Posted by Miranda Roberts
October 3rd, 2012
Assistance League® of the Eastside’ signature program Operation School Bell® is once again in full swing – bringing delighted smiles to over 2,700 students in the Lake Washington, Northshore and Bellevue school districts. These children in need, identified by their school counselors, will have the opportunity to shop for school clothes through Operation School Bell at designated shopping events, staffed by Assistance League of the Eastside volunteers in local Fred Meyer stores.
In addition to school clothing, each student receives a hand knit hat or scarf and a dental kit, donated by Dr Mark DiRe of Bellevue Dentistry. Additionally this year, Dr DiRe is offering these students reduced rate dental care at this practice.
Click here to read full article »
July 23rd, 2012
Preventive dental cleanings and annual exams during pregnancy are not only safe, but are recommended. The rise in hormone levels during pregnancy causes the gums to swell, bleed, and trap food causing increased irritation to your gums. Preventive dental work is essential to avoid oral infections such as gum disease, which has been linked to preterm birth.
What about other regular dental work during pregnancy?
Dental work such as cavity fillings and crowns should be treated to reduce the chance of infection. If dental work is done during pregnancy, the second trimester is ideal. Once you reach the third trimester, it may be very difficult to lie on your back for an extended period of time. The safest course of action is to postpone all unnecessary dental work until after the birth. However, sometimes emergency dental work such as a root canal or tooth extraction is necessary. Elective treatments, such as teeth whitening and other cosmetic procedures, should be postponed until after the birth. It is best to avoid exposing the developing baby to any risks, even if they are minimal.
What about medications used in dental work during pregnancy?
Currently, there are conflicting studies about possible adverse effects on the developing baby from medications used during dental work. Lidocaine is the most commonly used drug for dental work. Lidocaine (Category B) does cross the placenta after administration. If dental work is needed, the amount of anesthesia administered should be as little as possible, but still enough to make you comfortable. If you are experiencing pain, request additional numbing. When you are comfortable, the amount of stress on you and the baby is reduced. Also, the more comfortable you are, the easier it is for the anesthesia to work. Dental work often requires antibiotics to prevent or treat infections. Antibiotics such as penicillin, amoxicillin, and clindamycin, which are labeled category B for safety in pregnancy, may be prescribed after your procedure.
What about x-rays used in dental work during pregnancy?Routine x-rays, usually taken during annual exams, can usually be postponed until after the birth. X-rays are necessary to perform many dental procedures, especially emergencies. According to the American College of Radiology, no single diagnostic x-ray has a radiation dose significant enough to cause adverse effects in a developing embryo or fetus. Fetal organ development occurs during the first trimester; it is best to avoid all potential risks at this time if possible. If non-emergency dental work is needed during the third trimester, it is usually postponed until after the birth. This is to avoid the risk of premature labor and prolonged time lying on your back.
Suggestions for addressing your dental needs during pregnancy:
• The American Dental Association (ADA) recommends that pregnant women eat a balanced diet, brush their teeth thoroughly with an ADA-approved fluoride toothpaste twice a day, and floss daily
• Have preventive exams and cleanings during your pregnancy
• Let your dentist know you are pregnant
• Postpone non-emergency dental work until the second trimester or until after delivery, if possible
• Elective procedures should be postponed until after the delivery
• Maintain healthy circulation by keeping your legs uncrossed while you sit in the dentist’s chair
• Take a pillow to help keep you and the baby more comfortable
• Bring headphones and some favorite music
June 5th, 2012
Using imaging tools to detect BRONJ
Finding imaging tools to detect changes in bone associated with bisphosphonate use has been a challenge for clinicians ever since the first cases of bisphosphonate-related osteonecrosis of the jaw (BRONJ) were published in 2003
A study in the May 2012 issue of Oral Surgery, Oral Medicine, Oral Pathology, Oral Radiology and Endodontology underscores the value of cone-beam computed tomography in identifying those changes. Focusing on the dimensional changes of the mandibular cortical bone in the area of the mental foramen caused by bisphosphonate therapy, researchers say their findings could lead to earlier diagnosis of bone alterations associated with BRONJ.
