Geriatric Dentistry

As a patient gets older and they are diagnosed with dementia or Alzheimer, they tend to pay less attention to their dental care.  As these patients become dependent on others to care for their teeth, their teeth may become more decayed at a faster rate than before their diagnosis.

When we see a geriatric patient, most of the time, they are also complicated with many systemic diseases such as high blood pressure, diabetes, high cholesterol, stroke and are on a large amount of medications.  Many of these patients also have had joint replacements and have had strokes or are dealing with Alzheimer’s and dementia and this can result in a very combative or sometimes stoic patient who may not be able to respond or communicate their needs to us.

When we see geriatric patients, it is often that they have not kept up with their dental care and may have a lot of food trapped in their teeth, or have not even brushed their teeth for days or weeks or sometimes even months.  One can only imagine the type of damage that this can cause to the patient’s dentition.  Depending on the age of the patient, the oral assessment that is seen, the condition of the patient mentally as well as physically, we come up with the needed treatment for the patient.

Most of the time, depending on the status of the patient, sometimes the most conservative treatment is the best option for the patient.  Placing the patient on regular more frequent cleaning regimen is the best defense towards prevention of further destruction to the patient’s teeth and gums.  Sometimes, conservative treatment of leaving remaining root in the patient’s gums to prevent putting the patient through extensive dental surgery is warranted if the patient is very old or if their medical condition does not warrant them to undergo surgery.

Complications from medical conditions can cause severe decay in this population also due to dry mouth that the patient may  be experiencing due to age and also due to side effects of a large concoction of medications that they may be taking.  Many medications can cause the patient’s saliva flow to decrease and as a result of that, can cause the patient to have a lot of decay.  Saliva helps wash away food debris and neutralize the acidity of the mouth after eating.  If a patient experiences dry mouth, they will have a higher rate of decay.

Many geriatric patients also have special need due to strokes or joint replacements restricting them to having to be in a wheelchair.  Some patients can be transferred to the dental chair, while others would have to be treated directly from the wheelchair.  Some patients may have to be treated at their residence if they are bed bound.

Some patient’s who have had a stroke have to be upright due to the inability to swallow or have no ability to be treated in a recline position will also have to be taken in as an important factor during treatment.  Other times, if an extraction or oral surgery must be done on these patients, a medical consultation to the patient’s physician would have to be planned to hold any blood thinners or aspirin prior to the extractions.  Also, antibiotics that needs to be given to the patient prior to their treatment if they have had joint replacements in the recent years or with heart murmur or valve complications will require antibiotic premedication before a dental appointment.  Again, all theses factors must be considered and thorough evaluation of the patient’s medications and medical status must be considered.

Special care for the geriatric takes a very special dentist who has experience in taking care of these special growing aging population.  Picking a dentist who has been trained and have extensive experience in treating geriatrics is very important.  A dentist who is has had medical training and hospital dentistry training is imperative. As we know, care of a loved one as they age can present as a challenge as we need to advocate for them in many ways.  This is often the most delicate times in their lives.

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What Does FAGD and MAGD Mean After a Dentist’s Name?

Dental Cosmetix: Thu-Nga Ortega, DDS, MAGD

10721 Main St, Suite 2200, Fairfax, Virginia

(703) 352-3900

Have you ever seen the acronyms FAGD or MAGD after a dentist’s name? These acronyms aren’t just a few meaningless letters, but labels of great distinction.  A dentist who has a title of FAGD is a “Fellow of the Academy of General Dentistry.” A dentist who has the title of MAGD is a “Master of the Academy of General Dentistry.” Both are awarded by participating in one of the most rigorous dental education programs today. Although both titles are awarded through hours upon hours of post graduate dental education, there are some differences between FAGD and MAGD. To earn a FAGD, a dentist must participate in at least 500 hours of post graduate dental education, pass a comprehensive exam, and must be a member of the Academy of General Dentistry for at least three years. Only about 6 percent of dentists in the U.S. and Canada are Fellows of the Academy of General Dentistry.  I was awarded my FAGD in 2007. Very few dentists have the dedication to participate in this postgraduate dental education, hence I am very proud to be an AGD Fellow. Dentists who are AGD Fellows are some of the best practitioners in the field of dentistry. As an AGD Fellow, I am trained in all aspects of dental specialties which allows me to provide a multitude of treatment for patients from one practice. On the other hand, many other dentists have to refer their patients to another dentist who can perform certain treatments. To become a Master of the Academy of General Dentistry, a dentist must already be a Fellow of the AGD. A dentist then must participate in at least 600 hours of post graduate dental education which includes 400 hours of hands-on courses in addition to the 500 hours of post graduate education required to be a Fellow of the AGD. A dentist must also pass an exam equal in difficulty to board certification exams. Less than 2% of dentists in the U.S. and Canada have earned mastership in the Academy of General Dentistry. After working persistently for several years to further my knowledge of dentistry, I was awarded my MAGD in 2017. As a result of my years of commitment, I have mastered the entire spectrum of dental treatment. I can perform oral surgery, periodontal treatment, cosmetic treatment, orthodontic treatment, root canals, geriatric dentistry, prosthodontics, and general dentistry, all from one facility.  Having a dentist who is an AGD Master allows for close monitoring of patient’s treatment and makes their visits convenient and conservative. If you have the choice between a dentist who is a FAGD or MAGD and a dentist who is neither, choose the dentist who is an AGD Fellow or Master. A dentist with that type of distinction is one of the best and most qualified dentists in their field. When you see a dentist with FAGD or MAGD after their name, you can rest assured that they invest their time into learning the latest techniques and best practices in dentistry.



