Restorative Dentistry Billings MT – Periodontal Specialist of Montana

Jul 27 3

A Bright White Smile is A Confident Smile

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When most people view the Best Celebrity Smile List and see Vanessa Hudgens with her delightful demeanor, they think white, straight teeth. A bright-white healthy smile is a confident smile. Cosmetically the white smile is important in our society. There is a good reason for that, a bright smile is a sign of good oral health.

According to WebMD.com, tooth enamel changes as we get older. Our teeth get fine lines and cracks as we age and what we eat can get into the crevices and stain our smile.

Research from Melbourne University’s Oral Health Cooperative Research Centre states that sugary drinks and sweets are harmful to teeth because of their chemical composition. Sugar can destroy teeth when its fermented by bacteria that produces acid that leads to decay.

Snacking throughout the day makes it difficult for our mouth to be rid of food debris. When food debris builds on the teeth and in the mouth, plaque spreads.

Plaque isn’t the only thing that we need to worry about when it comes too discoloration of our teeth. Simple everyday drinks like coffee, tea and wine can stain our teeth.
Coffee, tea and wine have pigments that attach to the enamel of the tooth. Tea causes more discoloration than coffee. Red wine may be great for your health, but not so much for your teeth. Red wine is acidic and its color can stain your teeth. As we age, discoloration of our teeth increases.

The enamel on our teeth thins with age and it reveals the softer inner layer beneath called Dentin. Dentin naturally yellows as we age. The added discoloration from what we eat and drink only compounds the issue.

So what can you do to keep your teeth whiter as you age?

Brush your teeth right after you have any food that may discolor your teeth.
If you can’t brush your teeth, at least rinse your mouth with water after drinking coffee, tea or wine.
Use a straw so that the discoloring liquids bypass your teeth.
Some tooth discoloration can be removed with regular dental cleanings. Schedule regular teeth cleaning appointments with your dentist.

If you’re infectious smile is no longer white, contact Periodontal Specialists of Montana today!

Jun 27 37

Do you have an indentation in your gums after a loss of a tooth?

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Did you know that tooth loss can cause an indentation in the gums and jawbone where a tooth used to be. The reason that this occurs is because the jawbone recedes when it no longer is holding a tooth in place. The indention is not only unnatural looking, but it also requires that the tooth be replaced with an implant, so that you don’t have further dental issues down the road from the loss of your tooth.

Loss of Tooth

Ridge augmentation can fill in this defect recapturing the natural contour of the gums and jaw. A new tooth (implant) can then be places that is natural looking, easy to clean and beautiful. (AAP)

For all of your tooth loss needs and for all of your dental needs, contact Healthy Gums Montana today!

Mar 16 13

The Benefits of Technology in Dentistry

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Planmeca Promax 3D

From tablet computers to smart phones, Google to Uber, there is no question that our daily lives have been more than reshaped by technology. Some of these changes have been truly beneficial while some have been more a case of technology for technologies sake alone. Dentistry has not been left out of this revolution. Over the last 15 years technology has redefined many aspect of dentistry as well.

Nowhere in dentistry has these technological changes been more evident than in the case of X-rays. We are all acquainted with the standard drill of holding x-ray film in the mouth while an X-ray machine exposes the film or sensor. This is an inconvenience for most of us and quite literally a real pain for others. Jaw anatomy is not always conducive for comfortable placement of the film or sensor, not to mention the problem with gag reflexes. Over the past 20 years technology has replaced the use of traditional X-ray film with digital substitutes but the practice of placing something in t the mouth to capture the image has remained the same.

Extra-oral X-rays, those taken with the film outside of the mouth have been in existence for decades as well. These too have become digitized and capable of conveying more information including three-dimensional CT X-rays that have been a boon to implant dentistry. Again these technologies have been digital modifications to what we already doing rather than being a revolution in how we obtain information.