In the study examining CBCT images from BRONJ patients and controls, the researchers found that dimensional changes of the cortical bone predicted BRONJ in the patients who were taking bisphosphonates.
They further sought the most useful techniques for analyzing cortical bone dimensional changes. Measurements were made in three different ways: within a fixed triangle, in a rectangle varying with the cortical height, and a ratio between area and height. Using all three techniques, the bone measurements were strongly associated with BRONJ cases, and cortical bone measurements proved significantly higher in cases than controls.
One of the techniques—the rectangle that analyzed the inner and outer mandibular cortex—proved most promising to researchers. Measuring cortical bone in this way may give an indication of possible surgical complications of patients undergoing bisphosphonate therapy.
There is value in CBCT exams of patients taking bisphosphonates, for osteoporosis, the researchers concluded. Bisphosphonate-related changes in bone structure were even detected in areas of the mandible not comprised by the bone exposure of BRONJ. Thus, CBCT exams of patients might show early bone alterations associated with this treatment.
CBCT Cone Beam Computer Tomography
Our commitment to your Oral Health means that we have a CBCT machine and have been using it for the last 2.5 years. This article sent out by the ADA explains the ongoing research into using this great technology to help diagnose and treatment plan for oral conditions that co-exist with systemic conditions. Osteonecrosis is a serious malady associated with medications taken to increase bone density. It is only a problem, if that patient needs tooth extraction or other oral treatment that would involve healing of the jaw bone.
When this research is deemed useful clinically, we will offer the test to our patients!
February 13th, 2012
With the increased popularity of 3D in movies and television, we thought it would be good to take some time to talk about the evolution of 3D technology in the dental field. As many of you know, we have been involved with CEREC CAD/CAM technology since the late 90’s. More recently we have utilized the GALILEOS cone beam technology to evaluate the structures around the teeth and jaws in three dimensions. These advances have allowed us to view and plan things in more detail, allowing for heightened communication to our patients and fellow dentist.
The CEREC optical scanning technology allows us to create digital models of your teeth for the preparation of porcelain crowns and onlays. This intra-oral scanning technology produces detailed images of both your teeth and the surrounding gums. This creates a virtual model of the teeth that would otherwise require impressions of your mouth. Optical scanning is now a rapidly growing technology in dentistry, frequently used for dental implants, orthodontic planning and transmitting digital impressions for the fabrication of crowns.
The GALILEOS CBCT produces a three-dimensional radiograph of your teeth and the surrounding hard structures. With the imagery of the GALILEOS we are now able to view the bone, sinuses and jaw joints in an interactive 3D image, allowing us to screen for pathology and revealing details not visible in traditional x-rays.
Individually, these technologies are great advancements in the field of dentistry. When CEREC and GALILEOS are combined, we are able to convey our vision for you by “virtualizing” the plan, allowing our patients to interact with the process. The technology relates the structures you see daily with the underlying structures that you do not, greatly improving the predictability of both simple and complex cases. With the help of these continued improvements in dental technology, we hope to continue providing the most comprehensive care possible for our patients.
September 21st, 2011
Bi-annual recalls are important for oral health, because it allows us to evaluate both the teeth and the surrounding tissues. While most people are familiar with the routine of checking the teeth and x-rays for decay, most people are not aware that oral cancer screening is a routine part of your dental exam at our office. We examine the floor of the mouth, tongue, cheeks, palate and jaws for anything out of the ordinary in color, texture or shape.
If it has been over 5 years since your last panoramic x-ray, we will routinely take a Conebeam CT to evaluate both the bone and soft tissue areas for any abnormalities in the sinus, jaw bone or airway. This 3-dimensional view of the jaws allows us to screen for pathology thru the cross sections of the scan in more detail.
