I met an interesting a lady this week whom was seeking a dentist to replace
a failing veneer. After evaluating her mouth I felt deeply troubled to see
the condition of the dental care she had received over the years. There was
no organized approach used to restore her teeth.  Some teeth were shorter,
some longer, some slanted. Her bite did not fit. There was clearly a lack of
a systems approach to her dental care.  Why did this happen?
There are many reasons that patients can find themselves in trouble years
down the road. Finances,time,and fear are several that come to mind. What
responsibility do we as healthcare providers have in helping patients save
their teeth by setting a systematic plan for the future? Many times the
dentist and patient may feel forced to treat according to the dental
benefits allowed.Is this what is best for our patients? Why wasn’t the
patient given the option to restore her mouth in a systematic method which
would require very little if any dentistry in the future?
Many of our patients do not understand what we do. To many we are tooth
mechanics trained in the latest advancements  . Do patients understand that
function is just as important if not more important than the appearance of
teeth? Do patients understand there is a limited amount of dentistry that
can be performed on a tooth before it requires extraction. How do we as
dentists treat patients today when insurance benefits will pay to
permanently fix one tooth a year? I truly believe that we as dentists must
sit down with each and every patient and ask our patients what they want for
their dental health over the next 10,20 or 30 years. How they envision to
spend their golden years? Let’s help our patients take control of their oral
health. It will NEVER be the responsibility of the dental insurance carrier.

  Is it caries? Or is it a healthy tooth? Dentists often experience anxiety when attempting to diagnose the phenomenon known as hidden caries. A suspicious-looking tooth presents a treatment dilemma for dentists. Should the tooth be opened up? Can we place a sealant over it?  What if no caries is found? Should the tooth just be watched? Or does that give caries more time to destroy the tooth’s structure? In the case of  hidden caries, traditional diagnostic methods all too frequently yield indeterminate results. If you can’t detect a sub-surface lesion, how can you treat it?

 A Changing Caries Model

 Due to fluoridation, caries has gone “underground.” While helping to improve the oral health of many Americans, fluoridation has resulted in harder tooth enamel. Incipient caries lesions that once began on the tooth’s surface have now migrated below the surface.

 Proven Clinical Results

    Treatment decisions require a higher degree of certainty. The DIAGNOdent laser caries detection aid reduces the doubt from treatment decisions regarding hidden caries or questionable stained grooves. The device’s ability to aid in seeing into occlusal pits and fissures enables dentists to treat sub-surface caries lesions with confidence. The DIAGNOdent is a diagnostic device that aids the dentist in making treatment decisions with confidence. Unlike traditional diagnostic methods, DIAGNOdent is an extremely accurate and reliable adjunct for the detection of subsurface caries. It removes the guesswork that accompanies many treatment decisions regarding questionable areas, such as stained or discolored grooves. 

 What is DIAGNOdent and how does it work?

 • DIAGNOdent uses laser technology as an aid to detect and quantify hidden or sub-surface caries by measuring laser fluorescence within the tooth structure.

 • The device operates at a wavelength of 655 nm. At this specific wavelength, clean healthy tooth structure exhibits little or no fluorescence, resulting in very low scale readings on the display.

 • Altered tooth substances and bacteria, including caries, will fluoresce. The DIAGNOdent will react with elevated scale readings on the display• An audio tone allows the operator to hear changes in the scale values. This enables the user to focus on the patient — not solely on the device.  The DIAGNOdent is an extremely accurate, reliable and non-invasive method to aid in caries detection. The device is successfully used by more than 20,000 dental professionals in the United States and is integrated into the curriculum of a growing number of dental schools.

 DIAGNOdent offers the following benefits :

 • Accurate – Over 90% accurate to aid in the detection of lesions not detectable with an explorer or bitewing X-rays.*

• Conservative – Helps prevent “exploratory” excavation or undertreatment of suspect teeth.

• Quantifiable – Precise, reliable measurement allows objective monitoring of caries activity over time.

• Confidence Builder – Allows dentists and hygienists to treat questionable sites and sub-surface caries with confidence.

• Empowering – Allows hygienists to educate patients on caries disease process.

.• Easy to Use – Compact, portable device with user-friendly design.

• Safe – Uses light energy — NO XRAY exposure. Poses no danger to staff and patients. PAINLESS, non-invasive examination for patients.