Recently these worlds of intra-oral and extra-oral X-rays have started to merge. Planmeca, a medical equipment company from Finland recently released its new series of Dental CT X-ray units that is capable of obtaining intraoral, extra-oral and 3-D CT dental X-ray images all using a sensor that goes around the patient’s head. The most important aspect of this advance is not just that the days of placing a sensor in the mouth to get X-ray images is coming to an end but that all of this is being accomplished with dramatically reduced exposure to X-rays as well.

The new Planmeca Promax is equipped with an ultralow dose HD setting that can produce a full 3D image with less radiation than an X-ray series taken with conventional sensors. It can also produce regular 2D images with less radiation than two regular intraoral X-rays. In addition to a faster and more comfortable experience for patients, this also means better and more complete information for diagnosis with reduced need for follow up up X-rays and less overall radiation exposure.

Please schedule an appointment today with Dr. Marnhart for all of your periodontal needs!

Feb 16 22

The Wide-Ranging Role of the Microbiome: “We Are What We Eat”

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It is well known that the gut serves as the largest immune system in the body. Recent research, however, has extended our understanding to the

links between the immune system and the host microbiome, as well as the subsequent effect this may have on a broader range of disease activities. The focus of this paper is on how exactly existing diet and potential modifications to it may influence these effects.

The Real Risk of Artificial Sweeteners

While many understand the role of excess sugar increasing the risk for diabetes, it will come as a surprise to most that so do artificial sweeteners. Experiments with both mice and people indicate that artificial sweeteners can actually induce glucose intolerance (a pre-diabetic state) via alterations in the gut microbiome. The bacteria that are responsible are the same group that causes periodontal disease.

Asthma and Allergies

In the past several decades, there has been a dramatic increase in chronic inflammatory diseases, such as asthma and allergies. The association between asthma and the immune cell regulation by the microbiome is particularly striking.

The Western diet leads to an altered microbiome that increases symptoms of Asthma and the frequency of allergies. Again bacterial digestion of certain fibers produce compounds that turn down immune system stimulation and helps prevent problems with “leaky gut”.

The diseases mentioned here are very commonly treated with medications; in most cases powerful medications. Given this new information we need to also start considering diet as a potential adjunctive, if not primary, treatment for many of these diseases. Our drugs are minimally effective if we keep feeding the problem with inappropriate diets.

Excerpted from Medscape 10/15/15

Original article by David A Johnson, MD

Professor of Medicine, Chief Gastroenterology

Eastern Virginia Medical School, Nofolk VA

Feb 16 20

Maximum, Not Snapshot, BMI Is Best Predictor of Mortality

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Pam Harrison January 12, 2016

Capturing an individual’s weight at a single “snapshot” in time significantly and consistently underestimates mortality risk attributable to obesity because it fails to factor in high-risk, illness-related weight loss in the formerly obese, new research indicates.

The work shows that past obesity is a marker for higher death rates in the same way that former smoking can be, say the researchers.

“It’s not the case that intentional weight loss raises your risk for death,” investigator Andrew Stokes, PhD, Boston University School of Public Health, Massachusetts, told Medscape Medical News. “Rather, we found that weight losers as a group are at higher risk of dying because of illness-associated weight loss.”

“By using maximum body mass index [BMI], we were able to distinguish between low-risk individuals whose weight never exceeded the normal-weight category and higher-risk individuals who were formerly overweight or obese. This simple step shows that obesity is more dangerous than is commonly appreciated.”

The study was published online January 4 in the Proceedings of the National Academy of Sciences.

Use Maximum Lifetime BMI for Highest Mortality Risk

Together with Samuel Preston, PhD, University of Pennsylvania, Philadelphia, Dr Stokes examined the association between excess weight and mortality using data from the 1988–2010 National Health and Nutrition Examination Surveys (NHANES) that were linked to death records through 2011.

A key independent variable in their analysis was lifetime maximum BMI, based on a question in NHANES that asks respondents to recall their maximum lifetime weight, excluding weight during pregnancy. The sample was restricted to adults between 50 and 74 years of age at the time of the survey.

In total, 39% of NHANEs participants who had previously been in a higher BMI weight category had migrated down into the normal-weight category over time.