In the instance that the tissue is abnormal for over 3-4 weeks and is suspicious in appearance, we will often refer you to a specialist to be evaluated further to determine if a tissue biopsy is necessary.
Your health and happiness is important to us. If it has been a few years since your last exam, do yourself a favor and schedule a recall to have things looked over.
Factors contributing to oral cancer:
- Age (50 and up tend to be more at risk)
- History of chewing tobacco or smoking
- Sun Exposure/Damage
Here are some suspicious signs that would warrant calling in for an evaluation:
- Patches inside your mouth or lips that are persistently white, red/white or red
- Non-healing sore in your mouth (Greater than 3-4 weeks)
- Sudden loosening of teeth
- Difficulty wearing dentures
- A lump in the neck region
- Difficulty or pain swallowing
July 7th, 2011
Dental whitening has become the leading elective dental procedure in offices and at home. It is an easy and efficient way of whitening your teeth and achieving a whiter smile in a few days or a few weeks. So what kind of whitening would be best for you? Hopefully after reading this article you will have a better understanding of dental whitening and be able to choose the option that would work best for you.
Patient Factors Treatment Factors Whitening Options
Cost Starting/Desired Shade Over the Counter
Time Compliance Custom Bleach Trays
Sensitivity Dry Field In-Office Bleaching
Expectations Strength/Type of Whitener Whitening Toothpaste
The great thing about whitening is that no matter which option you choose, you should generally see some results. It is up to you as the patient to determine what level of whitening you want and having the appropriate expectations for the treatment you choose.
Whitening Toothpastes ($5 and up)
These products achieve whitening from rapid release peroxides or micro-polishers in the toothpaste. While it should do a good job of maintaining whitened teeth, it may not get you the whitening effect that you desire.
Over the Counter Whitening (Crest, Rembrandt, etc. $20 and up)
Over the Counter Whitening is here to stay and the reason is that it works. If you have lightly stained teeth and you would like lighter teeth, then this may be what you are looking for. One draw-back of over the counter products is that they lay loosely over the teeth, often missing curved spaces. This “general” fit often leads to contact of these whitening agents with the gums resulting in secondary sensitivity around the teeth In addition to this, saliva often pools up around the strips shortly after they have been placed. If you take nothing else from this article, know that the contamination of whitening agents by saliva will deactivate the whitener! So if you are going to whiten this way, do not flush your money away! Invest in a $2 pack of cotton rolls and try to isolate the area while you whiten for 20-30 minutes. This should lead to much better results.
Custom Fit Bleach Trays ($250 and up)
Custom fit bleach trays are made from molds taken at the dental office. The advantage of custom fit trays is that they fit your teeth tightly, keeping the build-up of moisture out and the taste of the whitener inside the trays. With these trays, you have the option of using a carbamide peroxide whitening agent or a hydrogen peroxide whitening agent. Hydrogen peroxide whitener is stronger and only used for 30-45 minutes at a time to bleach during the day. Carbamide peroxide whiteners are meant to be used for over-night whitening. Either one will provide an effective result, but the longer the whitener is in contact with your teeth, the greater the whitening effect you get!
In-Office Bleaching (Deep Bleach $500 and up)
While previous in-office bleaching consisted of one in office bleaching session with a stronger whitening agent, we are now of the belief that you can get better results by combining two in office treatments with 2 weeks of whitening at home. This Deep Bleach option would be best for those that have not had much luck previously due to dark staining or those that want a dramatic result in a short amount of time. Custom trays are fabricated for use both in the office and at home.
June 20th, 2011
|With the increased news regarding radiation exposure in the medical, dental and even airport settings, we thought that it would be a good idea to accumulate some information on general effective doses of radiation as it relates to dentistry.
