The NobleDentist Blog

This is an article that was published recently in the Hartford Courant – United States.

As a pediatric dentist, Dr. James Musser sees many cautionary tales.

In his 26 years of practice in Sacramento County, Calif., Musser has on occasion placed stainless steel crowns on all of a young patient’s rotted baby teeth. Sometimes these tiny teeth are so decayed they are unsalvageable, and he must remove them all.

“Parents think they get a free ride on the first set,” Musser said. “But baby teeth can decay and abscess, and the child can go through severe pain.”

Musser sees some of the most serious cases in the county because he is one of the few pediatric specialists able to administer the general anesthesia that many of the patients referred to him require during treatment.

Tooth decay is children’s worst chronic health problem, a “hidden epidemic,” according to the Dental Health Foundation’s 2006 ” California Smile Survey.”

And dental health officials say the problem will only get worse with a weak economy and fewer funds going to medical assistance programs nationwide.

In Sacramento, Yolo, Amador, El Dorado and Placer counties, for example, about 65 percent of children living in poverty do not have adequate access to dental care, according to the Sacramento District Dental Foundation. Statewide studies have shown that poor access is the result of lack of insurance.

(It’s not just a California problem, as evidenced in April when a two-day free dental clinic in Tolland was overwhelmed by more than 1,000 people, many of them children who hadn’t seen a dentist in years.)

More than half of all California children have experienced tooth decay by kindergarten.

Almost one in five have extensive decay, the study shows. As with many other health conditions, poor and minority children have a disproportionately high number of cavities and poor oral health.

Latino children have the highest risk for dental problems, according to the survey. Among Latinos, 72 percent have experienced decay and 26 percent had cavities on seven or more teeth.

“All things are not equal,” said Gayle Mathe, manager of policy development for the California Dental Association. “Eighty percent of disease is in 25 percent of children.”

Untreated tooth decay can lead to infections in other parts of the body, such as children’s ears and sinuses, as pathogens spread from their teeth. Dental problems also cause children to miss many days of school, according to the Dental Health Foundation.

And dental disease is infectious: Cavity-causing bacteria can be passed from person to person, according to experts.

Dental diseases can be greatly reduced through good prevention practice such as regular dental visits, experts say, but those are precisely the practices that are sacrificed first when parents can’t afford treatment.

Smiles for Kids provides dental screening and treatment to children in several counties in California whose families don’t qualify for public assistance, or who are waiting for other coverage to kick in.

Lack of dental insurance or not being able to afford dental care was the main reason parents gave to the Smile Survey for not taking their children to the dentist.

This is an article that was recently published by Dentistry.co.uk.

A recent survey reveals that more than four in 10 adults admitted they lie to their dentist.

That’s according to a story at www.drbicuspid.com.

One in four, meanwhile, said they would fib about flossing, too, according to a Harris Interactive poll of 1,001 US adults.

The survey was commissioned by Philips Sonicare and the non-profit group Oral Health America.

Experts suggest this illustrates why asking direct questions may not prove the best means of helping patients improve their oral health.

People lie especially frequently to dental receptionists, said Gary Kadi, who heads NextLevel Practice, the dental management consulting firm.

In one of his surveys, only 15% of patients told receptionists why they were really cancelling appointments, said Kadi, whose clients can have cancellation rates as high as 50%.

Also worrying are those patients who fail to mention that they suffer from debilitating diseases – a crucial omission that could lead to serious medical complications.

While it would be nice for patients to talk openly about their hygiene habits, remember that finding out the truth is not the ultimate goal.

It’s far more important for dentists to build strong relationships with their patients – and convince them to become more compliant, Kadi said.

Dentists should not be satisfied with a patient’s first answer, psychologists say. It’s often helpful to ask the same question in different ways and move from general, open-ended questions to extremely specific ones.

Dentists can ask patients directly if they are on specific medications, and explain why they need to know.

Patients are also ‘expecting to be beat up’, said Kadi.

Surprise them and tell them something good, he said, even if it’s just ‘you’ve got good bone structure’.

Too many dentists focus on the means such as tooth brushing, rather than the patients’ ends: the desire to have a sexy smile or live long enough to watch their children grow up.

