Sawdust Festival

We like to take occasional field trips. Recently the staff went to the Sawdust Festival. It was a beautiful day. All of us had a chance to enjoy one another’s company, shop and have a wonderful lunch. Allison came along and it was so good to see her.

Left to Right: Bonnie, Chris, Adrienne, Jamie and Teri

More photos will be published shortly.

Dr. Urban on Today’s Dentistry/I Hate My Dentures! Fixing Loose Dentures With Mini Implants

Most people are aware that dentures are poor substitutes for missing teeth. Dentures “float” on the remaining gums and wiggle around during chewing, talking and swallowing motions. Dentures become looser as the supporting gums recede away. Sores may develop and abnormal tissue growths may occur under loose dentures. Dentists have grappled forever trying to make a suitable replacement for lost teeth.

Replacing lost teeth with implants is a good alternative to loose dentures. However, this can be enormously expensive and require a lengthy interval of time from start to finish. A less costly implant is now available that will attach to new or existing dentures and enable the wearer to chew securely, keep the denture seated, and eliminate the wiggle. These implants are called mini implants.

Mini implants are titanium and are about half the size of standard implants that are used to hold a single tooth in place. Researchers have discovered that the quality of the bone is the most important factor with implant success-not the size. Mini implants are usually not used to replace individual teeth unless the gap is very narrow. However, they can easily bear the load of a removable denture.

Mini implants are placed by your dentist and can be used to secure the denture. Sometimes the denture can be attached to the implants the same day. The denture movement will be severely limited by the implants and chewing should be more effective and more comfortable. The denture will be secure and will not drop while talking or fly out of the mouth when sneezing.

Furthermore, the denture can be popped off the implants and cleaned as normal. The denture wearer will have the comfort of wearing a denture to which they have become accustomed for a much more affordable investment.

Some people shy away at the thought of implants into the bone. However, implants are being placed for knees, hips, shoulders, spines, and other areas all the time. They are reliable, stable, and long wearing. They are biologically compatible and proven to be effective alternatives to “getting along” with chronic disabilities.

The procedure is relatively simple. An x-ray, medical history, and examination is done by your dentist to determine if you are a candidate. The next step will be implant placement and denture attachment. This takes about an hour and requires a little local anesthetic. Remember, the bone has no nerves and does not feel the implant. The amount of anesthetic is the same as for a filling. You will go back to your dentist the next day to check the denture. It fits much tighter than before so there may be a small adjustment to the denture. You will go back in six months for a long-term follow up visit. That’s it.

Mini implants can also be used for removable bridges. The metal clasps that hold the bridge can be removed and the bridge attached to the implant. This is a big bonus for people with big smiles.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Osteoporosis and Dentistry

Osteoporosis a disease characterized by the loss of bone mineral density. The bones become more susceptible to fracture and compression fractures. It affects mainly women, but can affect men as well. To treat osteoporosis doctors prescribe a class of drugs called bisphosphonates (i.e. Fosamax, Boniva, Actonel, Reclast). Also, people who have such conditions as Paget’s disease, multiple myeloma, and hyperparathyroidism are often prescribed this type of medication to slow down the “eating away” of the bone. It is a valuable asset in medicine, but it may come with unexpected dental side effects.

Calcium is the main mineral component of bone tissue. Consider the bone as a calcium bank. Calcium is constantly being deposited and withdrawn according the body’s needs. What does all this have to do with dentistry?

Dentists have seen jawbone problems develop in a small, but significant, number of people who take this medication. It is called bisphosphonate-associated osteonecrosis of the jaw (BONJ). It can occur after dental surgery or it can be spontaneous. It is characterized by bone becoming denuded of the overlying gum tissue and lying exposed in the mouth. It may be painful, become infected and last for several weeks. It is not a pretty picture and must be treated. I believe your dentist should see any mouth sore lasting more than two weeks.

Studies seem to indicate that a majority of these bone exposures are a complication from dental surgery and 40% from other causes. We are not exactly sure why this occurs, but it is associated with the bone remodeling process and the calcium bank. Bone remodeling occurs after extractions and during wound healing. Inform your dentist of the prescribed drug, length of usage, and dosage when you update your medical history.

You and your dentist will determine if elective surgeries are a good alternative. Most elective dental surgery is discouraged. If extractions are necessary dentists will prescribe antibiotics and oral rinses during the healing phase. Extra precaution and strict adherence to directions after surgeries will lessen the chance of BONJ.

Presently, it is unclear whether implant placement failures are directly linked to bisphosphonate use. The numbers of patients in these studies remains quite small and it is difficult to establish a relationship. The decision to place implants in patients taking bisphosphonates depends on the experiences of the implant dentist who have to remove and replace implants. Also, it depends on the person electing to have the procedure performed of being aware of the most common risks and outcomes.

In mild cases wound closure can occur with the use of antibiotics and wound dressings. In severe cases the exposed infected bone is surgically removed and the wound closed.

