Clark B. Hicken's Blog

Tooth Erosion

Acid erosion is the irreversible loss of tooth structure due to chemical dissolution by acids not of bacterial origin. Dental erosion is a common chronic disease.  There is generally widespread ignorance of the damaging effects of acid erosion of teeth.  This is particularly the case with erosion due to fruit juices, because they tend to be seen as healthy. Erosion is found initially in the enamel and, if unchecked, may proceed to the underlying dentin.


The most common cause of erosion is by acidic foods and drinks. In general, foods and drinks with a pH below 5.0–5.7 have been known to trigger dental erosion effects.  Numerous clinical and laboratory reports link erosion to excessive consumption of drinks. Those thought to pose a risk are soft drinks and fruit drinks, fruit juices such as orange juice (which contain citric acid) and carbonated drinks such as colas (in which the carbonic acid is not the cause of erosion, but citric and phosphoric acid). Also, wine has been shown to erode teeth, with the pH of wine as low as 3.0–3.8.  Other possible sources of erosive acids are from exposure to chlorinated swimming pool water, and regurgitation of gastric acids.

CLINICAL PHOTOS:  This is a case of tooth erosion caused by gastric acids from a condition called GERD.


Gastroesophageal reflux disorder is a chronic condition—often called heartburn—which is caused by stomach acid regurgitating into the esophagus or oral cavity. The American Gastroenterological Association has published the Montreal consensus, which defined GERD as “a condition which develops when the reflux of stomach contents causes troublesome symptoms and/or complications;” its manifestations have been subclassified into esophageal and extraesophageal syndromes. The prevalence of dental erosion in adult GERD patients has been documented to be around 25%.  Various factors—including consumption of alcohol and caffeine; the existence of medical conditions such as obesity, pregnancy, and sleep apnea; and the use of drugs like NSAIDs—are risk factors for GERD.


Dental Manifestations of GERD

The oral manifestations may include tooth erosion, sensitivity, sour taste, halitosis, and mucositis. Dissolution of enamel begins when the pH drops below 5.2. The pH value of gastric acid is found to be around 2.

Dental healthcare professionals are in a position to be the first to diagnose GERD or biocorrosion due to acids. For this reason, they need to look for the signs because most patients are “silent refluxers.” The typical dental manifestations of erosion from intrinsic causes are listed in Table 1.

Acid dissolves the palatal enamel of upper anteriors, thus exposing the underlying dentin. This makes teeth appear higher in chroma and leads to hypersensitivity as well as supraeruption of opposing incisors.

Treatment of Acid Erostion/GERD

In a case as severe as this one the only realistic long-lasting treament is full coverage all-ceramic crowns.  These are CAD/CAM CEREC crowns.  The end result is life-changing and amazing.  Once the GERD is under control and the patient comes back for regular 6-month check ups at the dental office these can realistically last forever if proper home care is practiced. 

PHOTOS of Crowns:


January 11, 2013
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Digital Dentistry is here to stay.  Some dentists have not embraced this state-of-the-art technology, but Dr. Hicken has at Main Plaza Dental.  If you need a crown, want veneers, or a complete smile makeover you can come in to Dr. Hicken's office and leave with them in one simple appointment.  With advanced training, expertise, and a lot of experience, Dr. Hicken can provide you with a perfect result.  He has mastered the art of designing and fabricating high end all-ceramic crowns and veneers via CAD/CAM CEREC technology.  The days of taking an impression, sending it to a lab, having to wear a temporary crown for 2 weeks, and coming back to have the crown cemented are over!  From start to finish the procedure takes about 90 minutes.  Each additional crown/veneer adds another 30 minutes to the procedure.  See the pictures below of a recent crown that Dr. Hicken did.


After prepping the tooth, it gets scanned with a special blueray camera.  The images get put onto a computer.  Dr. Hicken then designs the crown and sends the design to the milling unit. 


Once the crown is removed, we remove the sprue and try it in the patient's mouth.  Here is Chelce (head dental assistant) removing sprue from crown


Once we have verified the crown will be a perfect fit, we glaze it and bake it in the oven.  Here is an assistant painting the glaze onto the crown


Crowns ready for the oven


Ivoclar pressurized oven


Once the crown has finished baking, Dr. Hicken will make any necessary adjusments and polish the crown.


Final product -  Perfetly polished all-ceramic e.max crown


X-Ray of tooth before treatment


X-Ray of tooth after root canal retreatment and after cementation of all-ceramic crown.

A perfect crown with perfect margins.

The root canal retreatment was performed by Dr. Jon Jenson, DDS at Cascade Endodontics.  He does excellent work!

Did you know that oral hygiene was a top priority in society as early as 5000 BC? Even though the brands of toothpaste that we have today are the most effective in preventing oral disease, the concoctions up until now haven’t been too far off. Take a ride on a fantastic voyage into the history of toothpaste.

4 AD: The world’s oldest-known formula for toothpaste was created by Egyptians. They crushed rock salt, mint, dried iris flowers and pepper and mixed them together to create a cleaning powder. Although this concoction is known to create bleeding gums, research suggests it is the most effective compared to most toothpastes used as recently as a century ago.

1780: People were known to scrub their teeth with a powder that was made up of mainly burnt bread. That’s right – what a lot of us eat for breakfast was once considered an effective solution for clean and healthy teeth.

1824: A dentist named Peabody added soap to toothpaste for added cleanliness. Soap was later replaced by sodium lauryn sulfate to create a smooth paste

1873: The first commercially produced, nice-smelling toothpaste was launched by Colgate and sold in a jar.

