Love and Teeth

Publication: Montana Woman Magazine

A funny thing happened the other day. My mother was visiting for Mother’s day and her conveniently appointed, ‘Extreme Makeover’. My laboratory technician had worked late on her case, and I was able to redo all of her 10 crowns on her upper teeth. I realized that it was just not fair. Her treatment took almost 8 hours that day, nonstop for me, and my assistant Dawn. We worked diligently and were able to have Mom in her prototype crowns with a new awesome smile, and we were tired. My beautiful Mother, on the other hand, seemed almost refreshed afterwards smiling happily after her mild sedation, (yes, I gave Mom drugs). She remembered very little of her appointment and was thrilled with her pretty new grin. I was wiped out, after focusing on almost microscopic details all day in the confines of my mother’s smaller than average mouth. I thought to my self that it was all worth it to see the smile on her face and know that for the rest of her life she will be smiling and bragging about the smile that her son created for her. I am sure I will never hear the end of it and I don’t mind, as long as I don’t have to do it again!

On this year’s Mother’s Day, I was seeing things differently than I ever had before. Love has transformed my life and brought Holly, Arthur, Amber, Kate, Loren, Julia, and Rusty the dog, into my life. My appreciation of motherhood is exceptionally acute this year because of the little girl growing in Holly’s womb. I don’t begin to have the words, if they exist, to describe the greatness of mothers, so, for the record, I am blown away! The love, patience and perseverance of mom’s, is something powerful. Only love could power an engine with that much energy, and caring. We can all learn from and use the energy that love gives us, after all it is the most powerful emotion we have. Moms know this, and they will someday rule the world because of it.

Dentists the world over are caring people who love to help other people improve their health. It takes patience, skill, compassion, and did I mention patience? Performing intricate sculptures on living tissue inside people’s steamy mouths is a challenge not many people want to undertake. It can be challenging and stressful dealing with the intricacies of treatment, while at the same time, managing staff and business. Training, practice, patience and compassion are required in great quantities to maintain a level of performance adequate to satisfy the high standards of most dentists. Dentistry is a unique blend of art and science delivered as health care, that must be guided by principles and ethics in a balanced fashion. I treat every patient with respect and dignity, and give them

the information and options for the best treatment, as well as other options. I have found that when people feel they are being respected, they respect themselves and make good choices for their long term dental health. When they see the value and benefits of good oral health, the choices become easier to make. As my old partner used to say, beware of bargains in parachutes, brain surgery, and dental work!

My mother is arriving tomorrow, so that we can complete her treatment. She will be able to eat better and smile with confidence. I love to see the way her face lights up when she looks in the mirror. This is the reward of the dentist. To be able to lift spirits and change lives for the better is a great feeling.

Love makes the world go ‘round. Actually I think it is gravity, but both are indomitable forces of nature that are immensely powerful and affect every moment of our lives. If only we could harness and focus that power to change things in the world for peace and harmony with each other and the planet, our lives would be transformed. Love is the one thing we should focus on, besides flossing, because it has the power to effect all kinds of changes, all good! That is my philosophy for the future. My new practice will be called One Dental, to reflect the one thing we all need to focus on in all our decisions and actions. It is the only way we will survive the darn mess we have created. When we start loving ourselves and each other, we may stop trashing our mother(earth), for monetary gain and create a home for her children to be safe and healthy. Come visit us at Onedentalcenter.com. I will post pictures of mom’s teeth so you can see her smile too!


Medicine and Dentistry

Publication: Montana Woman Magazine

Dentistry has long had the reputation of being medicine’s redheaded stepchild. Some people think that dentists aren’t real doctors. The first two years of dental school were very similar to medical school. My biology degree was part of a Pre- Med curriculum. Now that modern science has revealed the long ignored link between oral health and general wellness, the dentist’s role will become more aligned with the medical profession.

Some of the alarming new information about the role of oral inflammation and infection will now require Doctors to refer their patients for dental care, to reduce their risks for many conditions. The common thread that is being discovered to be an underlying danger to long term health is inflammation. Most of us think of bursitis or a swollen bug bite when we think of inflammation. Think again. Inflammation is an amazing cascade of biological and chemical events associated with tissue injury or infection. When it is present as a long term or chronic condition, inflammation has so many sneaky side effects, that it has been named, the “Silent Killer”, by the media.