MAGD_My Education Didn’t Stop

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How Can I Brighten My Smile?

Your wedding is coming up and you want your smile to be its brightest.  Tooth bleaching is not just for the movie stars.  Many people have had their teeth bleached, and many more are thinking about it.  There is a stronger desire for a brighter smile, and tooth bleaching safely lightens the color, lasting for up to five years.  The most effective and safest method of tooth bleaching is dentist-supervised. 

Is Bleaching For You?

Bleaching is successful in at least 90 percent of patients, though it is not an option for everyone.  Consider tooth bleaching if your teeth are darkened from age, coffee, tea or smoking.  Teeth darkened with the color of yellow, brown or orange respond better to lightening.  Gray stains caused by fluorosis, smoking, or tetracycline are lightened but results are not as dramatic.  If you have very sensitive teeth, periodontal disease, or teeth with worn enamel, your dentist may discourage bleaching.

What is involved?

Once you have been approved as a candidate for bleaching, there are several options.  If you are in a hurry for whiter teeth, you may decide to have your teeth lightened immediately.  The dentist will then use an in-office bleaching system.  This method usually takes one hour and can be completed in one visit with noticeable results.  Performed by a dental professional, a whitening gel is applied to the teeth.  Then a refracted light is used to activate the gel on the teeth.  In a matter of 60 minutes, a whiter shade is achieved.

However, most patients choose dentist-supervised at-home bleaching, which is more economical.  With this option, the dentist can provide you with take home trays which you can use with professional strength whitening gel that cannot be bought over the counter.  This stronger strength whitening gel is very effective at whitening teeth in as little as 5 days into their 10 day treatment.

How long does it last?

Whitening should last from one to five years, depending on your personal habits such as smoking and drinking coffee and tea.  At this point, you may choose to get a touch-up.  The re-treatment time is much shorter than the original treatment time.

How does it work?

The active ingredient in most of the whitening agents is 15%-35% carbamide peroxide. When water makes contact with this white crystal, the release of hydrogen peroxide lightens the teeth.  Depending on the patient, some patients are also given formulas containing Hydrogen peroxide in varying concentrations of 10-15% depending on the patient’s desire to wear the treatment overnight or during waking hours.

Is it safe?  Any side effects?

Recent studies have proven bleaching to be safe and effective.  The American Dental Association has granted its seal of approval to many tooth bleaching products.  Some patients may experience slight gum irritation or tooth sensitivity, which will resolve when the treatment ends.

What are realistic expectations?

No one can really predict how much lighter your teeth will become.  Every case is different.  Typically, there is a ten-shade improvement as seen on a dentist’s shade guide.  The success rate depends upon the type of stain involved and your compliance with the treatment.  Bleaching does not lighten artificial materials such as resins, silicants, or porcelains.

~ Thu-Nga H. Ortega, D.D.S., M.A.G.D



Fairfax Medical Center. 10721 Main Street, Suite 2200. Fairfax, VA 22030.
Office: (703)-352-3900, Fax: (703) 352-2048
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Why You Shouldn’t be Scared of Going to the Dentist (Sedation Dentistry)

Although dentistry has changed so much in the past years, for so many Americans, going to the dentist is a frightful event.  A visit to the dentist should be relaxing and comfortable.  Unfortunately, approximately 145 million people still avoid the dentist due to fear.

