Periodontics and the Connection with Laser

Hello everyone and happy Thursday!

Today's post comes from an interesting article on the Center for Dental Medicine website. The focus of this program is to help educate patients and doctors alike in how periodontal problems have strong connections to diseases like heart disease, diabetes and even cancer.

This article talks about how we can use laser therapy to help improve results when treating periodontal disease.

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The Laser Connection –Toward a Kinder, Gentler, Periodontal Treatment
by Robert J. Schulhof, AB, MA Math Statist.
Until recently the only periodontal therapy available was deep cleanings and in more advanced cases, surgery. More recently, antibiotics were added to kill the bacteria. Such treatment made a lasting impression on those who went through it. However, the periodontal disease often came back again, creating the belief that the disease can never be "cured." The good news is that with the advance of laser gum surgery and gum treatment, and our understanding of the disease, laser periodontal treatment can be accomplished painlessly, quickly, and with your cooperation, can be kept in remission.
At each appointment, we will perform a typically painless gum disease laser "decontamination" which includes tracing the laser around the gumline of each tooth quickly, killing the bad (anaerobic) bacteria. It has been shown that laser decontamination is more effective than antibiotics. In addition, there are no strains of bacteria resistant to lasers (16). Periodontal laser surgery and treatment does not create resistances to medicines you may need some day and they do not suppress your immune system as antibiotics can.
We will then send you home with your special oral hygiene products, rinse and nutritional supplements. When you return the next week for your first deep cleaning you will be in much better shape, have less bleeding and sweeter smelling breath.
At the next appointment you may receive some topical anesthetic to avoid any possible discomfort. Periodontal disease laser treatment, followed by the use of a special gentle scaler, will occur in order to make sure your roots are clean. It is only when the roots are decontaminated that the gums can re-attach to the roots of the teeth. We will then use the laser to go around each pocket to vaporize the diseased tissue and treat the roots to allow better growth of new tissue and bone (18). Pocket depth will normally decrease by 1mm per visit. We will perform a refreshing irrigation of the tissue and then your visit is complete. The laser actually helps minimize the discomfort of the cleaning and you should feel fine the next day. You may have two to four of these visits, depending upon the depth of the original pockets and how your tissue responds.

If you have advanced pockets of 6mm or more you may have a few more painless visits where only the laser is used. This whole process should take no more than a month or two, after which you continue with your home care until your first periodontal maintenance visit (PMT) where your progress will be measured. This process will work 90% of the time for moderate cases of the disease, defined by 4-7 mm pockets. Deeper pockets can exist because of diseased teeth, broken down restorations and poor bite relationships. Bone grafting, soft tissue grafting and other more costly treatments might be required.
The Benefits of Treatment
Recent research has shown that laser treatment for gum disease will do more than save your teeth and sweeten your breath. It may be the best way to reduce your CRP (21), lower a factor called "glycated hemoglobin"(HbA1c) which can reduce the risk of diabetes, (4) and, if you are diabetic, greatly increase your life expectancy (5). If you are an expectant mother it can reduce your chance of a pre-term birth by a factor of 7 (6).
Costs
Our unique non-surgical laser treatment for periodontal disease protocol will be less costly and less painful than traditional periodontal surgery or even your co-pay on a one-day stay in the hospital. Since periodontal disease is now recognized as a systemic infection it is likely that in the future your medical insurance would cover some or all of the costs of periodontal treatment. In the meantime, you can be assured that the protocol we have developed will be a worthwhile investment in your total health as well as your dental health.
Get Checked and Get Tested
The first step is to come see us for a complete periodontal examination and if you do have periodontal disease, to have an hs-CRP test to assess your risk of heart attack and stroke and an HbA1c test to see if you are in danger of becoming a diabetic.

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We've been using our laser for periodontal therapy for a while now, but are ever more motivated to be using it with every patient coming to us with periodontal problems.

To check out more articles such as this, please visit centerfordentalmedicine.com.

Hope you all have a great day!
Richard Stickney DDS PS

It's 2013!

Hello everyone!

