I have seen number of patients that suddenly have generalized teeth sensitivity after use of tartar control formula tooth pastes. The reason for this sensitivity that goes away after the use of the tooth paste is stopped is due to the anticalculus component of the tartar control dentifrice. Tetrasodium and /or Tetrapotasium Pyrophospahate are the chemical names of these tartar control components. Pyrophosphates alone are not responsible for hypersensitivity. In order to mask the strong bitter taste of pyrophosphates concentration of flavoring agents, known to cause sensitivity are increased. Also increased concentration of detergents is needed to make Pyrophosphates soluble in the dentifrice. These changes are the causative factors in hypersensitivity reactions. Teeth restored with restorations like porcelain veneers should not have sensitvity.
Improving Oral Health
With an increasing number of toothpaste to choose from, recommending an appropriate dentifrice for patients can be difficult. Flouride containing toothpaste has been the primary choice of the most dental offices. With cosmetic dentistry our goal is to make sure that the smile makeover lasts for a long time. (more…)
Evaluation of efficacy for various treatments in managing sleep bruxism
A recent study (c.Manzini, J Prosth Dent 2006 vol19 P21) shows that the short -term use of dental splint was the treatment presenting the most important reduction in sleep bruxism. Two types of dental splints were tried, one an upper splint and the other a mandibular anterior positioning device (MAD) that actually reduced bruxism more than just the upper splint. An through evaluation by a dentist trained in occlusion and cosmetic dentistry will determine which device should be used. A MAD device is mainly used for sleep apnea and although it has definite benefits but dental devices, including MAD, is not as effective as CPAP therapy, but patients may be more satisfied with them. They do have side effects, however. For example, the following problems are reported with MAD devices:
Side effects of MAD can include nighttime pain, dry lips, tooth discomfort, and excessive salivation. In general, these side effects are mild, although over the long term, nearly half of patients stop using them. Devices made of softer materials may produce fewer side effects. In some cases of long-term use, permanent changes in the position of the teeth or jaw have occurred. Periodic check-ups with a health professional are advised. In a small percentage of patients, the treatment may worsen apnea.
Also the effect of Clonidine (alpha 2 cardioactive drug) was evaluated and it seemed like this medication had an important effect in reducing sleep bruxism but this result was hampered by severe morning hypotension in %25 of subjects. Bromocriptine (dopaminergic agonist) increased the sleep bruxism in this study while propranilol (antihypertensive) decreased it just slightly
Porcelain Veneers
These are before and after of using Feldspathic porcelain veneers to create the desired cosmetic dentistry. http//www.drsamsavar.com/gallery
Bisphophonates, Osteonecrosis, and Dentistry
Reports of bisphosphonate-associated osteonecrosis of the jaw (BON) associated with the use of Zometa (zolendronic acid) and Aredia (pamidronate) began to surface in 2003. The majority of reported cases have been associated with dental procedures such as tooth extraction; (more…)
Periodontal Treatment Does Not Lower Preterm Birth Risk
Link: www.sciencedaily.com/releases/2006/11/061102092603.htm
Source: NIH/National Institute of Dental and Craniofacial Research
| Scientists supported by the National Institute of Dental and Craniofacial Research, part of the National Institutes of Health, report in this week’s New England Journal of Medicine that pregnant women who received non-surgical treatment for their periodontal, or gum, disease did not also significantly lower their risk of delivering a premature or low-birthweight baby. |
These results come from the largest clinical trial to date to evaluate whether treating periodontal disease during pregnancy reduces a women’s risk of early delivery, an idea that has emerged as a possibility in recent years. Non-surgical, or standard, periodontal treatment involves thoroughly cleaning the teeth above and below the gums, commonly called scaling and root planing.The study, called the Obstetrics and Periodontal Therapy Trial (OPT), also evaluated the safety of general dental care during pregnancy. It found that dental treatment through the second trimester – both general and periodontal care — did not increase the number of adverse events for women during pregnancy. Until now, little research had been conducted on the subject, although dentists generally provide limited dental care to women only during the second trimester when the fetus has reached a more stable developmental stage and before treatment becomes too physically cumbersome for the mother.“Dental care during pregnancy has long been an issue dominated by caution more than data,” said NIDCR director Dr. Larry Tabak. “The finding that periodontal treatment during pregnancy did not increase adverse events is important news for women, especially for those who will need to have their periodontal disease treated during pregnancy.” In the United States, more than one-half million – or about one in eight – babies are born prematurely, which is defined as a birth that occurs before 37 weeks of pregnancy. Extremely preterm babies can be so small and underdeveloped that they must remain hospitalized for months, and, if they survive, spend years battling chronic health problems. This has spurred scientists to identify several risk factors associated with premature births. These include smoking, low-income status, hypertension, diabetes, alcohol use, and genitourinary tract infections. However, the list remains incomplete. As many as half of all preterm births occur without any