identified and intervened, the better for you, your overall health and your happiness.


George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595








How Dry I am – Dry Mouth

Know and Love Your Smile

Do you know where smiling comes from? We have not drifted far from where the smile first started; today we often received or give smiles to strangers in passing. Chimpanzees were known to have a “fear grin” that told others they were harmless. 1.pngMany of our traits are quite similar to them including our smile. Smiles bring us comfort and make us happier.

From a young age, we have been told, “smile for the camera.” How many times have you heard “say cheese” while posing for a picture? How often have you said it? Now think back to old historic pictures, have you ever wondered why nobody is smiling in the pictures? One reason is their horrible teeth or lack of. Oral health was not a part of their daily routine. Fortunately, we live in a time where dentistry is prominent. Technology has advanced and quality dental care is readily available. Take advantage of dentistry and love your smile!

Smiling more brings positive emotion to your life. It’s easier to smile than frown and it’s also the universal sign of happiness. Babies are born with the ability to smile, and the most recognizable facial expression that can be seen from up to 300 feet away.

Your brain can tell immediately whether someone’s smile is genuine or not. It compares the geometry of a face to a standard smile. Our minds evaluate the situation and determine whether or not a smile is expected.  After our mind makes a conclusion about someone else’s smile then it automatically mimics their smile. Smiling is contagious!


Smiling not only brings comfort to others but also ourselves. Try smiling throughout the day and here’s why:

  • Even a fake smile is a mood booster
  • Helps to relieve stress
  • Smiling makes you more approachable
  • Smiling gets the creative and productive juices flowing

“Laughter is the best medicine” is a well-known phrase and for all the right reasons. There are short and long term benefits to smiling and laughing. Short term, it can stimulate your heart, lungs, and muscles. In the long run in can improve your immune system, be a natural painkiller, boost your interpersonal skills, and help make you feel livelier.  Source: mayoclinic

Would you rather approach someone who’s smiling at you or mugging you? Of course we choose the smiling person because we’re social creatures. We want acceptance and approval.  If we are in a funk and someone smiles at us, it can instantly change our mood turning our bad day into a good one.

The more you smile; your brain will create more positive patterns than negative ones. Our brains are naturally negative. Smiling more trains our brains to be positive. Creativity and productivity will increase and we can produce better work in our everyday lives. Source: fast company

How often do you smile? You can flash your lovely smile at someone, make their day, and yours too. Remember to love your smile! Treat your smile with the care it deserves, schedule your appointment today.



George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595



Know and Love Your Smile

Meth Mouth

Rampant tooth decay seen in methamphetamine users is commonly called meth mouth.  The teeth look like they have been dipped in battery acid and, in a way, they have. Methamphetamine is extremely acidic and corrosive. Decay also results in meth users from dry mouth, poor oral hygiene, poor nutrition, drinking large amounts of soda, and teeth clenching and grinding.

Often, there is no hope of treating the meth-damaged teeth, and the teeth need extractions. The teeth often decay to the gum line, abscess, and become non-restorable as no healthy tooth structure remains, but only a soft mushy substance.  Often, the gums will grow over the remaining stumps of the roots and thus make extractions difficult.

Methamphetamine is an inexpensive, easy-to-make illicit drug. It is known by several street names: “meth,””speed,””ice,””chalk,””crank,””fire,””glass,””crystal” and “tina.” It is made in tens of thousands of illegal laboratories across the country.  Meth abusers are commonly called tweakers.

Meth is an addictive drug that affects the nervous system by causing high levels of the neurotransmitters norepinephrine, dopamine and serotonin, to accumulate in the brain.  This overstimulates brain cells and produces euphoria.  Meth users become increasingly tolerant to the euphoric effect of the drug, so have to increase the frequency of use and take ever-larger doses.  Due to this effect, users can become quickly addicted.

The use of methamphetamine is on the rise in the United States, even though it produces devastating effects on users’ health.  Meth can cause shortness of breath, increased respiration, hyperthermia, nausea, vomiting, diarrhea, an irregular heartbeat, high blood pressure and permanent brain damage. Other effects include irritability, insomnia, confusion, hallucinations, tremors, convulsions, anxiety, paranoia, and aggressiveness.

