The NobleDentist Blog

Its that wonderful time of year again and naturally there will be some changes to operating hours.

There will be a skeleton staff working over the festive season. Memberships will still be processed and posted the same day and on the next working day if you join on a weekend or public holiday. You should also know that the post may be slower than usual to reach you as a result of Australia Post’s busy Christmas period.

Our telephone lines will cease to be operational from noon today but will resume at 8.30am on Tuesday, 29 December 2009. Our telephones will cease to be operational again at noon on Thursday, 31 December 2009 but will resume at 8.30am on Monday, 4 January 2010. We recommend that you join via online, fax, or post in the event that you would like to join over the telephone at a time when the telephone lines are not operational.

On behalf of the team at NobleDentist, we wish you a very Merry Christmas and Happy New Year!

This article recently appeared on dentalplans.com – United States of America.

The wheels have been set in motion to begin development of a vaccine to prevent the dangerous gum disease peridontitis, which may launch a revolution in dental care.

According to the Sunday Morning Herald, a team of Australian researchers in Melbourne recently signed a development contract between the pharmaceutical company CSL and vaccine maker Sanofi Pasteur.

Dr Andrew Cuthbertson, CSL’s chief scientific officer, told the news source that though work on the inoculation has been in progress for more than 10 years, the development deal adds significant support and resources for expanded research.

Currently, the companies are performing a clinical trial of the vaccine in mice and anticipate future trials in humans depending on the results of the animal study.

“Periodontitis is a serious disease and dentists face a major challenge treating it, because most people will not know they have the disease until it’s too late,” Professor Eric Reynolds of the University of Melbourne, who assisted in the study.

The disease has been linked to a heightened risk of heart disease and some forms of cancer.

While the studies on the vaccine continue, the American Dental Association recommends brushing, flossing and regular dentist visits to stave off dental health problems.

This is an article by Ross Fitzgerald that recently appeared in The Australian – Australia.

QUEENSLAND Premier Anna Bligh’s spectacular backdowns on recycled water and on the controversial Traveston dam project will not save her at the next state election. Not unless she shelves her plan to add fluoride to the drinking water.

Those who think the introduction of fluoride is a minor issue should think again. It was, after all, a highway through koala habitat in southeast Queensland that ended the government of Wayne Goss.

Fluoride will be added to Queensland drinking water just before the new year break. The problem for Bligh is that the citizens who vociferously rally against fluoridated water are part of the same group that was instrumental in denouncing recycled water. It’s issues such as these, where governments run roughshod over the electorate, that really bite.

Bligh claims that most Queenslanders are in favour of fluoridation, but there is widespread scepticism, particularly among farmers, who have known for many years that some bore waters high in natural fluoride have a detrimental effect on the health of livestock.

Chronic fluorine toxicity results from continuous consumption of fluorine while the sheep are young and teeth and bones are growing. The teeth become chalky white, mottled and pitted. The bone of the lower jaw thickens and bony outgrowths may develop.

In some instances this can lead to lameness and fractures.

Selling the message that fluoride is good for human consumption is a hard task in country Queensland, especially as the Department of Primary Industries warns against a consumption of 2mg a litre for sheep. This amount would be drunk by a farmer in a normal day’s work if the drinking water had fluoride levels proposed by the Bligh Government of 0.8 to 0.9 parts per million.

During a visit to Queensland, Andrew Harms, past president of the South Australian branch of the Australian Dental Association, said the addition of fluoride to water in these mining towns would increase the uptake of lead by children and adults who already had gravely high lead levels in their blood samples.

City folk may be a different matter, especially as a substantial number of Queenslanders have migrated from NSW or Victoria. This group is seemingly content with the message that they have better teeth than their next-door neighbours. The problem is that not all Queenslanders agree with the message and that many citizens are against any form of mass medication in the water supply.

The Bligh mantra of “safe and effective” does not convince everyone and there is much evidence that contradicts the government line. In November 2006 the American Dental Association announced that baby formulas made up with fluoridated water should be avoided for infants younger than six months.

The Australian Dental Association and the National Health and Medical Research Council came on line with similar suggestions: babies six months to a year should have only about 600ml of fluoridated water, increasing slightly as the child grows.

Mistrust of government festers within a community that has started looking elsewhere for information. The Lancet medical journal and Scientific American put the cat among the pigeons with negative comments about water fluoridation and its effects on body systems.

Add to that data from the national survey of adult oral health (2004-06), published in 2007, which showed no difference in the dental health of Queenslanders and people in other states.

Some medical professionals have tried to stem the flow of indoctrination but have been ridiculed for their objections. A prime example is the highly respected Brisbane-based general practitioner John Ryan, who has postgraduate qualifications in nutrition and children’s diseases and in environmental medicine.

