SInce this is the time of year for halloween parties, I thought I would take this opportunity to discuss the facial changes in denture wearers, commonly referred to as "witch's chin."  There will be no tricks, but we will be offering a treat to all individuals currently wearing dentures or a single denture. Essentially, the face (soft tissue) changes shape because of the underlying bone changing shape.

Witch's chin starts when a patient loses all their teeth and begins wearing dentures.  Each year, for the remainder of the patient's life, that patient will continue to lose bone in their jaws from disuse atrophy.  Disuse atrophy does not only occur in the jaws.  For example, I lifted weights regularly while playing basketball in college.  My body swelled to 185 pounds.  Now I weigh 165 pounds because I no longer lift heavy weights.  My muscles shrank in size because of disuse atrophy.  I view disuse atrophy as a universal human law because I can relate other human qualities to it.  For example, I have not retained any of my language education from high school nor college.  I can't speak Spanish or German fluently anymore, because I stopped conversing in those languages upon graduation of college.  The difference between the different atrophies are:  I can build my muscles back up to 185 pounds if I chose to do so.  I can relearn forgotten languages and speak them again.  However, the effects on the jaws are not as responsive.  Once you lose it, it is gone forever.  We lack the capabilities in modern dentistry/science to grow the patient's bone back.  We have some interesting, inapplicable capabilities like distraction osteogenesis which can help build bone in isolated areas.  Physicians use bisphosphonates such as fosamax and boniva to help preserve the bone in osteoporotic individuals.  Neither are suited to solve the problem of witch's chin and loss of bone from the jaws in denture wearers. 

Obviously the best solution is prevention.  Prevention of dental decay and periodontal disease will help patients retain their teeth longer.  These measures do not help the 30 million edentulous patients in the United States of America, whom already lost their teeth and are wearing dentures.    For some individuals currently wearing dentures, there is a solution to prevent future facial changes.  That solution is dental implants.

Before we discuss why dental implants stop the disuse atrophy, let us first discuss why the facial changes occur in the first place.  In 1892, a German surgeon Julius Wolff stated that bone remodels or changes when excessive loads are placed on it.  For example, martial artists have increased bone density in their striking arms and legs from hitting and kicking things.  Weight-lifters have increased overall bone density as a result of their training.  Surfers, namely knee-paddling longboarders, will get bony growths on their knees as an adaptive reaction to the weight distribution onto their knees, called "surfer's knots."  In 1922, Misch described the skeletal structure of a 90-year-old woman without teeth for several decades.  Bone needs stimulation to maintain it's form and density.  Therefore, we see patients without teeth for long periods of time, losing the bone in their jaws from lack of stimulation (no teeth.)  These patients undergo a slow deformation of their face causing a predictable outcome.  They will develop a "reverse frown" as their face begins to change.  These individuals typically are unaware of this due to the slow process and not visiting dental offices because they feel no need to visit a dentist without teeth.

 The soft tissue, this man's face is beginning to change due to the bone loss.  This makes him look unhappy, upset, even when he tries to smile.  In addition to the disuse atrophy, dentures rest on the tissue of the jaws, blanching out the blood vessels.  This decreases blood flow to the area which contributes to the rate of bone loss. We lose bone 4 times faster in the back of our lower jaw than we do in the front of the jaw.  This results in the "reverse smile" or frowned look.  If no intervention is planned, the anterior jaws start to lose bone more rapidly causing the chin to rotate upwards, termed a "witch's chin."

The chin will continually rotate upward until the patient expires.  This is not the way most of us want to be remembered by our grandchildren.  The solution is simple.  By placing dental implants under the denture, we can simulate tooth function.  The simulated tooth function stimulates the jaw preventing future bone loss.  By preventing the bone loss, we prevent the facial changes seen in these pictures.  Ultimately, without dental implant intervention, some long-time denture wearers end up as oral invalids, unable to wear a denture with advanced bone loss rendering dental implants impossible.  I met many of these individuals while volunteering dentistry at local nursing homes throughtout the seacoast.  Garbled speech, inability to be understood, unable to chew food, dehumanized these individuals.  They were left isolated due to their inability to communicate with their own peers while at the nursing home.  The key is to not let your loved ones progess to that state.  Prevention is key.....even if you are missing all your teeth! 

