Dental Talk
What happened today, well something that happens more than we would like. Someone came
into the office and there front tooth chipped. It was a large front filling that
was patched recently to hold a patient over until they could follow up on the
rest of there treatment plan. I like to say yes to patients and get things
looking as normal as possible while we get the basics back in order. In this
case and in many other cases we are asking way to much of our tooth colored
filling material. It is in no way as strong as our natural tooth structure. So
if you have broken your natural tooth or have a big cavity in just one tooth we
can use that tooth colored filling material to get things looking natural again
with some success. The problem is when you have a lot of these tooth colored
filling materials and they are covering many of your teeth then we do not have
much of your natural teeth to help us keep this in shape. It is like cementing a
post in outside, when most of the post is underground and push on it that thing
is not moving. If most of the post is out of the ground then when you rock on it
that thing is coming out. Right?... The same thing happens here with the teeth,
when we have a good system we can do some big tooth colored fillings and the
teeth seem to do fine. But there is a tipping point when that doesn't work
anymore. That tipping point is different on every person, some people grind or
clench there teeth all night long. They are going to tip easy, a person who
doesn't grind there teeth might be able to handle a little more pushing and
rocking of that pole in the ground... The person today wanted to know why it had
been fine for all this time and now a simple filling didn't work. Truth is I
can't know for sure without doing a full work up and seeing the bite close up
and personal. But, I think we just reached our tipping point for that patient.
It always comes at the worst time for a patient. You know when you are stressed
about all these other things and then a front tooth breaks, well all that stress
probably helped us get to the tipping point with the teeth and hopefully that is
all that is going to tip with the health. Anyway we are going to do some
looking into it in the next few weeks and together we can find out where to go
from here.
Thanks for reading dental Talk today!!!!!
--------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------
Today some one asked about there options with an abscessed tooth. The tooth
had been bothering them all week and they finally couldn't take it any longer
and came in to see us. What can we do in that situation? Yes, most all of this
can be avoided and waiting is the worst thing the patient did, but I understand
priorities and fear of dentistry way's heavily on patients minds and I can not
judge people. What we do is get to the problem and figure out where to go from
here. A abscessed tooth can be a tremendous amount of pain for a patient. I have
had women tell me it was as bad a child birth, but there must be some baby amnesia
that goes with that statement. I witnessed my wife through labor and that looked
as painful as it gets. Dental pain is real and can be tremendous because it
doesn't stop until the infection is taken care of. Enough about that, back
to the patient who had a few real choices. One we could do a root canal, if the
tooth is savable and can be used as a tooth after we remove the cavity and the
nerve; and this tooth was savable. Or another option was to remove the
tooth. This we try not to do if a tooth is worth saving for the patient but in
some cases it is the best option for the patient. It is there tooth and we work
through that with them if they decide to remove the tooth.
There are always two other options in this case; one is we can do nothing.
That option I never recommend because it usually comes with a lot more pain and
that is why the patient is sitting in the chair! The last option is to remove
the tooth and place an dental implant. This option has become a routine option
for many patients and is a great alternative to traditional dentistry. Is it for
every tooth? No, and I still feel that if a tooth is worth saving and a root
canal can be done then we should at least try that and see how it goes for a
while. Dentists today have very different opinions about this exact situation
for a patient. Do you take the tooth out and put in a new one or do you fix what
was there? A root canal is not always successful, and neither are implants, but
implants now have a higher success rate for the long term. Are they perfect, no.
So a patient considering dental implants needs to know more about them to make a
good decision about that choice. Back to the issue at hand; what dentists do
agree on is the keeping the bone and the muscles that support that tooth in good
shape is the priority. A implant can do that as well as a tooth and if the
success is better with the implant than this is a good option for
patients.
So what I do these days with this patient is give them all the options and
let him or her decide what to do with there tooth. Three good options, all have
there place in time with each patient and you can not rule out any one for any
given patient. I don't know everything there is to know about anyone so them
must make that decision. I always try and help them through the decision process
but in the end they need to be on board which ever way the go. And that is what
we went over today with our new patient!
