Todd Welch's Posts (31)

Sinus Augmentation

Poor oral function and inferior self-esteem are just a couple of the many difficulties associated with tooth loss. Complete or partial dentures, often the solution to the problem of tooth loss, may not restore oral function completely because of poor fit due to jaw bone deterioration. Bridges, often the solution to single tooth loss, have their drawbacks too, because placing a bridge requires the teeth surrounding the missing tooth to be ground down and compromised.

To improve the aesthetics and function of tooth replacement, dental implants were developed and have gained popularity in recent years. Dental implants are titanium “screws” which are placed in the jawbone replacing the root of the lost tooth. Dental implants provide an alternative to standard removable complete and partial dentures and bridges while improving chewing function almost completely.

The Problem

In order to be a candidate for the dental implant placement procedure, a patient must have sufficient bone height and width to support the titanium post or artificial tooth root. Unfortunately, if a patient has been without a tooth or teeth for a prolonged period of time, the bone that once supported the teeth becomes weakened and deteriorates, resulting in a lack of bone height to sustain a dental implant. This is especially true when tooth loss occurs in the maxillary (upper) jaw bone. Because the maxilla rests against the sinus, when bone loss occurs, the sinus expands to fill the space once occupied by jaw bone.

The Solution

To solve this issue, sinus augmentation (lift) procedures have been developed allowing bone in the upper jaw to be regenerated providing ample space to place a dental implant. The sinus lift procedure, invented in the mid 1970′s has been refined and is now frequently successfully performed. Different versions of the sinus lift procedure have evolved over time, each successful in different cases.

Successful, predictable dental implant placement in the posterior maxilla typically requires a minimum of 10mm of vertical bone height. Moreover, bone density in the posterior maxilla is often poor, which could lead to complications during implant fixation. To address these problems, maxillary sinus elevation surgery was developed to increase the amount of bone available for implant placement and has proven successful and become popular, allowing patients with insufficient bone to undergo dental implant surgery. The type of sinus augmentation that a surgeon chooses to use on a given patient depends on the surgeon’s preference as well as patient anatomy.

Types of Sinus Augmentation (Lift) Procedures:

The Lateral Window Technique (LWT)

Implant placement can be performed simultaneously with the sinus elevation procedure or following a healing period that can last 6-9 months. Immediate placement during sinus elevation reduces overall healing time and eliminates another surgical procedure, which can be desirable to patients. The decision to place an implant during sinus augmentation is dependent on the presence of adequate bone volume and quality to provide for initial stability of the implant. Rosen and colleagues (1999) recommended at least 5mm of native bone for immediate implant placement during sinus augmentation. However, more recent studies have found that implant stability can be achieved with less than 5mm (Peleg 2006).


Lateral Window Sinus Augmentation: The lateral approach involves a modified Caldwell-Luc operation to gain access to the sinus cavity. A bony window is created in the lateral maxillary wall, the Schneiderian membrane is elevated, and bone grafting material is a combination of autogenous bone and allograft. An absorbable collagen membrane is placed between the bone graft and the membrane as well as over the bony window.

This technique is usually the preferred method of sinus elevation in situations of poor bone quality and minimal residual bone height because it allows for direct visualization and accurate bone placement and volume at the position of the implant. Also, tearing of the membrane can be easily treated, minimizing contamination of the graft during healing.

The Crestal Core Elevation (CCE)

The Crestal Core or Crestal Window Elevation technique is an alternative to the traditional Lateral Window technique typically used in Sinus Elevation surgeries. While usually successful, the Lateral Window technique may cause patients to withstand post-operative pain, bruising and swelling. This limitation of the Lateral Window technique may be due to the “blind” nature of the procedure and the lack of visibility when the clinician is manipulating the Schneiderian Membrane and opening the sinus floor. To combat the associated post-op complications, the Crestal Core technique was developed.

The Crestal Core technique for sinus augmentation is reportedly less invasive than the lateral window technique. In an August 2010 study posted in the Journal of American Periodontology, 45 patients who had undergone the CCT were retrospectively evaluated over a 1-11 year period of time. The Crestal Core technique was successful in 31 of 45 sites (68.9%) and partially successful in 6 sites (13.3%). Surgical failures were reportedly due to core detachment which resulted in large tears of the sinus membrane. Implants placed in successful sites presented 100% survival rate during the duration of the study.

The conclusion was made that the Crestal Core Technique, when implemented simultaneously with molar extraction provided therapeutic benefits to the patient post-operatively. The subsequent dental implant placements using CCE showed a fantastic survival rate as well in the evaluated population.

The Crestal Window approach to sinus augmentation is simple, predictable technique which results in very low patient morbidity. It is, therefore, a suitable alternative to traditional sinus augmentation, giving clinicians a choice of techniques when approaching cases of varying degrees of difficulty and complication. The Crestal Core Technique may be the best option for elevating the sinus for many patients.

The Osteotome Technique (Summers Technique)

One of the more conservative methods of sinus elevation is the Osteotome or Summers Technique. This technique involves sinus elevation immediately followed by dental implant placement. During the osteotome technique, a tiny hole is made in the jaw bone and bone grafting material is inserted into the area between the sinus floor and the bone, increasing the distance between the sinus and the jaw. This technique allows for immediate implant placement and allows for shorter post-treatment waiting times. The Osteotome technique is considered one of the least invasive of the sinus augmentation techniques.


Balloon Sinus Elevation

The minimally invasive Zimmer Sinus Lift Balloon allows for improved vertical sinus elevation results and gives clinicians added security when performing a traditional lateral wall sinus lift procedure — protecting the Schneiderian membrane from tearing, which can significantly disrupt an implant case. The balloon instrument is also well-suited for effectively measuring the required bone grafting material. For example, 1cc of saline, which is used to inflate the balloon, is equal to 1cc of grafting material.




The Zimmer Sinus Lift Balloon is available in three convenient, single-use configurations for optimum efficiency and ease-of-use. The angled design is ideal for lateral window procedures, the straight model is well suited for a crestal approach, and the popular micro-mini design can be used for either of these indications.


Numerous studies have shown that dental implant survival rate is higher in patients whose dental implants were placed in grafted sinuses than the dental implants placed without sinus lifts. The sinus augmentation procedure provides a way to increase the amount and quality of available bone and allows for the placement of longer implants, leading to increased stability. Many different techniques exist for effective bone augmentation below the sinus, a few of which were discussed earlier in this report. Which approach is used is largely dependent on the extent of the patient’s bone loss and the specific procedure that is slated to be performed for the dental implant and final restoration. Given the many options available for sinus augmentation, it stands to reason that only a highly trained dental specialist can decide which procedure is the most suitable option for proper, successful treatment.

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Top 10 Dangerous Toothpaste Ingredients


Even though toothpaste (in some form or another) has been around as long as the Ancient Greeks have, the formula (as we know it) did not become popular until World War I. As soon as companies began manufacturing toothpaste, people began to purchase the magical concoction – guaranteed to produce glistening teeth! White teeth were all the rage after World War I had ended, and toothpaste quickly became a product that most people simply couldn’t live without.

Toothpaste is one item that nearly everyone uses today, but what makes this concoction so special? Whether you brush your teeth once per day or three times per day, chances are that you’ve never taken the time to read that ingredient list. Some believe that the ingredients contained in a standard package of toothpaste are essential – others believe that water may be just as effective. In the end, there’s a good reason why most toothpaste packages warn: “Do Not Ingest!”

10. Formaldehyde


That same ingredient that coroners can’t live without can be found inside of your toothpaste tube. Formaldehyde kills all of those small bacteria that climb onto your teeth after eating or sleeping. If a large amount of formaldehyde is accidentally ingested, the result could be fatal. Severe formaldehyde ingestion results in jaundice, kidney damage, liver damage, and death.

9. Detergent


Foam, suds, activation! What would toothpaste be without that satisfying soapy feeling? Manufacturers use regular detergent in order to appease the masses that prefer bubbly toothpaste. While bubbles may be fun, be careful if you accidentally ingest a large amount of this stuff – swallowing detergent can cause digestive tract burning.

8. Seaweed


Stretchy and slimy, seaweed holds that paste together. Without this green stuff, toothpaste would simply fall apart! The good news is that seaweed isn’t toxic. In fact, seaweed has a number of nutritional benefits, though hitting the sushi bar is a better way of gaining those benefits.

7. Peppermint Oil

peppermint oil

Minty, minty, minty! Fresh breath can only be kept fresh with the help of peppermint oil! While refreshing when brushing your teeth, peppermint oil can cause a slow pulse, heartburn, and muscle tremors if it is consumed.

6. Paraffin


As slick as the petroleum that it is derived from, paraffin creates a smooth paste that oozes onto your toothbrush. As you might imagine, paraffin wasn’t meant to be eaten. If you happen to swallow this ingredient, you may end up with abdominal pain, nausea, vomiting, and severe constipation.

5. Glycerine Glycol


Never heard of this ingredient before? Sure about that? Glycerin glycol is added to toothpaste in order to prevent the paste from becoming too dry – it’s also found in antifreeze. Even though glycerin is not toxic, this additive may cause nausea if swallowed.

4. Chalk


That’s right – chalk. Thanks to the fact that chalk is made from exoskeletons, it’s hard enough to remove all of that caked on gunk from your pearly whites. Chalk dust may cause lung problems if inhaled, and swallowing a bit of chalk could cause bleeding.

3. Titanium Dioxide

titanium dioxide

This is another common toothpaste ingredient, though it’s usually found in white paint. When added to toothpaste, titanium dioxide has the safe effect on your teeth as it does on walls – it keeps them nice and white (for a few hours, at least!). Ingesting titanium dioxide won’t hurt you, but it isn’t recommended either.

2. Saccharin


Something has to combat that terrible detergent taste! Saccharin is sweet, but not too sweet – just the way that most people like their toothpaste! Saccharin has been a hot topic of debate every since Theodore Roosevelt was in the White House. The USDA tried to ban the substance in 1972, though it is considered “safe” to ingest today.

