Dental Implants of Multiple Teeth

Multiple Dental Implants

DENTAL IMPLANTS

A dental implant, which is also known as an endosseous implant or dental fixture, is a type of dental treatment to replace a single missing tooth.  There are however, times when it may be necessary to replace more than one missing teeth, and multiple dental implants may be a viable treatment solution.

WHEN ARE MULTIPLE DENTAL IMPLANTS INDICATED

There are times when more than one dental implant may be considered:

1. There is an existing dental bridge that has failed due to extensive tooth decay or root fracture, and the teeth supporting the bridge needs tooth extraction.  Multiple dental implants may be used to replace the teeth supporting the bridge.
2. There are multiple missing front teeth, and a long span fixed dental bridge is not desirable as part of conservative dentistry and to prevent over treatment, or when a  partial denture or flipper is not a desired option.
3. There are more than one missing consecutive posterior / back teeth in a row, and one wants to gain back chewing function of their back teeth.
4. One is missing all of their teeth, and as part of a comprehensive dental reconstructive program, multiple dental implants may be used to restore the patients smile, form, and give back proper chewing and occlusion.  Such cases may be done by the prosthodontists, dentists who specializes in full mouth rehabilitation scenarios.
5. One has a denture that is loose, and is not able to be supported well by adhesive or denture relines.  By placing several dental implants, the implant will help anchor the denture in place.
6. There is severe periodontal disease (gum and bone disease) and more than one teeth have to be extracted due to advanced bone loss and/or gum infection.

AM I A CANDIDATE FOR MULTIPLE DENTAL IMPLANTS?

You, your dentist, and dental surgeon will discuss together if more than one dental implants are suitable for you.  Factors that need to be considered include medical history, bone width, age, existing conditions and habits that may delay healing (ie. smoking presence, diabetes), conditions that may prolong bleeding (ie. blood disorder), and finances.

If you have any questions or concerns regarding multiple dental implants, the steps and costs involved, please consult with your family dentist.
 
From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Teeth Whitening At the Dentist

Teeth Whitening

Teeth whitening has become a popular part of cosmetic dentistry, and is easy to do!  Thinking about getting your teeth whitened?  What is it like getting your tooth bleached?  Ever wonder what exactly it is?  How and why does it work? 

A tooth has essentially three layers: enamel, dentin, and pulp.  Enamel is the hard outer layer, dentin is the softer inner layer of the tooth, and the pulp is where the nerve and live tissues are.  Children's teeth (baby teeth) are naturally white when they first erupt.  Over time, as people age and permanent teeth erupt, teeth become less porous and the teeth appear darker and stained.

FOODS THAT CAUSE DARK AND GREY STAINS

Foods and drinks such as tea, wine, soy sauce, coffee, blueberries, and betel nuts can cause dark and yellow stains within the enamel of the teeth.  Over time, the stains can penetrate the enamel layer and the dentinal tubules, causing teeth to appear grey, dark, and yellow.  Other products than can also cause teeth staining include coke, certain antibiotics like tetracycline, and excessive fluoride.

HOW TEETH WHITENING WORKS

Bleaching products use hydrogen peroxide that interacts with water to form carbamide peroxide.  The peroxide travels within the enamel tubules to the dentin, breaking down the stains in the enamel and dentin.  Teeth thus appear to be whiter and brighter as the stains are dissolved and the enamel and dentin are more porous in the process.

TEETH WHITENING WITH STORE PRODUCTS

In the store, one can purchase whitening toothpastes, paint-on gels, and whitening mouthwashes.  These products may contain a mild abrasive that remove very mild extrinsic surface stains.  Some companies such as Crest sell whitening strips, which can help remove mild to moderate dark stains.  Most of these products contain very little hydrogen peroxide and have not been tested, so such whitening effects may not be as effective.

IN-OFFCE TEETH BLEACHING

• The dentist can fabricate custom whitening trays for one to do tooth whitening at home.  Once molds of teeth are taken and trays are made, one places a hydrogen peroxide gel within the custom trays.  The trays are worn over a period of two to three weeks.
• Some dentists also offer same day bleaching.  A high concentration of carbamide peroxide gel up to 40% is placed on the teeth for a duration of 25-30 minutes and repeated two to three times.  This method is effective against moderate to heavily stained teeth due to the gel concentration, and usually takes a single 90 minute session.

