Spring time almost felt like spring time Saturday, minus the wind and cold water.  The ocean water felt like full-on winter Saturday as I surfed a few waves in the wind storm.  The water temp was 39 due to the "upwelling" effects that western, offshore winds have in early spring in our parts, namely the Atlantic Ocean.  The warmer surface water is blown out to sea, as cold water cycles in to fill it's place, the water in the surfzone drops in temperature.   Dropping into a wave on my 10' Tudor Classic pin felt like 2 or 3 firefighters trying to put out a fire on my face, with ice cold water.  Nevertheless, it was still fun to make some turns and enjoy the ocean after a long, hamstring influenced layoff. 

Another Springtime phenomena, is sinus congestion and infections, sometimes allergy related.  In February of 2012, The Washington University School of Medicine in St. Louis, Missouri released an important study of antibiotics and acute sinus infections, and was published in JAMA that same month.  The purpose was to give namely primary care physicians the evidence needed to tell patients they will get better on their own, and to not take antibiotics.  The researchers saw no difference between the patients given Amoxicillin and the placebo.  Hence, they concluded antibiotics are unneeded for symptoms to resolve in 10 days.  As well as they intended, 

I have the following comments on this study:

1.  Amoxicillin is not the drug of choice for sinus infections.  Streptococcus aureus, one of the bacteria involved in a bacterial rhinosinusitis produces Beta-Lactamase which renders drugs like Amoxicillin inactive.   Yep, you read it correctly,  Inactive.  However, when combined with clauvonic acid (Augmentin), the amoxicillin can fight the infection.  The clauvonic acid acts like a "suicide molecule" and inactivates the Beta-Lactamase, allowing the Amoxicillin to fight the infection by killing the bacteria, even resistant-bacteria.   

2.  Hence, Amoxicillin and placebo comparisons are useless because neither will fight the bacteria causing the infection.

Lets compare something useful to determine evidence for clinician direction.  Lets compare the symptoms of one group of patients' breathing in steam (boiling salt water) versus another group of patients taking antibiotics that would help symptoms, such as augmentin. 

My bet is breathing steam would be better for the patient and safer when factoring in the 6-7% of patients that will have an adverse reaction (Alanis. A, and Weinstein AJ. 1983)  Nasal sprays such as Oxymetazoline (over-the-counter spray Affrin) are effective but should never be used more than 3 days.  More than 3 days can cause rebound congestion rendering the medication inactive and symptoms to worsen.

Take home points: amoxicillin is useless for sinus infections and needs to be combined with clauvonic acid (augmentin).  Try breathing in steam, using a netti pot, and getting to the root of the infection cause (deviated septum, clogged ostium, infected tooth) prior to reaching for that antibiotic. Keep wishing on Spring conditions. 

In the first 6 months of our life our weight doubles.  In the first 3 years of our life, our height doubles.  This proportional growth is not seen in human growth and development again.  Obviously, early child development is critical for our wellness.  If the young moms reading this are not stressed enough following the gluttony of recommendations for your children's health in our present "information age," may I add another thing to your watch-list, but not your stress-list.  Make sure your children can breathe through their noses.  If they are not, get them on the right medical track to correct the problem, not the symptoms.  It is very important for your children's normal growth and development. 

My dental school classmate Adam used to torment his fun-Uncle, with the above expression as a greeting.  Napolean's profile and facial expression is an example of a "long face," or sometimes referred to in medical literature as "adenoid face."  Lack of chin, open mouth, short upper lip, small underdeveloped nostrils, and gummy smile.   This prevalent facial deformation has been linked to a simple but chronic, nose blockage.    Proper breathing in early child development is essential for the normal growth of our children, but strong evidence suggests tonsills and adenoids are secondary to the real problem, a chronically stuffed nose.   First some background, then our recommendations.

