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If you’re facing cancer treatment, we wish you the best outcome possible. Treating this disease has advanced tremendously in recent decades, but the available options are still often challenging to endure. It will be your primary focus for the foreseeable future.

As a dental provider we also want you to be aware how the two main treatments, chemotherapy and radiation, could adversely affect your teeth and gums, especially if you’re receiving radiation therapy near the head and neck. The aim of cancer treatment is to attack and destroy cancer cells to prevent their growth. Unfortunately, it can also destroy neighboring healthy cells and lead to harmful consequences in different parts of the body, including the mouth.

Salivary glands, for example, are especially vulnerable to damage during cancer treatment. This could create a situation where the mouth no longer produces adequate saliva flow, leading to a condition called xerostomia or dry mouth. Besides a lot of discomfort, restricted saliva flow can also increase your risk of tooth decay and other dental diseases. This is because saliva is the body’s acid neutralizer (acid can erode tooth enamel) and its first line of defense against microbial infection.

To guard against this, it’s important to support salivary flow as much as possible if you experience dry mouth symptoms during treatment (as well as beyond—it’s possible the damage to these glands could be permanent). Since some medications also contribute to dry mouth, you should speak with your physician about the prescriptions you’re taking: if any have dry mouth side effects ask if there’s an alternative drug without these side effects. You should also drink more water during the day and especially when taking medications. And consider substances like xylitol gum that can help boost saliva flow.

Unfortunately, it may not be possible to fully avoid the effects of these treatments on your teeth and gums. So, be sure you keep up daily brushing and flossing and see your dentist regularly for cleanings and checkups. If necessary, there are a number of restoration options to restore your smile after you’ve completed your treatment.

If you would like more information on dental care during cancer treatment, please contact us or schedule an appointment for a consultation.

By Gale Marana, DDS
March 06, 2018
Category: Dental Procedures

Have you put off improving your smile because you assumed that correcting your issues would involve lengthy or costly dental treatments?dental bonding Cosmetic bonding offers a quick, simple, relatively inexpensive way to address many tooth imperfections. Our Aiea, HI, dentist, Dr. Gale Marana, explains how bonding can enhance your smile.

What is cosmetic bonding?

Composite resin, a soft material made of plastic and powdered glass, is applied to your tooth to conceal flaws or change the look of a tooth during the bonding process. When the resin is exposed to a curing light, it bonds to your enamel, becoming a permanent part of your tooth. Bonding doesn't usually require any anesthesia and may be performed in conjunction with reshaping, a treatment that removes small amounts of enamel to eliminate overlapping tooth edges or improve the shape of a tooth.

How can cosmetic bonding help me?

Cosmetic bonding is often used to:

  • Repair Chips and Small Breaks in Teeth: Bonding fills in chips at the bottom of your teeth and can also be used to reattach small pieces of broken teeth in our Aiea office. Larger breaks may require a crown and possibly root canal treatment.
  • Conceal Cracks: Crowns are the best choice if you have a large or deep crack, but cosmetic bonding offers an excellent way to hide shallow cracks that don't extend beyond your enamel.
  • Hide Flaws and Discolorations: Adding a few layers of bonding material to your teeth conceals bumps, pits, discolorations, and other imperfections from view. Composite resin is available in a range of tooth-colored shades to ensure that your dental work isn't noticeable.
  • Close Gaps: Bonding also fills and hides slight spaces between teeth.
  • Lengthen Short Teeth: Your teeth can shorten after years of biting and chewing, or may wear down prematurely if you grind your teeth. Adding composite resin lengthens your teeth and improves your smile. If your teeth have shortened due to grinding, you may benefit by wearing a custom-made nightguard while you sleep.
  • Fill Teeth: When used as a filling material, composite resin strengthens teeth and offers a more natural appearance than silver amalgam fillings. Although anesthesia isn't necessary for most cosmetic treatments that use composite resin, you may require a local anesthetic when you receive a composite resin filling.

Upgrade your smile with cosmetic bonding. Call our Aiea, HI, dentist, Dr. Marana, at (808) 488-7868 to schedule your appointment.


Is a chipped tooth big news? It is if you’re Justin Bieber. When the pop singer recently posted a picture from the dental office to his instagram account, it got over 2.6 million “likes.” The snapshot shows him reclining in the chair, making peace signs with his hands as he opens wide; meanwhile, his dentist is busy working on his smile. The caption reads: “I chipped my tooth.”

Bieber may have a few more social media followers than the average person, but his dental problem is not unique. Sports injuries, mishaps at home, playground accidents and auto collisions are among the more common causes of dental trauma.

Some dental problems need to be treated as soon as possible, while others can wait a few days. Do you know which is which? Here are some basic guidelines:

A tooth that’s knocked out needs attention right away. First, try and locate the missing tooth and gently clean it with water — but avoid holding the tooth’s roots. Next, grasp the crown of the tooth and place it back in the socket facing the correct way. If that isn’t possible, place it between the cheek and gum, in a plastic bag with the patient’s saliva or a special tooth preservative, or in a glass of cold milk. Then rush to the dental office or emergency room right away. For the best chance of saving the tooth, it should be treated within five minutes.

