Cosmetic Dentistry Blog Cosmetic and General Dentistry Questions Answered

February 22, 2016

Breathing through mouth during sleep may increase tooth decay risk

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On our Facebook page, we linked to an article that appeared two weeks ago in Medical News Today with that title: “Breathing through mouth during sleep may increase tooth decay risk.” Click here to read the original story.

We got an interesting reaction from a follower: “My husband and I both sleep with mouth open. We wake up with dry mouth in the morning. I asked my dentist he replied just use duck tape all around. ??? lol”

Which prompted me to do a critical analysis of this study. The bottom line—the title and the phrasing of the conclusions are overblown.

The Facts

The first thing we need to understand is that the article from Medical News Today is not the original study but is a reporting of the study. The study itself was published in the Journal of Oral Rehabilitation, a scholarly journal. Medical News Today is merely reporting on the study, as are a number of other publications.

Here is what the study demonstrated: Normal daytime oral pH is 7.3. Normal nighttime oral pH is 7.0. In those study subjects who were forced to breathe through their mouths during sleep, their average oral pH was 6.6.

Now here’s what you need to know about oral pH. 7.0 is neutral. Anything lower than that is acidic. Acids in the mouth can damage enamel. But damage to enamel requires a pH below 5.5. But the average pH in mouth breathers in this study was 6.6, which is well above that threshold. It looks like there is nothing to worry about.

But wait. The article states that the researcher discovered that, “at stages during the night, pH levels inside the mouth dropped to 3.6 in individuals who breathed through their mouths.” THAT is low enough to cause erosion of enamel.

Did it ACTUALLY cause erosion of enamel? No, that wasn’t measured by the study. Did it cause tooth decay, as is suggested by the title? No, the study didn’t get into that either. All of that is conjecture, based on this little fact that “at stages” the pH dropped to 3.6. How long were those stages? It doesn’t say.

The Whole Story is More Complicated Than This

There is a lot going on in your mouth that affects what happens to your teeth. There are buffers in saliva that counteract the acidity mouth breathing and tooth decaycreated when you eat and mouth bacteria feed on the carbohydrates you eat. There are minerals in your saliva and enzymes that repair the enamel. This idea that there is any decay or other damage to the teeth during the sleep of mouth breathers is a hypothesis based on this one tiny observation. And while the article correctly phrased this hypothesis as “may increase tooth decay risk,” the “may” is lost on too many people. It’s a guess that “may” warrant further study.

So in mouth breathers, “at stages” the pH dropped to 3.6. I’d be interested to know how low the pH dropped “at stages” in the non-mouth breathers. We’re not told. My cynical side leads me to think that little tidbit was left out because the author wanted to sensationalize the findings. But that is only a hypothesis that would need further study to corroborate.

– Dr. David Hall

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

November 1, 2012

What to do about all that Halloween candy?

Filed under: Tooth decay — Tags: , , , — mesasmiles @ 5:11 pm

I heard on the radio a supposed health expert advising parents on how to handle Halloween candy, telling them to have the kids budget out their eating of it because too much isn’t good for them.

I profoundly disagree with that approach. Let me explain what I did with our children when they were trick-or-treaters.

When they would come in with their stash of candy, I would look it over and then announce something like this: “Okay, you have until Saturday night to finish off this candy. Anything left after that gets pitched.”

I absolutely did not want the candy-eating to drag on for weeks. Two big reasons for this:

1. I didn’t want the candy-eating to become a habit. Eat your candy. Get it over with, and then get back to a normal diet.

2. Concentrating the candy into a shorter timeframe is the single best way to limit the tooth damage.

On the second point, here is the physiology. A lot of people aren’t aware that your saliva has built-in defenses against tooth decay. There are minerals in your saliva that act to repair the acid attacks against your teeth. If the acid attacks are minimized and you give the saliva time enough to respond, you don’t get new cavities. The people that get a lot of cavities are the ones who snack all day long, every day. So eat your candy, get it over with, and then give your body time to respond.

My wife and took this approach every year, and my kids never got sick from Halloween candy. But if they had gotten sick, that would have been okay with me, too. Any association created between excess candy consumption and unpleasant experiences would have been welcome.

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About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

May 12, 2010

What to do about too many cavities

Filed under: Tooth decay — mesasmiles @ 6:37 am

I have what I thought was soft teeth, however i guess not. I brush my teeth 1-2 times a day and no matter what I constantly have to have alot of work done on my teeth. My teeth are sensitive, I brush with Sensodyne. I am wondering wh! at to do. I constantly have a large balance due to the amount of work and when I get it paid down I go back and am back to where I started. More work and more bills. Is there anything you can suggest? I am a single mom with no real money to keep paying high bills but my teeth and smile mean the world to me. Too bad the smiles don’t happen often.

