Dr. Frank Liu's Dental Blog

Green Tea equals LESS cavities

noreply@blogger.com (Frank Liu DDS) — Tue, 31 Jan 2012 01:48:00 +0000

Ever wonder why native chinese people have fewer cavities than their western counterparts? Its because native chinese people tend to drink a lot of tea! Studies have shown that drinking tea especially green tea decreases cavities. Green tea contains bioactive compounds of the catechin family, a group of flavonoids (phenolic compounds). These Catechins have anti-inflammatory, anticariogenic, antioxidant and antibacterial properties.

Overdentures vs Regular Dentures

noreply@blogger.com (Frank Liu DDS) — Tue, 13 Dec 2011 07:52:00 +0000

Overdentures are dentures that have inserts underneath them that snaps onto either a root or implant attachment. It is superior to complete dentures in terms of retention since a complete denture relys solely on suction with saliva against the underlying tissue.
So why aren't more people asking for overdentures? Probably because of financial reasons. A common excuse that I hear would be "I'm too old for stuff like this and who knows how long I'm going to live given how much it costs." It's too bad that those patients feel that way because overdentures really allow a person to live and have a high quality of life with enjoyment of food and without worries that when they sneeze or talk, the dentures will fall out of their mouth.
There are actually a wide range of different attachment systems that are effective ranging from the Locator attachments by Zest Anchors as pictured here and other systems such as bars with Hader clips, etc. The Locator attachments are low-profile and constructed with easily replaceable parts. The attachments are retained inside the denture base with stainless steel housings. In terms of clinical technique, once the master cast is prepared, the appropriate cuff height of the stud-type attachments should extend 1mm above the tissue. If the stud-type attachment is part of an implant it needs to be torqued to 20Ncm. The acrylic thickness of the denture where the locator abutments are placed needs to be at least 2mm in thickness and ideally should have either a wire mesh or bar incorporated into the denture itself to prevent fracture. The stainless steel housings on the underside of the denture come with 5 different types of plastic inserts which are replaceable and vary with retentiveness. The colors are white (5lbs retentive force), red (3lbs), blue (1.5lbs), green (angled) and red (extra light angled).
If you are a patient wearing a denture with no natural teeth, ask yourself this. How important is it to you to eat with confidence and bite into whatever you want without worries?

White Spot Lesions or Cavities and use of MI Paste

noreply@blogger.com (Frank Liu DDS) — Wed, 07 Sep 2011 17:53:00 +0000

     So my daughter is starting braces this year and she has several white spot areas around her mouth which were also noticed by her orthodontist. These white spot lesions or pre-cursor cavities as I like to call them are areas of decalcification of the enamel on her teeth. They are seen most commonly where the tooth meets the gums and around the orthodontic brackets because patients usually do not brush those areas of the teeth very well. In my daughter's case, she had 5 areas of decalcified or demineralized enamel around the gum line area. This was a warning sign that if she did not brush her teeth well without braces, then after undergoing braces it would get even worse. Every parent's worst nightmare is to go through two years of braces to straighten their child's teeth only to have the braces removed to find that the teeth are full of cavities and white spot lesions. Fortunately, there are a number of proactive solutions that many families can take. The child needs to improve their oral hygiene and brushing technique. Fluoride treatments and the addition of a relatively new product called MI Paste also needs to be added to the daily regimen.
     MI Paste contains an ingredient called RECALDENT a/k/a casein phosphopeptide-amorphous calcium phosphate (CPP-ACP) which causes calcium and phospate to bind to the tooth surfaces and remineralize the tooth. This remineralization is effected by the deposition of fluorapatite thereby increasing mineral content. In addition, the casein phosphopeptide (CPP) interacts with the salivary proteins which forms a protective enamel pellicle against caries. Another benefit of using MI Paste is that it promotes the incorporation of fluoride into plaque and sub-surface enamel producing effects superior to fluoride alone.
     In summary, if you see white spot lesions or teeth with early cavities, they may be reversible with the use of fluoride treatments and MI Paste.

Tooth Sensitivity

noreply@blogger.com (Frank Liu DDS) — Sat, 23 Apr 2011 14:59:00 +0000

Tooth sensitivity also known as cervical dentin hypersensitivity is a fairly common condition affecting approximately 15-20% of the population. Sensitivity can be thermal (cold), tactile (touch), evaporative, chemical (acid exposure), or due to osmotic changes (sweets or drying of the surface). The most basic layman's explanation for how sensitivity occurs is: The exposure of root surfaces and subsequent traveling of the stimuli through the dentinal tubules inside the root to the nerve causes the sensitivity.