TEETH WHITENING SIDE EFFECTS

Dental bleaching is relatively safe but as with any dental procedure there are side effects.  Tooth whitening side effects include minor cold/hot tooth sensitivity, gums irritation from the hydrogen peroxide gel, and lingering tooth sensitivity to cold.

Interested in teeth whitening?  Be sure to consult with your family dentist.  Tooth bleaching can be a regular part of your regular dental care; you and your dentist can discuss which whitening method may be appropriate.

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Dental Implants Single Tooth

Dentistry today is vastly different due to increases in oral health research and technology, and dental implants is one of the leading services dentists are able to provide today for their patients.  Implants are many times a viable option as to afford a long term replacement and viable solution to missing teeth.

Today, let's go over the single tooth dental implant, which is also known as an endosseous implant or dental fixture.

WHAT IS A DENTAL IMPLANT?

A dental implant is a component that is surgically placed within the jaw bone, which in turn supports a prosthesis (ie. dental porcelain crown, bridge, or denture).  Via a biological process called ooseointegration, the implant fixture (typically made from titanium), forms an intimate bond to the bone.  At this point the dental surgeon would also determine if a bone graft is required.  If there is insufficient bone structure to hold the implant firmly in place, additional bone may need to be be added to the implant site via a bone graft.  If the implant area is in an area of esthetic importance (ie. front tooth with an exposed smile line) the dentist may elected to add additional gingival tissue to improve the appearance of the implant fixture via a soft tissue graft.

After the implant is placed, the implant fixture is given time to heal and integrate with the bone, usually for 3-6 months.  Once the implant osseointegrates with the bone, an abutment is attached to the implant which contains and hold the dental prosthetic (ie. crown, bridge, or denture).  The dental prosthetic may then be attached to the abutment and implant via cement or screw..

WHEN IS A SINGLE TOOTH IMPLANT INDICATED?

There are situations when a single implant may be desirable:

1. Accidental trauma to a single tooth, while the teeth adjacent to the affected area are normal and healthy.  An example would the loss of a front tooth due to an accident.
2. A tooth has cracked from heavy occlusal trauma (bruxism and nighttime grinding) and is not saveable with a root canal and/or dental crown.
3. A tooth that has such severe decay it is no longer restorable with a root canal and crown.
4. A tooth with an existing filling or crown that has such deep and severe decay it is not longer saveable with a new restoration.
5. A tooth that has luxated (tooth fell out of its socket) from a sports or playground accident, or physical altercation. 
6. A tooth has cracked and sustained a fracture after a root canal from normal chewing, and the tooth is no longer saveable and requires tooth extraction.
7. A tooth that has severe localized periodontal disease with aggressive bone loss.  With such periodontal involvement and bone loss, the tooth may be mobile and have poor bone support and susceptible to infection.
8. One particular area of the jaw has an inherent missing tooth.  For example, some people are genetically born with a single missing adult tooth, and this may cause difficulty chewing, self awareness in their smile, or food-induced gum trauma and irritation.

AM I CANDIDATE FOR A SINGLE TOOTH IMPLANT? 

The dentist and surgeon would determine if you are a viable candidate for a single tooth dental implant.  A successful implant would require healthy jaw bone and gingiva.  Oral hygiene, diabetes, smoking, a compromised immune system, and heavy uncontrolled bruxism/grinding are important factors to take into consideration of the implant's success.  Age may be a factor; one may want to wait until the age of 20 as that is when the jaw bone has completed its full maturation growth cycle. 

COST OF DENTAL IMPLANTS

What does a dental implant cost?  The costs of the implant from start to finish will vary widely and dependent on many factors. These factors include: type of material used, state where the service is performed, the type of insurance coverage, if a bone graft is required, the type of abutment used, and the type of crown that is placed.  The dentist's front office would be able to give you an estimate of the costs associated with the dental implant. 

If you have any questions or concerns regarding dental implants, the steps involved, and the costs involved, please consult with your family dentist.
 
