Technology and Dentistry

Technology and the Dentist

There are so many different technologies that we in dentistry have available to us, that it is really a difficult task to figure out which ones are truly useful, and which ones will simply sit on a shelf somewhere! Believe me, I have had my share of both kinds!

But it is really exciting to see how these new tools can improve the patient experience and the results that people get. And the whole point is being able to deliver better treatment, as painlessly and as permanently as possible!

The most important technologies we have now in our office fall into three categories:

1. Informational- where we can transfer what we know, or who is scheduled, confirm appointments - all electronically and easily.
2. Diagnostic- with digital x-rays, digital photographs and other diagnostic tools.
3. Treatment tools that help us to do better dentistry.

Let’s look at each one of these a little deeper

Our informational technology ranges from our practice management system, where we can look at x-rays, or photographs from any room, we can email them to specialists, and even have dentists from other countries to help figure out difficult challenges. Many times, I can see something I have never seen before, and take a digital photograph, and  send it to a dental board of great dentists, and before the patient leaves, I will have a good idea of what we might be dealing with!  It truly is an amazing time! 

In addition, we can confirm people’s appointments with email or texts, eliminating that embarrassing “oops” where an appointment is forgotten or the time gotten wrong.

We also have the new scan technology where we are able to scan most paperwork from other doctors into a person’s chart and eliminate most of the tribulations of trying to find paperwork!

Our Diagnostic Technologies

Still one of the most amazing things for us is our digital x-ray system. We can snap a digital radiograph, and  have it on the screen in seconds, ready for an immediate diagnosis. The image is clear and can be enlarged and lightened and darkened like no film image could be, and of course, can be shared with specialists just as quickly. There is NO Question that digital x-rays give us more information to diagnose a problem of any kind.

Another fun digital technology is our TechScan technology. This amazing unit allows us to measure electronically how a person’s teeth are coming together, showing which teeth are hitting prematurely and more forcefully- it is very useful in finding out why some teeth are sore and loose. It really takes most of the guesswork out of finding out troublesome bite issues.

Treatment technologies

Dental treatment is much more accurate today, much of this because of the magnification and direct lighting we use, as well as the things that our diagnostic tools can show us. That means treatment is more comfortable and more predictable than ever!

One very exciting technology with some huge benefits is our dental laser. Laser energy is being used more and more in all areas of medicine, but in dentistry it is especially useful for treating peridontal (gum) disease and helping us to avoid surgical intervention. Lasers are extremely good at killing bacteria and viruses, so we can reliably and painlessly treat gum infections, cold sores and other issues that are infective. They are truly a game changer!

Another great technology is our Ozone generator- which creates ozone, another very potent antibacterial agent. We use it to disinfect any sort of infected area- tooth or gum tissue, often in conjuction with the laser. It also has an unbelievable effect on dental decay- really stops or slows down the progress of decay in the mouth!

Our last piece of technology we are incorporating is our Neuromuscular technology- using a TENS device for relaxing and deprogramming the muscles of someone with head and neck pain, and our Myotronics K7 unit, which allows us to measure the EMG’s of the muscles that control the jaws, to find the most comfortable and predictable position to place the jaw. Some amazing technologies!

All in all, what I have tried to do with all this technology is to keep things in perspective, because if it doesn’t help the patient to get better treatment, more comfortably, then it is just a waste! But I feel that the challenge for any dentist is to keep up, and be able to deliver a state of the art experience, even if it is done through the hands of a trusted and  long time friend!

Three things that can cause your Teeth to wear prematurely

Seems like the last few years, we are seeing more and more extreme wear of people's teeth, and a lot of times the patients are young, even in their twenties or thirties.  The wear can be extreme, even damaging, and the wear can be painful, making the teeth sensitive as well as making the smile look bad! This photo is of a 40 something year old man, and he has worn his teeth down to where he was having a constant sore tongue from the sharp surfaces of the worn teeth. His lower front teeth were simply slicing the upper  front teeth on the wrong side.