The more complete explanation is the Hydrodynamic Theory which was confirmed in the 1960s by Branstrom and Astrom:
This theory postulates that the fluid changes within the dentinal tubules together with the odontoblasts are the cause of tooth sensitivity . Various stimuli (i.e. thermal, tactile, chemical, or osmotic) displaces the fluid in the dentinal tubules thereby stimulating the odontoblastic processes. The subsequent mechanical disturbance of the odontoblast process contained in the dentinal tubules stimulates a baroreceptor that leads to depolarization and subsequent pain in the pulp.

Studies of surface morphologies of hypersensitive and non-sensitive dentin report that dentin which is exposed and sensitive exhibits more numerous, patent and wider dentinal tubules than in non-sensitive areas. In addition, hypersensitive dentin areas were found to have a smear layer that was thinner, different in structure and was more likely to be undercalcified than non-sensitive dentin.
These findings are consistent with the hydrodynamic theory and Poiseuille's law which states that the volume rate of flow within a tube is directly proportional to the fourth power of the tube's internal radius. Therefore, an increase in the tubule diameter results in an increase of fluid flow by a power of 4 thus amplifying the pain when tubules are open to the oral cavity. Accordingly, dentinal hypersensitivity can be treated by minimizing the movement of intratubular fluid.

There are basically three treatment strategies for tooth sensitivity:
-The first is to desensitize the tooth by modifying the neural response within the dentin tubule. The most common OTC product is Sensodyne. It contains potassium nitrate which when used daily will provide desensitization for up to 4 weeks. Potassium nitrate is believed to increase the extracellular potassium ion concentration thereby depolarizing the nerve and prevent its subsequent repolarization.
- The second method to treat tooth sensitivity is to block the distal terminal ends of the exposed dentinal tubules. Products that contain chemicals which have precipitating agents (ie. sodium fluoride, stannous fluoride, monofluorophosphate, casein phosphopeptide-amorphous calcium fluoride phosphate, oxalates) such as GC MI Paste Plus by GC America can be used. Additionally, adhesive resin impregnation such as Gluma Comfort Bond by Heraeus Kulzer can be applied onto the dentin forming a hybrid dentin layer. This resin barrier also prevents continued diffusion of toxins and bacterial invasion toward the pulp while producing minimal adverse pulpal inflammation. Another technique involves application of calcium hydroxide paste which relieves cervical sensitivity by increasing peritubular dentin mineralization.
- Finally, the third treatment modality is to cover the exposed dentinal tubules through either surgery by way of gingival graft or restoration. Restorations that can be used include various glass ionomers, compomers, composites, laminates or crowns.

How Fluoride Prevents Cavities

noreply@blogger.com (Frank Liu DDS) — Fri, 14 Jan 2011 14:42:00 +0000

Since the introduction of water fluoridation, fluoride supplements and topical fluoride therapies in the late 1940s, the way fluoride works, dosages, and delivery methods have changed over the years. During tooth development, the ingestion of fluoride through fluoride supplements, foods (i.e. fish), water/drinks results in the formation of fluorapatite crystals instead of hydroxyapatite crystals by way of fluoride ion replacing the hydroxyl ion of the hydroxyapatite crystal in the tooth enamel. The resulting fluorapatite crystals are more resistant to demineralization associated with the dental caries process.

Topical fluoride applications such as gels, foams and varnishes work through a different mechanism of action. In the most simplest of terms, they work by preventing demineralization and promote remineralization of the tooth structure and they also inhibit bacterial growth. Application of high concentrations of fluoride results in the formation of alkali-soluble calcium fluoride-like globules at the tooth surface. When there is caries and the resulting high acid attack, the globules break down releasing the calcium, phosphate and fluoride ions which migrate to the demineralized sites and remineralize the defects forming fluoridated hydroxyapatite. Additionally, the intraoral fluoride combines with hydrogen and enters the bacterial cell where the fluroide ions then inhibits the bacterial enzyme enolase responsible for carbohydrate metabolism

Aspirin - An update for Dentistry

noreply@blogger.com (Frank Liu DDS) — Tue, 20 Jul 2010 02:52:00 +0000

It is well known that low-dose aspirin can prevent arterial thrombosis in both high risk patients with known occlusive vascular disease and in low-risk healthy patients with no known history of vascular disease.