1892: Dr. Washington Sheffield is the first person to put toothpaste in a collapsible tube. It has been suggested that this version of toothpaste is the most similar to today’s version.

1914: Fluoride is added to toothpastes after discovering it significantly decreased dental cavities.

1975: Herbal toothpastes, such as Tom’s, become available as an alternative to cleaning teeth without fluoride. These toothpastes include ingredients like peppermint oil, myrrh and plant extracts.

1987: Edible toothpaste is invented. What is mainly used by children just learning to brush their teeth was actually invented by NASA so astronauts could brush their teeth without spitting into a zero-gravity abyss.

1989: Rembrandt invented the first toothpaste that claimed to whiten and brighten your smile.

With the world of dentistry evolving at such a rapid pace, what do you think is the milestone in the toothpaste timeline? Let us know below.

For your Holiday Shopping: Best Dental Books for Kids


The holiday shopping season is upon us. Are you ready?

Of course, here at the Main Plaza Dental, we can’t pass up the opportunity to promote good dental health – even when Christmas shopping. As you think about gifts for the littlest dental patients on your list, why not make learning about teeth fun (and maybe even a little funny) with some of our favorite dental-related kids’ books?

5. Going to the Dentist by Anne Civardi

Great for toddlers and preschoolers, this book helps little ones know what to expect during that first trip to the Smile Center! Bonus: Finding the duck hidden throughout the book.

4. The Tooth Book by Dr. Seuss

Nothing tops Dr. Seuss when it comes to entertaining and silly children’s books, but this book truly helps kids learn about the importance of teeth (and have fun doing it). Probably best for preschoolers or kindergarteners, it answers a range of questions, from what kinds of animals have teeth to why they are needed.

3. George Washington’s Teeth by Deborah Chandra, Madeleine Comora and Brock Cole

This book is great for the little history buff on your list, spilling all the details about the Father of Our Country’s worst-kept secret: horrible teeth!  From the age of 24 years old, George Washington lost one tooth per year. Yikes! Great for elementary school-aged readers.

2. You Think It’s Easy Being the Tooth Fairy? By Sheri Bell-Rehwoldt

This hilarious read will keep you and your kids laughing for a long time. Appropriate for kids in their Tooth Fairy prime, the book gives the scoop on the not-so-glamorous side of the Winged One’s famous work. As an rater wrote: “it takes sweat and muscles, a keen eye, and agility to avoid the perils of the job!”

1. Open Wide: Tooth School Inside by Laurie Keller

A great book for the whole family – and, I’ll admit, my personal favorite. “Open Wide” gives young children an inside look – literally – at teeth and keeps them laughing while – surprise! – teaching a lesson about proper dental care. You and your kids will want to read this one over and over.

So there you have it – our top 5 for your holiday shopping convenience, which include favorites for a variety of ages and interests. Obviously this list is by no means exhaustive. Got a favorite tooth-related book? We’d love to know about it. Let us know in the comments or share on our Facebook page.


Don’t Get ‘Tricked’ By Teeth-Damaging Halloween Treats
Save your smile by avoiding certain candies

Don’t get “tricked” by the sticky, sugary, and teeth-damaging potential of some Halloween treats this holiday season, says the American Academy of Cosmetic Dentistry (AACD).

Halloween is traditionally a time when consumers of all ages indulge in candy and sweets, whether it’s at Halloween-themed parties, or after trick-or-treating. While some of these treats might taste sweet, their potential to damage teeth can leave a bitter taste in one’s mouth.

Here are some treats to avoid, whether you’re on the giving or receiving end of “trick or treating” this year:

Sour candies (Sour Patch Kids and War Heads) These candies cause the most damage because of high amounts of citric, fumaric, and malic acids, all which cause damage to tooth enamel.  

Milk duds The caramel is super-sticky so it remains on the tooth for a long period of time increasing the exposure of sugar to teeth. Also, its stickiness can pull out crowns or fillings.

Raisinets While this may seem like a healthy choice, these chocolate-covered raisins are sticky and the sugar sticks to teeth for long time periods.

M&Ms/Reese’s Pieces —These chocolate-covered treats are not as sticky as gummies and maybe a better choice, although the colored candy shell may stain teeth the more you eat. Peanut butter is also less sticky than some of the other candy options mentioned.

Popcorn balls-- Crunching down on an unpopped popcorn kernel is a common cause of painful dental fractures. Popcorn husks can also become lodged between the back teeth and the gums, often requiring a course of antibiotics to clear up the resulting infection after removal.
While it can be tough to avoid candy or sweets altogether when celebrating Halloween, there are some better treat alternatives.

Dark chocolate is the least processed and closest to the cocoa bean, which contain tannins, polyphenols and flavonoids. Each of these is a strong antioxidant that benefits your mouth and teeth.

If you have to have a sweet candy, one option might be Pixie Stix, which are poured directly on the tongue so you avoid chewing altogether.  They are quickly consumed and out of the mouth before they can cause any major problems.

Of course, sugar-free treats are becoming more common in grocery stores and supermarkets and flavors and varieties continue to improve. If you really want to make your dentist proud, choose a treat with little or no sugar.
“The reality is that even with their best intentions, most people will enjoy candy and treats to celebrate Halloween this year,” Dr. Ron Goodlin, AACD president. “But when you treat yourself with these Halloween goodies, be sure to drink some water afterward to help wash away some of the sugar and acids. Flossing also helps keep the spaces between teeth clean.”

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