What irritates him is the failure of the Bligh Government to tell Queenslanders of the NHMCR fluoride warnings to mothers with babies. “Where is the Government’s duty of care?” he asks.

Ryan is angry that the Government would deceive the public about data from a much-publicised Townsville study. Oral health data was collected about children living in Brisbane (non-fluoridated) and Townsville (fluoridated). There was much publicity by the Government indicating a supposedly vast difference between the two cities. In fact, the study showed there was less that half a tooth difference.

This, Ryan says, is an ancient and poor quality study, on which the media indoctrination largely is based. “We were so shocked by five very significant untruths told to the public by the Government,” he says. As a consequence, opponents of introducing fluoride into the water supply took the matter to the Criminal Misconduct Commission. The CMC indicated it was not within its brief and referred the matter back to Queensland Health. Eight months later it has still not responded.

The primary aim of the new Queensland Safe Water Association is to inform metropolitan and country Queenslanders about the negative aspects of recycled and fluoridated water. The message is simple: the state Government is putting public health at risk. Adult Queenslanders do not have the worst teeth in Australia and babies should not be given fluoridated water.

The Bligh Government has estimated that about 30 per cent of the population is not in favour of water fluoridation, so you can bet the number is much higher. In the state election due next year, the Liberal National Party led by the urbane Lawrence Springborg, who is opposed to compulsory fluoride, maywell ride to power on the back of this debacle.

This is an article by Dr. David Leader that recently appeared in The Malden Observer.

Malden – Recently, a patient arrived with a toothache. Unfortunately, the pain was due to a fractured tooth. It was not possible to fix this tooth. The dentist removed the tooth right away.

It is important to replace most missing teeth. Today, there are more options than before. Two of the most common techniques to replace a single tooth are the three unit fixed bridge and the implant retained crown. The dentist examines their patient and understands their oral and medical health before recommending the best way to replace a missing tooth. Ultimately, it is the patient’s prerogative to choose the best replacement technique for them.

Dentists do not replace teeth until the patient’s gums are healthy and all teeth are free of decay. To replace a tooth with a three unit bridge, the dentist reshapes the two teeth (abutment teeth) on either side of the missing tooth to allow for a thickness of gold and/or porcelain in order to fully or partially cover the tooth. In other words, the dentist will shave down two teeth up to 2 millimeters to be able to place a bridge to replace one missing tooth. Those teeth could become sensitive and may need root canal treatment before or after the bridge is in place. The dentist sends a mold of the teeth with instructions to a dental lab. Normally, the patient leaves with a temporary bridge after the first appointment, and the porcelain/metal bridge is in place within a few weeks, by the end of the second or third visit.

The three unit bridge is a natural choice for a patient who will benefit from crowns on the abutment teeth. Dentists recommend crowns (also known as caps) for teeth with large restorations (fillings), or teeth that would benefit from a cosmetic change of shape or color. Crowns and bridges can be instrumental in correcting a malocclusion or bad bite.

Three unit bridges feel pretty natural. The three teeth are a single unit. That means that it is important to clean around and under the replacement tooth — the pontic. Some people find feeding floss under the pontic to be tedious. Depending on the construction of the bridge, there might be a space between the pontic and the gum, or a space may develop over time. Dentists charge about the same price for a three unit bridge that they charge for three crowns.

Many patients who replace missing teeth with implant retained crowns report that the new teeth feel identical to the originals. An implant retained crown is a crown anchored in place to a titanium cylinder or screw that is set into the same bone that previously supported the natural tooth.

Replacing a tooth with an implant supported crown is very technique sensitive. First, placing the implant is a surgical procedure and success depends on thorough healing. The patient must be in good health. The dentist must account for any medications the patient takes, or medical conditions that affect the patient. For example, diabetes is a disease that delays or interferes with healing. The dentist will need to know that the patient’s diabetes is under control before the surgery. Bisphosphonates are medications people take to treat osteoporosis and Paget’s disease of bone. Bisphosphonates will delay healing of bone. That delay in healing can cause dental implants to fail. Sometimes, the dentist will confer with the patient’s physician to be sure that their patient has a clean bill of health.

Next, the dentist determines the position of the crown on a model of the patient’s teeth while consulting radiographs (X-ray images) or a CAT scan as a reference. A surgical stent made on the model guides the placement of the implant. The surgical dentist will line up the stent with the natural teeth, then line up the drill with the stent. That is how the surgeon places the implant where the restorative dentist needs it.

