Implant crown delivery

We recently delivered two crowns that are supported by dental implants.  Here are a few pictures of the process:

 

After the surgeon placed the implants, he attached a healing cap to each one.  The round, silver healing caps cover the implant for a few months after they are placed to allow bone to grow around the implants until they are well-anchored.  The implants, just like fence posts in cement, must be firmly anchored before attaching the crown and applying forces.

 

Here are the implant crowns in place while we check the fit.  The hole in the center is for the screw that holds the crown securely to the implant.

 

Once the fit is confirmed, the screws are torqued to 35 Newton/cm, covered, and the access hole restored to a natural look.  The patient can chew with these teeth immediately without restrictions.

 

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The Floss Blog

Brushing cannot clean between your teeth, but bacteria certainly can live there quite happily, creating enamel-destroying acid 24/7.  Rinsing does not remove plaque anywhere, so flossing is a must.   Here is an x-ray of a cavity between teeth:

OB-GYNs Encourage Pregnant Women to See a Dentist:

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From the September 16, 2013 edition of ADA News:

“Teeth cleanings and dental X-rays are safe for pregnant women, according to recommendations issued by The American College of Obstetricians and Gynecologists. OB-GYNs are being advised to perform routine oral health assessments at the first prenatal visit and encourage their patients to see a dentist during pregnancy, the College said in a July 26 statement.” (View the statement: http://www.acog.org/About_ACOG/News_Room/News_Releases/2013/Dental_X-Rays_Teeth_Cleanings_Safe_During_Pregnancy)

X-rays? Yes, X-rays. Dental x-rays have produced very small amounts of radiation for a very long time. A full set of x-rays, even with the older film technique, produced as much radiation as standing outside for 10 minutes. Today’s digital radiography produces approximately 1/8 of that already low amount. Dental professionals step out of the room during exposure because radiation is cummulative. None of us should be exposed to it every day all day long. Protective shields covering abdomen and thyroid are used on all patients, and has been standard for decades.

Also from the ADA News article, “…local anesthesia (with or without epinephrine) are safe during pregnancy.”

“…conditions requiring immediate treatment, such as extractions, root canals, and restoration (amalgam or composite) of untreated caries, may be namanged at any time during pregnancy. Delaying treatment may result in more complex problems.”

“For patients with vomiting…the use of antacids or rinsing with a baking soda solution (i.e., 1 teaspoon of baking soda dissolved in 1 cup of water) may help neutralize the associated acid.” Acid is the cause of dental decay.

In Washington State, pregnant women are eligible for free dental care during pregnancy thru Medicaid.

Mothers transmit their oral bacteria to their babies, who are born with no oral bacteria. Good oral health for Mom, especially during pregnancy, reduces her own oral bacteria and thus reduces what she transmits to Baby. Rinsing with a non-alcohol antibacterial mouth rinse such as Chlorhexidine is recommended for pregnant women.

Health care providers weigh risks and benefits of treatment and non-treatment. Lack of oral health care during pregnancy presents unnecessary and avoidable risk to Baby. Care for Mom=Care for Baby.

Smiles,

Dr. Cook

Why Extract Wisdom Teeth?

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First, what is a wisdom tooth? A wisdom tooth is an adult tooth that erupts (comes up through the gums) in the mid-teen years. Normally, there are four wisdom teeth, one in each quadrant of the mouth: upper right, lower right, upper left, and lower left. The wisdom tooth is the molar which is the farthest back. Dentists refer to them as 3rd molars because they are the third molar in each quadrant to erupt. (First molars erupt around age 6. Second molars erupt around age 12.)

Wondering why wisdom teeth are so often extracted? Here it is:

1) Human jaws often are not long enough to allow enough room for the wisdom teeth to fully erupt.
2) Because there is insufficient room for wisdom teeth to erupt upright, they almost always lay at
a slant, pushing against the second molar in front of them.
3) Pressure from the wisdom tooth pushing on the second molar causes pain, infection, and swelling.
4) Because third molars are often in contact with the tooth in front of them, there is not room for bone between the two. Think of this as two nails in a board that are so close together they touch. It’s easy to imagine that with no wood (bone) between the two nails (teeth), the nails (teeth) are not well-supported.
5) Because wisdom teeth are so far back, they are difficult to clean, so they are cavity-prone.

My recommendation: Have all wisdom teeth extracted as around age 16. The younger, the better because we heal better when we’re younger and over time, the roots grow longer, making extractions more challenging and healing a bit more involved.

-Dr. Cook

Sensitive teeth? Like hard bristles?

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Last time I discussed correct brushing and showed a photo of the type of toothbrush abrasion dentists see all day. Here are before and after photos of toothbrush abrasion that was very sensitive and our restoration.