Thanks for reading Dental Talk! Keep smiling.
############################################################
Recently I had a patient ask me about lasers and how good are they for
working on teeth. I have been looking into them for months and I was excited to
tell the patient all I knew about the new technology. When I started to notice
there eyelids getting heavy I realized that maybe I had gone into to much
detail. I apologized for going into that much detail and just said they have
come a long way and do have some great uses in dentistry these days.
I have been looking at lasers for the last 6 months in great detail for uses
in our practice. I won't bore you with all the details that I was so happy to
give my patient. I think if she had not been standing she might have fallen
asleep, I guess I still have that effect on single woman... It has been a lot of
fun looking into the new technology. Oh, I am doing it again. There are two
types of lasers being used in dentistry today, one is only used on soft tissue
like the gums and the other one is used on hard tissue like a tooth. As I have
found out they are very different. The soft tissue one is a great adjunct to
many esthetic practices and practices that do a fair amount of surgery. The hard
tissue laser has not been widely used and does have some limitations that
are worth mentioning. After getting countless sales pitches for the hard tissue
laser I went to a couple of experts that use these every day. My main question
to them was; "Will this take the place of my drill, even though we only use
electric here in the practice they still have some noise and patients don't like
that?" No was the answer I got back. Two reasons, one the laser still can't
take out an old amalgam filling and the second reason I kept hearing was that it
did not remove tooth structure as fast as a traditional drill. So, you as
patients would probably be in the chair longer for a simple procedure. I think
they are very close to the answer to these two problems with the hard tissue
laser and I am going to review it every few months. I think in the next year or
so they will work out some of these bugs...
As for the soft tissue laser I found two, both with different wave
lengths. The older one that has been used a lot in practices for the last
5 or so years can not be used with water and is a bit smelly because of that.
And, a new one that increased the power of the laser a small amount but changed
the frequency to keep it to soft tissue allows us to use some water spray and
suction to keep the tissue healthy and no smell... Oh no I am doing it again.
Going into the details and your eyes are rolling about power and
frequency. Sorry! Suffice it to say I found a good fit for the practice at this
time. The new soft tissue will allow us to do more with the gums and soft
tissue. We can do more with patients with periodontal disease, with children
before and during orthodontics, with patients in pain from a tooth ache, with
patients that suffer from apthus ulcers, and infection control procedures inside
the tooth. In short it extends our capabilities and simplifies some of your
procedures. we can do better dentistry with it and I can't wait to get started
with the new laser!!!!
Now, are we going to go out and advertise that we are a laser dentistry
practice? No, if someone asks yes we use laser dentistry here at Trentalange
Family Dentistry. It is for you the patients and for us as staff to do the very
best least invasive dentistry we can do. Lasers are the very least invasive
instruments we can use when we do surgery and those procedures listed above. So,
if we have to do surgery it is great to know we are doing our best to do only
what we need to do and the tissue will be healthy as soon as we are done with
the procedure; not two or three days from the procedure!
Thanks for reading this addition of Dental Talk!
Keep smiling, Doc Jim
###############################################################
I had a patient ask me today for reasons she could give to her husband to
come to the dentist. What motivates people to come to the dentist was another
one of her questions? For me the answer to the first question was easy. The
reason to go to the dentist is to take care of your oral health, i.e. teeth
gums, muscles and tissues and TMJ... Here are some great reasons why visit a
dentist regularly.
1. Food will taste better when your gums are healthy and
not bleeding all over your food. That's not fun to think about but it is true;
if the gums bleed when you brush they also bleed when you eat, and you are
swallowing all that blood and bacteria... Yuck!
2. Regular check up's prevent the big holes (cavities) that
become painful. And by the way if you are a faithful we catch cavities early,
then they not only save tooth but they are less expensive! You don't need root
canals when we get them before they hurt. You don't need crowns when we have
tooth to work with for filling material. Save yourself time, funds and heartache
by coming before it hurts.
