Make Overs

See Complex Reconstructions

Medical Conditions And Dentistry

The Mouth-Body Connection

The mouth has implications for the whole body

What goes on in your mouth can affect the rest of your body, and what goes on in the rest of your body can have an effect on your mouth

• The state of your mouth often can provide information about your overall health and dentists can be the first to detect some medical conditions including Diabetes, Heart Disease, oral cancer, colon cancer, Hodgkin's lymphoma and chronic heartburn
• Gum Disease may increase the risk of a number of health problems, including heart disease, diabetes and premature births. Bacteria that cause gum disease release toxic byproducts into the bloodstream, which can increase levels of blood sugar, cholesterol and C-reactive protein (CRP – a measure of systemic inflammation) If treatment of gum disease does not lower levels of blood sugar, cholesterol and CRP, it could indicate that a patient has some underlying disease

MEDICATIONS

Side Effects

• The most common oral side effect of medications is dry mouth (see Xerostomia) with 63% of the most commonly prescribed medicines listing this side effect. [36] It is most common with:
  • Antihistamines
  • Antidepressants
  • Decongestants
  • Pain killers
  • Blood Pressure Meds
  • Diuretics
  • Illicit stimulants (especially methamphetamine and cannabis)
• Abnormal bleeding — reduced blood clotting is a result of aspirin and prescribed anticoagulants, like heparin or warfarin. These medications are prescribed to treat strokes or heart disease, but can cause bleeding problems during oral surgery or periodontal treatment.
• Gum tissue overgrowth — also referred to as "gingival hyperplasia," gum tissue overgrowth is associated with anti-seizure medications, immunosuppressant drugs such as those taken by organ transplant patients and calcium channel blockers taken by heart patients. Studies suggest that gum tissue overgrowth can be controlled if meticulous oral hygiene is started at the same time or before medication is taken. Tissue overgrowth can complicate oral hygiene. Sometimes, a laser gingivectomy (a procedure used to remove excess tissue) may be necessary.
• Soft-tissue reactions — oral sores, inflammation or discoloration of the soft tissue can result from taking medications prescribed for blood pressure control, immunosuppressive agents, oral contraceptives and some chemotherapeutic agents.
• Tooth discoloration — intake of tetracycline products when teeth are developing can cause permanent staining in those teeth. Cosmetic dentistry techniques like veneers, crowns, bonding procedures, or, in some cases, bleaching may be used to lighten teeth with tetracycline stains.
• Other medications may cause taste alterations, mouth burning, numbness or tingling and movement disorders

Medications can have oral side effects such as dry mouth, which can increase your risk of decay, oral yeast infections and other oral infections

MEN ONLY

Most research and our experience at Sydney Aesthetic Smiles shows that women brush their teeth better and more frequently than men

Thus, men may be more susceptible to Gum Disease

The link between gum disease and many Systemic Illnesses is well established

You may say “but I brush my teeth twice a day” and the answer to that is that it’s not how often you brush but how well you brush that is important. Correct tooth brushing and flossing is essential for healthy teeth and gums see Oral Hygiene

Poor oral hygiene leaves a coating of Plaque on our teeth and gums and directly causes:

• Bad breath see Halitosis
• Yellow teeth see Stains
• Decay
• Gum Disease

Good dental health not only contributes to a healthy mouth and overall health but also to your smile and confidence

Nothing is more noticeable than a great smile

MERCURY


Mercury is a heavy metal that exists as a silver liquid
Its old name Quicksilver means “living” silver
• Its modern name comes the Roman fleet-footed messenger of the gods Mercurius
• The symbol for the planet Mercury☿ has been used since ancient times to represent the element
• The periodic symbol Hg is derived from the Latinized Greek Hydrargyrum meaning watery or runny silver
• Mercury is an important element due to its:
  • interesting history
  • numerous uses and
  • toxicity
• Mercury is stable in acids and alkalis but dissolves to form Amalgams with many metals including gold and silver
• Quicksilver was familiar to ancient civilizations and was found in Egyptian tombs that date from 1500 BC. It was used in China and Tibet to prolong life, heal fractures, and maintain generally good health. One of China's emperors, QínShǐHuángDì — allegedly buried in a tomb that contained rivers of flowing mercury on a model of the land he ruled — was poisoned by drinking a mercury and powdered jade mixture (causing liver failure and brain death).The ancient Greeks used mercury in ointments; Egyptians and Romans used it in cosmetics which sometimes deformed the face. By 500 BC mercury was used to make amalgams with other metals. The Indian word for alchemy is Rasavātam which means "the way of mercury"
• Mercury is extracted from a red ore called cinnabar (the source of the red pigment vermilion), which is composed of mercury and sulfur. Sometimes shiny globules of mercury appear among outcrops of cinnabar, which is probably why mercury was discovered so long ago. People learned to extract mercury from ore and used it to purify gold and silver. Ore containing gold or silver would be crushed and treated with mercury, which rejects impurities, to form a mercury alloy, called an amalgam. When the amalgam is heated, the mercury vaporizes, leaving pure gold or silver.

Much of the world's mercury has traditionally been mined in Spain and Italy In 2005, China was the top producer of mercury with almost two-thirds global share followed by Kyrgyzstan.