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Brush gently in circles twice a day with the softest brush you can find.

-Dr. Cook

Brush up on brushing

spider brushBy this time, toothbrushing is so mundane that you don’t know how you’re doing it or for how long, much less how effective your technique is. Maybe your only reasons for brushing are to freshen your breath and because you were told to do it ever since you can remember. Yes, we know that brushing helps prevent cavities. Here’s the skinny on Safe, effective plaque removal:

    Use a soft or extra-soft-bristled brush
    Brush at least 2x a day: morning and night
    Angle the bristles 45 degrees so that they are directed into the gum line.
    If using a manual toothbrush, brush in a circular motion.
    If using an electric toothbrush, gently hold the moving bristles at the gum    
        line.

    Brush each quadrant of your mouth for 30seconds.
    Remember to brush the cheek side, tongue side and biting surfaces.
    Gums, cheeks, and tongue harbor bacteria; brush them, too.

Back-and-forth brushing results in heavy, irreversible wear of the tooth, forming grooves that are sensitive and decay easily.  These teeth have been abraded by back-and-forth scrubbing.abrasion

In my office, I give patients the tongue cleaner by Discus Dental to remove plaque that forms on the surface of the tongue, which is a reservoir of bacteria.  Try brushing your tongue with a toothbrush then using a tongue cleaner.  You won’t believe the amount of debris left behind by a toothbrush.

Brushing removes sticky, acidic plaque that cannot be rinsed away.

Best times to brush: first thing in the morning and right before bed.
Bacteria are present everywhere in the mouth constantly. They require simple sugar to proliferate. When we feed ourselves, we also feed them. They produce acidic plaque between meals.

Proper brushing begins with a soft or extra-soft toothbrush. Extra-soft toothbrushes are often marketed to people with sensitive teeth, but they’re good for everyone. Do not use a medium or hard bristled brush. I checked my local Safeway and was sad to see that Colgate, Reach, and Safeway brands all sell Medium bristled brushes. Shame on them!! Enamel may be the hardest substance in the body, but it certainly is not immune to abrasion or erosion.

Electric toothbrushes clean better than manual toothbrushes because there is more movement in the bristles.

Find a head that is small enough to reach the cheek side of your upper back teeth and the tongue side of your lower back teeth. Often, the jaw joint and tongue make it difficult to fit a toothbrush into those areas. These are areas that dental hygienists constantly find heavier plaque deposits, and where dentists often find cavities.

Brush twice and floss daily.

Dr. Cook

How Cavities Form

Cavities are holes in our teeth that are created by acid. The acid in our mouths is created by the bacteria that live in our mouths.  We are not born with oral bacteria;  we pick them up as soon as we are born.  Generally, mothers, because of their close contact with their babies, transmit their own oral bacteria to their babies.  One major strain that causes tooth decay is Streptococcus Mutans.  Once we contract them, we cannot get rid of them.

Oral bacteria require glucose to live.  We provide them plenty of glucose in the form of sugary foods and grain-based foods (simple carbohydrates).  Examples of foods that cause cavities are crackers, pretzels, bread, rice, pasta, and cereals.  Unlike healthy complex carbs in fruits and vegetables, simple carbs begin their breakdown in our mouths.  Oral amylase (an enzyme) in our saliva breaks grain-based carbohydrates into glucose, feeding our oral bacteria.  Bacteria eat the glucose, metabolize it, store some for later (like when we’re sleeping), and excrete the waste.  Bacterial waste is plaque.  Plaque is that creamy white coating that develops on our teeth (even between meals and after we brush).  Plaque is very sticky and very acidic.  Bacteria have evolved to live very happily in an acidic environment.  Plaque CANNOT be rinsed off.  It must be mechanically removed by brushing and flossing.

For more info, visit the Centers for Disease Control: http://tinyurl.com/p95octw

Dr. Amy Cook

Auburn, WA

 

http://tinyurl.com/p95octw

Facts about Fluoride, Vol I

Hello to a special population who take interest in and ownership of their own oral health.  To those in this world who trust the pure and beautiful thing that is science (ie, testing theories to confirm truth), I salute you!  For those who still fear or mistrust science, I wish you an open mind and the oral health benefits of fluoride that have been proven safe and effective only with the agonizing labor of scientific method over decades and thousands of studies.  Enjoy this:

*Water fluoridation is recognized as a major public health achievement of the 20th Century by the Centers for Disease Control and Prevention (CDC).CDC

*Although dental caries (decay process)  is largely preventable, it remains the most common chronic disease of children ages 5-17 years.

