Last week I spent three wonderful days at the Spear Institute in Scottsdale, Arizona, for some intense continuing education. While some would think Scottsdale would be an ideal place to sit by the pool or play some golf( well it is), I spent most of my time in the hands on lab perfecting techniques that we use every day. Our day began at 7:30 am and ended at 5:30 for three days with a little time for lunch but not much else. I wouldn’t change a thing.
The atmosphere and excitement by the staff and students is electric. Everyone there wants to learn, share and renew our excitement for excellent dentistry. While exhausting and at times overwhelming, the Spear Center is a place to learn from the best in the world. It is an environment that stimulates learning and fosters excitement about what you can bring home to share with our patients. So if I seem fired up, I am. I can’t wait to share with you what excellent dentistry can do to improve your life.

It is with great concern that tonight I read of a dental office in Oklahoma that might have not been sterilyzing instruments properly creating possible disease transmission.
While I am usually very skeptical concerning anything reported by the media, it appears some serious violations of normal operating practices were violated in Oklahoma.
We realize patients have enough anxiety about visiting us without needing to worry about the prospect of cross contamination and the spread of disease. Let me assure all of our patients that all infectious disease protocols are followed to the letter at our offices. Anything that comes in contact with a patients mouth is either sterilyzed or thrown away. The dental chair and surrounding areas are thoroughly sprayed and wiped with a disinfectant spray.
In our sterilyzation area, there are compartments that are clearly segregated to keep any pre autoclaved instruments from coming in contact with those already sterile. Our dental assistants and staff routinely take continuing education on infection control to provide our patients with a safe dental office.
All of us here take infection control very seriously. I have spent many thousands of dollars to create a state of the art infection control area. If you have any concerns, please ask one of us about our infection control protocols. We will happily talk with you or show you the procedures we take to keep our patients safe.

I think that there are times when patients are not sure what we are trying to do. I will try to clarify what we as the dental team are trying to accomplish.
When we examine a patient, either for the first time,at recare visits or during an emergency visit, there are several things that should be considered. First, an easy one, pain. One of our priorities is to determine the causes of pain that a patient reports. Frequently we will question the patient to help identify the source. Is pain constant? Temperature related? What is the duration? How long have you noticed the discomfort. These questions along with other diagnostic aids such as visual examination and dental xrays will aid us in determining ways to eliminate pain.
A second area we must address is the elimination of disease. There are several types that we see frequently. Caries, or more commonly dental decay. Periodontal disease, or gum disease is also common. Occlusal disease is the loss of tooth structure through excessive wear, chemical(ie acid) attack or trauma. And certainly we must be on the lookout for any soft tissue changes that could be cancerous.
And finally, we must check the health of the jaw joint or TMJ’s.
So with this information, what are the goals of treatment. For me, there are three. 1. Eliminate disease. 2. Restore form and function. 3.Create stability. In upcoming posts, I will break down these three goals and relate them to what we see during our examinations.

Hopefully, people are regaining their power and internet service so that you can read this. You will remember that last month I began a discussion on some of the realities regarding silver amalgam.  I finished last months blog stating that silver amalgam fillings are held in the tooth by the shape of the cavity preparation created by the dentist.

Unfortunately, the “undercuts” created by cavity preparations for silver amalgam create what I feel is one of the biggest drawbacks. The cavity preparations for silver amalgam often will remove more solid tooth structure than a preparation for composite, or tooth colored fillings.  Often these preparations, combined with the different expansion contraction properties between tooth and silver amalgam often create cracks in teeth that can lead to a fractured tooth. It has been my experience over the past 22 years to see many more teeth that fracture with silver fillings as opposed to composite fillings. I will not say that teeth with composites never break but it seems much less frequent. Why is this?

As I said, cavity preparations for silver amalgam usually require more tooth removal than for composite. Composite fillings are bonded restorations meaning the tooth is treated to allow a microscopic bond to keep the filling in place. This allow the dentist to simply remover the decay or stain and bond the new filling in place. No undercuts are necessary and along with the bonding process, the tooth actually becomes stronger.

That should be enough to think about until next time where we will discuss the big winner. Asthetics!