60% of our facial skeleton is formed by the age of 4.  By the age of 12, our facial skeleton has typically surpassed 90% of it's growth.  In the US, children are typically referred to orthodontists at 11 years of age despite the American Academy of Orthodontists recommendation of 7 years of age.  This is significant because we are utilizing orthodontists way too late.  Earlier interception could allow the talents of Orthodontia to guide and develop childrens facial skeleton way easier that at age 12 when the skull is 90% of it's overall size.  For all parents scratching their heads about the last statement, orthodontics do way more than straighten teeth for growing children.  However, this is a topic in itself that I can elaborate on separately if interest is there.

What happens to a child that has a long-term nasal stuffage (months-years) and breathes through his/her mouth?  A cascade of muscle events that is unpredictable occurs, but varies in adaption individually.  Normal tongue position is on the roof of our mouth when breathing properly.  Therefore, proper breathing will actually shape the palate or roof of your mouth (your tongue should fit into the pocket of the roof of your mouth) by pressing the palate while breathing.  The muscle, our tongue, shapes the bone over time by proper position, just like glaciers and water cut through rock with time.  Time and frequency are direct factors.  It has been reported we swallow 2000 times per day and breathe relatively every 3 seconds.  The time and frequency our tongue spends on the roof of our mouth shape our development oral-facially. 

A mouthbreathers tongue drops to the floor of the mouth.  The tongue then protrudes (sticks out) to allow a greater volume of air into the back of the throat.  This is probably due to the ineffectiveness of oxygen delivery to the lungs when mouth-breathing.  This effects the muscles that swallow and changes our swallowing patterns.  The nostrils underdevelop by "disuse atrophy," or don't develop properly due to lack of use.  The lip appears short because it is not needed to balance out the tongue when in proper position.  As you can see, a cascade of muscle changes occur.  Remember, muscle shapes the bone.  Also recall that skeletal growth doubles in the first 3 years, then grows another third before the age of 12.  These different muscles pulling in an unbalanced fashion, cause alterations from our normal growth.

The changes in our muscle then shape the bone growth by pulling at the bone in an unbalanced fashion.  The jaw rotates backward causing a "vacant" expression with an open mouth.  The chin rotates downward when the jaw goes backward.  Dropped, double chin makes the face appear long.  The resultant gummy smile is a common result.

 Thus, the long face in some individuals was a result of a chronic nasal obstruction.  Typical presentations of an adult patient that dealt with this as a child include  TMJ signs and symptoms, a gummy smile, and a history of breathing problems and sinus infections.   The facial skeleton is already formed with built-in dysfunctional muscle imbalances.  The rest of her young life we will treat her symptoms palliatively because we can't correct the source of the problem, because she is already fully developed.  Some doctors recommend surgical correction, breaking jaws called "orthognathic surgery," and repositioning them.  However, aside from having your jaws wired shut for 6 months, we see a high relapse rate, meaning the jaws get pulled back to their original position because of the developmentally incorrect pull of muscles. 

 I assisted over 12 orthognathic surgeries in my residency performed by a team of surgeons.  The surgeries would take over 8 hours as we fractured the upper jaw off the skull (called a Lefort fracture), fractured the lower jaw on both sides then pulled the lower jawbone forward and placed titanium plates to hold the new position.  We did a chin graft to improve their profile.  We performed cheekbone implants and installed them, all to improve the effects of a chronic childhood breathing problem.  As I hope you now realize, the key is prevention.  A little more info, then the recommendations.

The best analogy in nature I have found is this.  Oxygen is to humans as sunlight is to trees in the growth phase of development, not for respiration.  Do you see how this tree is deforming trying to reach it's growth source?  The body also deforms its growth in the attempt to get more oxygen to our system.   This rubber tree sits in a corner between two windows.  It deformed by growing sideways to get to the sunlight. 

