Do you think it has to do with keeping teeth free of caries or gums free of bacteria?!
It has to do with people enjoying life, spending their valuable time with families, with their loved ones, enjoying vacations, laughing out loud so hard that the cheeks hurt – true happiness, being able to achieve professional goals, focusing on a soaring career… This is what a good doctor does: keeps people healthy, free of worry and empowers them to focus on what “moves” them rather than letting them worry about risk and pain.
Is this a different approach?!
Yes, it is – a proactive preventive approach also called Direct Primary Care. “I am not just here when you need me, I am here to take care of you so you do not have to see me very often. I am here to help you age as slow as possible and feel/look Great!” – is the message a good doctor is sending.
The studies around the world are putting together all the pieces of puzzle: we live longer than ever, we are much more active intellectually, more socially engaged and connected while our bodies age faster than our minds. Therefore, an experienced doctor DOES NOT focus just on the skills or technology how to fix something but on How to Anticipate the Disease, keep the body less stressed and age slower. In dentistry, manage the patient so he/she needs the Minimum Amount of Dentistry in a Lifetime. It means less crowns, less fillings, less implants… After all, they are inorganic and our body cannot fully integrate them but just TOLERATE and COMPENSATE for them. Cumulated compensation, especially functionally, can during Middle and Senior years lead to decompensation and structural failure. And then it is a lot harder to “fix”…
How does this Proactive Medicine work?!
It is based on a scientific detailed analysis of patient’s lifestyle, genetic and epigenetic risk factors and consists of a Total Body Approach protocol. It takes a perfect collaboration of different medical specialties where Dentistry plays a key role. Why dentistry?! Because nowadays it has evolved into Oral Medicine, able to detect through saliva and tissue composition the slightest variations of body health and lifestyle changes. Is your doctor taking more time to understand WHY rather than HOW?! Great! – it means he/she is treating you holistically and comprehensively; “looking” at the whole body takes time and a lot of thinking energy.
What can you do?
Inform yourself, ask a lot of questions and choose a doctor focused on taking care of You and not just the teeth and gums. Doctors who keep their knowledge up-to-date really enjoy patients asking a lot of questions. It gives them the opportunity to get to know the patients better and to educate them on prevention. Now, that is true medicine.
Dr.-medic stom., D.D.S. (USA)
“How could that be? When I snore, I sleep with my mouth open!” … says everyone. And in fact, they are right but they are also wrong. Teeth clenching still occurs episodically during the night, for some people more often, for others less. The cumulated effects over years can lead to damaging tooth wear associated with a bite sinking effect, tooth movements, enamel/porcelain fractures, teeth cracking and yellowing…
The latest studies analysed in depth the connection between snoring and clenching/grinding. Independently from each other, researchers from all over the world discovered that episodes of low oxygen levels in the blood stream – due to less air reaching the lungs – causes the brain and heart to go in “panic mode” followed by:
- Heart rate accelerates to compensate for less brain oxygenation
- Brain “wakes up” from deep sleep to a more superficial state
- U.A.R.S. – Upper Airways Resistance Syndrome – due to the difficulty in breathing (snoring), chest pressure becomes negative by comparison with the abdominal pressure causing an acidic reflux from the stomach in the esophagus
- As an automatic reflex to compensate for the lack of oxygen, we slightly wake up (toss and turn), raise the head off the pillow and clench the teeth together
- Clenching is a reflex in bringing the lower jaw forward together with the tongue so the airways get opened for more air.
It has been also found that many people who are snoring are also suffering from L.P.R. – Laryngopharyngeal Reflex or the Silent G.E.R.D.. This is a form of acidic and non-acidic (pepsin) reflux that does not respond very well to medication and is constantly “burning” the larynx and/or pharynx, past the upper esophageal sphincter. These tissues are not designed to withstand such acidic aggression and they get inflamed, the throat membranes swell up restricting even more the airflow and also increasing the risk for throat cancer. Few signs of L.P.R. are:
- Voice hoarseness in the morning
- The need of constantly “clearing the throat” (mucus excessively produced by the body to defend against stomach acids reaching the throat)
- Restless sleep or insomnia – low sleep quality due to difficulty of reaching and remaining long enough in the deep, regenerative sleep state (sympathetic vs parasympathetic healing sleep)
- Jaw muscles tired and teeth sensitivity/looseness
How can a dentist discover these issues?!
