Scott Froum, DDS
Kyle L. Summerford
The long-term success rate of dental implants has been well-documented in the literature1 and is a technology that has been a boon to the financial element of dentistry. Similarly, retention of teeth with moderate to advanced bone loss via various periodontal treatment methods has enjoyed similar to higher long-term success rates.2 The practitioner often relies on clinical experience and therapeutic familiarity when deciding whether to extract periodontally involved teeth and replace with dental implants vs. saving the natural dentition with regenerative or resective therapy. A relatively new concept, however, that should be incorporated into this decision matrix is the long-term cost effectiveness to the patient when comparing treatment modalities.
Retention of periodontally compromised teeth with initial, surgical, and supportive therapy has been shown to have high long-term success rates in the literature.3,4 Typical periodontal treatment for patients with moderate to advanced disease when first presenting to a dental office can consist of quadrant scaling and root planing, osseous surgery with or without regenerative therapy (Figs. 1 and 1a), and supportive periodontal maintenance at specific intervals. Estimated totals for this type of "start-up" treatment are in the range of $2,000 to $4,000 depending on geographic location (see Table A). This treatment, if maintained by the patient with diligent home care, has proven to be effective in terms of the prevention of further periodontal progression and tooth retention over a long-term period.5
When analyzing the cost to maintain this start-up treatment via supportive periodontal therapy with maintenance intervals of three to four times a year with or without local adjunctive antibiotics, dollar amounts range from $500 to $1,000 a year, again dependent upon geographic location. In a small subset of the population (less than 5%), periodontal disease can reoccur after treatment, excluding those patients who demonstrate blatant noncompliance with home care, and treatment will have to be rendered again, increasing the overall costs of this type of therapy.6
Although implants have typically enjoyed high long-term survival rates,7 their associated initial financial impact is much higher than that of saving the natural dentition.8 Conservative valuations place start-up costs for implant treatment around two to three times higher than saving natural dentition via periodontal therapy (Table 2). In addition, implants are not without complications, and both biologic and/or mechanical complications can be associated with additional treatment costs to the patient. Recently, the literature has been replete with discussion of biologic complications in the form of peri-implant disease. Peri-implant diseases fall into two categories: peri-implant mucositis and peri-implantitis.
The term peri-implant mucositis describes a reversible inflammatory reaction in the mucosa adjacent to an implant,9 a term that has become known as implant gingivitis. Typical treatment involves quadrant scaling and root planing with implant-friendly armamentarium. The literature also has shown that mechanical debridement in conjunction with systemic and/or local antibiotic placement has increased the efficacy of this type of treatment10, but it can obviously be associated with higher treatment costs (Fig. 2). Studies show that the prevalence of peri-implant mucositis can be as high as 50% to 80% of implants in function.11 Peri-implantitis has been defined as an inflammatory process that affects the tissues around an osseointegrated implant in function and, like periodontitis, results in loss of supporting bone.
Clinical treatment of this disease is often determined by severity, but in general often includes flap surgery, bone grafts, membranes, growth factors, and/or soft-tissue grafts12 (Figs. 3 and 3a). The overall financial impact upon the patient for this type of treatment can be quite high considering the patient was already subject to initial start-up costs of treatment. (Table C). In addition, maintenance intervals after implant therapy should be equal to if not more stringent than those of natural teeth. The prevalence of peri-implantitis has been shown in some studies to range from 11% to as high as 47% of implant sites analyzed.13 A large disparity in percentages can be seen when comparing the prevalence of reoccurring periodontal disease after treatment vs. the percentage of implants that will demonstrate complications after prosthesis insertion. With that said, studies show that periodontal therapy has proven to be cost effective when compared to other types of tooth replacement therapy over a 15-year period evaluation.14
The following tables present actual treatment cost differences between the patient opting to "save" the natural tooth (Treatment Plan A) vs. "removal" with extraction and implant (Treatment Plan B). These fees are dependent on geographic location and represent insurance codes from the New York City, Los Angeles, and Chicago areas.
This information was presented to a real patient in a private practice setting along with long-term survival rate percentages of each of the comparative treatments. After reviewing the survival rates as well as the financial costs in relation to each treatment plan, the patient accepted Treatment Plan A, citing the following reasons: desire to keep her own teeth, less cost, and quicker time to completion.
Another real scenario that took place in a private practice with actual dollar amounts can be seen with Table 3. A patient had already paid for treatment in Table 2 in the $5,000 to $7,000 range and presented to the office with moderate peri-implantitis. In addition to the invested money, she was now going to be responsible for the dollar amounts shown in Table 3.
After reviewing the additional costs and lengthy healing time involved with surgery to correct the ailing implant, the overall costs associated with treatment were in the $8,000 to $9,000 range with more than three years of treatment time invested. Of important note is that most insurance companies limit the amount of reimbursement for implant-related services. Accurate ADA coding and submissions when dealing with insurance companies must occur in order to facilitate services and expedite reimbursements.
In conclusion, when deciding between saving the natural dentition and extracting and placing implants, there are many factors to consider. In addition to long-term success rates, the practitioner and the patient need to consider the long-term economic impact the patient will endure. Both implants and periodontal therapy to save natural teeth have high initial success rates with implants usually demonstrating higher start-up costs. However, when looking at long-term retention rates, teeth often demonstrate fewer complications and have less of a financial impact when correction is needed.
References
1. Simonis et al. Long-term implant survival and success: A 10-16-year follow-up of non-submerged dental implants. Clin Oral Implants Res. Jul. 2010;21(7):772-777.
2. Carnevale G, Di Febo G, Tonelli MP, Marin C, Fuzzi M. A retrospective analysis of the periodontal-prosthetic treatment of molars with interradicular lesions. The International Journal of Periodontics & Restorative Dentistry 1991;11:189-205.
3. Hirschfeld L, Wasserman B. A long-term survey of tooth loss in 600 treated periodontal patients. J Periodontol. 1978;49:225-237.
4. Oliver RC, Brown LJ, Loe H. Periodontal diseases in the United States population. J Periodontol. 1998;69:269-278.
5. Axelsson P, Lindhe J, Nyström B. On the prevention of caries and periodontal disease. Journal of Clinical Periodontology, 1991;18:182-189.
6. Magnusson et al. Refractory periodontitis or recurrence of disease. J Clin Periodontol. Mar. 1992;23(3 Pt 2):289-292.
7. Simonis P, Dufour T, Tenenbaum H. Long-term implant survival and success: A 10-16-year follow-up of nonsubmerged dental implants. Clin Oral Implants Res. Jul. 2010;21(7):772-777.
8. Schwendicke F, Graetz C, Stolpe M, Dörfer CE. Retaining or replacing molars with furcation involvement: A cost-effectiveness comparison of different strategies. J Clin Periodontol 2014; 41:1090-1097.
9. Albrektsson T, Isidor F. Consensus report of session IV. In: Lang NP, Karring T, ed. Proceedings of the First European Workshop on Periodontology. London: Quintessence, 1994: 365-369.
10. Salvi et al. Adjunctive local antibiotic therapy in the treatment of peri-implantitis II: Clinical and radiographic outcomes. COIR 2007;18:281-285.
11. Lindhe J, Myle J. Peri-implant diseases: Consensus report of the Sixth European Workshop on Periodontology. J Clin Periodontology 2008;35(suppl 8):282-285.
12. Froum SJ, Froum SH, Rosen PS. Successful management of peri-implantitis with a regenerative approach: A consecutive series of 51 treated implants with a 3- to 7.5- year follow-up. IJPRD 2012;32(1):1-20.
13. Koldsland O et al. Prevalence of peri-implantitis related to severity of the disease with different degrees of bone loss. J Perio Feb. 2010;81(2)231-238.
14. Pretzl B, Wiedemann D, Cosgarea R, Kaltsch-mitt J, Kim TS, Staehle HJ, Eickholz P. Effort and costs of tooth preservation in supportive periodontal treatment in a German population. Journal of Clinical Periodontology 2009;36:669-676.
