I recently came across an excellent article on the Mayo Clinic website at: http://www.mayoclinic.com/health/dental/DE00001.  The article “Oral Health: A window to your overall health,” discusses the connection between oral health and overall health.  It explains that your mouth may harbor the first signs of disease and that diseases of the mouth, such as gum disease, can cause problems in other parts of the body.
Your mouth is loaded with bacteria which can be kept under control with brushing, flossing and regular dental visits. Saliva also defends against bacteria because it contains enzymes that destroy bacteria. But if the bacteria are not kept in control, a gum infection, or periodontitis, can result.  Gum disease may provide bacteria with a means to enter your bloodstream. Dental treatment might also be a means whereby bacteria can enter the bloodstream.
•     Research has shown that heart disease, stroke and clogged arteries may be linked to oral health and periodontal disease.
•    Gum disease has also been linked to premature births.
•    Diabetes increases your risk of gum disease and oral infections. And poor oral health can make your diabetes more difficult to control.  Oral infections can cause your blood sugar to rise, requiring more insulin for its control.
•    People who have HIV/AIDS often exhibit oral manifestations, including ulcers, dry mouth and painful fungal, viral or bacterial lesions. One of the first signs of AIDS may be severe gum infection.
•    The first stages of osteoporosis, or bone loss, may manifest in loss of supporting bone of the teeth, resulting in loose teeth.
•    Other conditions that may first exhibit in your mouth include Sjogren’s syndrome, some cancers, eating disorders, sexually transmitted diseases and substance abuse.

The relationship between your oral health and your overall health provides another good reason to take care of your teeth and gums.  An investment in your oral health is an investment in your overall health!

Several years ago I read the book The Tipping Point by Malcolm Gladwell.  The tipping point is defined as the level at which the momentum for change becomes unstoppable.
It is a “moment of critical mass” or a threshold.  The book describes the many tipping points in our society in which a trend crosses a threshold, tips, and spreads through the public. Sometimes I use the tipping point concept to explain dental disease to my patients.  Their teeth may have large worn out fillings, heavy deposits of calculus, and be battered by uneven occlusion.  Then a tipping point is reached and the teeth break from the stress.

The challenge is to get people to restore their teeth before the tipping point is reached.

The singer Patti Smith was the recent commencement speaker at the Pratt Institute in New York.  She took that opportunity to speak of dental care.  No kidding!
Here is the YouTube link: http://www.theawl.com/2010/05/the-patti-smith-pratt-commencement-speech.
Here is her quote: “My greatest urge is to speak to you of dental care.  My generation had a rough go dentally.  Our dentists were the Army dentists who came back from World War II and believed that the dental office was a battleground.  You have a better chance at dental health.  And I say this because you want at night to be pacing the floor because your fuse is burning inside of you, because you want to do your work, because you want to finish that canvas, because you want to help your fellow man.  You don’t want to be pacing because you need a damn root canal.  So, floss.  Use salt and baking soda.  Take care of your damn teeth.”
Great words of wisdom! - but the audience laughed.  She was spoofing the commencement speech.  But who gets the last laugh?

Today’s knowledgeable dental patients often know that excellent cosmetic dentistry is a partnership between the dentist and the dental ceramist.  The ceramist who fabricates my porcelain tooth veneers and crowns is Peter Kouvaris.  Peter has been a ceramic artist for more than 20 years.  He was the Cosmetic Designer at the JK Dental Laboratory and recently opened his own dental studio in New York City: Peter Kouvaris Dental Studio at  http://peterkouvaris.com/.

Peter is a member of the prestigious Oral Design International, a group of dental ceramists who have studied under Master Willi Geller.  Willi Geller resides in Switzerland and is considered to be the world’s leading dental ceramist.  He was one of the first ceramists who realized that teeth reflect and refract light like prisms because of layers of tooth dentin and enamel.  He invented a buildup technique which involves layering different density of porcelain in different colors and degrees of translucence. His method is used by a highly trained and talented group of 80 ceramists and is used to create beautiful, life-like veneers, crowns and implant crowns.  Peter Kouvaris is one of Willi Geller’s proteges.