Today, I would like to begin a discussion on the two major types of filling materials most commonly used in dentistry today. This topic is surrounded with controversy but my discussion will focus on facts that everyone will verify. As a disclaimer, I have not used metal fillings for the last fifteen years. Here we go.

Silver fillings are sometimes referred to as mercury fillings. This is partially true. These fillings are also known as amalgam fillings because they are actually an amalgamation of several metals such as silver , copper, zinc and yes, mercury. This material has been used for dental fillings for many, many years. The mercury in them is thought to stable when the material is set and is thought to remain that way in the mouth. This is one of the major controversies, whether the mercury remains stable. Much research has been done and the material is still deemed safe by the American Dental Association and the Food and Drug Agency. It is banned, however, in several countries in Europe.

One thing is certain. These are heavy metals that would be toxic in the tissues of the body. Dentists are required to have sophisticated filtration systems in their offices to prevent the contamination of waste treatment facilities when they are removed from the mouth. Further, the disposal of amalgam that has been removed from teeth is strictly regulated and very costly.

Another negative aspect of silver amalgam is with the techniques required to place them. These fillings are held in place by the shape of the cavity. The dentist must create undercuts in the tooth which creates a mechanical retention of the material when it sets. These undercuts can weaken teeth as most anyone who has broken a tooth while eating can attest.

In the interest of not being overwhelming, I will end the discussion today and pick it up in the next blog. Stay tuned.

Within every area of our lives, proper communication is critical. This is especially true between the dentist and patient because much of dentistry is done to satisfy a patients concern about a problem that they have identified.

Years ago, dentistry was fairly simple. Our understanding of the disease process was limited and the focus was on the obvious. Usually the conversation revolved around if the patient had cavities, how many and how many appointments would it take to fix them. Even the financial discussion was fairly brief because years ago, dental insurance would pay a much greater percentage of treatment as compared to today. That is a topic for another blog.

Today, we have a much greater understanding of  the several disease processes that affect our patients. We also have a tremendous number of new materials and techniques at our disposal to restore teeth to their original beauty. This has led to a number of different options usually available to treat specific dental concerns.

It is because we now have these options that communication has become more important between patient and doctor than ever before. The options available to us vary greatly in cost,  complexity and in the final result. We are blessed to be able to give our patients more treatment options than ever before.  It is critical that the patient and the dental team agree on an appropriate treatment plan for each individual patient.

No two patients are alike, so treatment must be tailored to the individual. This is where communication is key, both from the patient and from the doctor. So please, ask your dental team to explain your treatment options so that you completely understand your choices. No question should seem too trivial and keep asking until you understand all the issues. It will make everyone happier. There is nothing better than an educated patient.

I would like to spend a couple of moments discussing some easy and relatively inexpensive ways to brighten your smile.
Frequently, patients are reluctant to discuss cosmetic concerns because of several factors. There are numerous reasons people defer treatment, but the common reasons are fear, expense, lack of time and not understanding treatment options available.
Many people desire to improve their smile. Fortunately, cosmetic dentistry has become faster, easier and even more affordable than ever before. Bleaching, tooth reshaping and bonding procedures can dramatically change the appearance of your smile often with one visit and with no discomfort.
I am often surprised when patients somewhat reluctantly ask if we can make their smiles better. Please, if you have a concern about the way your teeth look, ask your dental team. We love improving the way people look and the way they feel about themselves. It is one of the most rewarding things we do!
If you have a concern about how your teeth look, please ask. You may be delighted at how easy we can change your life.

We usually think of athletic mouthguards as protection for the teeth during contact sports. Many sports have mouthguards as required equipment, which seems like common sense in sports such as football or hockey. It is important, however, to consider many sports as potentially causing serious dental injuries. I will not bore you with an endless list of sports that have caused dental distress, but parents and participants may want to consider the nature of the sport and make an informed decision.

In my twenty two years of dental practice, the unfortunate winner of dental injury is basketball. Other sports injuries that I have treated involve baseball(groundballs and bats), field hockey, soccer and mountain biking.

With regard to the injuries we are concerned with several. Obviously direct contact causing trauma to the teeth,and attachment, but also consider a blow to the chin which will cause the teeth to smash together. This can lead to damage to the teeth and/or damage to the jaw joint(orTMJ).