Scott Froum, DDS, is a periodontist and coeditor of Surgical-Restorative Resource e-newsletter, as well as a contributing author for DentistryIQ and Dental Economics. He is a clinical associate professor at the New York University Dental School in the Department of Periodontology and Implantology. Dr. Froum is in private practice in New York City. You may contact him through his website at www.drscottfroum.com.
Kyle L. Summerford is CEO and founder of Summerford Solutions, Inc., and editorial director of PennWell's Dental Assisting Digest e-newsletter. He provides private business coaching for dentists. Mr. Summerford is a professional speaker focusing on topics such as increasing profits, staff etiquette training, and maximizing dental insurance benefits. He is a contributing author for Dental Economics, DentistryIQ, and Surgical-Restorative Resource. Visit his website atwww.ddsguru.com, available to dentists and team members for educational purposes, or contact him by email at KyleLSummerford@gmail.com with inquiries regarding his practice management consulting services.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-2/science-tech/dollars-and-sense-saving-teeth-vs-placing-implants.html
Visit us: http://affinitydentalfresno.net/
Showing posts with label Dentist. Show all posts
Showing posts with label Dentist. Show all posts
22 Jul 2015
Dental implants have been around since ancient times, but new teeth can also fall out
People usually lose their adult teeth because of neglect or a lifestyle or environment that places them at high risk of decay or destructive gum disease. While high-sugar diets can lead to tooth decay, genetics can also increase the risk of bad gum disease, as does smoking and poor glucose control in diabetes patients. If you combine these with inadequate oral hygiene then tooth loss is a real possibility.
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
Using digital impressions for implants
Bart Silverman, DMD
Computer-aided design/computer-aided manufacturing (CAD/CAM) devices seem to be taking over the dental space. Of these, 3-D intraoral scanners are revolutionizing the way we take impressions. However, many focus only on the restorative aspects of this exciting new technology, not realizing that advancements in digital impressions apply to implants as well.
The way we were taught to take conventional impressions in dental school is quite a process. The initial setup includes choosing the correct impression material (whether alginate or polyvinyl), setting up the mixing pads, spatulas, adhesive, lubricating agents, mixing bowls, and a whole slew of different tray size options. Then, we have to select the correct maxillary and mandibular tray, prep the tray, and start mixing the materials.
And, of course, this all has to be done on a live dental patient-one who sometimes doesn't want to be there, has dental phobias, and who sometimes gags. When all is said and done, taking the impression can be stressful for both the patient and staff. If all went well, only one impression was necessary; however, a whole range of errors could occur, whether in the practice or at the lab, requiring us to do it all over again.
Fortunately, digital impressions have exponentially simplified this process. Setup is as easy as unplugging the scanner from one laptop and plugging into the USB port of the computer you want to use. A series of quick intraoral images are stitched together by the computer, completing the digital impression in a matter of minutes. The speed and efficiency a scanner offers can combat any champion dental-phobe or gagger.
In my practice, we use the CS 3500 intraoral scanner by Carestream Dental. Featuring "plug-and-play" technology, the handpiece is lightweight and can be easily moved from operatory to operatory. And, while some units require powder to take an impression-something that doesn't make sense when it comes to scanning a surgical site-this scanner is powderless.
Once the digital file is obtained, it can be sent to a lab or opened in implant- or surgical-planning software.
Basic surgical guides
When placing dental implants, using a surgical guide is always recommended. In addition to aiding in the proper placement of dental implants, surgical guides can help prevent malposition and spacing of dental implants, which can be a nightmare to restore. They can also prevent the need for a custom abutment during the restorative phase, keeping patient costs down.
Fabricating a surgical guide using the conventional impression technique requires taking a conventional impression with alginate or polyvinyl and pouring up the stone model-two time-intensive steps. After the model sets, the lab places a denture tooth or teeth in the edentulous area and a vacuform tray is made by heating a thermoplastic material and adapting it down over a model with a special vacuum machine.
Fortunately, with a digital scanner, once the intraoral scan is performed, the digital file is sent to the lab where a virtual tooth is added and a guide is fabricated and sent back to the office. No model is made, eliminating additional costs.
Implant dentistry
After an implant is placed and osseointegration occurs, one must determine what type of abutment will be placed. Should you choose a standard or stock abutment or a custom abutment to serve as the connector on top of which the crown will be placed? A standard abutment is one that is provided by the implant manufacturer and is typically used when there are no concerns about angulation of the implant, while a custom abutment is considered when implant positioning or interocclusal space is a concern.
If conventional or analog impressions are used to take an impression of a standard abutment, an impression coping is placed on top of the abutment. A goopy material is syringed into a tray and then the patient's mouth. Once set, it is removed from the mouth with the coping. An implant analog is placed into the coping and the lab receives this and pours up a stone model. Along the same line with analog dentistry, if a custom abutment is planned, we are taking an impression of the top of the implant fixture, affording the fabrication of a connector specific for each patient. A fixture-level impression coping is placed inside the implant and a similar impression technique is performed. The laboratory technician takes the impression, pours up a stone model and waxes up a custom abutment. The wax abutment is then invested, cast, and polished.
This conventional technnique, which many of us are used to, has many steps that allow for the introduction of potential errors. This has a direct impact on patient care, as we cannot accurately predict the length of crown insertion appointments and the results are inconsistent. In addition, this unknown chairtime can cost our practices a lot of potential lost income.
Let's explore digital dentistry as an alternative. We choose whether we are going to use a standard or custom abutment using our same criteria; this first step does not change. However, from there, digital impressions make for a more accurate and streamlined process. If we decide to place a standard abutment, we use a digital scanner to scan the actual abutment. Here, in the adjacent photo, we used the CS 3500 to take a digital impression of the abutment in the patient's mouth.
The patient presented with three edentulous areas and multiple implants were placed. Standard abutments were torqued into position and the CS 3500 was used to capture the impressions. No setup time was needed for trays, and there was no gagging or clean up.
In the next case, we decided to fabricate a custom abutment which would require a fixture level impression. With analog dentistry, a fixture level impression coping is placed. With digital dentistry, we have the ability to place a scanning body, which is the digital equivalent of a fixture level impression coping.
A couple of caveats: the scanning bodies are implant- and digital lab-specific. In other words, you must request these specifically from the digital lab that you will work with for the specific implant that you placed.
Guided surgery
The latest trend in implant dentistry is to be prosthetically driven when we plan our cases; that is, we need to go to the final result and work backward to plan where we have to place our implants. Guided surgery enables us to do this and place our implants precisely based upon final prosthetic restorations limited by bone morphology. In order for us to do this, we take impressions, pour up models, and plan our cases. We then need to send this along with a CBCT scan to a guided surgery facility. Guides are fabricated and implants placed. We can now shorten the process by using the intraoral scanner to scan our patients instead of using the analog model technique. This STL file is then merged with the DICOM file of the cone beam scan into the implant-planning software to plan our cases.
Digital dentistry is in its beginning stages. The technology is new and exciting, with many uses in dentistry and-more specifically-implant dentistry. It allows for more precision when treating our patients. From guided surgery to abutment and crown fabrication, digital technology provides more exact treatment planning and decreased chairtimes. In the days of trying to maintain and attract new patients, the patient "WOW" factor can't be matched.
Bart Silverman, DMD, is a graduate of Fairleigh Dickinson University in New Jersey. He completed his graduate training from Fairleigh S. Dickinson Jr. School of Dentistry in 1986 where he received his doctorate of dental medicine degree. He completed his residency in oral and maxillofacial surgery at Westchester County Medical Center and served as chief resident in 1989. He currently is board certified in oral and maxillofacial surgery with a private practice in New City, New York. Dr. Silverman is a clinical assistant attending at Westchester County Medical Center in Valhalla, New York.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/using-digital-impressions-for-implants.html
Visit us: http://affinitydentalfresno.net/
Computer-aided design/computer-aided manufacturing (CAD/CAM) devices seem to be taking over the dental space. Of these, 3-D intraoral scanners are revolutionizing the way we take impressions. However, many focus only on the restorative aspects of this exciting new technology, not realizing that advancements in digital impressions apply to implants as well.