Not every dentist can or will work with an oral design ceramist.  The dentist needs to have advanced training and needs to work at a higher level and with increased attention to detail.  Excellent cosmetic dentistry is a collaboration between the cosmetic dentist and the dental ceramist.

Is your lower denture loose?  Do you have to use gobs of denture adhesive and you still can’t keep the denture in place?  Your upper denture functions well, so why do you have problems with the lower denture?

An estimated 8% of the U.S. population has no teeth in at least one dental arch.  In people 75 years and older, 44% have no teeth in one arch.  It is more frequent for the upper arch to be edentulous than the lower arch.  That is, more people wear upper dentures than lower dentures.  But lower dentures cause most of the problems, resulting in a decreased quality of life.

The extraction of a tooth results in a loss of bone width by 25% and a loss in bone height of 4 mm during the first year.  The loss of bone width occurs on the lip side of the ridge so the ridge is shifted back.  This bone loss continues throughout the patient’s life, thus making retention and stability of dentures more and more difficult.  The remaining bone is sharper and irregular - resulting in sore spots.  Muscle attachments and the tongue are also closer to the resorbed lower ridge, thus causing the lower denture to lift up during use. The upper ridge also resorbs when teeth are missing but the larger surface area of the palate allows for better retention of the upper denture as opposed to the lower denture.

However if dental implants are placed, the bone loss is minimized.  Implants help stabilize dentures and also preserve facial height.  A revolution in dentistry!

Patients have been asking me about the mini implant. They have heard that it is less expensive than the standard implant. But is the mini a viable alternative to the full-sized implant?

The most popular mini implant, the MDI, is manufactured by IMTEC, a 3M Company, http://www.imtec.com/implants/products_MDI.php. In 2003 the FDA approved the MDI mini implant as a long term method to stabilize dentures. The MDI implant has a narrow diameter (1.8 mm) compared to the 3.5-6 mm standard implant. The MDI implant acts like the root of a tooth with an attached ball that seats into a denture. This ball and socket stabilizes the denture.

Mini implants are also sometimes used to support crowns when there is not enough room for a standard sized implant. But this use does not have FDA approval and is still controversial. Some general dentists are placing mini implants after attending a one or two day MDI certification course. This also may not be in the patient’s best interest.

The mini implant typically costs a third of the cost of a standard implant. It is an alternative to the standard implant when cost is a major factor but you need to know that the major success of the mini implant is with the stabilization of full and partial dentures. The MDI does not have the range of use of the standard implant that can replace almost any tooth in the mouth. According to IMTEC, the MDI implant was designed as an alternative for patients who can’t tolerate the conventional implant surgery or afford the traditional implant. I haven’t been able to find comparison studies and IMTEC doesn’t claim that the MDI is as good or better than the conventional implant – just an alternative if the conventional implant is not an option for the patient. The patient needs to understand that these are not comparable products.

In a 2006 review article in the Journal of the American Dental Association, Dr. Gordon Christensen concluded that “Continuing research is needed for further verification of the acceptability of mini-implants.” http://jada.ada.org/cgi/content/full/137/3/387.  The jury is still out!

Did you grow up in the 1950’s or 1960’s?  If so, you probably have several large silver fillings in your back teeth.  Over time, these fillings begin to break down: the margins leak, bacteria invade and the teeth decay.  Your dentist replaces the fillings with still larger fillings in order to remove the new decay.  In time, these newer fillings also begin to break down.  Sometimes the fillings fracture, taking part of the tooth with them.  You might be eating a bagel or a potato chip and chomp down on a hard object.  It is filling material or tooth.