Some dentists prefer for the patient to be asleep during the implant surgery. Most dentists prefer to use a local anesthetic (something like Novocaine); the patient is awake during the procedure. The dentist creates a hole in the bone using a very slow auger drill to carefully cut the bone. Then, the dentist taps or twists the implant firmly into the bone, and sutures the gum over the implant.

Six months later, the dentist who placed the implant, or the dentist who will place the crown will uncover the implant and attach a healing screw. The gum will heal in a couple of weeks, leaving the healing screw exposed. During the next appointment, the restoring dentist removes the healing screw and firmly attaches a small device to the implant, a transfer coping. After making a mold of the teeth and gums with the transfer coping in place, the dentist sends the mold, transfer coping and instructions, including a color match, to make the crown. The dentist will be ready to install the implant retained crown in two or three weeks.

Some dentists are using new procedures to place the implant and a temporary crown on the same day. This is an experimental technique. Ask the dentist what their success rate is for this procedure. Ask them what their definition for success is, and how long they follow their cases.

Deciding how best to replace a tooth is more than simple preference. Some patients may not be able to tolerate the surgical phase of implant treatment. It may be that teeth on either side of the space will benefit from the crowns that support a three unit bridge. Patients with a high rate of tooth decay will appreciate that implant retained crowns are impervious to tooth decay. Tooth decay can ruin a three unit bridge; expensive crowns and bridges are not appropriate for patients with active tooth decay. Active gum disease, gingivitis or periodontitis, must completed prior to surgical placement of implants or making the mold for a three unit bridge. Implant treatment usually takes from several months to a year to complete. A temporary three unit bridge can be ready in less than a week and the long term restoration in two weeks.

Which is better for you, bridge or implant retained crown? Speak with your dentist. Bring insurance information. The dental office staff will be able to determine coverage for these procedures. Expect the dentist to explain your options. Ask the dentist to explain answer your questions and explain whatever you do not understand. Expect the dentist or office staff to give you a written estimate and explain your insurance coverage.

Dr. David Leader has practiced in Malden since 1989. He is a member of the Health Advisory Committee of the Lynnfield Schools, the medical advisory board of the New England Chapter of the Scleroderma Foundation, and the Massachusetts Dental Society Council on Dental Care and Benefits Programs. Dr. Leader is an Assistant Clinical Professor of General Dentistry of Tufts University School of Dental Medicine. Past articles are available on Dr. Leader’s Web site, theMaldenDentist.com.

This is an article that recently appreared on virtualmedicalcentre.com.

Health experts now say taking a look inside the mouth may provide a snapshot of the overall health of the body, especially for those aged over 55 years.

If you are over 55 years of age you should know that recent findings suggest that the improvement of oral health may have a positive impact on your general health, and addressing oral health issues can prevent illness, assist the diagnosis of serious conditions early and maintain optimum overall health.1

Dr Neil Hewson, President of the Australian Dental Association (ADA), says indicators for a range of serious diseases that particularly confront those over 55 (but can be equally applicable to us all), such as diabetes, cardiovascular disease, oral cancers and even Alzheimer’s and Hodgkin’s disease, can often be detected by careful professional examination by dentists of patients’ mouths. As Australians get older, they have an increased susceptibility to some common illnesses and early diagnosis of these can prevent some serious consequences.

“Dentists are in a position to look out for symptoms that present within the mouth, which might indicate that a patient may be at risk of a range of different health conditions.”

“The ADA has developed a self-check test that allows adults of all ages to answer a couple of simple questions, which may indicate that they might be at risk of these conditions,” says Dr Hewson.

Diabetes: Gum diseases such as gingivitis (the first stage of periodontal disease) can contribute to higher blood glucose levels. Professional treatment of gum disease, combined with regular brushing and flossing, will reduce infection and can help improve blood glucose levels.

Cardiovascular disease: Current evidence suggests periodontal disease (bacterial infection in the gums around the teeth) can lead to systemic inflammation in the arteries, which can in turn lead to cardiovascular disease.2

Oral cancers: People between 55 and 64 years are most at risk of chronic mouth diseases, including oral cancer.3 Oral cancer most commonly occurs on the borders of the tongue, on the lips, and on the floor of the mouth. Patients with a white or red lesion that persists for longer than two weeks are encouraged to have their dentist review any unusual lesions.