As Drs Stokes and Preston point out, this is a large volume of individuals and this downward flow from higher BMI classes to the normal-weight category clearly has the capacity to change survival outcomes of the normal-weight class.

They then compared the effect on all-cause mortality risk of using participants’ BMI at the time of the survey only (model 1) with the effect that maximum lifetime BMI had on all-cause mortality risk (model 2)

“In both models, each higher BMI category above the normal-weight category carried with it succeedingly higher mortality,” they point out.

“However, the degree of excess mortality associated with a particular BMI category was higher when that category referred to maximum weight rather than survey weight.”

When maximum weight was used instead of the one-time snapshot of participants’ BMI, the risks associated with overweight increased from 10% to 19% while for those in obese class I, mortality risk increased from 47% to 65% and for those in obese class II, mortality risk increased from 72% to 149%.

Hazard Ratios for All-Cause Mortality According to BMI at Survey vs Maximum Lifetime BMI
BMI category	Model 1: Survey BMI (Estimated HR)	Model 2: Maximum lifetime BMI (Estimated HR)
Normal weight	1.00	1.00
Overweight	1.10	1.19
Obese class 1 (30-34.9 kg/m2)	1.47	1.65
Obese class II (≥35 kg/m2)	1.72	2.49
Further Findings: Consider Past Weight The authors also calculated hazard ratios for mortality using two other models that combined data on weight at the time of the survey and maximum weight. In these, they differentiated between individuals who were at their maximum weight at the time of survey and those who were below their maximum weight at the time of survey. Results showed that people who lost weight were at a greater risk of dying than those who remained in the higher weight class they had previously occupied. Drs Stokes and Preston also examined the prevalence of diabetes and cardiovascular disease among participants. For both conditions, people who had moved to a lower BMI class had a higher prevalence of both diseases than those who remained in a higher BMI class. “The high prevalence of both diabetes and CVD among people moving to lower BMI classes demonstrates that weight loss is often associated with illness,” the authors emphasize. “An analogy to smoking makes it clear why it’s important to consider past as well as present weight when studying the effects of obesity on mortality,” Dr. Stokes explained. “If you were to compare smokers and nonsmokers, you might arrive at the conclusion that smoking is beneficial and the reason is that the nonsmoking group may include a large number of former smokers whose mortality risk is elevated,” he added. To avoid this bias, Dr. Stokes points out that studies investigating the effects of smoking on death rates have long distinguished between nonsmokers who never smoked and former smokers (nonsmokers who smoked in the past and quit). “Surprisingly, this distinction is rarely made in studies on obesity,” he observed. “And as a result, the effects of obesity on mortality have been consistently underestimated.” Neither Dr Stokes nor Dr Preston had relevant financial relationships. Proc Natl Acad Sci USA. Published online January 4, 2016. Abstract

Jan 06 130

What Are the Advantages of Dental Implants?

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The goal of dentistry is to help patients care for and maintain their teeth. Compared to previous generations we have made great strides in this regard. Adults today have only a fraction of the restorations and missing teeth of previous generations. Yet despite our best efforts teeth can still be lost to trauma, wear & tear, the slow onslaught of chronic disease and poor anatomy. Ultimately most of us will have to deal with replacing some missing teeth in our lifetime. The options to replace teeth are removable restorations, restorations attached to natural teeth, and dental implants.

Over the last 20 years, dental implants have moved to the mainstream of dental treatment. Yet many patients are unsure about the advantages of implants over other restorations. When having to decide between options for replacing missing teeth, patients have to weigh the risks and benefits of each. While each individual situation must be judged on the specifics, below is a list of advantages implant provide that apply to most people.

Better nutrition:
In our appearance centered culture we often overlook the obvious. The primary function of teeth is to help you extract nutrition from the food you eat. Dentures can restore only 20% of chewing efficiency. Simply put, sliding dentures make chewing difficult. Consequently denture patients select foods that are softer that tend to be low in fiber and high in sugar & salt. Dental implants function like your own teeth. They can restore up to 80% of the chewing efficiency of natural teeth allowing you to eat your favorite foods and have a healthier diet.

