Gastric Reflux and your teeth

Gastric reflux can have a negative impact on oral health.  While soft tissues can try to heal after an acid burn, hard tissues such as the enamel of your teeth, are dissolved away irreparably through acid erosion.  Patients who have been diagnosed with GERD (gastroesophageal reflux disorder) at least should be aware of the possibility of enamel loss, though prescription and over-the-count medications can help control and even prevent  the damage.  But what about patients who have not been diagnosed with GERD? Does this mean they are not at risk of enamel erosion.  Unfortunatley, some patients have low enough levels of reflux which do not seem to warrant a diagnosis of GERD, and yet show the dental evidence of acid erosion.  The acid causing the erosion can be from internal causes such as builimia or reflux disorders, or external, such as the large consumption of acidic beverages such as soda.  Discounting external sources (not many people drink several cans of soda every day, or suck on lemons regularly) many patients show the dental signs of erosion which can be attributed to low level, and sometimes undiagnosed, reflux problems.

What is important is that unlike the soft tissues of the body which can replenish itself, once enamel is eroded away it is gone for good.  The danger then, is when the erosion becomes so severe; it jeopardizes the health of the tooth.  As the erosion progresses, it encroaches upon the pulp, or “nerve” of the tooth.  If the nerve gets irritated or dies, it will need a root canal, which in turn necessitates a crown (cap) for the tooth.  So what begins as a little notch of erosion can end up killing the tooth and becomes quite costly.  Most frequently, the erosions are seen by the gumline where the enamel is thinnest and most vulnerable to erosion.  These notched surfaces can reasonably treated when small by placing a filling, typically a tooth colored bonded composite restoration, or “bonding” for short. In addition, your doctor may recommend a medication to control and prevent the release of stomach acids.  The use of antacids is of little benefit in prevention, but may be of value when a person is aware of the presence of acid in the mouth.

It is important then, to see your dentist, in addition to your gastroenterologist to make sure all is being done to prevent damage to your teeth.

Good News for Pregnant Women

The ADA reported on recommendations made by the American College of Obstetricians and Gynecologists in which they advised it is safe for pregnant women to see their dentists during their pregnancy.  This includes routine cleanings, X-rays,  fillings, and treatments such as root canals and extractions.  In addition, dental anesthetics, with or without epinephrine have been deemed safe during pregnancy.

Oral health is important, and disease should not be left untreated.  Some oral diseases are transmissible, such as caries, which can be passed from mother to infant. Delaying treatment can cause increased problems and costs.  Early prevention is always advisable. A healthy mother has a better chance of having a healthy baby!

Amalgam Free

We have been amalgam free for over twenty years now.  Ever since I attended a lecture given by John Kanca on bonding and avoidance of amalgam fractures back in 1992, I put my stock of mercury and silver on the shelf and used the composite resin: tooth colored, bonding materials.  With one exception, most of the different brands have held up very well. I dropped amalgam from use, not from any fear about toxicity or safety, but for biomechanical reasons.  I do believe amalgam is safe when properly placed by a clinician.  However, there is no question amalgams weaken teeth  and can set them up for fractures. Bonding composite  can be more conservative, and can help hold a tooth together better.  However, even bonding (resins/composites) have their limitations, and there is concern about bis-phenol A in the oral environment.  Gold still remains the most biocompatible  material, and has the longest longevity. Of course, not many people want to show off the “bling” in their mouths, and would rather show it off on their wrist, ears, lapels, etc.

The future of dental restorative materials may  fall by the wayside,  With stem cell harvesting, the future may bring the genetic manipulation to the forefront and relegate tooth repair to the rear.

Going Paperless

We are making the transition to a paperless practice!  With our new dental software, all our records will be digital.  As part of the process, we will have greater ability to access your records comprehensively, and communicate with other specialists or insurance companies electronically.  We already process all insurance claims electronically, but now have greater ability to track claims and verify benefits.  The transition has not been without its difficulties.  Because our previous dental software used a PICK operating system and proprietary software, we could not convert our data and have had to enter it all manually. That takes time!  Our new Windows based software is fully integrated and we are thrilled to use it.  So next time you are in the office, you will see it in action.

