Category Archives: Dental Health

All-on-4®, A Dental Miracle

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All–on–4® is the name for a technique used in the total rehabilitation of patients who have lost or will soon lose all of their teeth in one or both arches. This system was developed in the 1990s through studies which were funded by Nobel Biocare which has been a corporate leader in the implant industry since the early 1980s.

The All-on-4® treatment concept is a miracle because patients arrive at their dentist’s office in the morning with either no teeth or teeth which cannot be saved in one or both arches.  At that appointment, the implant surgeon (usually a periodontist or oral surgeon), the prosthetic dentist (in this case, me) and a lab technician work collaboratively.  A few hours later the patient leaves the office with a complete set of teeth which are not removable, which function well and which look amazing.

In addition, no grafting is required before placing the implants with this system. Therefore, most patients who have been told that they are not good candidates for implants because of a lack of bone, or large sinuses, or other anatomical circumstances are perfect candidates for the All–on–4® procedure.

There is no grafting, and no lengthy healing time required. Four implants are placed in each treated jaw. This procedure takes advantage of the dense bone which is available in the front of both the top and bottom jaws and places two implants there. Two more implants are placed in the back of the jaws and at an angle to both avoid sensitive anatomic areas as well as to take advantage of available dense bone there. Permanently fixed bridges can then be secured to these four implants immediately because of the solid primary stability which is gained by these strategically placed implants.

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The full dental bridge which is attached to these implants is not removable, has no coverage of the palate, and can be used immediately to eat a complete diet without restriction. After four to six months, a final fixed prosthesis is placed over the implants once total healing is assured.

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The advantages of All–on–4® are many:

1. Get implants in one day with minimal surgery.

2. Entire procedure completed in one location and one day.

3. Avoid the expense and healing time of bone grafting.

4. Have fixed, not removable teeth.

5. Have a complete new set of teeth which look and feel natural – Smile Again!

6. Have the ability to again eat all the foods that you desire.

If you have any questions about the All–on–4® procedure or if you know someone who would benefit from it, please contact us at 908.359.6655 or via our website at www.designsfordentalhealth.com

Your Shimbashi Number And Your Bite

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I am writing this article in honor of Dr. Henry “Hank” Shimbashi, a practicing dentist and researcher from Edmonton, Alberta who passed away this week. Dr. Shimbashi was a very influential friend of comprehensive restorative dentists and his research is used every day in offices like mine where problems with the bite and TMJ’s are treated.

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As a result of his research, the Shimbashi number was established to indicate an ideal relationship between the upper and lower jaws. When there is an optimal position of the lower jaw relative to the upper jaw, the muscles which are connected to them will also be at their optimal length and can function ideally.

If the relationship between the upper and lower jaws is altered, one or more of the many muscles of the head, neck and face may be overworked causing them to go into spasm — i.e., be painful. This can happen if the lower jaw is too close to or far from the upper jaw, too far forward or back, or shifted in any direction relative to the upper jaw.

Dr. Shimbashi’s research measured muscle activity in over 500 patients. He found that there was an ideal vertical dimension at which the jaw muscles functioned at their maximum potential. In addition, at this ideal position, patients had no symptoms of muscle pain. This vertical dimension was found to be universally applicable in all age groups and all races.

This simple number which we use is the measurement from the gum line of the upper front tooth to the gum line of the lower front tooth. Dr. Shimbashi found this ideal distance to be approximately 19 mm plus or minus one mm (about three quarters of an inch) when a patient bites.  In our office, we often see patients with bite problems whose Shimbashi number is significantly less than ideal  measuring as little as 10 mm or even less. In such patients, the lower front teeth are often nearly completely covered by the upper teeth. Such patients are much more likely to develop tooth and pain problems resulting from their bad bites.

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So what is your Shimbashi number?  If you have any questions about your bite as a result of this article, please feel free to call our office at 908.359.6655 or via our website at www.DesignsForDentalHealth.com

Is It Really A Migraine??

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Last week in the course of a routine examination, I asked a standard question of our young woman patient: “Do you have any problem with headaches?” She replied that she does have “migraines”. So I asked a few relevant questions about the headaches, and as is often the case, this patient’s answers led me to believe that her headaches are, in fact, not migraines.

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In our office, we often treat patients with head and neck pain who have been diagnosed by their doctors as having temporomandibular joint dysfunction. Oftentimes, such patients visit their doctors because they assume that the headaches from which they suffer must be migraines.