Chronic inflammation has now been linked with nasty conditions like alzheimer’s, cancer, diabetes and atherosclerosis. One of the diagnostic items that you may have heard of lately, is “C”-reactive protein, or CRP. High levels of CRP indicate an increased risk for many serious diseases and conditions that are very difficult or impossible to treat. The reason for this discussion in a dental column is that periodontal disease is a major source of chronic inflammation that has been overlooked by doctors for years! More than 80% of adults have some degree of gum disease, or pyorrhea as it used to be called. Doctors can no longer ignore this significant health risk to their patients, and will be called upon to refer them to a dentist for treatment. Maybe, finally, our patients will do what we have been telling them all along, since they have the doctor’s orders!

Periodontal disease is a prototypical example of inflammatory pathology secondary to bacterial infection. Bacteria and their byproducts enter the general circulation through diseased gum tissue. The activation of immune cells and natural chemicals I will call chemokines, occurs, and is our body’s response to the inflammatory stimuli. The liver responds by releasing CRP, in response to the synergistic interplay between the body’s cells and chemicals. CRP has become a marker to measure inflammation by. It is much more than that, it is a biologically active chemical that has a direct effect on different cell types. This can be explained with lots of big words but I will say for now it increases the risk for atherosclerosis and blood clots. My uncle Emil just died from a blood clot following a sprained ankle. Other conditions work against you in the presence of inflammation as well. Obesity, arthritis, atherosclerosis, diabetes; well you get the idea.

Let me sum up the point of all this for you. C-reactive protein is the part of the body’s response to inflammation. CRP is more predictive of heart disease than cholesterol, and so is gum disease by the way! CRP is a causative agent in the disease processes, because of it’s direct effect on different cell types. CRP is an indication that inflammation and/or infection are present somewhere in the body. Periodontal disease and dental infections are a primary cause of inflammation. This disease can be managed and reduced by antimicrobial tissue therapy. It is now clear that your doctor has a duty to recommend dental care as a part of your health care.

Dentistry has other trends, that reflect the medical management of oral conditions. Recognizing the bacterial differences in people prone to tooth decay, has led to simple treatments to change the oral microflora in addition to repairing the holes in the teeth. I say it’s about time we can do something more than fix cavities and wag our fingers. Finally patients have options to greatly reduce the continual cavities. We also are developing simpler and more comfortable methods for the treatment of the evil gum disease. Lasers and antimicrobial techniques are showing great promise in this direction.

The future is coming and it will be amazing, and healthier too. Keep flossing and visit your dentist, it’s good for your heart, your breath and your life.


What If……….?!

Publication: Montana Woman Magazine

The holidays and the New Year, bring out a lot of wishes and resolutions in everyone. I thought, what if we applied hopes and dreams to the dental realm. In light of recent developments in dental technology, many of the things we wish about in dental care are actually possible! To enlighten you further, this column will give some answers to some of the, “What if?” questions we may have about dental care.

What if the dentist could make it so I stopped getting cavities? We can do that, with a little help from you! It is more than the usual brush and floss and never have sugar or pop again for the rest of your life. A medical model of treatment for tooth decay has emerged that treats the underlying causes of decay that have been virtually ignored for years. Yes, you still have to brush and floss and watch what you eat and drink, that is common sense. In addition to having the actual cavities treated there are things you can do at home to keep them from coming back! These are fun easy things like chewing Xylitol sweetened gum, rinsing with a special mouthwash, and using a special remineralizing paste to return the minerals to your weakened enamel. This regimen will reduce the cavity causing bacteria, adjust the acid levels and allow the teeth to remineralize and be more resistant to cavities. This is great news! I am excited about this protocol. We can measure the effectiveness of the treatment by measuring the bacterial activity in the mouth, before and after treatment, using a cool new tester that only requires us to wipe a couple teeth with a Q-tip. Now extensive and expensive dental care can have some protection from recurring decay, and no more fear of bad news and lectures at your check ups!