With oral conscious sedation, you don’t need to be afraid of going to the dentist anymore.  Special training in sedation will allow a dentist to treat people in a relaxed state of mind.  The first step is assessing your health history including age, weight, current medications, and a number of other factors.  Using this information the dentist can then determine the exact dose of medication to administer orally.  The patient can then have their dental care accomplished while totally relaxed and comfortable.  While under sedation the patient’s vital signs are constantly monitored.  The doctor’s assistants will do everything possible to keep the patient comfortable while they are sedated.

There are many reasons why 50% of the population put dental care at the bottom of the healthcare list.  Some people are extremely fearful while others have suffered bad experiences in the past.  Other people just need extensive care and don’t have time to make numerous trips to the dentist.  Sedation dentistry can solve all of these problems.

The goal of conscious sedation is to create a relaxed, comfortable, and safe experience for the patient with little or no anxiety.  The patient will be drowsy, and unaware of the time passing by.  A specially trained assistant will monitor you continually throughout the appointment.  The big plus:  Your dental makeover can be accomplished in one visit, with little or no memory of the experience!

Dentistry is very advanced today with all sorts of gadgets that get the job done better and quicker, but now with anxiety-free dentistry, the gap can be bridged between technology and comfort.  Wake up to a new, beautiful smile.  Try sedation dentistry today!

~Thu-Nga H. Ortega, D.D.S.



Fairfax Medical Center. 10721 Main Street, Suite 2200. Fairfax, VA 22030.
Office: (703)-352-3900, Fax: (703) 352-2048
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What is Cosmetic Dentistry?

The term “cosmetic” usually brings up images of make-up, beauty salons, or plastic surgery.  “Cosmetic,” when applied to dentistry, is not so elective as these other terms may imply.  Dental Implants are considered cosmetic, as well as veneers, all-porcelain crowns, whitening, and even some gum surgeries.  For many patients, cosmetic dentistry is not merely an elective, but a necessary treatment that also improves quality of life.

Consider that you have a tooth missing and you wish to replace that tooth.  A bridge may be too aggressive if the adjacent teeth have not had large cavities or fillings.  An implant, however, may be the ideal solution.  An implant is placed surgically and painlessly into the area of the missing tooth.  After this area has healed, your dentist places the crown.  Implants are easy to maintain and do not require frequent replacements as a bridge may.  Many insurance companies pay for implant placement.  The aesthetic value of an implant speaks for itself.  Implants look much more natural than a bridge.

Veneers are usually chosen for their aesthetic value rather than as a necessary treatment.  There are instances, however, where veneers may be recommended instead of a crown for large restorations.  For example, a large filling on a front tooth may be a candidate for the more conservative veneer rather than a more aggressive crown treatment.  A tooth in the front that has had a root canal and is now discolored may also be an ideal candidate for a veneer rather than a crown.  Veneers are excellent treatment for teeth that are slightly misaligned, misshapen, or stained from tetracycline or other factors.  Veneers offer a uniform, beautifully aligned and bright smile.  They can give an instant boost to your self-confidence.

All-porcelain crowns are a great alternative to the older technology of metal and porcelain fused to metal crowns.  Porcelain fused to metal often leaves a gray tint showing through the crown as well as the metal line around the gums. All-porcelain crowns offer a natural-looking, beautiful alternative to these other materials and can be used in most cases.

Whitening is the perfect solution for yellow, stained, or darkened teeth.  Even if your teeth are only slightly dark, the power of whitening should not be underestimated.  Your smile is often the first and last impressions people have of you.  When you look into the mirror and smile, do you smile halfway or keep your lips closed when you smile?  Do you often reach up to cover your mouth when laugh or smile in public?  People often notice this as a sign of insecurity with your smile.  When professionally monitored by your dentist, whitening is a safe, cost-effective way to boost your confidence!  If you are considering veneers or crowns on your front teeth, you should seriously consider whitening your teeth first, as crowns, veneers, and fillings would not change color once they are placed.

Cosmetic dentistry is becoming more advanced and popular than ever.  Why not ask your dentist about your best options?

~Thu-Nga H. Ortega, D.D.S.




Fairfax Medical Center. 10721 Main Street, Suite 2200. Fairfax, VA 22030.
Office: (703)-352-3900, Fax: (703) 352-2048


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Are Silver Fillings bad for you?

Are silver fillings bad for you and should you remove all silver fillings?

These are common questions that are proposed by our patients. The ADA and FDA comments are that they are safe despite allegations that they leak mercury. We do know that silver fillings are older technologies and they do contain mercury and some mercury does leach from the silver fillings into your body, but how much of it is actually detrimental and dangerous? There have been studies that silver amalgam can cause Alzheimer’s, but it has not been proven because there are many other factors that come into play.