I am an evidence-based restorative and surgical doctor of medical dentistry.  The recommendations I will offer are based largely on my experience treating 3 converging fields; sleep apnea, TMJ disorders (TMD), and sinus evaluations using a digital CT scanner in my office primarily used to surgically place dental implants.  I cannot say I have concrete evidence that this is a definitive occurence.  However, prevention is key and I cannot think of one single reason why improper breathing would be a good thing for our bodies.   My qualifications to offer a recommendation:

As stated previously, I was on a team of doctors in my residency that performed over a dozen orthograthic surgeries to correct the chronic childhood breathing problem in adulthood.  I have treated sleep apnea with appliance therapy since 2002 when I earned a certificate for Orofacial Pain Management while in residency with the USAF at Keelser AFB in Biloxi, MS.   This training helped me recognize airway problems in my patients.   I have treated craniofacial problems such as TMJ disorders since 2001 while focusing on proper positioning of the lower jaw into the skull to reduce muscular activity and muscle tension. I receive many referrals from local physical therapists, chiropractors, physicians, and dental specialists for treatment of their patients TMJ/TMD problems.   I surgically graft sinuses and take/view hundreds of CT scans in my office to evaluate our patients sinus anatomy evaluating their anatomy and have worked with local ENTs to improve airways for my patients. 

Recommendations for the concerned mother:

1. Any chronic nasal obstructions (long-term stuffy noses) should not be taken lightly nor treated with antibiotics as the first line of defense.

2. Ensure your medical team of pediatricians, dentists, ENT, and allergist can recognize the problem first.  Your team should have the same philosophy as you regarding the health of your child.  Pills for treatment (i.e. antibiotics) are oral bandaids that do nothing for the problem if chronic. 

3.  Get allergies under control (even if you have to remove a pet) prior to having tonsils and adenoids removed.  Sinus allergies precede infections.  I have seen many children with their tonsils and adenoids removed yet have an nasal airway obstruction.  It is my opinion that tonsil and adenoid removal is routinely secondary to the nasal airway obstruction. 

4. Do not be fooled into thinking chronic mouth breathing is normal.  It is not.  It effects the facial bone development of a growing child in addition to nearly every one of our systems from breathing, to sleep, to chewing, etc. 

5. Early interception is better and easier than a mid-course correction.  An adult correction can be very aggressive (orthognathic surgery) or only palliative in nature (unable to treat the source or problem; only able to treat it's symptoms.)

6.  The biomechanics of our bite, longevity of our teeth, reduction of TMJ-related headaches, improved muscular function, and a toothy smile are some of the benefits of breathing properly your children's dental well-being.

7.  Improved concentration and brain development (improved oxygen), improved energy levels in "lazy kids" that may be under-oxygenated, improved athletic performance (more oxygen to muscles is better just ask Lance Armstrong), improved facial profile, better sleep, reduced cardiac problems linked to sleep apnea, are some of the reported advantages by improving nasal breathing in growing children.  If you want to feel the difference, do one of your normal workouts with a motorcycle helmet on.  Wait until you see the difference in your performance from balance to strength and endurance. 

Recommendations for the overly-concerned mothers (you know who you are);

1. Don't panic, your child will be alright.  Knowledge leads to recognition.  Recognition leads to diagnosis.  Diagnosis leads to successful treatment.  Successful treatment early will improve your childs development.  There are plenty of individuals I am sure, that defied the odds and still matured in a normal fashion with unnoticeable changes. 

2. Do not start asking doctors to radiate your child with a medical CT scan to determine if your child's breathing complex is healthy.  Go by the signs and symptoms.  Medical CTs (MSCT) have much more radiation than the digital CBCT (cone beam CT scan) found in dental offices. For comparison, MSCT of the upper jaw only is roughly 1400 (units of radiation).  My digital scan for both jaws is 130 (units of radiation). Less than ten times the radiation of a medical multi-slice CT scan, with more information.  A plane flight from Paris to Tokyo is roughly 139 (units of radiation) for comparison.

