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Dr. Kovitch Discusses Teeth Shifting and Other Dental-Care Tips during Pregnancy


We hear it in our office all the time: “I just had a baby, and noticed my teeth have shifted….”

Ever wonder why all of a sudden you have a space between your teeth or now your teeth look crooked?  This is extremely common.  During pregnancy, lots of changes occur.  Not only does your body gain weight and move organs around to make room for the growing fetus, but your bone also changes and your body produces relaxin.  Relaxin does several things, including relaxing your pelvic muscles, making your feet grow and affecting tooth movement.

What Is Relaxin?

Relaxin is a hormone present in both males and females.  Its main action is to increase the turnover of fibrous connective tissues. Thus, this hormone might increase the amount and rate of tooth movement through its effect on the periodontal ligament (PDL).  It increases tooth mobility, thus teeth naturally move towards the path of least resistance.

If you ever visit pregnancy sites like the Bump or Baby Center and search the topic of shifting teeth, you will find this to be a very common issue.  Women can also have other dental issues like TMJ disorders or bleeding gums during pregnancy that should be well-maintained rather than ignored.  In fact, women with periodontal disease are more likely to have a baby before term.

Don’t Wait Until After Your Pregnancy

To address these issues, don’t slack on your regular cleanings.  Be sure to get your teeth cleaned at least twice during pregnancy and floss diligently to care for your gums.  And as far as the shifting teeth goes, don’t wait to fix it till you have all your kids.  Instead, prevent it by being custom-fitted for a retainer at your dentist’s office to wear every time you sleep during your pregnancies and while nursing.

Mouth Guards: A Preventive Necessity

Field Hockey Athlete

It’s fall, and for many that season is synonymous with one of America’s favorite pastimes—football and other fall sports.   For dentists, however, sports seasons mean more than just entertainment.  It also means higher potential for dental injury in their patients.  Many of us are familiar with the typical athletic mouth guards, but have we given much thought as to why they are worn?  And to how successful they are in actually preventing dental injury, both in football and in other sports?

One Size Does NOT Fit All

An over-the-counter appliance won’t fit everyone or be very comfortable.  Mouth guards should be specifically prescribed by a dentist and designed according to variables like “age of the patient, sport being played, level of competition, and previous history of injury” (drbicuspid.com).  All athletes should consult a dentist prior to engaging in any sport from football to weight lifting.  Protruding teeth are a dangerous dental risk, as a large majority of those teeth are hit, broken, fractured and even knocked out from trauma to the head and neck area.

Where You Should Get Your Athletic Mouth Guard

There is great potential for facial and dental injury in most sports, even in those with fewer players.  Mouth guards can protect against several possible injuries, including concussion, neck injury, teeth and TMJ, and lip and soft tissue lacerations.  Even more seriously, a strong blow to the mandible (or lower jaw) can even cause a brain injury.  Not something to be taken lightly and definitely not an issue to be trusted to a random piece of plastic bought over the counter without a professional’s advice.  In many cases the fabrication of a custom-fit pressure-laminated mouth guard may be the best method of prevention for any athlete, and is an appliance that can only be obtained through proper molding and fitting at your dentist’s office.

See Your Dentist BEFORE Beginning a Sport

In addition to obtaining a custom mouth guard, every athlete should visit their dentist’s office to have a full dental scan performed prior to beginning any sport.  This will ensure your dentist has the most up-to-date images and records of your mouth and bite patterns so as to make an accurate assessment should any sports-related dental injury occur.

Facts About Fluoride (for Adults and Older Kids)

Toothbrush with paste amount

Fluoride IS a Good Thing

We spoke about fluoride and young children in our previous Smile Blog originally posted September 29, 2015, Kids and Fluoride, but we wanted to revisit the topic to discuss how fluoride can be a huge benefit to mouths of all ages.  Originally designed to combat tooth decay, fluoride has LOTS of benefits when it comes to cavities.  Dentists recommend fluoride use in different applications to both treat and prevent decay.   For example, if you look at the ingredients list on your tube of toothpaste, fluoride is typically included.  Some of us may have even been instructed by our dentists to rinse with fluoride mouthwash growing up.  And dentists also use fluoride trays to help treat cavity-ridden teeth as an in-office procedure.