What if the dentist could treat my gum disease without all the pain and expense of scraping and numbing my poor sensitive inflamed teeth and gums over and over? Great news! We can! I have recently been certified in a new FDA approved method of treating gum disease, called PerioProtect ™. This novel approach is simple, comfortable and fits in well with the other treatments for decay if needed. The main side effect is a slight whitening effect on the teeth! Oh no! Who would want that! Not only does this technique reduce the need for gum surgery, and challenging “deep cleanings”, but it may accidentally make your teeth whiter. By using specially designed FDA approved custom made trays, we can direct healing medications into the crevice between the teeth and gums, to fight bacteria and soften up the hard deposits. This makes your tender gums less inflamed and easier to clean when the time comes to remove stain and tartar. This is a great option for people who haven’t been responding to the standard treatment of gum disease. It is also a great way to provide long term maintenance of gum health for protection of nice dental work and periodontally compromised dentitions. Wishes can come true, you can do most of this on your own time at home! With the proof in from research about the horrid effects that gum disease has on the rest of the body, this is great news indeed! I had an older gentleman in the other day, with severe heart disease. He said last time he had his teeth cleaned it hurt for three years! Oh, how I wanted to scrape those dirty teeth with those red inflamed gums. I just knew they were making him sicker. Now, I can’t wait to make him some trays and send him home to get healthy.

What if I could get my not so pretty teeth transformed into a great smile, with no shots or drilling? Ok, there is a way to do that! It works great for patients with dental fears. With only an impression and some dental cement, we can make and place super thin porcelain veneers over teeth, to improve color, and shape of the smile! The rewards of a confidant smile will be reaped painlessly for years and years. Recently one of my patients remarked to me, that after we improved her smile, the responses she received from other people were much more positive now, even though she has always been outgoing. That was really cool to hear. This is great news for many patients. Combined with the other treatments for cavities and gum disease, the whole experience just got a whole lot easier, for both of us!

What if I could get rid of these floppy stinky dentures, and get real teeth back? Are you kidding, we can do a lot but, wait a minute, Yes, we can do that! With the use of implant dentistry, some patients can say goodbye to their dentures with fixed implant reconstructions. Implants are titanium tooth root replacements that we can use to support prosthetic teeth that stay in the mouth and are permanent. They will never get cavities, and will not develop the kind of gum problems real teeth can. How cool is that! This is great news for individuals who can afford the best, but what about the rest of the denture wearers? I have great news for you too! By placing only two implants, you may be able stabilize new, and sometimes, old dentures, with snap like attachments, that hold those wiggly (especially lower) choppers firmly in place. This has become my new standard of care for lower denture patients. Even if you have a partial denture, implants can be used for anchors. This protects the remaining teeth from damage caused by the removable partial that hooks onto them. Scary and expensive you think, not really! The discomfort associated with implant placement is minor to moderate. The dependability of the implants makes them a lifetime solution in most cases. I would say the quality of life gained by the patient, is priceless. Generally speaking, the cost of avoiding dental care can be much higher due to increased medical problems, time off work, and increased severity of dental and medical complications.

The wish list goes on, but the page is short. I wish this brings hope for those dental dreams and New Year’s resolutions. Have faith, dental medicine is becoming more comfortable all the time, and you can have a healthy and pretty smile if you want it. Good luck and keep smiling. Have a tremendous New Year!


Good News!

Publication: Montana Woman Magazine

Last month I promised some good news. I am going to be a father! How’s that for good news. Boy, are we ever excited! Not only will there be an heir, maybe, (I have five nieces), I have some good news to put in a dental column. Please look for a picture of my wife in the new ad about healthy smiling! It is not difficult, for me, a dental optimist, to find great things to say about dentistry, but sometimes the dentist and good news don’t come to mind in the same sentence even if it is a run on. If you are ready to start thinking about heading in to the dentist, there is some good news to be had.

First, one of our main obstacles is cost. Dental treatment is expensive to provide and to receive. You want to obtain maximum value on your treatment. The good news is, there are a few nice options to help you finance treatment if you like, and some treatment options that will reduce your dental spending long term. Dentistry has the most value when it is durable, comfortable, and health enhancing. Many patients are mainly concerned with health and function, before looks. I tell them that is great, because without first addressing health and function, doing cosmetic treatment will have less value. Studies have shown that the positive health benefits of good dental care are priceless.

Another obstacle to treatment is fear! Good news! With most dental care today, there is very little discomfort, and with a few safe, simple techniques, many dentists can alleviate your anxiety and make the experiences more relaxed and comfortable for everyone. Many fearful patients avoid us like the plague, and come crawling to the doors in fearful desperation when pain drives them in to seek help. The like some superhero, we swoop in and relieve their pain and anxiety . We remove the spectre of fear and replace it with feelings of relief and trust and safety. One of the more rewarding moments in my job is when a fearful patient gains trust and achieves dental health comfortably. Now we have some new stuff to ensure long term management of our two main enemies, decay and gum disease. With these in our arsenal, longevity of dental work, and probably our patient will be greatly enhanced too!