Understanding Dental Insurance: Clearing up Confusion between Routine Cleaning and Gross Debridement

Insurance companies are particular with the protocol and coding for  procedures regarding cleanings.  A routine cleaning (prophylaxis, or prophy for short) consists of scaling and polishing (Code D1110). If a patient comes in with lots of tartar, or other periodontal problems, more than just a one visit prophy is needed.  This might be another cleaning (prophy), or periodontal treatment depending on how bad the findings are.  But if a person needs another cleaning because there was too  much for one visit, or because there are periodontal conditions,  the prophy code D1110 should not be used for the initial cleaning.  Here’s  where insurance gets a little tricky.  In this case, a Gross Debridement code (code D4355) must be used.  Then another cleaning under the prophy code, or if needed, the more aggressive root planing  code can be used.   However, unlike a prophy code, the gross debridement code falls under periodontal treatment  and may not be covered at the same percentage as the  prophy.

So, if you just need a routine cleaning- prophy (D1110)

If you need more than routine cleaning, Gross Debridement code (D4355), followed by either prophy  (D1110)or root planings (D4341).

Now with regard to insurance, the prophy code D1110 is considered a Preventive service ( typically covered at 100%) and is covered as such, but the Gross Debridement code D4355 is considered a Periodontal, or Basic service (typically covered at 75-80%) or in some case even a Major service (typically covered at 50%).

Antibiotics Warning

A recent report in the New England Journal of Medicine, as reported in the General Dentistry (Vol.61, #2, p8) indicated there was a small potential increase in the risk of cardiovascular abnormalities resulting in death from certain antibiotics.. These antibiotics are know to cause an increase in the QT interval of the heartbeat; this can cause cardiac problems and even death. Of concern are ERYTHROMYCIN, CLARITHROMYCIN, AZITHROMYCIN and LEVOFLOXACIN. The study reported 29 deaths in a 14 year period involving million of prescriptions.  The risk of using these antibiotics, therefore, is extremely low.  It is unknown at present whether the vasoconstictor in dental anesthetics has an adverse  effect in such  patients with prolonged QT intervals, so caution is advised.

The Grammy’s, Music and Health

The link between music and health has been scientifically investigated in numerous medical disciplines.  Music has been used to help treat patients with pain, stress, and anxiety (sounds like someone going to the dentist, right?), and for conditions ranging from Alzheimer’s to Cancer.  Music is not the cure, but an adjunct to stimulate the mind and nervous system.  Music also has deep emotional connections.  So what does this have to do with dental health?

Well, for starters, we try to play upbeat music throughout the office.  Since everyone has different musical tastes, we offer wireless headphones and Pandora Music (you pick your own artist and a station is created with similar music). when you are in the chair.  It is easier  to work on a relaxed patient than a fidgety one.

The Grammy’s award music to a variety of artists.  I am not sure how many artists would welcome being told their music is played in a dental office,  nevertheless, many of the Grammy winners have found their way into the ears of our patients. From Rap to Rock, from Classical to Jazz, it all has been chosen by patients for their comfort.  I was glad to learn Mumford & Son’s won the album of the year. I know their music has a beneficial effect on me, and that might be important too, for no patient wants to face an irritable dentist!

 

Healthy Gums, Healthy Heart

There is increasing evidence that there is a link between periodontal disease and cardiac disease.  Whether the “C-reactive” proteins found in periodontal disease contribute to cardiac disease is still under investigation, but at the very least, it is in your interest to maintain periodontal health.  While we are the topic of cardiac health, here is something we can all do to help prevent heart attacks: ASPIRIN.

Dr. Virend Somers reported in the Journal of the American College of Cardiology that most heart attacks occur during the day, particularly between 6 AM and noon.  He also noted that  he suspects sleep apnea as the cause of those heart attacks that occur during the night. If you take aspirin once a day, take it at night when the aspirin is strongest in your system while sleeping.  The aspirin can help thwart a heart attack.  SInce aspirin loses it potency in the body after 24 hours (its half-life), it is still most potent while sleeping.

SO, AFTER BRUSHING AND FLOSSING, SCRAPPING YOUR TONGUE OF DEBRIS, AND USING YOUR APPROPRIATE ORAL RINSES BEFORE GOING TO BED, TAKE YOUR ASPIRIN!

February is Children’s Dental Health Month

February has been designated as National Children’s Dental Health Month by the American Dental Association. Early detection of caries (the cavity is the hole left after caries attacks the tooth) is posible with  a number of new and more senstivie technologies such as lasers and  digital radiography. Advances in fluoride toothpastes and fluoride vitamins and  preventive procedures such as sealants, have marked the delcine of cavities with children.  As always, proper home care, including brushing, flossing, approriate rinses, diet and nutrition,  and regular dental appointments contribute to the well being of children and their teeth.