teeth extractions | South Lake Tahoe, CA | High Sierra Dental Care, Mireya Ortega, DDS Inc | 530-541-7040

Learn more about how to keep your mouth healthy.

High Sierra Dental Care wants to keep you informed.



Dental scaling and it’s importance in your annual care.

One of the easiest ways to reduce the risk of developing the most common type of cardiac dysrhythmia, atrial fibrillation (AF), is to have annual dental scaling.

What is dental scaling?
Scaling and root planing, otherwise known as conventional periodontal therapy, non-surgical periodontal therapy, or deep cleaning, is the process of removing or eliminating the etiologic agents – dental plaque, its products, and calculus – which cause inflammation, thus helping to establish a periodontium that is free of disease.

It is a structured resilient yellow-grayish substance that adheres tenaciously to the tooth surfaces including removable and fixed restorations. It is an organised bio-film that contains primarily bacteria in a matrix of glycoproteins and extracellular polysaccharides. This matrix makes it impossible to remove the plaque by rinsing or using sprays.

Materia alba is similar to plaque but it lacks the organized structure of plaque and hence easily displaced with rinses and sprays. When this plaque gets mineralized it forms into calculus. Calculus is thus the hard deposit formed by mineralization usually covered by a layer of unmineralized plaque,

Poor hygiene and disease.
Oral infections due to poor oral hygiene may predispose patients to new-onsel AF by adding to your inflammatory burden. AF, atrial fibrillation, affected approximately 2.7 million Americans in 2010, the year of the studies by the Centers for Disease Control and Prevention (CDC).

How can you prevent this?
Have an annual exam with your dentist. I am a South Lake Tahoe dentist so I am able to provide these services for those in the South Lake Tahoe area but you can contact your local dentist for an exam. It is very important to see a dentist even if you don’t see any problems or have any issues (for now).

If you would like to meet with me for your annual exam, please call us at 530-541-7040.

Oral burning and burning mouth syndrome.

If you’re like most people, you’ve never heard of these, but if you suffer from either one you know all too well about how hard they are to deal with.

There was a recent story in the Journal of the American Dental Association in which a dentist described a recent visit he’d had with a 60 year old woman who had been suffering from oral burning for over 5 years.

She had never smoked, drank excessively or used drugs and had a unremarkable dental history. She’d gone to many dentists and doctors, undergone x-rays and numerous other tests to try and find the cause. Many treatments were started but the pain never went away.

She was finally sent to the Faculty Dental Practice at the University of Illinois at Chicago College of Dentistry. Practitoners with training in oral medicine and orofacial pain established a diagnosis of primary burning mouth syndrome (BMS).

Burning Mouth Syndrome

BMS can be classified into two categories:

  • Primary BMS – Characterized by a burning sensation in the oral mucosa and perioral areas, typically with a bilaterals and symmetrical distribution, and with no clinical or laboratory findings to account for the burning.
  • Secondary BMS – Oral burning that occurs as a result of clinical abnormalities, including oral mucosal lesions, systemic diseases, certain psychological conditions and adverse effects of certain medications.
  • First it must be determined which type of situation a person is suffering from. To do this tests are run to determine if there is an underlying disease.

Local, systemic and psychological factors potentially related to burning mouth syndrome:

Local Factors

  • Dentures – Fit and design.
  • Dental trauma
  • Mechanical or chemical irritants
  • Parafunctional habits – Clenching, bruxism, tongue posturing.
  • Allergic Contact Stomatitis – Dental restorations, denture materials, oral care products, foods, preservatives, additives, flavorings.
  • Infection – Bacterial, fungal, viral.
  • Hyposalivation – Salivary gland disorders, medications, radiation therapy.
  • Oral Mucosal Lesions – Lichen planus, benign migratory glossitis, scalloped or fissured tongue.