Minimally Invasive Dentistry

At Sydney Aesthetic Smiles we are big fans of Minimal Intervention Dentistry (MID) We believe in providing optimum service with the minimum amount of treatment

MID is based on advances in science and means:

1. Minimal drilling of teeth
2. Stronger and healthier teeth
3. Reduced cost

We lean towards the use of High Tech Nano Composites to mould and bond onto teeth rather than traditional drilling and cementing of Porcelain Crowns

When placed by skilled dentists composites are extremely Aesthetic and totally undetectable

Evidence based procedures and protocols are employed to avoid the loss of unnecessary tooth substance

The common delineator is tissue preservation, preferably by preventing disease from occurring and intercepting its progress, but also removing and replacing with as little tissue loss as possible

The introduction of predictable adhesive technologies bridges the traditional gap between prevention and surgical procedures “ restoring teeth is a temporary palliative measure that is doomed to fail if the disease that caused the condition is not addressed properly. Today, the means, motives and opportunities for minimally invasive dentistry are at hand, but incentives are definitely lacking. Patients and third parties seem to be convinced that the only things that count are replacements. Namely, they are prepared to pay for a filling but not for a procedure that can help avoid having one” Ericson D . Oral Health Prev Dent. 2004;2Suppl 1:287-92

“There has been an obvious trend in dentistry toward complex techniques and accomplishing more treatment than required. Recently, I had the opportunity to speak at the annual meeting of the World Congress of Minimally Invasive Dentistry. It was refreshing to be with a group of fellow practitioners who were attempting to provide optimum services for patients with the minimum amount of treatment the group is interested in promoting optimum, minimally invasive treatment for patients in all areas and specialties of dentistry“ Gordon Christensen, D.D.S., M.S.D., Ph.D. J Am Dent Assoc, Vol 136, No 11, 1563-1565
2005

American Dental Association

Examples:

• Placement of preventive resin restorations using laser
  When teeth appear to have minimal dental caries in them and this suspicion has been verified by using the Diagnodent laser decay detection device
  The use of laser to also remove the decay means minimal tooth structure removal with optimum small restorations
• Miniature implants versus standard-size implants
  The use of "mini" 1.8-mm–diameter implants allows conservative placement of implants in bone that is only 3 mm thick in a facial-lingual dimension, thus avoiding bone grafting and significant trauma and expense for patients.
  The conservative nature of the surgical procedure means:
  • preservation of bone
  • greater blood supply
  • minimal post operative discomfort
  • faster more predictable healing
  • reduced cost
• Bleaching or placement of veneers instead of crowns
  Crowns are very invasive and expensive seldom simulate natural teeth over the long term. Composite veneers are versatile and can be resurfaced or added to to maintain Aesthetics
• Placement of composite crowns, inlays and onlays instead of porcelain crowns Most dentists restore teeth with crowns instead of tooth-coloured or gold alloy inlays and onlays. The apparent reason is that the crown procedure is believed to be simpler and more predictable than the inlay or onlay procedure. Also, some third-party payers fund crowns more fully than they do inlays and onlays, which is unfortunate
• Full mouth reconstructions in composite rather than porcelain
• Use of laser for crown lengthening which AVOIDS ALL OF THE FOLLOWING
  Traditional crown lengthening procedures are usually performed by a Periodontist and involve:
  • Cutting along the gum line using a scalpel
  • Peeling the gum back
  • Drilling bone
  • Cutting away excess gum
  • Stitching the gum back over the bone
  • Post op swelling and pain
• Use of occlusal splints to avoid excessive wear and vertical dimension loss seen with bruxism
• Repair of crowns instead of replacement. Over many years of service, the gingival margins of full crowns begin to develop carious lesions. When these crowns are in the posterior portion of the mouth and do not require an optimal esthetic result, repair of margins is indicated. Easily placed,high-fluoride–releasing restorative materials are excellent materials for such repairs. Many repaired crowns continue to serve for decades when this minimally invasive repair techniques used.
• Preventive therapy for patients undergoing orthodontic treatment In recent years, dentists practicing orthodontics have moved from use of zinc phosphate or glass ionomer cement containing fluoride to use of resin cement "with fluoride added." Although it is possible to develop resin cements that release a slight amount of fluoride during service, this release is minimal compared with that of the cements of the past. The result is a well-known epidemic of demineralized white spots or overt dental caries in patients whose orthodontic work is completed. High-level fluoride toothpastes such as Prevident 5000 (Colgate, Canton,Ohio), Fluoridex (Discus Dental, Culver City, Calif.) or ControlRx (Omnii, West Palm Beach, Fla.) can reduce or eliminate this problem. The fluoride toothpaste is applied twice per day, after breakfast and before retiring, to the teeth undergoing orthodontic therapy. Patients who use these high-fluoride toothpastes have fewer invasive carious lesions after orthodontic therapy
• Digital radiography versus conventional radiography. Many dentists have changed to digital radiography, but numerous practitioners still are using standard radiography. Digital radiography reduces the amount of radiation dental patients receive by at least 80 percent, with the obvious advantages of less cumulative radiation exposure during therapy.
• Sealants. Properly placed sealants do not require any cutting of tooth structure. Placement of sealants in suspect teeth within six months of tooth eruption is highly effective in preventing the need for future tooth restoration or potential tooth removal at a later time. I suggest that grooves and fissures should be cleaned with air slurry polishers before placement of sealant material to ensure that plaque has been removed from the grooves.