More good news is that, the longer it is that you have stayed away from the dentist, the more things have improved since you had been there last! The recent surges in dental technology have been a challenge to keep up with, and things just keep getting better. Greater understanding in biology help us treat dental diseases earlier, more effectively and less invasively. New advances in every aspect of diagnoses and treatment have made this fascinating subject clearer and even more interesting. I wouldn’t recommend putting off dentistry though. Most problems won’t get better or go away, and we know professional prevention is still the core of our message and our best advice.

Now , here is some good news. Dentistry is starting to pick up on the idea that customer service is the most important part of what we do. Our job is to satisfy the needs, wants and expectations of our patients. Each patient deserves the most attentive friendly and professional treatment we can provide. This individual attention to detail allows us to be the most effective at delivering healthcare and cosmetic services. In today’s world, few things are appreciated in the course of the day, than being treated like a human being, and pampered a little too! Feedback from our patients is critical in developing a relationship that will insure the best care for that person and their family and friends. What this means to you, is that it is important to let us know how we can serve you best.

So I guess what I am trying to say, is that the good news is, that I will be a daddy!! I mean the good news about dentistry is that we have cool , safe, and comfortable ways of providing dentistry and enhancing health and esthetics. Don’t be intimidated by your friendly neighborhood dentists. They are all good people who like to help! I know this, I am the president of the First District Dental Society this year, and the more I know these fine doctors, the more I admire them. Come and see us when you are ready, and maybe sooner. Thanks for listening, and keep smiling, it’s healthy for you!


Life and Teeth

Publication: Montana Woman Magazine

Dr. Tom Pittaway has practiced dentistry at Plaza West in Kalispell since 1993. He is an American, born in Germany, raised in Calgary and educated at Gonzaga U. and Washington University School of Dental Medicine, in St. Louis. He began his career in the Canadian Arctic, shifted extremes to Honolulu for three years and then settled in Kalispell. A member of the American Dental association, Montana Dental association, and the 1st District Dental Society, Dr Pittaway is also a Mentor for the Kois Center for Advanced Dental Learning in Seattle, one of the premier educational facilities in the U.S. and the world. An expert in cosmetic and reconstructive dentistry, Dr. Tom believes in constant learning and improvement .

LIFE AND TEETH

By Dr. Tom Pittaway

When I was given the opportunity to write a column for this magazine, I had no idea that deadlines would approach with such blinding speed. Life as well, has been racing along, good and bad, a continuum of our journey through the universe. Some friends died recently, suddenly, young men in their prime. I was reminded that, every day we wake up, could be our last.

My dilemma became apparent, should I attempt to write fun informative columns about dentistry, or share my feelings about life in an empowering way to enrich the lives of my readers. I’ve decided to give all of you the best three or four hundred words I can muster, in an informative, enlightening and fun way. To provide some answers about dentistry and perhaps life as well. After all, who reads columns about just teeth, except dentists!?

We are all different and we are all the same. All of us are together on this round speck of dirt that has hurtled through the universe for eons. We are in this together, waiting and searching for enlightenment about our miraculous existence. According to the mysteries of metaphysics, we are all connected, one.

Fortunately teeth are no such enigma. A smile can be magic, much more than enamel and tissue, it is an expression of love, happiness, joy . A smile can be priceless, and yet we can give one to everyone we see, and almost always get one back! A smile is how we express ourselves.

A smile is also a measure of health and happiness. My greatest reward was to give back a smile to a person who had damaged her teeth when she was younger. When she left my office crying, because she could smile without embarrassment, I knew I had given her something valuable. It is not easy to measure how our emotional health affects our general well being, but we know for sure, there is a big connection.

Research does provide sobering facts about health and teeth. We now have proven that gum disease increases risks of heart disease, stroke, premature birth, and even premature death. I have quipped to patients, floss or you will die. Of course that is overkill, we all die, but did you know we live longer when we have more teeth! The health of our mouth is intimately connected to the health of our bodies, and vice versa.

The good news is that, in Nature, health is the rule, disease the exception. If the conditions are right, all creatures are completely healthy, carefree, perfect visions of our miraculous creation. Civilization comes with a price however. Adaptability, resistance and susceptibility to disease determine what can happen to a dynamic biologic system that is interconnected with the entire body, not to mention the universe. Dental medicine is evolving continuously to meet the challenges posed by our existence. One thing I know for sure, if you love your teeth they will love you back. Love is the answer. So keep smiling, and floss dammit!