So, should you remove your silver fillings or not? That is the crucial question….. We know from many of our patients and for almost 20 years of practicing, we have seen many silver fillings that patients have opted to replace solely for esthetic reasons end up with a lot of decay under them when we remove the silver. Silver fillings are not bonded to the tooth so they tend to leak more and therefore allow bacteria and saliva to leak under the fillings over the years and allow decay to reach under and behind the silver fillings and these decay can sometimes be difficult to detect since they do not show up well on x-rays. So should one replace all silver fillings? We would recommend that as they get older and seem to be pulling away from the tooth and show signs of leaking, to replace them. White fillings are bonded to the tooth and presents less leakage and does not leak mercury. White fillings are not only esthetic, they are better for the tooth as less tooth structure is needed to be removed in order to have them placed.

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Gluten Intolerance and Edema Remedy

Be aware that even though you may be on a gluten-free diet, sometimes, you can still have swelling.  Gluten free products, sometimes have other grains in it that may be GMO (genetically modified organism) ( I will blog about this later).

I have discovered that if you stop eating gluten, you will feel better, but even better, you have to detox your body from the toxins that you may have ingested be it gluten or other grains that may be GMO.  What I am suggesting is that you go on a low carb or at least a No carb diet for at least 2 weeks and then see how you feel.  That means a very strict no carb diet.  Also, if those of you have swelling in your stomach, it is very much due to the possibility of having fructose  and possible lactose intolerance.  What fructose intolerance does is it makes your stomach swell and feel as though you all the mucosal lining in your gut is swollen.  You can go from having a flat stomach to a stomach that looks like you are holding a basketball in it.

So in order to feel good, you need to rid your body of all the toxins.  No carbohydrates, gluten and no fructose and lactose.  That means, eating green leafy veggies that does not have a lot of fructose in it along with lean protein such as fish or chicken or turkey.  This is not considered a diet but a way of life.  Once you feel better after two weeks, you will want to continue to do this for months to come.  Not only will you shed the water weight, you will not suffer the swollen belly and the water retention in your arms face hands and feet.  What a relief.  I did this and lost 25 lbs.  I did this for 4 months and felt better than I have in a long time.

What is a gluten-free, low carb, fructose-free diet consist of you may ask?

It is not eating gluten-free store bought products.  Eating gluten free processed food sometimes has too much sugar in it or fat and other things that can aggravate your stomach, so I will stay away from them.    The key is eating healthy wholesome food.  Try to keep to an organic way of looking at things.  Also, I will limit the amount of dairy I have as it may agitate me the way fructose does.

What types of things have fructose and should be avoided?

-sodas (high fructose corn syrup), milk

-fruits: apples, pears, cherries, plum, apricots, watermelon, honey dew

-onions, asparagus,

-legumes- soy, beans,

-artificial sweeteners: anything that ends in -ol: sorbitol, mannitol, xylitol, maltitol

Try this and all the swelling and discomfort will go away.  But you have to keep to a strict diet.  You cannot stray even for one bite, as it will take a while for your body to get back to the clean state during the first 2 weeks.  By doing this diet, you will put your body into ketosis and you will be getting rid of water retention, and also lose any stubborn body fat in areas that have been hard to rid of fat.  You will need to purchase ketone strips to see if your body is in ketosis.  These strips are used to test the ketones released from your urine as your body starts to burn fat.  You can start to see if your body goes into ketosis within 1-2 weeks of being on this diet.  Remember, it only works if you are gluten-free, no carb, and lactose and fructose free.  I know, it seems as though you can’t have anything, but there are lots you can have and I can blog on that later.  Meanwhile, I would love to hear if anyone has tried this and has been successful…. good luck.  It will work if you are good at being disciplined with it.