If you know someone that wears dentures, have them visit a dentist to determine the level of bone loss.  At our office, the following protocol is typical:

1.  Patient visits our office and has a 3-D CT scan taken in about 30 seconds.  The computer takes about 2 minutes to create a virtual model of the patient's skull.

2.  We analyze and measure the available bone to determine the progression of bone loss.

3.  We offer recommendations by creating a treatment plan to prevent future bone loss with dental implants.  Some dentures can be converted and used to attach to the dental implants without purchasing a new denture. 

4.  Some patients can have implants placed and the denture attached to the implants immediately.  They walk in with dentures, they walk out with a denture screwed into their new implants. 

5.  We create different options (2 implants up to 15 implants) dependent on your budget and can even stage treatment over several years if it is in the best financial interest to our patients.

6.  Last but not least, we are offering ALL DENTURE WEARING PATIENTS, a free CT scan and free implant consultation for the remainder of 2012.  (nearly $500 in diagnostics saved)

Have a safe and happy Halloween!!

The 2012 Summer Olympics were pretty impressive to say the least.  Gabby, Phelps, May-Walsh Volleyball, Dream team, thrown badminton...the list goes on and on.  One thing I noticed on the face of almost all the athletes were smiles.  Smiling is the epitome of health, success, and achievements.  Sadly, some athletes that won medals were on the podium sans smile.  To the viewer, it left me with questions:  Why are they not smiling?  Are they embarassed about their teeth or smile?  Are they self-conscious?  The smile-less athletes left me with quite an impression. 

These athletes spent nearly a lifetime of dedication to get to that moment.  Sacrifice, commitment, and perseverance are qualities that all these athletes had in common.  For some of the athletes, their moment on the podium was less than joy.  What a shame?  They did not show their happiness, were unable to smile confidentally, and it left the onlookers with a confused image.  Dogs wag their tail when they are happy and social.  Humans smile.  Dogs with short tails are viewed by other dogs as "unfriendly."  What do we humans see in other humans?  Lack of smiling can give off a feeling of "something is not right," to onlookers.  Whether the beholder views a frowning individual as angry, conceited, or "different" has more to do with the beholder than the frowning individual.  The point is we humans react more positively to other smiling folk.  In addition, we are confused when someone is not smiling.  When these athletes were on the podium without a smile, I thought what a wasted opportunity. 

Opportunity comes in many different forms.  Some opportunities are hidden, others slam into your door.  The question is:  Are you ready for your opportunities in life?  If the answer is yes, awesome.  If the answer is no, take action.  Whether you feel like you should lose a couple pounds, start eating healthier, fixing your teeth, placing implants under ill-fitting dentures all improve your health and give us more opportunities.  Members of the opposite sex may view us differently.  Interviewers may view us as "this one has what it takes."  May land us a date.  May land us a job.  Who knows?  Better fix ourselves rather than buy a lottery ticket though.  I would rather invest in myself than on a dream or a 1 in a billion chance to discover which opportunities may present themselves to me in the future.

Lack of opportunity will bore a hole in your soul and make us feel helpless.  I remember that feeling when I was a child.  My Aunt Pinky had down-syndrome and had to have all her teeth removed when I was a young boy because she did not have the hand dexterity to clean her teeth.  My family could not afford dentures for her.  She never was able to talk to me, which probably didn't bother her at all.  However, to this day, it still bothers me that I could not help her.  However, the situation created an opportunity for me when I visited my dentist.  I asked him  about the reasons my Aunt Pinky had her teeth removed.  He took a liking to me and spent time with me showing me what dentistry was about.  He showed me how to become a dentist.  Thank you Dr. Joe Maximiek for giving me the opportunity to help others and for giving me direction in my life. 

In my short 38 years of life, opportunities have always presented themselves.  Some have been good, others not so much.  For example, the Air Force scholarship in dental school that I was awarded was an opportunity I took without thinking about the consequences.  It "felt" right.  Little did I know it would accelerate my knowledge and abilities in my career, allow me to live in places like Santa Barbara, and connect me with a rather large network of similar professionals.  My thoughts were on saving $150,000 in tuition to be honest.  Despite serving during two wars, I felt fortunate for the opportunity to serve my country and I feel fortunate to never stepping a foot in "the desert," where thousands of soldiers took their last step. That is the interesting thing about opportunity, you never know what it will bring into your life, either positive or negative.