Why does something like this happen? What are the factors that trigger this?

There are Three Major factors:

1. Sleep apnea- interestingly enough, is a major cause of wear, through sleep bruxism, where the person is awakening many times during the night, and often when this happens, they grind or clash their teeth together. One of the first things I check today when I see a patient with extreme wear is their sleep status.  There isn't any reason to put new restorations in a mouth if the patient is going to just keep wearing them away!

2. Acid Drinks- this is more of a problem with young people- teenagers and twenty- somethings, but at any age, drinking soft drinks or sport drinks that have a low ph, not only will make their decay incidence much higher, but can actually dissolve and soften the enamel in their teeth. If you combine that with vigorous gum chewing, you can see an incredible amount of wear in a very short time! All soft drinks and most sports drinks have a low ph! Water and tea are your best bets!

3. Occlusal reasons- other than sleep apnea and sleep disturbance concerns, many people just grind their teeth at night anyway, for all sorts of reasons. Young children grind their teeth very often when their permanent teeth are coming in, and many people seem to grind when they are feeling stress. Not only does this grinding and clenching trigger headaches and sore jaw joints, but it wears the teeth away. Sometimes is it do to bad tooth position, and sometimes to bad jaw positions, but that is why we do the thorough examination.

So, what do we do to treat teeth with wear?

1. First of all, we typically get a sleep study done to see if Sleep Apnea is a concern. We certainly might uncover a life threatening problem, as well as be able to help solve a dental problem. 

2. After we do a very thorough examination, we talk with the patient to see if they can be okay staying where they are, and just not damaging their teeth any further, in which case we can make a protective splint. If their teeth are too worn, we have to figure out a bite position that will allow us to  a long lasting correction of their smile, and then make them a night splint to protect their new teeth!

THE KEY IS PREVENTION

It is always a lot easier to prevent damage than to fix it, so when we find someone in the early stages of a tooth wear pattern, we want to get them diagnosed and in the appropriate treatment, before they have damaged their mouths so badly that it will take major dental treatment to get their mouths back in shape.

Typically, if it is early enough, we can combine a bite splint with some remineralizing toothpaste to harden the enamel and to prevent further damage. And of course, the patient has to stop the habits that might be causing the problems to begin with.

In any light, the problem of excessive tooth wear can be a painful and expensive malady, and the earlier you pay attention to it, the less treatment will need to be done, and you can save a lot of money!

As always, if you have any questions, don't hesitate to call or email me at riccoker@gmail.com!

Have a great day!

Dr. C

Cosmetic Dentistry, is it time for you?

"It's time for me!"

It seems like that I hear those four words a lot these days. Many times it is either a woman who has raised her family, and kept the home together for many years, and finally realizes that she would like to feel better about her smile, and her appearance.  Sometimes it is a man who has been working intensely at his profession for decades, and now just doesn't like the way his mouth feels or his smile looks!

What should a person do when they feel that it is their time?  I feel that the most important thing is to really start thinking of what are the most important issues they have, what bothers them the most. Here are the things I hear the most from people over 50:
   1. Tooth color. "My teeth are dark and yellow"
   2. Uneven color- many times there are crowns and tooth colored fillings that stick out, and the color is just all wrong.
   3. Wear- lots of us grind our teeth, and doing that for many years will often cause excess wear, and shortening of the front teeth, making them look too short, and the smile hardly shows unless the person pulls the lips way back, in an exaggerated smile. Often one or two teeth will be more worn than others, too.
   4. Uneven gumlines. Often, the gums may shrink back around some teeth more than others, and that makes some teeth look a lot longer than others. The eye likes things to be symmetrical and even.

Well, the next thing you do, once you know what you have issues with, is to call your local cosmetic dentist! And ask for some time to explain your issues and decide whether this office is going to be right for you! You are interviewing the dental office, in other words, because it is your choice to do that!