Three other clinically important facts should be mentioned:

1- Sudden aspirin withdrawal may elevate the risk of myocardial infection

2- Ibuprofen may interfere with aspirin's cardioprotective effects

3- Patients with coronary artery stents on aspirin/Plavix antiplatelet therapy who prematurely discontinue this regimen strongly increases their risk of stent thrombosis leading to myocardial infartion and/or death

As an emergency drug, chewing two to four baby aspirin tablets (81 mg each) or a single standard non-enteric coated "plain" 325 mg aspirin tablet during a suspected heart attack reduces the risk of death from a myocardial infarction

Gum Disease in Mom Linked to Stillborn

noreply@blogger.com (Frank Liu DDS) — Fri, 11 Jun 2010 17:33:00 +0000

An article published in the February 2010 issue of Obstetrics & Gynecology reports a case where oral bacteria associated with periodontal gum disease in a mother caused the death of her fetus. The lead researcher in the study, Yiping W. Han, PhD found that the mother's excessive gingival bleeding allowed the bacteria Fusobacterium nucleatum to migrate from the mouth through the bloodstream where it reached the placenta. A postmortem exam revealed F. nucleatum in the fetal tissues including lungs and stomach which ultimately resulted in a deadly septic infection. Through DNA testing, it was ascertained that the F. nucleatum in the fetus matched the same bacteria that was found in the mother's diseased gingival tissues.
This article just shows how important it is to maintain good oral health care with regular dental visits in women who are pregnant or wish to get pregnant.

Toothbrush Sanitizers

noreply@blogger.com (Frank Liu DDS) — Thu, 03 Dec 2009 04:50:00 +0000

VIOlight Inc, creator of ultraviolet light toothbrush sanitizers, recently announced that an independent laboratory test conducted by Microbiotest, an industry leader in antimicrobial efficacy testing, has proven that the VIOlight toothbrush sanitizer to be effective in the elimination of influenza A (H1N1) from toothbrush bristles.
The report identifies Violight's ultraviolet germicidal light as the reason for killing 99.999% of the H1N1 virus. The H1N1 application consisted of 0.2mL of a stock virus of the flu spiked onto the toothbrush bristles. After six minutes inside the VIOlight device, the toothbrush was practically free of the virus.
This is exciting news since it was shown in past studies that VIOlight was also highly effective against not only viruses but also bacteria.
VIOlight UV toothbrush sanitizers can be purchased at most major stores and online.

New Performance Mouth Guards

noreply@blogger.com (Frank Liu DDS) — Sat, 05 Sep 2009 05:31:00 +0000

A new category of mouthguards have appeared onto the dental market scene. Under Armour which is already well known for its full line of performance apparel and one of my personal favorite athletic lines is entering the dental space with Under Armour Performance Mouthwear powered by ArmourBite technology. It is the first in "an entirely new category of performance mouthpieces and mouthguards" that are custom-built in conjunction with the patient's dentist. This product reportedly increases strength, reduces athletic stress, and can improve endurance and reaction time in addition to providing added protection to the teeth from injury. See www.underarmour.com for more information...

FDA Reaffirms Amalgam Safety

noreply@blogger.com (Frank Liu DDS) — Tue, 28 Jul 2009 23:52:00 +0000

After years of careful investigation and review of over 200 scientific studies, the U.S. Food and Drug Administration today reaffirmed its view that dental amalgam is a safe, effective material for use in dental restorations.

The FDA ruling classifies amalgam as a class II medical device which places it in the same group as gold and composite (white) fillings.

The FDA's position is that patients with dental amalgam fillings are not at risk for mercury-associated adverse health effects. This includes not only adult patients but also patients who are children, breast-fed infants and developing fetuses.

The FDA has noted that some patients have an allergy or sensitivity to the mercury or other metals in dental amalgam and therefore may develop "contact reactions" within the oral cavity. In order to address this issue, the FDA has instructed manufacturers to add certain information to the product labeling of amalgam including:
-warnings against the use of amalgam in patients with mercury allergies
-recommendations to dental professionals to use adequate ventilation when handling amalgam
-review of the benefits and risks of amalgam

Hopefully this FDA position on amalgam safety will make patients feel better about the presence of amalgam in their mouths. I always felt that there are certain instances when amalgam fillings are better than white composite fillings. I also believe that patients should not feel bad if they can't "afford" white composite fillings since they are more expensive than amalgam fillings.

