New technology at Bell Family Dentistry: Cerec one Day Crowns

February 22, 2017

New technology at Bell Family Dentistry: Cerec one Day Crowns

one day crown digital camera
Cerec Digital Camera

Not all dental technologies are advances or improvements

Having been around for over 37 years we have seen technology make huge changes in the practice of dentistry. We have been lucky to practice during the bonding revolution that has allowed us to take dentistry to a new level. That being said numerous technologies and materials have come and gone. We have been cautious adopters of new techniques and technologies and still we have a closet of expensive  “great ideas” that weren't so great.

Digital Dentistry: A new proven technology

Digital impressions and CAD/CAM crowns are a technologies that we have been following and evaluating for over 10 years.  I was skeptical of the process at first especially after seeing some of the first crowns being produced but the process has now been perfected and has  reached our threshold for adoption: It produces results better or as good as previous technologies and is more convenient and comfortable for our patients. The concept is simple but technique sensitive: Use a digital image instead of an impression with goop and then produce a crown by precisely milling a porcelain crown with a CAD/CAM machine. Instead of sending an impression to a dental laboratory and scheduling a second appointment to seat the crown, the crown can be produced in our office and seated the same day. For us it allows us to completely control the process from start to finish and as control freaks that is a good thing as laboratories can have a difficulties meeting our demanding requirements for fit, shape and color. More importantly for you the patient you do not have to have a temporary crown or have a return visit that often requires a injection to get numb to seat the crown made by the laboratory. Unfortunately not all crowns or teeth can be done in a single visit with digital impressions and cad/cam. We will enlist the help of dental laboratories and use what ever techniques will produce the best result for our patients but we are excited to have the option to offer our patients

Cerec CAD/CAM
Specialized Dental CAD/CAM

A Special One day crown for a special day



poorly fitting porcelain crown
Fake looking ugly porcelain crown

old porcelain crown with decay
Close up of the ugly crown showing the decay along the edge. This is the first anterior (front) crown we made using the system. We were not anticipating doing the crown that day but the patient announced she was going to her son's wedding in two days so could we make the temporary “look better”. We make good temporaries but she is one of our favorites so we decided to use our new system to get a better result. We figured if it wasn't perfect we could always use it as a “good” temporary. We replaced her “old” porcelain/metal crown(note the dark line) with a new CAD/CAM crown. She was ecstatic and we were pleased with the results.

New porcelain crown
One day crown and a perfect match of the tooth next to it. So if you need a crown and want it done the same day let us know and we will see if we can make that possible.  Again not all cases are best done using this technique.

What is the Best Mouthwash?

February 22, 2017

What is the Best Mouthwash?

What is the best mouthwash? It depends on what you need the mouthwash for: to stop gum disease, prevent cavities or prevent bad breath. If you are looking for a treatment to prevent bad breath visit our blog do I have bad breath for advice. Curing the other problems in your mouth; gum disease and tooth decay simply with a mouthwash is a dream at this point. The scientist who makes it unnecessary to floss will be a billionaire. We can not sterilize your mouth killing the bacteria that cause gum disease or decay. If fact killing all the bacteria in your mouth would be a bad idea as many are helpful “good” bacteria. Also we have seen that if you destroy one type as in those that cause gum disease you often get an overgrowth of the bacteria that cause cavities. It almost seems as if they compete and which ever is able to grow the best also holds the other bacteria down. Seems like we just cant win or that the bacteria are actually smarter than us. Reducing the numbers of bacteria in your mouth by keeping your teeth as clean as possible works for either gum disease or decay. This in general requires mechanical disruption of bacteria: think tooth brushing, floss, tooth picks or water pik to reduce their numbers and organization. So mouthwashes are not a cure but they can be a very useful adjunct to help reduce bacteria and specifically treat gum disease and decay.

