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Conservative Single Tooth Replacement
From the Newsletter “Your Valley Smile” Fall 2004
Bridges & Implants
Historically, bridges have been the treatment of choice, for both patients and dentists, when replacement of a single tooth was called for.
Today, though, dentists are looking to be more and more conservative in their treatment of patients, and have identified implants as a predictable and economically sound option for those in need of replacement of just one tooth.
Obviously, several factors come into play here, like the health of the surrounding bone and the overall health of the neighboring teeth, but for those in need, the end result can be just as esthetic and functional as the original tooth.
When she was 18 years old, my wife tried to break a fall at a Pocatello swimming pool with her mouth. As a result, she fractured one of her central incisors, necessitating the need for a root canal and crown. Twelve years later, the tooth finally gave up, and had to be removed.
Due to the location of the fracture, our local periodontist, Dr. Brad Morlock, removed the tooth and root tip. He also successfully placed a bone graft in the extraction site to buttress and preserve the bone.
A few months later, Dr. John Morrison, one of our two area oral surgeons, placed her implant. After a few months of healing, I was able to complete her case, and she now has a porcelain tooth which looks and functions like the real thing.
My wife’s situation was unique in that neither adjacent tooth had anything wrong with them. A traditional bridge would have required preparing (drilling) these teeth for crowns, punishing them unfairly for the loss of their clumsy neighbor.
To be perfectly honest, since we were able to do most of the work “in house,” a significant savings was realized on her tooth replacement. Regardless, a traditional fee-for-service patient could expect to pay approximately the same fee as a three unit bridge. All things being equal, though, I would personally spend my money on a single tooth implant and porcelain crown.
I never make as much on such cases, but the end result, for many patients, far surpasses an oftentimes less favorable bridge. My professional satisfaction, comes from meeting the needs of my patients in as conservative a manner as possible, all the while staying mindful of the economic factors that each individual come in with.
I would love to say that the cost of such services will eventually come down. Regretfully, this seems to be just wishful thinking on my part, though I am hopeful that as more and more specialists and general practitioners become trained in the art of implant placement, costs will come down. Until that happens, at least for me, I will continue to refer my patients to our talented specialists for placement, and make every effort to pass along any potential savings I can so that this “state of the art” service can be enjoyed by many to come.
Where Do I Start?
Depending upon the patient and the situation, I refer my implant placements to one of our specialist in town. We are happy to provide you referrals if you are interested. Moreover, if you feel you are a candidate for such a procedure, we will happily provide you a FREE consultation, here.
Fluoride... for the Life of Your Smile
From the Newsletter “Your Valley Smile” December 2005
Fluoride is a mineral that is found naturally in many things we eat and drink, and it is nature’s way of helping us prevent cavities.
Professional strength (in-office) and low strength (home use) fluorides each play important roles in helping to keep your teeth for life. In the lifelong battle against cavities, both adults and children can benefit from home fluorides and in-office fluoride applications. Professional strength products can only be applied in the dental office, though we have prescription strength fluoride toothpastes and gels available for home use.
These in-office products make teeth stronger and can even help “heal” weakened areas. Over time, the high level of fluoride will gradually be released from the teeth. This is where low strength fluorides, such as those found in toothpastes and some fluoride rinses (ACT), play a valuable role. As the strength of the high levels diminish, the daily applications can help replenish and maintain the beneficial levels of fluoride in the teeth...it’s a great one-two punch that helps make your teeth more and more resistant to decay. Complete one of our surveys to see if you’d benefit from in-office fluoride.
Best Management Practices – BMP
From the Newsletter “Your Valley Smile” Fall 2004
Idaho State Dental Association
In 2003, the ISDA made several recommendations to Idaho Dentists which addressed everything from water lines to scrap metal in the dental setting.
Taking these recommendations into consideration and accommodating them into our new office remodel was a perfect fit, resulting in many patient and environmentally friendly changes.
Over the past 10-12 years, potential water line contamination has been a concern over the entire country. Though I know of no known cases of contracted illness from such potential contamination, we have changed from a traditionally “plumbed–in” system to a “self-contained” system, with each room housing it’s own bottled water. By utilizing steam distilled water and water line preventive measures to guard against contamination, we are confident that our lines are as clean as possible.
Did you know that the foil backing on dental x-ray films is made from lead?
Even in a small office such as ours, several pounds of lead can accumulate in only a couple of months.