Recommendations for mothers with "internet based medical knowledge" rather than a medical degree;

1.  There are many doctors out there with a deeply caring disposition.  Find them and do not determine your children's future health because of poor experiences or misdiagnosis of previous ailments in your life.  In some instances, medicine can be trial and error due to lack of ability to objectively determine. 

2.  The internet is an excellent tool to find information.  The problem can be if your sources are not evidence-based.  In our information age, anything can be stated.  Look at politics.  Just because things "make sense," does not make them true.  Be critical of your sources of information and learn how to critically evaluate a study.

3.  Alternative medicine is a great blend for "western medicine."  Alternative medicine involving prevention.  There is an emerging form of alternative medicine appearing mostly on the internet, that is business based and not evidence based.  Be critical.  A broken clock is correct, twice a day!  

Today's blog will concentrate on the different materials we as dentists use, to fix teeth.  This blog is posted as a reference for patients to access when determining what material is best for their mouth.  We discuss biocompatibility including mercury-fillings, and BPA containing fillings.  We recommend any of our computer designed restorations.  We advise against "silver fillings" and "composite resin" fillings for most applications. 

 A historical perspective was included in these material discussions to help you understand why some materials were used in the past. Just like furniture or sneakers, there are tons of different materials that can fill an immediate need.  Some dental materials were developed and are good for cheap public health if your personal goal is to have the cheapest job done today.  However, just like cheap furniture or cheap sneakers, cheap materials lead to future problems involving breakage.  The major difference resides when cheap furniture or sneakers fail,  routinely the body part is unscathed.  If your foot needed to be removed because of the damage caused by a sneaker, the manufacturer would go out of business after all the lawsuits.  However, many large silver fillings fail and take the tooth with it, meaning that the remaining tooth is unfixable.  We accept this as the normal consequences of aging and health.  30,000,000 edentulous americans (without any teeth) could probably speak out and confirm what I am saying. This is not a normal aging process.  This is a failing material process.

I am here to say that by taking control of your own health, engaging your dentist in a discussion about materials is a good thing.  Oral health is not determined solely by genetics.  Oral health is determined by an individuals' effort to clean their gums and teeth (brushing, flossing), having professional cleanings bi-annually (at least), and having an expert supervise your biomechanics preventing headaches, broken teeth, sensitive teeth, root canals, cracked teeth, missing teeth, etc.  When patients commit to this level of oral health, small problems are found before they become larger.  Fillings occur rather than root canals.  Minor problems are corrected before they become expensive "projects." The field of implant dentistry I believe, has grown rapidly in the last 30 years reflecting the dental materials used.  Choosing a "temporary" silver or resin material is a guarantee for future work needed. 

Below is a material summary to reference.  It is rather informative when you compare the latest technologies compared to the 19th century filling materials that are still be used today.   

Computer-Designed Restorations 

We use several brands of porcelains and ceramic filling materials from different manufacturers. Starting with the top-of-the-line material, EMAX porcelain.  We can use it on every tooth in the mouth for any application such as inlays, onlays, crowns, or veneers.  This is my 10th year providing computer-designed restorations.  We use the original CAD-CAM system Cerec to provide our restorations.  Cerec is just a tool.  Those few individuals that have said Cerec restorations don't work for them, realize the Cerec is just a tool.  The restoration is more determined by the "archer than than arrow," if you understand what I am saying.  

EMAX

The strongest, most beautiful porcelain we offer.  Lithium-Disilicate is the material of choice for large restorations on back teeth.  Works well for grinders, clenchers, or ice chewers because it will last longer than other materials.  Translucency resembles natural teeth.  Great toughness.  Best option to restore most molars.

Material                                Fractures at:

cement                                 10MPa

Enamel                                 45MPa

Porcelain                              120MPa

EMAX                                   360+MPa

3M Lava Ultimate 

A resin- nano ceramic offers our patients a more economic alternative to EMAX and a better solution to composite resins that wear out on average every 6 years.  They have increased flexural strength allowing the material to flex rather than break.   Good solution for implant crowns.  Good economic solution for posterior teeth however, bonding problems have been reported.  We will begin offering this product some time in 2013 when the evidence supports better bonding to teeth.  We are currently using a different 3M product called Paradigm.