While there are different measurements of radiation, we are interested in measuring the “Dose Equivalent Radiation”. Around the world, this is measured in Sieverts, but in the United States it is measureed in REM, or millirem (mREM). The average person in the United States is exposed to 300-360 mREM in background radiation each year. Background radiation is the radiation constantly present in the natural environment of the Earth, which is emitted by natural and artificial sources.
The following list will allow you to compare dental radiographs with other sources of radiation that you may encounter in your life.
|Digital Bitewing X-rays(4)
|Digital Fullmouth Series X-rays(18)
|Digital Panoramic X-ray
|Gaileleos Conebeam Scan
|Film Based X-ray (1)
|Film Based Fullmouth Series(18)
|Film Based Panoramic
|Brain CT Scan
|Chest CT Scan
|Gastrointestinal X-Ray series
|Cross Country Flight
|Cooking with Natural gas
|Smoking 30 cigarettes/day
|Radiation from dental visits result in a small percentage of your annual radiation exposure. While the bitewing series is taken on an annual basis to evaluate the teeth for cavities, none of the other radiographic procedures are taken more frequently then at 5 year intervals.
Dental radiographs play a critical part in comprehensive dental treatment and we have always strived to accumulate the best data, while limiting the radiation exposure to our patients. Over the years we have integrated digital x-rays and a 3D conebeam scan to expand our diagnosing capabilities while reducing the amount of radiation exposure. While there is no way to say that any amount of radiation is “safe”, we do our best to ensure that your exposure at the dental office is kept to an acceptable minimum.
April 6th, 2011
Do you want to look your best? Do you want to look younger? Or do you just think that you would like to do something nice for yourself? By far the best choice for all of these concerns is to make your teeth look better, younger, and brighter. Cosmetic medical procedures are increasing every year. They are also expensive, painful, require extensive healing time and are relatively short in their affect. I was channel surfing a while back and found the Miss America pageant. Wow those ladies have the greatest teeth! I know you are thinking he is just looking at their teeth because he is a dentist! Well yes, but evening gown or swimsuit the look would not be the same without a beautiful smile!
Now most of us are not interested in the beauty pageant smile, but crooked, discolored, misshapen teeth at any age detract from our public image. We want teeth that look great for who we are. Dental care is not only reasonable in cost but when you consider how long the result lasts, the costs are minor.
If your teeth are crooked twisted and uneven then first consider orthodontic correction (braces). “No now wait a minute I am 55 years old and braces are for kids.” None of that statement is true! In fact most of my referrals to our Orthodontist are for adult care. One of the main reasons for this is patients’ concern about their front teeth wearing down. Ground shorter, on the upper or lower front teeth, the result can be one long and one short looking tooth next to each other, or flat ground off lower front teeth, or badly chipping and broken edges on their front teeth. The best treatment for most of these conditions is NOT PORCELAIN VENEERS! DO NOT GO GET YOUR TEETH CAPPED! These treatments may become a part of the entire treatment picture in a few cases, but many many cases can be treated by repositioning the teeth into a correct balanced non destructive esthetically pleasing bite; smoothing and contouring the edges, and bleaching them to a wonderfully brighter color. This will give you a lifetime of great looking teeth without any further treatment.
Some patients will require additional care. Orthodontics and bleaching may not be the answer for everyone. Some may need to cover their teeth due to a history of visible or large fillings, crowns and or root canal darkened teeth. Where possible choose the procedure that reduces the least amount of your tooth to get the desired result. With these parameters, Porcelain Veneers are an excellent choice and if the teeth are too broken down All Porcelain Crowns may be needed. These additional procedures can add considerable additional cost to the process. But remember it is not the first choice but rather a choice in the process.
Is all of this care expensive? Well yes but let us not forget the original point:
• Predictability-medical procedures are not-dental procedures are absolutely!
• Pain-medical procedures are painful and the recovery is lengthy-dental procedures are painless relatively quick and require minimal to no recovery!