1. Menthol


One last ingredient to add a minty note to your breath. Without menthol, toothpaste might taste like, well, chalk, glycerin, paraffin, detergent, titanium dioxide, and seaweed! Go ahead and ingest menthol if you like, but sipping some tea containing menthol is a far better idea than chewing on your tube of toothpaste.

My advice is to always buy toothpaste that has the ADA seal of approval on the box and has fluoride as an active ingredient.

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Glucometer testing is a simple means of determining the blood glucose level at the time the test is taken. After the discovery of insulin in the early 1900s, glucometer testing has probably done more to save lives than any other device in diabetes care. Because glucometer testing is so simple, people are willing to keep track of their glucose levels much more frequently and consistently. Some people with diabetes check their blood sugar five or six times a day, especially those taking insulin.

Right now, glucometers are not accepted as a means of screening people for diabetes but this could change in the future. If the American Dental Association (ADA) decides that glucometers are a great screening tool and dental offices are a good health care setting to do it in, then that’s wonderful. There is some hope that the ADA will look at dental offices and decide that it might be a good place to screen patients, especially those who may have some oral sign or symptom of undiagnosed or poorly controlled diabetes. I do not think it’s appropriate to test every dental patient for diabetes with a glucometer because of the cost. Instead, dental offices should look for signs and symptoms of undiagnosed diabetes and refer the patient to a physician for formal evaluation and testing.

Usually new medical history forms are done every 6 to 12 months in most dental practices. Patients should always be asked if they are taking any new medications before treatment is started each visit. In my opinion, patients who take insulin should test their blood sugar before treatment begins in the dental office. The risk of hypoglycemia is higher in any patient who takes insulin—always—so getting a baseline pretreatment glucose level is important. If the patient is taking oral medications instead of insulin, the risk of low blood glucose is reduced. Risk is also affected by which drug class the patient is taking since some oral agents are more likely to cause hypoglycemia than others.

Glucometers are generally quite accurate in determining blood sugar levels, within 10% to 15% of a plasma laboratory test level. There is a difference between the glucometer test and an actual laboratory blood test. The results will be different because the glucometer test is done from capillary blood pricked from the finger and a blood test is from venous blood. The capillary blood results typically show lower levels of blood sugar than the plasma derived from whole-venous blood.

If I have a long treatment planned and the patient’s glucose level is either below the average level or even at the lower end of normal, I will give the patient glucose before I start. I generally give about 4 ounces of juice, which raises most people’s glucose level by about 25 mg to 30 mg/dl.

If on the other hand, the person’s glucose level is above normal or at the higher end of normal, then I usually will not increase his or her glucose level. I will also pause mid-way through a long treatment to have the patient take his or her glucose level again just to make sure it has not decreased to a level that could cause hypoglycemia.

If a dental office elects to purchase a glucometer to test patients’ blood glucose, the dental office is now classified by the government as a medical laboratory. This is a federal law that most dentists are completely unaware of.

The law is called the Clinical Laboratory Improvement Amendment (CLIA). It was originally passed in 1988 and has been modified several times since then. CLIA is a federal quality control law that monitors medical laboratories to make sure they are doing quality controls on their equipment. The government views in-office testing as needing quality control procedures in place to assess the data because treatment decisions are made based on the quality of data gathered with in-office testing. So a glucometer is considered a laboratory testing device. Because of this, medical and dental offices that use glucometers fall under CLIA. If a physician wants to check a patient’s cholesterol with an in-office finger stick test, his or her office is now a medical laboratory. Most physician offices actually are labs. CLIA covers almost 200,000 labs in the United States and most of those aren’t actually medical laboratories. So the dental offices that keep a glucometer in their office fall under CLIA, meaning they need to be essentially approved by the government. This sounds like an onerous burden but it is actually a simple process.

Dental offices need to visit the Centers for Medicare and Medicaid Services, Health and Human Services’ website,, to get a CLIA certificate. Click on “CLIA: Clinical Laboratory Improvement Amendments” under the heading “Policies/Regulations” to find the CMS Form 116. This form is used to apply for a CLIA certificate, which registers the dental practice as a laboratory. While the form looks intimidating, most of it does not apply to the dental office using a glucometer. The dental office notes on the form that it wants to perform glucometer testing in the office to check glucose levels before and during dental treatment. Glucometer testing is called a CLIA waived procedure. So the dental office is registered as a lab to do a procedure that is actually exempt from the act. While it seems confusing, it’s really not.

The dental office becomes a CLIA waived lab, which allows the office to use its glucometer to check patients. The glucometer has to be tested using the control solutions that come with all glucometers, to make sure that the results are accurate. The waived lab designation costs $150 every 2 years. The dental office does need to post the CLIA waiver certificate that Health and Human Services will send to the office, just like licenses have to be posted.

The number one barrier to dental offices doing glucometer testing in their office is CLIA. The CLIA is not a big burden but it is a paperwork exercise, which turns many dentists off.

I think it’s good for dental offices to have their own, at least as a backup to the patients’.

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HowStuffWorks: Invisalign Braces

Invisalign braces are the most modern technology used in orthodontics, redefining orthodontic treatment. Invisalign straightens your teeth by using some plastic “mouthguard” like trays, you change every 2 weeks, for as long as needed till the end.

Any orthodontics treatment starts with the initial consultation and this doesn’t break the rule. Your orthodontist will check you with great care and, should you “qualify” for Invisalign, you’ll be ready to undergo the first step to the trays: your molds. For the Invisalign specialists to really be able to create your patient specific trays, they will need to obtain perfect dental impressions. So, don’t be scared if your orthodontist is that determined to have them perfect. They are needed this way, since your entire treatment for all these months will depend on them. At Align Technologies your impressions, the information about the course of treatment and all other initial materials, will be taken by other orthodontic specialists. They will make a positive out of your dental impressions; the plaster molds helping them see your teeth in their normal form. Because your orthodontist was so careful with those impressions, now, the Align Technologies specialists almost have your “teeth” there, and you won’t have to travel thousands of miles just so they can also do your consultation.

The plaster models are checked again and cleaned. Any residue or imperfection is manually checked and solved, so that the plaster can enter the other stage: 3D processing. State of the art scanners are able to create a three dimensional version of these plasters, and these can now be processed on the computer. A barrier coating is applied to protect it from the possible damage it can take on the next stage. Once sealed, the models get placed into a chase, then in a mixture of urethane resin and hardener. They spend some hours in a vacuum pressure chamber the resin hardens and makes them look as blocks. Each tray gets into a destructive scanning machine. This removes paper thin slices 3000 of an inch, while a digital camera takes two dimensional images of each of these slices. The computer gathers more than 300 such images to create the 3D model.

These materials get sent to the technicians, who check once again if all is correct, the teeth and also the bite as the patient has it. The graphic designers will use a proprietary 3D application to cut each tooth and save it as a separate geometrical unit. The teeth are now separated and re-grouped on each arch in the position they will have once the treatment is complete. From the initial stage to the final result, there are many intermediate stages that make up the entire treatment. These are carefully considered since the treatment is different for each patient and the entire orthodontic process needs time. As in traditional braces case, we cannot have straight teeth over night, so all these stages are just the normal tooth movement created with each aligner till the teeth are straight and the bite corrected.

The quality check process is next, so that all the process, the teeth movement, prescribed treatment etc. are correct. The orthodontist who takes care personally of the patient is the one to decide if the treatment is a “go-go”, together with the patient him/herself. This application form is called “clincheck” After all the treatment was checked and approved the aligners will be created. A series of models are created of photo sensitive thermo plastic, each of them will then be turned into an aligner. The thermo plastic sheet is pressed over each model by the use of heat. Trimming comes next so that the aligners come half a millimeter under the gum line, reducing the chances of sores and making the removal easier for the patient.

The aligners are polished and disinfected in a series of cleaning tanks, each set being then packaged, labeled and shipped to the prescribing orthodontist.

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Teeth Whitening Procedures, Risks, And Prices

In the blossoming world of cosmetic dentistry, teeth whitening procedures reign supreme. Universally valued by men and women alike, whitening (or bleaching) treatments are available to satisfy every budget, time frame and temperament.

Whether in the form of one-hour bleaching sessions at your dentist's office, home-use teeth bleaching kits purchased at your local drugstore or teeth whitening toothpastes; teeth whitening solutions abound. Yet only 15 percent of the population has tried the cosmetic procedure, and misinformation on the subject is rife.

The long and the short of it is that teeth whitening works. Virtually everyone who opts for this cosmetic treatment will see moderate to substantial improvement in the brightness and whiteness of their smile. However, teeth whitening is not a permanent solution and requires maintenance or "touch-ups" for a prolonged effect.

Bleaching vs. Whitening

According to the FDA, the term "bleaching" is permitted to be used only when the teeth can be whitened beyond their natural color. This applies strictly to products that contain bleach – typically hydrogen peroxide or carbamide peroxide.

The term "whitening," on the other hand, refers to restoring a tooth's surface color by removing dirt and debris. So any product that cleans (like a toothpaste) is considered a whitener. Of course, the term whitening sounds better than bleaching, so it is more frequently used – even when describing products that contain bleach.

There are various dental tooth whitening procedures to help people fulfill their cosmetic desire. The following reveal the three most prominent types of dental tooth whitening:

In Office Tooth Whitening

Significant color change in a short period of time is the major benefit of in-office whitening. This protocol involves the carefully controlled use of a relatively high concentration peroxide gel, applied to the teeth by the dentist or trained technician after the gums have been protected with a paint-on rubber dam. The teeth are cleaned first and a protective gel is applied around the mouth to protect the soft tissues. Next, a special gel containing peroxide is applied over the teeth and a light is used to activate the gel. The gel penetrates the enamel and releases certain compounds, turning your teeth white and bleaching it in the process. This is called laser teeth whitening. Side effects including sensitivity may exist but only for a few days, after which it subsides. Generally, the peroxide remains on the teeth for several 15 to 20 minute intervals that add up to an hour (at most). Those with particularly stubborn staining may be advised to return for one or more additional bleaching sessions, or may be asked to continue with a home-use whitening system. The two most popular in office tooth whitening systems are the ‘Zoom Whitening System ‘and ‘Britesmile’.


