Dental implants seen as best replacement for old bridges

According to the American Academy of Implant Dentistry (AAID), aging dental bridges are difficult to floss, often decay, and require replacement with longer bridges. The AAID recommends replacing them with permanent dental implants.

"Many of us have had the same bridges in our mouths for 20 years or more. They were put in at a time when bridgework was considered to be the norm for replacing missing or compromised teeth," said Olivia Palmer, D.M.D., of Charleston, SC, an associate fellow of AAID and diplomate of the American Board of Oral Implantology.

Palmer explained that bridges generally fail after five to 10 years because patients have trouble flossing them. "Because these bridges link missing tooth spaces to adjacent teeth, many patients find it very difficult to floss the bridge," she said. "Therefore, root surfaces below and around bridgework often decay, if not kept meticulously clean by flossing. It is impossible to repair this marginal decay, so the entire bridge must be replaced."

For most patients, implants are a better treatment alternative because they preserve the bone of the jaw, can be flossed easily, do not decay, and function just like natural teeth, she added. Today, highly precise computer-guided dental implant surgery has made the procedure faster, highly predicable, long-lasting, and 97% successful.

Palmer advises anyone with one or more missing teeth who might consider having a first bridge inserted or replacing an old one to weigh the benefits of implants before getting treatment.

Oral piercings: Where fashion and dentistry clash

Being a teen's dentist is not easy. You are already battling problem trends such as crystal meth, smoking, questionable eating habits, and even diabetes.

Now a new study has pushed an old enemy to the forefront: oral piercings.

Researchers at the recent International Association for Dental Research (IADR) session in Toronto reported that the most common complications related to oral piercings are chipped, fractured, or cracked teeth and gingival recession. Less common but life-threatening complications include Ludwig's angina, Lemierre's syndrome, and hemorrhage.

“Health professionals should be aware and knowledgeable of these risks in order to provide their patients appropriate advice.” The researchers noted that oral piercings are most popular among younger patients between the ages of 18 and 30, and the tongue and lip are the most common piercing sites. They conducted a systemic review of research on the adverse effects of oral piercings over the last 12 years.

"Piercers are usually unlicensed and untrained," the authors noted. "Health professionals should be aware and knowledgeable of these risks in order to provide their patients appropriate advice."

A previous study looked at research published between 1992 and 2007 and found that 10% of all New York teenagers have some kind of oral piercings, compared to about 20% in Israel and 3.4% in Finland (American Journal of Dentistry, December 2007, Vol. 20, pp. 340-344).

The authors reviewed articles on complications from oral piercings. From the reviewed literature, the lowest recorded rate of swelling and infection after a piercing by a study was 24%, while the highest rate noted was 98%. Pain or tenderness ranged between 14% and 71%, while speech interference came in at 14% to 51%. Numbness, eating difficulties, and bleeding were common short-term postoperation side effects as well.

Jewelry-induced complications included tooth fracture (13% to 41%), gingival recession (19% to 68%), and ingestion of jewelry (7% to 34%). Other side effects included taste interference and halitosis.

"There are short-term complications to piercings in low percentages of teens, and in rare cases a piercing to the oral cavity can cause death," stated Liran Levin, D.M.D., a clinical instructor at the Maurice and Gabriela Goldschleger School of Dental Medicine at Tel-Aviv University and an author of the 2007 study, in a recent press release. "Swelling and inflammation of the area can cause edema, which disturbs the respiratory tract."

"There is a repeated trauma to the area of the gum," he added. "You can see these young men and women playing with the piercing on their tongue or lip. This act prolongs the trauma to the mouth and in many cases is a precursor to anterior tooth loss."

Dan Peterson, D.D.S., who practices in Gering, NE, has had several teen patients come in with swelling and infection because of an oral piercing, and had to talk them into taking the piercing out and letting the area heal.

"I tell my patients that, even if they do not have any immediate infection, there will be some piercing-related complications in the future, so overall it's just a bad idea," Dr. Peterson said. "There are too many things that can go wrong."

With lip piercings, the jewelry constantly rubs against the gum tissue, which causes erosion over the long run, he said. In addition, biting down hard on a tongue piercing can chip teeth. People with tongue piercings are also subject to infections, and a severe tongue infection can cause breathing problems.

The piercing community does not deny these risks.

"There are always risks attached to oral piercings," said James Weber, president of the Association of Professional Piercers (APP). "We try not to downplay them."