When you find an office where you are comfortable, your next step will be a very thorough examination, where ever single aspect of your bite (finding out why you were grinding your teeth, etc), your gum and bone conditions, the status of all the fillings and crowns, just to name a few of the things that are examined. Once that is done, it is very important that you understand all your options and to be sufficiently informed to make a decision that will make you happy for the long haul!

Having cosmetic dentistry done is much different than regular dental care,  the patient has the opportunity to get what they want to a great extent, and the best results come as part of a team effort, between the patient, the doctor and the dental team. It is a fun thing to be involved with, and so gratifying to be part of making people happy with their decision and their smile. Indeed, it was "Time for me!"

Your Smile- your best fashion accessory!

The older I get, the more I am convinced that most people really want to be attractive to others, hence all the cosmetic procedures that people have these days. I know so many women who are getting surgery, or botox, or fillers, or cosmetic dentistry, and yet they are ignoring the single most important thing they can do to attract others!

That single most important thing is to actually SMILE! The action of smiling is a lot more important that how the teeth look, or how many wrinkles there are, or if the neck is getting a little saggy. If I am walking up to say hello, I will look at you and see your smile, your eyes, your welcome, long before I see any crow's feet or fine lines. So many women are beautiful when they smile, and yet when they frown or look serious, they just look older and despondent!

There are lots of studies that show when a person smiles, their own attitude and mood lifts, and that the person is often better off, no matter what anybody else actually thinks! Do you think it is a coincidence that most advertising shows pretty people smiling? It lifts the moods of two people- the smile sender and the smile receiver!

So, my blog is about making the decision to smile, and smile frequently. If you don't like your smile, it can be fixed, but it is more important that you are smiling than whether one tooth is turned or discolored or anything! If you want to look good, SMILE!

Your Health and your Dentist

It is really strange these days, it seems like over half of the continuing education I have taken lately has more to do with a person's general health, than just their teeth. And that isn't a bad thing!

This past weekend our Academy of Comprehensive Esthetics group had its annual meeting in Scottsdale, AZ. (Why we go to a great resort and stay indoors for three days is beyond me!) The topic of this meeting was The Relationship between Periodontal Disease and Systemic Disease, and the evidence is really getting scary.

There are three points I want you to remember, and this will be on the test!

1. Many of the disease causing bacteria and viruses we see and suffer from, have to have a way to get into your body. If your gums are leaking (bleedy), then that means there is a wound there, and it is easy for these bugs to get into your bloodstream. The main thing is to eliminate "leaky gums" so that pathological organisms can't get there!

2. Many chronic systemic diseases that we thought we knew the causes for, now are thought to be the result of bacteria or viruses. One speaker suggested that today, probably 20% of cancers were generally attributed to viral attack, but he thought in five years that would probably be 50%. Just think, half of all cancers caused by viruses! One of great concern today is the HPV, or human papilloma virus, which is the cause of much cervical cancer, and many oral cancers today in young people. But research is also showing us relationships between oral infections and heart disease, diabetes, and stroke incidence!

3. Today, we can test your mouth earlier with a painless bacterial DNA test to see which bacteria are there, and also what the relative bacterial load is there for that species. That will tell the dentist what antibiotic to use and what treatment regimen would be most likely to work.

Dentistry has been really guilty of ignoring this disease, and often not treating it until actual bone damage had occurred. Today, we are focusing on full time health, prevention of early disease, and the systemic health that occurs when someone is infection free.

If you have any question about this, please don't hesitate to call and ask for our help. 903-581-1777.

Here is what to look for with periodontal health:

1. Gums that bleed - anytime. Just like the skin on your hand, your gums shouldn't bleed when you brush or floss. Ever.

2. Persistant bad breath. It is an infection, and you know how that can smell!

3. A bad taste in your mouth- also the result of an infection.

4. Loose teeth are a bad sign, that means that bone has been lost and it is awfully difficult to get it back, if it is possible at all.