In-office teeth whitening cost: $650 per visit (on average) nationwide.

Professionally Dispensed Take Home Whitening Kits

Dental whitening can also be achieved with the help of trays and kits dispensed by dentists. Many dentists are of the opinion that professionally dispensed take-home whitening kits can produce the best results over the long haul. The whitening gel is kept in place over the surface of the teeth with a tray worn over the teeth. Different types of trays are available; one size-fits-all tray or custom made trays specially made for each patient. The custom trays are obviously more effective since they provide the correct fit and keep the gel in contact with the teeth to be bleached. In this method the gel usually used is 10-15% carbamide peroxide. The tray is advised to be worn for a particular amount of time accordingly. Take-home kits incorporate an easy-to-use lower-concentration peroxide gel that remains on the teeth for an hour or longer (sometimes overnight). The lower the peroxide percentage, the longer it may safely remain on the teeth. The two most popular take home tooth whitening kits are Opalescence, Dash, NiteWhite, and DayWhite.


Take-home teeth whitening kit cost: $100 to $400.

Over The Counter Whitening

The cheapest and most convenient of the teeth whitening options is over-the-counter teeth whitening. In many cases this may only whiten a few of the front teeth unlike custom trays or in-office teeth whitening that can whiten the entire smile. Here are the three most common over the counter teeth whitening products:
  • Tooth Whitening Strips: Out of the other effective teeth whitening procedures available, tooth whitening strips may be the most economical. Most of these strips are available commercially, over the counter. The effectiveness of the result achieved depends on the brand used. These strips contain peroxide of a low concentration 6-15%, and should be worn for about an hour once or twice a day for a particular number of days. It is said to achieve a shade three times lighter than that of the teeth originally present. The strips are generally comfortable when worn and may produce only mild difficulty while talking.

  • Tooth Whitening Toothpastes: Tooth whitening toothpastes seem to be one of the easiest dental tooth whitening types and are available over the counter. They are used just like normal toothpastes and may cost a little higher than the regular toothpaste. However they are not very effective and do not cause any obvious whitening effect on the teeth; though they function as well as any other toothpaste. The disadvantage may lie in the case of overeager individuals who may brush vigorously and many times a day hoping to achieve a productive result, which may do more harm than good to their teeth.
  • Tooth Whitening Chewing Gum: Most commonly advertised are tooth whitening chewing gums which contain bicarb soda, also used in the tooth whitening toothpastes. May be considered the best teeth whitening products available since they are easy to use. They do not contain any bleaching agent as that used in normal bleaching systems which are more effective. The gum should be chewed for around 20mins each, four times a day. Any difference in shade would take up to four weeks to appear.

Over-the-counter teeth whitening cost: $20 to $100.

Hydrogen Peroxide vs. Carbamide Peroxide

The bleach preference for in-office whitening, where time is limited, is powerful and fast-acting hydrogen peroxide. When used in teeth bleaching, hydrogen peroxide concentrations range from approximately nine percent to 40 percent.

By contrast, the bleach of preference for at-home teeth whitening is slower acting carbamide peroxide, which breaks down into hydrogen peroxide. Carbamide peroxide has about a third of the strength of hydrogen peroxide. This means that a 15 percent solution of carbamide peroxide is the rough equivalent of a five percent solution of hydrogen peroxide.

Teeth Whitening Risks

Teeth whitening treatments are considered to be safe when procedures are followed as directed. However, there are certain risks associated with bleaching that you should be aware of:
  • Sensitivity: Bleaching can cause a temporary increase in sensitivity to temperature, pressure and touch. This is likeliest to occur during in-office whitening, where higher-concentration bleach is used. Some individuals experience spontaneous shooting pains down the middle of their front teeth. Individuals at greatest risk for whitening sensitivity are those with gum recession, significant cracks in their teeth or leakage resulting from faulty restorations. It has also been reported that redheads, including those with no other risk factors, are at particular risk for tooth sensitivity and zingers. Whitening sensitivity lasts no longer than a day or two, but in some cases may persist up to a month. Some dentists recommend a toothpaste containing potassium nitrate for sensitive teeth.
  • Gum irritation: Over half of those who use peroxide whiteners experience some degree of gum irritation resulting from the bleach concentration or from contact with the whitening trays. Such irritation typically lasts up to several days, dissipating after bleaching has stopped or the peroxide concentration lowered.
  • Technicolor teeth:Restorations such as bonding, dental crowns or porcelain veneers are not affected by bleach and therefore maintain their default color while the surrounding teeth are whitened. This results in what is frequently called "technicolor teeth."

In Closing

In addition to the aforementioned risk factors, a number of caveats should be considered before undergoing teeth whitening:
  • No amount of bleaching will yield "unnaturally" white teeth.
  • Whitening results are not fully seen until approximately two weeks after bleaching. This is an important consideration if you are about to have ceramic restorations and want to be sure the color matches that of your newly bleached teeth.
  • If cosmetic bonding, porcelain veneers or other restorations are part of your treatment plan, they should not be placed until a minimum of two weeks following bleaching to ensure proper adhesive bonding, function and shade matching.
  • To avoid the technicolor effect, tooth-colored restorations will likely need replacement after bleaching.
  • Recessed gums often reveal their yellowish root surfaces at the gum line. That yellow color has proven difficult to bleach.
  • Pregnant or nursing women are advised to avoid teeth whitening. The potential impact of swallowed bleach on the fetus or baby is not yet known.
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Ozone Dentistry: What Is Dental Ozone Therapy

When you hear the word ozone, the first thing that many people think of is air pollution. Yet ozone protects us from harmful sunlight that causes skin cancers. In fact, many critically important uses of this powerful, naturally-occurring gas are not so well known, but they serve us every day.Major cities throughout the U.S. and the rest of the world use ozone to sterilize their public water systems, and ozone is commonly used to sterilize the fruits and vegetables we eat and the bottled water and sodas we drink. It's used in air purification systems, commercial laundries, and swimming pools and spa baths.

The medical community — especially in Europe — has been using ozone for decades to speed up wound-healing and to treat a variety of diseases. Most of the original research was carried out in the U.S. and Europe in the early 1900s.

Controlled ozone application has been found to be extremely safe and free from side effects — far freer than most medications, including antibiotics. What could be more natural since our own bodies produce ozone at the white-cell level to kill offending microorganisms? The ozone molecule is the most powerful agent that we can use on microorganisms. It is deadly to bacteria, viruses, and fungi, yet the more highly evolved human cells are not damaged by ozone in lower concentrations. Ozone's pioneering use in dentistry naturally followed.

Reversing cavities

Another way of looking at ozone is to see it as an activated, excited form of oxygen. The highly unstable ozone molecule (O3) wants desperately to kick off one oxygen so it can return to the more stable O2 molecule. So, does that powerful reaction drive oxygen beneath the surface of a tooth through the tubules and kill bacteria in early decay? Does that essentially start a process that removes bacterial waste products, halts dental cavities, and begins a process of repair via accelerated remineralization? Dr. Ed Lynch and Dr. Julian Holmes, coauthors of the book, “Ozone, the Dental Revolution” (Quintessence 2004), say an unqualified “yes.”

Dr. Lynch has been researching ozone for decades and has been involved in almost 100 studies on ozone's effectiveness. One of cosmetic dentistry's pioneers, Dr. Ray Bertolotti, has been touting Dr. Lynch's work for years. The KaVo Company has manufactured a dental ozone delivery unit called the HealOzone, and it is being used by dentists all over the world.

Millions of patients have already been treated with the HealOzone worldwide, and not a single adverse side effect has ever been recorded. Estimates are that there are over 100 HealOzone units currently in use in the U.S.

Originally, the HealOzone unit was about to receive approval as a medical device, but then the FDA decided to treat ozone as a new drug and started the slow approval process all over again. This has stymied sales of the units in the U.S. There is a common misconception among dentists that using ozone in their practices is illegal. Actually, ozone has been grandfathered into usage in the medical and dental world because it was in use before the 1906 Pure Food and Drug Act.

There also have been rulings specifically permitting ozone use, most notoriously with the Dr. Atkins case. We can select many materials for use in our dental practices that have not had FDA approval, such as hypochlorite for endodontics. So FDA approval is not necessary and it is completely legal for dentists to use ozone.

Dentists Phil Mollica and Robert Harris have set up training here in the U.S. to teach other dentists the science of ozone, as well as its applications for their dental practices. They already have trained 150 dentists here in the U.S.

Dr. Julian Holmes from England and South Africa also regularly travels to North America to teach and train dentists in the use of ozone in modern dental care.


Uses in dentistry

Lime Technologies is a new international company with a mission to bring ozone and ozonated products not only to the dental world, but also to other types of practices including veterinary science, skin care,home, and recreation, and to help the HIV-infected community. Ozone, for instance, is ideal to treat diabetic foot ulcerations and the intractable MRSA infections.

Lime Technologies made their official U.S. debut at the IAOMT meeting in February. Estimates are that many hundreds of dentists in the U.S. are now treating patients with ozone, utilizing it in a wide variety of areas including periodontal therapy, decay therapy with remineralization of early lesions, root canal treatment, tooth sensitivity, canker sores, cold sores, bone infections, and more.

Most minimally invasive

Cavities develop as the environment below the surface of the tooth becomes acidic. Ozone not only kills the acid-making bacteria, it also neutralizes their acidic waste. This creates a new environment that is hostile to the bad streps and lactobacilli that love the acid niche. A new environment allows healthier bacteria to replace the bad ones. If we just kill off the bacteria, they're back in weeks. But if we get rid of their acid niche, they are gone for two to three months. Ozone treatments at this interval just might keep teeth decay-free indefinitely!