Chipped teeth, gum recession, and swelling are potential side effects of piercing, he said. But appropriate placement and the right kind of jewelry can lower those risks significantly, he added.

"Right now, most piercing salons have to abide by very few regulations, if any, and that is why the clients need to take responsibility," Weber said.

The APP urges people to go to a piercer who is skilled, experienced, and uses sterile instruments, jewelry, and disposable needles. Clear aftercare instructions should also be provided. According to the APP, if a piercer tells their clients to treat a piercing with harsh soap, ointment, alcohol, or hydrogen peroxide, the studio is not keeping up with industry standards. The APP recommends sea salt and a mild liquid soap. (For more details on ensuring safer piercings, you can direct your patients to the APP Web site, which has information on choosing a piercer and oral piercing risks and safety measures.)

ADA consumer advisor Matthew Messina, D.D.S., who practices in Cleveland, has done fillings and crowns on chipped teeth and dealt with several infections -- all related to piercings.

An oral piercing is an open wound, he pointed out. Unlike an ear piercing, if you remove the jewelry from an oral piercing, the hole closes because it is moist tissue.

An antibacterial rinse should be a mandatory part of the daily routine for anyone with a tongue piercing, as should cleaning the piercing bar regularly to avoid tartar buildup, Dr. Messina said. He also recommended having patients seek immediate medical help if there is any redness, swelling, or pain around the piercing.

In the long run, however, the dental community's advice: Don't do it!

"Teenagers are not easy to manage," Dr. Levin noted. But "try where possible to dissuade your teen from getting a piercing," he said. "They will thank you when they are older."

Why Spend $300 to Collect $100?

Here's a scenario typical at many dental offices: A patient comes up to the front desk after receiving their services and doesn't know there's a co-pay. Perhaps they thought their "dental insurance" would cover it. They say they didn't bring their wallet, checkbook or whatever. So the front desk says, "No problem, we'll send you a bill." Your collections person prepares the bill and sends it out. No payment comes in. A second bill is sent. No payment. The patient is called. A message left. More calls. More answering machines. But still no payment. A letter is sent telling the patient they'll be turned over to collections. Zippo. The account is turned over. The agency collects on it and you receive a fraction of what the service was worth. Congratulations. You've just spent $300 to collect $100 and as a bonus you now have a former patient in your backyard who'll probably be bad mouthing you. Unfair, but true.

As a consultant, I'm always looking for ways a dental office can be more efficient. At least half of these scenarios could be avoided if, as an example, the front desk simply reminded the patient during the confirmation call that there will likely be a co-pay.

What are dental implants?

The Benefits of Dental Implants

Improved Appearance
When teeth are lost, ongoing shrinkage of the jawbone occurs making the face look older. Dental implants can slow or stop this process. Dental implants look and feel like your own natural teeth.
Improved Comfort
Dental implants eliminate the pain and discomfort of removable full or partial dentures. Since dentures sit on top of the jawbone and gums, continuous shrinkage of the jaw bone alters the fit of the denture resulting in slipping or rocking of the dentures. Exposed nerves and irritation of the gum tissue may add to the discomfort. Implant supported replacement teeth are like natural teeth because they are anchored securely to your jawbone. Gum irritation and the pain of exposed nerves associated with conventional full or partial dentures are eliminated.
Improved Speech
With ill fitting dentures, the teeth slip and slide around the mouth. The facial muscles become tense in an attempt to hold the teeth in place. This often results in mumbling, slurred speech or clicking noises.
Replacement teeth allow you to speak with confidence in a relaxed and natural tone.
Eat Better
The average denture patient with an excellent fitting denture eats at 15-20% efficiency when compared to a person with natural teeth. As the jawbone shrinks, your chewing efficiency is reduced even more, making it difficult to eat certain foods. Dental implants can restore chewing efficiency comparable to that of natural teeth.
This allows you to eat your favorite foods with confidence and without pain, enjoy what everyone is eating and not think twice about it. A full upper denture covers the palate of the mouth and reduces the ability to taste foods. With dental implants, you can have the palate removed from your upper denture so you can taste and enjoy your food.
Convenience
Dental implants can eliminate the numerous embarrassing inconveniences of removable partial and full dentures. You will eliminate the use of gooey denture adhesives that must be re-applied throughout the day. You will no longer need to cover your mouth when you laugh or smile, for fear that your teeth will pop out or fall down.
Protect Your Remaining Natural Teeth
Dental implants are often more appropriate than a bridge for the replacement of one or more adjacent teeth. With conventional bridgework, the teeth surrounding missing teeth must be ground down. Dental implants often eliminate the need to modify these teeth, resulting in a conservative, yet esthetic restoration.
Improved Self Esteem
Considering all other benefits, dental implants can improve your self-esteem. You may feel better about yourself. You can regain nearly all the capabilities that most people have with natural teeth, giving you renewed confidence, and allowing you to enjoy life, do what everyone else is doing and not think twice about it.