What are the typical signs and symptoms of a migraine headache? A typical migraine may last several hours to as many as three days. The pain is moderate to severe, pulsating, and usually on one side of the head. Typical associated signs of migraines include nausea and/or vomiting, as well as sensitivity to light and noise. Many migraine patients describe an “aura” just before the migraine begins. Auras are exhibited as a change in vision or hearing. Episodic migraines occur fewer than fifteen times per month with only some of these headaches being actual migraines. Such headaches occurring more than fifteen days per month with pain lasting four hours or more over a three-month period are considered to be “chronic migraines”.

Migraines may be triggered by various factors, and three out of four migraine sufferers describe specific triggers. Common examples of these triggers are physical exertion, stress, hormonal changes, weather changes, and others.

Tension headaches are the most common primary headaches. Such headaches may be misdiagnosed as migraines and vice versa.

Cluster headaches are severe attacks of pain on one side of the head lasting between fifteen minutes and three hours. These headaches may occur every other day or as often as eight times each day. Cluster headaches may be associated with facial sweating, restlessness, agitation or nasal congestion.

Other types of headaches include those brought on by exertion or coughing.  They may be described as feeling like stabbing pain or other equally unpleasant feelings.

If you or someone that you know suffers from headaches, we can generally help determine whether or not migraine headache is a proper diagnosis. The determination is made based upon the patient’s history and description of the pain as well as a screening examination to rule out the possibility of TMJ-type pain. We even have a computerized evaluation system to diagnose which muscle or muscles may be causing the problem. Patients often find it hard to believe that their headaches may be related to their jaw joints or their bite. The truth is, the connection between head and neck pain and the muscles involved in moving the jaw as well as those holding the head erect are commonly the source of such pain.

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If you have a question about headaches or would like additional information please feel free to contact us via our website www.DesignsForDentalHealth.com or by calling our office at 908.359.6655.

Cracked Tooth Syndrome – What You Need To Know

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We have had several patients recently who have had problems related to cracked teeth. The symptoms of which these patients complain can be difficult for both the patient and the dentist.  Both can become frustrated because the underlying cause of symptoms is frequently difficult to pinpoint.  Often, patients will complain about pain which is caused by biting pressure and sometimes temperature.  It is frustrating for both parties because the described symptoms are often difficult to duplicate in the dental office.  It’s kind of like bringing your car to the dealer with a specific problem which suddenly vanishes as soon as you arrive at the dealership.

Cracked teeth generally occur for two reasons.  First, silver or amalgam fillings expand and contract as we consume hot and cold foods and beverages. The expansion and contraction of the filling is slightly greater than the tooth itself.  So, after years of such cycling in temperature-associated expansion and contraction, cracks frequently develop in the teeth.  Second, cracks may occur while chewing foods.  Commonly patients will describe a sharp pain in a tooth while they had been chewing, and the tooth will remain sensitive to biting pressure and/or temperature.

Cracked teeth are addressed in stages depending upon symptoms.  First, a bonded filling may be placed in an attempt to prevent the cracks from propagating further.  Depending on the depth and severity of the crack, an onlay or crown may be necessary to prevent the tooth from breaking.  An onlay covers any thin walls of the tooth which may be at risk for fracture and is considered a conservative, aesthetic and long-term restoration.  If the tooth has an extensive existing restoration or a more severe crack, then a crown which covers the entire tooth will be required to prevent the tooth from breaking.

In either case, the problem needs to be addressed as quickly as possible to prevent the crack from propagating further into the tooth leading to more severe dental problems.  For example, if the crack reaches the pulp of the tooth, then root canal therapy will be required as well.  The most severe complication would be the vertical tooth fracture which includes the root thereby making the tooth non-restorable.  In such cases removal of the tooth and replacement in some fashion will be required.

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The important points to remember are as follows:

1. Determine the exact source of discomfort first

2. Address the symptoms as quickly as possible

3. Begin with the most conservative treatment and progress as needed to eliminate all symptoms

Such teeth need to be followed on a regular basis to ensure that damage to the pulp has not occurred.  Appropriate x-rays at routine intervals will be helpful for this.  Keeping your dentist apprised of precise symptoms will also go a long way to help in diagnosis.

If you have any questions about cracked tooth syndrome please do not hesitate to contact our office by calling 908.359.6655 or on the web at www.DesignsForDentalHealth.com

What Are Loupes And Why Must Your Dentist Wear Them?

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Dr. Nadler and Zora Circa 2003

Dental loupes are the magnifying glasses that dentists wear to enlarge everything that they see in the mouth. There are two basic reasons why these glasses are worn. First and foremost, vision is improved simply because everything in the field of view is so much bigger. Secondly, loupes are worn to allow dentists to have a more “physiologic” posture while working, and thereby minimize the slouching which dentists are historically known to develop.