Allowing repair

The new environment that occurs following the bio-chemical change in the lesion allows minerals to flow back into the tooth, hardening and reversing the effects of decay. Early cavities can heal. The minerals to assist this repair can come slowly from the saliva or much quicker from mineral-rich solutions soaked into the teeth following the ozone treatment. Research seems to indicate that once a tooth is remineralized, it is very unlikely the decay will come back. Multiple ozone treatments over a period of months can improve chances even better.

Now we have to be realistic here. If your tooth has a big hole in it, ozone isn't going to regrow that tooth structure. Not even the tooth fairy can do that! But if there is still structure remaining in the earlier phases of attack, that structure can harden. That cavity can heal, and ozone can be a big contributor to this process. Fluorides help; cleaning helps. But these modalities may not be enough compared to the power of ozone.

To improve the chances of staying cavity-free, we can seal challenging grooves of the teeth with glass ionomer such as the fluoride-rich Fuji Triage. To speed up mineralization, we also recommend the use of calcium-rich MI paste Plus or products containing Novamin (GC America). Novamin's remineralizition potential shows strong promise, and it is readily accepted by families that prefer an alternative to fluoride.

Dental ozone can also be used regularly to comfortably and immediately eliminate canker sore pain. Patients are now who seeking out dental ozone treatment at the earliest sign of a developing canker sore or cold sore. You only have to treat patients once to make a believer out of them. Meanwhile, some dentists are also using ozonated water and oils in their practices while they guide their patients to use them at home as well. Mixed into water or plant extracts, ozone allows dentists and patients to use a mouth rinse or agent that eliminates mouth infections, promotes healthy gum tissue, and accelerates surgical healing.

Differences of delivery

The KaVo HealOzone only delivers the active gas once a seal has been made with the silicone cup at the end of the handpiece. Then, and only then, will the 2,000 ppm concentration of ozone flood the area inside of the cup. If the seal breaks, the ozone ceases to flow, and any ozone that remains in the cup is vacuumed back into the main unit where it is broken down into pure oxygen that is released back into the room.

The new Lime Technologies CMU3 dental ozone unit utilizes an unrestricted free flow of ozone that requires no seal. This makes it much less complicated to deliver ozone to the teeth and oral tissues that previously presented a challenge in sealing with the HealOzone. The CMU3 utilizes a lower concentration of ozone, and hence, a slightly longer exposure protocol. It is simply used with our normal high speed suction to rid the oral air of overflow ozone.

We can now bathe carious teeth in ozone and also deliver it directly deep into periodontal pockets and root canals. Full-mouth trays can also be fabricated to bathe entire arches in ozone to offer efficient, rapid therapy for early cavities and gum disease. We are just scratching the surface of this powerful technology. Look for even more radical potential uses in the years to come as ozone tackles systemic disease and modulates the immune system.

Cosmetic dentists should take note that we have also used ozone to whiten teeth. Ozone sends activated oxygen below the enamel surface, much the same way as the dental bleaches. So now imagine a day when patients come to the dentist's office and receive a whole-mouth ozone treatment to whiten their teeth, control their gum disease, and reduce carious activity. That day is upon us, and these treatments are happening in thousands of dental offices around the world and in hundreds of offices in this country. Dental ozone is right here, right now, and poised to make us look at traditional dentistry with a new set of eyes!

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Tooth Jewelry Adds Flash To Your Smile

People have worn gold, silver, and jewels in their ears, nostrils, eye brows, and belly buttons for years. It should come as no surprise that the next place to flash some jewelry is in your smile. Tooth jewelry has been very popular in Europe for years and is just starting to become popular in the United States.
Tooth jewelry is bonded to the enamel of a tooth. The tiny spot where the jewel is placed is etched to make the surface microscopically rough. Some bonding liquid and a drop of dental composite are then bonded with the jewel onto the surface of the tooth. The process is quick, simple, and painless.

Tooth jewels come in many shapes and stones. There are gold and white gold jewels with designs such as, stars, hearts, motor cycles, crosses, golf balls, butterfly’s, etc.. Jewels come in many colors including, amethyst, blue, pink, white, and red.

Dental jewelry is subtle, but certainly will get you some attention, or at the very least, help you start a conversation when you smile. For dental hygienists, the latest trend in tooth jewelry might lead to increased visits from patients. That's because without professional application and appropriate dental hygiene, these hot new itty bitty bits of sparkly bling could lead the way to increased dental damage.

The reason? Bacteria and plaque can build up around tooth jewels, irritating the gums, which as any dental hygienist can tell you is the first step towards dental decay.

From Grills to Tooth Jewels

While it may come as a surprise to some, tooth jewels have been designed to be less problematic than those other trendy dental accessories, dental or mouth grills. Since most mouth grills cover the whole tooth and often come into contact with the gum line, they have already been identified as a serious dental hygiene concern by the American Dental Association. That's because even though the owners must practice scrupulous dental hygiene and regularly clean the grills, most people don't.

Are Tooth Jewels Safer Than Dental Grills

The new dental jewels are not yet listed on the ADA Web site as potential dental hygiene risk; however, smaller tooth jewels, which are applied to the teeth with a specialized adhesive, are still quite new. And, while there are tooth jewel kits that people can use to install them at home, it is best to consider having your dentist install them (after seeing a dental hygienist for a thorough cleaning of course) to ensure they are properly fitted and are securely adhered, reducing the risk for potential tooth damage and decay.

The Best Bling: Regular Care From A Dental Hygienist

While mouth grills and tooth jewels may look like fun accessories, those looking to have true mouth bling might consider more regular trips to the dental hygienist for cleanings as they can cause damage to teeth. After all, a bright, clean, healthy smile - the kind of smile that comes from top notch dental hygiene - is tough to beat.

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The Truth About Trench Mouth


Acute Necrotizing Ulcerative Gingivitis (ANUG), more commonly known as “trench mouth” for its common occurrence among soldiers in the trenches during World War I, is a painful gum disease caused by the gram negative bacteria known as spirochetes.

Trench mouth is commonly associated with stress and acute anxiety, which, for teens, can take place around exam times, but it can occur in anyone going through an acute period of stress — if the underlying conditions are right.

It is often associated with an underlying or pre-existing minor gingivitis in individuals who may have not been taking good care of their oral health, brushing, flossing and getting regular dental checkups and cleanings. ANUG is also commonly associated with smoking, which seems to dry the mouth and change the bacterial flora — the normal bacteria that reside in the mouth, and is even necessary for health.

Trench Mouth Symptoms:
  • Severe gum pain
  • Bleeding from gums when they're pressed even slightly
  • Red or swollen gums
  • Pain when eating or swallowing
  • A gray film on your gums
  • Crater-like sores (ulcers) between your teeth and on your gums
  • A foul taste in mouth
  • Bad breath
  • Fever
  • Swollen lymph nodes around your head, neck or jaw


Trench Mouth Disease Treatment (ANUG)

ANUG is very treatable and completely reversible if caught early. Most importantly, contact your dentist or a periodontist (a dentist specializing in the diagnosis and treatment of gum diseases), to confirm that this is indeed what you have. Although ANUG is quite easy to diagnose by a trained professional, there are other conditions that it could be confused with, which range from viral infection to localized malignancy (cancer).

Treatment is aimed first at relieving the symptoms and then the underlying or predisposing conditions that led to it. Non-steroidal anti-inflammatory and pain controlling medication of the aspirin and ibuprofen family are ideal for this situation, in addition to prescription antibiotics. Metronidazole is an antibiotic that works well to kill the specific bacteria associated with ANUG; amoxicillin is broad-spectrum penicillin that also works well in treating the acute phase. These are antibiotics that must be taken orally to work their way through the body. Taken together with chlorhexidine, a prescription antibacterial mouthrinse, and saline (mild saltwater) rinses, symptoms should abate within 24 to 48 hours.

It is also important to treat the underlying conditions that led to the ANUG in the first place. Good oral hygiene including training in brushing and flossing technique, together with treatment for any underlying chronic gingivitis, generally by thoroughly and meticulously removing stain, bacterial biofilm and calculus (tartar) from the teeth, will allow the gums to heal. In addition, if there is underlying periodontal disease this should also be treated. Quitting smoking, getting rest and maintaining good nutrition are also important.

If only the acute symptoms are relieved, or only the acute phase is treated, the condition can become chronic. The papillae (triangle of gum in between the teeth), which initially becomes ulcerated and necrotic, will not heal and will become permanently lost or blunted. Chronic necrotizing ulcerative gingivitis can affect the deeper structures becoming chronic necrotizing ulcerative periodontitis, particularly if there is a pre-existing periodontitis, with both gum tissue and tooth supporting bone loss.

Therefore, it is very important to see your dentist or periodontist immediately to have this treated before the condition becomes serious.

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The finding that the effects of Gatorade on teeth are worse than Coke and Red Bull doesn't mean that Gatorade and other sports drinks are necessarily harder on your teeth than are Coke and other soft drinks. But it may be a surprise that they aren't any better.

I don't think everybody realizes how erosive these things are, especially Gatorade and Red Bull.  People need to be aware that all sorts of beverages can be causing dental erosion.  More and more dentists now think sugary drinks are the major culprit in tooth decay, says Brian Burt, PhD, professor emeritus of epidemiology at the University of Michigan School of Public Health.

"There is pretty good evidence now that this is not just sports drinks, but soft drinks and juices in general," said Burt.  "They have become the main source of sugars in the diet. It comes down to the more sugar in the drink, the more risk of [cavities] to the person drinking it."

Effects Of Gatorade On Teeth

The University of Iowa researchers covered extracted teeth with nail polish. They left bare two patches on each tooth, one on the enamel and one on the root. Then they dunked the teeth in test tubes filled with regular Coke, Diet Coke, Gatorade, Red Bull, or 100 percent apple juice.

Every five hours, the researchers refreshed the beverages. After 25 hours, they examined the teeth with a microscope. All of the beverages eroded the bare spots on the teeth. But different beverages had significantly different effects.  On the enamel, Gatorade was significantly more corrosive than Red Bull and Coke. Red Bull and Coke, in turn, were significantly more corrosive than Diet Coke and apple juice.