Meth Mouth

Meth Mouth
Cheap, Easy-to-Make Illicit Drug
Methamphetamine is a cheap, easy-to-make illicit drug. It’s known by several street names: Meth, Speed, Ice, Chalk, Crank, Fire, Glass, and Crystal. It is highly addictive and its use is on the rise in the U.S. even though it produces devastating effects on users’ health.

Meth Mouth
Dentists are seeing “more and more of a condition we call meth mouth,” ADA President Robert M. Brandjord told U.S. senators trying to get a better picture of methamphetamine abuse at a Capitol Hill forum. Meth mouth is characterized by rampant caries or tooth decay. Some users describe their teeth as "blackened, stained, rotting, crumbling or falling apart," he testified with clinical illustration. “Often, there is no hope of treating methamphetamine damaged teeth, leading to full mouth extractions.” “The American Dental Association believes meth mouth is a very serious disease that is robbing people, especially young people, of their teeth,” Dr. Brandjord testified.

Potent Central Nervous System Stimulant
Methamphetamine is a potent central nervous system stimulant that can cause shortness of breath, hyperthermia, nausea, vomiting, diarrhea, irregular heart beat, high blood pressure, permanent brain damage and rampant tooth decay.

Meth is Highly Acidic
The extensive tooth decay is attributed to the drug’s acidic nature and its tendency to dry mouth tissues. A methamphetamine “high” lasts much longer than that produced by crack cocaine (12 hours versus one hour for cocaine). This can lead to long periods of poor oral hygiene. And while they are high, users often crave high-calorie, carbonated, sugary beverages or they may grind or clench their teeth, all of which can harm teeth.
Heavy users may appear malnourished because methamphetamine acts as an appetite suppressant.

National Survey on Drug Use and Health
According to the 2003 National Survey on Drug Use and Health, 12.3 million Americans age 12 and older had tried methamphetamine at least once in their lifetimes (5.2 percent of the population), with the majority of past-year users between 18 and 34 years of age. Significant decreases in the past year use were seen among 12- to 17-year-olds.

Traffickers have aggressively targeted rural areas in an effort to escape law enforcement, and most use is found in the western, southwestern, and midwestern U.S.

Pregnancy Gingivitis and Its Implications

How does pregnancy affect your patients' teeth and gums?
About half of women experience pregnancy gingivitis. This condition can be uncomfortable and cause swelling, bleeding, redness or tenderness in the gum tissue. Conversely, periodontal disease, may affect the health of your patient's baby.



Is periodontal disease linked to pre-term low birth-weight babies?
Studies have shown a relationship between periodontal disease and pre-term, low birth-weight babies. In fact, pregnant women with periodontal disease may be seven times more likely to have a baby that's born too early and too small.

Periodontal disease is a bacterial infection of the gums and bone surrounding the teeth. It is believed that the bacteria associated with periodontal disease are responsible for increased levels of prostaglandin (PGE2) before the ninth month of pregnancy. PGE2 is a protein responsible for inducing labor. When the PGE2 levels rise significantly before the ninth month of pregnancy, early labor is triggered. Premature onset of labor is responsible for low birth weight babies. These findings have taken into account other pre-term risk factors such as the use of alcohol, drugs and tobacco and level of prenatal care, nutrition and vaginal infections.
While a normal pregnancy is about 40 weeks, babies born before the 36th week of pregnancy and weighing less than 5 pounds 8 ounces (about 2.5 kilograms) are called pre-term, low birth weight babies. These babies often face extra challenges such as slow development, learning disabilities, attention deficit disorder, and serious health problems including cerebral palsy, epilepsy, and chronic lung disease.

