ADA Meeting

I recently returned from a dental meeting in San Antonio,
Texas.  It was for the American Dental
Association (ADA) annual meeting.   It
started off with a key note speaker, George W. Bush.   He answered some personal and international
questions provided by the ADA president.  
His presentation was warm, enlightening, and entertaining.

The meeting also showcases the latest products by many
manufacturers.  I took a panoramic photo
of one of the halls to highlight the number of manufacturers present. 

There were many excellent presentations but the ones I enjoyed
most was a presentation that addressed ways to improve customer (patient)
service.

Implant Conference

I just returned from a meeting of the American Association  of Oral and Maxillofacial Surgeons (AAOMS) Dental Implant Conference 2013.  I was a guest of Dr. Loetscher who is an oral and maxillofacial surgeon here in Atlanta.  Although most of the attendees were oral surgeons, the conference was more than just surgery.

It started out with a presentation about dental esthetics  presented by a new favorite lecturer of mine, Dr.Chiche.  He reviewed key determinants of good esthetic  design no matter if natural teeth or implants are involved.   The conference went on to discuss options available in the materials used to restore implants like titanium or zirconia.  Of course there were plenty of surgical techniques presented.  Most of the emphasis was on improving outcomes or preventing complications.  Among the surgical options,  there was a lot of emphasis on the use of grafting materials and correct placement of implants relative to the bone and  teeth.   Another presenter identified complications relating to diabetes  as a systemic illness that has a profound effect on surgical outcomes.

There were cases presented  that illustrated the techniques  necessary  to improve the results of relatively basic implant procedures that only involve single teeth.  Other cases presented complex multi-year treatment that involved significant surgery and reconstruction of the whole mouth.  In either situation the attention to detail and understanding of the various options available will have a profound effect on the outcome.  It is important that the restorative dentist and the lab communicate with the surgeon  with the knowledge of the issues that each one faces.

It was good to see how far the use of dental implants have come in just a couple of decades of use in this country.  It has become a predictable treatment that can be used under a wide variety of circumstances depending on the goals of the patient.  But there is always room for improvement.  It was good to see that over 3 thousand people took several days to improve their results in providing dental care.

Pregnancy and Dentistry

I have frequent questions about dental care during pregnancy.  There are several changes that occur during pregnancy that can have an effect on the mouth and those changes can also cause us to modify our normal course of treatment.

There is a common concern that pregnancy causes the calcium to be lost in the mother’s teeth.  This is only a myth.  The teeth do not repair and remodel like bone does and are not directly effected by changes in hormones.  If a woman has healthy teeth before the pregnancy and maintains good hygiene there is no reason to believe that there should be any calcium lost due to pregnancy and the teeth will remain healthy.

Morning sickness could be a dental concern in that it can have an effect on the enamel.  The gastric acid from re-flux or morning sickness softens the enamel that it contacts.  As a result the enamel is easier to wear off of the tooth with a process as simple as brushing the teeth. If there is active decay present the addition of an acidic environment from morning sickness would only worsen the decay’s progression. A dentist can provide some alternatives like rinsing with water and baking soda after an episode that will neutralize the acids left in the mouth.  There are also products that are designed to help remineralize the teeth after being exposed to high levels of acid.

A more common problem in real life is the effects that the hormone changes during pregnancy have on the gum’s reaction to plaque.  Plaque forms on the teeth is a matrix of bacteria, their byproducts, and food debris.  If the plaque is not removed from the teeth in a timely manner the nearby gums respond by turning red and swelling.  The gums become tender and are easy to bleed.  This condition is called gingivitis which is a form of gum disease and can occur in any person who has an excess of plaque on the teeth.  During pregnancy the hormones exaggerate the body’s response to plaque thereby worsening the gingivitis causing “pregnancy gingivitis”. This reaction will dissipate after the pregnancy without consequence if the oral hygiene can be maintained at a high level throughout the pregnancy.

If a woman has gingivitis or a more advanced periodontal disease before becoming pregnant, the hormones will cause the condition to worsen sometimes at an alarming rate.  Sometimes the red and tender gums grow to an alarming amount forming “pregnancy tumors.”  These are benign but extreme overgrowths of the gums that make eating and brushing uncomfortable. This condition would indicate the need for more aggressive dental treatment.

In addition to the reaction of the gums to the plaque, the baby may also be effected.  If the gums become more inflamed and there is more bacteria on the teeth then there will be a higher likelihood that there will be bacteria that will enter the mother’s bloodstream.  There is some research that suggests that that the body’s reaction to that bacterial insult could ultimately result in a premature birth.

The gingivitis can be prevented keeping the teeth clean. The teeth should be brushed with fluoride toothpaste at least twice a day and after each meal when possible. The teeth should also be flossed thoroughly each day. If brushing causes morning sickness, rinse with water or with anti-plaque and fluoride mouthwashes. Good nutrition – particularly plenty of vitamin C and B₁₂ – help keep the oral cavity healthy and strong. More frequent cleanings from a hygienist or dentist will help control plaque and prevent gingivitis. Controlling plaque is also good at any age for any person and will help prevent gum disease and tooth decay.