On the roots of the teeth, Gatorade was more corrosive than Red Bull. Coke, apple juice, and Diet Coke followed in that order.  The difference in the effect isn't simply due to their sugar content. Gatorade is 6 percent carbohydrates, mostly sugars. Coke is about 10% sugar. Both are acidic beverages.

University of Michigan pediatric dental researcher Michael Ignelzi, DDS, PhD, has recently reviewed new research on the effects of beverages on children's teeth. But he says there's no evidence showing that sports drinks are any worse than other soft drinks .  "I know of no data that sports drinks are more harmful than other drinks," said Ignelzi.

Tooth Erosion

Sports Drinks and Cavities

Because of their acidity and sugar content, researchers have studied the role of sports drinks in the development of cavities. Most of the studies, however, exonerate the sports drinks.

Craig Horswill, PhD, senior research fellow at the Gatorade Sports Science Institute, in 2005 reported a study of saliva flow in endurance athletes who drank Gatorade, diluted orange juice, a homemade sports drink, or water. The study showed that if the sports drinks had any effect, it was to decrease dehydration and increase saliva flow, which reduces cavity formation.

More to the point, a 2002 Ohio State University study of 304 athletes found no link between sports-drink use and dental erosion. The study was sponsored by Quaker Oats, which makes Gatorade.  "Dental erosion among users of sports drinks in the Ohio State study was the same as it was in nonusers," said Hoswill. "And they averaged 10 years of sports drink use."  Ignelzi says that what matters most isn't which beverage people drink. It's how and when they drink it.

"A lot of things can cause cavities, including sugared drinks. It is the way they are taken that is most important," he says. "The frequency of exposure is key. If you sip a Pepsi all day, that is very harmful. But if you are taking any sweet or carb -- cheese puffs, bread, raisins -- if you take it during meals, it is a good thing. Because the saliva stimulated by your chewing buffers the acid. But if you are constantly snacking on sweets or sipping a sweet beverage, your teeth are exposed to acid all day long."

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Our bodies are changing all the time as we age, going from infant and toddler to active senior still in the game. So changes to various body parts are routine. We may see a new mole, but not recognize it as a potential danger sign of a simple skin cancer. Men may visit the bathroom 30 times a day due to an enlarged prostate gland and either choose to live with it or simply accept frequent urination as part of the aging process. Living with changes, or ignoring change, is especially true of oral cancers – cancer of tongue, lips, checks, esophagus, larynx and other body bits around your mouth. As with all cancers, the earlier a cancer is detected and treatment undertaken, the better the outcomes. This is especially true of tongue cancer and other oral cancers, yet how often do we examine ourselves for early signs of oral cancer?

You’re the one most familiar with your body and the changes and phases it goes through. You’re also in the best position to discover changes that may indicate a form of oral cancer is present since you spend more time looking at your mouth than anyone else. So, what to look for? Well, oncologists – medical doctors who specialize in the prevention and treatment of cancer, have some suggestions. These tips for self examination don’t take long, they don’t hurt, you can do them yourself and, in the process, make yourself a strong advocate for your own good health.

Here are seven simple self-examine steps you can take to help identify oral cancers in their earliest stages, so you can get yourself into a treatment program NOW!

1. Tongue and floor of the mouth

  • Look in a mirror and stick out your tongue.
  • Examine the upper surface of the tongue for any unusual lumps or obvious changes in color. Dark blotches, for example, on the upper surface of the tongue should be examined.
  • Pull the tongue forward and examine the sides for lumps, bumps, masses and, again, obvious changes in skin color or texture. If you discover any obvious swelling, see a doctor. Oral cancers are often painless, making them difficult to diagnosis based on pain. But you can see oral cancer, in many instances, early enough to solve the problem as an out patient. How cool is that?!
  • Examine the underside of your tongue by placing the tip of your tongue on the roof of your mouth. Same procedure. See any unusual bumps, lumps, swelling or changes in skin color.
  • Your tongue should have a uniform texture and uniform color. Glide you finger along the underside of your tongue to feel for unseen bumps. Any deviation should be examined by your family doctor first to see if a visit to an oncologist is step #2.

2. Examine the roof of your mouth

The roof of the mouth is easy to examine with your eyes and with your fingers. Tilt your head back as you stand in front of a mirror. Position yourself so you get a good view of the entire upper mouth.

Perform a visual exam for discoloration. Then gently slide your finger over the roof of your mouth feeling for any kind of protrusion. (Pizza blisters don’t count.) If you feel anything out of the ordinary, report to your doctor stat!

3. Check your cheeks

Visually inspect your cheeks. Extend them (be gentle) to look for red, white or dark-colored patches. Next, place your forefinger on the interior check and your thumb on the outer cheek. Gently squeeze as you rotate you fingers across the entire cheek. This is the best way to detect lumps, bumps or swelling – through the sense of touch. Cheek cancer can often be felt before there are any visible symptoms.

4. Head and Neck

Stand with your head straight up in front of a mirror. Usually, your face is uniform, i.e., has the same shape on both sides. However, a lump, bump or other protrusion on one side of the face is a definite signal to see your doctor. It may be nothing, it may be something. In either case, it’s worth checking out and a visit to your family doctor is the best place to start when you first detect unevenness within your facial structure.

5. Lips

The lips are highly sensitive to sunlight and lip cancer is one possible (and unfortunate) result. Open your mouth and examine both the outer and inner lip for changes in color or texture. Gently extend you lips to get the best view of the interior lip area. (You may have to do a little twisting to get the view you want. If so, use a hand mirror to get a good look at the interior lip surface.) Discoloration and protrusions are sometimes early signs of lip cancer. However, you accidently bite your lip, the lips are constantly moving as you talk, you moisten your lips with your tongue and so on, so expect to see changes. Even the seasons change the exterior portion of the lip so dried lips in the middle of winter aren’t a sign of cancer, though you may want to get some chap stick to keep lips moist.

6. Neck Area

This is where the esophagus and larynx are located, but we can’t see that far down our own throats, even if we stand on our heads. (Please don’t try this at home.) However, using a feather-light touch, gently slide you fingers along the sides and front of your neck feeling for any lumps that you discover on one side of your neck but not the other. Use your finger tips to gently glide over the skin of your neck feeling for anything out of the ordinary. Next, apply a small amount of pressure as you slide your fingers over the skin. This time note any tenderness, soreness of swelling. So, first a gentle exam, and then add a little pressure to identify any soreness or swelling.

7. A Persistent Cough

You can feel it and hear it – a cough that just doesn’t go away. Often, you chalk it up to a cold, but you don’t have any symptoms of a cold. Just that cough. Smokers (28% of Americans still smoke despite all the solid evidence that smoking is bad for just about every part of your body) may experience “smoker’s” cough that comes and goes. This often occurs when the upper portion of the lungs become irritated.

It also occurs when the airway to the lungs becomes irritated and inflamed. Most smokers just live with it, though for many, not as long. Quitting, even for a couple of days, will sometimes clear up a case of smoker’s cough but if you still have a scratchy sore throat even though you’ve given up smoking until your throat feels better, make an appointment to see your doctor.

There are some other things you can do to ensure early detection of mouth cancers beside kicking butt. Ask your dentist to perform an examine each time you’re in for a cleaning. Some dental professionals perform this examine routinely. All will be happy to give your mouth and throat a good look if you ask.

Make examining your mouth part of your oral hygiene regimen each day. Takes less than a minute, you get a better feeling for what’s going on in there (and therefore can more easily identify changes), and you may hit the jackpot and discover a form of oral cancer before it even has the chance to do any damage.

Today’s treatments, using computer-assisted and robotic surgery, deliver better outcomes for those who do find a lump, bump or notice a dark spot on the cheek that wasn’t there six months ago.

Take the time to check for oral cancers. It may give you more time, even though it only takes a minute.

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Tom's Of Maine Organic Toothpaste Review

As a periodontist, I am asked on a daily basis what toothpaste, floss and mouth rinse I recommend. My patients are typically surprised when I recommend Tom's of Maine organic oral health products.

Tom's of Maine was founded in 1970 by Tom Chappell and his wife, Kate, on their farm near Kennebunk, Maine. Tom, a 1966 graduate of Trinity College in Connecticut, and Kate, an artist and poet, had moved to Maine from Philadelphia in 1968 after Tom quit his job as a benefits counselor at Aetna. Both were intent on living closer to the land and raising their children in a more natural environment. Tom's of Maine was one of the first green companies on the scene to develop commercial organic toothpaste. Today they have a variety of organic mouth care products on the market.

Tom Chappell, whose deep concern for the environment and his employees' well-being have been key factors in determining the company's path. Tom's products contain no artificial ingredients, are not tested on animals, and are packaged in recycled materials. One unusual byproduct of Tom's of Maine was the decision to "tithe" 5 percent of Tom's of Maine's profits and donate the money to environmental, arts, and human needs causes. This figure soon became 7 percent, and then 10. In addition to public giving, the company also looked after the welfare of its employees, offering them retirement savings and profit-sharing programs, childcare benefits, and parental leave, and even free fruit to eat on the job. Factory workers rotated stations every hour to avoid fatigue and boredom, and all were encouraged to perform volunteer work in the Kennebunk community on company time

In 1995, after a seven-year effort, Tom's became the first natural toothpaste to win the approval of the American Dental Association (ADA), allowing it to put that organization's seal on its products. This was a crucial endorsement, as all of the company's major competitors had long sported the ADA seal, which served to assure consumers that their products were effective. The process had taken far longer than usual because the ADA had no standards for natural products, and also because Tom's did not allow testing on animals, which meant new methods of testing had to be devised and certified. The three most popular flavors, spearmint, cinnamon and fennel, were approved first, and the company continued to seek ADA certification for the rest of its fluoride line. Tom's products contain no artificial ingredients, are not tested on animals, and are packaged in recycled materials. Another very important point to mention is that Tom’s of Maine tests their products for safety without the use of animals.