clear explanation, and that has left scientists searching for additional susceptibility factors to help more mothers and ultimately reduce the estimated $26.2 billion annual cost to the nation for preterm births. Over the last two decades, scientists have generated data in observational studies that suggest periodontal disease during pregnancy might be one of those elusive risk factors. The theory is based on the idea that bacteria associated with periodontal disease may spread to the womb and help to induce preterm births. Results of a previous small-scale clinical trial further supported this idea, but what’s been missing are more definitive data from larger, randomized clinical trials. To fill this public-health need, the NIDCR funded two large, randomized clinical trials. The first to publish its results is the OPT, which included four participating centers: Hennepin County Medical Center in Minneapolis, University of Kentucky in Lexington, University of Mississippi/Jackson Medical Mall in Jackson, Miss., and Harlem Hospital/Columbia University in New York City.Launched in March 2003, OPT enrolled a total of 823 women with periodontal disease, all of whom were between 13 and 17 weeks pregnant upon entry into the study. Each woman was randomly assigned to receive either: (1) scaling and root planing of the teeth prior to the 21st week of pregnancy, then monthly tooth polishings or (2) scaling and root planing after delivery, meaning women in this group did not have their periodontal disease treated during their pregnancies. All women were 16 years or older to participate, and basic dental care was provided to everyone in the study.According to Dr. Bryan Michalowicz, a periodontist at the University of Minnesota and the lead author of the study, one of the OPT’s strengths is its four regional centers generally provide prenatal care to low income, underserved women of all races, who are recognized as being at particularly high risk for early delivery. “When trying to define risk factors for preterm birth, it’s difficult to control for characteristics that may differ between full and preterm mothers, such as socioeconomic status or access to health and dental care,” said Michalowicz. “By randomly assigning women from the same high-risk populations to receive treatment either before or after delivery, we could minimize such differences between groups.” As reported this week, the OPT data show:Birth Outcomes: Forty nine (12.0 percent) women in the treatment group had pregnancies ending before 37 weeks compared to 52 (12.8 percent) of those in the control, or delayed treatment group. Nineteen miscarriages occurred, although the numbers were not indicative of a statistically significant trend in either group. These included: Six spontaneous abortions (two in the treatment group, four in the control group) and 13 stillbirths (three in the treatment arm, 10 in the control group. A spontaneous abortion was defined as a loss of the baby before 20 weeks, while a stillbirth was considered to occur from 20 weeks to 36 weeks and six days. The researchers also found no significant differences among the two groups in the proportion of infants who were of low birthweight, defined as weighing less than 2500 grams, or about five and half pounds. Periodontal Disease: Most women had early to moderate periodontal disease. The researchers found that the treatment improved all clinical measures of periodontal disease. These included the bleeding of gums when probed, the probing depth between the tooth and gum, and measuring tooth attachment. As additional evidence, the researchers found no difference in risk for preterm birth when they compared treatment and control women who had the most extensive bleeding of the gums, a sign of inflammation, or more advanced periodontal disease at entry. They also found no differences when they examined a subset of women in the treatment group whose periodontal disease had improved the most during the study. Safety of Periodontal Therapy: Women in both groups had similar rates of adverse medical events, such as hospitalization of more than 24 hours for labor pains. This is an indication that periodontal therapy had no obvious effect on pregnancy. “This study highlights the power of merging disciplines, in this case dentistry and obstetrics, to pursue a public-health question,” said Dr. Virginia Lupo, an author on the study and an obstetrician at the Hennepin County Medical Center in Minneapolis. “We literally set up dental practices within our obstetrics clinics, and that was a very unique and needed approach.” Although OPT is now the largest study to publish on the subject, the NIDCR-supported Maternal Oral Therapy to Reduce Obstetric Risk (MOTOR) study is ongoing. “It’s just good science to conduct more than one large clinical trial on any public health question,” said Dr. Jane Atkinson, program director of NIDCR’s Clinical Trials Program. “If periodontal disease plays any role in preterm birth, we want to cast a wide enough investigational net to determine which women are at risk.”Atkinson said the 1,800-patient MOTOR study is designed a little differently than OPT. It involves a broader socio-economic cross section of women, provides fewer basic dental services, and includes women with slightly less severe periodontal disease. MOTOR will likely report its results within the next two years.The article is titled “Treatment of Periodontal Disease and The Risk of Preterm Birth” and appears in the November 2, 2006 issue of the New England Journal of Medicine. The authors are: Bryan S. Michalowicz, James S. Hodges, Anthony J. DiAngelis, Virginia R. Lupo, M. John Novak, James E. Ferguson, William Buchanan, James Bofill, Panos N. Papapanou, Dennis A. Mitchell, Stephen Matseoane, and Pat A. Tschida. The National Institute of Dental and Craniofacial Research is the nation’s leading funder of research on oral, dental, and craniofacial health.