 

Why is it important to have an enlarged view of the working area? The most obvious answer is that a better and enlarged view of the treatment site automatically results in more precise dental work. Dentists are better able to see the shapes that they are carving or preparing in the natural teeth as well as in the final restorations which they are providing for their patients. Perhaps even more importantly, dentists are better able to make more accurate and complete diagnoses of what is occurring in each patient’s mouth.

 

As an example, I was testing out a new product which was touted to assist in better diagnoses of oral cancer. This system required the wearing of colored lenses used in conjunction with a special light. Using this system, I would be unable to wear my loupes. I first examined a patient using this new system without magnification. And then, put on my loupes and re-examined the patient. There was no comparison between the two examinations. Without magnification, even with the special light effect, much more was visible and apparent with magnification.

 

I began wearing loupes back around 1990 while I was taking advanced classes at the L.D.  Pankey Institute in Florida. It was at this time when I truly feel that the quality of the treatment which our office provided moved to an entirely new and higher plateau. Not only was I learning some amazing skills, but also the use of the loupes alone allowed significant improvement in my ability to provide excellent treatment.  Since that time, the loupes that I use have gotten increasingly longer and provide more magnification. These glasses are simply addictive to any dentist who is serious about doing his or her absolute best work.

 

A few years after beginning to wear them, I decided to try a headlight mounted right on the  loupes. After the first patient to be seen with this light, and in spite of the discomfort of extra weight on my nose, there was no turning back. The benefits of the light are nearly as significant as those of the loupes themselves. As good as the overhead dental light is, there are still shadows as we lean in as well as from the lips and tongue, etc.  Whereas, wearing the loop-mounted headlight, the light shines exactly where I am looking.

 

I don’t see how any dentist can work without either magnification or head-mounted lights. I believe that dental schools should teach the use of this equipment as mandatory – at least in the final year of dental school. If you’ve ever seen the intraoral photographs that we take for our patients, you’ll know what it’s like to look through loupes with light. It’s just so easy to see!

 

If you have not had the opportunity to see an intraoral photo of your teeth, please ask us for a demonstration at your next appointment. It will only take a moment and can be quite eye opening. If you have any questions or concerns please visit us online at www.DesignsForDentalHealth.com or call us at 908-359-6655.

Free Sleep Apnea Screenings Offered in November

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Again this year, we are offering free Obstructive Sleep Apnea (OSA) screenings during the month of November. This is our way of giving thanks for all the blessings which we have received during the year, and it is our hope that we may potentially save a life by providing this service.

 Sleep apnea is a serious condition with potentially life-threatening side effects. Most people are not at all aware of this condition and certainly do not think that it affects them.  People who have Obstructive Sleep Apnea are at risk for various medical conditions including:

  •  Adult onset diabetes (the #1 growing disease currently in the US!)
  • High blood pressure (especially when resistant to treatment)
  • Anxiety and depression
  •   Daytime sleepiness
  •  Heart attacks and strokes
  •   Gastro-esophageal reflux disease (GERD)

In addition, OSA patients are prone to daytime sleepiness which places them at risk when driving. Also, these patients may struggle with diet-resistant weight gain.  Such patients frequently lose significant weight when treated for their sleep apnea condition.

If you have any of the above symptoms or conditions, or have been told that you snore or stop breathing while asleep – or you just sleep poorly – perhaps finding out if sleep apnea is the problem may be the prudent thing to do. The screening is very quick and easy. It involves a history form and a brief examination, after which a preliminary diagnosis can immediately be made.

This offer is available to all of our patients as well as their friends, family, and coworkers. Please take advantage of this service! The first step is to determine if you are at risk for sleep apnea.   Once a diagnosis is established, there are various ways to control the condition, allow you to sleep better, live healthier and feel great!

Call us at 908.359.6655 or visit our website at www.DesignsForDentalHealth.com to schedule your free screening.

Have a wonderful holiday!

Richard M Nadler DMD, FAGD and the Designs For Dental Health Team

New Root Canal System Offers Major Improvements

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Several months ago we began using a new root canal technique and have found it to be vastly improved compared to the methods we were taught back in dental school some 30 years ago. If you have ever undergone a root canal, you will remember that we use little files that are twisted with our fingers. This technique, when followed to completion, was a very painstaking  as well as time-consuming one. Some years ago we began using a somewhat different technique which involved using a French-made piece of equipment to clean out the canals using an electric motor and rotary files. This technique was certainly a huge improvement over the finger file techniques we previously used. But, now, our newest system which was developed by Dentsply Corporation and called WaveOne™ offers even more advanced improvements.

