CBCT 3D Imaging

Technology in dentistry, like technology in general falls under a few categories.  Some innovations allow us to do things quicker and more predictably.  A great example of this is our Isolight system that we sometimes use to help with suction and giving you something to rest your jaw on instead of having to stay open.  Some technologies allow things to be done faster, but not necessarily better.  Offices that offer crowns in a day have jumped onto this technology.  CEREC crowns are becoming a popular option in many offices due to the fact they eliminate the temporary crown stage and having your definitive crown placed the same day the tooth is worked on.  This technology is one we haven't adopted yet and doesn't improve the final crown (there are definitely plusses and minuses to the system).  Another type of technology is one that allows us to do things we have not been able to do before in our office.  We are very excited to be adding a Cone Beam CT (CBCT) scanner to our office.

What is CBCT?

A CBCT machine is a 3D imaging system that captures data by rotating around the patient and taking images then reconstructs these to form a 3D representation of the patient’s teeth and jaws.
The radiation level from a dental CBCT scan is very low, and significantly lower than medical type CT scans.  CBCT scans do not replace the need for traditional x-rays and you may never need a scan.  

Uses of CBCT in Dentistry

The volume of data we get from this technology allows for a wealth of possibilities in terms of diagnosis and treatment. Some of the uses we’re most excited about:

• Diagnosis of infection/source of discomfort- Traditional radiographs are limited by two dimensions.  We have been bound by films that are burdened with overlapping structures, distortion and lack of comfort.  
• Implant Placement- 3D imaging allows us to know much more accurately where the bone is compared to a 2D image.  By having a representation that is this accurate, we can combine with other models and impressions and have guided surgery for implant placement.  This is the dental equivalent of endoscopic surgery.  Many times we can place these implants without any need for sutures and very minimal post op recovery.

Adding the right technology at the right time...

For diagnosing cavities and periodontal (gum and bone disease), our digital radiographs that we have been taking are still top of the line and you will continue to receive these films as needed.  Many of our patients will not need a 3D scan.  However, those patients who have missing teeth and are interested in implants, patients who have had those "phantom" pains that have not been able to be visualized on 2D imaging, those needing extractions, especially of wisdom teeth and those who have had numerous root canals that haven't felt right you may find use of the new technology we are STOKED to be adding to our practice.  By allowing use to see what we would otherwise be unable to see, by allowing us to limit complications by knowing and utilizing what information was hidden and by having at our hands the power to show and teach by having a model and image that people can see and understand we are convinced in the power of this technology.

Do I really need to floss?

“Do I really need to floss?”

Unfortunately, I have heard this question more this month than I probably ever had.  I get it.  Flossing isn’t sexy.  It takes time when we can hardly find time to brush our teeth.   Sometimes it gets splatter on the mirror.

This month an article came out from the Associated Press stating the government has done little high quality research to prove flossing works.  A good scientific study is done over a long period of time, is well documented and has a control group.  Studies that lack these are considered to have lower validity. 

If we were jumping out of plane, most of us would feel a lot safer with a parachute.  We KNOW that with the parachute we will have a much greater chance of a nice landing.  If we wanted to have a scientific study that was good, we would have a control group that was jumping without a parachute to so we could compare between the outcomes of the two groups.  Ideally the people jumping out of the plane would have no idea if they have a real parachute to a placebo bag on their back.  Are you ready to partake in this study?  The government has no high quality research that a parachute works!

On big issue with the studies that are done with flossing are that most have involved patients who report back that they do floss daily.  How reliable are we when we have to self-report anything?  Do you think our children are any better at this?  I know when I was asked as a kid if I flossed I always told my mom that I had.  I probably didn’t brush all the time either.  At least not as often as I say I did.  One question I always ask younger kids is how often they brush their teeth every day.  The most common answer is “yes.”  After that I probably get the answer “100,” followed by “5.”  The real answer is almost never one of those. 

