Drs. Mackler, Siurek and Associates, Inc. - The five questions posted most recently: We offer you the chance to get free advice from a licensed dentist. You can browse the questions of others or ask you own questions simply by clicking on one of the links below. Dr. Mackler does his best to respond within a few days to all questions. http://www.jeffmackler.com/healthymouth <![CDATA[Dear Dr. Mackler. For almost 2 years now I have had constant and chronic cracking in the corners of my mouth. When it started, I thought it was from eating too many strawberries but it has not subsided. I am constantly using lip moisturizers and I got a prescription for Noritate cream 18 months ago but it only helps short term. When I eat acidic foods, it really becomes worse, starting first as a red bump, and then turning to a crack. I have good dental habits, eat a good diet, and exercise. I take a multivitamin and a calcium supplement daily, at the same time. I cannot remember going more than 1 day without this problem. PLEASE help. This is such an annoying conidition. Should I be concerned about a more serious underlying problem?? Many Thanks!! T. ]]>
Obviously, without seeing you I can’t be sure what is causing the chronic cracking at the corners of your mouth. However, it is most likely a yeast infection caused by candida albicans, a yeast that is commonly found in saliva. Every time you lick your lips you keep re-infecting the corners of your mouth. Noritate (metronidazole) is a member of the imidazole class of antibacterial agents and is classified as an antiprotozoal and anti-bacterial agent. If you have a yeast infection, the use of noritate actually will make your condition worse since it will eliminate the healthy bacteria, which normally compete with the yeast and keep it from overgrowing in your mouth. Mycolog cream contains the antifungal agent nystatin and the synthetic corticosteroid triamcinolone acetonide. Applied four times a day for at least two weeks, it should clear up your problem. I suggest you discuss this with your dentist.

]]> http://www.jeffmackler.com/healthymouth/index.php?action=artikel&cat=1&id=4&artlang=en Wed, 17 Jan 2007 19:09:10 GMT <![CDATA[Dear Dr. Mackler, I have porcelin veneers on my two front teeth. They were put on in August of 1999 and they have each fallen off twice in the past 5 years. This is so devastating to me and I'm so self-concious about it happening again at work or a party. The last one fell off in early October. I don't bite down on any foods at all and I cut everything into small pieces. Is this normal?? What do you recommend?? Thanks!! Kathy]]>
Porcelain veneers will often stay in place for ten or more years. Sometimes, though, they will come off as yours have, and we don’t always know why. Without examining you, it’s difficult to say why yours have fallen off twice. Do you bite your fingernails or chew on ice? Do you clench or grind your teeth in your sleep? If your dentist cannot find a good reason why your laminates keep coming off, I would suggest that you have two porcelain full crowns placed. They will not come as easily as laminates and you can enjoy eating, smiling and talking with the worry  ]]> http://www.jeffmackler.com/healthymouth/index.php?action=artikel&cat=1&id=3&artlang=en Wed, 17 Jan 2007 19:08:40 GMT <![CDATA[Dear Dr. Mackler, I have recently been diagnosed with having an infection at the Base of tooth #3 which is a molar. In the past that tooth has undergone a root canal and presently has a crown. My dentist gave me penicillin to clear up the infection but he says that the tooth needs to be extracted. No if ands or butts! He then suggested that I get a dental implant and he E-mailed my x-ray to a facial surgeon who would perform the surgery required. Dental implants are very expensive! Looks like I'll be spending about $4,500.00 of my own money because my dental insurance claims that this is a cosmetic procedure. My question is: Do I have any other options rather than a dental implant? Right now since I have taken the antibiotics from my dentist I have no pain. Is the infection gone? Will it return? I hate the thought of removing a tooth removed and not replacing it with anything. Thank you, Chuck Dougherty ]]> I suggest that you have your tooth evaluated by an endodontist (root canal specialist) before having it extracted. It is often possible to re-treat the root canal and keep the tooth. Tooth #3 is a three-rooted tooth and if only one root is infected, it may also be possible to surgically remove that root. The tooth will remain stable and can last indefinitely with two roots. If the tooth must be removed, an implant is your best, long-term option. You could also have a fixed bridge to replace tooth #3. The usual way to do this is to place crowns (caps) on the teeth on either side of the space. This will cost somewhat less than an implant restoration, but the average life of this type of bridge is 15 years whereas the implant should easily outlast that. If the teeth on either side of the space are perfect and do not need crowns, then a bonded (Maryland) bridge might be another option for you. This will cost less than the conventional bridge but does not require much preparation of the supporting teeth. Bonded bridges occasionally come loose and need to be recemented. You could have a bonded bridge now to save money (your insurance may even pay something toward it) and plan to have the implant done at some future date when your financial picture was better. Clearly, the best long-term answer is the implant. Hope this helps with your decision.  ]]> http://www.jeffmackler.com/healthymouth/index.php?action=artikel&cat=1&id=2&artlang=en Wed, 17 Jan 2007 19:07:52 GMT <![CDATA[Dear Dr. Mackler, About 2 years ago I had a dental implant put in one of my top front teeth. Last year it fell out, and my doctor put it back in and gave me a mouth guard because I sometimes grind my teeth while sleeping. Though I wear the mouth guard every night, the tooth fell out again. Is this common? What are the possible reasons for this? ]]> While you did not specify exactly what fell out, I will assume that you are referring to the crown which is attached to your implant since it would be extremely rare for the implant itself to fall out and have to be replaced two more times. I can’t tell you exactly why it is falling out without knowing more details. If your crown is held in place by a screw, a heavy biting pattern may be breaking the screw. If the crown is cemented in place with a temporary cement, heavy biting may also loosen it up and cause it to fall out. The answer to your question is no – it is not common for an implant or implant crown to keep falling out. I suggest that you discuss this problem with your dentist to determine why this keeps happening.]]> http://www.jeffmackler.com/healthymouth/index.php?action=artikel&cat=1&id=1&artlang=en Wed, 17 Jan 2007 19:05:56 GMT