From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600

Medication Effects on Teeth, A Dental View

 MEDICATIONS EFFECTS ON TEETH, A DENTAL VIEW

There are unfortunate (sometimes emergency) cases where one can sustain a traumatic and inadvertent injury to the dentition and oral cavity.   Such dental trauma may also stem from a medical or pharmacological condition, such as a drug's side effect or due to a body's physical condition.
A cursory understanding of medical conditions, diseases, and side effects from drugs will help one see how said conditions relates from a dental point of view, and also allows one to see how the body and the oral cavity, teeth, and gums inter-relate with one another.

Let's examine some possible dental and teeth damage due to various medical conditions:
1) Xerostomia 2) Sjogren's syndrome 3) Bulimia and Gastroesophageal reflux disease 4) Methadone side effect 5) Recreational drug use side effect 6) Medication side effects 7) Chemotherapy and radiation

XEROSTOMIA

Xerostomia, or dry mouth, can be due to aging, immunosuppressive medications, prescription medications, and chemical and radiation therapy.  With dry mouth saliva production is lowered, placing the teeth at higher risk of dental decay, necessitating the need for tooth colored fillings (resins).
Medications are many but can include antihypertensives, antidepressnats, diuretics, steorids, anticonvulsants, antianxiety agents, antipsychotics, and acne treatments.

SJOGREN'S SYNDROME

Sjogren's Syndrome is an autoimmune disorder that is characterized by excessive antibody production that are directed against certain tissues in the body.  Gland inflammation is a distinct characterization of Sjogren's, and affects the lacrimal glands in the eyes and also causes inflammation of the salivary glands.  The affected glands result in decreased tear production in the eyes and decreased saliva production in the mouth, hence dry eyes and dry mouth and lips are key indicators of this Sjogren's Syndrome.  With dry mouth dental decay may be more prevalent and may require tooth colored fillings to restore the dentition. 

BULIMIA / GASTROESOPHAGEAL REFLUX DISEASE

Bulimia is a psychologically induced condition where vomiting is forced and self-induced. Patients have tremendous fear of weight gain and have a severe negative overweight image of their bodies, thus forcing themselves to vomit in order to lose weight .  Hence the teeth are constantly exposed to acids in the stomach, if untreated can lead to enamel erosion and deterioration, which can then affect the dentin.  Tooth colored fillings or porcelain crowns may be required.

METHADONE SIDE EFFECTS

Methadone, a prescription medication by one's physician, is used as an anti-addictive medication for opioid addiction (ie. oxycodone, hydrocodone), and may also be used as an analgesic and antitussive. 
Methdaone's damage on the teeth can be extremely extensive, from enamel and dentin erosion to teeth fracture.  Such cases often require extensive dental treatment including porcelain crowns, surgical tooth extractions, and dental implants.

RECREATIONAL DRUG USE SIDE EFFECTS

Methamphetamine is a recreational drug when taken due to dependence, can cause severe teeth erosion and rampant dental decay / cavities.  Dental fillings, root canals, and porcelain crowns may be required in such cases to restore the dentition. 

MEDICATION SIDE EFFECTS

Tetracycline is an antibiotic, when taken during tooth formation, can cause malformations of the teeth.  Malformations may range from relatively minor enamel striations to complete enamel discoloration and dentin weakness, causing eventual tooth failure and fracture.  If the effects are minor, treatment may not be required.  If the effects are major, dental treatments may include porcelain veneers, dental crowns, and/or root canal therapy.

CHEMOTHERAPY / RADIATION

Chemotherapy and radiation, commonly used for cancer treatment, can negatively affect salivary production and thus cause dry mouth, which increases one's risk of tooth decay and gum disease.  Common dental affects may include rampant and extensive cavities and swollen & bleeding gums.  Patients undergoing chemotherapy and radiation may thus be at increased need of fillings.

CONCLUSION

It is this author's hope that after reading this blog, one will have a little more appreciation of the negative side effects of various drugs and medical treatments on the oral dentition.  While in most cases dental treatment can be rendered to address aforementioned negative effects on the dentition, a close relationship between the patient's dentist and physician is necessary to control and maintain the drug side effects, and to prevent the drug from overpowering teeth and periodontal health.