Please make your dentist aware of your medications. Usually, medications will not have an overbearing effect upon the dental treatment you have. If everyone remains informed, however, problems can be avoided or properly treated when they do occur.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Urban on Today’s Dentistry/What is Laser Gum Sugery? Lanap! No Cutting, No Stitches!

Your dentist has determined that you have moderate to advanced periodontal disease. What happens now?

The term disease refers to a negative or reversing force that impairs normal function. Invading organisms or internal factors such as autoimmune factors can cause this tearing apart of our normal states of health.

Periodontal disease turns out to be a very complicated process that can vary greatly from one person to the next. Basically, dentists are now aware that there are over two dozen different bacteria that can team up in different numbers and infect the gum tissues that normally form little tight collars around the teeth. The bacterial invasion will creep down past these collars and onto the roots. The body will fight back with its immune system and the gums will bleed. Prolonged exposure will result in gum recession, bleeding, swelling, pus, bone loss and eventually tooth loss.

Treatment of periodontal disease is also a complicated process. We must remove the invading bacteria, cleanse the root surfaces, and maintain the healing site until gums are fully restored to normal health. In moderate to advanced conditions this has traditionally been done with surgical techniques involving cutting the gums, exposing the roots, removal of hardened bacterial, reshaping the supporting bone, and stitching everything back together.

I believe this is pretty common knowledge and perhaps this has made people fearful of the periodontal “solution”. Remember, periodontal disease does not hurt until the teeth become very loose and have to be extracted. Now we have a technique that should remove the fear of treating periodontal disease.

LANAP (Laser-assisted new attachment procedure) is a minimally invasive procedure that avoids the cutting and stitching associated with periodontal surgery. The technique removes the bacteria, cleanses the roots, and stimulates new gum and bone growth around infected teeth without the post-operative discomfort associated with traditional surgery. It is performed in one or two phases with just local numbing agents.

Simply put the laser is attracted to dark matter (bacteria and calculus) that is residing in the gums and in the surface of the tooth. Diseased tissue around the tooth is vaporized so the doctor can peer under the gums with magnification. Hardened calculus deposits are removed and the laser again is used to develop a clot that forms a seal like an “O ring” around the neck of the tooth leaving the remaining tissues intact and untouched. Healing and regeneration in an undisturbed sterile environment will then begin. Teeth are slightly adjusted so they hit together in balanced harmony.

Dr. Eric Johnson, who recently joined my staff and is trained and licensed with the perio laser, has performed this procedure for several years. He has performed it on many of my patients and I have seen some astounding results. In addition to the regeneration of bone growth, patients heal very fast. There is very little bleeding, no stitches needed and they can resume their normal activities with little or no down time. It is exciting to see a procedure that can stop the ravages of periodontal disease without having to resort to periodontal surgery. The cost is less that two implants with crowns or about the same for extractions and dentures. The result is that you may continue to have your own teeth serve you for years to come.

Don’t let fear make you wait before it is too late. Check the alternatives before your teeth are hopeless.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Your Medications and Dentistry

When you visit your dentist you have to fill out a health questionnaire and current medications list. It seems redundant and seemingly remote that medications should interfere with your dental visit. Why is this important?

My intention with this article is not to list all the drug interactions with dental disease and dental restorations. I intend to list the most common problems and consequences and to let you know that you should tell your dentist and hygienist your most current medical status.

Xerostomia or dry mouth occurs when the salivary output becomes diminished, usually through age or side effects of medications. Dry mouth can become especially uncomfortable when a removable bridge or denture has to be worn. If dry mouth can be tied to a new prescription then the prescription can be changed. If this is impossible then extra effort is made to enhance salivary output by using over-the-counter salivary stimulants or chewing gums. The Biotene company has many products that fit this description. Chewing gums with Xylitol help prevent the high incidence of decay in people with dry mouth.

Cardiac and hypertension medications present different problems. Your dentist should know if there is a need to limit the use of a local anesthetic that contains a vasopressor. Vasopressors are commonly used with anesthetics let the numb effect linger longer. Sedation may be necessary for more lengthy dental visits or for those who are anxious.

Warfarin or Coumadin is given for people who need anti-clotting medication to prevent thrombosis. Current thinking is that there is little (short of a lot of dental surgery) that is done in the dental office that would require cessation of this medication several days prior to dental work. Oral surgery may require going off the medication. This should be done with the advice of the cardiologist.

Antihypertensive drug therapy can lead to a dry sore mouth or lichenoid infection. These conditions can be treated, but dentists should be aware of the cause.

Diabetes treatment consists of maintaining metabolic control of blood glucose levels. Oral complications include poor response to the bacteria that cause periodontal disease., candidiasis (fungus infection), poor wound healing, dry mouth and increased decay at the gum line. Your dentist should know if you are a controlled diabetic.

Allergies to drugs are also common. If you suspect that an allergic reaction to medication has occurred in your life, let your dentist know. For instance there are many other antibiotics that can be administered for those who are allergic to penicillin. If you have aspirin or anti-inflammatory NSAID sensitivity, make your dental office aware.