Organic Mouth Care: Tom's of Maine

Tom's of Maine is one of the better known established organic and environmentally friendly companies on the green scene today. The company first began developing organic mouth care in 1975. Tom's of Maine single natural toothpaste was the spark that lead to the organic creation of several types of natural toothpastes, mouth washes and dental flosses. Today they have developed a total of seventeen organic mouth care products, all which now have expanded distribution through a joint venture with Colgate-Palmolive.


The Tom's of Maine line of organic toothpaste products contains thirteen different types of pastes. While a few of the pastes focus on general mouth health, there are other pastes that have been created for specific mouth related issues . One Tom's of Maine toothpaste is the Anti-plaque Propolis and Myrrh paste created without fluoride to promote healthy teeth and gums while fighting plaque. They also have developed a paste for sensitive teeth and gums called Sensitive CareSLS-free. The Sensitive Care paste uses a purified form of licorice root as an alternative SLS, which is an ingredient in non organic pastes that can sometimes cause more sensitivity when used over an extended period of time. They also have an organic, all natural toothpaste that does contain fluoride.


The natural mouthwash line from Tom's of Maine only contains two forms of wash for organic mouth care. The first one is the Natural Cleansing mouthwash that uses witch hazel as an astringent and is alcohol and saccharin free. The second one is the Natural Anti-Cavity mouthwash made from Green Tea, Chamomile, Aloe Vera leaf juice and naturally sourced fluoride.

Dental Floss

The organic dental floss that Tom's of Maine offers is made from nylon filaments that are woven together, making a stronger floss. Currently, they have only two products of the same type but where one floss is rounded the other is straight. Both flosses are coated in a combination of natural waxes to help the nylon slid through the teeth easier and be less abrasive to the gums.

I have always believed that it's what's inside that counts. Tom's hopes you'll apply that same rule to their products. They strive to use naturally sourced, wholesome ingredients that just make you feel right when you choose them.

They are proud of their ingredients and they feel like you deserve to be informed, so they post every ingredient on their website. Every ingredient in their products is posted along with their reason for using it and where it's sourced. Here is the link to a list of their incredients: Click Here

If you have read my blog, you know that I am a big believer in green dentistry and environmental causes. In my opinion, if the ADA (American Dental Association) gives a product its seal of approval, then that product has passed a number of vigorous tests and is worthy of being recommended to patients. So if the ADA feels that a product is clinically beneficial, then why not recommend a product that is composed of natural ingredients and packaged in environmentally friendly packages?

I can’t imagine buying any other brand of toothpaste now. If you are looking for a line of natural dental products, I highly recommend Tom’s of Maine for you and your family. As a periodontist, I do feel it is prudent to use fluoridated products to help maintain cavity free teeth.

If you would like to learn more about the organic mouth care products that are created by Tom's of Maine, you can visit their main web site at:

I am a member of the Eco-Dentistry Association. The cost is about $300 dollars per year, which is extremely reasonable. If you want more information about eco-dentistry and how to make your practice green, I suggest you either visit there website, or you can read a few of my previous blog posts. If you enjoyed this blog on Toms of Maine toothpaste, then there is a good chance you will also like:
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Why did I choose to use MacPractice DDS and Apple computers for my periodontal practice? It is an often asked question by every clinician that steps into my office. There are a multitude of options to choose from, and the effect of those choices is critical as they will have a direct impact on how you practice today and well into the future. This is your practice management software, otherwise known as the central nervous system of today's dental office.

Certainly, choosing a system requires significant time and consideration. Many factors come into play, including the total cost of the entire package, such as hardware, software, training, and ongoing support. How do you plan to use the system both today and in the future? Will it be used in the treatment rooms where it will need to interface with digital radiography, intraoral cameras, and other systems? Will you use it for digital charting, patient data collection, electronic treatment planning and the like? What are you looking for in terms of the business software? Most likely you will want the ability to manage all patient data and forms, run key reports to track production, collections, accounts receivable, insurance and more.

The first thing you need to do is decide which type of computer system is best for you: Mac or PC? Although they both have their pros and cons, in my opinion, Macs have many advantages over PCs.

What Are The Advantages Of Using A Mac Over A PC

Operating System:

The main difference between Macs and PCs, the operating system, can be seen as an advantage of Macs vs PCs. Mac OS X is a great operating system. It's easy to use, efficient, and features a very friendly user interface. Mac OS X is a completely different animal than Windows. Windows is a good operating systems, but it does not have the simplicity and stability of OS X.

Operating System Flexiblity:

If you should ever need Windows for anything, you can install Windows on a Mac computer, legally. You cannot however, install Mac OS X on a PC, legally. This is a big advantage of Mac vs PC. Many computer users like to use different operating systems for different things. With Macs, you have the flexibility of OS X+Windows operating systems on one machine. You also have the option of running Windows via Bootcamp, or via a virtual machine, such as VMware Fusion or Parallels. I use Parallels if I need to use a windows program.


Cosmetically, Macs are extremely well designed computers. They are visually appealing with a "high-end" feel. They have the backlit Apple logo, backlit keyboard, Chiclets-style keys, etc... Many PCs are well designed as well. Some are visually appealing and have a "high-end" feel... and some have backlit keyboards. But, did the new Sony Vaios and HP Envys get some design inspiration from Apple? Just saying.


The vast majority of the world's hackers spend the vast majority of their time making trouble for the vast majority of computer users. That's why almost all known viruses, trojan horses, and other malicious applications attack only Windows PCs. Including really dangerous ones that can steal your credit-card and banking information.

Using Mac computers does not let you simply opt out of worrying about computer safety. Still, a Mac owner who runs no security software is vastly less likely to be the victim of a successful attack than a Windows user who is protected up to his eyeballs. This means much more stability, security, and less IT support and cost for repairs and downtime for your practice.

Compatiblility With Other Mac Products:

Apple products just work well with each other. Often times, PCs will have compatibility issues with iPhones, iPods, iPads, etc... Mac computers don't have that problem. If you are a big iPhone , iPod, iPad or Apple TV fan, or the type of person that owns multiple iPods or an iPad, chances are, you will enjoy owning a Mac computer just as much.

MacPractice DDS:

Ok, so now you know why I chose Mac computers for my office. In my opinion, Apple computers are made better, safer, more reliable, and look absolutely georgeous in a dental office. But the bigger question is why did I choose to utilize MacPractice DDS dental practice management software for my periodontal practice.

The first thing I did was an analysis of total hardware, software, and support costs among all the different systems. A lot of people are put off by Apple products because the hardware is expensive, and it is. However, MacPractice does not require a dedicated server, you can use one of your work stations as the server. When I did the math, it was cheaper to go with MacPractice because of the server issue, and I did not have to puchase any additional IT support.

The next thing I looked at was ease of use. If you can use iTunes then you get up to speed with MacPractice in a couple of hours because the two programs look and fuction virtually the same. MacPractice is very good at managing patient insurance. It allows me to keep a database of insurance payments and reimbursment levels. Sheduling is very straightforward and you can also use either digital sensor radiography or phosphor plate technology seamlessly with the system.

MacPractice can interface with my iPhone and iPad which allows me to access and write up patient records remotely. Additioanlly, the system allows for all patient documents to be completed electronically, and has the ability to use email and text messaging for patient appointment reminders.

One of my favorite features is the ability to generate numerous financial reports. I can track virtually everything from recall, collections, insurance, marketing, and accounts receivable with a click of the mouse. You can track production with dozens of different metrics- by month, by category, type of procedure and provider. You can also see outstanding pre-authorization as well as referral sources which is extremely helpful with marketing.

The software is also capable of utilizing MacPractice Kiosk and MacSpeech Dictate. MacPractice Kiosk is a simple yet powerful, easily customizable solution for a paperless practice that makes registration, health history, HIPAA, consent, treatment acceptance and all other forms available for completion and signiture by patients electronically on a Kiosk computer in the office. After the patient electronically signs their forms on a Mac computer designated to operate as a Kiosk, the forms are automatically incorporated into their Electronic Dental Record in MacPractice. An iPad can be used as a Kiosk, so the patient can simply sign the iPad with a stylus and virtually any paper form may be recreated in electronic format in MacPractice EDR and made available for completion by the paient on the Kiosk computer.

I also use MacSpeech Dictate. Instead of typing my clinical notes, I use my voice to input text, commas, paragraph breaks and signiture. Rather than using a keyboard and a mouse, I just speak commands. This saves me a lot of time writing clinical and surgical notes.

MacPractice also supports National Electronic Attachments.

Here is a list of the software abilities:

  • Electronic Dental Records
  • Digital Radiography
  • Periodontal Charting
  • Restorative Charting
  • Attachments: Insurance, patient intake forms, etc..
  • Scheduling
  • eClaims
  • RX
  • ePrescrbe
  • Notes
  • iPhone and iPad interface. Both remotely and in office.
  • Patient Web Interface
  • Reports
  • Reminders
  • Managers
  • References
  • Help. This is a nice touch. You simply touch the question mark on the software, type in a question you may have and you will get a phone call withing an hour to resolve the problem or answer your question. And this service is not an additional cost.
The software is absolutely amazing. It is extremely user friendly. As I said before, if you can use iTunes, you can use MacPractice. Apple computers are extremely reliable. Although the hardware may be more expensive, not needing a dedicated server offsets that cost. It is actually cheaper than most of the practice software systems I looked at. It is like all other Mac programs. It is drag and drop. You drag a file, x-ray, insurance statement onto the patients name and the software understands what the attachment is and places it into the appropriate folder.

MacPractice is dedicated to developing, implementing, and supporting the premier practice management and clinical software solutions for doctors who prefer to use Macs. For more than 25 years, the developer of MacPractice has listened to clients and responded by creating applications that leverage the powerful features of each new version of Apple’s operating system and developer environment.

The expertise and experience of MacPractice’s design and development team, technical support department, and MacPractice DDS Practice Consultant field representatives is unrivaled. MacPractice for OS X is a revolutionary, best-of-class practice management and clinical software.

