Laser Dentistry

Laser Dentistry

"La-ser"

Lasers are familiar to many of us from science fiction (think of the Star Wars light saber) to comedy (remember Austin Powers’ Dr. Evil?).  The fact is that lasers surround us in every-day life.  For example, in the home you will find them in CD players, while industry uses them for high-speed metal cutting machines and measuring devices.  Hair replacement, tattoo removal, dermatologists, eye surgeons — they all use lasers.

So do dentists.  And so does our office.

This begs the question, just what is a laser?  How is it different from any other kind of light?  “If Dr. Evil planned to destroy the world with one, why won’t it hurt me when you use it on my gums?!”  Actually, that’s three questions . . . .

Anyway, let’s try take them in order:

The word “LASER” itself is an acronym that stands for light amplification by stimulated emission of radiation.  This concisely describes exactly how a laser works.   The laser is a device which controls the way that energized atoms release photons (a quantum of electromagnetic energy).  When we say “radiation” however, we are not talking about ionizing radiation — such as would be produced by an x-ray.

Laser light is very different from normal light or radiation emitted by an x-ray.  Laser light has the following properties:

  • The light released is monochromatic. It contains one specific wavelength of light (one specific color). The wavelength of light is determined by the amount of energy released when the electron drops to a lower orbit.
  • The light released is coherent. It is “organized” — each photon moves in step with the others. This means that all of the photons have wave fronts that launch in unison.
  • The light is very directional. A laser light has a collimated (very tight) beam.  This makes it stronger and concentrated. A flashlight, on the other hand, releases light in many directions, and the light is very weak and diffuse.

Why won’t it burn you to a crisp when we use it on your gums?  Clearly, we’re using a controlled power setting (in our office we use a diode laser) — in fact, most patients tell us they don’t feel anything when we use it in conjunction with their dental cleanings.  But that doesn’t mean it isn’t effective!

Watch the video below for a demonstration and explanation of how a dental laser is being used during a routine cleaning.

Laser Dentistry in Philadelphia

If you would like to read more about how we use a dental laser in our office and how it can benefit your health, check out the following article posted in the Services section of our website:

LASERS IN DENTISTRY

Toothpaste and Your Dental Work

Toothpaste and Your Dental Work

Very often patients ask me about what toothpaste they should use.  Seldom, however, am I asked about the best technique for cleaning teeth, when brushing should be done, how often they should brush, or for how long.

The subject of tooth cleansers can be confusing.  There are pastes, powders, cavity-fighting and gum-protecting formulas, as well as whitening varieties.  Most toothpastes use some form of mild abrasive to clean teeth, while others rely on enzymes to lift the stains out of your teeth. Some are foaming and some are not.  Most contain fluoride, while others don’t.

While I do have a personal favorite toothpaste, I honestly believe that an effective job of cleaning can be accomplished with the vast majority of toothpastes available on the market.  Why are there so many out there?  In a word: marketing.  I’m pretty sure toothpaste companies have discovered that if a toothpaste has the word “whitening” on it, they are likely to sell more than if it is omitted — even if the whitening benefit is small.

Some people have even taken to the idea that almost anything will work to clean your teeth.  Even soap.  Here is a short video I ran across recently that discusses this, and also why you may not want to wash your mouth out with soap.  I tend to agree that you should use the right product for the correct purpose.

 Click on the toothbrushes below to view the VIDEO:

Toothbrushes

For the curious, here is an earlier posting that answers some of the other questions discussed above, including how often you should brush.

Cracked Tooth: Yet Another Example

Cracked Tooth: Yet Another Example

Cracked in half

Just last week I encountered another case of a cracked tooth needing to be extracted.
I can’t say this is uncommon. Yet something about this one stuck with me . . . probably because I felt it was avoidable.

Cracked teeth as a result of the grinding and clenching of teeth — also known as bruxism — appears to be reaching epidemic levels. Frankly, that wasn’t the only case of of problems I saw as a result of tooth clenching that day.

The patient I treated right after him had a series of problems connected to clenching as well: among them, bone loss — (with at least one tooth that will have to be removed as a result), front teeth that were chipped, and another that that developed an abscess. Yes, all of these problems had direct connections to the patient’s habit of clenching his teeth.

Cracked Tooth

But let’s return to original patient for a moment. When he first came in and saw me for his initial consultation six months earlier, I pointed out that there was evidence of bruxism. I recommended doing something about it at that time.

The patient looked at me funny — it was clear that he didn’t think he had that problem. I explained why I thought he clenched his teeth and pointed to several things that indicated that condition. He handled a few other problems, but decided to let this one go (“for now”). I’m not going to put a gun to anyone’s head when it comes to my recommendations, but inwardly I wished him good luck.