‘Look beyond the soft and hard tissues, and get to the emotional issues of the patient,’ he said. With this philosophy, he said, his clients have not only been able to convince their patients to be more compliant, but the dentists have also reaped big financial rewards.

He said his more than 600 clients saw their collections grow an average of 37% from May 2007 to May 2008, despite the poor economy. And appointment cancellations are down. ‘People buy for emotional reasons,’ he said.

This is an article that was recently pulished in www.forbes.com – NY, USA.

A new sweet treat that actually prevents children’s cavities should please children and their parents, researchers say.

The tasty syrup, which contains the sugar substitute xylitol, prevented early decay in infants’ teeth and may play a role in protecting permanent teeth, says a team from the United States and the Marshall Islands, in the South Pacific.

Xylitol has long been approved by the U.S. Food and Drug Administration and is already found in food products such as chewing gum.

The compound protects children’s teeth by reducing the number of oral bacteria that cause decay, explained study author Dr. Peter Milgrom, a professor of dental public health sciences at the University of Washington, Seattle.

“I kind of look at tooth decay as a kind of malnutrition,” he added. A diet high in sugar promotes the bacteria that take in sugars, metabolize them, and produce the lactic acid that creates tooth decay, the researcher said.

The study involved 102 children from the Marshall Islands, ranging from 6 to 15 months of age. The researchers picked these islands as the study site, because childhood tooth decay occurs there at rates that are nearly triple that seen among kids on the mainland.

According to the researchers, 76 percent of the children whose caretaker applied the xylitol-laden syrup to their teeth three times a day were free of cavities a year later.

That compares to 48 percent of the children who did not receive daily xylitol applications.

Milgrom was expected to present the results this week at the annual meeting of the International Association for Dental Research in Toronto.

“It’s a real problem that we’ve got all this dental disease in kids, and we really don’t have all the tools we need to battle it,” he said. “Of course, we knew that xylitol had these benefits for teeth from other studies that have been done, but they had never been done in small children. So, we sort of put two and two together,” he added.

The bacteria, which are the “bad actors” here, can’t metabolize sugars from xylitol, and so they die off, Milgrom explained. Only the so-called “good” bacteria that do not create decay and can tolerate being around xylitol live, he said.

Preventing early tooth decay is important to children’s overall health in a number of ways, Milgrom added. He said that children with early decay tend to be underweight, often fail to thrive, and don’t eat or sleep well, which affects their performance in preschool.

Early tooth decay also is a problem among many children in the United States, according to Dr. Paul Casamassimo, a professor of pediatric dentistry at Ohio State University and a spokesman for the American Academy of Pediatric Dentistry.

For example, in Ohio, about half of five-year-olds have some tooth decay, he said. That number tends to be higher in minority communities because of poor diets and lack of access to dentistry.

Decay in baby teeth is a “gateway disease that leads to decay in permanent teeth,” Casamassimo added. “It’s probably related to the fact these people have these bacterial factors in their mouths that continue on.”

The study, which was co-authored by researchers from the Marshall Islands Ministry of Health, was funded by the U.S. National Institute of Dental and Craniofacial Research and the HRSA Maternal and Child Health Bureau. Milgrom said none of the researchers have any financial ties to manufacturers of xylitol.

This is an article that recently appeared in VHI - Kilkenny, Ireland.

Tooth sensitivity is a serious oral health problem and now affects almost 1 in 5 adults in Ireland, new figures released by the Irish Dental Association (IDA) have revealed.

The IDA survey of 150 Irish dentists found that over half of dentists (53%) now treat patients with sensitive teeth on a daily basis, a 7% increase since 2002.

The IDA warned that tooth sensitivity can be associated with receding gums; a serious oral health issue which can result in symptoms such as discomfort after eating cold food, drinking cold liquids, or even breathing cold air.

“The most common cause of tooth sensitivity is gum recession, often due to vigorous or heavy handed brushing,” said Dr Garry Heavey, IDA.

“Our gums are like protective blankets, covering the roots of the teeth. If this protective covering is worn away the roots, which are linked directly to the nerve, become exposed and painful. Many people don’t realise that brushing with too much pressure can result in receding gums, and eventually lead to sensitive teeth.”