It’s All about Moderation

However, just like most other things in life, moderation is key.  Over-use of fluoride can cause fluorosis, or permanent tooth discoloration, or even more serious problems, especially for young kids who don’t understand to spit out their toothpaste rather than eat it.  Which is why many of these same tubes of toothpaste also contain a poison warning on it.  In fact, the FDA has required it since 1997 for every one containing fluoride that is sold in the U.S.  And according to fluorideallert.org, the risks from over-ingestion of fluoride include the potential for “stomach ailments, acute toxicity, skin rashes (perioral dermatitis), and impairment in glucose metabolism.”

This is why it is recommended to use only a pea-sized amount of toothpaste to brush your teeth.  Most of us are probably guilty of being overgenerous in our applications.  It’s an innocent mistake, really.  If you watch toothpaste commercials or look at advertised images of a toothbrush with paste on it, rarely will you see a smear or pea-sized amount (as shown above on the image from dear doctor); rather, a huge swirly glob artistically placed on the bristles is the common image we are all accustomed to seeing.

“But I don’t want cavities,” you might say.  “What if I don’t use enough toothpaste to help prevent tooth decay?”

Other Sources of Fluoride

Luckily these days, we can realize the benefits of fluoride in other ways than just brushing our teeth.  As explained in our previous Smile Blog about Kids and Fluoride, we are also getting fluoride through our local water supply.  In fact, According to kidshealth.org, “as of 2012, CDC statistics show that more than 60% of the U.S. population receives fluoridated water through the taps in their homes,” whether it’s naturally occurring in their water or added at processing plants.  You can even check the Environmental Protection Agency’s database to find out what’s in your water.  The same website demonstrates that water fluoridation is actually estimated today to reduce tooth decay by “20%-40%.”  And it’s been doing so safely for over 60 years.  The American Dental Association even cites the CDC as naming it “one of the 10 great public health achievements of the 20th century.”


Fluoride is a good thing as long as it’s used properly.  Like most other things that are good for you (nuts and fish oil, for example), it’s only the overuse of a good thing that could cause problems.  That’s why a lot of dentists these days recommend that children don’t begin using fluoride toothpaste until around age 6.  But this shouldn’t stop you from taking advantage of its benefits altogether.  After all, tooth decay is still the more serious issue and if our dentists trust fluoride to help minimize cavities, then so should we.  The important takeaway here is to be informed and to ask your dentist if you have any questions about this or any other mouth related topic.

Give the Gift of A Smile for Domestic Violence Awareness Month

atlanta smiles and wellness teeth whitening special

Give the gift of a smile!

It’s October, and in honor of Domestic Violence Awareness Month, Atlanta Smiles is having special discounted prices on teeth whitening. Both our in-office Zoom teeth whitening and our take-home custom trays and whitening solution are drastically discounted this month. And even better, all proceeds from these sales will go directly to the Atlanta Smiles Foundation to help survivors of domestic violence and their families.
The Atlanta Smiles Foundation is a non-profit organization founded in 2006 to help domestic abuse survivors and their families by providing pro-bono dental restoration and facial reconstructive services. Based on individual circumstances, the services provided may range from preventive and routine work, to cosmetic dentistry, to dental and facial reconstruction. Dr. Marc Yune, an Atlanta Facial Plastic Surgeon, works in conjunction with founder Dr. Dina Giesler by providing surgery to the head and neck areas for those who have been injured in severe domestic abuse cases.

As health care professionals, we believe we possess special gifts and talents for making a huge difference in the lives of our patients. We utilize our skills to eliminate serious pain and improve overall health to survivors and to their children. Aesthetically speaking, our work can make a critical difference by giving people a renewed confidence to function at a higher level in their everyday lives. We believe this confidence gives survivors the courage to leave the violence that threatened to destroy them and their children.   Dr. Dina Giesler, DDS, MAGD

The Atlanta Smiles Foundation works in partnership with area shelters, agencies and programs that are dedicated to survivors of domestic abuse. Its mission is to send survivors of domestic abuse on their journey to reclaim their self-esteem, their sense of value and their lives.

This month, do your part by helping the Foundation give the gift of a smile to these deserving people, and brighten your own in the process!

For more information on the Foundation and how you can help during any month of the year, see our website here: http://www.atlantasmiles.org/.

Kids and Fluoride


Emery Brushing Teeth

Have you ever watched a child put toothpaste on their toothbrush?  It’s not usually the delicate pea-sized amount that the American Academy of Pediatrics (AAP) recommends for kids 3 and older.  Even for younger kids, the AAP says only to use a “smear (grain of rice amount)” prior to the 3rd birthday.  But, why is it that the amount of toothpaste is such a big deal?