The full statement from the FDA regarding the use of dental amalgam can be found at this link:
http://www.fda.gov/MedicalDevices/ProductsandMedicalProcedures/DentalProducts/DentalAmalgam/default.htm

Hopefully

Another Article Stressing Importance of Oral Health

noreply@blogger.com (Frank Liu DDS) — Fri, 26 Jun 2009 02:36:00 +0000

For a dentist, the mouth holds clues to many ills

By Michael Birnbaum The Washington Post
9:05 PM EDT, June 25, 2009

Your mouth can tell you a lot about your overall health.Troubled teeth and gums aren't always just a dental problem. Sometimes they indicate deeper issues, and dentists are increasingly picking up the clues."We look around the mouth and we look for color changes. We're looking for certain smells. Spots around the gums," said Washington dentist Joseph Kravitz.The relation of oral health to the rest of the body has gotten increased attention in recent years, spurred by such experts as Richard H. Carmona, who as U.S. surgeon general urged policy-makers in 2003 to "increase the understanding of how the signs and symptoms of oral infections can indicate general health status and act as a marker for other diseases." The publicity reminded a lot of dentists that their jobs weren't just about root canals and fillings, and it educated the public, Kravitz said.

Following are some non-oral-health issues and the possible clues Kravitz says dentists may be able to identify:--
Heart disease. Gums that have turned a "bright beefy red" or purple. Kravitz checks his patients' blood pressure when he notices those symptoms.--
Type 2 diabetes. Gums that bleed at the slightest touch although there is no plaque evident. Kravitz said patients with diabetes also typically have sores elsewhere on their bodies that they may not have connected to the disease.--

Kidney disease. A sweet ammonia smell on a person's breath, detectable even from behind a dentist's surgical mask.--

Acid reflux. Teeth that look worn and pitted, as if they'd been "dipped in battery acid." Only some teeth will be affected, depending on where the acids settle during a person's typical sleeping position.--

Oral cancer. Gum tissues with white spots that last two weeks or more. (Kravitz said spots that clear up more quickly can indicate many other things, including something as simple as having bitten into too-hot pizza.)--

Leukemia. Fiery-red swollen gums that just won't heal, distinguishable from diabetes symptoms with a blood test.--

Osteoporosis. Certain black spots on tooth X-rays that indicate air pockets and dead bone.--

Stress. Gums that have pulled away from teeth, or teeth that themselves are fractured. All sorts of fungal, bacterial and viral infections can enter the body through cracked teeth, Kravitz said.-- Sleep apnea. An enlarged tongue and inflamed gums in the part of the mouth through which air passes.--

Pregnancy. Deeply swollen gums can indicate hormonal changes.--

Bulimia. Upper front teeth that are paper thin, with the enamel almost completely worn away, and teeth that hurt. Distinguishable from acid reflux because different teeth are affected.

Tooth Erosion Caused by Sport Drink Consumption

noreply@blogger.com (Frank Liu DDS) — Mon, 08 Jun 2009 16:39:00 +0000

A recent study by Dr. Mark Wolff at NYU College of Dentistry showed that drinking sports drinks all day leads to a high exposure of acids from the sports drinks which can cause tooth erosion and hypersensitivity. The citric acid found in sports drinks has been linked to erosive tooth wear. According to Dr. Wolff, brushing teeth immediately after drinking the sports drink actually compounds the problem of tooth erosion because the softened enamel is more easily removed by the abrasive properties of the toothpaste and toothbrush.

Xrays, Radiation Exposure and Dentistry

noreply@blogger.com (Frank Liu DDS) — Fri, 02 Jan 2009 04:57:00 +0000

I am often confronted with questions from patients regarding radiation exposure and issues of whether dental xrays are necessary. Dental xrays or radiographs are truly necessary to properly diagnose the various diseases that are found in the mouth. Xrays are used to detect cavities, cysts, tumors and other defects like fractures that cannot be seen through clinical examination alone. Patients often make the mistaken assumption that if nothing hurts then everything is fine. Small cavities do not produce any pain or sensitivity because they are not near the nerve. Similarly, certain cysts and tumors found in the jaw bone are also asymptomatic. The frequency of the xrays varies between patients depending on the needs of the individual. For example, a person that is prone to getting a lot of cavities will require more frequent intervals of xrays to detect the caries while they are still small compared to someone who doesn't get cavities.