Simple, we often see excessive enamel wear on the front teeth but not so much in the back teeth. The lower jaw is pushed forward in a reflex attempt to open the throat for air, bringing the front teeth way more often in contact. Normally, teeth come in contact just 20 minutes a day and this is when we swallow. Having them in contact more than that, especially in a forward position (edge to edge) and while experiencing episodes of snoring possibly associated with restless sleep, could be the signs of your body trying to cope with a developing problem. Maybe it hasn’t developed yet in an Obstructive Sleep Apnoea (O.S.A.), which is a much more serious condition, but the risk is definitely increasing.
If not properly diagnosed, any attempts to cosmetically repair the worn front teeth will most likely end up with repeated restoration failure. Simply put, the teeth are not the issue but just the victim of a complex problem, otherwise treatable based on a correct diagnosis.
What to do?
Tell your dentist about any episodes of snoring, restless sleep, jaw muscle tension and/or heartburn. There are technologies nowadays that can be used to determine the true cause of problems. One of them is a portable sleep/breathing monitor that I even tried myself and I often prescribe to my patients. It proved to be very useful in finding the right bite/jaw position for optimum breathing and a regenerative deep sleep. Correlating the findings with the jaw muscles tension led to a long-lasting dental treatment and also prevented more serious issues.
Dr.-medic stom., D.D.S. (USA)
Professional Teeth whitening is a fulfilling and sought after dental procedure meant to improve the smile contrast with the other aesthetic facial features. It has been practiced even by the ancient egyptians, as a method of influencing the social interactions by communicating health, beauty and affluence. At first glance, even today it seems to be a rather aggressive procedure, making use of powerful oxygen releasing substances – peroxide. Many patients are expressing their concerns about it, also due to the rumor that is painful. Of course, the teeth whitening systems evolved quite a bit in the last fifteen years and they are perfectly safe. In my over 16 years of experience in using multiple bleaching systems (Laser, Blue Light, Trays, Strips…) both in USA and Germany,
… I noticed that pain is actually not a significant issue and the teeth are not damaged (on a contrary, they are strengthened) if a certain protocol is closely followed.
To better understand how bleaching works – physically and emotionally – we’ll look a bit at the facts of teeth coloring and white perception. The actual shade of a tooth is determined by combination of dentin color, enamel transparency and its mineral content. Dentin is more yellow, “shining” through enamel which is more transparent. Enamel can let the dentin color go through more or less depending on the mineral content and the distribution of such minerals. Teeth can also stained at the surface or from inside:
- Intrinsic stain (dentin stain) – such as tetracycline stain or fluorosis, caused by chemical/biological processes from inside of the tooth and they cannot be removed through external bleaching.
- Extrinsic stain (enamel stain) – such as those caused by coffee, wine, teas, smoking, etc. and they are located on the superficial layers of teeth.
Upon removing the extrinsic stains and changing the optical properties of enamel, light quality and quantity reflected back to the eye changes. Hence, the appearance of white is enhanced through more light getting reflected vs. refracted (light wavelength also incurs less phase change through reflection) – that is why matte white looks “whiter” than glossy white.
How is Teeth Whitening working?
The professional procedure involves powerful peroxide-based gels placed only on enamel. They remove all the surface stains through oxygenation and breake down the chromophores’ bond to large, dark molecules inside the enamel. Meanwhile, the superficial minerals are also extracted, giving the teeth a more opaque appearance. After bleaching, teeth are more susceptible to stains but with the Pure White protocol. This risk is almost completely eliminated through to a powerful and high quality remineralization. This is based on a research first initiated in Japan at the Showa University in Tokyo, where they found that In-Office bleaching is much more beneficial to the tooth structure than at-home bleaching due to a better remineralization pattern and consequent stronger enamel resistance against mouth acids.
What “speaks” against Teeth Whitening?
Caries, enamel cracks, excessive biofilm and tartar, periodontal disease with recessed gums – root surface exposure might give a lot of sensitivity if not properly covered. In other words, before attempting any type of bleaching, a thorough dental exam is necessary. For the best results and minimum sensitivity, the procedure type and the sequencing of teeth whitening with other dental procedures need to be individualized.
Which are the benefits of Teeth Whitening?