Fluoride and infant formula
It is a proven fact that fluoride prevents cavities but American Dental Association has just come out with interim guidlines regarding the use of fluoridated water in infant formulas
fluoride intake above the recommended level for a child’s age creates a risk for enamel fluorosis in teeth during their development before eruption through the gums. According to fluoride intake guidelines set by the Institute of Medicine, the amount of fluoride recommended for babies under a year old is less than that for older children and adults. Infants less than one year old may be getting more than the optimal amount of fluoride (which may increase their risk of enamel fluorosis) if their primary source of nutrition is powdered or liquid concentrate infant formula mixed with water containing fluoride.
More information is available at www.ADA.org
Head Immobilization Impairs Jaw Function
Jaw opening and closing relies both on mandibular and head movements. Jaw and neck muscles are jointly activated in jaw functions. Restricted head-neck mobility can impair jaw function. Recent studies show that head fixation due to neck injury leads to reduced manibular movement and shorter duration of jaw-opening/closing cycles. Considering this relationship it is important that during different cosmetic dental procedures the occlusion or bite be evaluated as well as the position of the neck. Venetian Veneer procedure is a porcelain veneering procedures developed at the International Institute of Cosmetic Dentistry to address the issue of occlusion.
Minocycline
Minocycline, a tetracycline derivative is commonly used to treat acne vulgaris and rosacea. It is also used to the treatment of Mycoplasma, Chlamydia and Treponem infections, chronic respiratory disease and rheumatoid arthritis. Minocycline may cause abnormal pigmentation of the skin , nails , bone and teeth. The stains are generally Green/grey, blue/grey and mostly happen on the incisal edge and most intensely the middle third of the crown. Staining appears to occur in 3-6% of patients taking long term minocycline at >100 mg daily . The onset of discoloration can occur at any time from 1 month to many years after the initiation of treatment. The resolution is rare in teeth. The solution might be teeth whitening which helps to a certain extent but since the stain is intrinsic it can not be completely removed although it is usually less sever than Tetracycline staining. Porcelain bonded restorations using Venetian Veneer technique developed and perfected by Dr. Samsavar could generally give patients a desired smile back.
Gum disease can kill your patients
Gum disease and tooth abscess not only can cause the loss of teeth, but we now know that gum disease and chronic tooth abscesses contribute to the death of hundreds of thousand of people each year!
Recent studies have now proven the link between gum disease, tooth abcesses and multiple health problems such as cardiovascular disease, stroke, heart attack and even low birth weight babies. These maladies were the focus of the studies, however it is felt that oral infections have significant effect on many more organ systems.
For example, the recent retrospective studies showed that a person with gum disease or chronic tooth abcesses is more likely to die from natural causes than someone without oral infections. These studies also found that patients with long-term presence of gum diseae have an average life span of ten years less!
The very advances in the battle against gum disease involve a unique combination of no-surgical therapy, ultrasonic root planing and several types of antibiotics developed at International Institute of Cosmetic Dentistry.
You should be most aware of this effect on your patiens that require antibiotic premed before visiting the dentist-patients with certain murmurs, significant mitral valve prolapse, prosthetic heart valves, recent heart surgery, recent prosthetic joints, or a history of bacterial endocarditis are at higher risk if they have untreated periodontal disease.
About International Institute of Cosmetic Dentistry:
Dr. Aalam Samsavar is a world renowned, author, speaker and cosmetic dentist with over 20 years of experience with modern techniques of cosmetic dnetistry. He performs close to 2500 smile enhancement procedures per year. Dr. Samsavar’s International Institiute of Cosmetic Dentistry offers a wide variety of cosmetic and rejuvenation procedures.