The following units were obtained from the Health Physics Society www.hps.org

Dental Bitewing xrays (4 films) = 0.04 mSV
Dental Full Mouth Series xrays (18 films) = 0.15 mSV

Exposure to cosmic rays in roundtrip flight from NY to LA = 0.03 mSV
One Chest xray = 0.10 mSV
One Mammogram = 0.70 mSV

Average Radiation in the U.S. from natural sources (per year) = 3.60 mSV

Information for Patients who are Pregnant:
The National Council on Radiation Protection and Measurements and the American College of Doctors and Gynecologists both agree that the potential health risks to a fetus in a pregnant patient are not increased from most standard xray and medical tests that produce a radiation does below 50 mSV. The accepted cumulative dose of ionizing radiation during pregnancy is 5 rad = 0.05 SV = 50 mSV.
Basically, what this means is that you would need to take 50,000 dental xrays to reach the cumulative 5 rad dose to the fetus. The risk of radiation exposure to the fetus is further reduced since the dental xray beam is aimed in the head/neck region and in addition the patient is wearing a lead apron covering the abdominal/reproductive area to block scatter radiation. Obviously, if you are pregnant, you should still inform your dentist and a decision on a case by case basis will be made regarding the need to take xrays to diagnose your problem.

Pain Control in Dental Care with Local Anesthetics

noreply@blogger.com (Frank Liu DDS) — Fri, 19 Dec 2008 16:32:00 +0000

Dentistry is a field that is dominated by a lot of surgical procedures whether it is cutting hard tissue such as teeth and bone or cutting soft tissue. Obviously, pain control during these surgical procedures are of paramount importance. There are a lot of misconceptions out in the general public regarding local anesthetics in pain control and I will try to address them here.

A lot of patients mention that they want "novacaine" (brand name Procaine) when they get dental work done. The truth is novacaine is rarely used now. Novacaine was first developed in the early 1900's and falls into the category of ester anesthetics. Ester anesthetics are not as lipid soluble as the newer amide anesthetics that have since been developed since the 1940's and therefore are not as effective at achieving local anesthesia. Other characteristics of ester anesthetics are that they are metabolized in the plasma by pseudocholinesterase into para-aminobenzoic acid (PABA). Certain patients are allergic to PABA due to cross reactivity with similar antigens. In addition, some patients have an altered form of pseudocholinesterase which will prevent proper metabolism of the novacaine and result in subsequent toxicity.

The vast majority of dentists these days use ester type anesthetics with the most common being lidocaine (brand name Xylocaine). Lidocaine is an amide type of anesthetic and is metabolized by the liver. Patients with liver disease and altered liver function will have increased potential for toxicity due to reduced bio-transformation of the drug. Lidocaine, Articaine, Prilocaine are often used in conjunction with epinephrine in order to increase the duration of the anesthetic by constricting nearby blood vessels. In patients in which epinephrine is not indicated, an ester anesthetic such as mepivicaine (brand name Carbocaine) is often used. These anesthetics produce numbness with an average duration time of 1 to 2 hours. There is one long acting anesthetic, bupivicaine (brand name Marcaine) that is commonly used to provide extended relief from pain with an average anesthesia duration time of up to 7 hours however it is not recommended for use in children younger than 12 years of age.

True documented and reproducible allergies to local anesthetics used today in dentistry are so rare as to be essentially nonexistent. Allergy to epinephrine is nonexistent. Most instances of "allergy" as reported by patients are due to side effects of the drug or psychogenic reactions such as increased heart rate or fainting. A true allergic reaction results in contact dermatitis, skin rash, urticaria, erythema, itching, swelling of the intraoral area and throat. As mentioned earlier allergies to para-aminobenzoic acide (PABA) need to avoid ester anesthetics. Patients who are allergic to sulfites are at increased risk of being allergic to anesthetics containing vasoconstrictors since sulfites are included with vasoconstrictors as antioxidants.

Localized complications of anesthetics include:
Trismus - a spasm of the muscles of mastication with limited ability to chew or open mouth. It typically resolves in a few days.
Hematoma - a bruise or discoloration from leakage of blood. It typically resolves in about 14 days.
Paresthesia - anesthesia of an area that is still present after 24 hours. Most paresthesias resolve in about 8 weeks without treatment.