Improved appearance.
When teeth are lost, bone support for the lower face is lost as well. This loss of support is what gives people a “denture look” when they lose their teeth. Dental implants look and feel like your own teeth. Dental implant restorations can be design to recreate the support for the soft tissues lost with tooth extraction. Dental implants can give you back your smile and help you feel better about yourself.

Improved speech& comfort.
With poor-fitting dentures, the teeth can slip within the mouth causing you to mumble or slur your words. Implants fuse to the bone and become part of you. Because they are fixed in place, implants eliminate the discomfort of loose removable dentures allowing you to speak without the worry that teeth might slip.

Improved oral health.
In addition to providing artificial surfaces upon which bacterial can grow, dentures cover the soft tissue of the mouth preventing the normal flushing of bacteria and yeast organisms. The increases in these microorganisms can lead to inflammation in the soft tissues. Further the physical irritation of the denture rubbing on the soft tissue can produce acute ulcers. In rare cases this chronic irritation can contribute to the development of oral cancer.

Maintenance of your natural teeth.
Any time dental work is done on a tooth there is a risk of complications. Dental implants don’t require grinding down other teeth, as a tooth-supported bridge does. More of your natural teeth are left unaltered, improving long-term oral health. Individual implants also allow easier access between teeth, improving oral hygiene.

Convenience.
Removable dentures are just that; removable. Dental implants can eliminate the embarrassing inconvenience of removing dentures, as well as the need for messy adhesives to keep them in place.

How Successful Are Dental Implants?
Dental implants are the longest lasting dental restorative treatment available. Success rates vary, depending on where in the jaw the implants are placed. Depending on location, dental implants have a success rate of up to 98%. With proper care (see previous posts), implants can last a lifetime.

Dec 07 24

Implant Treatment For Problems That Can Occur

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Implant bone loss
Last months topic pertained to dental implants and what you can do to ensure your dental restorations serve you for the longest time. Yet even with our best efforts a few implants will develop bone and soft tissue problems. This month I will discuss treatment options for the problems that can arise.

Implant infection and bone loss:
Dental implant infections can happen but are not common. The good news is rarely do these infections cause significant symptoms. The other good news is just because you have bone loss on an implant does not mean it must be removed. If the implant is stable and functional it can remain in place as long as the infection can be controlled. However the minimal symptoms associated with these infections often permit patients to ignore the problem until there is a substantial amount of bone loss.

Treatment:
If there is only inflammation in the gum tissue with minimal one loss, nonsurgical approaches alone or in conjunction with topical antibiotics can often address the problem. More commonly there is significant bone loss present around the implant. These situations will require some form of surgery to remove foreign material, clean and decontaminate the surface of the implant. Placing graft materials and/or growth factors to regenerate bone support is often included in these procedures.

Lasers
While effective, conventional surgery carries significant downsides such as post treatment pain and significant gum tissue recession. While recession may not be an issue for implants in the molar areas that are not visible, it can be disastrous for implants in the front. In areas where post surgical recession of the gum tissue cannot be tolerated surgery can be done with a Laser, which can preserve the gum tissue in most cases. Laser based therapy, according to patient feedback, is significantly less painful and conventional surgical approaches.

Fortunately, more than 90 percent of dental implants will never experience bone loss problems. Keeping you implants clean and having the bite checked periodically to protect from overload are the most important aspects of maintaining these type of restorations. If problems arise early treatment is always best. If the problem have progressed beyond the early stages fortunately there are good treatment options that can repair and maintain your implant restorations.

Nov 16 5

Dental Implants

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Dental implants have been a boon to many patients. Not only do implants provide options to avoid loose and poorly fitting dentures, they can be used to provide crowns and bridges avoiding placing at risk the natural teeth that traditionally have been used to secure fixed dental work. Implants have truly revolutionized modern dentistry.