Can you believe it is already 2013? This year has flown by! I just wanted to write this blog to share with all of you some of my new hopes and goals for the 2013 year.

First of all, I want to thank you for choosing us for your dental care. We are honored and delighted to be working with each of our patients and look forward to building on those relationships in the years to come.
Secondly, we wish to continue to evolve and grow in the practice, always looking for new ways to make things better for you and for us. Recently we have been making some refinements to our procedures and techniques. We've made some refinements in our laser treatment with regards to root canals and we've also had new and further laser advancements in our non invasive approach to periodontal health and how that relates to overall health.
This year we will be introducing a new laser into our office, in addition to our Waterlase. This laser is called the Biolase Epic. It is a surgical and therapeutic device designed for a wide variety of oral soft tissue procedures and dental whitening, as well as for use in providing temporary relief of minor pain.

As always we are looking for the most minimally invasive ways to do treatment and to prevent dental disease in any form.

I hope you are all having a great day!
Richard Stickney DDS PS

Laser Helps With Sensitivity

Hello everyone!

I hope this blog post is finding you all happy and healthy! We just returned from our two week vacation, and we are ready to start up our weekly blog again, sharing timely and informative news with you!

This week's blog is talking again about our dental laser! (Boy do we love it!) But this time we are focusing on how the laser can help with sensitivity during and after dental procedures and how it can help with general tooth sensitivity. We've attached a video at the bottom on this post that explains how the laser can help with sensitivity caused by gum recession and exposed nerve endings. These exposed nerve endings can cause sensitivity to brushing, and cold.

This week alone, we've done a couple of composite fillings with the use of our Waterlase. Asking the patients afterwards how they felt during the treatment, all of them said they had no discomfort. No anesthetic was used during either of these treatments. Unfortunately, we cannot use the laser for every procedure, but we do use it as often as we possibly can. Many of our patients prefer the use of our laser opposed to the use of anesthetic and the drill. On the flip side, some people prefer not feeling anything at all and want to be numb, so we definitely respect all of our patients wishes.

If you'd like to see an animated demonstration of how the laser can help with tooth sensitivity, please follow this link to watch a short video.

Please feel free to leave feedback in the comments section or on our Facebook or Twitter pages!

Be well,
Richard Stickney

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 Treatment in Our Hygiene Room Pt. 3

Hello all! Hope you are all having a great week! Here's the final part of our 3 part blog about how we are using our dental laser in our hygiene room! Feel free to let us know what you think in a comment, or on our Facebook or Twitter! Enjoy.

We have begun a new treatment protocol for periodontal disease. In addition to analyzing bacterial samples with our microscope, we now are able to send saliva samples to a lab and see exactly which periodontal pathogens are present and in what concentration, and test for genetic susceptibility for periodontal disease. The sample collection in simple and non-invasive, it involves a 30 second swish with a small amount of saline solution. After analysis, the lab includes a specific antibiotic recommendation for treatment of those who have concentrations of harmful bacteria above threshold. As you know, Dr. Stickney is not in the habit of prescribing antibiotics, so this has been a new leaf for both of us to turn over. One great benefit is that since we know the exact bacteria causing the infection, we are able to target the bacteria with the most effective type of antibiotic available, instead of simply using a broad spectrum antibiotic and hoping it works. Knowing whether or not someone is more genetically prone to periodontal disease, it helps us gauge how proactively we need to address signs of disease. Once we have this information, we are able to plan out our course of action. For those who have results with bacterial concentrations above threshold, typically the treatment includes scaling and root planning, or "deep cleaning", performed in the middle of the eight-day antibiotic regimen. The purpose of this is to attack the bacteria systemically (with the antibiotic) and locally (with the scaling and root planing). The results that we have achieved with the combined antibiotic therapy and scaling and root planing have been amazing. It used to be that we didn't see this kind of healing and recovery unless periodontal surgery was performed. Being a minimally invasive practice, we are happy to have this option for those who show the need for it and are comfortable taking the eight-day course of antibiotics. For those who have results that are positive for harmful, disease causing bacteria but are below threshold, typically antibiotics are not recommended. In these cases the body's own immune system, along with proper professional dental treatment, should be able to overcome the infection. The laser can also be used in conjunction with this treatment protocol for those who would like an option other than antibiotics. You are welcome to have a look at the lab's website, they have great educational resources: www.oraldna.com


Again, we'd love to hear what you think!
Hoping you are all well,
Richard Stickney

Laser Treatment in Our Hygiene Room Pt. 2

As we brought out in our last post, there would be 3 parts to this topic of using the laser in our hygiene room. This is Part 2. Enjoy.