By safely storing and recycling this potentially harmful material, we are confident that we are doing our best to help the environment.
Dental amalgam has been used as a restorative material for over 100 years. Though I personally believe that there will always be a place for silver fillings in dentistry and in our office, here, I do fewer and fewer such filling each year.
What to do with the mercury, silver, and tin containing scrap, has become a hotbed of controversy over the years.
To alleviate this problem in our office, we have employed the use of an “amalgam trap” in our new vacuum system, and send our “other” scrap (from extracted teeth, bits and pieces, etc.) to a qualified recycler.
Film Processing Chemistry
Little known to me when I opened the office in 1997, the developing and fixing solutions used to process photographs and x-rays pose a potential environmental risk. With this in mind, we have installed a “Chemical Recovery” filter, which enables us to safely dispose of the chemistry through another recycling service.
I am thrilled with the changes we have made since our remodel back in 2004; we were able to incorporate these changes for both our patients and the environment.
Diabetes & the Dental Patient
From the Newsletter “Your Valley Smile” Fall 2007
Diabetes is a disease where the body does not produce or properly use insulin, a hormone that is produced in the pancreas. Without adequate amounts of insulin, our bodies cannot properly use sugar, the primary fuel for our cells. As a result, a diabetic’s cells can become starved for energy, and over time, the presence of so much unused sugar in our blood, can cause a wide range of conditions.
There are currently 20.8 million Americans with diabetes. According to the American Diabetes Association, about 1/3 of this population is unaware that they even have the disease (undiagnosed). Moreover, for those who have been diagnosed, only about half have it under control.
In the human circulatory system, we have the centrally functioning heart. This powerful muscle pumps blood out through large arteries, which eventually branch to smaller arterioles, and ultimately to tiny capillaries, where oxygen and nutrients are exchanged. From this point forward, veins of progressively larger size return the blood back to the heart, where the whole cycle begins again.
As I have always understood it, it is the turnaround point (small capillaries) in this blood journey where diabetics can experience the greatest difficulty. In particular, it is the high level of unused sugar in the system that can lead to problems with vision (even blindness), kidney failure, nerve damage, and even heart disease. Wound healing also can prove to be difficult in areas where reconstruction processes depend heavily on oxygenated blood from capillaries.
In our line of work, diabetes has been linked to an increased risk of periodontal disease, a bacterially driven infection that initially causes inflammation of the gum tissue, causing them to bleed. Over time, the disease process will destroy the bone and the soft tissues that support and hold in the teeth. Though periodontal disease does in fact occur in non-diabetics, the condition is more common in diabetics and can be far more severe.
Here’s the kicker… New research is showing that periodontal disease can also effect a diabetic patient’s ability to control blood sugar levels. As periodontal disease is a chronic inflammatory infection which has been shown to increase risk of heart disease, pre-term and underweight babies, and strokes, it becomes glaringly obvious that paired together, diabetes and periodontal disease can prove to be a deleterious disease cocktail.
Research also shows that when patients undergo active periodontal therapy, the level of inflammation about the affected teeth diminishes and sugar levels become more manageable.
So, to summarize, let it suffice to say that diabetics can be caught in a particularly vicious cycle. Diabetes often walks hand in hand with periodontal disease, a disease process that can ultimately cost you some or all of your teeth. Moreover, active periodontal disease can contribute to diabetes.
How to treat such a potentially fragile group of patients in the dental office has become a topic of debate over the years. For “cookie cutter” offices, such patients may automatically be sent to the periodontist. Still other offices may put all of their diabetic patients on a 3-4 month cleaning schedule.
Though I am not opposed to placing patients on a more frequent cleaning (or maintenance) schedule, I believe that each patient is an individual, and that as such, we need to assess their condition at least annually, and make any necessary changes in hygiene/maintenance frequency. At a bare minimum, I still believe that every adult patient should be seen twice a year in the hygiene chair, where gum and bone health can be assessed thoroughly. If significant changes pop up, we can take note, and treat you, refer you to a specialist, or bump you back to your physician for an evaluation
Eighteen months ago, our office upgraded its management software, which included a very inclusive periodontal recording tool. We use this tool at least once a year on every adult patient with teeth, and can compare, from year to year, any changes. Moreover, when we take photographs of the teeth, we also scan the mouth for gum related changes, and plan accordingly. If you are interested in your numbers, photos, or diagnoses, don’t hesitate to ask, because your involvement (home care, brushing, flossing…) is an integral part of our goal for you...ideal oral health.