Gina from Michigan

Gina,
I guess you read our page about soft teeth. There are some extremely rare genetic conditions where people have teeth with no enamel or little enamel, but in all my years of practice I never saw anyone like this and never saw a patient with “soft teeth.” Though I had many who claimed to have soft teeth or who told me their earlier dentist told them they had soft teeth. But their teeth were always just as hard as anyone else’s.
They were looking for a cause as to why they had so much decay. In every case but one I found that they had a serious snacking habit. Now I don’t know if this is the case with you, but I will mention it.
Here is my list of misconceptions about tooth decay:
1. A high rate of tooth decay is caused by “soft teeth.” In all but rare cases, this is totally false. It is usually caused by too frequent snacking.
2. Toothbrushing totally prevents tooth decay. So many people believe this, but toothbrushing prevents only one type of tooth decay, and that is smooth surface decay. And even then, it can’t overcome the effects of too frequent snacking. Most tooth decay occurs either between the teeth or in the pits and fissures of the teeth where the toothbrush can’t reach. And why is that? It’s because most people brush their teeth.
3. ONLY toothbrushing prevents decay. Actually, the strongest decay prevention comes from your own body defenses. Your saliva has minerals that will actually re-mineralize early decay lesions and repair them. This remineralization process takes several hours, though. So if you are constantly snacking, like say every hour (some people snack every few minutes!), you will overwhelm your body’s defenses and the decay will grow rapidly.
4. Only sweets cause decay. While sweets cause decay, anything that has carbohydrate in it will promote decay just as readily. Bread, crackers, fruit, (especially dried fruit, because it sticks to your teeth)–all of these things can cause serious decay. Potato chips and pretzels are bad because they also stick to your teeth.
5. It’s okay to snack in bed. This is actually the worst time for you to eat anything. When you fall asleep, your body shuts down saliva production. It’s your saliva that has the reparative substances that battle decay. Babies that are given bottles of formula when they go to sleep can see their teeth completely rot down to the root in a matter of weeks.

My advice to you: Eat only at mealtimes and then maybe have one or two snacks during the day. And soda with sugar in it counts as a snack. Brush right before going to bed, and floss then, too, so you also clean between your teeth. Brush again after breakfast. I believe that 99% of the people that follow a prevention routine like that will have very minimal tooth decay.

I hope you find this helpful and that you will implement what I’ve told you here. It will make a total difference in your dental health.
Dr. Hall

A related link: read about whitening toothpastes, and one that we recommend.

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

March 31, 2010

I’m so discouraged about my teeth.