Preventing decay with a mouthwash

So lets talk about mouthwashes that can help prevent decay from progressing. This would apply if you are a patient who has been told you have lots of watches; soft spots that are progressing to decay and will need to be filled if the progress is not stopped or you are one of those people who has decay and needs fillings every time you go to the dentist. You would really like to stop the drill, fill , bill cycle. Perhaps even go on your own vacation rather than paying for the dentist's vacation. You have good oral hygiene, use a fluoride toothpaste and have cut back on your soda, candy, sports drinks and sugar in your coffee. OK, maybe not completely but you are trying. A mouthwash containing fluoride used in the morning before you brush and after you brush at night would be a great adjunct to prevent decay. Which one? They have become so popular that TV commercials tout different brands. For years we recommended Act but the new Listerine Total Care (the purple one)has a higher fluoride uptake into the tooth and creates a tooth surface more resistant to decay.  The American dental association has approved many fluoride containing mouthwashes for controlling dental decay If you have an aversion to fluoride your options are limited. If even a fluoride mouthwash does not seem to arrest the decay for additional ideas see our blog on Can You stop decay.

listerine for tooth decay and gum disease

Controlling gum disease with a mouthwash What if you are the patient who does not get decay but is a “tarter builder.” Your problems tend to be with your gums: gingivitis and periodontal (gum) disease. You do everything you can brushing and flossing. You even get your teeth cleaned three times a year but you still have bleeding gums and/or bone loss/recession blog. What mouth wash would be best? The good news is that many of the anti-cavity mouthwashes have some effect on gum disease also. The bad news is that no mouthwash is going to cure gum disease. Antibacterial mouthwashes help but are not a cure all. Many contain special substances that kill or disrupt bacteria. The original Cool Mint Antiseptic Listerine has the American Dental associations seal of approval for helping to reduce gingivitis with its active ingredients: Eucalyptol 0.092%, Methyl salicylate 0.060%, Menthol 0.042%, Thymol 0.064%. The new Total care Listerine mentioned above for decay prevention does not have proof of an ability to fight gingivitis. However it almost seems as if anything you do to change the environment in your mouth can be helpful. The latest craze is coconut oil “pulling.” You put a glob of coconut grease in your mouth let is melt and swish for 20 minutes. That is a long time. Try it with water. We actually have had some patients using this method get good results, less bleeding and redness. I think you could rinse with almost anything for 20 minutes and you would dilute the toxins produced by the bacteria enough to help you. But I do not argue with what ever works because this is not an exact science and what works for some does not work for all. A mouthwash specific for gum disease called Peridex,containing chlorhexidine can also be used to reduce inflammation. Unfortunately it often results in an ugly brown stain that is very difficult to remove. We do not often recommend it as a total mouth rinse rather for application into specific areas in the back of the mouth.

peridex mouthwash for treating gum disease

How to use a mouthwash

This is not that difficult, just get some mouthwash out of the bottle and into your mouth. You can pour it in a cup, use the dispenser that comes with most bottles or simply take a swig out of the bottle and swish. Do not swallow it. Just get a comfortable amount in your mouth so that you can control it and can swish it between your teeth. How long depends again on the bottles instructions usually about 30 seconds, which can seem like an eternity standing over a sink. I would err on the long side as the action is increased by time. What's too long? If it makes your gums or teeth uncomfortable thats too much time. Do not rinse with water right after as the effect will be diluted.

When to use a mouthwash

Once a day may be enough for some. Morning or night is a personal choice. The easiest time for many is to simply put the mouthwash in the shower, use it, and spit it down the drain. This allows you to multi task and gives you plenty of time since you are not wasting your time standing over a sink.

Before or after you brush?

Among mouthwash nerds this is a big debate. In our office we recommend rinsing twice a day for the best results; In the morning in the shower before you brush and in the evening after you brush. The teeth benefit from the pre rinse in the morning hardening them after a long night during which saliva production is decreased resulting in teeth that are more easily abraded away by brushing. The post brushing rinse at night coats the teeth after all the days accumulation of “stuff” (food and bacteria) have been removed increasing its effectiveness. If you are rinsing to prevent gingivitis rinsing twice a day will not hurt. Of course mouthwashes do not replace tooth brushing and other oral hygiene methods to clean your teeth, flossing or tooth picking.

Are Vitamins Good for Childrens’ Teeth?

February 22, 2017

Are Chidrens’ vitamins good for their teeth?

At UCLA Dental school In 1976 my out of shape British human physiology MD/professor’s famous comment on nutrition and vitamins was “When I feel like I need some vitamins I put a piece of lettuce on my wimpy(hamburger) once a week” He was also the teacher for the medical students and that may explain why it has taken traditional medicine so long to recognize the importance of nutrition. Today the pendulum has swung the other way with supplements being pushed like candy to a baby especially vitamins for children. In fact gummy vitamins are just like candy causing the same problems for childrens’ teeth. I believe a balanced diet and nutrition are important, my problem is that I have seen vitamin supplements damage young childrens’ teeth.