Preparation for a moment is an opportunity in itself.  Self motivation to improve our health and wellness, eat better, get more sleep, spend more time with our kids, volunteer more all have positive outcomes.  The opportunities from those outcomes can help accelerate our lives.  For instance, the jamaican sprinter Bolt wants a tryout for professional soccer and has NFL teams knocking at his door for a tryout.  Bolt is cashing in on his opportunities.  Other olympians are never heard from again.  Many think Bode Miller squandered his olympic opportunities by partying at the Italian winter olympics.   Whatever the next opportunity that may be in store for you, be prepared.  If you can't show your joyful feelings at your moment of glory by smiling, take action.  I heard Ryan Lochte was not confident in his smile prior to the olympics (hearsay) yet he figured out a way to seize the moment.  I viewed a news report that stated his "custom grill cost $25,000."  The maker of the custom grill is attempting to seize an opportunity through worldwide marketing.  I personally think an individual must have money to burn if they invest in such a stupid, gimmicky attempt at whatever these "custom grills" say to the beholder.  Ryan Lochte however, will be the new posterboy for "the bachelor," and will probably end up on "dancing with the stars" and Donald's Trump's television show.  Despite my negative vibes on his grill, he is seizing opportunites that I am not able to.  Good on 'ya. 

Preparation begats opportunity.  Be prepared. Stay healthy.  Keep smiling.  Enjoy the ride.  (pray for waves too!!)

My surgical fellowship with Dr. Carl Misch has been excellent, however the preparation for class has been quite extensive.  My sincere apologies for not posting more recently.  The surf has been pretty good the last 3 weeks as well.  Jess and I are beach walking more often with the warm temps.  Golf is in full swing.....So little time....Today's Blog is on herbal supplements.  Please welcome Meg and Mandy to our team. Two talented dental assistants with hearts of gold.   In addition, Melissa will be the new voice on the phone when you call.  She can do wonders with hair as well.  She is like Houdini trying to hide my bald spots... Speaking of hiding, enjoy the barrell shot!  No, I did not make it out, but a nice squinty view. 

 

Many people take herbal supplements for a variety of health benefits.  Personally, I have used herbal supplements for myself for different reasons, namely palliative care,  throughout my adult life.  Like most people, I never included the supplements on any medical history forms under the question "Do You take any medications?"  My answer was ALWAYS no.  The purpose of this blog is to highlight the importance of two things in regards to dental care:  1.  Always tell your dentist/physician the entire list of pills and supplements that you may be taking.  2.  Supplements, even when a prescription is not written, can be dangerous when mixing with other medications. 

It has been reported that over 180 herbal supplements interact with "blood thinner" medications such as aspirin, ibuprofen, and coumadin.  Roughly 12-24% of individuals use herbal supplements and 70% don't report them to their physician/dentist.  Death related to non-steroidal anti-inflammatory medications are the 16th leading cause of death in the United States.  For comparison, homicide is the 17th leading cause. 

Below is a list of some herbal supplements under 3 classes of complictions.  This is important specifically for individuals having any type of surgery including dental implant, routine tooth extractions and bone grafts, or impacted wisdom teeth.  

Increased Bleeding Time (clotting takes longer)

Garlic, chamomile, fish oil, ginger, gingko, ginseng, vitaming E, St. John's wort

Increased inflammation

Celery, dandelion, goldenseal, juniper

Possible NSAID drug interacting supplements 

gingseng, ginkgo, St. John's wort

 

Enjoy the day.  Matt

A recent study published on April 10,2012 linking dental xrays to an increased risk of "brain tumors."  I was watching Morning Joe on MSNBC yesterday morning when the news release scrolled across the bottom of the screen.  It read "dental xrays linked to brain tumors."   First opportunity, midnight last night...I finally had the time to research the study. 

Irresponsible reporting by MSNBC, certainly.  Poor wording and assumptions IMHO, possible to start a scare similar to the Vaccine Scare based on poor research.  Please allow me to point out a reasonable argument to why this study is inappopriate. 

 The study was of nearly 1500 patients that had been diagnosed with meningiomas between ages 20-79 that "self-reported" they had dental xrays.  The control group consisted of nearly 1400 patients of individuals of the same age, sex, living in the same general area whom did not have a meningioma, we assume. 

The study was released recently from the Department of Epidemiology and Public Health at Yale University by Elizabeth Claus et al.