3M Paradigm

We have been using this material since 2004 with fabulous results.  Ultrafine zirconia crystals dispersed in silica improving wear resistance and strength.  I started using this material almost 10 years ago because you can fix them easily if they fracture, as opposed to porcelain fillings.  It made perfect sense for my grinding patients! 

I still have yet to have a single broken 3MZ100 restortion almost 10 years later!  I have seen 4 or 5 debond out of 750+ restorations.  Excellent alternative for moderate size cavities in molars.  Great option for an economic alternative to Emax porcelain. 

ECAD by Ivoclar

Leucite glass ceramic material with nice translucency, similar to natural teeth.  I would say this is the average ceramic out there.  Great esthetics, great bonding, 160 MPa flexural strength.  The material has several transulcency options for different situations.    High translucency ceramics chameleon the surrounging colors of the tooth to "hide" the restoration.  The low-translucency ceramics block out dark teeth (tetracycline stained, dead and discolored teeth, previous silver-filling-stained). 

Coming soon!  Vita Enamic

Vita Enamic  

This hybrid Ceramic has just been released.  It's reported benefits seem promising.  The idea combines the benefits of ceramics with composite resin.  Combining properties such as stiffness and resilience.  Wear resistance and wear kindness to opposing teeth.  These are properties that have conflicting engineering principles but are able to be combined in this material.  Instead of ceramic crystals floating in a sea of polymer, these ceramic crystals are all crosslinked.  This is essentially the breakthrough.  Composite resins don't have a network, they have filler.  This is the first resin-ceramic that has a network of ceramic particles acting collectively rather than individually.  The company states a better failure resistance than even EMAX.  Abenaki Dental Care will be awaiting non-biased test results prior to offering this material in 2013, but it seems promising.

Dental Amalgam "silver fillings"

An alloy of mercury (50%), silver (22%), tin (14%), copper (8%), and other trace metals.  The toxicity of the mercury has been questioned since the civil war.  Civil-war era dentists were also placing lead and asbestos in mouths.  We still debate this today with huge organizations leading the charge.  In 2008, Sweden, Norway, and Denmark banned the mercury fillings from being placed.  The WHO (world health organization) has a similar position to the Netherland countries.  The ADA (American Dental Association) still supports the usage of dental amalgam stating "...is considered a safe, affordable, and durable material."  Our opinion is more in line with the World Health Organization rather than the American Dental Association. 

Abenaki Dental Care only removes silver fillings.  We do not recommend or use dental amalgam.  Dr. Heimbach has not placed a silver filling in his private practice career.  Aside from the mercury toxicity argument, they pose many other problems. For example, they are not "glued" in because they count on the bacteriostatic effects of the mercury.  The lack of seal allows bacteria to get under the amalgam rather quickly.  Combine the lack of seal with the thermal expansion and we see a recipe for disaster. 

You see, everytime a patient drinks hot coffee the metal inside their teeth expands.  This can cause cracks in the teeth.  Whenever the patient enjoys a cold beverage, the metal contracts within their teeth.  This shrinkage/expansion causes the metal to "creep" out of it's hole allowing bacteria to get in between the filling and the tooth.  This was a great 19th century material that we no longer need because we have better options.

Other problems include how we prepare the tooth to "hold onto" the silver fillings.  Dentists undercut the tooth cusps to allow the material to be "retained" within the tooth.  Let me say that again.  Dentists UNDERCUT the cusps!  The cusps are the load bearing portion of the tooth and by undercutting them, the dentist sets them up for fracture.  This engineering violation cannot be argued.  If it were my tooth, I would prefer to have my restoration bonded or glued into place rather than undercutting my cusps weakening my tooth.   

We highly recommend removing mercury fillings with a rubber dam to prevent swallowing the mercury and metal material. 