Though we are by no means perfect in our collection of data, we are far more thorough that we have ever been. As a result, we believe that we can help not only our periodontal patients, but our diabetic patients as well.
I am by no means an expert on diabetes, nor do I know even a fraction of all the knowledge about periodontal disease. Coupled with the knowledge I do have, I used an article written by Brian Mealey, from the University of Texas Health Science Center at San Antonio, to help me put together this short article. I hope that what I have provided will shine a bit more light on what I have always viewed as a very confusing disease.
Whether you are an existing patient or searching for a dentist in the Lewiston area, we're excited you are here. With the dental industry advancing, we recognize the importance of keeping our patients and visitors up to date with all of the new and exciting things taking place in our practice AND up to date on personalized newsletter articles and stories that Dr. Johnson puts together on occassion.
Most new patients have come to find our quarterly newsletters both informative and entertaining, so we will do our best to interject a great deal of this office fun into our BLOG.
In addition,we hope to promote dental awareness as a vital part of your healthy lifestyle. Here you will find a variety of articles and topics including dental news, advancements in dental technology and treatment, practical dental health advice and updates from Dr. Johnson and his team.
We hope you find our blog to be helpful, engaging and informational to ensure your best dental health.
As always, feel free to contact us with any dental questions or concerns.
December 18th, 2010
Page 1 Article for Dr. Johnsons Newsletter, "Your Valley Smile." The article is entitled: At Least You Can Recycle the Can
If imitation is the ultimate form of flattery, then the Missouri Dental Association should love this article. Debby and Lainey stumbled across this really cool brochure a few weeks back which I just couldn't avoid plagiarizing...well just a little bit. We should have a few of these brochures in the office soon, so if you need further clarification on the subject, let us know and we will gladly get you one.
First and foremost, let me tell you right off, that this article is about tooth decay. Surprise!! I know that you have become accustomed to the front page "glam," but give me just a couple of minutes to enlighten you.
As we have discussed in the past, our mouths are a pretty violent place, and it is the teeth that take the brunt of the abuse. Day in and day out, our diets are loaded with sugars, which once digested by the bacteria in our mouths, form an acid which attacks the tooth. Left alone, this acid can de-mineralize the hard enamel and dentin and cause a cavity. Luckily for us, a healthy mouth has a neutral pH (acidity level) and the minerals in our saliva can often help re-mineralize enamel. It is kind of a push-pull relationship, and if the de-mineralization overpowers the re-mineralization, then you get a cavity. Otherwise, the teeth stay pretty much intact.
On top of the sugar in our diets, many Americans subject their mouths and their teeth to highly acidic drinks almost daily. This in itself can cause problems, since it is reported that de-mineralization of tooth structure starts when the pH in our mouths approaches 5.5. Keep in mind that pure water has a pH of 7, and is therefore considered neutral. Check out the table to the left, but take into consideration that the list is not all-inclusive, and just because you're a "Mountain Dew Guy," you are not necessarily off the hook.
So what we have going on is a real battle. Sugar and acid promote decay, and other than stopping soda and similar drinks all together, maybe it is simply a matter of keeping things in moderation all together. For example:
Since each acid attack can last up to 20 minutes, keep in mind that with each "sip," you are resetting the clock. As such, DO NOT sip on soda all day long. This prolonged exposure can be brutal on your teeth.
Drink in moderation. Back in the 1950's, the average bottle of soda was only 6.5 ounces. Today, the standard serving comes in a 12 oz can, unless you want to super size it to a 20 ouncer!! So, if you do drink soda, sports drinks, or fruit juices, limit your daily consumption to one 12 ounce serving...preferably all at once, and with a meal.
After consumption of a soft drink, brush your teeth. If you can't brush, swish with water to dilute the sugar and neutralize the acid. Xylitol containing chewing gums are gaining promise as decay fighters, and the mere presence of gum stimulates salivary flow, which will help with the re-mineralization process.
Concerned parents have recently been pushing schools to limit the sale of soft drinks on campus' all across the country. In addition to the problems that such drinks can cause to the human dentition, they also contribute to a multitude of potential health issues which often don't materialize for years. For example, as the MDA brochure notes, it is not so much what is in the beverages, but what they push out of the diet...namely minerals, vitamins, and fiber. Since less than 50% of all adolescent girls do not consume enough calcium daily, the additive effect of the soda can lead to osteoporotic effects in the future. Moreover, kidney stones, weight issues, and type 2 diabetes can ultimately come into play for both teens & adults.