The major improvement as far as patients will be concerned regarding this newest system is that cleaning the canals is completed in a fraction of the time that it used to take when we were filing with our fingers. In addition, the files used with this technique are meant to be used one time only. Each pre-sterilized file assures that there will be no contamination since each patient has her own single-use file.

In addition to these improvements in instrumentation, this technique offers an activator, which may more appropriately be called a vibrator, to agitate an antimicrobial or antibiotic solution within each prepared canal. This agitation thoroughly cleans the canal and any adjacent pores in the root where bacteria may hide, thus offering more complete debridement of each canal.

Finally, this system utilizes a filler which is warmed first to allow it to be more flowable. This flowability permits the filler material to better seal not only the canal itself but also any adjacent openings or tubules in the root.

We as dental practitioners have truly enjoyed using this vastly improved system, and patients have expressed their opinions of how simple and straightforward having a root canal felt to them. This was especially true of those patients who had previously undergone root canal therapy with older techniques and systems.

If you have any questions about root canal therapy or would like more information about the system that we use, feel free to contact us @ www.DesignsForDentalHealth.com or by calling our office @ 908.359.6655.

Does Your Posture Make You Look Older?

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As we discussed in an earlier blog article, many people develop poor posture for one reason or another – sleep apnea (often undiagnosed), slouching over a desk, poor physical condition, etc.  Whenever we treat patients for Temporomandibular Joint Dysfunction (TMD), their posture must be addressed.  Simply by changing the position of a person’s head, the bite will change.  Try it for yourself.  Tap your teeth together while sitting or standing with your head level.  Now, tap the same way with your head tilted back and notice how differently the teeth meet.   Since a “bad” bite is the most common cause of TMD, the posture must first be “aligned” as we address the TMJ problem, and we do this using various techniques one of which will be highlighted in this article.

The simplest way that we employ to help correct the posture involves an exercise used to correct forward head position.  You may have read our earlier article about “Upper Crossed Syndrome” in which the head and neck are angled forward giving the appearance of “hunching” over.  Not only is this posture not proper for comfort and  physiology reasons, but people who carry themselves this way look older and less attractive.

 We ask our patients to address this posture problem while we are analyzing and treating their TMD problems by having them correct their hunching in this way:  Make believe that there is a string coming out of the top of your head.  Now see this string being pulled straight up so that you are being stretched taller.  Just sit or stand straighter, not military-style with the shoulders back, but just longer.  Finally, keeping your head level, tuck your chin back bringing your ears in line with your shoulders.  This exercise may be done during the day to help correct an acquired poor posture, while, at the same time, helping you to look younger and more “conditioned.”

Here is a link to a great video which demonstrates this exercise:  http://www.posturevideos.com/posture_video/forward-head-posture-correction/

If you have any questions about posture and TMD feel free to call us at 908.359.6655 or contact us via our website at www.DesignsForDental Health.com

I Learned First Hand What Being a TMD Patient Feels Like! AND, It’s All About the Bite!

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First, I believe that this is one of the most important articles that I’ll write.  For the past twenty plus years, the study of occlusion (how the teeth meet plus A LOT more) has been my passion.  It is very difficult to explain to patients how the bite can be responsible for so many dental issues.  And, it is even more difficult for patients to understand that fixing the bite does not generally mean just getting braces (orthodontics).

richardtensTENS To Relax Muscles

Having just returned from a three-day advanced TMD (Temporomandibular Disorder or TMJ disorder) program, I learned updated techniques to assist in the establishing of proper bites for patients –  especially those who suffer form head, neck and facial pain.  We were able to see objectively with the help of computer analysis how getting the jaw position right results in muscles which RELAX, and, therefore, STOP HURTING!

 And that is the big paradigm shift that is difficult for patients to understand.  Occlusion involves a system which includes the teeth, the upper and lower jaws, muscles, ligaments, nerves, etc.  And, when this system is out of balance, there may be a variety of signs (what the dentist sees) and symptoms (what the patient experiences) which develop.

If a person’s occlusion is out of balance, he or she may develop loose teeth, sensitive or painful teeth, worn and broken teeth, headaches, neck and shoulder pain, facial pain, dizziness, clicking or popping jaw, ringing in the ears, tingling fingers, and much more.  Most people, if told that they have problems due to their bite, assume that the only way to fix it is by having orthodontics or braces on their teeth. 