Composite "white fillings"; plastic; resin fillings   

Two discussion points with these materials used in 99% of dental offices in the USA.  First, most resin fillings contain BPA (Bisphenol A).  We use a non-BPA formulated filling material made by voco.   Second, these materials are soft and should be used for anterior (front teeth) fillings where chewing forces are small or for micro-sized holes in posterior teeth (back teeth).  Any cavity larger than micro on back teeth should be restored with computer-designed indirect restorations primarily for longevity.  However, the computer fillings also provide increased strength and decreased sensitivity in comparison.   

BPA is a chemical that some health organizations consider a carcinogen, other agencies do not.  The National Institute of Health evaluated the evidence of BPA as a carcinogen.  They concluded there was not direct evidence but an increase in cancer susceptibility was found. 

The landmark dental study on BPA had several findings.  They measured the BPA levels of kids before a composite-resin filling and BPA levels after the resin filling was placed.   The BPA levels immediately after having a composite filling placed were increased for roughly 15 minutes, then leveled off toward baseline levels.  Interestingly, each individual prior to having the composite filling placed, already had BPA in their mouths when attaining the baseline levels.  We live in a plastic world.  Even 2000 miles from Los Angeles.  It is hard to avoid BPA in 2013 in America. 

We prefer not to place resin in our patients molars because they are soft.  A recent past ADA president released a study in September of 2012 that reported an average longevity of 6 years.  Digging your fillings out each 6 years is putting the health of your tooth at risk.  We use this material for small fillings or anterior fillings only.  We also use a BPA free filling material as does most dentists.  However, the "glue" has trace amounts of BPA as well. 

That concludes the material discussion.  Keep in mind your job is harder today than it was even as little as 100 years ago.  Your job is harder because we live longer.  Life expectancy in Roman times was 27.  The middle-aged Alexander the Great conquered the world at 16!  19th century the life expectancy rose to 42.  Today it is 85 years of age.  We effectively doubled our life expectancy in the last 100 years roughly.  Your teeth have to last longer.  30% of American over the age of 65 are missing all their teeth.  If we don't learn from the previous generation, how can we move forward.  Choose health!  It is almost always the best option. Happy St. Patricks Day 2013.

Rory Mcilroy:  Not a Hockey player!

Wisdom tooth pain ruined Rory's chances at the Honda Classic in Palm Beach Gardens, Florida this week.  His competitors complemented his decision to put off the dentist, welcoming the field to the $6,000,000 purse up for grabs (cue in sounds of a wooden box being dragged across concrete.)  Soapbox please!   I understand it is not fun to frequent the dentist and there are more rewarding adventures to be had elsewhere.  However, talk about a missed opportunity for Rory.  He embarrased himself walking off the course after firing a +7 in the first 8 holes, declining the chance to grab the largest share of the 6 million dollar purse.

As spring quickly approaches, let's learn from Rory's wisdom tooth experience rather than his golf swing which few of us could emulate.  Small dental problems = small dental solutions.  Putting off dental problems leads to unplanned emergencies, unplanned dental bills, pain and swelling, and worsening of the condition.  Attending to the problems when recognized leads to planned expenses, smaller bills, no pain or swelling, and resolution of a problem.  "It might just cost you a share of 6,000,000 dollars one day," can now be a documented risk on consent forms. 

Now, after properly bashing the young lad lets offer a genuine thank you to Rory and my golf pro, Ben Alexander.  Ben worked with my swing last spring utilizing Rory's training described on the titleist web site.  The training improved my handicap, made golf more consistent for me, enabled me to shoot my first under-par round, and improved my successes in tournaments. Sorry, i felt like I had to provide a ying to the yang. 

We are the team dentist for a local hockey juniors team with young men competing from Canada, Sweden, and across the United States.  These kids have skated through some pretty scary wounds.  Several of the young lads were just chosen for the all-star game in Las Vegas.  Congrats to Shayne, Ziggy, Sully, and Alfie for their selection.  