Your dentist may have to contact your physician before dental work is initiated. Make sure you have all the necessary phone numbers available. Your dental office is there to help you have a problem free visit.
For answers to your dental questions, contact

Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today's Dentistry/What is a Root Canal?

I sure get a little nervous when my doctor combines treatments and canals in the same sentence. Justifiably my patients react the same way when I recommend a root canal treatment.

When it becomes impossible to restore a severely decayed or fractured tooth merely with a filling or crown I have to recommend root canal therapy or extraction. I still get people fidgeting and wincing at the thought.

The vast majority of root canal treatments are successful and are provided with minimal discomfort. Just like the TV news and printed newspapers we only hear about tragic events, crumbling economies and horrible acts done by man. In other words no news is good news. So the uneventful successful root canal fillings go by unnoticed.

There are a few failures. It ranges between 2% to 5%. Some teeth are just untreatable or not worth the time and expense due to predictable unfavorable outcomes.

Root canal myths abound. Root canal treatments remove the roots, pulling a tooth is better than a root canal filling, pregnant women can’t have root canals, root canals cause illness, and if it doesn’t hurt don’t fix it with a root canal. These are just myths. Let me explain.

Anatomically, the teeth are formed with a hard outer enamel shell covering a less dense dentin core. This core protects the pulp of the tooth which has a nerve and blood supply. When trauma or bacterial invasion penetrates through the enamel and into the dentin core the living tissues of the pulp will die off leaking out into the bone through the end of the root and causing an abscess to form.

Pain may not be present when the dentist examines the x-rays and finds a latent abscess or dead tooth. The tooth is best treated before a severely painful infection develops. Infections will compromise pain control and the outcome of the treatment. Do not delay.

Root canal fillings obliterate the space that was once occupied by the nerve. It takes a lot of clinical know-how and patience to place these fillings. Once placed the fillings need protection from the mouth fluids with a restoration like a crown or sealed filling.

Root canal fillings can be placed during pregnancy without any special precautions. Also, there is no evidence to suggest that root canal treatments will develop into an illness. Save your teeth if you can. In the long run it is far easier the alternatives.

Do all crowns need root canal fillings first? No. Only about 20% of crowned teeth will need root canal fillings later on in normal situations. Do most root canal fillings need crowns? Yes. Root canal filled teeth become brittle and may fracture later so they require full coverage of the chewing surface. Once properly restored the tooth should perform like a normal tooth for a long time.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com

Dr. Urban on Today’s Dentistry/Fluoride and the Continuing Saga

Fearful that communists were fluoridating our water supply General Jack D. Ripper in the movie Dr. Strangelove started a nuclear war with Russia. The absurdity is that it reflected the public controversy at the time over the addition of fluoride to our water to help lower the incidence of dental decay. I would like to discuss the brief history of fluoride and the impact it has made.

Modern dentistry came into it’s own early in the 20th century. It was observed that people who lived in areas of the country with naturally higher levels of fluoride in their water had fewer cavities. Research after World War II confirmed that optimal levels of fluoride (0.7-1.0 ppm) reduced cavities by 20%-40%. Furthermore, fluoride was relatively inexpensive and could be safely added to water much like chlorine for general consumption.

Consequently, other formulations (NaF)) of fluoride began to appear in dentifrices and rigorously advertised as anti-cavity agents. This reduction of decay proved especially true in European countries that did not add fluoride to water. Fluoride continues today as one of the great advances in preventing tooth decay.

The public outcry over fluoridating water was eased with announcements from public health agencies like the World Health Organization and professional societies like the ADA that optimal levels of fluoride were safe. There are still those who would believe otherwise.

When I went to dental school it was believed that ingestion of fluoride during childhood was most beneficial. The fluoride was “taken up” in the developing tooth enamel before it erupted and, hence, made the enamel more decay resistant. Although this was somewhat true it proved to be only part of the story. It is now acknowledged that topical applications of fluoride are more effective with the interference of cavity formation.

Dentists have been using topical fluoride rinses (acidulated phosphate fluoride-APF) for years. They come as liquid rinses, gels, or foams and have been very effective in reducing cavities on the smooth surfaces of teeth. I have been most impressed with newer fluoride varnishes (5% NaF). They are extremely safe and are used in adults and children under 1 year. Stronger prescription toothpastes (1.1% NaF) are dispensed as an at-home adjunct for some people.

Are you getting tired yet? Unless you have a lot of time on your hands don’t try to remember this information. Let your dentist and especially your hygienist recommend the best prevention program for your needs. Some of the newer dentifrices are more costly than standard toothpastes. However, when only costs are compared you could buy a three-year supply for less than the cost of one filling.

Back to General Jack D. Ripper. Concern and over reaction are two different beasts. It is smart to be concerned and informed when making health choices. Over reaction is usually based on fear and mistrust. It is ironic that dentists are basically trying to work themselves out of a job by eliminating the very thing they are paid to fix.

For answers to your dental questions, contact
Douglas Urban, D.D.S.
Cerritos, CA 90703
562 924-1523
DrDouglasUrban.com