If a tooth is loosened or displaced (pushed sideways, deeper into or out of its socket), it’s best to seek dental treatment within 6 hours. A complete examination will be needed to find out exactly what’s wrong and how best to treat it. Loosened or displaced teeth may be splinted to give them stability while they heal. In some situations, a root canal may be necessary to save the tooth.

Broken or fractured (cracked) teeth should receive treatment within 12 hours. If the injury extends into the tooth’s inner pulp tissue, root canal treatment will be needed. Depending on the severity of the injury, the tooth may need a crown (cap) to restore its function and appearance. If pieces of the tooth have been recovered, bring them with you to the office.

Chipped teeth are among the most common dental injuries, and can generally be restored successfully. Minor chips or rough edges can be polished off with a dental instrument. Teeth with slightly larger chips can often be restored via cosmetic bonding with tooth-colored resins. When more of the tooth structure is missing, the best solution may be porcelain veneers or crowns. These procedures can generally be accomplished at a scheduled office visit. However, if the tooth is painful, sensitive to heat or cold or producing other symptoms, don’t wait for an appointment — seek help right away.

Justin Bieber earned lots of “likes” by sharing a picture from the dental office. But maybe the take-home from his post is this: If you have a dental injury, be sure to get treatment when it’s needed. The ability to restore a damaged smile is one of the best things about modern dentistry.

If you have questions about dental injury, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Repairing Chipped Teeth” and “Porcelain Crowns & Veneers.”


Due to financial circumstances, people often have a lost tooth restored with a removable partial denture, an effective appliance that restores function and a degree of aesthetic appearance. Later, though, they may want to improve both function and appearance with a dental implant.

If this describes you, you’re making a great choice. Dental implants are the closest technology we have to a natural tooth. But there may be a roadblock to your implant, especially if a long time has passed since your tooth loss—there may not be enough bone at the site to place an implant.

The heart of an implant is a titanium metal post surgically imbedded in the jawbone. The titanium naturally attracts bone cells, which grow and adhere to it to form a solid hold that can support a porcelain crown or other restorations like bridges or dentures. But to achieve a natural appearance it’s important that the implant is placed in the right location. To achieve that requires adequate bone.

But there may not be adequate bone if the tooth has been missing for a while. The forces generated when we chew travel through the teeth to the jawbone, which stimulates bone growth. If that stimulus is absent because of a missing tooth, new bone cells may not replace older ones at a healthy rate and the total bone volume begins to diminish. A denture can’t compensate and, in fact, accelerates bone loss.

But there may be a solution: bone grafting. With this procedure we place a donor bone graft into the area of bone deficiency some time before implant surgery. The graft serves as a scaffold for new bone cells to grow upon. Hopefully, this will produce enough healthy bone to support an implant. If the bone deficiency is minor, we may place the implant and the bone graft at the same time.

If you have experienced bone loss, we must first determine the amount of bone at the missing tooth site and whether grafting is a viable option. Bone grafting postpones your implant, but the delay will be worth the wait if we’re successful. With increased bone volume you’ll be able to obtain a new tooth that’s superior to your current restoration.

If you would like more information on dental implants, please contact us or schedule an appointment for a consultation.

By Gale Marana, DDS
January 29, 2018
Category: Oral Health
Tags: nutrition   sugar  

It's easy to go overboard with sweets during the holiday season. But overconsumption of sugar, month after month, can jeopardize your oral and general health. A sugary diet nourishes the bacteria that cause tooth decay. Eating too much sugar over time also promotes general health problems such as diabetes and excessive weight gain.

The beginning of a new year is a great time to bring your diet back into balance. But if you really want to cut down on sugar, you'll need to be aware that there is a lot of sugar hiding in foods you where wouldn't normally suspect it. Here are some examples:

Ketchup. Do you like ketchup on your burger and fries? For every tablespoon of ketchup you use, you'll be adding about 4 grams of sugar (one teaspoon). That can add up pretty quickly into a significant amount of sugar!

Canned tomato soup. Read the label of your favorite brand and you might see as much as 12 grams of sugar per half-cup serving. That equals three teaspoons of sugar in every half cup of soup—even more in a full bowl!

Granola. You may think of granola as a healthy choice for breakfast. Yet you're likely to see sugar listed as the second ingredient on many favorite brands—right after oats. This typically adds up to 15 grams of sugar per serving. That's almost 4 teaspoons, in a food promoted as healthful!

Yogurt. Here, the amount of sugar varies widely among brands and flavors. One container of vanilla yogurt might contain 3 or more teaspoons of added sugar. Put that on a breakfast serving of granola, and your first meal of the day has already topped the 6-teaspoon daily limit recommended by the World Health Organization.

So, to prevent sugar from sneaking up on you, it's important to read those labels! And if you have any questions about sugar and oral health, please contact us or schedule an appointment for a consultation. You can learn more by reading the Dear Doctor magazine articles “The Bitter Truth About Sugar” and “Nutrition and Oral Health.”

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