While conducting my follow-up exam I observed a crack running through his root. Given it’s size and location, his only option is removal. It didn’t hurt him as much as it could have because the nerve had already been removed, but I couldn’t help thinking this was a shame. Had we followed the recommendations I made six months ago, we probably wouldn’t be dealing with this now.

It’s too late for that patient, but the underlying message here is simply this: if a dentist tells you there is a body of evidence suggesting you grind your teeth — don’t ignore it. Most people simply don’t know if they grind because they often do it while they are sleeping. What is more, they don’t do it consistently. Remember, damage can occur in many different ways. It can be slow and steady, like wind erosion wearing down mountains or very quick and short-term, like a bullet to the head. Either way, there is visible change in the end.

Here is a link to an earlier article I wrote about grinding. If a dentist has ever told you that you might grind or clench your teeth, take it to heart. You may be saving yourself a few dollars . . . as well as a few teeth.

Understanding Tooth Clenching and Grinding

I might also give this article the byline:  “The Daily Grind.”  But I wouldn’t be talking about work.  For millions of people, the daily grind is happening to their teeth — and they are often working them to death.  I’m not talking about the normal work you would expect, such as that which is associated with eating.

I’m talking about the grinding and clenching of teeth, known as bruxism.

“Bruxism.”  It even sounds grating.  And, believe me, it literally is.  The word itself is taken from the Greek “brugmos,” which means the “gnashing of teeth.”  Many people are surprised to learn that it is considered to be one of the most common sleep disorders.

While grinding and clenching can occur either during the daytime or at night, it is bruxism during sleep that causes the majority of dental and health issues — and it can even occur during short naps.

Unfortunately, all of the causes of bruxism are not yet well established or understood.  There are several theories, but by most accounts it is classified as a habit.  Among the theories that prevail are that some medical conditions such as digestive ailments or stress can contribute to the condition.  Others speculate that changes to the bite, such as might occur following tooth loss is a contributory factor.  Still other concepts include spinal misalignments (following accidents) or nutritional deficiencies (thought to be calcium, magnesium, and pantothenic acid) as being causative factors.

Some of the activity that occurs when people brux is rhythmic (like chewing) and some is sustained (like holding the teeth together tightly).  Both can cause significant damage to the teeth and underlying bone.

It is interesting to note that almost everyone experiences bruxism at one time or another.  Until recently, dentists found that only a relatively small percentage of patients would go on to develop symptoms alerting either the patient or the dentist to the problem.  Commonly, this would be headaches or jaw pain that might prompt treatment.  At other times it might appear as wear patterns on the biting surfaces of the teeth, cracks in the enamel, chipped fillings or crowns, abfractions (notched-out areas of teeth typically found at the gum-line), receding gums or loose teeth.

What is particularly alarming, though, is that over the last several years, bruxism is being reported by dentists as an increasingly common occurrence.  One recent report that I read suggested that as many as one in four patients seeking routine dental care grind or clench their teeth.

Most bruxers are not aware of their condition.  In fact, many people will insist that they don’t grind their teeth.  Spouses or “significant others” often reinforce this by suggesting that they watch the person while they are sleeping and notice the individual snores or has their mouth open.  This is difficult to dispute (unless an actual, controlled sleep study is conducted) but it unfortunately can cause dentists to defer intervention while still more damage can occur.  And, over time, it usually will.  Keep in mind that with sufficient force, the contact does not have to take a long time to do damage.  Think of a bullet, for example.  It’s a small object and has very brief impact, but the velocity is sufficient to cause harm.

Certain sleeping positions will cause more stress than others.  People who sleep on their stomachs usually experience the highest levels of stress.  Again, remember, one doesn’t have to be in this position all night for damage to occur.  People who have broken teeth or dental restorations while sleeping sometimes report hearing a “pop” and then feeling a loose fragment in their mouth.  This is a momentary occurrence.  Of course, one typically sleeps every night, so if outright fracture doesn’t occur right then, it doesn’t mean physical stress isn’t being applied.

Here are a few other factors associated with bruxing that may be subject to your control:

  • Relatively high consumption of caffeine, such as is found in coffee, colas, and chocolate
  •  Smoking
  •  High levels of blood alcohol
  • Drug use, such as SSRIs (anti-depressants) and stimulants like Ecstasy, MDA, and other amphetamines, including those taken for medical reasons.
  •  High levels of anxiety and stress, irregular work shifts, and stressful professions or relationships
  • Disorders such as Huntingdon’s and Parkinson’s Disease

Keep in mind that other habits in combination with bruxism can accelerate the problem — such as consumption of abrasive foods and acidic soft drinks.  These can weaken the enamel mechanically or chemically, thereby accelerating the process of wear.