With all the good news about implants it is easy to overlook the few but important problems that can arise with this type of treatment. Implants can experience bone loss. This can happen for several reasons. First is inadequate home care. Although implants cannot decay they still must be cleaned daily to the best of your ability. Bacterial accumulation around the base of the implant where it meets the gum tissue will cause inflammation and if left long enough can induce bone destruction. Therefore it is essential that you clean the implants daily. Each implant and restoration is unique so there is no cookbook approach to what works best. Certainly brushing is essential. Automated brushes can be more effective in some case but are not usually mandatory. Using some thicker forms of floss that can frame out and adapt to the implant surface. Some patients find that a thin yarn works very well.

Regardless of your efforts some bacterial will work into places your homecare cannot reach. Professional cleanings on a regular basis will be needed to address this problem and maintain health tissue around your implant. The frequency of such cleanings will be based on you previous history of periodontal disease problems. If you have a history of periodontal bone loss you need to be seen on a more frequent basis. If you have active periodontal disease on your natural teeth it is essentially guaranteed that your implants will lose bone as well.

Other health issues can affect the survival of your implants. First among these is smoking and other uses of tobacco. Tobacco use shortens the life of dental implants. Ideally you should quit before beginning the treatment process. If you have implants and are currently smoking quit or at the very least reduce your frequency of smoking dramatically. While you still with have the systemic smoking risks the topical effect on the gum tissue will be lessened.

Poor management of systemic diseases, particularly diabetes, can make bone loss more likely around your implants. High blood sugar depresses your immune system function allowing more aggressive bacterial to grow around your implants. Following your doctors recommendations to keep blood sugars under control will help limit any damage.

Excessive bite forces can induce bone loss around implants. Unlike natural teeth, implants do not move, they are fixed into the jawbone. Great care is taken during the construction of your dental restorations to minimize the risk of too much force being placed on the implants. However as time goes forwards your teeth can shift and wear, you may have other restorations placed the shift the bite slightly and in younger patients some delay facial growth can result in the implants coming und increasing bite forces. This happens slowly so it is not very noticeable to you. After a certain point the increased forces can begin to cause small fractures in the bone where it meets the implant. If not dealt with early this bone loss is progressive and can result in the loss of the implant.

To minimize these problems the bite on the implant should be checked at least once a year. It must be checked any time you have other dental work done.

Even with the best care, some problems may be unavoidable. We are just now reaching a time where a significant number of implants are in the range of 20+ years old. Most of these implants have reached this age with minimal problems. It does appear however that due to long term bone turnover some implants develop gum tissue problem for no apparent reason other than they have been in service for a long time. Fortunately most of these problems can be dealt with and rarely do they cause the implant to fail.

Checklists for implant care:

1) Avoidance. Be sure to check with your dentist that you do not have active periodontal disease before beginning implant treatment.

2) Quit smoking and other uses of tobacco. Keep other systemic disease such as diabetes well managed.

3) Once your implants are restored have your dentist check the bite, several times if needed, to assure the implant is not overloaded.

4) Be sure to do your best to clean your implants daily.

5) Remain faithful with your professional cleaning visits.

6) Ask to have the bite checked anytime you have new dental restorations placed.

7) If you have problems with your implants deal with it early. Small problems are easier and less expensive to fix.

Dental implants have been truly revolutionary. Yet no treatment is a panacea. Each therapy option brings with it a unique set of risks that if ignored can endanger the long-term success of your implants. Taking these simple steps can go a long was to assuring the comfortable functions of your implants for many years.

Dec 09 80

Hooka smoking more dangerous than cigarettes

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PR Newswire, CHICAGO, October 28, 2015
According to the Centers for Disease Control and Prevention, 2.3 million Americans smoke tobacco from pipes, and many of those who smoke waterpipes, or hookahs, believe it’s less harmful than cigarettes. However, research published in The Journal of the American Dental Association (JADA) suggests hookah smoking is associated with serious oral conditions including gum diseases and cancer.

“We found that waterpipe smoking is associated with serious health problems affecting the head and neck region,” said study author Teja Munshi, B.D.S., M.P.H of Rutgers University. “The public needs to know they are putting themselves at risk. They should be made aware of the dangers of smoking hookahs.”