• Longevity-you can have a face lift or eye procedure or tummy tuck or liposuction and it can all return within a couple of years-dental care like orthodontics and bleaching are for a lifetime and Porcelain restorations will last for decades or more.
• Bang for your Buck-is anyone really going to notice your medical procedure besides you and close friends and family- You meet the entire public every day face first- everyone notices your teeth and smile!
I have been in dental practice now for 35 years and I have been fortunate to grow older with a large number of my patient friends. I do not run a “Cosmetic” practice (no such specialty by the way). I now notice more people my age (60) and see very few 50 to 70+ year olds that would not benefit from a comprehensive approach esthetics. After all, who wants their teeth to look worn, stained, discolored, crooked and old?! Change is so easy. Just buy some over the counter bleach kits to start. If that doesn’t work talk to your dentist about custom fitted tray based bleaching systems. The quick in office highly advertised bleaching gimmicks do not work and can cause hypersensitivity (I know because we have been there tried that). The good tray based systems take longer, 2 to 6 weeks or longer, but they work. This process does not harm your teeth gums or bone. Everyone over 50 should do this!
If you need more than bleaching-get it done! You have a lifetime of smiles left to give- brighten someone else’s day with a great smile!
April 4th, 2011
The toothpaste you are using may be wearing away the enamel and dentin on your teeth, especially at the gumline! The use of “grit” in toothpaste is not unlike the use of grit on sandpaper. The more grit there is, the more effective it is at removing stain and plaque. Unfortunately, a significant downside is the destruction of tooth structure.
There is an abrasive index for toothpastes called the RDA Index. The higher the value, the more abrasive it is. At or below 45 may be acceptable balance between benefit and risk if you must use toothpaste. Over 45 is a matter of how quickly the loss of tooth structure can occur based on the RDA, frequency of use, type of toothbrush and brushing technique. If you don’t know the RDA of your toothpaste, you can find out by using the consumer contact information on the package or container. The following list gives the RDA index of just some of the many toothpastes that exist today.
Abrasivity of common toothpastes:
RDA – Dentifrice brand and variety
04 ADA reference toothbrush and plain water
07 plain baking soda
08 Arm & Hammer Tooth Powder
30 Elmex Sensitive Plus
35 Arm & Hammer Dental Care
42 Arm & Hammer Advance White Baking Soda Peroxide
44 Squigle Enamel Saver
48 Arm & Hammer Dental Care Sensitive
49 Arm & Hammer Peroxicare Tartar Control
49 Tom’s of Maine Sensitive (given as 40′s)
52 Arm & Hammer Peroxicare Regular
53 Rembrandt Original (“RDA”)
54 Arm & Hammer Dental Care PM Bold Mint
57 Tom’s of Maine Children’s, Wintermint (given as mid-50′s)
63 Rembrandt Mint (“Hefferren RDA”)
68 Colgate Regular
70 Colgate Total
70 Arm & Hammer Advance White Sensitive
70 Colgate 2-in-1 Fresh Mint (given as 50-70)
83 Colgate Sensitive Maximum Strength
91 Aquafresh Sensitive
93 Tom’s of Maine Regular (given as high 80′s low 90′s)
94 Rembrandt Plus
94 Plus White
95 Crest Regular (possibly 99)
101 Natural White
103 Arm & Hammer Sensation
104 Sensodyne Extra Whitening
106 Colgate Platinum
106 Arm & Hammer Advance White Paste
107 Crest Sensitivity Protection
110 Colgate Herbal
110 Amway Glister (given as upper bound)
113 Aquafresh Whitening
117 Arm & Hammer Advance White Gel
117 Arm & Hammer Sensation Tartar Control
120 Close-Up with Baking Soda (canadian)
124 Colgate Whitening
130 Crest Extra Whitening
133 Ultra brite
144 Crest MultiCare Whitening
145 Ultra brite Advanced Whitening Formula
150 Pepsodent (given as upper bound)
165 Colgate Tartar Control (given as 155-165)
168 Arm & Hammer Dental Care PM Fresh Mint
175 Colgate Luminous (given as 150-200)
200 Colgate 2-in-1 Tartar Control/Whitening or Icy Blast/Whitening (given as 190-200)
200 FDA recommended limit
250 ADA recommended limit
Powered toothbrush users should avoid toothpastes from near the bottom of the list. Long term use of such toothpastes might wear down your enamel.