The most powerful effect is the contrast enhancement of the smile in relationship to the other facial features. Depending on the type of complexion, eyes color, white of the eyes, lip form, hair color, the newly bleached shade can be anywhere between very dominant (darker skin, dark eyes and hair) to nicely integrated with the face (fair skin, blue eyes, blonde hair). Bleaching provides a distinctively brighter smile which thereafter only with the Pure White protocol can be toned to a shade that fits best one’s aesthetic outlook. The emotional gain is immense and the social benefits are also not to be neglected.
In the same time, with the remineralization protocol the teeth gain a newly-infused high quality mineral layer, which makes them stronger against acidic foods or drinks.
In conclusion, tooth whitening is a safe and beneficial procedure as long as it is done with products chosen specifically for your needs and while the dentist is designing the appropriate protocol for bleaching, remineralization and shade maintenance/toning.
Dr.-medic stom., D.D.S. (USA)
The obvious goal of medicine is to preserve health and minimize disease.
This is also called prophylaxis (a combination of Latin and Greek words dating almost 200 years in the past). How efficient is medicine today in doing that?! Quite efficient considering that the average human lifespan has more than doubled in the last 100 years. Insurances do have a beneficial impact by enabling access to necessary medical procedures otherwise too expensive to afford on everyday basis.
How do the present and future look like from the perspective of medical care?
In the past, medicine was concerned more with repairing and healing. Nowadays, we are more concerned with the preservation of function and structure for as long as possible. Given the considerably longer lifespans and the latest knowledge, methods and diagnostic tools available today, reactive medical care is considered unacceptable. Instead, proactive prophylaxis and individual risk management are the keys in health preservation. A total body approach is the new approach of the healthcare prevention systems. In other words, the focus on modern medicine is on early systemic diagnostics.
How do insurances fit in the picture?
Insurances, by definition, are reactive systems, protecting against damage and enabling expensive repair. An overhaul in their structure is necessary to shift focus from procedure to diagnostics. This will also have an impact on the medical educational system. Doctors will be trained to “stay” more in the diagnostics mode and understand patients better rather than quickly jump into “symptomatic treatment”. In insurance “talk”, procedures are the ones to be paid while diagnostics is inclusive, therefore shifting importance away from systemic diagnostics to limited procedural treatments, sometimes only symptomatic (palliative). With the development of computerized medical technologies, the amount of diagnostic data has increased exponentially requiring even more attention and effort in correctly interpreting the true root of the problems. Diagnostics and risk management have never been more important than today and the healthcare systems need to quickly adapt to the new medical standards.
What can you do about it?
“Don’t get hung up on HOW until you know WHY!”
Ask your doctor first Why health has been compromised and only afterwards How can it be fixed. In the medical profession, we “See only what we know and treat only what we see”. It is therefore critical to collect thorough diagnostic data and take the time to see and understand big picture. The diagnosis is only one! Insist on your insurance to cover a thorough, interdisciplinary diagnosis and … don’t forget to get a second opinion.
Dr.-medic stom., D.D.S. (USA)
Part of the new wave of computerized dental technologies, smile simulator software are offered by different companies and educational institutions, enabling dentists to visualize and communicate a virtual smile design. For patients, the educational value is very high and quite emotional. Like any new technology, it also comes with pitfalls of which patients should be aware of:
- A smile simulation alone has only a cosmetic value. It needs to be further tested to see if the prototype smile can be actually achieved in reality.
- “Form follows function”. Any alteration of the teeth shape and position will most definitely have a functional impact: chewing, speaking and even breathing. A digital smile prototype alone cannot provide any information about patient’s functional status.
- The color rendering from a computer screen can be slightly different in real life. Tooth structure and dental ceramics posses much more sophisticated optical properties, which cannot be replicated by flat computer screens.
As I outlined in the article “Esthetic and Functional Dental Digital Imaging” published in Contemporary Esthetics in 01.2007, digital imaging should not be used to emotionally manipulate the patients into accepting an esthetic treatment. Such technology should be used only to confirm an already established comprehensive diagnosis and visualize a treatment that is both medically necessary and functionally possible. The digital smile prototyping is especially useful in proving or disproving if the patient’s expectations can match the medical necessity.
When and how should smile prototyping be done?
… only used in conjunction with other techniques and skills that complement the enumerated pitfalls:
A Smile Simulation +
1.-1 A completely reversible mock-up (composite material temporarily sculpted on the teeth but not bonded) can show if the new tooth form and position can be tolerated by the patient – speaking, chewing, facially-integrated…
2.-2 A functionally-integrated wax design can confirm if the jaw joints geometry and muscle dynamics can be tolerated and accept the new smile design.