The authors conducted a literature review that focused on waterpipe smoking and head and neck conditions. They found waterpipe smoking to be associated with gum diseases, dry socket, oral cancer and esophageal cancer among other conditions. According to the World Health Organization, smoking a hookah is the equivalent of smoking 100 cigarettes, based on the duration and number of puffs in a smoking session.

“This study sheds light on the common misconception that smoking from a waterpipe is somehow safer than smoking a cigarette,” said JADA Editor Michael Glick, D.M.D. “Whether you are smoking a cigarette, an e-cigarette, a cigar, or tobacco from a waterpipe, smoking is dangerous not only to your oral health but to your overall health.”

Think hookahs are safer than cigarettes? @amerdentalassn JADA study tells another story. #hookah

The American Cancer Society is hosting The Great American Smokeout on November 19, 2015, an annual event that encourages smokers of all kinds to give up the habit. The event asks smokers to quit even for just one day to take a step toward a healthier life.

Millions of Americans still use traditional methods of smoking, but emerging trends in the smoking industry, such as hookah smoking and e-cigarettes pose dangers as well. E-cigarettes are devices that turn liquid into a vapor containing nicotine. In an editorial in the September 2015 issue of JADA, authors warned readers of the potential dangers of e-cigarettes, indicating that oral health effects of their use has been inadequately investigated.

“Additional research is needed on the impact smoking has on overall health, but it’s clear that smoking of all kinds has the potential to be dangerous,” said Dr. Glick.

Dentists have an important role in advising patients of the dangers of smoking. The American Dental Association has long been a proponent of educating the public about its hazards and has urged for continued research into the adverse health effects of tobacco use. For more information on smoking and its oral health effects, visit MouthHealthy.org.

Oct 13 65

Procedure Focused versus Problem Focused Dentistry

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The first decision you must make is what dentist you are going to see. While individual practitioners have their specific approach to treatment, the fundamental issue for you is the choice between the Procedure Focused practices versus a Problem Focused office. Procedure focused offices tend to look at individual tooth problems, i.e drill and fill. You have pain from a particular tooth, the dentist treats that particular issue with minimal regard for other issues you may be unaware of. For many people the course of dental diseases is protracted over many years. This fact allows you to get away with a procedure focus for a while. However, this approach will often lead to more work needing to be redone in the future.

Problem focused practices (sometimes called Holistic practices) take into account the overall dental and medical conditions as well as potential future dental problems as part of making treatment decisions for the immediate concerns. This approach emphasizes the treatment and control of dental disease and the overall function of the dentition. Such an approach tends to address more than your immediate perceived problems but leads to more predictable restorations and avoidance of large-scale failures. Such practices emphasize a long term Doctor/Patient relationship compared to the episodic relationship of Procedure Focused practices based on emergent dental problems. This approach focus’ on the establishment and maintenance of dental health.

Is one approach better?
That depends on many factors. If your needs are minimal, procedure focused practices are very efficient in treating the few isolated concerns you may have. However in the early stages, most dental disease has minimal symptoms so patients are usually in a bad position to assess their needs. Waiting for symptoms such as pain and swelling means problems have progressed much further than they should have and treatment will be far more complicated.

Patients with several different dental problems tend to do better with Problem Focused practitioners. In this setting finding treatment solutions that achieve a harmony in addressing the multiple concerns is best. As we get older the complications from the accumulation of multiple past dental procedures tends to magnify. In adults the need to view cases in the entirety is essential to achieve the highest levels of success.

By their very nature, some dental specialties are more procedure oriented. Orthodontists, Oral Surgeons and Endodontists are specialty-trained dentists that are seen only when specific procedures are needed. Once the specific treatment is completed you return full time to your general dentist to continue care. Periodontists, Pedodontists, Prosthodontists tend to have longer-term relationships with their patients due to nature of the problems they deal with. You may still see your general dentist as part of your care as well.

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Loss of Tooth