Filed under: Tooth decay — mesasmiles @ 6:49 pm

Dear Dr. Hall,
I am writing to you because I am so depressed about my teeth and I just want some advice from somebody who cares. I have had extreme problems with my teeth since I was very young. As a child we were poor and had no isurance a lot of the time. My teeth were crooked and kind of buck toothed. I also had a lot of cavities and pain. Iremember having several root canals as a teenager. I had a lot of this work done by dentists who obviously did not care. I had a root canal done on my front tooth, but the problem was they would start the root canal but never finish because we could not afford it. I had a hole in the back of this tooth and it became an ugly grayish color and then one day the tooth just broke in half! I felt like my life was over! I was 19 with a broken front tooth and no money! I found a dentist close enough to ride the bus to and cried my eyes out to him! Since my front teeth were so crooked we deceided to get a bridge that way I could replace the broken one and the other crooked ones. A few years later I got married and finally had solid insurance so I set about getting issues fixed, but the problem is that I had SO many issues I could ! not keep up with them! Then I had the worst pain of my life when my ot her front tooth becamed abcessed. I then got a new front bridge which extended from one eye tooth to the other. Then a few years later a bottom bridge. In between this I still had root canals, crowns, ect… Well about a year ago I started having pain in a bottom left tooth.( I have root canals and crowns on pretty much all of my bottom left teeth) I went to my dentist who was out for the day, another dentist who was filling in for him said that I had the start of an abscess on a tooth that had a root canal, and a sinus infection. He gave me antibiotics and sent me to an endodontist who found nothing wrong with any of the teeth. I then went back to my dentist and he found nothing out of the ordinary. Well some days the pain hurt so bad then it would go away. As a matter of fact it went away all summer. Then bam about 3 weeks ago it came back again. I then went to my physcian because I thought I had an ear ache and she said my ear was fine. In between the pain from last year! to this year my husband lost his job, and we had no other choice but to get help from the state and get state insurance. Well let me tell you finding a dentist that cares is a joke. I finally found a dentist who saw me for 5 minutes, said you have TMJ disorder. you can get a mouthguard for $350.00 there’s nothing else I can do for you, bye. I know my teeth pain! Maybe I do have TMJ but I also think I have a bad root canal that nobody can find! I am convinced that that one dentist saw what nobody else could! My pain is like a terrible ear ache that travels down my jaw to my throat down a little ways to my chest. It is an ache type of pain, but I can feel it evolving into some random shooting jabs of pain. I have no fever and when I went to the doctor she checked my blood and said I had no sign of infection. I feel so depressed! I am 35 years old and I’m so embarresed to open my mouth! I have cracked and chipped teeth! 2 obvious looking bridges, Black between my teeth from old fillin! gs, and now pain that consumes me with no chance for help. I want to d o so much with my life but my teeth hold me back! And more importantly how can I go on in this pain with nobody to help me? These dentists are so uncaring and lack the effort to even try! What if they pull a tooth and it’s the wrong one! I am tempted to let them just pull it out, but i’m worried that my teeth wil shift and my bridge will fall out. I also thought about just trying to get dentures but everybody says that’s a terrible idea. I’m so sorry that I rambled on like this, I guess I was just so excited to stumble upon a person with knowledge and who cares about people’s well being. Do you think in my situation I should just let them pull it out? Thank you so much for listing to me! I appreciate it! Regards-Elizabeth

Elizabeth,
When I practiced, I saw a number of people like you, whose teeth, it seemed, would fall apart faster than I could fix them up and put them back together. It is very discouraging for you, I know, but it was also discouraging for me. And while there are some dentists who don’t seem to care, my experience was that, of all the professions, there are a large number of dentists who really do care – that is why they are attracted to a healing profession. I know there are some who don’t, who are in it for the money, but I think what you are seeing in the dentists you have visited must be a combination of maybe some not caring but also just a feeling of discouragement when they see your situation and wonder how to help you. And some of them might be tempted to be judgmental of your situation – thinking erroneously that the condition of your mouth indicates that you don’t care, so why should they care? But I’m confident you can find a dentist who will understand and be able to help. I know a number of such dentists.

And really, to get a handle on your situation, I think you need to take some action that may be hard medicine. First, keep looking for a dentist who will help you. Call up the office and ask if you can get a tour or just come in for free and meet the dentist and the staff. When you find someone with whom you feel really comfortable, and you sense that they care and they won’t be overwhelmed by your situation, then get into a program to get your dental problems under control. And what you are going to have to do is do all you can to shut down the decay process, so that you don’t have so much decay. And here is how you do that.

A lot of people are under the misconception that toothbrushing is the biggest weapon against tooth decay. Toothbrushing helps, but it is your own saliva that has the biggest defense you have against decay. Your saliva has antibodies that fight the decay bacteria and minerals that remineralize tiny spots of decay. In order to maximize the effectiveness of your saliva in fighting decay, you need to strictly limit the NUMBER OF TIMES you eat. You see, toothbrushing only cleans the smooth surfaces of your teeth. So it won’t clean out the cracks and crevices, and the contact points, and other vulnerable areas. So here is the program – you strictly limit yourself to eating three to five times a day – three regular meals and a maximum of two snacks. Then brush your teeth twice a day – three times if you can. And floss once – at night before you go to bed. That way, there is enough time between eating times that your saliva will have time to repair the little spots where decay starts. Most people who do this program dramatically reduce the number of cavities and the rate at which those cavities grow. In fact, if they’re strict about it, these people will get to a point where they have zero new cavities.

Then you can start getting your teeth fixed. Try to save all the teeth you can. Once a tooth is gone, the bone where that tooth was begins to collapse, and the only way to stop that is to get a dental implant, which is expensive. But all your problems sound fixable.

In looking for a dentist, you might want to try dentists who do a lot of sedation dentistry. These dentists are used to seeing people with “bombed out” mouths, and may be more understanding of your situation.

Good luck. I hope this was helpful.
Dr. Hall

Other links:
Read here about the myth of soft teeth.

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

December 11, 2008

Is chewing gum bad for your teeth?