Systemic Factors

  • Deficiencies – Iron, vitamin B, folate, zinc, vitamin B complex.
  • Endocrine – Diabetes, thyroid disease, menopause, hormonal deficiencies.
  • Hyposalivation – Connective tissue disease or autoimmune disorders, iatrogenic conditions such as drug induced or associated with radiation therapy, anxiety or stress.
  • Medications – Angiotensin converting enzyme inhibitors, antihyper-glycemics, chemotherapeutic agents
  • Esophageal reflux disease
  • Taste disturbances
  • Neuropathy or neuralgia

Psychological Factors

  • Depression
  • Anxiety
  • Obsessive-compulsive disorder
  • Somatoform disorder
  • Fear of cancer
  • Psychosocial stressors


Treatment options for patients with BMS are limited because of the incomplete understanding of the disorder. Current treatment approaches include three strategies that may be used alone or in combination:

  1. Behavioral strategies such as cognitive behavioral approaches, group psychotherapy or both.
  2. Topical therapies such as anxiolytics, atypical analgesics, antimicrobials, artificial sweeteners and low level laser therapy.
  3. Systemic approaches involving the use of various h as antidepressants, anxiolytics, anti-convulsants, antioxidants, atypical analgesics and anti-psychotics, histamine receptor antagonists, monoamine oxidase inhibitors, salivary stimulants, dopamine agonists and herbal supplements.

If you suspect you suffer from BMS, please make an appointment to see me. Once we rule out certain causes we’ll determine the next step.

Because many of the approaches have reported variable outcomes and because they fall outside the training and expertise of general dental practitioners,we may have to refer you to an oral care provider who is experienced in treating orofacial pain disorders.

Will the Affordable Care Act prompt patients to drop dental insurance?

What results from the Affordable Care Act (ACA) remains to be seen, but the speculation has begun where current insurance coverage is concerned.

Adult’s and Children’s Dental Insurance
There are 5.3 million children that will gain dental insurance in 2014 due to the Patient Protection and ACA which may result in almost 11 million adults dropping their coverage when their children are covered separately. According to a recent article on drbicuspid.com, adults that switch to dental coverage under their medical insurance may have to change dentists.

Insurance Exchanges
The Affordable Care Act helps create a competitive private health insurance market through the creation of Affordable Insurance Exchanges. These State-based, competitive marketplaces, which launch in 2014, will provide millions of Americans and small businesses with “one-stop shopping” for affordable coverage.

Many employers bundle their employee’s insurance together with their dependents, and medical is usually kept separate from dental. There will be 10 essential health benefits under the ACA and one of them is that pediatric dental benefits be part of the medical plans sold outside of the insurance exchanges.

Pediatric dental plans will also be sold in insurance exchanges, both packages with medical plans and as stand alone dental plans.

What we’ll have to do in 2014
Large companies won’t be affected by the changes coming up in 2014, but employees in small groups will have to decide this year how to get the dental benefits mandated for their children.

What this means is the dental coverage that nearly 23 million children now have as part of their parent’s policy in the small group market will be duplicated by their medical coverage beginning in 2014. About 5.3 million children are expected to gain dental coverage then, mostly through public programs such as Medicaid or the Children’s Health Insurance Program.

To avoid duplication, parents have to decide by the end of this year whether to take their children off their separate dental coverage. If they do, they may have to change dentists for the children, depending on which dentists are in the medical carrier’s network.

So, while dental care expands for children, adults may be dropping their coverage according to Evelyn Ireland, Executive Director of the National Association of Dental Plans. She says that potentially 10-12 million adults may drop their coverage when their children are covered on a separate plan because they may decide to get their kid’s teeth cared for instead of theirs.

Studies show that adults who don’t have dental insurance stop going to the dentist as often.

We’ll know a lot more towards the end of the year when people have to start selecting their mandatory insurance for 2014.

Bleaching changes teeth.