3.-3 Computer-designed and manufactured provisionals can provide valuable feedback on the light reflection/refraction with the tooth surface, color depth/distribution, translucency and texture. This way, the new smile design can be evaluated from different light angles and in various environments.
In essence, a digital smile simulation is just the beginning on the path of discovery if a necessary dental treatment can also complement one’s appearance, character and biology.
Dr.-medic stom., D.D.S. (USA)
In sharing knowledge lies the power of discovering new ideas
Information at the right time and related to the right question is invaluable, especially in medicine. It could mean the difference between restoring health by removing the cause or postponing health by addressing just the symptoms.
That is why, nowadays, doctors have to communicate as much as they treat patients. Having an informed patient as partner in treatment has a distinct positive effect on treatment efficiency, comfort and permanency of results. Modern medicine is addressing the risk factors rather than the pathology, intercepting the disease in its early stages or even preventing its inception.
In my over twenty years of practicing dentistry, patients asked me many questions related to teeth, gums, chewing, smiling… A question is the perfect opportunity for discovery. Our job as doctors is not to tell patients what to do! It is to facilitate the next question so the discovery process can continue and together understand what is takes to restore as well as preserve Health.
From a multitude of patient questions, I selected a few, the most relevant in my opinion and I answered them based on the current stand of medical research. Today, I am excited to announce the first edition of my printed blog book – “A Collection of Blogs” – dedicated to everyone looking for answers or simply wanting to know more about oral health and the art of a beautiful smile.
First of all, Beauty lies within our perception. We experience it about others and we are very subjective when we evaluate ours. So the question is: how do we see others beautiful?! Tip: it is not only the looks.
“BEAUTY LIES WITHIN THE FITNESS OF PARTS IN MOVEMENT”
“THE ANALYSIS OF BEAUTY” – WILLIAM HOGARTH, 1753
In his 1753 book “The Analysis of Beauty”, William Hogarth outlined the principles lying at the foundation of visual aesthetics. It is not the individual details that matter but the way they “fit together while in movement – function”, the “variety”, “regularity”, “simplicity”, “intricacy” and only lastly “quantity”. In his analysis, an S-shape curve (serpentine line) is the ultimate reflection of beauty, exuding dynamism.
But this is just half of the story: aesthetic parameters in movement need a purpose. The most powerful human motivator is happiness. The emotion that “gives us wings” also makes us look more beautiful than we can ever imagine. From far away we can see happiness : rosy cheeks, sparkling eyes, chin up and a big, big smile! Often hands rise up to touch the sky… We all know how it feels: it is grandiose. We are constantly on the pursuit of happiness and we have a fine eye for seeing it in others, perceiving them as beautiful. This has been also extensively researched with surprising results about the smile alone:
- Smiling happily makes us look more intelligent and attractive
- Smiling triggers additional release of endorphins, dopamine and serotonin – the euphoria mediators
- The smile stimulates our brain reward system. A smile can generate the same brain stimulation as up to 2000 chocolate bars.
- Univ. Uppsala, Sweden found that is very difficult to frown while looking at someone who is smiling.
- … and the list can continue.
So, how we can we restore beauty?! Quite simple: in the heart and in the details that reflect what we feel – appearance. Do the smile, face, hair, skin tone need to be specifically designed to show happiness or the other way around: to communicate happiness?! Displaying happiness without the true inner energy is basically a cosmetic cover-up (a mask). Reflecting actual inner joy is much more powerful and does not require all aesthetic details to be perfect. We have a fine sense for detecting the difference: we can feel the energy / glow / character. Imperfect aesthetic parameters of the face and smile are seen more beautiful in the presence of emotion, being labeled as “character-carriers”. For instance, a fine balance between imperfection and apparent symmetry complements the aesthetics of a smile.
Can aesthetic medicine/dentistry help?! Only through restoring Health so the energy robbed by disease or dysfunction can then be transformed extrovertly into joy. All we have to do is restore the “fitness”, “function” and “intricacy” of the body; beauty is just a pleasant side effect of health and happiness.
Dr.-medic stom., D.D.S. (USA)
Occlusion – the way teeth come in contact with each other and the role it plays in the context of mouth/body health.