Another issue with the article is the conclusions that were drawn from some studies.  A 2006 study divided kids into three groups.  One group was professionally flossed 5 days a week by a dental professional.  One group flossed only once every three months.  The other group self-reported daily flossing.  This study lasted 18 months.  The results showed that there was no difference in the group that self-flossed and flossed only once every three months.  The group that was professionally flossed 5 days a week had a 40% decrease in the incidence of interproximal dental caries (the fancy term for “flossing cavities” or cavities between the teeth).  The point taken home from the AP study was that there was no difference between not flossing and flossing yourself.  The point I took from the study was proper flossing reduces cavities by 40% and most people do not take the time to floss properly or just say that they floss, when in fact, that may be an embellishment of the truth.

So, do you really need to floss?  Should we wear a parachute? 

It’s your call.  I do, twice daily in fact.  We tell you once daily is effective.  I have no financial interest in Proctor and Gamble.  If you buy truckloads of floss each time you visit Target, I do not get my pockets lined with green.  I tend to be busier when people do not floss.  I invite to take this challenge.  Floss every day for a week, this is even better if you do this after a cleaning.  On that seventh day, smell the floss.  Take a week off of flossing and smell the floss after that and see if you notice a difference.  I have a feeling that while not flossing keeps our schedule a little busier here, not flossing may open up your social calendar some. 

Writing an article telling people that they do not have do something that really don’t like doing is a great way to get some clicks and sell some ad space.  

Children's Dental Health Month

Among other things, February is Children’s Dental Health Month and with my son just celebrating his first birthday this month (that first year goes by so fast) it seems like a good time to write about setting up your child for a lifetime of smiles.

                Parents of little ones are inundated with facts on development.  There are typical dates we tend to see our kids reach certain milestones such as sitting on their own and crawling.  Cutting their first tooth is one of these less exciting times.  Typically, we see the lower front two teeth breaking through the gums between 6-8 months, but this is a range, there isn’t necessarily anything to be worried about if your child gets his first tooth early or late. 

                As guardian of your child’s mouth, your job should begin before you reach this milestone.  Good habits start early.  After feeding, it is never too early to get started on your oral hygiene regimen.  A moist cloth quickly run over and massaging your baby’s gums not only helps clean them but it teaches the more important routine of you working in their mouth before it’s a painful area that they do not want you to touch.   One great product out there is xylitol wipes that helps with this.  I know it’s tough, but it is a little work to save you a lot of headaches later.  

                 Once they get that first tooth though, it is important to get a toothbrush on it. Luckily, there aren’t too many teeth to brush at this point so this is a quick thing to do.  Usually, I let my son watch me brushing my teeth with my electric toothbrush and then I let play around on his own.  After playing two minutes of keep away with my brush he is quick to let me get the brush in his mouth.  It doesn’t have anything other than water on it at this point.

                The ideal time to touch base with a dentist for your child is 6 months after that first tooth has come in.  This first visit isn’t necessarily a cleaning, but a great chance to talk about their oral development and help with parental education.  We are often talking about the need to break the child of their pacifier habit around this age, adding a little toothpaste into the brushing routine (just enough for a little flavor at this point, almost always less than you’d think), and setting up good mealtime habits.  In my office the rule is to make sure the visit is a happy one.  Developing a good relationship with a dentist is important.  We start off on the right foot so we can build to where we need to be.  We typically like to see your child as far away from his most recent pediatrician visit as possible.  It can be a little tough on your child to be in a dental office immediately following an appointment where they just had routine vaccines.  They are skeptical of those in white gloves!

                Until your little one is 5 or 6, they will need help with brushing.  Help will flossing will need to continue until 10.  At this age, you child should have the dexterity to brush by themselves, but they do not always have the compliance they should have.  The earlier it becomes a routine the easier to it will be to transitioning them to being able to do it themselves.  Make sure they are spending a full two minutes, brushing all surfaces of the teeth front and back. 

                Both general dentists and pediatric dentists are fantastic at fixing decay.  Preventing decay from happening starts at home.  Frequent checkups can help prevent big surprises.  If we can find a cavity that is small enough, we can sometimes reverse the process and prevent a filling in the first place.  If the decay goes unchecked we frequently have to deal with early tooth loss. 

                I often tell patients if we can get them to adulthood with no cavities, we can usually keep them that way most of their lives.  The “big ticket” items we usually dread as adults such as crowns, root canals and extractions almost always found on teeth that needing a filling as a kid.  So many complex issues that we work to solve with braces are issues that started because of early tooth loss.  Our baby teeth are the foundation for our oral health the rest of our lives.