Next month, the real scoop on whitening.


Women’s Special Dental Needs

Publication: Montana Woman Magazine

Men and women are not the same. Most dental principles apply to either sex and there are many special considerations for our female patients. I will review a few of these this month. We all know the body’s systems are interconnected, but few of us recognize that the health of a woman’s smile is strongly influenced by hormones, and may be an indicator of overall cardiovascular and systemic health. Most systemic diseases have oral symptoms. Educating consumers on the link between oral and systemic health can save lives!!

The link to systemic health has been recent news as researchers have discovered that oral health scores were a stronger predictor of heart disease risk than well studied factors like cholesterol levels! Diabetes mellitus increases risk and susceptibility for gum disease.75% if adults over 35 have some degree of gum disease. Somewhere between 3 and 5 hundred species of bacteria are found in the mouth and they multiply 36 times while you are sleeping. Uncontrolled, the body’s immune system may be overwhelmed or over stimulated resulting in damage to the oral tissues and systemic ramifications such as blood sugar problems or sepsis. Good nutrition and hygiene become important in maintaining a healthy balance.

The ebb and flow of hormones during a woman’s life may affect her response to plaque, the sticky bacterial film responsible for most dental woes. Changes in estrogen and progesterone that occur during puberty put young women at greater risk for gingivitis. In younger women, dentists are also on the lookout for signs of bulimia, which is terribly destructive to enamel. Monthly fluctuations of menstruation also make some women more prone to gingivitis, canker sores, cold sores, and swollen salivary glands. Birth control pills can increase the risk of bleeding gums, dry mouth and dry sockets. Some antibiotics have been suspected of decreasing the effectiveness of oral contraception, so it is wise to check with your doctor or pharmacist when taking drugs to fight infection.

Pregnancy gingivitis occurs in 60-75% of women between 2 and 8 months due to the rush of progesterone. Good hygiene and preventative measures are important at this time. Most dental procedures can be safely performed on pregnant women, but take extra special caution during the first trimester while the little one is forming .It is important for expectant mom’s practice good hygiene for her and her child’s benefit. It is also true that decay causing bacteria can be passed to small children from us, once they have teeth!

At menopause, when hormone levels decline, other oral changes may occur. Burning mouth syndrome, dry mouth, altered taste perception and osteoporosis are not uncommon. Hormone replacement therapy may ease these symptoms. Bisphosphonate drugs used to treat osteoporosis and some cancers (breast), have recently been associated with severe bone necrosis (large portions of bone may die and slough) in the jaws. Before you undergo surgical procedures in the mouth, alert your dentist about the drugs you are taking, especially if they are intravenously administered for cancer therapy.

Xerostomia or dry mouth can be a result of physical changes or drug side effects. In severe cases a change in medication may be indicated. Products by Biotene, such as the mouthwash Oasis help relieve the discomfort associated with dry mouth. Saliva is a very important lubricant, full of minerals and enzymes to maintain the enamel fight bacteria and aid digestion and swallowing. Without it your teeth are sitting ducks for decay and gum disease bacteria. Be sure to let your dentist know if you are experiencing problems, and often your dentist will notice before you do!

Many other health conditions have oral signs that your dentist may notice. Since many folks don’t see a doctor regularly, a heads up from the dentist can be valuable. Diabetes, vitamin deficiency, anemia, leukemia, and oral cancer are a few examples. New technology is currently being developed to use saliva tests to check for markers of many conditions, including HIV and cancer .I think these will become widely available in the next few years.

Common sense and good hygiene is the mainstay to keep your teeth at their best. This is the key; we can never recover to the original state of health once infections damage our oral tissues. I had to say this sooner or later, prevention is the best treatment there is! Whew, I feel better now.


