Same day dentistry refers to an innovative new brand of treatment that condenses some traditional procedures into a single office visit. Thanks to in-office dental CAD/CAM technology, patients can receive milled metal-free crowns, veneers, onlays and inlays in one office visit, while they wait. If your dentist uses a CEREC or E4D Dentist System in the dental office, same day dentistry may be a treatment option for you.

The Technologies Behind Same Day Dentistry

CEREC: The CEREC in-office dental CAD/CAM equipment by Sirona includes a digital infrared camera for obtaining an optical impression of the damaged tooth, 3-D CAD software for designing the restoration, and CAM technology (milling unit) that uses high-speed burs to mill the restoration.

E4D Dentist System: Developed and manufactured by D4D Technologies, the E4D Dentist System uses laser scanning technology to capture the optical impression of tooth preparations. In most instances using the laser eliminates the need for the reflective powder agents required for some digital impression or CAD/CAM systems. The E4D Dentist System also includes 3-D CAD software for designing the restoration, as well as CAM technology (milling unit) that uses burs to mill the restoration.

Same Day Dentistry Procedure

After your dentist has examined your teeth and determined a same day CAD/CAM restoration is a treatment option, the area surrounding the affected tooth or teeth will be anesthetized and prepared for your metal-free restoration.

A digital impression is taken using an optical or laser scanner and entered into a computerized system. This system is used to create a virtual model of your teeth and design your crown, veneer, inlay or onlay. This process involves identifying the appropriate color, shape and biting/chewing surface for your restoration.

The design then is sent via cable or wirelessly to a milling unit in the dentist’s office that will fabricate the restoration in approximately 20 minutes. The metal-free materials used for CAD/CAM restorations include blocks of porcelain, composite and lithium disilicate.

The mill uses burs to cut the block to the precise shape of your specific restoration. When the milling process is complete, the restoration can be polished or stained and glazed to create a life-like appearance that will match and blend with your natural teeth. If stain and glaze are used (which can take anywhere from 15 to 20 minutes, depending on what’s required), the restoration will be fired in an oven (similar to pottery) for approximately 15 minutes or less. The total process may take as little as 60 to 90 minutes.

Once the restoration is finished and inspected, it is placed and checked for fit, then cemented. The result is a permanent treatment completed in a single office visit.

Same Day Dentistry Recovery and Follow-up Care

After your veneer, crown, inlay or onlay has been placed, your dentist will provide information about caring for your new restoration. In general, maintain proper oral hygiene habits by brushing twice daily and flossing with dental floss or interdental cleaners (specially designed brushes and sticks) once a day to remove plaque and help prevent dental decay and gum disease.

Avoid chewing hard foods, ice or other hard objects, since these could damage your restorations. It also is important to avoid biting your fingernails and grinding your teeth, which could significantly shorten the life-span of your restoration. If you clench or grind your teeth, your dentist may recommend wearing a night-time mouth guard to help protect your restorations while sleeping.

Benefits of Same Day Dentistry

With in-office CAD/CAM dentistry, multiple appointments for the same treatment are no longer necessary, which saves time. Instead, needed restorations are identified, created and cemented in the same day when appropriate.

Additionally, you may only need to receive local anesthetic once for any necessary tooth preparations, the effects of which can be minimized with an anesthetic reversal agent like OraVerse.

Because in-office CAD/CAM restorations usually are designed based on digital impressions obtained with optical scanning technology, traditional impression materials and trays are not used to duplicate tooth form and anatomy. As a result, there is no need for the traditional, distasteful materials previously used for impressions and therefore less likelihood of discomfort or gagging.

Same day CAD/CAM dentistry also eliminates the need for temporaries, since the permanent and clinically proven final restorations are placed in one visit. This reduces concerns about tooth sensitivities that could otherwise result when wearing temporary restorations, or about the temporaries falling out at inconvenient times.

Cost of Same Day CEREC or E4D Dentistry

All-ceramic restorations, including those fabricated using CAD/CAM technology, tend to be a more expensive restorative option. However, even though the materials for CAD/CAM restorations might cost more, the expense incurred by the dental laboratory and/or the dentist may not be passed onto the patient. Also, there is no additional fee or cost to have a restoration placed in one visit as opposed to two.