Orthodontics is a dental specialty which addresses how to straighten teeth and how to make the upper and lower teeth fit together.  It does not address the position of the jaw nor the muscles and other “soft” tissues which support the jaw.  And it is the jaw position and the muscles which need treatment to solve most bite-related problems.   Picture the jaw just hanging from the skull by muscles and ligaments.  As we close our mouths, we bite to bring our teeth together as best we can.  If our ideal “physiologic” jaw position and the tooth biting position do not match, the jaw is forced into a ”bad” position requiring muscles to work overtime.  Muscles which are over-worked build up lactic acid and begin to hurt.  Most people experience such pain when they begin a new exercise program.   So, just straightening the teeth without regard for jaw position nor muscle relaxation will not solve most problems of occlusion.

 Please do not misunderstand the value of orthodontics.  Due to various hereditary and environmental conditions, children develop crooked teeth which require straightening.  Such “malocclusions” are best treated early and after a thorough analysis of how the problem developed.  Orthodontists provide an excellent service and help both children and adults to look great and function well.  Having dabbled in orthodontics, I have a real appreciation for the amazing work that they perform.

richardk7Establishing a Correct Bite

But this article is intended for those who have true “occlusal” issues which tooth straightening alone will not resolve.  A thorough examination including a complete history, comprehensive examination, necessary xray evaluations, and diagnosis by a doctor or dentist who is well-versed with occlusal issues is the first step to successful  treatment.

 I am very excited about the wonderful advances that are being made in this field, and I welcome your comments and questions.  I plan to continue addressing this subject in upcoming blog articles.  Please let me know if you have specific questions which you will find interesting and pertinent.  You may contact me by calling the office at 908.359.6655 or through our website at www.DesignsForDentalHealth.com .

Problems Getting Numb?

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 Patients sometimes report that it is difficult for them to achieve adequate “numbness” for routine dental procedures.  Fortunately there are a variety of local anesthetics as well as various techniques for delivering them.  It is a very rare occurrence when we cannot find some combination of anesthetic and technique to help our patients to feel adequately numb.  There are, however, some very interesting reasons why patients may have such problems.  Most of these can be prevented once the causes are understood. 

Anything that causes the pH, or acidity level, of the body to be abnormal can result in poor anesthetic performance.  These agents require a very narrow pH range in order to be effective.  So, if a patient is taking high levels of vitamin C, for example, the body’s pH may be to low.  For these patients, curtailing the vitamin usage for two days before their appointment will be most helpful.  Similarly, when a patient has an acute infection, the pH in the vicinity of the infection may be off requiring additional anesthetic or a different method of delivering it.  It would be much better to have the problem treated before it becomes a full-blown acute infection.  In some cases, these patients will need to begin antibiotic therapy for a couple of days before proceeding with necessary treatment.  The lesson?  If a problem is suspected, have it checked out sooner rather than later to avoid unnecessary discomfort, expense and loss of time. 

Similarly, if a person grinds or clenches, her muscles may have a build up of lactic acid similar to that when we exercise any muscle heavily.  In this case, the pH is thrown off due to the accumulation of the lactic acid.  Such patients will benefit by taking a Tums ™ tablet three times a day for three days prior to their dental appointment.

Others experience anesthetic that does not seem to last long enough.  Sometimes, one’s metabolism can be in high gear contributing to the short-lived effects of the anesthetic.  For example, patients who are very nervous may have this issue.  Similarly, those who have had significant caffeine may have the same problem.  Limiting the coffee or energy products on the day of your dental appointment will be helpful.  For those who are very nervous, a mild oral sedative may be the solution.

A small group of patients may have a rather rare genetic disorder called Ehlers-Danlos  Syndrome which effects various tissues in the body.  These patients may experience joint hypermobility, stretchy skin and may be easily bruised.  These patients also may not become adequately numb for dental procedures.  These patients may need additional anesthetic as well as more frequent doses.

Believe it or not, there is some evidence that people with red hair may have more difficulty achieving adequate numbness.  The same gene  which results in red hair and fair skin is the culprit.  Redheads may just need additional anesthetic to feel adequately numb.

Here are some basic rules to follow to insure the best result from your local dental anesthetic:

  1. Have a restful night’s sleep before your dental visit.
  2. Do not rush around and try to do a day’s work in a couple of hours before your visit.
  3. Avoid caffeine products especially the day of your visit.
  4. If you have had difficulty achieving adequate numbness in the past, try taking Tums™ three time per day for three days before your appointment.
  5. Talk to your dentist about your experiences with anesthetics as well as any concerns you may have.

 

If you have additional questions or concerns about dental anesthetics, it will be our pleasure to speak with you about them.  You may reach us online at www.DesignsForDentalHealth.com or by telephone at 908.359.6655.