The way we were taught to take conventional impressions in dental school is quite a process. The initial setup includes choosing the correct impression material (whether alginate or polyvinyl), setting up the mixing pads, spatulas, adhesive, lubricating agents, mixing bowls, and a whole slew of different tray size options. Then, we have to select the correct maxillary and mandibular tray, prep the tray, and start mixing the materials.
And, of course, this all has to be done on a live dental patient-one who sometimes doesn't want to be there, has dental phobias, and who sometimes gags. When all is said and done, taking the impression can be stressful for both the patient and staff. If all went well, only one impression was necessary; however, a whole range of errors could occur, whether in the practice or at the lab, requiring us to do it all over again.
Fortunately, digital impressions have exponentially simplified this process. Setup is as easy as unplugging the scanner from one laptop and plugging into the USB port of the computer you want to use. A series of quick intraoral images are stitched together by the computer, completing the digital impression in a matter of minutes. The speed and efficiency a scanner offers can combat any champion dental-phobe or gagger.
In my practice, we use the CS 3500 intraoral scanner by Carestream Dental. Featuring "plug-and-play" technology, the handpiece is lightweight and can be easily moved from operatory to operatory. And, while some units require powder to take an impression-something that doesn't make sense when it comes to scanning a surgical site-this scanner is powderless.
Once the digital file is obtained, it can be sent to a lab or opened in implant- or surgical-planning software.
Basic surgical guides
When placing dental implants, using a surgical guide is always recommended. In addition to aiding in the proper placement of dental implants, surgical guides can help prevent malposition and spacing of dental implants, which can be a nightmare to restore. They can also prevent the need for a custom abutment during the restorative phase, keeping patient costs down.
Fabricating a surgical guide using the conventional impression technique requires taking a conventional impression with alginate or polyvinyl and pouring up the stone model-two time-intensive steps. After the model sets, the lab places a denture tooth or teeth in the edentulous area and a vacuform tray is made by heating a thermoplastic material and adapting it down over a model with a special vacuum machine.
Fortunately, with a digital scanner, once the intraoral scan is performed, the digital file is sent to the lab where a virtual tooth is added and a guide is fabricated and sent back to the office. No model is made, eliminating additional costs.
Implant dentistry
After an implant is placed and osseointegration occurs, one must determine what type of abutment will be placed. Should you choose a standard or stock abutment or a custom abutment to serve as the connector on top of which the crown will be placed? A standard abutment is one that is provided by the implant manufacturer and is typically used when there are no concerns about angulation of the implant, while a custom abutment is considered when implant positioning or interocclusal space is a concern.
If conventional or analog impressions are used to take an impression of a standard abutment, an impression coping is placed on top of the abutment. A goopy material is syringed into a tray and then the patient's mouth. Once set, it is removed from the mouth with the coping. An implant analog is placed into the coping and the lab receives this and pours up a stone model. Along the same line with analog dentistry, if a custom abutment is planned, we are taking an impression of the top of the implant fixture, affording the fabrication of a connector specific for each patient. A fixture-level impression coping is placed inside the implant and a similar impression technique is performed. The laboratory technician takes the impression, pours up a stone model and waxes up a custom abutment. The wax abutment is then invested, cast, and polished.
This conventional technnique, which many of us are used to, has many steps that allow for the introduction of potential errors. This has a direct impact on patient care, as we cannot accurately predict the length of crown insertion appointments and the results are inconsistent. In addition, this unknown chairtime can cost our practices a lot of potential lost income.
Let's explore digital dentistry as an alternative. We choose whether we are going to use a standard or custom abutment using our same criteria; this first step does not change. However, from there, digital impressions make for a more accurate and streamlined process. If we decide to place a standard abutment, we use a digital scanner to scan the actual abutment. Here, in the adjacent photo, we used the CS 3500 to take a digital impression of the abutment in the patient's mouth.
The patient presented with three edentulous areas and multiple implants were placed. Standard abutments were torqued into position and the CS 3500 was used to capture the impressions. No setup time was needed for trays, and there was no gagging or clean up.
In the next case, we decided to fabricate a custom abutment which would require a fixture level impression. With analog dentistry, a fixture level impression coping is placed. With digital dentistry, we have the ability to place a scanning body, which is the digital equivalent of a fixture level impression coping.
A couple of caveats: the scanning bodies are implant- and digital lab-specific. In other words, you must request these specifically from the digital lab that you will work with for the specific implant that you placed.
Guided surgery
The latest trend in implant dentistry is to be prosthetically driven when we plan our cases; that is, we need to go to the final result and work backward to plan where we have to place our implants. Guided surgery enables us to do this and place our implants precisely based upon final prosthetic restorations limited by bone morphology. In order for us to do this, we take impressions, pour up models, and plan our cases. We then need to send this along with a CBCT scan to a guided surgery facility. Guides are fabricated and implants placed. We can now shorten the process by using the intraoral scanner to scan our patients instead of using the analog model technique. This STL file is then merged with the DICOM file of the cone beam scan into the implant-planning software to plan our cases.
Digital dentistry is in its beginning stages. The technology is new and exciting, with many uses in dentistry and-more specifically-implant dentistry. It allows for more precision when treating our patients. From guided surgery to abutment and crown fabrication, digital technology provides more exact treatment planning and decreased chairtimes. In the days of trying to maintain and attract new patients, the patient "WOW" factor can't be matched.
Bart Silverman, DMD, is a graduate of Fairleigh Dickinson University in New Jersey. He completed his graduate training from Fairleigh S. Dickinson Jr. School of Dentistry in 1986 where he received his doctorate of dental medicine degree. He completed his residency in oral and maxillofacial surgery at Westchester County Medical Center and served as chief resident in 1989. He currently is board certified in oral and maxillofacial surgery with a private practice in New City, New York. Dr. Silverman is a clinical assistant attending at Westchester County Medical Center in Valhalla, New York.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/using-digital-impressions-for-implants.html
Visit us: http://affinitydentalfresno.net/
15 Jul 2015
Dental implants have been around since ancient times, but new teeth can also fall out
People usually lose their adult teeth because of neglect or a lifestyle or environment that places them at high risk of decay or destructive gum disease. While high-sugar diets can lead to tooth decay, genetics can also increase the risk of bad gum disease, as does smoking and poor glucose control in diabetes patients. If you combine these with inadequate oral hygiene then tooth loss is a real possibility.
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
Destructive gum disease (or periodontal disease as it’s known in dental circles) is the leading cause of tooth loss and is the most common chronic inflammatory disease in humans and almost 50% of the world’s population suffer from periodontitis, where the gums pull away from the teeth and form spaces that become infected and bacterial toxins and the immune system break down the bone and tissue system supporting the teeth.
Replacing lost natural teeth with prosthetic implants secured into the jaw bone is one way to overcome the problem of losing teeth. However, as an NHS consultant who has had to salvage implants that have failed, they may not be the perfect answer you imagine.
Ancient implants
Screw-in teeth are not a feat of modern dentistry. Archaeological evidence suggests the ancient Chinese used bamboo pegs to replace lost teeth. The purpose of these early implants was much the same as today – to restore an aesthetic smile (in life or after death perhaps) – but rather than being made from titanium they were fabricated from other materials. Dental implants have also been dated back to the Maya in 600 AD. Ancient Egyptian and Celtic remains have revealed precious metals, ivory and even other human teeth used in their implants.