Therefore, costs for CEREC or E4D same day dentistry will depend on the normal and customary fees charged by dentists in your area, the extent of treatment required and your dental insurance. Insurance reimbursement for in-office, same day dentistry is similar to reimbursement for restorations created by a laboratory.

It should be noted that the initial very high cost of the equipment to the dentist may affect the cost of the restoration for the patient.

Xerostomia

Xerostomia, more commonly known as dry mouth, is not a disease in itself. Rather, it is a symptom of many other diseases and conditions. These conditions cause saliva production to decrease or stop.Saliva moistens your mouth and helps you to swallow and taste food. It helps in fighting cavities by washing away food and plaque from the teeth. It also helps to neutralize acids in the mouth that harm tooth enamel.

If you have less saliva in your mouth, your teeth and gums are at increased risk of tooth decay. People with xerostomia also are more likely to get illnesses that affect the soft tissues of the mouth, such as yeast infections (thrush). In addition, your diet may be affected because you cannot taste food as you normally would. People with complete dentures who develop xerostomia also may notice that their dentures lose some of their suction. They may feel loose in the mouth.

Xerostomia may occur for several reasons. Some common causes include:

• A side effect of medicine — Hundreds of drugs can cause dry mouth. These include pain relievers and medicines for depression, cold symptoms, muscle spasms and allergies. Medicines are the most common cause of xerostomia. Older people often take many medicines, including those most likely to cause dry mouth. For this reason, they have an especially high rate of dry mouth.

• A complication of diseases and infections — Several diseases are associated with dry mouth. They include diabetes, anemia, cystic fibrosis, rheumatoid arthritis, high blood pressure and HIV infection. Xerostomia also occurs with Sjogren’s syndrome. In this disease, the body’s antibodies attack the salivary and tear glands. Some viral infections, such as mumps, also affect saliva production and cause xerostomia.

• Dehydration — Any condition that leads to loss of body fluids can also cause xerostomia. These conditions include fever, excessive sweating, vomiting, diarrhea, blood loss or loss of water through the skin after a burn.

• Radiation therapy — Xerostomia is a common side effect of radiation therapy to treat cancers in the head and neck.

• Surgical removal of the salivary glands — If a mass develops in a salivary gland, surgical removal of the gland may be recommended.

Although xerostomia is a symptom, it often occurs along with other symptoms. These may include:

• Frequent thirst
• Burning or tingling sensation, especially on the tongue
• Red, raw tongue
• Sores in mouth or at corners of lips
• Difficulty swallowing
• Problems with taste
• Sore throat and hoarseness
• Bad breath
• Problems with speech
• Dry nasal passages
• Dry, cracked lips
• Increase in dental problems, such as cavities and periodontal disease
• Difficulty wearing dentures
• Repeated yeast infections in the mouth
• Women’s lipstick may stick to their front teeth

Xerostomia is a symptom, not a disease. Tell your dentist and hygienist about your dry mouth. Your dentist will ask you about your medical history and your symptoms. He or she will ask about any drugs you are taking. This includes prescription, nonprescription and herbal remedies. The dentist also will examine your mouth. He or she will assess the flow of saliva and look for cracks, sores, and signs of cavities and gum disease.

The symptoms of xerostomia can be treated. However, the condition often remains a problem as long as its cause (medicine, illness, dehydration) remains. If the salivary glands have been removed or destroyed, the condition is permanent. Radiation therapy to treat cancer in the head or neck also may permanently affect how well the salivary glands can produce saliva.

To prevent dry mouth, avoid things that cause it, if possible. For example, if dry mouth is related to a medicine, your physician may be able to prescribe a drug that causes less dryness. Do not overuse cold medicines and antihistamines. You also can take steps to prevent or manage the symptoms of dry mouth.

The treatment of xerostomia focuses on three areas:

• Relieving symptoms
• Preventing tooth decay
• Increasing the flow of saliva, if possible

Your doctor will recommend that you practice good dental hygiene. This means that you should brush and floss properly. You also should have regular dental visits. In the office, your dentist or hygienist also will regularly apply fluoride to your teeth. You may be given a prescription for a fluoride rinse to use at home. Your physician may work with your dentist to manage your condition.