To stop the gums from receding, Dr Heavey advised that people should use less pressure when brushing and use a soft bristled tooth brush, making sure to properly brush and floss all tooth surfaces twice daily.

The IDA also recommends that people experiencing pain use a special toothpaste, such as Sensodyne toothpaste, which desensitizes the tooth nerve directly. In addition people should use a fluoride mouthwash, and avoid acidic foods. Sensitivity should fade away in a matter of weeks but anyone experiencing tooth sensitivity should consult their dentist, say the IDA.

On the positive side, the research showed that people are becoming much more aware of their dental health, of the importance of taking care of their teeth and gums, and are attending their dentist on a more regular basis.

“We would further advise that people of all ages should make regular appointments for check ups with their dentist as this is the most effective way to prevent gum deterioration, the onset of gum disease, and the maintenance of good oral health,” concluded Dr Heavey.

NobleDentist telephone lines are fully operational again after a Optus fibre optics issued affected our telephone lines today. We can once again be reached on 1300 657 395 or via email.

Telephone lines to NobleDentist are currently down. A report from www.news.com.au explains below.
(All membership applications should be done online or via post. Enquiries should be directed to contactus@nobledentist.com.au. We will post an entry in the NobleDentist blog once this is sorted.)

A MAJOR telecommunications fault has shut down mobile and landline phone calls and internet connections in Queensland and some parts of New South Wales.

Optus today blamed a broken fibre optic cable on the Gold Coast for the widespread outages and said mobile phone services and all calls to and from fixed line numbers were affected.

The fault has also disrupted internet access to servers outside Queensland from within the state.
Problems have also been reported by customers in northern New South Wales and users on the 3 mobile network.

Several businesses have reported problems processing EFTPOS payments and it is believed some ATMs could also be affected.

This is an article by Barbara Lantin recently published in Times Online – UK.

People used to stay away from the dentist unless they needed remedial work or were screaming with pain. Today, they are just as likely to visit a dental surgery for a dazzling new smile as a mercury filling. Our obsession with physical perfection, driven by the cult of celebrity and TV makeover programmes, has nurtured a cosmetic dentistry market that is already worth £519 million and is likely to double in the next five years, according to business analysts Mintel.

The latest innovations include digital cameras that measure cavities, pain-free injections, drill-less dentistry and veneers no thicker than a contact lens.

LUMINEERS

What?

Ultra-thin porcelain veneers that are bonded to the front of your own teeth.

Why?

They are no thicker than a contact lens, so very little of the tooth structure needs to be removed before they are fitted, unlike conventional veneers, when teeth may need to be shaved down first. Martin Fallowfield, a spokeman for the British Dental Association and a specialist in cosmetic dentistry, says their thinness means that Lumineers may not mask any staining unless the dentist uses an opaque cement. “That can prevent refracted light going into the tooth and give a very white and less natural-looking smile.”

Who for?

Patients with stained, damaged or crooked teeth who want a brighter smile.

Cost?

£400 to £1,000 a tooth, comparable to veneers.

Where?

lumineers.com or call 0800 0280155.

Surgeries offering Lumineers include Perfect Smile practices; www.perfectsmile-dental.com

THE WAND

What?

A computer-controlled pain-free injection that delivers anaesthesia.

Why?

Terror of needles keeps many people away from the dentist’s chair, but the needle is not what makes an injection painful: it is the pressure of fluid going into the tissue. The microprocessor in the Wand delivers a slow and constant flow of anaesthetic, numbing the site.

Who for?

Fallowfield says that it is useful for children, patients who are needle-phobic or who have a few cavities at different sites – “especially if you need to anaesthetise the palate. But it is very slow, so we would not use it all the time”, he says.

Cost?

About £10 an injection.

Where?

Dental Practice Systems; www.d-p-s.uk.com or call 01438 820550

LASER DENTISTRY

What?

A laser that does the work of the drill.

Why?

It replaces the dreaded whining vibration of a dental drill and the makers say that lasers are more comfortable, there is less bleeding and healing is quicker. The expert’s view? Fallowfield says that they are “virtually painless and fantastic for gum surgery, but that is about it”.

Who for?