From your family Bellevue dentist,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Oil Pulling and Dental Health, Coconut Oil

Some may have heard or see the term "oil pulling" which some swear to its positive effects.  Not sure what it is?  Let's find out...

WHAT IS OIL PULLING?

Oil pulling has actually been used as an traditional old style remedy in India, originating from Ayurvedic medicine.

It involves swishing your mouth with oil anywhere for 5 to 15 to 25 minutes so it coats your teeth and gums with the oil.  The oil is then spit out from the mouth.  That's it.  

So which oil can be used?  The most common oil used is coconut oil; other oils used to a lesser extent include sunflower oil, sesame oil, corn oil, rice bran oil, and soybean oil.

HOW DOES OIL PULLING WORK ON THE TEETH AND GUMS?

The concept is simple and as follows: There exists in everyone's mouth a colony of microbial bacteria that are beneficial and bacterial that are harmful.  The mouth has an extremely favorable environment for bacteria: it is constantly warm due to body heat, moist with saliva, has a narrow neutral pH of ~7.0, and has a constant source of nutrients from food and liquid ingestion. 

Some of the beneficial bacteria include: Streptococcus sanguinis, Streptococcus oralis, Actinomyces naeslundii, Neisseria subflava, and Veillonella dispar.  Some negative bacteria include: Streptococcus mutans, Tannerella forsythia, Porphyromonas gingivalis, and Fusobacterium nucleatum.

The body's goal is to keep the "good" bacteria and the "bad" bacteria in check and in balance.  If such microbial are dominated by the negative bacteria, the result in one's oral health and dentition may include dental decay (cavities), gingivitis, and periodontal disease (gum disease with bone loss).  Bacteria causes such negative oral health effects by creating a visible biofilm, or a thin layer of plaque on the teeth.

The theory with oil pulling is that the oil disrupts the binding of bacteria to food particles, and that the oil traps and kills the bacteria.

WHAT IS THE COMPONENT IN THE OIL THAT IS EFFECTIVE AGAINST BACTERIA?

Coconut oil appears the most effective oil in oil pulling.  Coconut oil contains Lauric acid, a medium-chain fatty acid.  Lauric acid is rarely found in nature; aside from coconut oil, which contains the highest concentration of Lauric acid available, human breast milk also contains Lauric acid.  

The body converts Lauric acid into monolaurin, a monoglyceride compound that has antimicrobial and antibacterial properties.  The monolaurin disrupts the mechanical formation of the gram negative bacteria's lipid membranes, hence destroying the bacteria.  The monolaurin is also high effective against fungus (Giardia Lamblia) and lipid coated virus (ie. HIV, herpes).

Sesame oil and sunflower oils contain high concentrations of Oleic acid and Linoleic acid and are regarded as less desired than coconut oil.  Sesame and sunflower oils are lesser used oils as such  acids are respectively omega-6 fatty acids (high concentrations can disrupt the healthy effects of omega-3 fatty acids found in fish and nuts) and omeg-9 fatty acids (a nonessential acid the body can manufacture).

OIL PULLING STUDIES AND EFFECTS ON ORAL HEALTH

Studies of oil pulling remain unfortunately not widespread.  I was able to find a few published studies of oil pulling below.

A 2008 oil pulling study of S. Mutans count in plaque and saliva demonstrated the benefits of coconut oil on reducing the level of S. Mutans in the mouth, and has been shown to approach that of chlorohexidine, though not as effective as the chlorohexidine. 

A 2010 study of oil pullling on microorganisms showed similar results of reduced bacteria count.

CONCLUSION

Oil pulling originally started in India many years ago, but its use is currently not commonplace in the United States.  Though it has started to gain traction and popularity due to recent media events, it is the humble opinion of this author that oil pulling holds promise within its regard to positive antimicrobial oral health effects with respect to the teeth, gingiva, and periodontal bone structures, and that oil pulling has a sound scientific basis.  More and larger prospective epidemiological studies are needed and recommended before the author can deem oil pulling a definitive practical recommendation to practice as one's daily oral hygiene habits .