If you have ever had a filling done, you
probably have noticed some type of lingering
sensitivity to the tooth for a period of time.
This discomfort with biting, or exposure
to certain temperatures will usually pass
within one to two weeks in most cases. This
sensitivity can be caused by several things.

The tooth is protected by enamel, which
has no nerve sensation. The next layer in
is dentin which consists of thousands of
tubules that conduct sensation to the nerve
or pulp of the tooth. upon cutting into the
dentin to remove decay, these tubules are
opened. once the decay is removed, the
tooth is thoroughly cleaned and conditioned
prior to placing the white resin filling. Care is
taken by precisely layering the filling, since
this material shrinks as it is cured by a dental
light. This contraction can set up internal
stresses on the tooth causing discomfort
when pressure is applied to the tooth during
chewing. The larger the filling, the greater
risk for post-operative discomfort.

The larger the filling, the
greater risk for post-operative
discomfort.

Proper technique when placing a filling
is critical to both the longevity of the restoration,
as well as post-operative comfort.
Proper isolation to keep saliva and blood
out of the field is of critical importance. The
advantage of these bonded white fillings is
that they truly adhere to the tooth giving
back some of the strength that had been lost
from the cavity. If properly handled, the tooth
can be restored to proper form and function.
If the sensitivity lasts longer than two weeks
it is important to return to your dentist for reevaluation.
Many times, a simple bite adjustment
is all that is needed. .

May we all take a moment to thank God for all we have.

Millions of people are tormented by teeth that have to be taken in and out daily.  Many of these patients can recall more than one moment of embarrassment when their denture slips or falls out. Many will avoid certain foods due to discomfort and inability to chew the food. Well today with the success of dental implants , these moments can be a thing of the past. After placing titanium cylinders into the jaw, the denture is attached to the implants providing retention and stability.
A conventional denture gains its retention by increasing the surface area of plastic on the gums. During chewing the denture will move causing sore spots and instability. Many patients resort to annoying pastes and pads to combat the poor function. As times goes on the denture moves more and more as the underlying bone shrinks away.
By using dental implants, the patient can stop the bone loss and gain the retention they need to function and smile predictably. Depending on the number of implants and the bone available, a patient can move from a removable denture to a fixed denture that is not taken out. Many patients facing tooth loss due to periodontal disease have an emotional hurdle to face. Standing in front of a mirror and seeing a toothless smile can be emotionally devastating . Today, a patient can walk in with their problematic teeth and walk out with the new restoration fixed in the mouth in a few hours. These new procedures have been coined ” All on Four , Teeth in a Day, Teeth in an Hour “.
If you or a loved one is faced with this  unfortunate situation, have them contact their dentist about this revolutionary new procedure. Dentures in a glass are a thing of the past!

How many of us brush our teeth and notice blood on the tooth brush? What happens when your gums bleed during a routine cleaning at the dentist’s office? Are you dismissed after hearing a lecture about the importance of flossing or told to return sooner for your next cleaning? We know that three out of four adults are unaware that they have some form of gum disease. Healthy gums DO NOT bleed. Is the bleeding from lack of care, a genetic predisposition to periodontal or gum disease or bacteria in the body taxing the immune system? Many times the dental team with unpredictability relies on traditional approaches.

We now have two revolutionary molecular tests that help periodontists and general dentists identify patients with and at risk for periodontal disease. MyPerioPath® detects the presence and quantity of specific bacteria associated with periodontal disease, while MyPerioID PST® (which the company licenses from Interleukin Genetics) provides a means of quickly and accurately assessing an individual’s genetic risk for periodontal disease.

MyPerioID PST—Determines the cause and depth of periodontal infection and identifies individual genetic susceptibility to periodontal disease. This test enables the clinician to establish which patients are at increased risk for more severe periodontal infections due to an exaggerated immune response.

Patients with a family history of periodontal disease and compromised immune systems should consider MyPerioID PST. Adolescents, patients who continue with disease activity despite therapy and who have lost, or will lose teeth to periodontal disease are also candidates for the test.

MyPerioPath identifies the type and concentration of specific perio-pathogenic bacteria that are known to cause periodontal disease. This test helps support the clinician with better risk assessment and personalized treatment options for more predictable patient outcomes.

This test can be used as a “baseline” for any patient who may be at increased risk for periodontal infections including those with signs and symptoms of a periodontal infection and those who are not responding positively to their current treatment. Patients who test positive for genetic susceptibility (with the MyPerioID PST test) or have Type I or Type II diabetes, a history of cardiovascular disease and tobacco use are also candidates, along with women of child bearing age.