A landmark discovery in the bio-engineering of dental implants came in 1952 when Per-Ingvar Brånemark, a Swedish orthopaedic surgeon studying the biology of bone healing, discovered that he was unable to remove implants of pure titanium cylinders that appeared to have integrated with the surrounding bone after healing. The titanium seemed to attract bone formation onto its surface and the term osseo-integration was born.
By the 1960s there was a desire for fixed replacements that were embedded into the jaws, rather than traditional bridges or dentures that sat on the surface. In 1967 “Blade Vent” implants became popular, but with mixed success. These were metal blades that were implanted into the jaw bone and healed with a fibrous capsule between the metal implant and the investing bone. It meant that they were not completely immobile, not truly integrated with the bone and prone to infection, inflammation and implant loss.
It wasn’t until 1981, after 30 years of meticulous research and human studies that Brånemark published his findings and modern implants as we know them were born. The first Brånemark implants were produced as parallel cylinders of titanium which had an external screw thread, so they could literally be “screwed into” the bone. A second generation of meticulously engineered “self-tapping” cylindrical implants appeared in the early 1990s.
Their placement was facilitated by a five-drill bit set with bespoke surgical instruments, along with cover screws, torquing wrenches and all manner of equipment, designed to provide a surgical procedure that no well-trained surgeon could fail to follow. It was essential to attend manufacturer-run training days and become certified to place these implants. In return each implant was guaranteed and replaced free of charge if it failed.
Changing landscape
Over the next decade competitor systems emerged. While some were well researched and manufactured, others were poorly conceived and doomed to create misery for increasingly demanding patients who wanted fast replacements and were prepared to pay obscene amounts of money. Travelling abroad for affordable implants, with no guarantee of any after care, became increasingly an option.
Manufacturers took risks, patients became more demanding, standards fell and the General Dental Council decided not to create a specialist list of trained and accredited implant surgeons. Now there are more than 500 different types of implant available. Patients can be ill-advised, completely unsuited to particular systems or they may simply ignore advice/warnings to travel abroad for “holiday implant surgery”.
The irony
The irony is, however, that dental implants are most likely to fail for the same reasons the teeth were lost in the first place. Implants are far harder to clean than natural teeth due to their narrow cylindrical shape and because the bone grows directly onto the implant surface they lack a periodontal ligament, which provides stem cells and healing proteins that can delay or help resolve inflammation. So if this inflammation starts the implants begin to lose their attachment to the bone. This can be relentless until the implants literally fall out.
The success rates of the original Brånemark implants were 95%-98% over three decades. However, designs changed to satisfy an increasingly demanding market place have changed our definitions of “failure”. Today, a quarter of patients with implants will experience failure of one or more implants within ten to 12 years.
Failure was originally defined as “loss of implant”. However, modern implants support a bridge or denture, and loss of one implant likely means loss of the bridge or denture, so the “proportion of patients who have lost one or more implants” was deemed a more appropriate definition of “failure” meaning a rise in failure rates to 11-12%. After another redefinition of failure as a “progressive loss of bone” around the implant the failure rate rose again to 22-25%. Moreover, the proportion with the early signs of inflammation around their implant – peri-implant mucositis – was 46%.
More importantly, studies have demonstrated that “periodontally hopeless” teeth over a 15-year period out-survive newly-placed dental implants, and protracted treatment to retain molar teeth most severely affected by periodontitis was more cost effective and successfulin terms of “tooth survival” than newly placed implants.
So if retaining teeth is possible, it is significantly preferable to extracting them and replacing with an implant. If planned carefully, placed well and maintained very carefully, implants are still an excellent treatment for missing teeth. However, for patients who have lost teeth to gum disease, who have gum disease, who smoke or who struggle to control their oral hygiene, or for that matter their diabetes, dental implants are a high-risk and high-cost option that may end in tears.
Source: http://theconversation.com/dental-implants-have-been-around-since-ancient-times-but-new-teeth-can-also-fall-out-41465
Visit us: http://affinitydentalfresno.net/
8 Jul 2015
Dental Implants improve lives of Postmenopausal Women with Osteoporosis
It is known that postmenopausal women with osteoporosis have higher risk of losing their teeth, but a new study suggests that dental implants can provide the highest satisfaction in such cases.
The study was conducted by Case Western Reserve University School of Dental Medicine.
According to Leena Palomo, associate professor of periodontics and corresponding author of 'Dental Implant Supported Restorations Improve the Quality of Life in Osteoporotic Women', dental implants may be the best path to take in such cases.
Findings of the research were published in the Journal of international Dentistry. The research is part of a series of studies analyzing dental outcomes for women with osteoporosis.
Researchers surveyed 237 women about their satisfaction with replacement teeth and how it improved their lives at work and in social situations.
The 23-question survey rated satisfaction about work, health, emotional and sexual aspects of their lives.
As per experts, osteoporotic women with one or more adjacent teeth missing were chosen for the study.
The women had gotten restoration work done, like implants, fixed partial denture, which is a false tooth, cemented to crowns of two teeth, a removal denture, better known as false teeth, or had no restoration work done.
Christine DeBaz, a third-year Case Western Reserve dental student, said women with dental implants reported a higher overall satisfaction with their lives.
Fixed dentures were the next best alternative for the highest satisfaction, followed by false teeth and, finally, women with no restoration work.
Women with dental implants also reported the highest satisfaction in emotional and sexual areas, while those without restorations scored the lowest in those two areas, found the study.
Source: http://uncovercalifornia.com/content/25025-dental-implants-improve-lives-postmenopausal-women-osteoporosis
Visit us: http://affinitydentalfresno.net/
The study was conducted by Case Western Reserve University School of Dental Medicine.
According to Leena Palomo, associate professor of periodontics and corresponding author of 'Dental Implant Supported Restorations Improve the Quality of Life in Osteoporotic Women', dental implants may be the best path to take in such cases.
Findings of the research were published in the Journal of international Dentistry. The research is part of a series of studies analyzing dental outcomes for women with osteoporosis.
Researchers surveyed 237 women about their satisfaction with replacement teeth and how it improved their lives at work and in social situations.
The 23-question survey rated satisfaction about work, health, emotional and sexual aspects of their lives.
As per experts, osteoporotic women with one or more adjacent teeth missing were chosen for the study.
The women had gotten restoration work done, like implants, fixed partial denture, which is a false tooth, cemented to crowns of two teeth, a removal denture, better known as false teeth, or had no restoration work done.
Christine DeBaz, a third-year Case Western Reserve dental student, said women with dental implants reported a higher overall satisfaction with their lives.
Fixed dentures were the next best alternative for the highest satisfaction, followed by false teeth and, finally, women with no restoration work.
Women with dental implants also reported the highest satisfaction in emotional and sexual areas, while those without restorations scored the lowest in those two areas, found the study.
Source: http://uncovercalifornia.com/content/25025-dental-implants-improve-lives-postmenopausal-women-osteoporosis
Visit us: http://affinitydentalfresno.net/
5 Jul 2015
Does digital dentistry make you a better dentist?
Gary Kaye, DDS, FAGD
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
Visit us: http://affinitydentalfresno.net/
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
Visit us: http://affinitydentalfresno.net/
Does digital dentistry make you a better dentist?
Gary Kaye, DDS, FAGD
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
Visit us: http://affinitydentalfresno.net/
I am often asked whether or not I believe that the addition of digital dentistry to a practice can make you a better dentist. Unequivocally, I believe that the answer is yes. Now, that does not mean that digital dentistry will replace every process in the office, or that implementing it will immediately change the treatment of patients or automatically improve our level of care.
Like anything in dentistry, there is a learning curve. It takes a certain level of commitment and preparation in order to take proper advantage of such leaps in technology. But, if the correct mind-set is paired with the right advancements, there is little doubt that it makes us better in our profession.