A person using crystal meth tweaks for days at a time and often stays awake and high for five to even thirty days.  During this period, the acrid smoke, decreased saliva flow, poor hygiene, lack of dental care, and extended periods without sleep take a toll on his/her teeth and health.

The Causes of Meth-Related Tooth Decay

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Meth’s acidic nature: Lithium, muriatic acid, sulfuric acid, ether, red phosphorus, and lye are key ingredients in meth manufacturing and traces of these corrosive, acidic agents are found in meth.  When a person smokes meth, these substances are heated, vaporized and swirl throughout the user’s mouth.  They irritate and burn the sensitive tissues inside the mouth, create sores, gum disease and lead to rampant decay from the continuous corrosive effect of the vapors on tooth enamel.

Snorting meth also causes chemical damage to teeth.  Snorting draws the caustic substances down the nasal passages, draining in the back of the throat and bathing the teeth with corrosive substances.

Dry Mouth:  Meth causes dry mouth by reducing saliva production.  Saliva constantly washes the mouth, reducing bacteria levels that cause decay and gum disease.  Saliva also acts as a buffer against acidic substances in the mouth, helping prevent decay. Without saliva, the acidic substances can eat away at the minerals in tooth enamel, quickly causing rampant decay.

Soda Consumption:  With a drug-induced craving for high-calorie carbonated beverages, meth users are notorious for trying to treat cottonmouth [dry mouth] by consuming sugary sodas. Bacteria in the mouth feed on the sugars from the soda, and secrete acid,  causing tooth decay.   Plus most sodas have high acidic solutions, which adds to the dissolving of enamel and increased decay.

Grinding and Clenching:  Meth often makes users feel anxious and nervous, causing them to clench or grind their teeth. This leads to cracked, or broken teeth or teeth worn down to short nubs.  Along with weakness from rampant decay, the teeth are often broken at the gum line from clenching and grinding.

Poor Nutrition:  Meth has an appetite suppressant effect. Drinking large quantities of soda, coupled with poor nutrition, the vomiting side effects of the drug and a decreased immune response creates the perfect environment for decay to occur.  Lack of good nutrition, as well as lack of sleep, reduce the meth user”s general health and natural defenses to infection including gum disease and decay.

Oral Hygiene Neglect: Methamphetamine users often neglect oral hygiene, along with personal hygiene.  Meth users aren’t likely to floss, brush and rinse when on a meth high.

Blood Vessel Constriction

Meth causes blood vessels to constrict or tighten, including blood vessels in the mouth.  This, in turn, causes a lack of the blood flow that normally nourishes the gums and teeth properly.  With repeated shrinking, the vessels will not recover, thus causing the dental tissue to starve and break down.  The end result is tooth decay, gum disease, and bone loss.

Another result of the constriction of blood vessels is the gaunt look and quick aging of the patients.  Tissues of the face quickly die and sag from the lack of nutrients and blood supply.  This aging effect causes intense itching from the constricting capillaries near the surface of the skin.  Compulsive scratching often leads to infection and sores.

Case Study

A 27-year-old male complained of pain and a draining abscess on his upper right front tooth.  Further investigation revealed that all his front teeth had rampant decay and most of his molars had been worn down to the gum line.  His plaque level was extremely high and he reported he did not know when he had brushed last.  His eyes were dilated, and his blood pressure was elevated to 165/89.

While waiting for his appointment he was observed pacing back and forth while picking at his skin.  He explained he was trying to remove the bugs he was sure were embedded beneath his skin.  Review of his health history revealed he had been using meth in the oral form for eight months.  His diet consisted of high sugar intake in the form of soda to moisturize his dry mouth.  Rampant decay resulted from lack of care, dry mouth, increased acidity, and a lowered immune response.  His skin was raw from constant scratching and his face was gaunt with deep lines in his sagging skin.