So, the next time you crack a can of soda or open a sports drink, look at the nutritional facts on the back of the can. Do you see sugars listed? How about high fructose corn syrup, or sucrose, or phosphoric or cirtic acid? Yep...I thought so too.
- coffee (black) 5.00 pH
- Diet Dr. Pepper 3.41 pH
- Red Bull 3.10 pH
- Propel (berry) 3.10 pH
- Sprite 2.90 pH
- Diet Coke 2.70 pH
- Powerade 2.63 pH
- Pepsi 2.43 pH
- Battery Acid 1.0 pH
December 3rd, 2010
Page 2 Article from Dr. Johnson's Newsletter, "Your Valley Smile." The article is entitled: The Stuff of Which Tears are Made
When Gabby was about eight years old, she was already a seasoned dancer, but was performing in one of her first big girl productions...the Nutcracker, which was being done in Pullman. Ever the dedicated friend, I tossed the wife and all four kids in the car and headed for Pullman on that December day, for no other reason than to support Gabby.
As I nestled into my seat, I sat next to Gabby's dad, Pat, who was the best man at our wedding and long time friend from my days back at the University of Idaho. Many of you will recall me making mention of a band of "particularly hairy brothers from Grangeville" a few years back, but that is an entirely different story all together. None-the-less, I am sitting next to Pat, when he leans over and whispers in my ear.
"Do you really like this stuff?" he lightly asked...except he didn't say "stuff."
"Well," I replied, "Not really, but we are here to support Gabby, you know."
As Pat's torture continued, I remember the long production finally coming to an end and Pat and his son, Sam, literally running up the stairs to the door...there must have been a Notre Dame game on that afternoon, 'cuz I can't remember Pat ever moving so quickly...least not anytime over the past ten years!!
Now, buzz forward about six years to another Christmas production...this one called "The Twelve Days of Christmas," with an even more polished Gabby dancing ballet as one of the Three French Hens. Wow!! What a difference a few years makes...I mean, 'she doesn't even look like she's having a seizure on stage anymore, ' I thought to myself!!
Once the production was over, I made a quick call to Gabby's house to congratulate her, but instead got her old dad, Pat, on the phone instead.
"Hey man, I need to talk to your daughter," I said. When Pat asked me why, I said, "I just wanted her to know that we went to her dance and she looked beautiful on the stage and she danced amazingly."
"I know," Pat replied with a gulp, "I can't hardly watch her dance anymore without wanting to cry."
What an amazing transition, I remember thinking, as I hung up the phone...from "stuff" to tears in about five years. I certainly don't recall him ever making mention of anything like that when he talked about Sam!!
And so it is with dads and their little girls...
So, the summer of 2010 finally did catch on sometime in June, and my little girl went to a local week-long dance camp. Upon completion of the camp, a short production was held at Pioneer Park, where I found myself sitting in a lawn chair, with about twenty other dads, watching their daughters, with lumps growing in their throats...stupid Pat!!
Just a few days ago, I was visiting with my assistant Evie, who was talking about how beautiful her children are. "Excuse me sister, but everyone knows that my kids are far more beautiful," I remember thinking. "They do have an exceptionally handsome father, after all."
Which brings me to something I think we all know...that our parents simply love us and that we will always be beautiful in their biased eyes...sometimes warts and all.
So it was, on August 12th, that my wife lost her little brother, Ethan, to a tragic mining accident in Nevada. As I sat there in the wet Elko grass, dodging water from the ill timed sprinklers, I listened intently to my mother-in-law, Lorene, as she talked lovingly of her recently departed son...and all I could picture was her holding his chubby, scruffy face and staring intently into his eyes...like only a mother can do, saying "...you sure are a handsome man, you sure are a handsome man..." Then, just as I do with my "littles," I could envision her holding his face only 30 years earlier, saying, "...you sure are a good looking boy...you sure are a good looking boy."
As one of my favorite family physicians relayed to Dealiah and I a few weeks ago, the bad stuff in life, goes away, but the good always stays and will always be there...it just gets stronger and stronger. Dr. Chavez is right, but he actually said that far more eloquently than I just did.
Love 'em while they're here, 'cuz they won't stay little forever and God forbid, you might just out live them. I wish you eternal peace Ethan.