It is very important that the principles of dentistry are considered in order to get the maximum benefit from digital dentistry. We arrive at a correct diagnosis and communicate that diagnosis to our patients. Thus, our patients understand the implications to their oral and systemic health. Furthermore, it gives us the ability to perform the treatment efficiently, cost-effectively, and to the highest standards. When it comes to diagnosis, there is an array of digital modalities starting with digital records, radiographs (both 2-D and 3-D), high-definition intraoral cameras, caries detectors, cancer screening devices, and digital occlusal analyzers that, when applied correctly, greatly improve our diagnostic capability. As for direct interaction with our patients, we now have tools that improve our ability to properly communicate conditions, treatment options, and outcomes. It is, of course, incumbent on us to implement these tools. Many can be delegated to a team member such as an assistant or hygienist.
When it comes to treatment, digital dentistry gives us the option for digital impressions and chairside CAD/CAM milling. This can deliver restorations with the benefit of complete, step-by-step control. We have immediate access to emergence profiles, marginal ridge heights, and precise occlusal stops. In addition, we can send the virtual impressions directly to the laboratory and have unprecedented two-way communication with our lab technician colleagues. This allows us to deliver a better and more consistent restoration, which, among the other benefits of digital dentistry, makes us better dentists.
How does digital dentistry improve patient treatment outcomes at lower costs?
Better outcomes at lower costs is a hot topic in medical care, and as the dental profession moves toward the model of being physicians of the oral cavity and masticatory system, the subject of treatment outcomes at lower costs will be crucial. The links between oral and systemic health continue to emerge and, as a result, we as dentists become more integrated into the public scope of overall health. It is going to be imperative that we be able to deliver better outcomes at lower costs if we are going to adapt to the rising importance of our branch of medicine.
In practice, we have been delivering this model of dentistry for quite some time. We focus on both disease control and eradication of caries with fluoride, as well as periodontal disease, through communication and patient compliance. Improvements in dental materials and techniques give rise to longer-lasting and better-functioning restorations. In line with the goal of producing long-term benefits to our patients, reducing overall caries gives rise to better patient outcomes and lower long-term costs, namely fewer restorations over time.
Digital dentistry fits right in with these principles. We have found that, through improved and more accurate diagnoses using digital modalities, as well as our enhanced ability to communicate, we have better engagement with our patients. The more engaged patients are, the more likely they are to take ownership of their care. This, in turn, leads to better compliance. Digital impressions, computer-aided design, and milling CAD/CAM improve the consistency and quality of restorations, which should lead to longer-lasting-and therefore improved-quality at lower costs. Lastly, our computerized practice management systems allow us to better track outcomes, further enhancing the use of digital dentistry in the modern practice.
Gary Kaye, DDS, FAGD, founder of the New York Center for Digital Dentistry, has practiced comprehensive dentistry in New York City since 1993. He graduated from Columbia University of Dental Medicine in 1993 where he received awards in endodontics, prosthodontics, and geriatric dentistry. Dr. Kaye consults with other dentists and dental manufacturers and lectures on topics including ceramics, occlusion, and digital dentistry. He is on the guest faculty of Planmeca University in Dallas, Texas.
Source: http://www.dentaleconomics.com/articles/print/volume-105/issue-6/science-tech/does-digital-dentistry-make-you-a-better-dentist.html
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26 May 2015
16 Jan 2015
Treat yellow teeth with these easy home remedies
Over time, teeth tend to get yellow. There could be various reasons for this -genes, unhealthy dental hygiene or eating habits or ageing.
Certain medications and dental problems could also be attributed for teeth discolouration. While a trip to the dentist twice a year is recommended, there are also some home remedies that help...
Do the soda
An effective whitening agent is baking soda. Not only will it lighten the colour of your teeth but also remove accumulated plaque. Mix half a teaspoon of baking soda with some toothpaste and brush your teeth with it twice a week. Alternatively , you can also mix a few drops of water with half a teaspoon of bak ing soda and brush your teeth with your fingertips.
Lime n lemoney
Lemons contain bleaching agents, which work well against yellow teeth.You could either use lemon peel extracts to rub on your teeth or simply rinse your mouth with lemon juice mixed with some water.
Apple a day
Some experts also recommend apples to whiten teeth naturally . Chew an apple a day to let the acidic properties of apples work wonders on your teeth.
Berry good
While strawberries aren't in season currently , when they are, you can use them as an effective tooth whitening aid as well. Crush a handful of strawberries and make them into a smooth paste.Rub this paste on your teeth every alternate night.WHITE SALT Notice all those advertisements, which ask whether your toothpaste contains salt? There's a reason behind that. Salt helps clean teeth and also whitens them. Gently rub common salt on your teeth daily to reduce discolouration.
Tulsi talk
Tulsi leaves are also said to be effective against yellow teeth.Grind the leaves into a paste and use it to brush your teeth.
All for orange
Orange peels contain calcium and vitamin C, which fight bacteria in the mouth. They also remove discolouration in the teeth. Scrub your teeth with orange peel thrice a week.
Source: http://timesofindia.indiatimes.com/life-style/beauty/Treat-yellow-teeth-with-these-easy-home-remedies/articleshow/45896777.cms
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from Affinity Dental Fresno http://affinitydental.livejournal.com/34463.html
8 Jan 2015
Do you need to see a dentist twice a year?
Dental professionals have long recommended a teeth cleaning every six months. One expert, Edmond R. Hewlett, a professor of dentistry at the University of California, Los Angeles, explains why a few people can get by with less frequent visits to the dentist, while others should consider going even more often.
The biannual dental visit was designed with the “average” person in mind, Dr. Hewlett says. That means people who are middle-aged, don’t smoke and who brush their teeth twice a day and don’t eat too many sweets. Within six months, the majority of people will produce enough tartar that it will need to be scraped off by a dental hygienist.
Some people may be fine going for longer periods between cleaning. But it’s a category of patient that might seem difficult to qualify for. Typically, these people are in their 20s and 30s who are otherwise healthy, eat extremely well and floss daily, Dr. Hewlett says. For the rest of us, whose dietary indulgences and dental hygiene aren’t so ideal, six months seem a safer bet.
A number of factors might make it a good idea to see a dentist three or even four times a year. People whose diet is rich in sugary foods or drinks should consider more frequent checkups, Dr. Hewlett says. And people who are older, or who have dry mouth, might be more prone to the damage bacteria can cause to teeth, gums and bones.
“As we get older, we start to accumulate more health conditions from the various problems we’ve had over a lifetime, so your risk status will change and usually go up,” says Dr. Hewlett. Dry mouth, which is a common side effect of many medications, means there is less saliva, which makes it easier for bacteria to grow.
Source: http://www.foxnews.com/health/2014/12/30/do-need-to-see-dentist-twice-year/
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from Affinity Dental Fresno http://affinitydental.livejournal.com/34154.html
7 Jan 2015
When It Takes a Dentist’s Chair to Disconnect
I was at the dentist because I had a cracked tooth that I had long put off fixing, partly because my schedule was already brimming over, and mostly because I didn’t really want to have the procedure anyway. After months of stalling, I had finally scheduled the appointment and resolutely blocked out my calendar for the entire afternoon. I was anticipating that afternoon with dread, but I was in for a surprise.
Let me say unequivocally that the dentist’s office was the last place I wanted to be, and certainly the last place I would ever think of as a refuge. But as I reclined in the dentist’s chair, unable to do anything but lay there in a mild stupor thanks to the anesthetics and a pair of busy hands moving around my mouth, I realized with some irony that this was the closest thing I’d had to a vacation in months: no computers, no phone calls, no emails, no smartphones.
Like most parents I know, my day starts early, then careens from a hasty breakfast to packing lunches to dropping off the kids and then on to work. After work, it’s time to pick up the kids, make dinner, supervise bath time, get the kids into bed and then spend an hour or two catching up on work or other tasks that didn’t get done during the day. Before I know it, it’s 10 or 11 p.m. and time to get ready to start all over again the next morning.