From your gentle family dentist in Bellevue,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com

Debunking the Myth that Root Canals Cause Cancer

Tooth with Root Canal Treatment

Cancer, a disease the medical, research, and practicing physician community have been battling since the dawn of the late 20th and early 21st century.  Cancer is a condition that has eluded the much needed cure; its etiology and causes are many and likely multi-factorial, some unknown, some known.

Some recent articles circulating on the internet have stated that a prevalent dental procedure is the cause of terminal cancer: root canals.  The information in the article claims that "97% of Terminal Cancer Patients Have Had This Dental Procedure" and therein it claims that the root canal is the cause of said disease.  The article then claims that the bacteria in the root canal tooth is the causal factor for cancer (among other regenerative diseases).   

This article claims that the cure of cancer is as simple as extracting root canal teeth, which allows one's immune to rebuild.

WHAT IS A ROOT CANAL?

First let's go over briefly what is involved in the root canal procedure.  During endodontic treatment the nerve of a tooth is removed out of necessity (ie. tooth infection, deep decay/cavity that has intruded the pulp, necrotic pulp, severely fractured tooth and/or restoration, failing restoration, traumatized pulp/ligament around the root).  The nerve and pulp in the root is mechanically cleaned out with a stainless steel instrument, filled with out a material called gutta percha, and which is then combined with a material called a sealer.

ARE THE MATERIALS USED SAFE?

The instruments used during a root canal procedure to remove the nerve are a stainless steel surgical grade quality.  It's the same material constructed in kitchen utensils people use everyday during meals.  It's the same material used in cooking knives and during surgery and most other routine physical examinations and medical/dental treatment.

The gutta percha used to obturate the canal (ie. fill the canal of the teeth) is made from a natural latex produced from the sap of a tree.  Gutta-percha is malleable, biologically inert, and biologically compatible.

Sealers are used to fill spaces within the root that the gutta-percha is not physcically able to fill.  Different types of sealers include zinc oxide-eugenol, resins, glass-ionomer, and silicon based materials.  Such materials have shown to be biologically compatible, and the vast majority of the population suffer no side effects from its presence or touch.

DO THE BACTERIA MENTIONED IN THE ARTICLE CAUSE CANCER?

No.  A major flaw of the article is its premise the research dentists found within the root canal teeth, the following bacteria:

Capnocytophagaochracea
Fusobacteriumnucleatum
Gemellamorbillorum
Leptotrichiabuccalis
Porphyromonasgingivalis

The dentists claim that the bacteria were found within root canal teeth, and it can affect one's heart, kidneys, brain, and sinus.  While this may be true, one has to realize that the above bacteria is found EVERYWHERE.  They have been shown to be common and present among immunologically compromised patients.  Such said bacteria are NOT exclusive to teeth with root canal treatment, and are present on the body due to the body's inability to ward of infections.  The bacteria are not present because of root canal treatment, and such claims from the article has no causative basis.

ARTICLE CLAIMS "DEAD BODY PART CAN LAUNCH AN ATTACK BY THE BODY"

False.  Another claim the article asserts is that leaving a dead part of the body within the body is ill-advised.  The article compares a gangrened finger or toe, or an aborted fetus in-utero due to a dead baby, which results in a miscarriage.  Granted yes, a gangrened finger or toe is surgically removed because if not removed in a timely manner, the bacteria within the necrotic finger/toe can travel and affect its neighboring healthy tissues.

And yes, the body may spontaneously removed the dead baby in-utero from the uterus, resulting in a natural miscarriage.  However one has to realize the dead fetus is expelled from the body naturally because the body recognizes the fetus as an organically necrotic material, and does not want to expend its nutrients and blood supply on necrosed tissue.

In comparison, a "dead tooth" is composed of inorganic materials.  Much like hair, fingernails, and eyelashes, the body recognizes such body parts as inorganic, including the root canal tooth.  Comparing a "dead" tooth to gangrened finger/toe or a fetus is not a viable comparison.  If such claim is true, then we can also state that one's body hair, head hair, or toe nails are a cause of cancer, and that our natural hairs and nails should be removed as such.