Sometimes we can replace the lost tooth substance with yet another filling - perhaps a tooth colored one.  But other times the too much tooth structure is missing and a crown must be placed in order to properly restore the tooth.   A crown surrounds the remaining tooth and holds it together.  There is still another scenario that unfortunately I see too often.  In this case the tooth is fractured. Sometimes it can be saved with root canal treatment and crown.  But other times, the fracture is vertical and involves the root of the tooth.  Then in all likelihood the tooth has to be extracted and an implant or bridge placed.

Many times I taken an emergency phone call from a person in distress from a broken front tooth.  The patient arrives at my office and I find that the tooth has broken at the gumline.  The tooth may need a crown, a root canal and crown, or if not salvageable, an implant or bridge.  To take care of the emergency, I make a temporary crown.  I use wonderful materials and I am proficient at creating lifelike temporary crowns which look incredibly natural.  The procedure doesn’t take long and is not painful.  The patient is always thrilled at how natural the temporary crown looks.  No one wants to walk around without a front tooth.

We place enormous pressure on the teeth when we chew and especially if we clench or grind our teeth.  In time, this pressure causes micro fractures in a tooth, and eventually the tooth can fracture.  If I see large fillings that are worn out, I will recommend a crown to protect the tooth before a fracture occurs.  This is prevention.  This helps save your teeth.

It’s time for summer sports - so don’t let an injury spoil your fun!  Protect yourself and your children with a mouth guard. A mouth guard acts as a cushion and will help to prevent a tooth from being knocked out or fractured and prevent trauma to the soft tissue and jaw bone. By absorbing the shock of a blow, the mouth guard may also help prevent a concussion of the brain or dislocation of the temporomandibular joint (TMJ). A mouth guard is required for several sports: field hockey, football, ice hockey, lacrosse and boxing. It is also recommended for many other sports, such as baseball, basketball, racquetball and soccer.

There are several types of mouth guards. The least expensive is a Stock Mouth Guard, usually bought at a sports store. This type of pre-formed appliance is bulky and it cannot be adjusted. It fits poorly and it can easily be dislodged. Another type of appliance is the Boil and Bite appliance. It is also relatively inexpensive and fits better than the stock appliance. But it deteriorates over time and the fit is still not the best.

I recommend a Custom Fitted Appliance for my Long Island dental patients who are athletic. The custom appliance has the most accurate fit and it is the most comfortable. It also provides the best protection and is the most durable. In order to provide this appliance, I take impressions of the mouth and my laboratory fabricates a custom mouth piece.

Mouth guards should only be worn while playing sports. Check the mouth guard for damage after you wear it. If it is damaged, it should be replaced. Don’t chew on the mouth guard. Keep it clean with toothbrush and toothpaste so there is no bacteria buildup. Have a safe and happy summer!

I was at Barnes and Noble last weekend and glancing through A ticket to the Circus written by Norris Church Mailer, the wife of the late novelist Norman Mailer. Even though I have read several of Mailer’s novels, naturally my attention was drawn to his wife’s discussion of his teeth. Apparently towards the end of his life he had to undergo bypass surgery and his surgeons told him to have all of his teeth removed in order to prevent infection. (Seems extreme.) She writes that that was the beginning of his decline. “His dental implants didn’t take, and he was forced to wear false teeth that never quite fit. He began to lose weight.”

Don’t let this happen to you! Be sure to get quality dental care - take care of your teeth – and keep them for life!

Have you had a joint replaced –A Hip? Knee? Does this mean that you need to have prophylactic antibiotics before undergoing dental treatment? Probably - but the American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) are now working together to develop new evidence-based guidelines for antibiotic prophylaxis for dental patients who have total joint replacements. The new guidelines are expected to be available by 2011.

The previous guidelines issued in 2009 were inconclusive: “Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.” Invasive dental procedures can cause bacterial invasion, so antibiotics need to be “considered” – and most cautious clinicians will recommend the antibiotics.

Prior to 2009 routine antibiotics were recommended only within the first two years following joint replacement and after that only for patients at increased risk. Confusing? You bet ya! For more information visit http://www.aaos.org/research.