I feel very fortunate to have a career and family, demanding as they can be at times. It’s just that I often feel, like many parents, that I barely have time to myself. As a psychologist, I counsel my patients on the importance of having a good self-care routine, but like them, I sometimes find it hard to follow through on this goal consistently. Life gets in the way.
So I was surprised to find an oasis of calm in a most unlikely place: the dentist’s chair.
There was nothing much to do but just be there. Multitasking was out of the question. The most I could do was listen to music or audiobooks. (I chose “Being Peace” by Thich Nhat Hanh, and cranked up the volume as far as it would go so that his soothing voice in my earphones drowned out the whine of the dentist’s drill.)
This realization that I could unplug for several hours for a dental procedure made me ask myself the obvious question: Why not set aside time for myself more often, and in more pleasant circumstances? Why did there have to be a near emergency to take the afternoon off?
To put it more bluntly: If I could lie in a dentist’s chair for several hours, why not a lounge chair?
I notice this same pattern with many of my patients. Everyone today feels busier than ever, and parents especially so. According to the results of a 2013 Pew Research survey, 40 percent of working mothers and 34 percent of working fathers said they always felt rushed, compared with 20 percent of adults without children. Clearly, we parents need a break.
But when it comes to taking time off, we seem ambivalent. Even when we have earned paid vacation time, over half of us don’t use it, and when we’re on vacation, 61 percent of us still work, according to a 2014 survey conducted by Harris Poll.
Time away from our work and other responsibilities may seem like a luxury that we can’t always afford, but consider this: A long-term study found that women who skipped vacations were 50 percent more likely to have heart attacks than women who took time off. For men, the figure was 30 percent.
We run from one thing to the next, rarely stopping to pause or catch our breath unless there is an emergency, illness or something else that simply forces us to stop or slow down. When we repeat this pattern day after day, as many of us do, we are missing out on what life has to offer. We become human doings instead of human beings.
Maintaining this fast-paced, routinized existence is why so many of us feel that, as the saying goes, the days are long but the years are short. To slow down and savor the life that we have requires that we do just that: slow down. To make time for ourselves, our families and our personal priorities beyond the everyday demands of life requires that we have a plan. We must schedule an appointment with ourselves.
Research consistently shows that to have the greatest chance of success in meeting our goals, we have to have a specific plan. If our goal is to have more personal time or more family time, then we must have a specific plan for making that happen, and part of that plan is scheduling the time. That means actually putting it in our calendar, not just thinking about it.
We all have so many demands on our time. If we wait until we have a free moment for ourselves, that moment may never come.
Source: http://parenting.blogs.nytimes.com/2014/12/31/when-it-takes-a-dentists-chair-to-disconnect/
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from Affinity Dental Fresno http://affinitydental.livejournal.com/33916.html
30 Dec 2014
25 Dec 2014
18 Dec 2014
5 Scary Health Conditions Your Dentist Can Spot
The health of your mouth may shine a light on what’s happening in the rest of your body. (Kulka/Corbis)
You expect your dentist to flag cavities, but did you know your drill-wielding doc might also be able to spot trouble that extends well beyond your pearly whites?
“It’s becoming clear that we need to consider integrating oral and general health care,” says Steve Offenbacher, D.D.S., director of the Center for Oral and Systemic Diseases at the University of North Carolina at Chapel Hill. “The oral cavity is the mirror to the rest of the body, so we can pick up on systemic problems by simple dental examinations.” In other words, the state of your smile may shine a light on the rest of your body — sometimes even before other symptoms show up.
Case in point: Offenbacher once told a middle-aged patient he suspected she was pregnant, based simply on the redness of her gums. “The next week, she came back and said, ‘I went to the doctor, and yes, I am pregnant!’’ he recalls. In that case, Offenbacher was the bearer of good news, but not all of the secrets your mouth may reveal are so positive. Your teeth may also provide clues about these five health-threatening conditions:
Diabetes
Your dentist isn’t just worried about how white your teeth are. In a 2014 study, nearly two-thirds of dentists said they’d refer a patient with periodontitis (inflammation around the gums) for a diabetes evaluation. Why that’s a good thing: “Diabetes is not only a common problem, but it’s also highly under-diagnosed,” says Offenbacher. Read: Lots of people have diabetes and don’t know it, which means adding your dentist to your team of health detectives is a smart idea.
So what’s the dental-diabetes link? High blood sugar may be as damaging to your oral health as the sweet stuff in a can of soda. That’s because the condition can cause dry mouth, which increases plaque build-up, making people with uncontrolled diabetes more prone to dental problems.
“[Periodontal disease in diabetics] is usually severe for their age or for local factors, meaning they have pretty clean mouths, but they still have a periodontal problem,” says Offenbacher.
Two common oral signs of diabetes: multiple abscesses on the gums and bad breath. “It’s kind of a sour fruit smell,” Offenbacher says. “It’s ketones — metabolic products associated with poor glycemic control — in their bloodstream that you can smell.”
Heart disease
Your teeth may reveal what’s going on with your ticker. A 2007 study review found that people with periodontal disease are significantly more likely to develop heart disease than folks with good oral health. Among people who have both diseases, “if the periodontal disease is treated, the heart disease is greatly improved,” says Marjorie Jeffcoat, D.M.D., a professor and dean emeritus of dental medicine at the University of Pennsylvania.
The common thread? Inflammation. “When you look in a patient’s mouth and you see chronic inflammation, you know that it’s creating systemic stress,” says Offenbacher.
Although there are no dental red flags specific to heart disease, “more severe periodontal disease is strongly associated with heart disease risk,” Offenbacher says. Signs include loose, shifting, or missing teeth, and increased probing depths, where the pockets around the teeth have deepened.
Dementia
Can tooth loss indicate memory loss? In recent British research, a lack of teeth was associated with mental decline, while a 2012 study found that older adults with poor dental hygiene were 76 percent more likely to develop dementia. This is a relatively new area of research, which means the link between the two isn’t entirely clear, says Jeffcoat. However, a small 2013 study detected Porphyromonas gingivalis — a bacteria associated with gum disease — in the brains of people with dementia, suggesting that it may play a role in the inflammation associated with cognitive decline.
Osteoporosis
Osteoporosis won’t cause your teeth to decay — but your dentist may be able to spot bone loss in the surrounding structures, like the jaw, with digital X-rays, says Jeffcoat. Normal, healthy bone should be dense both at the edges and in the interior, and when that’s not the case, “the patient is more likely to have osteoporosis,” she explains.
In fact, in a 2013 study in the Journal of Research in Medical Sciences, the thickness of postmenopausal women’s jawbones — as measured with a panoramic X-ray — was correlated with the bone density of their spine. This means that dentists could potentially diagnose osteoporosis, which often goes undetected until a fracture occurs, in its early stages, the scientists say.
Acid reflux disease
You may feel heartburn most intensely in your chest, but its effects may be most obvious in your mouth. If you have acid reflux disease, the constant uprising of stomach acid could wear away at the enamel on your teeth, says Jeffcoat. “You’ll usually see it in the lower front teeth,” she says. “You’ll see erosion of the teeth — they get thinner. You can’t miss it.” Another sign you may be suffering from acid reflux disease: You have a persistent sour taste in your mouth, she says.
In a 2008 study review, researchers found that about a third of adults with dental erosion also had gastrointestinal esophageal reflux disease, or GERD. Keep in mind, this erosion can happen even in the absence of chest pain — that is, you may have reflux without knowing it, until your dentist points out the damage to your choppers.
Source: https://www.yahoo.com/health/5-scary-health-conditions-your-dentist-can-spot-105279962062.html
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from Affinity Dental Fresno http://affinitydental.livejournal.com/33145.html
17 Dec 2014
Long-in-the-Tooth Dental Advice
Terry O’Brien, 73, a retired administrative assistant in Billerica, Mass., recently had to make a tough decision about her dental care.