The Top Ten or Eleven Reasons to Visit the Dentist

Publication: Montana Woman Magazine
  1. The Oral Systemic Connection. In plain English, this means that the health of your mouth, gums, and teeth, is connected intimately with your total health. Research is in on the fact that chronic infections in the teeth and gums can cause many other degenerative changes in the body. Risks increase for heart disease, stroke, atherosclerosis, diabetes, pregnancy, respiratory infection, arthritis, dementia, and I just read a report about increased risk for pancreatic cancer. Clearly, treatment and prevention of oral infections is important in longevity and quality of life. Your dentist can fairly easily help you identify and treat these frequently symptom free oral infections.
  2. Prevention! This includes maintenance.We have heard this before, and it’s as plain as the nose above your smile! Hard to believe something so simple effective and obvious, is forgotten so easily. Don’t get me started on this one! Look ahead not back at what can be prevented, since hindsight is 20/20, it just makes it worse. Starting now, we can change our path a little in the right direction. Love your teeth and they will love you back.
  3. Stop dental decline and decay in it’s tracks. So you missed the prevention program. It’s OK! We won’t yell at you . The consequences are penalty enough. Having imperfect teeth does not make you a bad person. Ask George Washington. Since cavities never go away, and only get worse with time, the prognosis for a tooth with decay is hopeless. Naturally, the sooner the better works on this one, and doing things daily, that reduce your risk and rate of decay makes a big difference. Try some Xylitol gum for instance.
  4. Keep your teeth for a Lifetime. When you stop and think about it, the quality and quantity of our lives, is affected by our oral experience. Happier , healthier, longer lives, follow smiling, infection free mouths. I have many remarkably healthy older patients to prove it! Who wants to get major dental treatment at 80? Not me. Die smiling!
  5. Safe treatment for other medical conditions. Are you a candidate for a joint replacement, kidney transplant, heart surgery, chemotherapy, cancer and or osteoporosis medication, or other complicated or immune suppressing medical treatment. Your doctor will probably recommend a dental exam, so that an oral infection won’t compromise the treatment they are rendering. This could be a life, or at least a limb saver!
  6. Detection of other undiagnosed medical problems. Many people don’t have regular doctor visits. I am guilty of this. Dentists have knowledge to recognize and identify many conditions and diseases that might otherwise go untreated. We can help recognize abnormal conditions and alert you to seek appropriate care. Some of these include, cancer, leukemia, sinus infections, tumors, STD’s, diabetes, malnutrition, and I could go on. Let’s talk about more positive stuff!
  7. Kids. Let’s face it, we love our kids beyond words. Early and regular dental visits, can make their lives and futures much better. Teaching them proper oral care habits and educating parents is valuable and rewarding. Prevention and early interception of potential dental problems can be priceless. Do the right thing, be responsible for your children’s teeth. Help them at home with good hygiene and food especially. Love and chocolate go together but not all the time!
  8. Get that Sexy smile you want. Patients have told me, people respond better to them when they have a more attractive and confident smile. This is a natural consequence that goes along with smiling more and feeling better about your self. Your dentist can do wonders, and it may be much easier than you think. And, no, you are not too old!
  9. Replace those missing teeth! Sure, many people function without some or all of their teeth. Teeth are not for everyone. Teeth are not necessary for life. Teeth sure as heck help you chew and smile and speak though. Dental implants and prosthetic treatment, can restore function and smiles for our patients. This probably won’t happen without our help! Visiting a dentist for an evaluation can help you understand what is possible for tooth replacement and repair. We are getting better at this than ever before thanks to dental implants and modern technology.
  10. Temporomandibular Joint Dysfunction, or TMD.
    According to some studies, up to 80% of people could benefit from some kind of splint or bite therapy, to reduce pain from sore muscles and jaws. There is a whole science to these related conditions. The truth is most of these patients have muscle tension and soreness that is fairly easily relieved. I can’t believe how many people suffer with regular headaches. I love to hear how they don’t get them any more after we do some splint and bite therapy. Some jaw problems are stubborn and mysterious and require more specialized treatment. Don’t suffer needlessly and be grouchy and mean and sleep deprived, get some help. Your family will thank you and you will thank your dentist! Don’t forget to thank yourself in the meantime. Take good care yourself and keep stress manageable. Don’t worry, be happy and smile no matter what!

Diabetes and Dentistry

Publication: Montana Woman Magazine

This month, I would like to discuss a disease that affects someone you know or love. A metabolic disease called diabetes. Current research is proving what we have known all along. The health of your mouth is directly connected to the health of your body, in many ways. The diseases we have, can affect the health of the mouth in many ways also. Diabetes is one of these conditions that can affect the health of every organ in the body! I will review the relationship between diabetes and oral health, and hopefully save a tooth or a life.

Diabetes is a serious, common, controllable illness. It is the 6th leading cause of death in the U.S. It is the #1 cause of lower limb amputation not related to trauma, the #1 cause of blindness, and kidney disease leading to dialysis. Diabetes is a leading contributor of cardiovascular disease, which is the leading cause of death in the U.S. 65% of diabetics die from cardiovascular disease. Adults with diabetes are 2 to 4 times more likely to have heart disease or suffer a stroke than non-diabetics. They are at risk for kidney disease, amputations, nervous system disease, and gum disease.