Both tests are very simple and require the patient to spit into a vile which is sent off for analysis. A detailed report is generated for you and the dental team in order to provide a treatment plan tailored directly to you with the specific answers we have been missing in dentistry in the fight to save teeth. 

Many situations can occur that may require us to find a new dentist such as moving, having a dentist retire, or needing special services our dentist can’t provide. Although we all know that proper dental care is vital to good health, most of us do not know how to choose a good dentist. It canbe difficult to know what questions to ask and what things to observe in the process of choosing one. As a patient it is very difficult to discern quality. Most of the time it is thenon clinical tangibles such as office hours, staff interactions, location, insurance constraints, etc that will help sway your decision.You will want to know both how the dentist treats you as a person and how he treats your mouth. Following are some key questions to ask and observations to make in the process of making your choice.

1. What is your philosophy for performing dentistry? Example: When do you recommend replacing a silver filling?

2. What continuing education have you had during this past year? Example: Are you current on the newer more conservative time saving techniques?

3. Do you comply with OSHA and American Dental Association guidelines for infection control?

4. Do you maintain a DMF (Decayed,Missing, and Filled) record? This is a detailed record of ALL treatment and diagnosis including periodontal charting to screen for gum disease?

5. Does the dentist consider you in the treatment planning process? Does the dentist and staff spend the time educating you and supporting you in your overall dental health? Is there a long term vision to get there?

6. Does the dentist focus on finding the cause of the problem versus continuing to fix and repair the same issues? Unfortunately, dental insurance has created a barrier formany patients when it comes to choosing a dentist. You only get one set of teeth as an adult. The relationship between the dentist and the patient will always dictate dental health. The insurance companies have tried to turn dentistry into a commodity. Dentistry is a service-based profession. You are not buying a filling or a crown!

Dentistry is rapidly changing today. Techniques taught in dental school as little as 10 years ago are now antiquated. The average shelf life of dental education and advancementstoday is three to five years. People understand how quickly technology is changing.While we now live longer and have a better appreciation for health and beauty, wehave more compact schedules and less time.

The advancements in modern dentistry address many of these issues. Lasers replace  traditional surgeries which allow for reduced patient chair time and post-op discomfort. Tooth decay can be found BEFORE it evershows up on a digital x-ray. Silver fillings are a thing of the past. We can treat patientswith the strongest porcelains in one day that would normally require two to three visits and multiple injections. Most traditional porcelain crowns which radically destroy good tooth structure can be treated conservatively with onlays, causing less destruction of the natural tooth.

Teeth replaced with dental implants help eliminate bone loss and facial collapse, and can restore appearance and function in as little as two visits. Patients who have esthetic and functional issues with traditional dentures can have life-changing results. Crowded teeth in adults can be corrected in as little as four to six months using clear brackets and a toothcolored wire. A major cause of tooth loss—gum disease—can be detected in its earliest stages. Products on the market today can stop decay in its tracks with no drilling involved.

Modern dentistry can stop the agingprocess. Prevention, coupled with conservative approaches through early diagnosis andadvanced technology is the new paradigm shift. What do you envision your dentalhealth to be in 20–30 years? The choices we make TODAY will impact that outcome

Many people are faced with the decision to replace a tooth. A three unit bridge is commonlyrecommended. Usually reimbursed by insurance, it can be completed in two officevisits. However, very few patients understand the long term ramifications of their decision.

What we now know is that there is a 33 percent failure rate at 10 years out and a50 percent failure rate at 15 years. The two most common complications are nerve death or pulpal necrosis and recurring decay. The chance of nerve death for a single tooth crowned is three percent. With the three unit bridge the chances of pulpal necrosis goes up to 25 percent for each tooth. Once an abutment tooth requires root canal therapy it is more susceptible to fracture. The stresses in the system go up when teeth are used as supports.Recurring decay occurs from flexure,cement failure and lack of adequate hygiene

The advances in dental implants no longer require enamel destruction to replace teeth. A tooth can be restored with a dental implant in as little as two to three office visits; sometimes the same day. Depending on the location in the mouth, the patient can leave with a temporary tooth attached to the implant.

Dental implants have become the gold standard. Some insurance companies are starting to cover the procedure. The cost is very similar to the three unit bridge and the success at 10 years is 98 percent. The advantagesof the dental implant are that there is no nerve to deteriorate and titanium does not decay.