Vitamin D: Impact on Cavities

Vitamin D Can Have a Positive Impact on Caries

I've taking this blog post from an email I recieved about Vitamin D and the effect it can have on Cavities. This is an excerpt from that email:

(http://www.drbicuspid.com/index.aspx?sec=sup&sub=rst&pag=dis&ItemID=312138&wf=1386)

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Study: Vitamin D has positive impact on caries rates

By Kathy Kincade, Editor in Chief

Research has shown a positive link between vitamin D and oral and systemic health, the IOM noted; however, these studies have yielded "conflicting and mixed results and do not offer the evidence needed to confirm that vitamin D has these effects."

Now a new systematic review, conducted by Philippe Hujoel, PhD, DDS, MSD, MS, of the University of Washington School of Dentistry and School of Public Health, points to a positive association between vitamin D and lower rates of dental caries (Nutrition Reviews, November 9, 2012).

Vitamin D was first discovered in the early 1920s, and at least 20 prospective clinical studies evaluating its impact on dental caries were initiated in Europe, North America, and Asia over the next two decades, according to Dr. Hujoel. However, professional and governmental groups varied widely in their interpretation of the scientific evidence.

For example, the American Medical Association and the U.S. National Research Council concluded around 1950 that vitamin D was beneficial in managing dental caries, but the ADA said otherwise -- based on the same evidence.

For the Nutrition Reviews study, Dr. Hujoel analyzed 24 controlled clinical trials (CCTs) that met the inclusion criteria. The CCT quality was quantified using a 21-item questionnaire and content-specific measures such as method of treatment assignment, setting, clinician blinding, use of placebo, commercial funding source, and study duration.

The 24 CCTs included in the study spanned the 1920s to the 1980s and were conducted in the U.S., U.K., Canada, Austria, New Zealand, and Sweden in institutional settings, schools, medical and dental practices, or hospitals. All told, the CCTs encompassed nearly 3,000 participants between the ages of 2 and 16 years.

The trials increased vitamin D levels in these children through the use of supplemental ultraviolet (UV) radiation or by supplementing the children's diet with cod liver oil or other products containing the vitamin.

These trials showed that vitamin D was associated with a 47% reduction in the incidence of tooth decay, he noted. No robust differences could be identified between the caries-preventive effects of UV therapy and nutritional supplementation with either vitamin D₂ or vitamin D₃. "The analysis of CCT data identified vitamin D as a promising caries-preventive agent, leading to a low-certainty conclusion that vitamin D in childhood may reduce the incidence of caries," Dr. Hujoel concluded.

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I hope you are all enjoying your week!

Richard Stickney DDS PS

Dental Seminar: Laser Dentistry

Hello everyone!

About 2 weekends ago I attended a Waterlase dental  laser seminar done by Dr. Marshall Golan. Much of this seminar discussed technical aspects of laser dentistry, and some of it I'd like to share with you all today.

I've had my Waterlase for over 5 years now, and I use it as often as I can on my patients. Dr. Golan outlined some suggestions that I've already been putting into practice during the seminar, but one thing he mentioned is that he uses the laser on just about every patient to kill bacteria and decontaminate after decay removal, even if he used the drill. On Dr. Golan's website, he outlines some other advantages of using the laser, such as:

• It helps remove areas of infection
• Removes gum disease with great precision
• The laser beam sterilizes as it works
• Anesthetic is not needed as often
• Faster healing
• Less bleeding and swelling
• Less noise so less anxiety
• Less post operative pain so less pain medication is needed.

92% of stained grooves on a non smoker's occlusal (or biting) surface has decay underneath, and this does not show on an x-ray. If that decay stays only on the enamel, then we can treat that as a sealant, but if it goes into the dentin layer of the tooth, at that point we have to do a composite filling. The laser can often be used in removing such decay without the use of anesthetic. Some other uses of the laser include:

1. Gum surgery- we can often treat gum disease with the laser to disinfect deep pockets, remove diseased tissue, and stimulate reattachment of the tissue to the gum without invasive painful scapel surgery.
2. Decay removal- the laser can remove decay, disinfect and biostimulate the tooth
3. Cosmetic purposes- the laser can re-contour the gums and eliminate a "gummy" smile

We love using our laser, and I enjoy learning new ways to use it. If you'd like more information about the Biolase water laser that I use in my practice, please visit their website.

Be well,
Richard Stickney DDS PS

Laser Dentistry

Hello!
We wanted to talk today about our laser and our continued success with using it. At this point, most of our patients prefer it to having anesthetic on procedures where we can use it. We use the laser for many different procedures including: decay removal, extractions, disinfection, root planning and scaling, gingivalplasty, gingivectomy, and biostimulation. We enjoy being able to use this helpful tool for periodontal and other surgical procedures. One of the advantages to using the MD Waterlase is that the recovery time for invasive procedures is less, and most of our patients report little to no pain after soft tissue procedures.

Here are some interesting comments that some patients have made about the Waterlase, taken from Biolase's official website. (http://www.laserdentistry.com/testimonials.html)

97% of patients who experience Waterlase treatment
would recommend it to their family and friends.