“I always took care of my teeth,” she said. But even so, she was told she needed a crown — an artificial cap — at a cost of about $2,000.
Since she and her husband lack dental coverage, she opted for a less expensive filling. She worries, however, about how she will fund dental care long term. “I’ll make 100, I bet,” she said. “But I wonder how long my teeth will last.”
Older Americans face such situations often, because many people over age 65 lack dental insurance. Only about 10 percent of retirees have dental benefits from their former employer, according to Oral Health America, a nonprofit advocacy group.
And 22 percent of Medicare beneficiaries had not seen a dentist in five years, the Kaiser Family Foundation reported in 2012. The main factor is the cost of care, said Tricia Neuman, a Medicare policy expert with the foundation.
Traditional Medicare, the federal health program for older adults and people with disabilities, doesn’t cover routine dental care or dentures. Some Medicare managed care plans offer coverage, but it is often limited to preventive care like cleanings. Medicaid, the federal-state program for low-income people, may cover some dental care for adults, but benefits vary by state. Individual plans are available, but they typically cap payments at low levels and may not cover any advanced treatments, like implants to replace lost teeth.
That means most older Americans must pay for dental care out of their pockets.
According to 2013 data from the American Dental Association, which surveyed private dentists, the average cost of a basic examination is about $45, while a cleaning is $85. X-rays are another $27; a tooth-colored filling is $149, while a silver filling is about $125. Costs vary widely, however, depending on the market.
Artificial implants average about $4,000 per tooth, the A.D.A. found. But the bill can be much higher, after adding anesthesia and related treatments like bone grafts. Implants involve inserting a metal screw into the jawbone to serve as the foundation for a replacement crown.
Implants are an economic impossibility for some patients, said Beth Truett, chief executive of Oral Health America. But, “If they can afford it, they are a great solution to maintaining not only that tooth, but the teeth around it.” A full set of teeth for an adult is 28 (32 if you still have your wisdom teeth), and you should have at least 22 teeth to eat properly, she said. Once a tooth is lost, nearby teeth bear additional strain and it gets more difficult to chew; that leads to a cycle of poor nutrition and further tooth loss, she said.
Ed Decker, 69, a retired hospital pharmacist in Ashland, Mass., said he had poor dental health his entire life and had budgeted to make dental care a priority. “I think my family was born with marshmallows instead of teeth,” he said. Ultimately, he lost so many teeth he couldn’t chew, and had 10 implants, at a total cost of about $50,000. He was able to pay for it, he said, because of successful investments recommended by his financial adviser. “When you put in an implant, it’s like having a natural tooth,” he said.
Judith Jones, a professor at Boston University Henry M. Goldman School of Dental Medicine and an authority on dental care for older people, recommends that after age 65, the bare minimum level of care needed is a professional examination and cleaning at least once a year. Poor mouth health has been linked to other ailments, like heart disease and diabetes.
Patients should brush at least twice a day for two minutes, she said. If older people aren’t able to do it themselves, family members or caregivers should assist them. Basic mouth hygiene, including daily flossing, is important to maintain healthy gums and remove tartar and plaque, which traps bacteria and can lead to infections.
People also need to be aware of the possibility of being pressured into unnecessary treatment. To find a reputable dentist, you may want to ask your doctor or your friends for a referral. And be skeptical of treatment that sounds overly aggressive. “If you go in and they want to replace every filling in your head, you should get a second opinion,” said Athena Papas, co-head of geriatric dentistry at the Tufts University School of Dental Medicine.
However, she noted, patients who haven’t been to the dentist for several years may have a real need for restoration work, particularly if they are on multiple prescriptions. Some medications can cause a reduction in saliva, which can promote development of cavities.
One way to limit costs for replacement teeth is to have implants on the lower jaw, and use dentures to replace upper teeth, said Dr. Papas; it’s easier to keep upper dentures in place.
Older adults on tight budgets generally should avoid cosmetic treatments like teeth whitening, dentists say. But many dismiss the idea that older people don’t need to spend on oral care because they are near the end of their lives. Patients who are in their 80s, but who are fit and have a healthy lifestyle, can benefit from technologically advanced dental care “because it is estimated that they will have another 10-15 years of life span,” Helena Tapias-Perdigón, an assistant professor at the Baylor College of Dentistry at Texas A&M Health Science Center, said in an email.
Some dental schools offer discounted treatment, although some require deposits and may have waiting lists. The American Dental Association lists accredited schools on its website.
You can also ask dentists if they offer a payment plan. But read the fine print of any discount program, said Jim Quiggle, a spokesman for the nonprofit Coalition Against Insurance Fraud, since some programs offer little in the way of true savings.
Source: http://www.nytimes.com/2014/11/19/your-money/long-in-the-tooth-dental-advice-.html
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from Affinity Dental Fresno http://affinitydental.livejournal.com/32971.html
4 Dec 2014
New recommendations for fighting dental caries
Do you know what the most common chronic disease is affecting American children? It's not obesity. And it's not allergies, though those are good guesses. It's cavities. Or as health experts call them, dental caries.
Well, that's no big deal, right? Dental caries just affect the teeth — teeth that kids are going to lose anyway as they make way for their adult chompers. So why worry?
Dental caries are a big deal. Cavities lead to inflammation and infections that could seriously harm a child's health. And they can affect the growth and development of permanent teeth even before they break the surface of the gums. To combat the recent increases in dental caries, health experts have announced new dental recommendations for kids that they hope will reduce the number and severity of cavities in kids.
Cavities are caused when bacteria sit around in the mouth and start to erode tooth enamel. According to a recent study by the American Academy of Pediatrics (AAP), 59 percent of kids between 12 and 19 have at least one cavity, and poor and minority children are disproportionately affected. A child's chances of getting dental caries depend on a number of factors, namely diet, genetics and oral hygiene.
The AAP recently announced new recommendations for dental hygiene for children, stating that all children should start using toothpaste with fluoride when their teeth appear, regardless of their risk level for cavities. Previously, health experts worried that fluoride toothpaste might be harmful for young children who may be more likely than older kids to swallow the paste. But these new recommendations reflect the view that a small amount of fluoride is necessary to protect teeth and keep kids healthy. The AAP recommends that parents use only a teeny bit of fluoride toothpaste — about as big as a grain of sand — to brush their child's teeth. And that they start doing so as soon as the teeth start popping through the gums.
Talk to your child's doctor or dentist for more information about kids and cavities and the best ways to protect your kids from tooth decay.
Source: http://www.mnn.com/health/fitness-well-being/blogs/new-recommendations-for-fighting-dental-caries
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from Affinity Dental Fresno http://affinitydental.livejournal.com/32761.html
3 Dec 2014
Saliva Really Does Help Protect Teeth From Cavities
Salivary mucins work to actively protect the teeth--what's otherwise known as the cariogenic bacterium. Now, recent findings published in the journal Applied and Environmental Microbiology reveal that bolstering these native defenses could help to fight dental caries instead of simply relying on exogenous materials such as sealants and fluoride treatments.
Lead study author Erica Shapiro Frenkel of Harvard University and principal investigator Katharina Ribbeck, a professor at Massachusetts Institute of Technology, both in Cambridge, Mass., found that the body's natural defenses work in a better way to prevent tooth decay while relaying on external agents such as sealants and fluoride treatments.
"We focused on the effect of the salivary mucin, MUC5B on S. mutans attachment and biofilm formation because these are two key steps necessary for cavities to form," said Frenkel, via Medical News Today. "We found that salivary mucins don't alter S. mutans' growth or lead to bacterial killing over 24 hours," she added. "Instead, they limit biofilm formation by keeping S. mutans suspended in the liquid medium. This is particularly significant for S. mutans because it only causes cavities when it is attached, or in a biofilm on the tooth's surface."
Furthermore, she went to say that the oral microbiome is better preserved when naturally occurring species aren't killed. "The ideal situation is to simply attenuate bacterial virulence," she concluded.