Gummy Bears

The myth of childrens’ vitamins

 

Yummy gummy vitamins, what a great way to get kids their required nutrients. Right? Unfortunately we have seen numerous young children who develop cavaties after their well meaning parents begin them on a regimen of gummy vitamins. Gummy vitamins in large part are just chewy candy with a healthy sounding name. Grab a bag of gummy bears and a bottle of gummy vitamins. Start reading the ingredients: sugar, gum, colors, vitamin c. Similar name and similar ingredients. Similar result: cavaties.

What is in gummy vitamins?

Gummy Vitamins

 

Two grams of carbohydrate, a complex sugar, one gram of simple sugar, Ascorbic acid(vitamin C), folic acid, pantothenic acid. Now all these acids may be good for us when we eat them with food but when they are stuck in the grooves of developing teeth by the gum sorbate they cause trouble. As an example:

Vitamin c is good for you contributing to all sorts of bodily functions: connective tissue repair, immune response etc. but when chewed into the grooves of teeth it causes problems. The formal scientific name for vitamin c is ascorbic acid. Its this acid property that causes the problem especially when it sticks in the groove of developing teeth. Teeth are actually softer, and easier to melt when they first erupt in the mouth so children are the most effected. Would you knowingly pack sticky acid into teeth given that we all know that acid created by bacteria is damaging to teeth? The word acid attached to a substance is just a description of a property. In large part all these acids share properties destructive to teeth; they dissolve enamel.

Are Chewable vitamins an alternative?

Chewable vitamins are not like gummy bears they are like sweet tarts, sweet from sugar and tart from the taste of acid. Instead of being sticky the sugar and acid are simply stuck/cemented and packed into the grooves of the teeth. Simply chew one yourself and then spend the next 10 minutes trying to get the stuff out of the grooves of your back teeth. Not what you want

The solution

Vitamin makers are trying to address these problems with artificial sweeteners( who knows what problems they can cause) but we are still left with acids that are vitamins stuck in the teeth. My suggestion is to have your children eat a balanced diet with maybe more than just a piece of lettuce on their “wimpy” once a week.


Toothbrushes in Costa Rica

February 3, 2017

Toothbrushes in Costa Rica

Many of you know of our families passion for southern Costa Rica, it’s not just because I am a goofy foot and the area we visit has one of the best left hand wave point breaks in the world. We fell in love the Costa Rican people, their happy, non confrontational spirit exemplified by their common greeting “Pura Vida”(pure life). The simple lives we encountered when we first traveled there taught us all about how few material possessions you need to be happy. They were always appreciative of even just a tooth brush. We have been visiting the schools for over 22 years now and have distributed over 18000 toothbrushes, most donated by the Butler Sunstar company. A special thanks to Aurora Cote, our Butler rep, David Mclaren, and Kathy Allen, V.P Sales for working hard to provide us with the necessary toothbrushes. So many of the villagers asked if I could help them with their dental needs that my dream was to set up a dental clinic in one of the villages so that I could donate my time. I did carry down equipment so that I could refurbish an abandoned clinic but as with most projects requiring government approval acquiring the permission to donate my work was a cluster of insurmountable hurdles. The clinic does get used by the public service dentists from Costa Rica and occasional foreign dental groups who have government permission.

kidergarden with toothbrushes

In addition we have brought pencils, pens,soccer balls, books, computers, clothes, and fishing equipment. Recently Dr Scott Paul, a great periodontist and avid fisherman donated spools of fishing line and lures. The economy on the village has been struggling because of a significant drought so many of the families have struggled to keep food on the table. Debi and I were on the beach watching as Miguel one of the young men who we gave some of Dr. Paul”s equipment to made his first cast. Within seconds his screams could be heard from a quarter mile away as he hauled in a 15 lb red snapper. He came running up the beach to show us his catch with Dr. Paul’s lure still in its mouth. He showed it off to all his friends, cast out again and promptly caught another smaller snapper. He was ecstatic knowing his family would be eating well. I just wish I had a photo of his smile.