ARTICLE CLAIMS ROOT CANALS LEAD TO BONE, HEART, KIDNEY, AND BRAIN DISEASE

False.  The article further claims that he transplated root canal teeth fragments into rabbits, and found that such transposition caused a heart attack within a few weeks in 100% of the rabbits.  The Arthur further claims such teeth fragments caused bone, kidney, and neurological damage in 80% of the rabbits.

Such above claims have again no causative factors and have no relevant cause in cardiovascular disease in rabbits.  Rabbits as an overall population suffer from unfortunate sudden death, and is linked to inherent heart failure and heart disease.  The article's assertion that root canal fragments cause heart disease in rabbits is no more true than claiming that drinking water causes heart disease, as there is no causation.

Additional claims of bone, hepatic, and neurological damage caused by root canal fragments has also no basis.  Rabbits in general also suffer from inherent bone, kidney, and neurological issues as common causes of death, and again, has no causation with respect to root canal treated teeth.

ARTICLE FINALLY ALLEGES ONE TO AVOID ROOT CANAL

Depends, but one should NOT avoid a root canal for the fear of it being carcinogenic and cancer causing.  A root canal is a safe and biologically compatible dental procedure.  Though there are inherent risks of any dental or medical procedure, and no biological results can be guaranteed, its overall efficacy is time and results proven, and its benefits far outweighs its risks.

FINAL STATEMENT

It is the humble opinion of this author that root canals have no causative biological factors in the role of cancer.  such articles circulating on the web is an attempt at sensationalism and are astray from the sound scientific medical and dental community, and are merely attempting to instill ignorance and fear on the overall general population.  Again, the claims such articles are no more relevant to stating that drinking water causes stroke and heart disease, or that owning a parrot causes dementia.  

If you have ANY questions regarding root canal treatment, be sure to consult your family dentist or endondontist. 

Warm Regards from your family Bellevue dentist,
Dr. Peter Chien
(425) 614-1600
www.bellevuefamilydentistry.com 

Healthy Teeth Healthy Mouth Happy Kids

 Here at Bellevue Family Dentistry, we place an emphasis on adults and kids oral health alike.  In light of the American Dental Association's National Children's Dental Health Month in February, let us examine the benefits of oral health in kids.

Why is Children's Oral Health So Important?

• In the United States, oral disease (ie. tooth decay, gum infections) causes kids to miss more an astounding 50+ million hours of school, and also their parents to miss more than 25 million hours of work per year.
• If cavities and oral health infections are left untreated, the pain and infection may result in problems with eating, learning, speaking, and concentration. 
• Early premature tooth loss may result in reduced self esteem and reduced confidence.
• Children and adolescents with oral health problems, compared to those without oral health issues, are unfortunately more likely to have problems at school, and less likely to complete their homework.  Those with oral health problems are also more likely to feel interior, shy, unhappy, uncomfortable, sad, and depressed.
• When children's oral health issues are treated and the kids are not experiencing pain or discomfort, studies show they are able to learn better and their attendance at school improves.

America's Tooth Fairy

America's Tooth Fairy has great resources and information on programs on community-based educational, treatment, and preventive services to children of all income levels.  In the year 2012, volunteers from America's Tooth Fairy were able to provide children with over 200,000+ dental cleanings, dental sealants, fluoride treatments, screenings, and oral health education.

What Can I do Help my Kids at Home?

The best care begins at home!  Starting at the age of 6 months when kids first baby/primary tooth erupts, start brushing their teeth right away with a soft toothbrush.  Use a pea-sized amount of nonfluoridated toothpaste if your child is unable to spit out yet.  Brush your kids teeth twice a day (morning and before going to bed) and start flossing as soon as you see two or more teeth adjacent to one another.  Use an over the counter anti-cavity fluoride rinse (ie. ACT) to help decrease the risk of cavities.  Bring your kids to the dentist twice a year for regular checkups, cleanings, and fluoride treatments.

Happy brushing and flossing everyone!

From your gentle family dentist in Bellevue,
Dr. Peter Chien
www.bellevuefamilydentistry.com
(425) 614-1600