There are two main types of Diabetes. Type 1 and Type 2.Type 1 diabetes (also known as juvenile or insulin dependent), begins in childhood or young adult hood with the autoimmune destruction of the insulin producing cells in the pancreas. These people need insulin and must check their blood sugar frequently. Diet plans and exercise are part of their life. Type 2 diabetes (adult onset or non-insulin dependent diabetes) is related to insulin resistance. This is where the body produces insulin but it is not well used by the body tissues. Insulin production gradually decreases. This tends to affect overweight and sedentary people, and is alarmingly becoming more common in young people. This is a concern because the risk of complications increases with the duration of diabetes.

Diabetes can lead to changes in the oral cavity. Unfortunately, caring for the mouth is frequently overlooked in the treatment of diabetes. The effects of diabetes on the gums and other oral tissues may be noticed by your dentist. Unfortunately for many people, gum disease has few symptoms and may go unnoticed until it is quite severe. Other conditions may include dry mouth, aggressive periodontal disease, saliva changes, burning mouth syndrome, abnormal wound healing, fungal infections and tooth decay. These findings are associated with dehydration from excessive urination, altered response to infection, altered tissue metabolism, micro vascular changes, and side effects from medications.

It has been shown that diabetics have a decreased immune response. The result of this is increased risk for infections. The double whammy here is that infection makes blood sugar harder to control. Uncontrolled blood sugar makes infection more possible. Add on to this conundrum some dry mouth and poor oral hygiene and we may have a serious health risk in your mouth. Decayed teeth may crumble bacteria into you lungs and give you pneumonia. Gum disease is more common and more severe in diabetics, and is harder to treat. To make matters worse, periodontal disease increases risk from heart disease and stroke, on top of the risks posed by diabetes. Don’t forget, uncontrolled gum disease makes it harder to control blood sugar, increasing risk for organ damage to the brain heart and kidneys!

Whew, if you have waded through all this bad news you deserve some good news! Diabetes is controllable, and in the case of type 2, frequently preventable. The same goes for gum disease. That’s why prevention is worth the trouble. When blood sugar is controlled, a diabetic is like everyone else, except they pay more attention to food and blood sugar. I have many diabetics in my practice, and they are great people, partly because they appreciate health that others may take for granted. There are 20 million diabetics in the U.S. and many undiagnosed cases. Great oral hygiene and professional dental care can make the difference, so brush, floss and see your favorite dentist regularly!


Everybody is Doing It

Publication: Montana Woman Magazine

Dental whitening is a safe, easy, cost effective way to brighten your entire smile. According to a recent USA Today survey, 85% of Americans would like whiter teeth! According to my calculations, that is almost everybody! The market blitz is on, with you, the consumer being the target of lots of confusing marketing and hype about toothpastes and lasers. This month I will cut through the crap and deliver the straight scoop from the inside. If I am missing next month the whitening hit man has found me!

Whiter teeth can be accomplished many ways. I will boil it down to three approaches. The first of these is restorative dentistry. This involves the use of dental porcelains, and composite resin filling materials in the form of bonding, veneers and crowns. These can change tooth shape and color and transform a smile. Although this isn’t tooth whitening in the bleaching sense, I usually recommend whitening before a smile makeover to improve the overall results. It is also a great way to improve the health of the gums prior to treatment. The peroxides used in whitening were originally used to heal gum lesions.

The other ways to “bleach” your teeth are what we hear about from our dentist and the marketers. Over the counter toothpastes with whitening on the label are slightly helpful and create only small improvements. Since the act of brushing your teeth can remove stains, any toothpaste can be marketed as “whitening”. Some products have a little added ingredient to make the marketing more plausible, but in general the benefits are minimal. Store bought home whitening products work for some. They are merely watered down versions of the professional systems.

Professional whitening involves two types of techniques. In office whitening, refers to the laser or light assisted techniques done in the office or at whitening centers. Tray or take home whitening, involves the use of lightweight custom tray mouth guards that fit right to the gum. The patient must then apply special peroxide gel into the trays and onto the teeth twice a day for an average of two weeks. This requires a patient at be responsible at home for the treatment. Some people lose interest or stop due to sensitivity, a mild temporary side effect of most whitening techniques. The gel fortunately has a long shelf life and can still be good even after a year in your refrigerator. The effects of tray whitening are dramatic and long lasting, but require good patient compliance. It is a less expensive way to go than in office, and new gel can be purchased from your dentist as long as your dog hasn’t chewed up your trays!