Filed under: Tooth decay — mesasmiles @ 4:03 am

Does chewing gum hurt your teeth? I mean chewing gum a lot, not just after meals.
Jessica from Pennsylvania

Jessica,
We used to think, in dentistry, that chewing gum was bad for your teeth, especially if it had sugar in it. But it cleans your teeth, and it stimulates the flow of saliva, which is very healthy for your teeth. It helps combat tooth decay, and is a good substitute for toothbrushing if you don’t have a brush with you.

As long as you chew it for long enough that the sugar is gone, it doesn’t reallly hurt your teeth.

However, if you have TMJ problems (temporo-mandibular joint disorder), you could be overworking your jaw muscles and they could become sore or go into spasms. But if your jaw muscles aren’t bothering you, then I wouldn’t worry about that.

Dr. Hall

Other links:
Which is the best toothbrush?
Which is the best toothpaste?

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

November 18, 2008

A DIAGNOdent question

Filed under: Tooth decay — mesasmiles @ 1:18 pm

Dr. Hall,
I just started at a new dentist. They used a laser to detect tooth decay. While they didn’t find any actual cavities, they found some four areas that could be cavities in the future. I am a little confused. They want to give me fillings where there are no actual cavities. Does this seem normal, and will it seal in decay? I feel a little bit like they were trying to sell me something that I don’t need? Thank you!
– Melanie in Indiana

Dear Melanie,
I don’t think your new dental office is trying to sell you something you don’t need, but I do think they need some help with their communication skills. I think it would be helpful for you to tell them how confusing their explanation was, so that they can explain this better to the next patient.

The new laser that is used to detect tooth decay is called DIAGNOdent. It detects actual decay, not areas that will in the future become decay. There may be someone in your dentist’s office who is confused about that, because the decay detected by DIAGNOdent doesn’t appear to be decay yet, since it is decay under the surface. But DIAGNOdent is very helpful because it enables the dentist to find and fill cavities when they are smaller and thus they can intercept problems before they become bigger and more expensive.

The way decay grows on a tooth makes it hard to detect when it is small. First, acids from decay-producing bacteria start to work on the enamel in a spot and they make it porous. This early change in the enamel often isn’t visible. Then the decay begins to grow just underneath the enamel in the dentin of your tooth. When the decay has grown enough, the enamel begins to cave in, and you have a full-fledged cavity that is visible to the dentist. What the DIAGNOdent does is it detects this decay under the surface before the enamel caves in. With the new bonding technology that is used with white fillings, the filling can be made quite small and unobtrusive.

And, besides being cheaper, smaller fillings tend to last much longer than large fillings, and they don’t weaken the tooth as much.

 I’m assuming, in this answer, that your dentist is interpreting the results of the DIAGNOdent properly. If the results aren’t interpreted properly, you can get a false positive – an impression that there is decay when there is simply debris, say, clogging the pit of the chewing surface of a tooth. But when the clinician is properly trained, the results of this instrument are highly reliable and most helpful.
– Dr. Hall

Related links:
Laser tooth whitening
Ask Dr. Hall a question

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 18, 2008

Why are my children getting so many cavities?

Filed under: Tooth decay — mesasmiles @ 3:48 pm

First off Dr. Hall your site is amazing and has been extremely informative.

This question is about my children. They are 6 and 4 and I brush their teeth morning & night, along with flossing nightly, and taking fluoride. Our 6 year old has had 4 cavities, while our 4 year old has had 11 🙁 Both children’s diets maintain very little sugar. Is the frequency of cavities a prelude to what is to come with their adult teeth? I am hoping not, I want so badly for my children to have beautiful healthy teeth. Is there any more that I could be doing to help them out?
– Kerri from California

Dear Kerri,
Sounds like you’re trying to be very diligent with caring for the teeth of your children.

Let me go over the risk factors for tooth decay. With the brushing, flossing, and the sugar consumption, you’re hitting a couple of the risk factors, but you’re missing the most important one.

1. The number one risk factor is frequency of eating carbohydrates. It’s not just sugar. Carbohydrates are changed into sugar by salivary enzymes, so any carbohydrate can cause decay. And it’s not the amount, it’s the frequency. If they’re snacking all day long, you’re going to get lots of decay, and brushing the living daylights out of your teeth won’t stop it.

2. Brushing and flossing help a lot, but they only help prevent smooth surface decay. They have practically no effect on pit and fissure decay, or decay in protected areas. So a prevention routine of brushing and flossing will reduce the number of cavities, but can’t eliminate decay.