Dentists, parents, and others should be concerned if they notice patients, family members or friends—especially teenagers and young adults—who have unaccounted-for and accelerated tooth decay. Dental treatment only slows down the problem in meth users.  A meth user will continue to have major dental issues without stopping his/her drug use and a change in lifestyle.  This is usually only accomplished with social and psychological intervention, due to the extreme addictive nature of the drug. This problem can only be solved when the addict truly wants help.


George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595


Meth Mouth

3 Ways Oral Health Influences Your Body: Heart Disease, Diabetes, Pregnancy

Happy 2018! New Year’s resolutions are not as popular as they once were, but that doesn’t mean you can’t make changes to your everyday life. Now is always the right time!  Did you know oral health affects your overall health?  It’s important to brush and floss daily along with dental check-ups every 6 months. Poor oral habits can lead to gum disease because your mouth is swarming with bacteria. And gum disease is linked to heart diseases, diabetes, and pregnancy. Oral health is connected to your total health.

Heart Disease

Are you wondering how your oral health relates to your heart? Everyday brushing and flossing manages the bacteria levels in your mouth.  Without daily cleaning, bacteria is free to flow into your bloodstream and can travel to your arteries.  Arteries are blood vessels that distribute oxygen from your heart to your body. This can lead to atherosclerosis where plaque builds up on the inner layers of your arteries. This can cause clots that can block blood flow through your body.  Increasing the likelihood of suffering a heart attack or stroke.

Source: American Heart Association



Did you know you are 3 to 4 times more likely to have gum disease after being diagnosed with diabetes?  Diabetes affects how your body processes sugar and leaving you at a higher risk for gum disease. It can also make your blood sugar level constantly increase. Meaning your body has a harder time fighting the bacteria attacking your gums. People receiving gum disease treatment along with antibiotics showed improvements with their blood sugar levels. Be sure to keep us updated on your health history and medication lists.

Source: American Diabetes Association


Pregnancy is no excuse to slack on your oral care. Hormone levels are uncontrollable it can cause your gums to bleed, swell, and absorb food. This leads to pregnancy gingivitis.  Another thing to look out for is pregnancy tumors. While harmless, they start to appear during your second trimester between your teeth. If you begin to feel pain or irritation your dentist can have them removed. Most of the time they disappear after your child is born.

A common side effect of pregnancy is morning sickness which can be alarming for your teeth. The acid from your stomach can lead to tooth decay. We recommended gargling with baking soda and water after an episode of morning sickness before brushing your teeth. Dental appointments and procedures are encouraged during pregnancy to help prevent gum disease. It is optimal to have dental work done during your second trimester because the developments of your fetal organs are complete and the risks of side effects are lower.  Once you are in the third trimester it may be harder for you to lay on your back for a long period of time.

Source: American Pregnancy Association

Living a healthy lifestyle can seem overwhelming but remember to make small strides daily. Here are five healthy habits for a happy life.

  • Brush your teeth twice daily
  • Floss once a day
  • Preventive health care screening, at least once every six months
  • Smile and Laugh
  • Physical Activity
  • Adequate sleep




George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595


3 Ways Oral Health Influences Your Body: Heart Disease, Diabetes, Pregnancy

Be Careful With Tongue Piercing!

Oral piercing is currently on the upswing. Many teens and young adults, as well as some older adults, are having this procedure. Over the years, I have had many patients with a tongue piercing. Most have not had problems, especially when the barbells have been short and plastic.  Some have had chipping of teeth, usually when the barbells have been longer and metal.  I have had three patients who have had serious dental problems because of their tongue bars and have eventually lost teeth and had to have dental implant replacement teeth.

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Some of the serious consequences of tongue piercing include:

Pain, inflammation, and infection.

Damage to teeth, fillings, and other dental work.

Injury or shrinkage of gums and bone.

Difficulty chewing or swallowing.

Greater saliva production.

Prolonged blood loss immediately after the procedure.

Disease transmission, such as hepatitis.

Need for orthodontic treatment due to repositioning the natural teeth alignment.