With a quick look on the dental aisle at the drug store you’ll see a plethora of at-home bleaching products for teeth. The same goes for countless commercials on TV. “Have a whiter, brighter smile in just one week.” There is a blossoming cosmetic dentistry world, and teeth whitening reigns supreme since it is available at every budget level and at many time frames.

Some teeth whitening products contain high concentrations of hydrogen peroxide, up to 35% (over the counter products contain much less). Brazilian researchers felt there was a lack of research on the affects of hydrogen peroxide so they set out to see how it impacts the mechanical properties of dental tissues.

In the December, 2012 Journal of Dental Research they concluded that it has a dramatic impact on dental hard and soft pulp tissue.

Research Results

The Brazilian scientists found:

  • Showed that 35% of hydrogen peroxide, used in commercial products, changes the enamel surface structure, increasing the roughness of these tissues.
  • Phosphate content in enamel and dentin decreased after bleaching.
  • The expression of collagen degrading enzymes increased substantially, promoting further degradation in the organic matrix of dentin.
  • Bleaching agents with 35% hydrogen peroxide induced a significant in vivo alteration in enamel and dentin, which could potentially trigger biological and/or mechanical responses of dental structures.

Limiting the Damage that Bleaching Teeth May Cause

The Brazilian researchers said, as a result of their findings, “despite reports that the use of bleaching agents at low concentrations has been considered absolutely safe, analysis of our data shows that use of 35% H2O2 (hydrogen peroxide) as a bleaching agent can be clinically adverse in the long term and/or after recurring bleaching treatments.”

To limit the damage to the inner layers of tooth tissue:

  • Reduce the hydrogen peroxide concentration
  • Reduce the time of each application and increasing the time between applications
  • Not using reaction catalysts such as lamps or lasers

Perioral Dermatitis.

What is Perioral Dermatitis?

Since Perioral means “around the mouth” and Dermatitis means “inflammation of the skin,” one would think Perioral Dermatitis is a rash around the mouth. It is actually an inflammation of the facial skin due to the development of small eruptions around the mouth. It is commonly seen in young women but it also affects men.

Those with this condition normally see tiny red bumps around their lips accompanied with a burning sensation in the reddened area. The rash may also appear on the checks, the skin next to the nose and lips, the chin or area right under the nose. Rashes may also appear around the forehead and eyes.

Who gets Perioral Dermatitis?

90% of all sufferers are found to be women between the ages of 20 to 45. 1% of the female population is thought ot have suffered from this disease at some time in their life.


Perioral Dermatitis has a number of symptoms:

  • Redness of the skin
  • Rashes
  • Itchiness
  • Dry Skin
  • Tautness
  • Peeling


  • Face Creams
  • Cosmetic Products
  • UV Rays
  • Fluorinated Toothpaste
  • Changes in Hormones
  • Oral Pills


  • Ointments without steroids
  • In extreme cases, oral antibiotics
  • Washing skin with warm water and applying soap substitute
  • Cutting back on cosmetics and moisturizers
  • Stop using toothpastes that have anti-tartar ingredients and fluoride until rash goes away.

Is Fluoride Really a Cause of Perioral Dermatitis?

There are several theories of this, and if you see above some recommend stopping the use of fluoride toothpastes while the rash is on the skin. But, I think there are plenty of other causes and that fluoride isn’t one of them.

Fluoride is in many community’s drinking water (except in South Lake Tahoe, for one), so if fluoride were truly a cause then drinking tap water would ensure a breakout. Fluoride can also be found in salt, so again, if fluoride were a cause then salt would be responsible for a breakout.

South Lake Tahoe Dentist’s Guide to Fluoride.

Fluoride has been used as an anti-cavity agent in the United States since the 1940′s when water fluoridation was first introduced. There are now several different ways fluoride can be used both as a topical application as well as a systemic application.

Systemic Fluoride

Systemic fluoride for the prevention of cavities will be intentional such as fluoridated water and fluoride supplements and unintentional such as well water, fluoride toothpaste, brewed tea, bottled water, drinks and food processed with fluoridated water, and some fish. Some medications also contain fluoride.