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Charlie Sheen's Two And A Half Teeth

Charlie Sheen appears to have had his porcelain crowns replaced with gold crowns.  The Two And Half Men star was recently released from rehab after going on a 36 hour drug binge with porn stars.  But his continued drug use has meant that it appears his porcelain crowns and/or veneers have had to be replaced with gold crowns.

The pictures taken of Charlie Sheen's teeth during his bender look interesting, to say the least.  While the troubled star was busy with rehab, photos and videos of his last bender were being released online. In one of the photos, he looks more out of it than usual, with a wide smile showing that a lot of dental work has been done.  Yet Sheen's problems began years before this latest breakdown, according to one of his porn star girlfriends.  TMZ received a video from the actor's now infamous 36-hour party binge. In it, he is seen dancing with three of his many girls, at the home of friend George Santo Pierto. But it is a picture from that night which seems to reveal more about his condition.  Beforehand, Sheen's teeth looked flawless, as he appeared to maintain his smile despite all of his drug use. Yet last week, he was caught smiling with his eyes closed, and with a good portion of his teeth broken and filled with gold.
Charlie Sheen on a bender

The mystery over this image was quickly solved by one of his porn star contacts. Kacey Jordan went on Howard Stern to explain that past drug use rotted out Sheen's mouth. But since he didn't like his porcelain crowns, he had gold crowns fabricated instead.  At the least, the Sheen teeth images aren't a result of his latest drug induced spiral. Yet it confirms just what his previous benders did to him, and that his most recent binges obviously didn't help any. Anyone could easily guess that this was the case, but it is another thing to see the effects.

Therefore, if the Sheen teeth photos are that bad from his past drug use, it stands to wonder how much more damage he's done over the last few benders. But even in spite of that, he needed a lot of convincing to voluntarily check himself into rehab, and still may not think he has much of a problem.

While professionals seek to finally prove to him that he is in trouble, the Sheen teeth images have had no problem convincing the rest of the country of what drugs can due to your teeth.


How Drugs Can Cause Dental Problems


There are a number of things that cause drug induced dental decay. Part of the reason that the drugs themselves contribute to the breakdown of the teeth, according to the American Dental Association, due to the acidity of the drugs. The extreme acidity, along with the kinds of contaminants present in drugs, contribute to teeth that decay relatively rapidly. But that’s not the only reason. Here are some more reasons that drug induced dental decay can develop:
  • Cracked teeth: One of the signs of drug induced dental decay is cracked teeth. This happens when drug users grind and clench their teeth. This can happen both while under the influence of the drug and in the aftermath while experience withdrawal symptoms.
  • Dry mouth: Xerostomia, which is known more commonly as dry mouth, results when there is a reduction in the saliva that is formed. Saliva provides natural protection for teeth and gums. The use of drugs reduces the production of saliva, and that means that there is lower protection. This condition can be exacerbated by the fact that many drug users sometimes sleep for more than 24 hours at time - often with the mouth open.
  • Indifference to oral hygiene: One of the hallmarks of an addiction is an increasing indifference to matters of hygiene. This includes oral hygiene. Many drug users do not bother to brush or floss their teeth, or eat foods that can help strengthen and protect them. This leads to a situation in which the mouth is vulnerable to weak teeth, gum disease and other problems.

It is important to note that the problem of drug induced dental decay can be enhanced by tobacco use, consuming sugary drinks, and the fact that drug users rarely eat (many drugs are appetite suppressants), meaning that there is less of a change for saliva to be produced and used in the mouth.

Early Stages of Drug Induced Dental Decay( Not Charlie Sheen
Late Stage of Drug Induced Dental Decay (Not Charlie Sheen

You should also realize that drug induced dental decay can result from the use of many different drugs.  Even though it is called typically know as "meth mouth", those who are addicted to other substances, including cocaine and even alcohol, may experience a similar oral condition. Additionally, those with problems related to saliva production - even if drug abuse is not an issue - can exhibit the signs of drug induced dental decay. Children, teenagers and adults who do not properly care for their teeth can also, over time, develop what appears to be meth mouth, even without going anywhere near drugs. However, in drug abusers, the characteristic signs of drug induced dental decay generally develop much fast.

If drug induced dental decay is not addressed, and the situation is allowed to continue, it can lead to a number of serious problems. It is possible for gum disease to develop, and for teeth to begin falling out. Additionally, oral cancer is a possibility. Another concern is that disease in the mouth can spread to other parts of the body. Also, poor oral hygiene can weaken the immune system, leaving someone with cavities more vulnerable to colds and the flu, and other attacks on the respiratory system.

I truly hope Charlie Sheen gets his life back on track. The point of this blog was not to bash Charlie Sheen, it was to educate the public of what drug use can do to your oral health.

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Pictures of grinning kids may reveal more than a happy childhood: a study from DePauw University shows that how intensely people smile in childhood photographs, as indicated by crow’s feet around the eyes, predicts their adult marriage success.

According to the research, people whose smiles were weakest in snapshots from childhood through young adulthood were most likely to report being divorced in middle and old age. Among the weakest smilers in college photographs, one in four ended up divorcing, compared with one in 20 of the widest smilers. The same pattern held among even those pictured at an average age of 10.

The paper builds on a 2001 study by psychologists at the University of California, Berkeley, that tracked the well-being and marital satisfaction of women from college through their early 50s. That work found that coeds whose smiles were brightest in their senior yearbook photographs were most likely to be married by their late 20s, least likely to remain single into middle age, and happiest in their marriage; they also scored highest on measures of overall well-being (including psychological and physical difficulties, relationships with others and general self-satisfaction).

Marital Success

The scientists speculate that one’s tendency to grin—an example of what psychologists call “thin slices” of behavior that can belie personal traits—reflects his or her underlying emotional disposition. Positive emotionality influences how others respond to a person, perhaps making that individual more open and likely to seek out situations conducive to a lasting, happy marriage.

But there could be a more cynical explanation, according to Matthew Hertenstein, a psychologist at DePauw who led the new study. “Maybe people who look happier in photos show a social face to others,” he says. “Those may be the same people who are likely to put up with partners because they don’t want to appear unhappy.”

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The Mouth Is A Window To Your Overall Health

Problems inside your mouth, such as with your gums, teeth and/or tongue, can all be indicators that serious health troubles are lurking beneath the surface. It’s critical to pay attention to any and all signs or symptoms of oral problems. If your mouth is causing even the slightest discomfort, or you’re having trouble cleaning your teeth and gums, it’s time to book an appointment today to see your dentist.

One common, yet frequently overlooked, oral issue is bleeding gums. Many people ignore inflamed or bleeding gums or brush it aside as a normal reaction to flossing, but the truth of the matter is that it’s one of the body’s clearest signs that something is awry. Think about the gums being similar to the skin on your body. If you developed an open sore every time you washed your hands, you would likely be very concerned and take immediate action to address the issue. The gums should be tended to with an equal amount of attention and care.

There are several, even some surprising, reasons for bleeding gums besides plaque build-up. These include pregnancy and hormonal changes, excessive stress, smoking, challenged immune system functioning, disease and illnesses, such as cancer, HIV and diabetes, and more.

And it’s not just about the bleeding gums alone. When you allow your gums to bleed chronically, your entire circulatory system is more vulnerable to the harmful bacteria in the mouth. If these bacteria gain entry into your bloodstream, it can cause a number of problems. These bacteria can bond to platelets in the blood and cause clots, which can lead to heart attacks, stroke, even dementia. As bleeding gums go untreated, inflammation in the mouth can result in the inflammatory process, setting up in other areas of your body and vital organs.

The bottom line is that good dental health is essential to good overall health. Pay attention to clues that your mouth is giving you and follow these tips to be the healthiest you in the new year.

Brush and floss at least twice a day.

Avoid fatty and sugary foods, as these can lead to plaque build-up.

Create a smile-friendly diet by eating foods high in fiber such as fruits and vegetables, which strengthen the hard and soft tissues of the mouth, and take calcium and vitamin C supplements to promote healthy gums. Additionally, fruits and vegetables raise the pH in the mouth which creates a healthier environment for the good bacteria to thrive and the bad bacteria to disappear.

Resolve to manage your stress levels for 2011. Too much stress can overload the mouth and affect the gums.

Care for your teeth, gums and tongue like any other body part, brushing and flossing regularly. Have a professional cleaning at least twice a year – and more if your gums are sensitive or inflamed, or you have had a good deal of dental work.

Small oral care steps you make today can bring a healthier you tomorrow.

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Tooth Loss Linked To Memory Loss

Researchers have found that elderly people who lose their teeth may be at increased risk for dementia.

The new study included more than 4,000 Japanese participants, 65 and older, who underwent a dental examination and a psychiatric assessment. Compared with participants who still had many of their natural teeth, those with fewer or no teeth were much more likely to have experienced some memory loss or have early-stage Alzheimer’s disease.

The findings were published online Dec. 31 in Behavioral and Brain Functions.

Participants with symptoms of memory loss tended to report that they had visited the dentist rarely, if at all. Dr. Nozomi Okamoto, the study’s principal investigator, said that this may be one explanation for the study’s findings but suggested that there may be other links between tooth loss and memory problems.

Infections in the gums that can lead to tooth loss may release inflammatory substances, which in turn will enhance the brain inflammation that cause neuronal death and hasten memory loss,” she said in a news release from the journal’s publisher. “The loss of sensory receptors around the teeth is linked to some of the dying neurons.”

Gum Disease Can Lead To Tooth Loss

This may lead to a vicious cycle, Okamoto explained. The loss of these brain connections can cause more teeth to fall out, further contributing to cognitive decline.

I found this research extremely interesting and it is the first study that I am aware of that has linked periodontal disease to memory loss.

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The Art and Science of Immediate Dental Implants

An immediate dental implant requires planning and skill, in fact it requires team work between the patient – restorative dentist, implant surgeon and laboratory technician. 

There is no question that given the current state of the art in dentistry, that dental implants are pretty much the best way to replace teeth; they are stand alone tooth replacement systems that look and function just like regular teeth. They do not attach to adjacent teeth like dental bridges and don’t have to be taken in and out like removable partial dentures.