Stem Cells from Wisdom Teeth

noreply@blogger.com (Frank Liu DDS) — Wed, 08 Oct 2008 03:20:00 +0000

Japanese scientists from the National Institute of Advanced Industrial Science and Technology recently have been able to create stem cells from the wisdom teeth of a 10 year old girl. Creating stem cells from embryos have always been frought with controversy and so this new discovery is very exciting. Wisdom teeth are commonly extracted and discarded but with this new finding, we have a huge source of potential stem cells that can be used to fight all types of diseases. Team leader Hajime Ogushi told the AFP that the wisdom teeth stem cells from this 10 year old girl were from teeth that were extracted three years prior and had been preserved. This means that there is a viable way for patients to store their teeth and then extract the stem cells for use at a later date. Japanese researchers have estimated that it would take another five years to use this method of creating stems to practical use in clinical trials.

Technology Integration in the Dental Office

noreply@blogger.com (Frank Liu DDS) — Tue, 09 Sep 2008 00:59:00 +0000

Its been a while since I've posted but I wanted to update several major changes in our office. As everybody knows, technology waits for no one and this is certainly true in health care. After much research, we've decided to overhaul our practice management software to the latest Dentrix Practice Management G4 (www.dentrix.com). Dentrix is from Henry Schein, the leading supply company for Dentists in the United States. There are basically two major dental management software companies in the U.S. and they are Dentrix and Eaglesoft. The standard Dentrix Software package currently retails for $10,000 however add-on modules for the software do increase the price. With this software we will have total integration with patient care in the treatment rooms including enhanced diagnostic capabilities using digital xrays and intraoral camera. At the front desk, use of the software will allow the office manager to more quickly process insurance claims and obtain preauthorizations from the insurance companies through the web. Treatment plans and patient education through the use of Guru will allow the patient to more ably choose the treatment option that is right for them.

Our office decided to move towards digital xrays because we finally felt that digital radiographs were superior in diagnosing caries and pathology. Digital radiography coupled with various software applications can analyze and manipulate an image (i.e. magnification, contrast/brightness control, density scan, reverse and false color imaging) so that extensive additional data can be acquired without exposing patients to additional radiation.

The main issue that we grappled with was whether to use a CCD (Charge coupled device) sensor based digital xray such as Dexis or a phosphor plate based digital xray system such as ScanX. The advantage of the Dexis sensor based xray is that you can obtain the image instantaneously however, the sensor is fragile and the wire that is attached to the sensor is obtrusive. The sensor is also bulky and it is difficult to take xrays in the back of the mouth. In addition, although there is a plastic sleeve for the sensor and wire, infection control of the sensor is difficult due to the fragile nature of the sensor.
The advantage of the ScanX phosphor plate system by AirTechniques ( http://www.airtechniques.com/Products/detailview2.aspx?id=88) is that it is not bulky so that you can take digital xrays anywhere in the mouth even in children, however, the image takes several seconds to appear onto the computer.
Ultimately, we chose ScanX for our digital xray needs because it is easy to use, more comfortable for the patients, and the Phosphor Plate Technology is the one most used in the medical field so it is highly dependable.

Periodontal Disease and their links with Systemic Diseases

noreply@blogger.com (Frank Liu DDS) — Sat, 07 Jun 2008 02:03:00 +0000

There was an article in New York Newsday and Bloomberg News today that discussed the link between Gum Disease and Diabetes. I'm glad to see that mainstream media is picking up on the importance of maintaining your gingival health.
Not only is there a link between gum disease (periodontal disease) and diabetes, there have also been research studies showing periodontal disease causing an increased risk in:]
1- heart disease
2- stroke
3- osteoporosis
4- preterm babies/miscarriages
5- respiratory diseases such as COPD
6- Alzheimer's
7- Stomach ulcers
The reason why periodontal gum disease is associated with so many other diseases is because the bacteria that attacks the gums can migrate to other areas of the body.
www.perio.org has a good overview of periodontal disease if anybody is interested.