Alzheimer’s disease: A recent study revealed that missing teeth and chronic inflammation of the mouth can significantly increase the risk of developing Alzheimer’s disease. Systemic inflammation caused by periodontal disease can go on to damage brain tissue which can lead to Alzheimer’s disease.4

Hodgkin’s disease: Bacteria that cause gum disease release toxic byproducts into the bloodstream, which can increase levels of blood sugar, cholesterol and C-reactive protein (CRP). If treatment of gum disease does not lower levels of blood sugar, cholesterol and CRP, it could indicate that a patient has an underlying health condition such as Hodgkin’s disease.5

Reduced saliva flow: Occurs as a result of drugs commonly used in the 55+ age group and the drier mouth can lead to increased tooth decay and soft tissue lesions. Patients need to discuss with their dentist the medications that they are taking, so that the dentist can provide advice on preventative care. Sometimes their doctor may be able to change their medication, which can also help.

References

1.Marshall, S. (2009) A Comprehensive Approach to Improving Oral Health for Seniors. American Journal of Public Health, 99(4)
2.Williams, R.C, et al. (2008) The potential impact of periodontal disease on general health. Current Medical Research and Opinion, 24(6)
3.National Institute of Dental and Craniofacial Research (n.d.) Detecting Oral Cancer: A Guide for Health Care Professionals.
4.Gatz, M., et al. (2005) Potentially modifiable risk factors for dementia: Evidence from identical twins. Alzheimer’s & Dementia, 1(1)
5.n.a. (2007) Can Be First to Detect Some Medical Conditions. American Health Line.

(Source: Australian Dental Association: November 2009)

This is an article by Jill Stark that was published recently in The Age – Australia.

THE teeth-bleaching industry is in free-fall with many outlets forced to close after Victoria’s dental and pharmacy boards warned that operators without dental training could be prosecuted.

Many services operating out of pharmacies and beauty salons have stopped treating clients, with owners accusing dentists of waging war against the industry in an attempt to lock out competition in the lucrative market.

One dentist is believed to have taken out a full-page advertisement in a local newspaper warning the public to steer clear of services offered outside the dentist’s chair.

The move comes after a Greensborough beauty therapist, Suong ‘’Becky’’ Van Thi, was last month convicted and fined $2000 for being an unregistered person who performed ‘’invasive or irreversible’’ procedures by whitening teeth in a beauty salon.

The woman who received the treatment had to go to hospital after her teeth became marbled and discoloured, her throat was burnt and her gums became swollen. She was prescribed antibiotics after the burns to her throat became infected.

Under the Health Professional Registration Act, dentistry is defined as the ‘’performance of any invasive or irreversible procedures on the natural teeth’‘.

Dentists maintain that teeth bleaching fits this definition while those in the cosmetic industry argue it is neither invasive nor irreversible.

Gavin Harrison, head of the Cosmetic Teeth Whitening Association – representing nine manufacturers and distributors of bleaching products – accused dentists of scaremongering.

‘’To apply something like that [court decision] to the whole industry and say that every single product and every single vendor is doing an unsafe, dangerous treatment for the public and therefore it has to be done by a dentist is absolutely ridiculous.’’

Mr Harrison, who also owns Pro-Teeth Whitening, a national chain operating in 19 pharmacies, said the dentists’ focus was on money, not safety.

While some dentists charge up to $1600 for bleaching, which is being advertised from as little as $139 in non-dental settings, others had started to lower their prices in the face of competition.

‘’If the dentists get a monopoly back … you can guarantee prices will go through the roof again,’’ Mr Harrison said.

He said his business had halved since the court decision.

Many pharmacists told him they would no longer offer the service after the Pharmacy Board of Victoria posted a warning on its website following the Magistrate’s Court decision stating that only registered dental practitioners could carry out whitening and anyone else risked prosecution.

It followed similar warnings on the Dental Practice Board of Victoria’s website, in which a spokesman said: ‘’The ruling set a precedent and will better protect the public by ensuring that tooth whitening is performed only by people who have dental training to accurately diagnose the causes of dental discolouration, to diagnose oral health problems and who comply with infection control and hygiene standards.’’

The move by the boards comes despite the Pharmacy Guild of Australia apparently backing the provision of teeth bleaching in pharmacies.

In a letter seen by The Sunday Age, acting executive director John Taylor wrote to the Pharmacy Board of Victoria stating that with appropriate controls in place, teeth whitening was a ‘’legitimate expansion of pharmacy services’‘.

He said that the controls and professionalism in the pharmacy setting would provide the ‘’ideal site for non-dentist teeth whitening services’‘.

Mr Harrison questioned dentists’ motives after attempts to negotiate hygiene and training standards for teeth whitening in non-dental settings were ignored by the profession.

‘’This has got to be about money, it can’t be about the safety of the public because anything could be potentially dangerous,’’ he said.

‘’Tongue piercing does a lot more damage to … the teeth, scratching enamel, and it puts a hole right through the tongue which is inside the domain of the dentist as well but they don’t do anything about that.’’