*Studies have demonstrated that people in communities with fluoridated water have 20-40% less tooth decay than those without.  (above facts from the Washington State Dept of Health)

*Fluoride occurs naturally in the earth’s water and is the 13th most prevalent element in the earth’s crust. (US Dept of Health/Human Svcs.  Oral Health in America, 2000 p. 158)

*Enamel is dynamic, like bones.  It gains and loses minerals.  (Have you heard of bones losing density (ie osteoprosis)?   Fluoride, because of its chemical properties, remineralizes enamel to make it stronger.

*Fluoride taken internally via water, tablets, or drops, strengthens developing teeth that are still under the gums.  Fluoride applied topically, as with toothpaste, soaks into the enamel and strengthens teeth that are exposed to harmful bacteria that cause cavities.

*Fluoride can be removed from water through reverse osmosis or distillation.

*Fluoridation of community water supplies is supported by the American Dental Association, the U.S. Public Health Service, the American Medical Association and the World Health Organization.

Want more?  Check this out:

Fluorine and Health:Molecular Imaging, Biomedical Materials and Pharmaceuticals (Google eBook)

Front Cover
 

Alain Tressaud, Günter Haufe

Elsevier, Jun 6, 2008 – Science – 816 pages
Fluorine and Health presents a critical multidisciplinary overview on the contribution of fluorinated compounds to resolve the important global issue of medicinal monitoring and health care. The involved subjects are organized in three thematic parts devoted to Molecular Imaging, Biomedical Materials and Pharmaceuticals.
Initially the key-position of partially fluorinated low molecular weight compounds labelled either with the natural 19F-isotope for Magnetic Resonance Imaging (MRI) or labelled with the radioactive [18F]-isotope for Positron Emission Tomography (PET) is highlighted. Both non-invasive methods belong to the most challenging in vivo imaging techniques in oncology, neurology and in cardiology for the diagnosis of diseases having the highest mortality in the industrialized countries.
The manifold facets of fluorinated biomaterials range from inorganic ceramics to perfluorinated organic molecules. Liquid perfluorocarbons are suitable for oxygen transport and as potential respiratory gas carriers, while fluorinated polymers are connected to the pathology of blood vessels. Another important issue concerns the application of highly fluorinated liquids in ophthalmology. Moreover, fluorine is an essential trace element in bone mineral, dentine and tooth enamel and is applied for the prophylaxis and treatment of dental caries. The various origins of human exposure to fluoride species is detailed to promote a better understanding of the effect of fluoride species on living organisms.
Medicinally relevant fluorinated molecules and their interactions with native proteins are the main focus of the third part. New molecules fluorinated in strategic position are crucial for the development of pharmaceuticals with desired action and optimal pharmacological profile. Among the hundreds of marketed active drug components there are more than 150 fluorinated compounds. The chapters will illustrate how the presence of fluorine atoms alters properties of bioactive compounds at various biochemical steps, and possibly facilitate its emergence as pharmaceuticals. Finally the synthetic potential of a fluorinase, the first C-F bond forming enzyme, is summarized.

– New approach of topics involving chemistry, biology and medicinal techniques
– Transdisciplinar papers on fluoride products
– Importance of fluoride products in health
– Updated data on specific topics

More »

Brush.  Floss.  Fluoride.
 
Amy JL Cook, DDS
Cook Family Dentistry
321 4th St. SE
Auburn, WA  98002
253.735.1106

The Sweet Life of a Tooth

Just about the time when a woman starts to wonder if she might be pregnant, around 6 weeks into the pregnancy, primary teeth, (aka baby) teeth begin to form.  Incredibly, by the 10th week, the permanent teeth begin to form. Developing teeth form into four lobes, which can be thought of as four balls of clay that blend together over time to create the classic tooth shapes that we are familiar with.  Think of the shape of a molar.  If you look straight down onto the biting surface of a molar, you will notice a four-leaf clover outline.  This shape is due to the melding of the four spherical developmental lobes.

The crown of a tooth develops first and begins to erupt (break through the gums) before the roots are fully formed.  Primary teeth (aka “baby teeth” or “milk teeth”) typically erupt around age 6 months, starting with the lower front central incisors.  If a baby is early to get his first primary teeth, he will stay on that schedule and will be early with the following eruptions and exfoliation (loss of) primary teeth.  The same is true of late eruption.  Usually, all primary teeth have erupted by age 3 years and the first baby teeth are lost during kindgergarten.  As the permanent teeth make their way to the surface, the roots of the baby teeth resorb away, leaving nothing but tiny crowns attached to the gum tissue.  Sometimes the baby tooth’s root does not resorb, in which case, the dentist will wiggle it out to make way for the permanant tooth.