A dental implant is a tooth root replacement made of titanium, which has the unique property of being osteophilic (osteo-bone, philic-loving) and actually fuses to bone. A dental crown, the part of the tooth that you see in your mouth, is attached to the implant. And the great thing about implants is they are not susceptible to decay or periodontal (gum) disease in the same way that teeth are.

Now here are a few important pointers, which hold for dental implants generally and are especially important in cases when replacing a front tooth for an imminent event like a wedding in which you need to look your best.

A photograph showing a fractured tooth broken off at the gum line.
A photograph showing an immediate implant and the abutment replacing the fractured tooth.
A photograph showing the final crown on top of the implant 3 months after the original surgery.

Many times, a periodontist, oral surgeon or specially trained dentist can place an implant directly into the extraction socket immediately following tooth removal. It is imperative that the extraction of the failing tooth be performed very carefully and without damage to the surrounding gum and bone tissue. This is known as an “immediate” replacement implant. Traditionally the socket is allowed to heal and fill in with new bone first before an implant is placed into it.

The benefit to having an implant placed “immediately” is that only a single surgical procedure is necessary as opposed to two separate procedures. Dental implant success is dependent upon initial stabilization and immobilization in the bone, meaning there should be no movement of the implant at all. This is critical to the fusion of the implant with the bone. Initially, the implant is held securely in place by mechanical forces. As the implant heals, it forms a microscopic bond with the surrounding bone which is known as osseointegration (osseo-bone, integration – to become one with).

It is more difficult to place and secure an implant at the time of tooth extraction because there is less bone available, and the security comes from being able to fit the implant as closely as possible into the remaining socket and to the bone beyond it (where the extracted tooth root ended). This is especially important in the front of the mouth where the teeth show more in what we dentists call the “esthetic zone”.  The procedure carries some risk, but is quite predictable in the hands of an experienced surgeon.

A crown, usually “provisional” in nature can also be placed immediately. This makes it all the more critical to have an initially stable, non-movable implant, because a crown placed immediately will tend to destabilize the implant with biting forces. The provisional crown therefore needs to be made so that it really doesn’t contact the teeth in the opposing jaw so you can’t bite or eat on it for a period of time – this means the new tooth is initially there just for social appearances. We call it a “provisional” crown, since we need to wait until we know that the implant has fully osseointegrated, a matter of 2 – 6 months, before making a final permanent crown. That way we can be assured that not only the bone, but also the gum tissue are stable and fully healed; that the gum level and the “papillae”, the little pink triangular gum that adequately fills the space between the implant crown and adjacent teeth. This can indeed result in a very esthetic, functional and long term tooth replacement.

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What if your toothpaste could tell you whether you needed to leave the house carrying an umbrella? Or how hot the day was going to be?  Odd as it may sound, David Carr of MIT's Media Lab is working on just such a prototype product, "Tastes Like Rain."Carr and his colleagues are focused on super-mechanicals, or the idea of taking a basic object and giving it dynamic properties (consider, for example, the Proverbial Wallets, also out of MIT Media Lab, that know your financial state and prevent over spending).

In this case, toothpaste is modified to dispense one of three flavors depending on the weather. If it's mint, you know it's colder out than yesterday. Cinnamon means it's hotter. Blue stripes indicate precipitation.

The prototype is currently hooked up to a small Linux computer that pulls forecasts, using custom software to compare previous and current temperatures and divvy up the flavors.

Then, linear actuators squeeze out the proper variety of toothpaste through a heavily modded Mentadent dispenser.

"Tastes Like Rain" Prototype

Eventually, the technology could be pared down so "Tastes Like Rain" shows up on store shelves alongside the Colgate and Crest. Minus the computer, Carr hints it could be powered on a low-cell battery.

The prototype is in the early stages and Carr is still working out technical specifications. Perhaps selling a base unit that plugs into the wall and serves as a both a communications hub and mixing valve would be a viable option with refill tubes available.

Of course, we're not sure how much reach Carr's device would have given today's easy access to weather apps on phones and computers. But the idea itself is remarkably creative and hints that we're likely to see many more super-mechanical innovations in the future. Cloudy with a chance of potentially awesome.

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An innovative device which cancels out the noise of the dental drill could spell the end of people's anxiety about trips to the dentist, according to experts at King's College London, Brunel University and London South Bank University, who pioneered the invention.

It is widely known that the sound of the dental drill is the prime cause of dental anxiety, and some patients avoid trips to the dentist because of it. This new device could help address people's fears and encourage them to seek the oral healthcare treatment they need.

The prototype device works in a similar way to noise-cancelling headphones but is designed to deal with the very high pitch of the dental drill. Patients would simply unplug their headphones, plug the device into their MP3 player or mobile phone, and then plug the headphones into the device, allowing them to listen to their own music while completely blocking out the unpleasant sound of the drill and dental suction equipment. The patient can still hear the dentist and other members of the dental team speaking to them but other unwanted sounds are filtered out by the device.

Containing a microphone and a chip that analyses the incoming sound wave, the device produces an inverted wave to cancel out unwanted noise. It also uses technology called 'adaptive filtering' where electronic filters lock onto sound waves and removes them, even if the amplitude and frequency change as the drill is being used.

The device was initially the brainchild of Professor Brian Millar at King's College London's Dental Institute who was inspired initially by car maker Lotus' efforts to develop a system that removed unpleasant road noise, while still allowing drivers to hear emergency sirens. Then with over a decade of collaboration with engineering researchers at Brunel University and London South Bank University, a prototype has been designed, built and successfully evaluated.

Although the product is not yet available to dentists, King's is calling for an investor to help bring it to market. Professor Brian Millar said: "Many people put off going to the dentist because of anxiety associated with the noise of the dentist drill. But this device has the potential to make fear of the drill a thing of the past.

"The beauty of this gadget is that it would be fairly cost-effective for dentists to buy, and any patient with an MP3 player would be able to benefit from it, at no extra cost. What we need now is an investor to develop the product further, to enable us to bring this device to as many dental surgeries as possible, and help people whose fear of visiting the dentist stops them from seeking the oral healthcare they need."

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How To Make Dental Implant Crowns Look Natural

We know how and why implants successfully fuse to bone, but making the crowns (the parts of the teeth that attach to them) look real is another matter. That is where art really meets science. What drives the result is how the tooth or crown shape actually emerges through the gums, and the ability to identically match the color to the adjacent teeth. What follows are some of the predictive factors and criteria for success that dentists involved in implant dentistry have learned through evidence based research, clinical practice and experience over the years.

The Bone Sets The Tone

The first factor is that there needs to be an adequate volume of bone and gum, in the right position to anchor or support a tooth implant. This means that when a tooth is lost, the remaining bone of the tooth socket has to be managed delicately so as to retain as much bone as possible, avoiding the natural tendency of the socket to collapse and resorb (melt away). This can be done by:

* Minimizing trauma during tooth removal, especially important if an immediate implant is to be placed the same day with a temporary crown;
* Using “bone grafting” materials and techniques to minimize resorption;
* Rebuilding bone where lost with regenerative surgical techniques.

These techniques allow an implant to be optimally positioned in order to place a crown in perfect position.

Good Neighbors

Believe it or not the second factor is the amount of bone on the adjacent tooth/teeth. Maintaining a normal volume and height of bone attached to the adjacent teeth actually controls the height of the “papillae,” the little pink triangles of tissue that fill the spaces in the areas beneath where the teeth contact each other. If bone is lost on either side of an implant against a natural tooth, there is no guarantee that the papillae (those small, pink triangle of gum tissue between teeth) will regenerate fully, leading to what we dentists refer to as “black hole disease.”

Tissue Is The Issue

The third factor to consider is the genetic tissue type you are born with. It is a lot more difficult to achieve a great result with genetically thin tissue than it is with thicker tissue types. Think of the gingival tissues like a curtain, the thicker the curtain, the more wear and shrink resistant it will be. Thin tissues are more delicate to work with surgically, tending to recede, and are more see-through, making it difficult to hide the metal of an underlying implant or other implant crown materials. Thicker gum tissues are more robust and resilient, easier to work with surgically, and hide more.

“Emergence Profile” — From Bud Into Flower

The seamless transition from implant into exact tooth replica is almost akin to the transformation of a bud into a flower — it involves the way the crown, which attaches to the implant seemingly emerges through the gum tissue, exactly like a natural tooth. This “emergence profile” involves both the implant shape and how far it is placed below the bone and gum tissues relative to the adjacent teeth. This is dependent upon good planning, surgical experience and skill during dental implant placement, allowing space for the “emergence profile” to be developed.

Work Out The Final — In The Temporary

Where aesthetics is of paramount importance as in the front of the mouth, a customized temporary crown acts as a template or blueprint for a final crown. This allows several of the criteria for success to be worked out ahead of time, including: color, shape and regeneration of papillae. This includes compatibility with the gum tissues and smile line, speech, and biting function. Choice of crown materials, color matching, even the dental laboratory technician — are all mechanical and artistic ingredients that go into the mix before baking this particular pie, and lead to good matching of the implant supported crown to adjacent natural teeth. These factors in and of themselves demand their own skill sets, expertise and experience to achieve optimal success.

Implant to Tooth Versus Implant to Implant

The picture changes when it comes to placing implants next to implants, in addition to adjacent teeth. The distance between the implants and the shape and size of the implants then become even more critical, and in fact it may not be possible to completely regenerate natural looking papillae between the implants relative to the natural teeth.

All Things Considered

There are in fact many more factors to consider in this special situation, but this consultation gives you a flavor for the variety. Good surgical manipulation (in the best sense of the word), experience and skill are all pre-requisites for great implant aesthetics in the most critical places, in the smile line or “aesthetic zone.” As with most of the endeavors discussed, pre-surgical assessment, diagnosis, and team planning (surgeon placing the implant, restorative dentist and laboratory technician making the crown), all go into both the planning and realization of success.

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