Water Fluoridation

Some communities have their public drinking water fluoridated but in South Lake Tahoe we do not. Many parents are used to having the fluoride in their drinking water so they may not be aware that their children will not get their protection from water.

Fluoride enriched salt

Many countries have fluoride in their table salt, such as parts of Europe and Latin America. Because of the salt, studies have shown a significant reduction in cavities in children age 8 and above after 3 years of use.

Fluoride Supplements

Children can receive fluoride drops, lozenges or tablets. The dose of the fluoride will depend on how much fluoride is in the area drinking water.

The American Pediatric Association does not recommend systemic fluoride to children under the age of 3.

  • The benefits of fluoride were discovered in one of nature’s own experiments – the incidence of dental carries proved to be fifty percent less in areas with naturally fluoridated water, while the incidence of major diseases in these areas was the same as in the general population. Studies of large numbers of people over many generations have attested to the value of fluoride as a safe and effective nutritional supplement for the prevention of tooth decay.
  • Fluoride has been added to drinking water for almost fifty years, and follow-up studies have validated the cavity-lowering effects of fluoride supplementation and failed to show any increase in diseases due to this public health measure.
  • According to public health officials, fluoride supplementation ranks along with water purification and vaccines as one of the top public health measures of the 20th century.

One must be careful on how much fluoride a child gets. Use the chart above as a guideline. Fluorosis results when too much fluoride is ingested and can cause white mottled areas of enamel, pitted and malformed areas of enamel and brittle enamel among other issues.

Topical Fluoride

Topical fluorides are available as in-office fluorides and home-use fluorides. Either can act intra-orally by:

  • Providing periodic high doses of fluoride (In-office)
  • Providing low regulat doses of fluoride (home-use)
  • Topical fluorides in the US include:
  • Sodium fluoride
  • Sodium monofluorophosphate
  • Acidulated phosphate fluoride
  • Stannous fluoride
  • Fluoride from glass ionomer cements
  • Other dental materials

Fluoride helps fight bacteria that can attack the teeth, which makes it very important to either have fluoridated water, fluoride treatments from your dentist or at home. The child’s dental home will be able to monitor what needs to be added, if anything, which is why it is VERY important to have your child see a dentist by the time they are 1.

Dr. Ortega of South Lake Tahoe can assist with all of your fluoride needs, contact her today.

Dentistry Not Exempt From Medical Device Tax.

Beginning on January 1, 2013, the IRS is implementing a “medical device tax” as part of the Affordable Care Act.

Items that were normally tax free will now be facing a tax which may result in higher costs for dental care.

Here are some of the services and items affected by the tax:

  • Nitrous and oxygen delivery systems and gas
  • Computer equipment used for diagnostic purposes
  • X-ray equipment, sensors, cone-beam CT systems, caries detection devices and cameras
  • Surgical equipment
  • Handpieces
  • Replacement parts
  • Remanufactured or refurbished equipment
  • Instruments
  • Imagine equipment
  • CAD/CAM machines
  • Prosthetic devices
  • Any imported dental devices

The dental profession has been watching Washington and the IRS to see what was going to happen. Dental groups have been lobbying to try and get this tax stopped, but apparently their efforts didn’t work.

There are some strange details of the new tax. If you buy over the counter teeth whitening strips at the store, there is no tax, but if you buy custom whitening trays there is a tax. The rule will be, if the item is required to be listed as a device with the FDA, then it is taxable.

The National Association of Dental Labs is continuing their efforts to get dental devices manufactured by dental laboratories and orthodontic manufacturers to be tax free. They aren’t giving up according to the CEO of the Dental Trade Alliance, Gary Price.

Periodontal Health.

“Periodontal disease is an important public health problem in the United States,” said the study published in the Journal of Dental Research, official publication of the International and American Associations for Dental Research. Periodontal health is imperative to the health of Americans today.