The other important role mouthguards can play is reducing the occurance of concussions. One can only wonder if  some of the high profile concussion injuries(Patrice Bergeron, Mark Savard, Sydney Crosby) would have been prevented if these players were wearing mouthguards. Recently the U.S. Equestrian Association recommended riders to wear mouthguards during jumping events to reduce the possibility of concussions.

Dental injuries can be serious and very expensive. Often a patient will be left with a lifetime of dental challenge. These can be avoided by an inexpensive piece of equipment. If you cannot find one that fits adequately at the local sporting goods store, see your dentist who can make a custom mouthguard(in a variety of colors) for a small fee. Very small considering the alternative.

The Thanksgiving holiday approaches in only a couple of days. It is a time for families to gather together, give thanks for what they are blessed with, watch a lot of football and? Eat.

 This holiday, perhaps more than any other, revolves around eating. The very first Thanksgiving was a gathering and a feast to celebrate the harvest that would allow the Pilgrims to survive the upcoming winter. We spend the whole year anticipating our Thanksgiving dinner.

While we all have many, many, things to be thankful for, I will get focus on my profession as I give thanks. As dentists, we have the ability to change peoples lives. Think back to the days of the Pilgrims and the horror of dental disease and treatment. People frequently died from dental infections. Really, you don’t have to look very far back in history to realize how far we have come in our ability to restore peoples dentitions back to function and beauty with little or no discomfort.

With modern materials, implants and improved anesthetics we now are in a place that allow dentists to create beautiful and functional smiles that can dramatically improve a persons quality of life.

 So, if you want to have this be the last holiday that you dread because of difficult chewing,painful or unsightly teeth, call us. We can change your life! Happy Thanksgiving.

Halloween Is Scarier Than You Think!
Any day now we’ll be putting on funny costumes, acting a little crazy and eating all kinds of stuff that we shouldn’t. And that’s just the adults! For kids, Halloween can be a fantastic time to have fun and be creative. But unfortunately when all those sticky sugary candies are involved, it can be a dental disaster.
The good news is, Halloween and dental health can mix if you just take a few simple precautions. Here are our suggestions to make Halloween 2010 a success without the cavities!
Let you kids know that even though they may come home with a sack full of goodies, there still are some rules to let them both enjoy the treats and keep their bodies healthy.
Don’t allow them to overeat. A few pieces of candy each day for a few days is much better than an all-out engorgement. And if they bring home hundreds of pieces, everyone can feel good about donating much of it to a local food bank.
Avoid the really “sticky” stuff like taffy and caramel corn. This is difficult to remove from the tooth surfaces and can actually damage teeth permanently.
Make sure that your kids are brushing three times per day for at least one minute per session. Before bed and after eating candy are “must-brush” times.
Encourage flossing to remove the sticky stuff from between the teeth. If you or your kids aren’t sure how to properly floss, we will gladly give you a lesson! It’s very easy to do once you know how.
Have your kids use a fluoride rinse before bedtime. If you’re not sure which is the right one for your child’s age, please ask us.
If your children will be eating candy as they are out trick-or-treating, make sure that they take a small bottle or container of water with them. Rinsing and swishing or even taking small sips of water right after eating candy can prevent things from sticking.
Have you considered taking a different route than giving out traditional candy when your doorbell rings? Not only will you differentiate yourself from everyone else on the block, you will be helping your community’s dental heath! Here are a few suggestions from about.com for things to give out other than candy:
Sugar-free gum
Vampire teeth
Halloween stickers
Party favor sunglasses
Small cans of PlayDoh
Noisemakers
Pencils with Halloween erasers
Halloween bouncy balls
Temporary tattoos
Small bottles of bubbles
Be creative! The “Dollar Store” is typically full of fun stuff that kids will love without rotting their teeth.
So have fun, enjoy this great time with your family, and do something scary – as long as it doesn’t involve giving kid’s cavities!!
If you have any questions about how to keep your teeth or your children’s teeth healthy during Halloween or any other time, feel free to give us a call at 978-687-5900. We’re here to help you!!