They can be used on teeth with new decay, but not if there are any fillings or other dental work in place already, which is the case most of the time. Fallowfield says that they will not replace the drill.

Cost?

Varies according to procedure. Prices start from £75.

Where?

Private dentists.

INCOGNITO LINGUAL BRACES

What?

A custom-made German orthodontic appliance.

Why?

Lingual orthodontic braces are fitted to the inside of the tooth, which makes them invisible. Incognito claims to be a cut above the rest because each bracket and wire is individually made for each patient, using computer technology, and then hand-finished. This produces a flat design which is said to stay on better, be more comfortable, cause no speech impediments and create a better long-term result.

Peter Huntley, a spokesman for the British Orthodontic Society, says that Incognito is “a huge step forward in comfort and precision with the potential to finish treatment more quickly”.

Cost?

About £5,000 per arch.

Where?

www.lingualtechnik.de

MINI IMPLANTS

What?

Narrow titanium alloy implants inserted into the gum to replace missing or dam-aged teeth.

Why?

Fitting conventional implants requires minor gum surgery, but the thinness of mini implants allows them to be inserted directly into the bone without opening the gum. This should reduce the pain and inconvenience during and after the operation. Mini implants are about 25 per cent cheaper than traditional implants.

Who for?

Currently, not for many, says Fallowfield. “They do not have the track record of conventional implants, which have a long history and have been peer-reviewed in dental journals.It is fairly new technology that is not yet proven.”

Cost?

From £1,500 each.

Where?

Private dental and orthodontic practices.

GUM PERIOBALANCE ORAL PROBIOTIC

What?

The world’s first probiotic lozenge for oral health.

Why?

The lozenge contains Lactobacillus reuteri prodentis and can reduce the build-up of bacterial plaque that can lead to gum disease and other oral health problems, including bad breath. A study in the Swedish Dental Journal shows a 59 per cent drop in levels of gingivitis (gum inflammation) after four weeks of treatment with the probiotic.

Who for?

Potentially everyone. “It is very difficult to change oral flora, which is a complex eco-system, but this sounds great in theory,” says Fallowfield.

Cost? £14.99.

Where?

www.sunstargum.co.uk , call 01677 424446

METAL-FREE DENTAL WORK

What?

Crowns, bridges and implants made from ceramics such as zirconia-oxide using com-puter-assisted design and manufacture.

Why?

The man-made ceramic zirconia is tough enough to be used in car disc brakes and has a natural translucence that makes it aesthetically ideal for dental work. Because it is light in colour, there is no dark line that can sometimes be seen close to the gum with traditional gold and porcelain restorations. A digital camera takes an “optical impression” of the tooth and from this image the replacement part can be milled under computer control from a solid block of material.

Who for?

The image-conscious. Luke Barnett, a leading dental technician who sits on the board of the British Academy of Cosmetic Dentistry, says that use of the material is mainly about appearance.

“It is easier to obtain natural-looking, translucent restorations with zirconia than with traditional materials, but it is not suitable for all applications and success depends on detailed and systematic technical work,” he says.

Cost?

From £600; about a third higher than for gold and porcelain crowns, bridges and implants.

Where?

Private dentists and orthodontists.

How I got new smile in a weekend

Suzi Godson heads to a Hertfordshire spa for Hollywood teeth

I am experiencing a “Five Star Hollywood Smile weekend”, the brainchild of Jeremy Hill, a dentist who has seen more A-list tonsils than most. It’s a fast-track dental makeover, which shrinks normal waiting time on cosmetic treatments such as veneers from two weeks to 48 hours.

I have a prior consultation at Hill’s surgery in Hertfordshire, but in most cases, the work – be it bridging, crowns, fillings or porcelain veneers – can be condensed into a single weekend, combined with a stay at the nearby five-star Hanbury Manor hotel, with spa and golf course.

It’s not cheap. The makeover starts from £3,999. For that you get your teeth whitened (£650) and four veneers, which cost from £750 each. Hill carries out all the preparatory work in his surgery on a Friday morning and once the enamel has been trimmed ready for veneers and he has taken an impression of your teeth, you and your temporary teeth covers retire to the hotel.

While you stroll through 200 acres of parkland or swim in the luxurious pool, Hill’s laboratories work through the weekend preparing your custom-made smile for a Monday morning fitting.