Websites you might want to peruse:

http://www.tyler-smiles.com

http://www.ada.org/public/topics/periodontal_diseases.asp

Hope you have a happy Thanksgiving season!

Heart Attacks and your heart

This was just posted on MSNBC this morning, and it reiterates something we have been saying- the health of your gums has a lot to do with the overall health of your body! The full story is at http://www.msnbc.msn.com/id/29990146/

WASHINGTON - People with the germiest mouths are the most likely to have heart attacks, U.S. researchers reported on Wednesday.

A study that compared heart attack victims to healthy volunteers found the heart patients had higher numbers of bacteria in their mouths, the researchers said.

Their findings add to a growing body of evidence linking oral hygiene with overall health.

Story continues below ↓

---

advertisement | your ad here

---

Oelisoa Andriankaja and colleagues at the University at Buffalo in New York were trying to find if any particular species of bacteria might be causing heart attacks.

Their tests on 386 men and women who had suffered heart attacks and 840 people free of heart trouble showed two types — Tannerella forsynthesis and Prevotella intermedia — were more common among the heart attack patients.

But more striking, the people who had the most bacteria of all types in their mouths were the most likely to have had heart attacks, they told a meeting of the International Association of Dental Research in Miami.

"The message here is that even though some specific periodontal pathogens have been found to be associated with an increased risk of coronary heart disease, the total bacterial pathogenic burden is more important than the type of bacteria," Andriankaja, now at the University of Puerto Rico, said in a statement.

"In other words, the total number of 'bugs' is more important than one single organism."

Doctors are not sure how bacteria may be linked with heart attacks but several studies have shown associations between gum disease and heart disease. Bacteria may set off general inflammation that in turn causes blood to clot.

Tooth Whitening

We get tons of questions all the time about tooth bleaching, tooth whitening (same thing) and the like. We have been doing this for a long time and know a little bit about it.

Tooth bleaching has really changed how dentistry works, because of its popularity. The lightest shade of natural teeth (we call it a B1 shade) used to be the lightest shade we would ever use for porcelain crowns or tooth colored fillings, and today, it is too dark for 80% of the treatment we provide!

Anyway, what happens when you bleach a tooth is that the peroxide solution that is the tooth whitening actually gets between the crystals of the tooth enamel and lifts off the old stains and debris that gets deeper than can be reached with a toothbrush or our cleanings. This turns the enamel (the outer hard shell of the tooth) to a lighter and more translucent appearance. 

When someone has a discoloration of the dentin, or inside part of the tooth, bleaching often won't help, and sometimes even makes it worse, by making the enamel more translucent. For instance, when someone has tetracycline stain, bleaching often doesn't do any good at all, since the problem is in the dentin.

You have probably heard of Zoom bleaching, or seen the places at the mall or at Sam's where they are doing instant (supposedly) bleaching. From my perspective, the Zoom and Britesmile sort of in-office bleachings are sort of a waste of time. You essentially are getting some immediate whitening, mostly from dehydration, and in order to get the final result you want, you are going to have to do the tray bleaching in addition.  It is sort of bittersweet for us to realize this, since we HAVE a Zoom light, but we just felt it wasn't fair to our patients to charge what we need to charge and not get the results we need and want.

Tooth bleaching has a couple of downsides- one is sensitivity. There are some special toothpastes that really can help with this, one is a high fluoride toothpast and another is called MI paste. Both seem to cut down on sensitivity greatly. You need to use these for a week or two before starting your bleaching.

The other downside is when you have already have some significant dentistry done, and you want to bleach your teeth. Your natural teeth will bleach, but any crowns, veneers or fillings won't change colors at all. We always recommend someone bleach before they have any cosmetic treatment.

As it is, tooth bleaching is inexpensive, effective and easy- what's not to like about that?

Have a good day!

Rick