I am still surprised today to sometimes hear adults comment that baby teeth are not important and therefore do not need to be cleaned, restored, and maintained until the permanent teeth erupt. The opposite is true.  First, consider the fact that baby teeth have nerves.  Ouch!  Poor oral hygiene, poor diet, and lack of dental care can not only lead to painful cavities, but also to infection. Infection is so commonly treated with antibiotics that the public has come to believe that antibiotics cure infections, but in the mouth, an infection treated only with antibiotics will only easy pain and swelling temporarily.  In addition to antibiotics, the source of the infection must be removed.  Often, this is achieved with root canal therapy or extraction. The baby teeth act as an alignment guide for permanent teeth, so premature loss of baby teeth leads to tipping and malalignment as well as increased risk of decay, gum disease and fracture. Baby teeth are important!

From kindergarten through puberty, a child is in the state of mixed dentition, during which they simultaneously lose baby teeth and gain permanent teeth.  It’s sometimes called the Ugly Duckling Phase, but I think it’s adorable.  During these growth years, a dentist evaluates the size and shape of the jaws.  Ideally, the upper teeth slightly overlap the lower teeth in a tiny overbite.  In case of an underbite at anytime, the dentist will make note and, depending on the child’s age, may refer to an orthodontist for early intervention.  During growth, pressure can be applied on the jaws to encourage or slow growth.  This was traditionally achieved with headgear but today it is more common to use intra-oral hardware that is cemented into place temporarily.  The main goal is to eliminate jaw size/shape discrepancies.  If this is not done during growth, surgery is required as an adult.

As we age, teeth begin to show wear on the biting surfaces.  Older populations often have worn through the lighter outer enamel layer to expose the darker dentin layer.  Also, our the jaw bones that support our teeth tend to exhibit bone loss over time.  As the bone levels drop, the gum tissue levels will follow, resulting in the “long in the tooth” look.  One benefit of aging is that as we age, the inner root canal of a tooth tends to become occluded, resulting in less sensitivity.  Ah, a benefit to aging!  With a healthy diet, good oral hygiene, and regular dental visits, it really can be a sweet life for your teeth.

Smiles,

Dr. Cook 

 

 

Toothless baby sees dentist?

As a general dentist, I am often asked by new parents, or parents of toddlers, when their baby should have their first dental visit. No one expects “6 months” to be the answer. Here is an excerpt from the American Academy of Pediatric Dentistry website regarding the first visit: “The AAPD recommends that the child be seen by a pediatric or general dentist at the time the first tooth comes into the mouth, and no later than the child’s first birthday,” AAPD national spokesperson Dr. Indru Punwani said. Our office offers two dentists, myself and Dr. Erika Smart, both trained at the University of Washington School of Dentistry, both trained in the oral examination of infants. The first teeth typically erupt around age 6months, although this is a rule of thumb. Some baby teeth erupt (break through the gums) earlier or later. The first eruption sets the schedule for losing baby teeth and eruption of permanant teeth. At the first examination of an infant, the dentist and the parent sit facing each other, “knee-to-knee” with the parent holding the child facing them and the baby’s legs around the parent’s waist. The parent then supports the baby’s back and leans them backward toward the dentist until the baby is laying on their back looking up at the dentist. In this position, the dentist can get a good luck at the baby’s mouth and yes, the baby usually does cry. This helps the dentist get a look, which doesn’t take long. Constant contact between parent and baby is a comfort to both parent and baby. After the quick exam, the baby can sit up again and is rewarded with a new toothbrush. During the visit, the dentist educates the parent about oral bacteria, how cavities are caused, healthy versus cavity-causing snacking, oral hygeine, teething, thumb-sucking, etc. One piece of advice that surprises many parents is that many common snacks are cariogenic (cavity-causing). Examples: dry cereal, fish crackers. Any grain product is a simple carbohydrate that is broken down into glucose in our mouths feeds our oral bacteria. The bacteria eat the glucose, metabolize it, store it, excrete their sticky, acidic waste product called plaque. The acidic plaque sticks to teeth and essentially eats holes through the enamel (hard outer layer) over time. Today, parents want so much to protect their children from everything. I see it all the time. They are happy to have this conversation with the dentist, avoid cariogenic snacks, and introduce their babies to the dentist in a comfortable way. In our office, children are not forced to do anything that they are afraid of, parents are always welcome in the treatment area, and children are encouraged to smell and touch everything. It takes very few visits for the little ones to feel comfortable sitting in the big chair, wearing the sunglasses, and getting their teeth counted. Mom and Dad are happy, Baby is happy, Dentist is happy.