3. The plaque on our teeth is the exact same plaque that clogs
our arteries. Cardiologists send heart patients to the dentist these days after
they are stable to evaluate there periodontal health. That plaque that clogs
your arteries is the very same plaque you are staring at in the mirror on your
teeth. If that isn't reason to come see us I don't know what is! How much does
it cost to be hospitalized and have them clean out your arteries, I can tell you
its a lot cheaper to come and have use get ride of the stuff we can see on a
regular basis.
4. Esthetics, that is about the number one reason most people
come these days. We can make you look better, well at least some of you. HaHa,
just kidding. Teeth are a major part of our face and when they look good our
smile and outlook looks good. I have seen this with just a simple whitening
procedure.
So, lets review this short summery of why you should visit us. Food will
taste better, no more painful tooth aches, improve overall heath and keep the
heart pumping; and you might even look a little better when we are all done. What's
not to like about that?
Thanks for reading Dental Talk!
Warmly, Doc Jim
#################################################################
Its that time again to answer some patient questions, and to just ramble on
as many of you know I can do with little effort... I have been answering a lot
of high tech questions about new things in dentistry. Implants, one visit crowns
and lasers are the big topics that have been covered recently.
First, implants. Why would any one ever want some strange titanium thing that
looks like a screw placed in their mouth? The easy answer is that for once in
your life you will have a tooth that can never get a cavity and will never need
a root canal! That's nice to think about... There are many other great reasons
to think about implants for lost teeth. The main reason for an implant is that
it will preserve the bone in your face where that old tooth was. It will help
the muscles in your face stay functioning normal. The muscles and the bone fade
away when the tooth is removed so your whole facial appearance changes when you
lose teeth. Most people don't think about that when they have a tooth removed.
They say," Its just a tooth." That is far from the truth, they forget those
teeth are attached to bone and the muscles help them function. Its just like
anything else, if you don't use muscles they fade away. Do you really want that
to happen to your face? If I lost a tooth tomorrow I would have an implant
placed in the space. No I would not get a bridge and cut down two perfectly good
teeth on either side to just cosmetically fill the hole. Bridges will just mask
the hole, it doesn't help with the bone or the muscles... Questions?
One day crowns, is that exactly the same as all other crowns? No, same day
crowns have to be milled out of a block of porcelain for your tooth. To date
they only have one system on the market for this treatment. It is a good system
and has its advantages for certain procedures. Would I or anyone else use it for
every crown, I hope not. When you have a laboratory produced crown you receive a
specifically designed crown for you. It does not come in a block, it is built
from the ground up for your tooth and only your tooth. Because of that it can be
custom designed to fit your specific functional and esthetic needs. Will same
day crowns become the norm in the future? Yes I believe they will and they have
come a long way. I recently had a chance to see one of the new machines that is
not yet on the market and was very impressed with what it has the potential to
do. One of the main draw backs of the technology that is available today is the
milling machine is a bit crude and does not allow for details that most of us
have come to expect of our crowns. The new milling machine is much more detailed
and can get close to the details a lab can create. Am I going to rush out and be
the first one to have one of these new machines in our office? They are computer
based and with that after the machine is running for a while they will have a
few updates... At the cost of 105,000.00 dollars I think we can wait and see how
it goes for the first few years. We will have one of these in the office in the
next 5 years or so, but I want to see how things go before we spend that kind of
money!
Lasers, can we really do restorations (fillings) without anesthetic
(The dreaded shot)??? Yes I have seen it myself and believe we can do many of
the things we do today without anesthetic. I have seen surgical procedures that
would require many shots done without any anesthetic. The only problem I am
still concerned with is long term effects on the tooth. We do not have any long
term studies to tell us how it will effect the nerve of the tooth after it has
been anesthetized by a laser. You see the laser has an anesthetic effect on the
tooth and that is how we can get around (the dreaded shot), but again we don't
really know what it is doing to the nerve. So, yes I am excited about the
technology and probably will have one in the practice in two to three years if
the studies that they are doing now go well. Until then I will continue to go
slow with the local and give you as much topical as I can fit in there.