If pregnancy is suspected or planned, a checkup with the dentist in the first trimester should be scheduled.  Normally we would assess the current oral condition and determine if there needs to be any improvements in the oral hygiene routine. A visit in the second trimester for a cleaning is also recommended especially if there were oral hygiene concerns determined before or during the first trimester.  Any necessary non-elective treatment can be done in the second trimester.  A cleaning can also be done in the third trimester if necessary with attention paid to keeping the appointment brief.

Non-emergency procedures generally can be performed throughout pregnancy, but the best time for any dental treatment is the fourth through six month. Women with dental emergencies that create severe pain can be treated during any trimester, but the obstetrician should be consulted during emergencies that require anesthesia or when medication is being prescribed. Only X-rays that are needed for emergencies should be taken during pregnancy. Lastly, elective procedures that can be postponed should be delayed until after the baby's birth.

Most dental problems relating to pregnancy can be overcome with good planning, good oral hygiene and careful treatment.    

  

Tooth Decay and Children

Tooth decay is a common chronic disease in children but there are several steps that can be taken to prevent the development of decay.

One important prevention idea is to reduce the prolonged exposure to sugar-containing liquids. Sugary beverages like sweetened fruit juice or soft drinks should be limited or closely monitored.  If a child uses a sippy cup for extended periods, fill it with water instead of sugary drinks and don’t allow him or her to take it to bed.  Learning to drink from a regular cup as soon as possible will reduce the contact that sugary liquids will have with the teeth.

Another idea is to limit the child’s consumption of starchy or sugary snacks.  The starchy foods can remain stuck in the teeth for a long time after eating and will promote the growth of the bacteria that cause decay.

A proper at-home oral health care regimen is also important. Make sure that your child brushes his or her teeth twice a day for 2 minutes.  Adult supervision is necessary.  Children over 2 years old can use a pea-sized amount of fluoridated toothpaste. Non-fluoridated toothpastes are available if the child appears to be ingesting the toothpaste.

The use of fluoridated water throughout the early years of life will help the primary and adult teeth to be more resistant to decay.  The use of bottled water or heavily filtered water may reduce the ideal amount of fluoride that the teeth are able to absorb during their development.

Start flossing between your child’s teeth as soon as there are two teeth that touch together. This will prevent the buildup of food and plaque in the areas that the tooth brush can’t clean.

Finally, regular visits to the dentist will help prevent the development of tooth decay.  The dentist can monitor the effectiveness of the at-home oral care regimen and make suggestions on where it can be improved.  Visits that are at are spaced at 6 month intervals are typical starting at age 2 to 3.  That allows the child to become familiar with the dentist’s office environment and allows the dentist to treat any small problems before they become more extensive.

April is Oral Cancer Awareness Month

April is Oral Cancer Awareness Month and I want to help spread the prevention message. According to the Oral Cancer Foundation, close to 37,000 Americans will be diagnosed with oral or pharyngeal cancer in 2012. The most common risk factors include tobacco use, excessive alcohol consumption and HPV infection.

But there are steps you can take to reduce your risk. American Institute for Cancer Research (AICR) experts estimate that Americans could prevent up to 63 percent of oral cancers via a healthy diet, healthy weight, ad regular physical activity. That's over 22,000 cases each year. 

Research is clear that smoking or chewing tobacco increases risk for cancers of the lung, mouth, lips, nasal cavity and sinuses, larynx, pharynx, esophagus, stomach, pancreas, kidney, bladder, uterus, cervix, colon/rectum, ovary, and acute myeloid leukemia. Research also shows, when combined with alcohol, tobacco can raise oral cancer risk significantly.

Alcohol also increases the risk for oral and throat cancer. If you drink alcohol, AICR recommends limiting your consumption to no more than 2 drinks a day for men and 1 drink a day for women.

Eating fruits and vegetables protect against cancers of the mouth, pharynx and larynx, stomach and esophagus. Aim for at least 5 servings per day. A cancer-fighting diet should also include whole grains and legumes, which contain fiber and other important phytochemicals.

In dentistry we are also concerned about early detection.  As part of a regular dental exam the soft tissues of the mouth are routinely checked for changes in color, texture or size.  By identifying suspicious areas early, there is a possibility that the cases that develop can be treated with greater success.

Hinman Dental Meeting

I am looking forward to attending  the Hinman Dental Meeting next weekend at the World Congress Center.  It is a good opportunity to experience the newest improvements in the dental profession without having to leave town.  It is the largest meeting in the South East with 23,000 attending last year’s meeting.  It is also a good chance to see friends that have been made over 25 years  in the dental field.  The lectures and exhibits are always interesting especially at a time when changes make every year a new experience.  We hope to bring back a lot of new ideas this year as well.

Follow up to the CURE fund raising:

I am pleased to report that we had a very nice response to the CURE Childhood Cancer promotion that finished up at the end of 2012.  The promotion was for the month of December. There were 10 people who participated in this fund raising effort.  All of the participants checks went directly to CURE with my office providing all of the supplies for the whitening.   In January I was honored  to present the staff at the Atlanta Cure office with checks totaling $2,000.00.