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. 

CURE Childhood Cancer

We have been following the progress of one of our patients who has been affected by childhood cancer this year.  Through her experience we have become aware or the role that CURE Childhood Cancer has played in her support and treatment and wanted to do something to promote this worthy charity.

This year we would like to support CURE Childhood Cancer by offering a special teeth whitening promotion.  For the month of December we will provide an upper and lower custom bleaching appliance and enough bleach for 10 days of whitening when the patient writes a tax deductable check to CURE Childhood Cancer for $200.  

This can apply to current patients or even friends or family that would like a professional home whitening treatment for over 60% off of the regular fee.   We are offering this to the first 15 people who  provide a check made out to CURE Childhood Cancer.

If you would like to get more information about this promotion, please call us at 770-441-1414.  To get more information about CURE Childhood Cancer you can check out their site at curechildhoodcancer.org or check out a PSA by Jeff Foxworthy on You Tube.

http://www.youtube.com/watch?feature=player_detailpage&v=LT4BHBZkLeU

Halloween Candy Options for Children’s Teeth

This time of year many people ask me about Halloween candy.  I don’t think there is any question that eating large amounts of sugary treats is not good for any one at any age. There are many health concerns  about the calories or sugars in candy that are linked to obesity and diabetes.  As for as the teeth, the goal is to reduce the acids that dissolves  enamel causing tooth decay.  The acids could come from drinks or sour candies themselves.  The acids could also come from plaque (germs that attach to the teeth) that thrives on sugars and produces acid as a waste product.  If you can reduce the amount of plaque (by brushing and flossing) or if you can reduce the growth of plaque (by not providing extra nutrients like sugar), then the acidic product of the plaque can be minimized.

Here are some strategies that may reduce the amount  and effects  that  the sugar in candy has on the teeth.  

Some people advocate a non-traditional Halloween event that deemphasizes the candy aspect of the holiday.  Certainly the quest and collection of the treats are a draw for the kids.  A healthy alternative would be to replace the  candy  with stickers or toys or healthy alternatives to candy.  This could be done  at an organized Halloween event or party.  However, If the children are not adequately prepared for a non-candy event their expectations based on previous years experiences may not be met.

Another idea is to fuel up before hand with a healthy, fun dinner that reduces the hunger for all of the candy on Halloween night.  To fill up on healthier foods at dinner prior to the trick-or-treating  would reduce the desire to consume candy as it is collected.  With proper planning the dinner could become an event  that could potentially diminish the emphasis on the quest and desire for candy later that night.

Preparing the child for an inventory of the trick-or-treat candies at the end of the evening will allow the parent to reduce some of the quantity of candies available following the holiday.  Those candies that are not thought to be safe would be removed.  Additionally those candies that the child has little interest in could also be removed without too much resistance.  All of this would be done with the preparation of how much of the candy could be consumed that night. 

If further selective reduction of the candies is possible, reducing the sticky sweets would be the next option. Sticky sweets such as gummy candies, taffy, and even dried fruit can be difficult for children and adults to resist, and even more difficult to remove from teeth. They get stuck in the crevices between teeth, making it difficult for saliva or a brush to wash them away.

As far as the teeth go, it is better to eat the candy at controlled times  in the days following  Halloween  so that the teeth can be cleaned after the candy is eaten.  Small amounts of candy eaten all day long with one cleaning at the end of the day  would be worse on the teeth than eating the same total amount at one time with one thorough cleaning afterwards.

Having a candy swap is another option that reduces the cumulative effects of the sweets.  The parent could trade the regular candy for something like sugarless candy, sugarless gum , other favorite foods, or even toys that the child likes.  If there is a healthier non-candy treat that the child enjoys,  the bulk of candy would be reduced and the child would receive a equally  enticing  food or toy.  The other advantage is that the parent can choose to use healthier foods that are not available in prepackaged  bite-sized quantities.

Finally, the care of the teeth is the same regardless of the holiday.  To reduce the effects of candy on the teeth a person needs to reduce the plaque on the teeth and the residual sugar and acids that may be present in the mouth.   Many sour candies and drinks are slightly acidic.  Drinking or swishing water after finishing the candy will dilute some of the residual acids  and sugars in the mouth.  Thorough  brushing with a fluoridated toothpaste and flossing especially before going to bed is the final and most important technique to reduce the effects that Halloween candy has on the teeth.

Halloween is a fun event for children and adults alike but it is only one event in the whole year.  Good daily habits and good nutrition thorough out the year make the effects of a unique event  like Halloween much less significant.

New Digital X-Ray Technology

I am happy to  announce an improvement in our  x-ray technology in the last few months.  X-ray technology  has taken the same path that general photography has taken from film that has to be developed, fixed, dried, and physically stored  to a digital process that allows instant image capture and storage into the patient’s record in a digital format.  

 The way we make x-ray images is greatly expanded using  a new panoramic machine.  The first improvement is in the quality of the images.  The quality is so good  that a single panoramic image can replace the multiple images necessary for a “full mouth series”.  The benefits are that it uses much less radiation,  takes much less time, and is much more comfortable for the patient than the traditional “full mouth series” was. 

Additionally, there is a new  feature available with this panoramic machine called Extra-Oral Bitewings. “Bitewings” are the small images that we take every one or two years to find the cavities between the back teeth. These are the ones everybody hates because you have to bite on that sharp film holder in your mouth … up to four times.  With our new machine we can look for those cavities without putting anything at all in your mouth. That’s what “extra-oral” means … nothing in your mouth.  Patients who have a strong gag reflex are very excited about the new and much improved experience.  These new images are more comfortable, faster, provide more information and require only one-quarter the radiation of our previous  bitewings. 

On the occasion that we need to make images from inside the mouth, we now use new digital x-ray sensors that also require much less radiation than film did.  They have more rounded surfaces that many people find more comfortable than the sharper film that was historically used. Additionally, we now can see the images instantly on the computer monitor.  That saves time and insures that the view includes all of the information that we need to see. 

All of these improvements are in addition to upgrades in the computers and software.  That has a  benefit  in enhancing  the diagnostic value of each x-ray image.  Previously the x-ray films would be stored physically in a patient’s chart.  If there were to be a disaster, the physical patient records and x-ray film could be rendered useless.  Now the images can be stored in the office computers on-site  and also backed up to an off-site location.

We are currently in the process of scanning the old x-ray film images for each current patient  into a digital format.  The benefit for us will be that all of the patient’s old and new x-ray information will be in the same place and in the same format in each patient’s file.   Additionally, this provides the ability to back up the old x-ray information to an off-site location that was previously impossible with film x-rays.

All of this is to enhance the diagnostic quality of the x-ray technology and also reduce the amount of radiation exposure.  Having a redundant back-up of each patient’s file is a benefit that I hope is never needed but one that is very important when the need arises