Thanks again
for reading dental talk.
Warmly, Doc Jim
###############################################################
Hello and welcome to this next issue of Dental Talk. Well, the holiday
season is upon us and what does dentistry have to do with that? For one,
without your teeth it might have been real hard to enjoy last week's
turkey, and lets not forget the dessert... But lets forget last week and look
at what happened today? We had some great questions, ones I have heard
before. Are all cleaning appointments the same? "But I just want a
regular cleaning." Many people, including some dentists do not understand
the insidious nature of our oral bacteria, especially the ones deep in the
gums. Did you know that the same plaque that clogs up our arteries way down by
our hearts shares the exact same protein configuration as the plaque that is
sticking to our teeth? If the plaque on your teeth and the plaque in your
arteries are the same doesn't it make sense to remove at least the stuff we
can get to? Did you know that these days when a person has a heart attack part
of their recovery is to visit the dentist and be evaluated for periodontal
disease? Periodontal disease is the silent killer of teeth, and now has been
implicated as one of many cofactors for heart disease.
So, what's the difference between a Adult Prophy and a Debridement or
scaling and root planing. An adult prophy will remove supra gingival plaque,
calculus and polish up the part of the tooth you see. Does it take away any of
those bad bugs hiding out under you gums that we can't see? NO, NO, NO. A
debridement or scaling and root planing however removes sub gingival plaque
and calculus and if an ultrasonic cleaner is used with antibiotics can also
flush out many of those insidious bacteria. So, which one do you want? Good
conservative dentistry treats patients preventively, before their is a
problem. If you have gingival (gum) pockets 4mm's or greater and have not had
any type of debridement before, chances are you have a few extra bugs. Lets
get rid of them before they can cause you harm!
Thanks for reading Dental talk,
Warmly, Doc Jim
******************************************************************************
Extreme Make-over/Zoom Whitening: Can whitening be done in a day? Can I walk
in with dark stained teeth and walk out a few hours later with nice pearly white
teeth? Is it as easy as it looks on TV? How do my teeth feel after you cook them
with that light for a few hours?
These and many other questions I have been asked in the last few weeks. If
any of you have seen the extreme make-over show you will recognize the big
"Zoom" light that they use on the show to whiten people's teeth. It
towers over the patient and looks more like something that should be in a
tanning booth rather than a dental office. Does it work, yes it does. Does it
also give you a tan and in some cases a burn on your face, yes it does. That's
one way of getting your teeth whitened by going out and getting a sun tan... We
have been receiving reports that in some offices people are getting the
equivalent of sun burns on their faces after the Zoom treatment. Is the Zoom
light something new in dentistry, no. Most all dental offices have some kind of
LED light to harden their dental materials and that light can be used the exact
same way the Zoom light is being used to whiten your teeth. And, since the
lights we already have are smaller, our lights will avoid giving you a sun
burn... So, can I whiten your teeth while you sit in the office and relax and
read or listen to music? The answer is yes, and we don't need the extra Zoom
light to do it... Is this procedure for all of you, no. If you want to go over
it I would be happy to review all the bleaching options we have for patients in
the office.
Now, what about one visit veneers? Something also shown a lot on the
extreme make-over show. Can we do that in the office? Yes we can! Can we
do it for all our patients, I wish we could. It is not for every one, some
patients might require two visits or indirect veneers. There are many things we
can do to a tooth these days, but great work takes time and if you give your
dentist the time we can do some wonderful things for you. Many simple esthetic
cases can be completed in a day, but more often they will take a little more
time than that. It doesn't take years any more with all the materials we have to
work with these days. Come see us and we can go over all that in the initial
exam!
Thanks for reading Dental Talk,
Warmly, Doc Jim