Too Much Toothpaste is Dangerous

Because of the fluoride.  Most of us know the HUGE benefit of fluoride—it helps to prevent tooth decay and cavities.  Dentists recommend fluoride use in different applications to both treat and prevent decay.   However, when it comes to small kids (ages 6 and younger), there are lots of potential issues which can be caused by fluoride as well.

According to fluorideallert.org, “children who swallow too much fluoride toothpaste can suffer acute poisoning, even death.  In fact a single tube of bubble-gum flavored Colgate-for-Kids toothpaste contains enough fluoride (143 mg) to kill a child weighing less than 30 kg (Whitford 1987a),” or 66.14 pounds.

Toothpaste for Kids

This is why introducing our children to toothpaste containing fluoride isn’t something parents should do too early.  Lots of kids will ingest the toothpaste even if they are old enough to “know better,” simply because a lot of those on the market have added flavoring like bubble gum or fruit juices to make them more appealing.

Children also don’t have the best swallowing reflexes, so they may be ingesting more of the paste than is physically safe whether they, or you, realize it or not.  Several of these kid-targeted toothpastes with fluoride will say they are safe for an age as young as 2 years, though many dentists recommend waiting until the age of 6 or older to let your child use fluoride toothpaste, simply because then you know they will be spitting it out.  It will benefit their teeth without getting ingested.

So, without fluoride toothpaste, how do parents ensure children are getting the actual amounts that are needed to perform the benefit that fluoride was designed to do, which is prevent tooth decay?

Here’s the Good News

The answer is water.  Parents are instructed to brush their babies’ new teeth simply with a toothbrush and tap water.  And parents of toddler-aged children have probably had the discussion with their pediatricians or dentists about the type of water their children drink.  Tap or filtered water from the refrigerator is safest, and beware of giving them only bottled water.  Why?  Because our local water supplies contain fluoride.  According to kidshealth.org in fact, “as of 2012, CDC statistics show that more than 60% of the U.S. population receives fluoridated water through the taps in their homes,” whether it’s naturally occurring in their water or added at processing plants.  You can even check the Environmental Protection Agency’s database to find out what’s in your water.  The same website demonstrates that water fluoridation is actually estimated today to reduce tooth decay by “20%-40%.”  And it’s been doing so safely for over 60 years.  The American Dental Association even cites the CDC as naming it “one of the 10 great public health achievements of the 20th century.”

These days, not all tap water is convenient to drink (or has the best flavor depending on where you live).  No worries there either.  Many bottling companies have joined the fluoride wave by adding it to their bottled water as well.  Just check the label—most of them will advertise it right on the front because they want you to know they’ve taken that extra step.

Alternative Toothpastes

If you are concerned at all about your children ingesting too much fluoride, there are other toothpaste options readily available than the fruity, bubblegum ones with cute cartoon characters on the outside.  Feel free to ask your dentist for a good suggestion.  Some alternatives, like xylitol-based toothpastes, can also help prevent other health issues like ear infections.  Toothpastes like these are either sold at your dentist’s office, your local health food store, or easily found through an online retailer.

Dr. Giesler on Atlanta and Company

In case you missed it, Dr. Giesler recently appeared on 11 Alive’s “Atlanta and Company” to talk about cosmetic dentistry and to show some real-life examples of cosmetic dentistry done right!

Dr. Giesler explains how listening to her patients is the first thing she does to help them improve their smiles.  As a successful cosmetic dentistry practice, Atlanta Smiles utilizes many options to fix common issues like teeth grinding that plague so many people.  One of these includes porcelain veneers, which can be read about in more detail on one of our previous Smile Blog posts here.  Dr. Giesler’s main goal when it comes to smile transformations is to make it look natural.  You want people to admire your smile, she explains, NOT your veneers.

If there are things you don’t like about your smile, there’s no reason to hide anymore.  As Christine Pullara, host of “Atlanta and Company” said on the show, “If you aren’t cheesing, make an appointment with Dr. Dina today!”

We All Have TMJ


TMJ Pain

What is TMJ?