What if you diagnose your patient with periodontal disease during her pregnancy?
Scaling and root planing may be recommended. Research suggests that scaling and root planing may reduce the risk of pre-term births in pregnant women with periodontal disease. The added bonus is that the procedure should alleviate many of the uncomfortable symptoms associated with pregnancy gingivitis, such as swelling and tenderness of the gums.

Cracked Tooth Syndrome

One of the most difficult diagnoses in dentistry is Cracked Tooth Syndrome. The patient generally presents with sharp pain on chewing in a certain area of his mouth, but he or she frequently cannot tell which particular tooth hurts. The pain is generally associated with a posterior tooth which becomes evident when the patient is asked to bite on piece of wood or a special device like the Sleuth Tooth.

As a rule, the dentist cannot see any problem with the tooth, either clinically or radiographicly. The tooth may have no fillings or decay, or it may have an intact filling with no visible associated problems. Nothing looks wrong, but the patient feels sharp pain upon biting pressure. Symptoms of sharp pain to pressure accompanied by no visible signs of a problem with the tooth are the hallmarks of cracked tooth syndrome.

The diagnosis can be further confirmed when the dentist uses an instrument that rests on one part of the tooth at a time. There is frequently sharp pain when the pressure is applied to only one particular cusp, and not to others. If the tooth has a crack in it, the pain is caused by movement of the affected cusp. The other cusps generally prove to be non-painful when the same pressure is applied. The "movement" of the fragment is usually microscopic, and not visible to the naked eye.

Q: When is a crack in a tooth not a crack?
A: When it's a craze!

Crazes are visible cracks in the enamel of the teeth.
They are always painless and generally they are vertical (but not always). They are most noticeable in the front teeth, and frequently cause patients a lot of concern. They tend to form as we get older, and are considered to be a part of the normal anatomy of the teeth. Crazes develop because of the differences between the coefficients of thermal expansion of the enamel and the underlying dentin. When a person switches quickly between eating and drinking hot and cold foods, these two components expand and contract at slightly different rates causing cracks in the more brittle outer layer of enamel. The underlying dentin is less brittle and does not crack. Since the enamel and the dentin are bonded to each other molecule for molecule, there is no danger of the enamel or the tooth breaking.

How can a tooth have a crack, but show no outward signs of a crack?
When a real crack occurs in a vital tooth, the crack frequently does not propagate all the way through the tooth. This type of crack is called a greenstick fracture because, like a green branch from a tree, the fracture may be mechanically present, but the unbroken segments of the branch hold it together. The crack usually propagates through sensitive parts of the tooth (the dentin), many times involving the vital nerve. When pressure is applied to the cracked piece of the tooth, a small movement of tooth structure occurs which stimulates the nerve. Even though the movement is tiny, it hurts a lot! Since the tooth cannot heal itself, the pain is always present whenever pressure is applied to the biting surface of that tooth.

The pain will not go away until one of two things happen. 1. The cracked piece of tooth may break off relieving the pain when pressure is applied to it. When this happens, the tooth can usually be repaired with a crown or a simple filling and the patient (and tooth) lives happily ever after.
2. The nerve may die as a result of the repeated assaults placed on it by the moving fragment of tooth. When this happens, the pain to pressure may stop, but the non-vital nerve leaves the patient vulnerable to a dental abscess unless a root canal, and subsequent crown are performed.

Can cracked teeth be saved? Whenever we are dealing with a cracked tooth, the patient must understand that whatever treatment the dentist prescribes, and no matter how hard he or she tries, the tooth may still need to be extracted at some time in the future! Repair of any tooth thought to be cracked is always risky, and no guarantees can be made about the outcome.

The safest way to repair a cracked tooth involves three steps:
1. Perform a root canal on the tooth. This procedure is absolutely necessary if the crack has propagated through the nerve space. While this procedure is not necessary if the crack does not involve the nerve, there is really no way for the dentist to determine if this is the case.
2. Once the root canal has begun, the dentist should look into the pulp chamber and try to see the crack. Unfortunately, the crack is not always visible to the dentist, even once the root canal procedure has been started and the chamber is empty. If a crack is seen in the floor of the chamber, it can be stabilized by bonding a passive post in each of the root canals on either side of the crack. Post placement in a root canal is NOT indicated if it can be determined that the crack runs through the orifice of that specific canal. The pulp chamber should be properly etched, bonded and filled with composite resin in order to help hold the tooth together internally.
3. Once the root canal is completed, a full coverage crown should be placed over the tooth.