Researchers said they believe that the research makes a fundamental contribution to scientific understanding of host-microbe interactions.
Source: http://www.scienceworldreport.com/articles/18973/20141117/saliva-really-does-help-protect-teeth-from-cavities.htm
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from Affinity Dental Fresno http://affinitydental.livejournal.com/32400.html
27 Nov 2014
Cheese May Prevent Dental Caries, New Study Suggests
According to new research led by Dr Ravishankar Telgi from the Kothiwal Dental College and Research Center, India, consuming cheese and other dairy products may help protect teeth against cavities.
The new study suggests that cheese has the highest anticariogenic property among the dairy products. The image shows cheddar cheese cubes (Guillaume Paumier / CC BY-SA 3.0)
In the study, reported in the journal General Dentistry (paper in .pdf), Dr Telgi’s team sampled 68 participants ranging in age from 12 to 15. The scientists looked at the dental plaque pH in the subjects’ mouths before and after they consumed cheese, milk, or sugar-free yogurt.
A pH level lower than 5.5 puts a person at risk for tooth erosion, which is a process that wears away the enamel of teeth.
“The higher the pH level is above 5.5, the lower the chance of developing cavities,” said co-author Dr Vipul Yadav.
The participants were assigned into groups randomly. Dr Telgi and his colleagues instructed the first group to eat cheddar cheese, the second group to drink milk, and the third group to eat sugar-free yogurt. Each group consumed their product for three minutes and then swished with water. The scientists measured the pH level of each subject’s mouth at 10, 20, and 30 minutes after consumption.
The groups who consumed milk and sugar-free yogurt experienced no changes in the pH levels in their mouths. Subjects who ate cheese, however, showed a rapid increase in pH levels at each time interval, suggesting that cheese has anti-cavity properties.
The findings indicate that the rising pH levels from eating cheese may have occurred due to increased saliva production, which could be caused by the action of chewing.
Additionally, various compounds found in cheese may adhere to tooth enamel and help further protect teeth from acid.
“It looks like dairy does the mouth good. Not only are dairy products a healthy alternative to carb- or sugar-filled snacks, they also may be considered as a preventive measure against cavities,” said Dr Seung-Hee Rhee, spokesperson of the Academy of General Dentistry, who was not involved in the study.
Source: http://www.sci-news.com/medicine/article01165-cheese-dental-caries.html
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from Affinity Dental Fresno http://affinitydental.livejournal.com/32025.html
In the study, reported in the journal General Dentistry (paper in .pdf), Dr Telgi’s team sampled 68 participants ranging in age from 12 to 15. The scientists looked at the dental plaque pH in the subjects’ mouths before and after they consumed cheese, milk, or sugar-free yogurt.
A pH level lower than 5.5 puts a person at risk for tooth erosion, which is a process that wears away the enamel of teeth.
“The higher the pH level is above 5.5, the lower the chance of developing cavities,” said co-author Dr Vipul Yadav.
The participants were assigned into groups randomly. Dr Telgi and his colleagues instructed the first group to eat cheddar cheese, the second group to drink milk, and the third group to eat sugar-free yogurt. Each group consumed their product for three minutes and then swished with water. The scientists measured the pH level of each subject’s mouth at 10, 20, and 30 minutes after consumption.
The groups who consumed milk and sugar-free yogurt experienced no changes in the pH levels in their mouths. Subjects who ate cheese, however, showed a rapid increase in pH levels at each time interval, suggesting that cheese has anti-cavity properties.
The findings indicate that the rising pH levels from eating cheese may have occurred due to increased saliva production, which could be caused by the action of chewing.
Additionally, various compounds found in cheese may adhere to tooth enamel and help further protect teeth from acid.
“It looks like dairy does the mouth good. Not only are dairy products a healthy alternative to carb- or sugar-filled snacks, they also may be considered as a preventive measure against cavities,” said Dr Seung-Hee Rhee, spokesperson of the Academy of General Dentistry, who was not involved in the study.
Source: http://www.sci-news.com/medicine/article01165-cheese-dental-caries.html
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from Affinity Dental Fresno http://affinitydental.livejournal.com/32025.html
25 Nov 2014
Our mouth naturally fights dental cavities
Salivary mucins - key components of mucus found in mouth - actively protect our teeth from the cavity-causing bacterium, a new study has found.
Bolstering native defences might be a better way to fight dental caries than relying on exogenous materials, such as sealants and fluoride treatment, said first author Erica Shapiro Frenkel, of Harvard University.
The bacteria Streptococcus mutans attaches to teeth using sticky polymers that it produces, eventually forming a bio-film, a protected surface-associated bacterial community that is encased in secreted materials, said Frenkel.
As S mutans grows in the biofilm, it produces organic acids as metabolic byproducts that dissolve tooth enamel, which is the direct cause of cavities.
"We focused on the effect of the salivary mucin, MUC5B on S mutans attachment and biofilm formation because these are two key steps necessary for cavities to form," said Frenkel.
"We found that salivary mucins don't alter S mutans' growth or lead to bacterial killing over 24 hours," said Frenkel.
"Instead, they limit biofilm formation by keeping S mutans suspended in the liquid medium. This is particularly significant for S mutans because it only causes cavities when it is attached, or in a biofilm on the tooth's surface," she said.
She adds that the oral microbiome is better preserved when naturally occurring species aren't killed.
"The ideal situation is to simply attenuate bacterial virulence," she said.
"Defects in mucin production have been linked to common diseases such as asthma, cystic fibrosis, and ulcerative colitis," said Frenkel.
"There is increasing evidence that mucins aren't just part of the mucus for structure or physical protection, but that they play an active role in protecting the host from pathogens and maintaining a healthy microbial environment," Frenkel added.
The research was published in the journal Applied and Environmental Microbiology.
Source: http://www.business-standard.com/article/pti-stories/our-mouth-naturally-fights-dental-cavities-114111200599_1.html
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from Affinity Dental Fresno http://affinitydental.livejournal.com/31872.html
20 Nov 2014
Improving oral health for ageing populations
Millions of elderly people across the globe are not getting oral health care they need. Poor oral health amongst older people has been particularly evident in high levels of tooth loss, dental caries and the prevalence rates of other dental disease and oral cancer.
Many elderly people worldwide do not have a full set of teeth. Poor oral health negatively impact on the quality of life of older adults and is an important public health issue which must be addressed by policy-makers. Experts warned that failure to address oral health needs today could develop into a costly problem tomorrow.
Advancing age puts elderly at risk of a number of health problems. As the number of aging population increasing worldwide, it will be a big problem in near future. The burden of oral disease is likely to grow in many developing countries like Bangladesh because of unhealthy diets rich in sugars and high consumption of tobacco.
In many developing countries, the only treatment is tooth extraction in case of pain and problems with teeth. Thus, millions of older people suffer tooth loss. Eventually they live without natural teeth.
As with other health issues, older people have very different oral health needs to children and younger adults. They are more likely to take medication that causes dry mouth, leading to tooth decay and infections of the mouth. More than 400 commonly used medications — many of them for chronic conditions to which the elderly are susceptible — can dry out the mouth.
Oral cancer is another danger that can strike after years of over-consumption of tobacco and alcohol. The incidence of this cancer is rising in places with growing or high tobacco use. In many cases, ill-fitting dentures can reduce a person’s quality of life, for example by impeding their ability to chew.
An unfounded belief by families and healthcare practitioners that tooth loss is inevitable during ageing, lack of education on the importance of oral health and components of dental care, poor access to services and a low dentist-to-population ratio complete the picture.
The World Health Organisation recommends that countries adopt certain strategies for improving the oral health of the elderly. National health authorities should develop policies and measurable goals and targets for oral health. National public health programmes should incorporate oral health promotion and disease prevention based on the common risk factors approach.
Source: http://www.thedailystar.net/improving-oral-health-for-ageing-populations-48420
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