What To Do If A Tooth Accidently Gets Knocked Out

noreply@blogger.com (Frank Liu DDS) — Sat, 26 Apr 2008 01:50:00 +0000

One of my patients recently fell off his bicycle and knocked out (avulsed) his front tooth so I thought this would be a good time to review the protocol for situations where there is an avulsed tooth. The first thing you need to do is determine whether it is a baby (primary) tooth or an adult (permanent) tooth. If it is a primary tooth that is knocked out then it is NOT reimplanted.

If it is a permanent tooth that is knocked out then gently rinse the tooth free of dirt and place it immediately back into its tooth socket. Do not rub the surface of the root because there are cells attached to the root that are important in successfully reimplanting the tooth to the bone. If you are not able to place the tooth back into its socket then place the tooth in ToothSavers (Hank's solution), or milk, or water in descending order of importance and see a dentist as quickly as possible. Even plain water is better than nothing because you don't want the periodontal ligament cells to dry out.

The dentist will then splint the tooth for 7-10 days and then at the end of that period will initiate root canal therapy so that the tooth will not "die off".

Dental Labs and their Importance

noreply@blogger.com (Frank Liu DDS) — Thu, 13 Mar 2008 03:29:00 +0000

Just the other day, I had a dental lab representative come to my office offering to fabricate crowns, dentures and implants for my patients. Most patients don't consider this important factor but a dental laboratory plays an important part of the dental office. Other than fillings, practically all dental restorations are custom made by an outside laboratory and then returned to the dental office for a final fitting. Of course you need a good dentist treating your mouth but you also need a good dental technician who has the skills and ability to fabricate the restorations that the dentist orders for the patient. Some large dental clinics have in-house dental labs but most dental offices use offsite labs. Our office uses several prominent local area dental labs which provided quality restorations up to my standards.
Just the other day, I had a dental lab representative come to my office offering to fabricate crowns, dentures and implants for my patients for a low price. I was skeptical because of how cheap it would have cost me but more so when I found out that not only was the dental lab representative not a technician by trade (he's just a salesman) but the lab work was fabricated in China. He explained that the quality was good however upon closer inspection I thought the restorations were only passable to fair. The teeth lacked detail and had very generic looking anatomy. In addition, the color was very monochromatic and bland. I therefore declined his offer and I thanked the dental lab representative for his time. Only about a week goes by and the following article appears on NY Newsday and other major newspapers:

Newsday.com
Dental patients urged to ask about foreign lab use
BY DELTHIA RICKS
delthia.ricks@newsday.com
March 4, 2008

In the wake of a Midwestern woman being sickened by lead-tainted dental work that was outsourced to China, consumers are being asked to inquire about the origins of their crowns, veneers, bridges and dentures.Millions of dental prostheses are being prescribed by dentists in the United States but are made in labs in China, India, the Philippines, Mexico, Eastern Europe, Costa Rica and elsewhere. Many experts are concerned about the outsourcing because raw materials used abroad may not meet U.S. standards.Foreign labs produce a substantial proportion of Americans' restorative appliances, and are supposed to follow rules, said Bennett Napier, co-executive director of the National Association of Dental Laboratories in Tallahassee. "The FDA regulates the raw materials used ... [and] these labs have to register with the FDA and they are supposed to use FDA-approved materials. But the FDA is inspecting less than 1 percent of the restorations that are coming in from foreign dental laboratories," he said.The new scare rekindles memories of lead-contaminated products from China last year.Long Island dental lab owners Leslie and Terry Cloper say consumers should be concerned because "patients do not know where their lab work is being done. When you buy food or clothing there is a label requirement," she said. "But when you have something inserted in your mouth there isn't," Leslie Cloper said.The couple, who own Lema Dental Lab in East Setauket, receive constant inquiries from foreign laboratories seeking work. Although the Clopers say they've resisted the pressure, other area labs and dentists find overseas pricing attractive. With the aid of global overnight shipping, dental appliances are ready in about the same amount of time they would have taken locally.Toxic levels of lead were found in the dental work of a 73-year-old Ohio woman whose crown was made in China. The case was reported last week by an Ohio television station.Afterward, officials at the American Dental Association notified federal regulatory agencies, calling on the government to investigate the case and to determine whether it's isolated or indicative of a wider trend. In a statement last week, the dental association said it has begun its own investigation."We will communicate our findings to the public and the dental profession, as well as to the appropriate government agencies," association officials said in a statement. Dental officials added: "The ADA is taking this report very seriously. However, we do want to keep it in perspective. There simply isn't enough information available to presume that the presence of lead in dental crowns or other prostheses is widespread."The National Association of Dental Laboratories estimates between 15 and 20 percent of all restoration work is outsourced - and patients are unaware.Dentists, often affected by what insurers are willing to pay, find the low-cost foreign work attractive, the Clopers said. Their lab, for example, charges dentists $128 for a single crown fused to a metal base, but labs in China do it for $29.Questions for the dentistThe American Dental Association encourages patients to discuss concerns about the safety of their dental crowns or other prosthetic devices with their dentists. The quality and the safety of dental materials you receive should matter most. Some questions you can discuss with your dentist:Do you fashion your own crowns, bridges and other dental materials in the office or buy them from a dental lab?Where is the dental lab located?Does the lab outsource crowns or bridges to a foreign country?What materials are going to be used in my restoration?What other options do I have?
Copyright © 2008, Newsday Inc.
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Don't worry L&L Dental Associates would NEVER outsource our dental work to any labs in a foreign country such as China or Mexico because there will always be questions of quality control.