Richter 7 Survey
"I would definitely recommend it.
It was much easier than I thought it would be."
- S. Pruitt, California
"After having this procedure done with a Waterlase MD, I would never want to have another procedure done with your conventional drills, and knives, and sutures, and everything – there’s no need for it."
- M. Roybal, California
"Before, they would get me numb, they’d leave the room, and I’d be sitting there, waiting for myself to get numb, and then they’d come back. This, they started right up."
- T. Flagler Oregon
"I saw a Waterlase® dentist just this morning, after a seven-year absence from the dentist. I belong to an online community and happened to mention how much I despise the dentist. One woman had heard about the Waterlase® and suggested I look into it. I made an appointment and then paid the price for my procrastination--four cavities and one crown (for a horrendous root canal done previously--I've been walking around with a temporary crown for seven years!) Today I went in to have two of the cavities filled and the crown prepped. The dentist used the Waterlase® on both cavities and it was the procedure I've been waiting my whole life for!"
- S. Hogan, California
"You can just have your treatment done, no anticipation. So I do think it’s going to change how people feel about coming to the dentist."
- N. Seyler, Oregon
"I just wanted to comment on the Waterlase®. I lost a crown (pin and all) and figured that the tooth couldn't be saved and I'd have a painful procedure to look forward to. My dentist recently purchased a Waterlase®, I noticed it as soon as I sat in the chair. He asked me if I was willing to have him use the Waterlase to cut back the soft gum tissue so he could reattach the crown. I have to say, even though he said he's only been using it for about 3 days, I had no pain beyond that I get from flossing. It was a wonderful experience and I should know, I've had extensive dental work performed over the last 10 years. I still can't believe I came out of today's visit without any pain or numbness. Thank you Biolase!"
- C. Stevens, Colorado


I hope you are all doing well!
Take care,
Richard Stickney

Advanced Laser Diagnostics: Diagnodent

Today we wanted to talk about something that we use here in the office when we diagnose treatment. This particular instrument is called Diagnodent and it is a laser specifically used to measure density in the tooth. When we shine the laser light onto tooth structure, the light is then reflected back into the device and gives us a reading of how dense the tooth is. A loss in density means decay is starting. When we look at the readings, anything under 20 on the scale is considered a "watch tooth". We mark it on the chart to recheck this tooth at your next exam. Anything over a 20 is considered needing treatment, which could mean something as simple as a composite filling, or something more involved such as an onlay or a crown. This device is helpful because sometimes decay is not visible to the naked eye, or even under magnification! And x-rays can only show us about 30% of non-visible decay, so having the Diagnodent is a useful tool for early detection of decay, and for "seeing" what we cant see!

Here is an example of a tooth that to the eye, looks normal. No visible decay.

(This next part of this post is taken from www.smilestudio.com/prevention.html)

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Before opening the tooth after use of Diagnodent dental laser. There is no visible decay and often these types of cavities do not show on x-ray.


This is the giant cavity found below the surface with the Diagnodent. It would have been impossible to notice until total disaster struck.


Think all you need to do to prevent dental problems is brush your teeth? THINK AGAIN!

The brush is an important thing you can do to keep teeth and gums healthy. The brush can disrupt the bacteria that cause decay and gum problems. That helps. But the floss is probably your best line of defense-- AT EARLY STAGES OF THE DISEASE PROCESS.

Later on, though, other specialized tools and techniques may be needed to get rid of the germs and germ waste products that plaque your gums and your teeth.

This is where our staff can really contribute to your long-term success by crafting a personalized preventive program just for you.

And this needs to be revisited every time you come back to see us. Things are always changing!
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The Diagnodent is used in harmony with our philosophy of being minimally invasive. We like to preserve as much natural tooth as possible. Treating decay early helps us preserve more of your natural tooth, and this tool is invaluable in detecting that at it's very first signs.

To your health,
Dr. Richard Stickney

Reduce Decay and Protect your smile

Our diets as Americans have changed drastically over the last several decades. It includes a substantial amount more of acidic and carbohydrate related foods. These cause oral and systemic acidity. There are several kinds of bacteria that use simple carbohydrates to breakdown a tooth’s minerals, creating opportunity for decay and cavities. Cavities are a preventable infectious disease if you balance your oral chemistry.

Sodas, fruit juices and sports drinks are highly acidic and have seemed to replace our water and milk consumption. Teeth start to demineralize at a pH level of 5.5. On average soft drinks to fruit juices, etc. have a pH level of 2.6-4.6 depending on the type of drink. Sports drinks and energy drinks have the strongest potential for tooth erosion.

Many medications diminish the protective flow of saliva resulting in acid buffering and micro repair to slowing or completely stopping. As we get older this protection lessens and the saliva available is less effective. It is important to not dilute remaining saliva with frequent drinking in these cases.

Enamel is about 98 percent mineralized; the crown of a tooth is much stronger and more resistant to acid attacks, than its roots. When roots are exposed due to bone and tissue loss they are at a higher risk for decay. So making better food choices, eating fewer fermentable carbohydrates and processed and acidic foods can help protect you teeth.