You’ve probably heard someone say “I have TMJ.”  Well, so do I.  And you do, too.  In fact, without TMJ, you wouldn’t be able to open your mouth to smile, talk, or move it around to chew.  The acronym TMJ actually refers to the temporomandibular joint, the joint that controls your jaw and allows it to move.  A TMJ Disorder, however, is not something everyone has.  And for those of us who do, we know how unpleasant and disruptive it can be.

So what’s the proper way to refer to a disorder relating to the TMJ?  According to Dr. Marianna Kovitch, TMJD (the Temporomandibular Joint Disorder), or the umbrella term TMD (Temporomandibular Disorder), covers pain and dysfunction associated with the TMJ and muscles of mastication.  It can be very painful, and when left alone, extremely damaging to your teeth, head and way of life.

Side Effects of a TMJ Disorder

A disorder of the jaw or TMJ can cause daily disruptions to your life including difficulty sleeping, sore teeth and jaw, and chronic headaches or migraines.  TMJD is commonly attributed to bruxism, involuntary or habitual clenching or grinding of your teeth (usually while you sleep), which can also lead to unnecessary wear and tear on the premolars and molars and eventually even causing holes.  When left untreated, a jaw disorder can be extremely detrimental to your dental health and overall wellbeing.

Treatment Options

If you have a disorder of the jaw or joint, don’t despair.  There are several treatment options available depending on the diagnosis, including splint therapy, occlusal adjustments, guards and medication.  Only your dentist can help determine which option may be best for you.

These treatments may are successful in protecting your teeth and minimizing the other side effects; however, the pain and discomfort is not always erased completely.  In these cases, there are additional treatment options available that some people have found helpful.  Some of these include chiropractic adjustments to the jaw, head and neck, massage therapy inside the mouth that helps to ease the muscle tension from clenching and grinding, and Botox© injections to the specific areas of facial tension to relax the muscles.

If none of the above completely eliminates the issues caused by the TMJD or TMD, then at times, it may be necessary to obtain a referral to an oral and maxillofacial surgeon (OMS) for analysis.  Types of surgery an OMS may suggest to treat a jaw disorder include Arthrocentesis, Arthroscopy or Arthrotomy, according to the American Association of Oral and Maxillofacial Surgeons (www.AAOMS.org).  During Arthrocentesis, fluid is flushed from the joint and the joint is then gently stretched.  Arthroscopy involves the use of a miniature telescoping tool inserted near the bottom of the ear to repair the joint.  And Arthrotomy is an open joint surgery used to reset the joint for the most complex issues.  However, as with most forms of surgery, it should never be entered into lightly as it cannot guarantee to fix the problem and could possibly even present additional issues.

Get Help Today

As with any other daily concern that causes chronic pain or discomfort, the sooner you obtain a diagnosis, the sooner you can find relief.  Do you clench or grind your teeth?  If you have frequent headaches and tooth or jaw pain, there’s a good chance you might have some form of TMJD/TMD.  But the good news is that surgery is rarely necessary, since so many other attractive and successful treatment options are available today.  Mention it to us at your next cleaning appointment to discuss your questions and concerns in more detail with your dentist.  Chances are, she can tell just by looking at your bite and grinding patterns which option will be best for you.

Ask the Dentists

We want to hear from you! 

We get lots of questions from our patients when we see them for appointments, and we are always happy to answer them and help you stay informed about your dental health and wellbeing.

But what about those questions or issues that may arise between your regular visits?  Instead of waiting for your next appointment to get an answer, why not ask us now?

This forum was created as an outlet for you, the patient (and your friends and family), to ask us whatever dental or mouth health related question you desire whenever you want!  Simply visit our facebook page at www.facebook.com/atlantasmilesandwellness or click on the image below to post your comment.  Feel free to share with your friends and family, too.  Chances are, somebody else is wondering the same thing.

Wedding Ready

Getting Married?

You’ve picked out your dress and your shoes, you’ve chosen flowers and the perfect venue.  You’ve planned your hair and makeup, and vetted photographers to find the one to capture your special day.  But did you think about your smile?  Let Atlanta Smiles and Wellness help get you and your significant other smile-ready with our wedding smile renewal!

Wedding enhancement services we offer include a special cleaning and in-office Zoom® whitening to get your teeth looking their best and brightest.  We also provide esthetic boosts like Botox®, Juvederm® and Restylane® for a more smooth and relaxed appearance.

Check out photos from the wedding of one of our most recent smile renewal brides to demonstrate what a difference your BEST smile can make!




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