Pay attention to pressure. If the bristles look mashed down, you are brushing way too hard. The bristles on your old toothbrush should look just as parallel as on your new toothbrush. Don’t brush so hard and your teeth will thank you for it.
August 4th, 2009
“The eyes may be the window to the soul, but the mouth mirrors a person’s health and well-being throughout life and into old age. That is because oral diseases and conditions can affect many other aspects of an individual’s general health status, and have an impact on emotional and psychological well-being through speech, laughter and social expression. Several health conditions can, in turn, have an impact on oral health. Oral health and general health are therefore inseparable, experts agree.”
Obviously an attractive healthy smile is more than skin deep! We know that neglecting your dental care leads to both financial and health related risk. The more we learn about the Mouth/Body connection the more we understand that neglecting your oral health can adversely affect your physical health. The leading causes of death in 2004 were still heart disease, cancer and stroke. The medical connection between cardio vascular disease (including heart disease and stroke) and periodontal disease is well accepted. Although the exact causative factor is still unknown, we do understand the need to control the risk factors involved in the onset and advancement of periodontal disease. A just released study by Harvard Medical School investigators states: “We found those with history of periodontal disease had 60 percent increase in risk of getting pancreatic cancer,” said Dr. Charles Fuchs of Dana Farber Institute. Periodontal risk factors can be categorized as Microbial, Systemic including Diabetes, HIV and genetic factors, Behavioral including tobacco use and smoking, and Local Factors including a poor bite and faulty dental restorations, poor home care and lack of professional care. How we control these risks is important to our future health.
The increased incidence of pneumonias associated with increased plaque levels in patients in institutional settings cannot be overlooked; in fact some insurance company studies find fewer medical care needs in patients who maintain their periodontal health. These studies support the notion that individuals in hospital ICU’s and nursing home settings have poorer oral hygiene than do those in the greater community, and are therefore at considerably higher risk that their dental plaque is infected by respiratory pathogens. This suggests that oral intervention to reduce or control the amount of dental plaque may be a simple, cost-effective method of reducing pneumonias and lung infections in high-risk populations. The cost to individuals and insurers to quell such infections is considerable to say nothing about the risk to life itself.
Some of the medications that are taken daily to reduce our health risks actually increase our risk of necessary dental care. The most ominous scenario lately is the use of bisphosphonate medications (like Fosamax) taken orally to help prevent or treat osteoporosis and Paget’s disease of the bone. Or others (like Bonefos) are given intravenously as part of cancer therapy to reduce bone pain and abnormally high calcium levels in the blood, in treating some with breast cancer, prostate cancer and multiple myeloma. In rare instances these medications have led to development of osteonecrosis of the jaw, a rare but serious condition that involves severe loss or destruction of the jawbone.
Not so threatening but still serious in its treatment scenario and financial impact is the tendency of many drugs to cause dry mouth. This condition is not just uncomfortable; it results in high decay rates. Patients, who have for years been dentally stable, are now faced with rampant decay affecting many teeth, which in turn affects existing bridgework and crowns. This often leads to extensive treatment needs including, root canals, replacing crowns and removal of teeth. The financial consequences can be considerable. There are no viable dental health programs available during retirement. Therefore, the financial burden of care rests solely on the patient. This is a risk many are not prepared to take and the result is unwanted loss of teeth.
Now is a good time to visit the dentist. Ongoing regular dental care is an important and necessary part of staying healthy as we age. The risks of not making that annual or semiannual dental visit can be substantial to our health and financial well being.