According to Centers for Disease Control and Prevention about half of American adults by the age of 30 or older have some form of periodontal disease. Periodontal disease is higher in men (56.4%) than women (38.4%) and highest in Mexican-American (66.7%) compared to other races, 64.2% for current smokes and the rates increase to 70.1% for adults 65 and older.

There are an estimated 48% (65,000,000) Americans with mild, moderate or severe gum disease (periodontitis) according to recent CDC national health and nutrition surveys.

What is Periodontitis?

It is an inflammatory disease affecting the supporting tissues of the tooth and there are several types of categories. Periodontal Disease is an infectious disease caused by anaerobic gram-negative bacteria. Science has demonstrated that long-term periodontal care is the most critical component in the overall success of oral health.

Periodontal Disease and Systemic Conditions

  • Diabetes – It has long been known that peopel with diabetes are more likely to have periodontal disease than people without diabetes. Research now shows that periodontal disease may make it more difficult for people with diabetes to control their bloog sugar.
  • Smoking – Tobacco smoking has been found to be a major factor associated with Periodontitis. Studies show that adverse effects of smokeing may affect the immune system, vascular system as well as the inflammatory systems.
  • Pregnancy – There is growing evidence that infection remote from the fetal-placental unit may have a role in the pre-term delivery of low birth weight infants.
  • Osteoporosis – Bone loss is a shared characteristic between periodontal disease and osteoporosis.
  • Cardiovascular – The chronic presence of periodontal microbes can lead to atherogenesis via two pathways: direct invasion of the arterial wall and the release, due to infection, of systemic inflammatory mediators with atherogenic affects. This is according to a article published by the National Institutes of Health.
  • Research Statistics – There are significant connections between these systemic conditions and moderate to severe periodontal disease. Further research needs to be done to establish the associations between gum disease and other systemic conditions. Simple oral healthcare tasks, such as brushing and glossing, and limiting other risk factors such as smoking, may assist in initially decreasing periodontal pockets and periodontal bacterial flora. This decreases the likelihood of the progression of periodontal disease.

Categories of Periodontal Disease

  • Gingivitis – Inflammation of the gingiva characterized clinically by changes in color, gingival form, position, surface appearance, and presence of bleeding and/or exudate.
  • Slight Periodontitis - Progression of the gingival inflammation into deeper periodontal structures and alveolar bone crest, with slight bone loss. Mild = 1-2 mm of attachment loss.
  • Moderate Periodontits – More advanced stage, with destruction of the periodontal structures, noticeable loss of bone support, tooth mobility. There can be furcation involvement of multirooted teeth. Moderate= 2-4 mm of attachment loss.
  • Advanced Periodontitis - Further progression of periodontitis with major loss of alveolar bone support, usually accompanied by increased tooth mobility. Furcation involvement of multirooted teeth. Severe = 5 mmor more of attachment loss.
  • Refractory Progressive Periodontitis – Includes several types of periodontitis characterized by rapid bone and attachment loss. There is resistance to normal therapy.

Other Periodontal Conditions That Can Be Present

  • Recession – loss of gum tissue from the crown of a tooth
  • Exposed root surfaces – the loss of gum tissue and the bone covering a tooth root exposes the root surface
  • Furcation involvement – bone loss around a multirooted tooteh wthich reaches the area where 2 roots meet
  • Tooth Mobility – teeth that loose bone will experience some degree of mobility depending on the severity of the bone loss.

Periodontal Treatment Options

  • Gingivitis – Good home care, brushing, flossing, regular dental check-ups
  • Periodontitis – There are several non-surgical and surgical ways to treat periodontitis, depending on its severity and the presence of other conditions. The goal of periodontitis treatment is to thoroughly clean the pockets of bacteria and to prevent more damage.