Tooth damage

The tongue jewelry can chip or break a tooth or a filling. Tooth damage results from the wearer “playing” with the barbell by rubbing it along his/her teeth. Metal barbells are more likely to cause tooth fracture than their plastic counterparts.  Tooth damage can be minimized by proper placement, the use of properly sized jewelry, and avoiding playing with the piercing.

Ten years ago, a 21-year-old woman with a beautiful smile cracked her upper left front lateral incisor due to biting down on her tongue barbell.  Root canal therapy, a fiber-reinforced post, and a porcelain crown were necessary to fix the fractured tooth.  At age 23, she fractured the porcelain crown, again due to biting on her tongue barbell and so a new porcelain crown was placed.   Finally, at age 25, the barbell caused the tooth to break off at the gumline.  The tooth was extracted and a beautiful dental implant was made as a replacement.  At that time, she decided to remove her tongue barbell and she has had no further problems.

Gap Between Teeth

According to a study at the University of Buffalo in New York, playing with a pierced tongue barbell can lead to a gap between the front teeth.  By pushing the tongue barbell continually up against their front teeth, those with tongue piercing were likely to move the teeth apart.  Orthodontic braces work by placing continual force on teeth in the direction that they need to be moved to produce a correct alignment.  Force, over time, moves teeth.  Individuals with tongue piercing are tempted to play with their tongue barbell, placing unnatural forces on the teeth and consequently causing gaps or other problems to occur with teeth.

Gum Damage

A tongue bar can cause damage to the gums along the inside of the upper or lower front teeth, leading to gum recession.  Receding gums expose the roots of the teeth, causing sensitivity to temperature and periodontal disease with bone loss.  This can sometimes be corrected with periodontal surgery and a gum graft.  But if not corrected early, a severe recession can lead to tooth loss.

Several years ago, I treated a 22-year-old male patient who rubbed the gums on the backside of his lower teeth with his tongue ring, causing severe gum infection, gum recession, and bone loss.  He was referred to a periodontist who attempted surgical gum grafting to save the teeth.  However, two years later, he ended up losing his lower front two central teeth.  Eventually with bone grafting, the placement of two dental implants and the removal of his tongue ring, he was in good health again.

Importance of Dental Check-Up Before Tongue Piercing

I recommend not having a tongue piercing.  However, if you do decide to get your tongue adorned, proceed carefully and have a dental examination and cleaning first.

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The goal is to examine your oral tissues and look for any signs of existing infection, such as gum disease or deep decay.  It is much safer having any infection removed from your mouth before proceeding with a tongue piercing.  A prior infection in your mouth could interfere with your tongue’s healing when pierced.  Also, ask your dentist for a prescription strength mouthwash. Rinsing before you have the tongue piercing procedure will decrease the bacteria in your mouth and lessen the chance of infection.

During your dental examination, it is important to check for dental issues that could make dental piercing more dangerous. For example, if you are a tongue-thruster (when you swallow, your tongue pushes against your front teeth), the tongue bar could seriously damage your oral tissues or teeth.

Safe Guidelines


If you decided to have a tongue piercing, please check out the piercing establishment carefully.  Pay particular attention to the following safe piercing guidelines:

The business is licensed and reputable, with clean, well-lit rooms for procedures.

Trained and experienced piercers [a member of the Association of Professional Piercers] use new gloves and a fresh disposable needle for each procedure (never go to an establishment that uses piercing guns — they are more difficult to clean and inflict greater tissue damage).

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An autoclave and ultrasonic cleaner for sterilizing instruments are on the premises.

All of your questions and concerns are answered openly and directly. If you’re unsatisfied or uncomfortable with the answers try somewhere else.

If I have not convinced you to forget about getting an oral piercing, please proceed with extreme caution. I want everyone to express their individuality, be safe, and have healthy teeth for a lifetime!




George A. Malkemus DDS
2 Padre Pkwy #200, Rohnert Park, CA 94928
Phone | (707) 585-8595




Be Careful With Tongue Piercing!