So far, there is no single accepted cure for bruxism, but it can be reduced or even eliminated if you treat the associated factors successfully.  As far as repairing the damaged already caused, typically a dentist will replace the worn natural crown of the tooth with prosthetic crowns.  In the event of tooth loss (following cracked teeth) implants may be advised.  The materials used will vary by location in the mouth.  To protect the new crowns and dental implants, a professionally fabricated custom occlusal guard should be made for wearing while asleep.

Most over-the-counter night guards (while very inexpensive) are deemed ineffective by dentists and in some cases may contribute to problems with the jaw joint, the TMJ.  Professional treatment is medically recommended to make sure that the bite has remained stable, to check the device for proper fit and to make any ongoing adjustments, if needed.  Monitoring the night guard is suggested at regular visits.  It is also important to note that night guards, are simply a first response to bruxism and do not cure it.  Their general goals, however, are to:

  1. Minimize the damage to the jaw joint (the TMJ) which at times can be severe and may even require surgery.
  2. Stabilize the wear patterns on the teeth that at first occur gradually, but progressively alter the bite to a point where the change becomes more rapid.
  3. Prevent tooth damage, including damage to existing dental work.
  4. Allow the dentist to evaluate (broadly) the extent and patterns of bruxism by physical examination of the patterns on the surface of the night guard.

Frankly, bruxism can be difficult to diagnose because it is not the only source of tooth wear.  Compound this with the fact that the effects of bruxism can be very advanced before the patient is even aware of it, and one has a formula for trouble.  In one of the most severe cases of bruxism that I have treated, what brought the patient in to my office for the first time was that he had worn down his front teeth to the point where the nerves were actually exposed.   That’s severe.  Tooth sensitivity can occur way before then, however.

The most reliable way to diagnose bruxism is through a sleep study performed in a hospital.  In my experience, relatively few patients are willing to do this, but the results are difficult to refute.

If you notice changes in your bite or your teeth that you suspect are caused by bruxing, you should point this out to your dentist so that he can evaluate the cause.  The sooner the better.

Dentists Need to Know Your Supplements

Dentists Need to Know Your Supplements

shutterstock 421421404

A friend of mine recently sent me the link to this video: Dentists Need to Know Your Supplements, and I found it somewhat timely.

As readers of my blog may know, I have long been an advocate of dietary supplements.  While the ideal form of nutrition is always a healthy diet, today’s food is simply not the nutrient-rich, non-chemically altered, or non-genetically engineered food our grandparents ate.

While that might just be a topic for another discussion, I want to point out that whereas supplements have their place, it is always prudent to understand what you are consuming and what potential effects it may produce.  This advice holds equally true for vitamins and herbs as it does for medications.Supplements

While the side-effects of supplements are typically far less dire than those encountered with many common medications, there can be side-effects nonetheless — especially when used in combination with medications.

As dentists, we are particularly interested in knowing what herbal medications a patient takes that may cause drowsiness, excessive bleeding, cardiovascular problems or that interfere with other drugs.

Here are a few examples:

  • St. John’s Wort, used as a mood enhancer, can interfere with the effectiveness of many heart and blood pressure medications, as well as blood thinners.  On the other hand, garlic, ginseng, ginger, chamomile and gingko, to name a few, can cause bleeding after surgery.
  • A patient given sedatives by a dentist or oral surgeon before surgery who is also taking Valerian root and kava may experience an interaction that causes excessive drowsiness.
  • Ginseng has been associated with an increased chance of arrhythmias (irregular heart beats.  Patients who take ginseng and also get a local anesthetic with epinephrine (commonly used for fillings and many other dental procedures) may be putting themselves at risk for cardiovascular complications.
  • Echinacea, while it is widely considered to be an immune system enhancer, may inhibit wound healing and increase the risk of post-surgical infection.

This list is by no means exhaustive, and the simple message here is just because an herbal remedy is considered “natural” doesn’t mean you should neglect to inform your dentist that you are taking them.  Neither he nor you want to risk negative effects or complications that can come about as a result of interactions.

Doctor & Patiet CommunicationMore likely than not, your doctor will simply ask you to stop taking a particular supplement before surgery or modify the anesthesia accordingly.

Good communication is the key.

Here is another example of this point.  Not uncommonly, patients take “baby aspirin” as a blood thinner.  Of course, this is not an herb, but many people feel it is not worth mentioning because it is just a “baby” aspirin.  That is, until they fail to stop bleeding after an extraction.

You should always be sure to tell your doctor about ALL of the substances you are taking, including prescriptions and over-the-counter drugs.  Even doctors aren’t always fully aware of every potential interaction between herbs and drugs, as new drugs are constantly being developed and introduced into the market.  It is in your best interest to let your doctor “know before you go.”