3. A lack of fluoride makes teeth more susceptible to decay.

4. Watch the types of food consumed. Sticky foods that stay stuck to teeth after eating, such as raisins, potato chips, caramels, are particularly bad. Non-sticky foods such as fresh fruits, chocolate, soups, any drinks, are better. But if any food is consumed often enough, it’s just the same as if it were sticky. Sugar-containing soft drinks, when consumed just at mealtime, have practically no effect on tooth decay no matter how much you drink. Sipped constantly throughout the day, however, they can cause rampant decay.

I hope this is helpful.
– Dr. Hall

Related links:
Best toothbrush
Tooth whitening and fillings

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

October 19, 2007

Another question about tooth decay from weightlifting

Filed under: Tooth decay — mesasmiles @ 5:09 am

Dr. Hall –
I saw your note to the effect that weightlifting will not affect tooth decay. But let me ask the question a different way. I have been lifting weights (squats) for a few months now and am beginning to get up to moderately sizeable weights. I am doing this to preserve/increase bone mass to avoid osteo problems ten or twenty years from now.

If I am building extra bone as a result of this exercise, the raw materials must come from somewhere. Obviously, preferably diet. But is it possible that it may take some calcium from the teeth to build the extra bone mass?

I have just found I have problems with two teeth after not having any material problems for some years. It just seems like a curious coincidence, that it has occurred a few months after starting some fairly serious weights exercises.
– Rodney in Ontario

Rodney,

Your body can’t extract calcium or anything else from your teeth. Once they’re formed, they’re done. Your body can and does take calcium from bones when they fall into disuse, but not teeth.

It’s conceivable that, if your diet isn’t providing enough calcium to build up these bones that your saliva could be deficient in calcium, and if that’s the case, you’re weakening one of your defenses against tooth decay. There is a constant repair process that goes on where your teeth have little acid attacks every day and your saliva provides the repair every day to rebuild the site of the attack.
– Dr. Hall
Related pages in the www.mynewsmile.com web site:
Bone loss from gum disease
What to look for in dental floss and flossing

Supersmile toothpaste

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

September 19, 2007

Can you catch tooth decay from kissing?

Filed under: Tooth decay — mesasmiles @ 8:23 am

Dr. Hall,
I noticed that someone I had kissed had a tooth that looked like it was decaying. Can I get sick from kissing that person if they had a decayed tooth in their mouth? This is a serious question not a joke, thank you so much.
– Jamie from California

Jamie,
Tooth decay isn’t contagious. The decayed tooth won’t hurt you at all, no matter how much you kissed this person.

Everyone has the same tooth decay bacteria (lactobacillus) in their mouth. The way the bacteria cause you trouble is when you feed them often or don’t clean them off daily. So brush, floss, don’t snack all day long, and you’ll be fine.

For more information, read our page about tooth decay. Also read about the myth of soft teeth.
– Dr. Hall

Thank you Dr. Hall I feel much better now, I hope he gets his teeth fixed soon.
– Jamie

We thank our advertisers who help fund this site.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

July 6, 2007

Tooth decay from weightlifting.

Filed under: Tooth decay — mesasmiles @ 8:58 pm

Dr. Hall,
When I weightlift, I feel a lot of pressure on my jaw and my molar teeth. I recently had a molar pulled because of a huge cavity far below the gumline, and am starting to feel similar pains in the molar on the other side. Is there anything I can do to protect my teeth and jaw while I do these sorts of strenuous exercises? Or am I doomed to lose all my molars?
Alan in Alberta

Alan,
While weightlifting can cause pressure on your teeth, and possibly even pain, it won’t cause tooth decay. So no, you aren’t doomed to lose your molars from weightlifting.

I’d suggest taking a look at your eating habits. Do you snack frequently or drink soda frequently? My guess is that’s what you’re doing.

If you eat or drink anything with carbohydrates in it frequently, there is no way to brush your teeth or floss enough to counteract the acid attacks that you are experiencing on your teeth. If you limit yourself to your regular three meals and maybe a couple of snacks, and then brush your teeth at the gumline, you should pretty well eliminate almost all tooth decay.
– Dr. Hall

We thank our advertisers who help fund this site. Our cosmetic dentist referral pages list cosmetic dentists we recommend.

About David A. Hall

Dr. David Hall was one of the first 40 accredited cosmetic dentists in the world. He practiced cosmetic dentistry in Iowa, and in 1990 earned his accreditation with the American Academy of Cosmetic Dentistry. He is now president of Infinity Dental Web, a company in Mesa, Arizona that does complete Internet marketing for dentists.

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