As some of you may have seen, we have a microscope in our hygiene room. We have been analyzing plaque samples that we collect from periodontal pockets, pockets that show signs of gum disease and inflammation. Signs of disease include pocketing of 4 millimeters or greater, inflammation, and bleeding. It is amazing to see how much bacteria is in even the tiniest of plaque samples. I haven't been this excited since my Microbiology and Histology courses in college! Some results have been surprising. For example one sample was from a moderately healthy pocket, three millimeters deep with only a little evidence of inflammation, but upon analysis of the plaque, there were harmful spirochetes evident on the slide. The spirochete family is a nasty one. This is actually the same type of oral bacteria involved in Alzheimer's disease, and here is a link that has research on this: Alzheimer's and oral bacteria
This bacteria is tissue invasive in cooperation with other bacteria, which means that it cannot only live on the surface of your gum tissue, but actually invade and live within gum tissue. It's DNA is found in artherosclerotic lesions of the aorta and is associated with pre-term low birth weight. Those are the systemic effects of this particular oral bacteria. Connections like these reinforce how important diligent daily flossing, proper brushing and regular professional dental care is when caring for our overall health. Those little bugs go non-stop. When I analyzed my own plaque sample and was thankful to see my white blood cells working hard to combat the bacterial onslaught. I felt such affection for the hard working little guys! It is amazing to see what goes on in our bodies without our being aware and how our own beautiful immune system is waging war on harmful microbes. It motivates me to do my part in supporting my immune system and my industrious little white blood cells.

Hope you enjoyed reading part 2 of this blog post! Stay tuned next Monday for the last part of this interesting subject!
Richard Stickney

Introducing: Laser Treatment in Our Hygiene Room

We are happy to be able to offer laser services in our hygiene room as well as Dr Stickney's treatment room. Our hygienist, Annika, received additional training in using our laser for the treatment of periodontal disease. She would like to share what she learned and how we are integrating this into our treatment.
This is Part 1 of 3 blog's we will do on this subject:

The course started with the physics of lasers and laser safety, and it always good to have those reminders. We went on to learn about all the applications of lasers in gum tissue treatment, from surgeries to biostimulation. We reviewed which types of procedures I am licensed to provide in the state of Washington, which include treatment of apthous ulcers (canker sores), herpetic lesions (cold sores/fever blisters), laser bacterial reduction, which reduces the amount of live bacteria in the mouth prior to cleaning. This helps to reduce the bacterial cascade that enters the bloodstream upon the manipulation of gum tissue during cleanings. Some types of oral bacteria are linked to upper respiratory tract infections, so it is a great tool to reduce the risk of spreading harmful bacteria to the rest of the body. We also learned the specific steps associated with laser assisted periodontal therapy, which is augmenting our periodontal disease treatment. Biostimulation means activation and regeneration of damaged cells. These non-active cells are stimulated and new cells are regenerated to get proper cell metabolism. This supports the function of the immune system and thus promotes the healing functions.
We are already implementing new treatment protocols in the office I am very excited to be able to provide these services. Our experience is that diseased gum tissue heals much faster and more completely after treatment with the laser. A simple topical anesthetic gel is all that is needed to prepare the tissue and treatment is typically very easy. In certain cases, we are adding laser treatment to our scaling and root planing (also called deep cleaning) procedures. The laser is not needed on every visit but it is wonderful to have such a practical tool at our disposal.


Stay tuned for the rest of this information in the coming week!
Hope you are all doing well,
Richard Stickney

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