AHA Premedication Recommendations to Prevent Bacterial Endocarditis

noreply@blogger.com (Frank Liu DDS) — Mon, 25 Feb 2008 01:20:00 +0000

Recently several of my patients with a history of heart murmurs and mitral valve prolapse have expressed concern over changes in the Premedication Regimen to prevent bacterial endocarditis. As a resident at Long Island Jewish Medical Center, I have come across inpatients with acquired bacterial endocarditis from dental procedures and the management of the disease was challenging especially in light of all the drug resistant organisms.
The antibiotic premedication regimen regarding the prevention of bacterial endocarditis has changed multiple times over the years. For example, back in 1995 when I was still in dental school, a patient needed to take antibiotics 1 hour before the procedure and 6 hours after the initial dose. Several years later, the amount of antibiotics was scaled down and the post-operative dose of antibiotics was eliminated. Finally, the most recent research showed that the risk of developing endocarditis was so small from dental procedures that it did not warrant the need to premedicate with antibiotics except in select situations as indicated below. Of course, some patients would rather take the antibiotics no matter how small the risk of acquiring bacterial endocarditis. In my office, I follow the most recent AHA Recommendations regarding Premedication to prevent bacterial endocarditis however, I have no problem with prescribing antibiotics to those patients with a history of heart murmur or have mitral valve prolapse who feel uncomfortable with the new guidelines and wish to continue taking antibiotics.

Summary of AHA Recommendations to Prevent
Infective Endocarditis During Dental Care
Cardiac Conditions for Which Prophylaxis With Dental Procedure Is Recommended:
• Prosthetic cardiac valve
• Previous infective endocarditis (IE)
• Congenital heart disease (CHD)
– Unrepaired cyanotic CHD, including palliative
shunts and conduits
– Completely repaired CHD defects with prosthetic
material or device for first 6 months after
procedure
– Repaired CHD with residual defects at the site
routine anesthetic injection through noninfected tissue
or adjacent site of prosthetic patch / device
placement of removable appliances
(which inhibit endothelialization)
placement of orthodontic brackets
• Cardiac transplantation recipients who
bleeding from trauma to lips / mucosa
develop cardiac valvulopathy
taking dental radiographs
adjustment of orthodontic appliances
shedding of deciduous teeth

Dosing Regimens (Single Dose 30 to 60 minutes prior to dental procedure):
Amoxicillin 2.0 gm

If allergic to penicillins then:
Cephalexin 2.0 gm
OR
Clindamycin 600 mg
OR
Azithromycin 500 mg

Welcome to my new blog

noreply@blogger.com (Frank Liu DDS) — Tue, 22 Jan 2008 04:47:00 +0000

Welcome to my new blog! It's January 2008 and I'm really excited about starting this blog both to review whats going on in the medical/dental world and to keep track of my practice. I have a dental office in New Hyde Park, New York and more information about my practice can be obtained at http://www.mylongislanddentist.com/ or http://www.landldental.com/ . I am a general dentist and I've been practicing dentistry since 1996. One of the reasons I decided to start this blog is so that my patients have an information resource to go to. An educated and informed patient makes my job easier at the office and it allows them to be more involved in their dental treatment rather than just saying yes to my recommended treatment plan. I also felt that this was a good forum for me to share and bounce my ideas to the world and learn from others who come across my blog.