school children waiting for toothbrushes

Usually we go to the schools as Bell Family Dentistry; Brandon, his wife Kristina, my wife Debi and I. Given Kristina’s pregnancy and the Ciska virus threat they stayed home this year. Debi and I went to one of the schools and by coincidence a “health fair” for the elders of the village was taking place next door. Most of these amazing elders are over eighty years old, proud and independent still working and in living in their shacks. One of my favorites was there; Sebastian, an 86 year old who I see almost every day on my way to surf. I give him t shirts but he is too proud to accept charity so he insists that he give me something in trade, usually bags of limes. How he is able to pick/collect so many limes is a mystery to me. He has a few teeth and his upper denture falls out whenever he smiles and he is always smiling. He is always thankful for a toothbrush. When he saw me he ran up to me and pumped my hand and introduced me like we were best friends. I made sure all the elders got toothbrushes too.

seniors getting toothbrushes

In this remote and some would say primitive area the older people have a civility and politeness you don’t see in our rushed society. They treat each other with respect. You acknowledge everyone you pass whether you know them of not if, whether you are in your car on horseback or just walking. If you know them you stop, shake hands with the men, kiss the women on the cheek and exchange pleasantries. One of the benefits of taking our children to Costa Rica was that they returned from this “ poor backward” community with better manners. I know I may seem old fashioned but manners matter to me. When you are introduced to someone you shouldn’t just sit on your couch, with your hat on backwards and grunt “hey dude” not even looking up while playing on your cell phone. Someday I will write about the effect technology has had on the Costa Rican people but for now rest assured the modern transition to impolite indifference is not an American anomaly as the electronic devices takeover communication.

These white faced monkeys were not polite and looking for a banana handout, not a toothbrush.

monkeys looking for a toothbrush


Thoughts on Becoming a Grandfather

October 25, 2016

Thoughts on becoming a grandfather

It is hard to live life without making mistakes and having regrets. Each stage brings new challenges and opportunities, and sometimes even a second chance, a do over, or for all you golfers a mulligan. I regret never learning to understand or enjoy little babies. Now I am a grandfather bringing with it joy and the opportunity for one of those second chances. Every patient who is a grandparent extolls the joys of grand parenting: spoiling and enjoying the grand children and then returning them without worrying that someone will reject your return for the destruction you have caused. Kind of like shopping at Costco. I have never been good with babies even my own. I was afraid, concerned, even scared. Crying, fragile, little bobble head dolls, their heads seem to keep wanting to fall off. What do they want ? Why do they cry? What will make them happy? Why don’t they just tell me? Babies of course can sense this angst, especially your own children making them even more unhappy. I am a problem solver and sadly it was a problem I could not solve. Of course I could always use the excuse that I had to work to support our family but it was just an excuse to mask my shortcoming. My saving grace was that I worked very hard at being a good father once our children were older and we could communicate. My other saving grace was that Debi was an incredible mother, calm, peaceful and intuitive to the childrens’ wants and needs. I was reminded of this the other day when my son, Brandon commented how awesome his mother was calming and helping during a difficult night with the baby. You could hear in his voice a new appreciation for how hard it is to be a parent and how thankful he was for his mother. Having never known my own grandfathers, both died young, I have no real role model to learn from but I get a second chance. I am sure my son,who is great with his new daughter and my granddaughter, Gwyneth can teach me how to be a good grandfather and better enjoy babies.

Epilogue

Dr Bell dentist and grand daughter

Gwyneth, Grandpa and The Little Prince

This is a photo of the first time I held Gwyneth. I had to get a whooping cough vaccination before I could get close….What a world. I am reading her one of my favorite books, the Little Prince, the allegorical children’s book that explains all the lessons in life you need to be happy. She listened for a while and then fell in to a peaceful sleep for three hours. I didn’t want to move for fear of disturbing her and breaking the peaceful, magical spell. I think it is the longest I have been still in my whole life. My arms went to sleep. After three hours Kristina, her mom came and said we needed to wake her to feed her or something. I asked why. She said the pediatrician told them it would help to get her on a routine. Oh youth, they have not figured out yet that life will never be routine again. It sounded like the advice of young med school graduate who had read a lot of books but never had children of their own. Having watched lots of parents who are good with babies I have come to the conclusion that the number one rule is: Never wake a sleeping baby. And the number two rule is: Never wake a sleeping baby. Rule number three is: never argue with a new mother, so off Gwyneth went. No matter, the spell was broken, my arms came back to life and I went back to my normal routine life fixing dental equipment at the office on the weekends. It was still a day made special by those magic, peaceful moments that I will never forget.

P.S. Her head did not even fall off.