1.   The population-based study consists of individuals in such a wide age range spanning from 20 years to 79 years of age.  They obviously did not receive the same amount of dental xrays because of the wide range in their age.  Not everyone sees the dentist, "twice a year." 

2.  The study states all individuals "self-reported".  "Self-reported," from what their memory? Since this study was based on memory, it is flawed.   I am sure they did not acquire their dental xrays reports from birth.  I am positive I could not tell you how many xrays I have had in the last 5 years and I am a 37 year old dentist.

3.  The study objective states " was to examine the association between dental xrays - the most common ARTIFICIAL source of ionizing radiation and the risk of intracranial meningioma."  Radon contributes to 55% of our ionizing radiation annually, according to the University of Ohio State via Rutgers University Environmental Sciences Data Sheet on Ionizing radiation. Dental AND medical xrays contribute to 11% of our annual average exposure to ionizing radiation. Ionizing radiation is radiation regardless of source.  The study reports the dental and medical xrays are "the most common artificial source of ionizing radiation."  The study does not say dental and medical xrays are the most common source of ionizing radiation.  I hope the intent was not to deceive. 

We have both 2D and 3D digital xrays at Abenaki Dental Care to minimize your exposure to radiation.  In addition, we started our practice in 2008 requesting and installing lead walls that enclose our radiation unit for the protection of all.  Many of us dentists are conscious to the environmental and medical impact that we make.  We also have better taste in clothes than Mike Barnacle but that is not saying much. 

We recently had another request to blog about tension headaches from a treated patient. "you don't realize how much time and money I spent trying to solve my problem. I never would have realized my neck and shoulders hurt because of my teeth.". Luckily for her, she has a caring chiropractor in North Hampton who sensed the signs and symptoms of "tmj" and referred our tense patient to me. It should be stated Dr. Sophia unravelled the patients many symptoms of headaches, neck and shoulder tension, ringing in the ears after many attempts by the patient to seek therapy in the modern medical maze. Ct scans, MRI's, recommendations for anti-depressant pills, pain medications, lost work time, etc. commonly referred as the medical maze. The patient reported ringing ears as her primary complaint. My examination revealed tense, non-tender facial muscles. Her present night guard was unacceptable in function in my opinion. The patient stated she hates wearing it, thinks it is part of the problem. Needless to say she was underwhelmingly excited to hear me say "I want to make you a new one.". She gave me a try after I discussed my intentions to make her a new bite on the night guard, and added my knowledge about what I felt was the problem. We delivered the guard last week, and I set up a follow-up appointment for 2 days as I was eager to hear about her body's response to the night guard. Sure enough, after several years of dealing with headaches and pain in the neck and shoulders.....she felt much more relaxed, less tense, less pain in her temporalis region (sides of head). Headaches were gone with the tension. After only 2 days wearing her new splint (night guard) made with basic physics in mind, her symptoms were improving drastically. The most fulfilling part for me was when I escorted the patient out. No, it was not when she paid the fee for the night guard. Patient X questioned at the front desk "since when did you add birds and ocean sounds out here.....?". I smiled knowing the ringing in her ear will continue to improve over time. The birds and ocean sounds were here the first day I opened, she was hearing them for the first time because the tension was taken out of her joint. The tension release finally allowed the fluids from inflammation to disperse. The inflammatory fluids caused the ringing sound in her ears. The joint is in close proximity to our ear canal. The tension was pushing or pulling the "cushion" between her bones in the joint, causing joint derengement. So, by turning the muscles down, we reduced her muscular tension and the strain applied on the joint. This relieved the pressure, reducing her body's healing process, which initially includes the inflammatory process of injury. Much like the theory of Communism. Communist societies first have "iron fist" political policies followed by several transitioning phases until utopia has been reached. Healing like utopia, is the final goal. However, your body is stuck like the USSR was in the "iron fist" stage of primary inflammation, actually causing more injury to the joint itself. No more inflammation, no more fluids. As the fluids disperse, she is beginning to hear as the ringing sound is going away. Headaches are gone. Neck and shoulder tension has been released. Mornings she feels relaxed and wakes with her jaw unclamped. Those of you still reading may want to nudge the person beside you, they are probably sleeping. Several clinicians that I have treated in addition to their referred patients, have expressed interest in team-treatment. Please email me any questions.....mahalo. Matt