Non-Surgical Treatments

Mild Periodontitis

  • Scaling and Root Planing – Removes tartar and bacteria from your tooth surfaces and beneath your gums. It may be performed using instruments or an ultrasonic device and root planing smooths the root surfaces, discouraging further buildup of tartar.
  • Antibiotics – The use of antibiotics to treat periodontitis remains open to debate. Oral antibiotics can be used to help control bacterial infection. They can include insertion of threads and gels containing antibiotics in the space between your teeth and gums or into pockets after deep cleaning. Oral antibiotics may also be used.
  • Laser Treatment – Since a bacterial infection is the initiator of the chronic inflammatory response of periodontitis, the bactericidal and detoxifying effect of laser treatment is advantageous.
  • Mouth Rinses – Rinses containing antimicrobial chemicals.
  • Good Home Care – It is recommended to brush for 2 minutes twice a day, floss daily, use an electric toothbrush and water pick.

Surgical Treatments

Advanced Periodontitis

If you have advanced periodontitis, your gum tissue may not respond to nonsurgical treatments and good oral hygiene alone. In that case your periodontitis treatment may require dental surgery. Which surgical intervention you will need is based on your case and the periodontist.

  • Flap Surgery (Pocket reduction surgery) – In this procedure, incisions are made in your gum so that a section of gum tissue can be lifted back, exposing the roots for more effective scaling and planing. The underlying bone may be recontoured before the gum tissue is sutured back into place.
  • Soft Tissue Grafts – When you lose gum tissue to periodontal disease, your gumline recedes, making your teeth appear longer than normal. A small amount of attached tissue from the roof of your mouth (palate) or another donor source is removed and attached to the affected site. This procedure can help reduce further gum recession, cover exposed roots and give your teeth a more cosmetically pleasing appearance.
  • Bone Grafting – This procedure is performed when bone has been destroyed surrounding your tooth root. The graft may be composed of small fragments of your own bone or the bone may be synthetic or dontated. The bone graft helps prevent tooth loss by holding your tooth in place.
  • Guided Tissue Regeneration – This allows the re-growth of bone that was destroyed by bacteria. In one approach, your dentist places a special piece of biocompatible fabric between existing bone and your tooth. The material prevents unwanted tissue from entering the healing area, allowing bone to grow back instead.


Once successful periodontal treatment has been completed, with our without surgery, an ongoing regimen of “periodontal maintenance” is required.

This involves regular checkups and detailed cleaning every six, three or four months to prevent re-population of periodontitis causing microorganism, and to closely monitor affected teeth so early treatment can be rendered if disease recurs.

Usually, periodontal disease exists due to bacteria containing plaque, therefore, if the brushing techniques are not modified a periodontal recurrence is probably.

By Dr. Mireya Ortega, High Sierra Dental Care

The Dangers of Sour Spray Candy.

It’s Halloween and kids all around South Lake Tahoe are excited about the big day. They’ll soon be touring the neighborhoods dressed in their costumes and carrying their bags door to door, filling them up with candy and other treats.

I’m a dentist, so I’m supposed to say “no” to the candy, but I don’t because I know it’s difficult to keep the sweets away. Of course, it’s better to not have sticky candy loaded with sugar, but kids are kids and this is Halloween. Just make sure they brush their teeth well three times a day, especially right after eating candy!

Sour Spray Candy
The thing I do say “no” to though is the popular sour candy spray. The acidity levels of this candy are just below that of battery acid! The enamel of teeth start to wear away when they come in contact with anything that has an acidity level of 4 or above on the pH scale.

The average candy with a mild tangy flavor has a pH of 3 to 2.5 (candy like Skittles and gummy bears). Wonka Fun Dip powder and Altoids Sours have a pH around 1.8. The worst? Warheads Sour Spray tops the charts at a 1.6 pH, just .6 pH away from battery acid (which has a 1) !

Enjoy Halloween but make wise choices! Please utilize this chart in your every day food decisions as well….look for the highest numbers which are the lowest acidity. Remember, the enamel of your teeth start to wear away when they come into contact with things of acidity level of 4 to 1.

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