Treatment is based on how severe your problem is and what caused it. Fluoride treatments can be prescribed to help prevent cavities. Artificial saliva is available over the counter as a rinse, spray or gel. Depending on your medical condition and diagnosis, a physician or dentist may prescribe a drug that causes more saliva to be released.

To relieve your symptoms, try the following:

• Drink water often to keep your mouth moist. Carry water with you. Sip it throughout the day. Keep water by your bed at night.
• Suck on sugar-free hard candies, ice chips or sugar-free ice pops.
• If you chew gum, try sugarless gum.
• Use an over-the-counter oral moisturizer or saliva substitute.
• Use mouth rinses or mouthwashes that do not contain alcohol.
• Avoid salty foods, dry foods (crackers, cookies, toast) and foods and beverages with high sugar contents.
• Avoid drinks containing alcohol or caffeine. These increase water loss by triggering frequent urination.
• Avoid smoking.
• To reduce irritation of dry tissues, use a moisturizer on your lips and a soft-bristle toothbrush on your teeth and gums.

Dry mouth symptoms can vary greatly. Only your dentist or physician can truly evaluate your mouth for xerostomia. If you feel the symptoms, discuss them with your dentist. Dental decay can develop quickly in a dry mouth that is otherwise healthy. If you have to sip water often and need liquids to swallow dry foods, see your physician or dentist.

With proper treatment, most patients with dry mouth can feel better and taste food normally again. With good dental hygiene, people with xerostomia can reduce dental problems associated with dry mouth.

Dr. Gardner was featured in the Spring/Summer 2011 edition of Glow magazine!

Dental Implant Procedure: Advantages and Success Rate

Although you have a number of restorative options for the treatment of missing teeth, none have proven to be as functionally effective and durable as implants. In many cases, dental implants may be the only logical choice for the restoration of all necessary functionality of the teeth and supporting structures. Dental implants are artificial tooth replacements used to counter tooth loss. The procedure is categorized as a form of prosthetic (artificial replacement) dentistry, though it also falls into the category of cosmetic dentistry as well.
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Over the past few decades, researchers have come to recognize that the plaque-forming microbes in the oral cavity live as complex microbial communities.

In addition to exploring the symbiotic interactions of, they also frequently note the presence of the other microbial inhabitants of the mouth, such as archaea and fungi. The problem is this recognition, particularly of the oral fungi, tends to be more conceptual than experiential. That’s because few oral fungi actually have been isolated and documented in the scientific literature, leaving many to be lieve that only a few species exist in the mouth.
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In order to prevent tooth decay in their childern, parents were advised to use toothpastes that contain fluoride with a minimum concentration of 1,000 parts per million (ppm) by researchers for the Cochrane Oral Health Group.

In a second related study, the authors suggest that concerned parents should consult their dentist to discuss the benefits and risks of fluoride use. The groupʼs latest research involved 79 trials on 73,000 children worldwide and examined the effect of different childrenʼs toothpastes. Toothpastes with fluoride concentrations less than 1,000 ppm were found to only be as effective as non-fluoride toothpastes at preventing tooth decay. Childrenʼs toothpastes range from 100 ppm to 1,400 ppm fluoride concentration. The report suggests that brushing a childʼs teeth with a toothpaste containing fluoride less than 12 months of age may be associated with an increased risk of developing mild fluorosis. Swallowing large amounts of toothpaste may still cause fluorosis in children up to the age of 6 years when the permanent teeth are still developing, but carefully using a small amount will reduce these risks.
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Gum Disease Linked to Heart Illness

USA TODAY 2004

PHILADELPHIA — The most common strain of bacteria in dental plaque can cause blood clots that induce heart attacks when they escape into the bloodstream, researchers reported Monday.

Mark Herzberg of the University of Minnesota said the findings are the first link to bacteria to the formation of potentially fatal blood clots.

Previous studies had found the incidence of heart disease is about twice as high in people with periodontal disease, but scientists didn’t know why. “Now we show a potential biological reason.” Herzberg told the 150th annual meeting of American Association for the Advancement of Science.
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