Magnetic declination is the difference between true north and where your compass points to north.  Those of you that don't understand this wont be reading this blog because you are lost.  Lame climber joke I could not resist.  This blog is for all of us that are lost when it comes to the mystery of oral health.  Most of the patients I survey think they are doing everything possible to maintain their oral health, but are only scratching the surface By brushing and flossing.

the four battles we face in our mouth:

1. Biological warfare (bacteria)  daily maintenance by brushing and flossing and semi-annual professional maintenance appointments ("cleanings") determined by your susceptibility and compliance.

2.  Bio mechanical oral stress.   Patients with a bulldog face can easily understand this.  Some of us will break anything placed in our mouths whether dentures, crowns, implants, or teeth.  Bradycephalic head shapes, "bulldog face," square jaws allow these individuals the leverage to destroy their teeth based solely on the head shape.  I can tell you stories of patients and dentists well into the $100,000 range in repair dentistry before both parties throw their hands up. Advice:  First, make an appointment for evaluation and consultation of the problems you are or have been experiencing.  I need 90 minutes of your time.

3.  Nutrition.  Sugar and flour are the evils.  Not for just cavities, but for the health of our pancreas and insulin hormonal levels, heart health, weight management, mental Health, behavior....where do I start?  

You are eating a peanut butter and jelly sandwich.  You are smiling because as soon as the jelly hits your mouth with that white bread, enzymes in saliva begin the breakdown of sugar.  Sugar triggers insulin to release.  Insulin has a message to all digesting parts of the food(protein, carbohydrate and FAT to go to the tissue for storage.  Hips, waist, arteries...the peanut butter we think is healthy is not because how we tell our body to use it.  without the simple sugars, the peanut butter is processed in a manner that uses the food for energy not storage.  Dopamine release from our brain makes us happy, telling us to eat more sugar.  Leads to depression when not flowing through our system because our "pleasure chemical dopamine" has not been released.   Our pancreas gets worn out from its involvement with insulin making us susceptible to diabetes at the very least.  Pancreatic cancer has increased in huge numbers.  Any relation to the increasing amounts of sugars in our foods and diet?  Diabetics have poor wound healing in addition to poor peripheral circulation increasing the amount of lost limbs and teeth because without blood, tissue heals poorly (i.e.Achilles tendon injury and long heal time due to poor blood flow to the area. I tore my tendon and used magnetic therapy to improve circulation, cutting my healing time in half, 3 months I was running again). Diabetes and periodontal disease have a strong correlation, so in addition to losing teeth they dsurgery a higher risk for stroke and heart disease.  How's that PB and J tasting?  

4.  Bad habits that accelerate tooth loss ("para function" and smoking)

Clenching and grinding cause more problems financially for patients unless it is identified and protected.  These unnatural forces on our teeth that we create are collectively called "parafunction."   Root canals, broken teeth, cracked teeth, failed root canals, cracked crowns, lost teeth can many times be prevented with  a simple night guard.  Some patients have actually stated they cant afford it, to which I replied "you can't afford not to," knowing the amount of bills in repairs that individual will face in maintaining their oral health in their lifetime.  

Parafunction is equivalent to driving your car, adding gas along the way, on a treadmill everyday, all day until the engine fails.  Cyclic fatigue in engines is a relative example outside of dentistry.  .  Hip and knee replacements have a shelf life.  Alexander the Great conquered the world at 17 years of age, what a teenage feat!  Life expectancy at that time was 27.   Today our teeth have to last 4 times that length of time. Signs precede the symptoms and depending on the study, only 25% of patients  have symptoms such as muscle pain, loose teeth, gumline craters called "abfractions."  

I hope this blog cast a large net mentally for all trying to grasp the concept of oral health in order to maintain their oral health.  The next blog will be on our philosophy, experience, and methods in achieving oral health for our patients. Mahalo.