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!