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Open Enrollment and Flexible spending

It’s that time of the year again, OPEN ENROLLMENT!  Many patients over the years have asked us to help suggest which dental plan they should pick in order to continue to come to our office.  We have over the years offered the service of helping our patients select their dental plan based on their dental needs.
Please don’t hesitate to give us a call or email us some of your dental insurance plan… options so we can review them. We can select ones that will help reduce your out-of-pocket costs and allows you to still see us.
Overall, if you stick to big companies such as:  Aetna, Cigna, Human, Guardian, Metlife  (these are good companies)
Try to stick to at least a PPO High Option plan.
Stay away from:  Delta Dental and BCBS plans.  (they pay horribly and you will have to pay a lot out- of- pocket)
Also, this is the time of the year where a lot of patients are trying to use up their flexible spending or they will lose it.  Many are opting for Invisalign,a new retainer, night guard or snore guard.  Please call us if you need to plan your flexible spending allocations for next year so we can give you an estimate for your treatment plan to help you save money for the next year.  We are happy to be of service to all the patients and this is just another one of those special things we do for you.  Have a great week!
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Gluten Intolerance and edema

I have been battling edema and stomach bloating for over 10 years without much resolution.  There are days where my body, hands, face and extremities swell to the point that it is very uncomfortable.  I seem to appear very healthy to a doctor when I go to the doctors to complain about my problem.  They seem to think that I have an eating disorder.  They think that it is in my mind that I have gained weight and I just can’t admit that I have put on weight.

Gluten intolerance has finally gained some respect in the community because 1 in 133 people in the US is affected by it.  Some don’t even know that they have it.  Most just think that they are gaining weight.  Many doctors don’t understand this new disorder or intolerance because it was not taught in medical school.  It is new because our food chain has been tampered with genetically modified food and processed food with GMO has affected us in many ways.  I am sure that there are more diseases out there that doctors have no answer to.

When I visit a doctor or an allergists or a kidney specialist about my problem, they run their typical blood tests and tell me that I am healthy and that there is nothing wrong with me and have even hinted at the fact I might need to go and see a psychiatrist.

I know that over the years, gluten does in fact causes me to feel dehydrated and therefore, I drink more water and subsequently I swell even more.    What gluten does is it makes your gut more permeable to protein in the gluten and water leaves your blood stream and moves out to your tissue.  This causes tissue swelling/edema.   Some people experience bloating of the abdomen and extremities.  Going on a gluten-free diet helps the situation, but I have also noticed that after being on the gluten-free diet for over 5 years, the gluten-free diet has lost its effectiveness.  I have started to gain more water weight even when I was on the gluten-free diet.  This puzzled me. ….I started to also have more swelling in my stomach and distention to the point that I felt as though I was 6 months pregnant when I wasn’t.  Through further research and trial and error with my diet, I realized that I also had another diagnosis.  I have acquired fructose malabsorption.  This is when your body is unable to process fructose, a sugar from fruits.  That meant that if I ate fruits that had more fructose than glucose content in it, I will not be able to absorb the fructose and it will cause bacterial overgrowth in my gut.  This in turns causes my stomach distention, gas, possible diarrhea and depression in some due to the lowering of tryptophan level in the blood.

Fructose high food such as apples, pears, and watermelons as well as other fruits and vegetables should be avoided to prevent further exacerbation.  You can get your hydrogen breath test to see if you have fructose malabsorption.  This test may give you false negative at which point, you might want to do a lactose intolerance test to follow.

Many doctors, have not accepted that fructose malabsorption as a real disorder or disease.  There are still many clinical trials to be done for both gluten intolerance and edema as well as that for fructose malabsorption.

In the end, it should be known that you know your body the best and if you don’t feel right, don’t let doctors tell you that you are fine.  There are many diseases out there that does not fall within what doctors are taught, but there are new diseases and disorders that all doctors should be aware of.  There are more diseases out there that are still being researched and they are mainly related to our food chain and what it is doing to our bodies.

Many diseases are related to food intake and doctors to this day are still unsure and not versed in are:  Gluten intolerance, fructose malabsorption, autism, fibromyalgia.

I encourage doctors to set up more clinical trials and studies to find out why people are having these problems because these problems are not going aways, they are just going to get more prevalent and more and more people are going to be affected.

Maybe not all of americans are becoming obese, many are afflicted with gluten intolerance that have gotten out of hand and they have suffered severed edema that results in sluggish ability for the water to be removed from the tissue as the disease worsen.

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Dental Insurance Plans which Pay Lower than National Average

During these tough economic times, many large companies are cutting costs by changing their insurance plan coverage for their employees to a very low paying plan.  Employers are looking to cut costs at the expense of their employees.  These plans pay very poorly so then the subscriber (the patient) ends up paying more out-of-pocket.  These plans tend to be Delta Dental and some Blue Cross/Carefirst plans.  Delta plans tend to cover less procedures for patients or only pay for bad quality restorations such as silver fillings and metal crowns. 

Employees can collaborate with each other to complain to their Human resources office so that they can request for a better plan in order to get better dental services with better dental materials in their mouth for the health of their bodies.

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