You can certainly get veneers more cheaply if you’re prepared to shop around, but once you’ve made a psychological commitment to spend an enormous amount of money on a cosmetic treatment, generally you will pay over the odds for a faster transformation in private.

The hotel breaks you in nicely

Staying in the hotel gives you a chance to adjust to the idea of your new teeth. It also allows you to avoid those who will insist on telling you that “there was nothing wrong with your teeth” or, worse: “X is a really great dentist and he does veneers for fifty quid.”

I volunteer for Zoom! laser whitening, a supposedly painless process that takes an hour and a half, just enough time to watch Ocean’s Eleven on the screen above me. The whole experience is the antithesis of the murky fish tanks that I associate with dentists. Hill says his own childhood fear of dentists prompted his decision to become one. But he urges us not to avoid them, particularly for cosmetic treatments. He explains that skill is needed to protect the gums from powerful whitening gels that can burn the skin but, with a broad grin, he assures me that I am in safe hands.

Then he puts a Hannibal Lecter- type shield in my mouth, spends 30 minutes protecting my gums and covering my teeth with gel, before leaving me alone with George Clooney and Matt Damon. On his dental colour chart, my middle-aged, middle-of-the- road gnashers start out as a D4, which puts me somewhere south of marzipan but north of chocolate. Ninety minutes later they are a B9,a full nine shades lighter, just due south of snow.

For more details: www.wcode.co.uk

My invisible brace

Katie Bowman straightens up the easy way with plastic aligners

“Teeth have a good memory,” said my orthodontist with a smile. He was right. I had worn a brace from the age of 15 to 16, putting up with fortnightly tightening that triggered horrendous headaches, while the sharp metal fastenings cut the inside of my mouth. But when it was taken off, my teeth were perfect; I felt so happy, defiant and liberated that I didn’t wear the retainer my dentist gave me for the next nine months. Thirteen years later, my teeth had begun to return to their original skew-whiffness.

I’d heard of Invisalign, clear plastic removable aligners — like see-through mouthguards — that gradually shift your teeth into place, but the cost put me off. The cheapest quote was more than £3,000 for nine months of treatment. But a photo of me with a crooked grimace sealed the deal.

“It had me hook, line and sinker”

I’m now eight months into my treatment. On the first session, an X-ray and digital images of my teeth were taken and sent off to the US. There is no Invisalign centre in the UK, so all my aligners had to be shipped over (hence the price). Three weeks later, a personalised schedule arrived, including a seductive computer-animated film that revealed how my teeth would look in one month, six months…It had me hook, line and sinker.

From then on I went to the clinic every fortnight to pick up my new retainers. They felt tight at first and when I pulled them out, it felt as if my teeth would come too. But this sensation disappeared in hours.

At first my orthodontist told me to wear the braces at least 20 hours of every day, which meant that I took them out only for eating and drinking. The unexpected bonus was that I lost a bit of weight — I refused all snacks since I couldn’t be bothered to remove my aligners.

Already, my bottom row of teeth are straight and the top row looks much neater; everybody asks me why I wear a brace when my teeth are “perfect”. There has, however, been one recurring problem — keeping track of my aligners. On holiday in Mexico last Christmas, we stopped for a margarita and I wrapped up my falsies in a napkin. Three drinks later and I realised the waiter had picked up my teeth and taken them off with the empty glasses. Invisalign treatment can last from six months to two-and-a-half years.

This is an article by Sue Dunlevy that was published recently in the Daily Telegraph – Sydney, Australia.

Tens of thousands of people are eligible for Medicare dental rebates worth up to $4250 after the Senate blocked a Government plan to axe the scheme.

However they may have just seven weeks to take advantage of the rebates, likely to be abolished by the new Senate in late August.

To take advantage of the scheme people needing dental care must have a chronic illness which is linked to their dental problem and must get their general practitioner to refer them to a dentist for dental care.

NSW residents have been the biggest beneficiary of the doomed scheme introduced in November 2007 by the Howard Government.

The Rudd Government wants to axe the Medicare dental rebates for the chronically ill so it can use the money to fund its new teen dental plan which started this month.

