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.

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

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.

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!

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)
62 Supersmile
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)
79 Sensodyne
80 AIM
80 Close-Up
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 Mentadent
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

Recommendations:

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.

“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.

So what is there to talk about in dentistry? It is fair question; I mean there is only so much you can say about “Cosmetic Dentistry” or Porcelain veneers, or “Whitening” or “Teeth Bleaching” that hasn’t already been overdone. But there is a lot more to discuss that has an impact on your health.  Dentistry at its best today is about:

·         Bisphosphonate think “Fosomax” therapy for osteoporosis and necrosis of the jawbone; should you be concerned?

·         Periodontal (gum tissue) health and the effect it can have on the health of your arteries and risk it can hold for cardiovascular disease.

·         Oral cancer risks and the means to early detection

·         Senior dental health issues are changing as more of us live longer, have our teeth and want to keep them.

·         What do you do when you retire and lose your dental insurance?

·         Dental insurance is it a benefit or a gigantic rip off?

·         Childhood decay rates are soaring, why and what to do

·         Conservative dentistry using Minimally Invasive techniques and approaches to care

·         How technology is a benefit to your dental care and this includes:

o   digital x-rays

o    3-D scanning

o   CEREC, lasers

o   technologies to detect decay without x-rays

o    intraoral digital photography

o    digital record keeping

o   3-D cone beam x-ray

o   3-D treatment planning software and more

·         Should you have that Root Canal done?

·         Should you have that tooth replaced with an Implant?

·         Should you have your denture or partial denture replaced with an Implant “supported” or Implant “retained” prosthesis?

·         Tooth decay:

o   What causes decay…really?

o   Lots of cavities? Are there some new approaches to treatment and prevention?

·         Hate to go to the dentist? It is not the same place you may be remembering, what to look for.

Dentistry today is about prevention of disease and retention of natural teeth for a lifetime.  You cannot be healthy without dental health.  There is a lot in Dentistry to talk about, that is what we will be doing here, and we invite you to join us.

There are several ways that Jaw Pain or TMJ Disorders may be treated. We will recommend what type of treatment is needed for your particular problem or recommend that you be referred to a specialist. Treatment may involve a series of steps. The step-by-step plan is in your best interest because only minor, relatively non-invasive treatment may be needed.

Diagnosis is an important step before treatment. Part of your clinical examination includes checking the joints and muscles for tenderness, clicking, popping or difficulty moving you jaw. Your complete medical history may be reviewed so it is important to keep your dental office record up-to-date. We may take x-rays and may make a “cast” of your teeth to see how your bite fits together. We may also request a specialized x-ray of the jaw joints.

If you or someone that you know is missing any or all of your teeth, you should consider permanently replacing them with implant supported crowns or bridges. The implant, placed into the jawbone, replaces the missing root of the tooth. This is extremely important because this allows the jawbone to remain intact and not dissolve with time. A crown or bridge is then fixed to the implant to replace the visible and functional part of the tooth or teeth. Placing the implant is painless and is done by a surgical specialist either Oral Surgeon or Periodontist.