In office whitening with brand names like Opalescence, Zoom and Britesmile, is for those who would like instant gratification. While research has shown that tray systems give results every bit as good as these heavily marketed light assisted systems, not everyone can fit the tray regimen into their lifestyle. An hour or two at the dental office is all it takes to power whiten and create sudden dramatic results. A word of caution here, since the teeth get dried out a bit, the existing immediate result is subject to a bit of fade as the teeth rehydrate . In office whitening also seems to fade a bit sooner than the tray technique, so many Doctors deliver a tray system for upkeep. Some reports of discomfort associated with in office techniques have prompted manufacturers to include new technology and ingredients into these products to improve comfort. I recommend a home fluoride regimen before, and possibly ibuprofen after treatment to minimize or eliminate discomfort. Also, while whitening is safe and penetrates deep into the tooth, it won’t change the color of fillings or crowns. Severely stained teeth require more sustained effort and may require restorative treatment for ideal results.

Regardless of color, every smile is welcome.

So keep smiling!


What’s up with Cosmetic Dentistry?

Publication: Montana Woman’s Magazine

Dentistry has been described as an art and a science. This is especially true in the case of cosmetic, or esthetic dentistry. The recent trends in dentistry have expanded the dental healthcare delivery model towards healthcare with elective treatment options and even purely elective treatment. A discussion with your dentist will help you decide the direction of your care. My philosophy is to choose the direction that reduces risk, and improves health and esthetics. I will explain this with a few examples.

Elective procedures are optional from the health perspective of the tooth. Please don’t confuse these with treatment that is good for the health of the teeth and improve the looks at the same time. For example, your son just took a baseball in the teeth. One got knocked out, one broke above the gum, and the ones beside these had stained fillings and are slightly rotated. These teeth are candidates for elective treatment, while the missing and broken ones are healthcare issues. A competent dentist may or may not recommend using this occasion to not only repair the smile, but enhance it. Simple porcelain veneers on the stained rotated teeth, could match up color of the porcelain on the repaired teeth to create a harmonious attractive smile. I think we have all seen people with repaired front teeth that did not blend in with the others. Frequently cost is an issue in the decision. When you think of the long term, being confident with your smile is remembered long after the money is spent.

The benefits of cosmetic dentistry are evident in our Extreme Makeover shows. These people have new confidence and improved self images, after all is done, and usually the biggest contribution is the smile. The emotional benefits and impact of an attractive smile are hard to measure. There are other benefits as well, to a properly restored smile.

My father, a retired orthodontist, has incessantly remarked to me, (and I will paraphrase out of consideration to my readers), that form follows function. What he means is that when the teeth are working as nature designed, the result is naturally attractive. If I had a choice between being prettier and being able to chew, I would settle for ugly! If I could be prettier, and be able to chew better with less jaw problems or tooth pain, the choice is easy. There is a lot more to the smile than the front teeth. Chewing is the first step of digestion, where the salivary enzymes mix with and prepare the food for the stomach. You won’t be smiling much if your indigestion causes reflux that accelerates erosion of your front teeth as they wear excessively from chewing with them. We can get by with less than 100% of our teeth, but we need back teeth for support and protection of the front ones.

Technology has elevated the art and science of dentistry to new levels, and it is a constant learning process to keep up with the information. In the past 10 years dentistry has changed more than it did in the preceding 50 years. The next 10 years will be another acceleration of technology. It’s like a reaction that progresses exponentially! What this means to you, the patient, is that there are trained doctors, willing and able to comfortably restore your smile and bite, to an attractive and functional result. When you deny yourself this opportunity it may mean years of embarrassment, discomfort, not smiling, not eating or chewing properly and hiding your teeth when you laugh. The benefits of cosmetic dentistry have enhanced the lives of many, and the kicker is, if it is well done, no one can tell it isn’t natural. Make sure you align your expectations with what your chosen doctor can do with your individual situation. Doing your part in being committed to the program is essential to its success, and remember to keep up the maintenance. I have never had a patient regret their decision after completing the entire treatment plan. It is our goal to provide a long lasting dependable result that minimizes risk to the health of our patients. It is our greatest pleasure to see a smile transformed into a work of art that will enhance the lives of the patient and everyone he or she smiles at!