Health Minister Nicola Roxon said the new public dental scheme funding will pay for one million public dental consultations.

The Association for the Promotion of Oral Health says the funding will only help 250,000 patients because most need an average of four visits to complete a treatment program.

There are about 485,000 people waiting for public dental care with waiting times averaging between 13 months and 34 months, some patients have waited 10 years to see a dentist.

The Medicare dental scheme was meant to end on June 30 and the government advised dentists and patients they had to be in the system before April to get a rebate.

Ms Roxon has written to dentists informing them that the rebates will continue.

“Practitioners should consider carefully whether to commence a course of dental treatment,’ she said in a letter to dentists.

“Medicare rebates for services under these chronic disease items will not be available for any patients once the scheme has closed”.

This is a press release published recently in Medical News.

Researchers at the University of Southern California School of Dentistry say they have improved upon a surgical procedure developed by periodontist Tom Wilcko that rapidly straightens teeth, delivering a healthy bite and attractive smile in months instead of years.

Led by Hessam Nowzari DDS, PhD, Director of the USC School of Dentistry, and Advanced Education in Periodontology program, the researchers have published the first case study of the successful use of a patient’s own bone material for the grafting necessary in the accelerated orthodontic surgical procedure. The report appears in the May 2008 issue of the Compendium of Continuing Education in Dentistry.

Accelerated orthodontics is gaining popularity as a way for patients, particularly adults with mature bones, to speed up the time it takes to straighten misaligned bites and fix crowded teeth. Wilcko, who operates a practice in Erie, Penn., offers courses in the procedure, trademarked as “Wilckodontics.”

USC dentists used a procedure known as PAOO, short for Periodontally Accelerated Osteogenic Orthodontics. With this technique, a periodontist or oral surgeon uses special instruments to score the bone that holds the teeth in place and then applies bone graft material over the grooves. The procedure is done under local anesthetic in the dental office operatory.

As the bone begins to heal, it softens slightly, allowing teeth to be moved into alignment with dental braces in a matter of months, rather than the years required with traditional orthodontics. The cost for accelerated orthodontics typically ranges from $10,000 to $15,000, depending on the course of treatment.

Prior to the USC study, the bone graft material used for this procedure was bovine bone and bioactive glass particles to help the bone strengthen as it healed. Nowzari says that his team believed they could improve the technique by using the patient’s own bone instead of the artificial or bovine graft.

“Given a choice for grafts, nothing is better than a patient’s own tissue,” Nowzari explains. “It encourages new, healthy bone formation in the grafted area. It’s very safe and eliminates the risk of any disease transmission.”

This article by Carol Kopf was recently published in the Chicago Tribune – USA.

The July 1 editorial “Look Mom – No Cavities,” is an assumption based on clever marketing without benefit of boring research which is just a google away. It should read “Look Ma – Even More Cavities.”

Despite five decades of water fluoridation, Chicago children have dismal oral health records with 59% of third-graders experiencing tooth decay and 32% of it unfilled, according to the Illinois Department of Health.

We’re made to believe that fluoridation equalizes decay rates between low and high socio-economic groups, but it doesn’t. Sixty-four percent of Illinois third-graders receiving free school lunch have cavities compared to only 46% who can afford to pay.

Fluoridation is state-mandated in Illinois. Yet, 70% of Spanish-speaking-only children have cavities compared to 50% of English-speaking-only children.

Tooth decay crises occur in all our fluoridated cities and states, but not from lack of fluoride. America’s school children are fluoride-overdosed according to the Centers for Disease Control, because 80% of dentists refuse to treat Medicaid patients and 108 million Americans lack dental insurance.

“There are 102 counties in Illinois, but the three counties with the most dental licenses account for 84 percent of all dentists,” reports the Illinois Department of Health

People in America are dying from tooth decay because they can’t find or afford a dentist to treat their dental disease.

Fluoridation schemes divert attention from what really needs to be done – mandate dentists to treat more Medicaid patients. If not, allow other viable groups to fill their void such as Dental Therapists which are two or three year trained individuals who have worked for decades in developed countries as effectively and as safely as dentists.

Organized dentistry lobby against Dental Therapists and for fluoridation using loads of PAC money and political capital. Who do you really believe benefits from fluoridation?