Recently there was a long cover article in the New York Times regarding the overuse of Conebeam CT scans in dentistry.  This article brought up some of the negatives of these types of scans, primarily the amount of radiation associated with them.  However, there are uses for these machines in dentistry, and when used appropriately, they provide diagnostic and planning information that cannot otherwise be obtained.

Radiation

The average digital panoramic radiograph in a dental office exposes the patient to about 8-15 μSieverts (μS) of radiation <  a dental conebeam CT is anywhere from 10-100 μS, depending on the size of the scan area and location <  a cross-America flight exposes a person to ~60 μS < a medical CT ~2000 μS < annual background radiation ~2500μS.  Therefore, the amount of radiation actually received by patients during a conebeam CT scan is minimal when compared to the amount of background radiation a person gets in a year, ~50/2500 μS = 2%.

Pros

Conebeam CT scans give 3-dimensional images of hard structures in the head and neck region.  That means they can let you see every aspect of the jaw, teeth, joint, skull, etc.  You can see the distance of structures from one another, and the location of abnormalities.  In dentistry, these scans are particularly useful in Implant dentistry.  A conventional dental x-ray, whether a periapical (small) film or a panoramic (large) film, only give the dentist a 2-D picture of a structure.  However in order to place an implant in the best location in bone, sometimes the third dimension is required in order to avoid missing the bone, hitting nerves, or severing arteries.  Conebeam scans also are useful in endodontics (root canal therapy), orthodontics (tooth movement), and of course general dentistry.  3D images which allow cross-sectional viewing in dentistry are extremely useful tools that will allow dentists to be more precise in their procedures.

Cons

The only true con of these machines is the radiation.  As discussed above, there is a significant dose delivered, however it is minimal in comparison to other medical scans and even normal activities like flying.  The primary concern demonstrated in the NYT article about conebeams is their overuse.  While these devices do have a great role, they should be used only when necessary.  Not all implants require scans, most orthodontics and endodontics do not require them either.  Therefore it is extremely important for dentists to properly diagnose when a conebeam CT is necessary for a patient.

Kodak 9000 3D Conebeam CT

Dr. Jan Linhart is proud to announce that he has recently added the Kodak 9000 3D Conebeam CT to his office. We chose the Kodak machine because it allows us to take a scan of a small area, thus giving it the lowest patient radiation dose of any conebeam on the market.  In addition, the Kodak unit allows us to take independent digital panoramic x-rays without delivering the radiation dose of a conebeam.  This is a unique feature that many other machines lack.

Dr. Linhart, as well as the specialists in our office including Dr. Roger Bronstein (periodontist), have been trained to identify exactly when a conebeam CT is necessary, and will only take scans when indicated!  We encourage you to contact us with any questions or comments regarding this new addition to our office.  I can be reached directly at Zachary@drlinhart.com

Finally, for the 4th installment of the tooth whitening section, let’s talk a bit about whitening toothpastes.

Mechanical Means

Most whitening pastes act by mechanical means.  They use an abrasive agent, usually silica, to scratch the stains off the surface of the teeth, revealing the whiter enamel underneath the stains.  This mechanical removal of stains is effective, however continued use of these pastes, or over use, can cause significant abrasion and harm to the teeth.

Chemicals

Other whitening toothpastes use chemicals to help whiten the teeth.  These pastes usually resort to the tried-and-tested peroxide route.  Whether it be hydrogen peroxide, carbamide peroxide, urea peroxide, they all create a chemical reaction that whitens the teeth moderately without removing any of the tooth structure.

What’s Right for You?

Which mechanism of tooth whitening toothpaste is right for you?  Well that is for you to decide.  However none of these toothpastes will be nearly as effective as an in-office whitening session with take home trays.

Stay tuned for more articles soon, and I welcome any questions.

Many major companies that you have all heard of, Colgate, Crest, etc, are now selling whitening products that you can easily purchase at your local pharmacy or grocery store.

These include non-custom trays with whitening gel, whitening strips, or whitening pastes that can be applied to the teeth in accordance with the instructions in order to whiten.

Because of the wide variety of products in this category, it is impossible to accurately review them all.  But in general, these products are a large step below in-office and custom tray whitening.  Usually the levels of whitening gel are significantly decreased, tooth contact is decreased, and overall effectiveness is thus diminished.

That is not to say that you should never use these products.  In the case of a quick touch up, nothing major, just to get your teeth to that sparkling white again after one too man cups of coffee that day, these products may be exactly what you need.

However in the case where your teeth have been tarnished by years of wear and tear, coffee, wine, and other stainers, in office teeth whitening or long-term custom tray whitening are certainly superior to these over-the-counter products.

Keep a look out for next weeks post on Whitening Toothpastes like PearlinBrite, Colgate, Arm+Hammer, and others!

The most typically recognized tooth whitening is at-home whitening with custom trays.  These trays are generally fabricated by the dentist by using an exact replica of your teeth.

Custom Whitening Tray – PROS:

A custom tray is desirable over a generic tray in that it keeps the whitening gel exactly where it is wanted, on the teeth.  Whitening gel can bleach and even burn the gums, so keeping it on the teeth only is very important.

Custom trays can be filled with either hydrogen peroxide (usually .5-1 hour use) or carbamide peroxide (usually overnight use) gels of varying percentages.  These gels are less concentrated that the gels used by dentists in order to maintain the safety of the patient.

Tray whitening at home is a great way for just about anyone to whiten their teeth, and is also great as a follow up to in-office whitening to maintain the brighter shade.

Tooth Whitening – CONS:

The main disadvantage of tooth whitening is sensitivity.  Often after whitening, pateints will experience transient sensitivity that ranges from mild to severe, hours to days.  Dr. Jan Linhart’s PearlinBrite laser whitening is specially formulated to REDUCE sensitivity, however elimination of sensitivity cannot be assured.

How to Reduce Sensitivity:

There are ways, however, to moderate and reduce sensitivity following whitening.  These include

1.) Brushing with a high fluoride/sensitivity toothpaste for a couple of weeks prior and after whitening (eg Sensodyne, Prevident 5000)

2.) Taking an OTC painkiller immediately following the procedure (eg Advil, Tylenol)

3.) Making sure to apply gel only to whites of teeth, and not exposed roots or gums

Stay tuned for part 3, at home OTC whitening products!

In-office tooth whitening is, with little questions, the most effective and quickest form of tooth whitening available to the general public.  In-office whitening usually involves applying hydrogen peroxide gel to the teeth, and then increasing their effects by activating them with light and/or lasers.

PearlinBrite Laser Whitening

PearlinBrite Laser whitening, developed by Dr. Jan Linhart, DDS, uses different percentage Hydrogen Peroxide gels, specially formulated by our own chemist, to obtain the maximum effect.  Freshness and quality of the gel is extremely important to achieve maximum whitening effect.  After the gel is applied, it is activated by two different lasers in order to increase oxidation.  This procedure was created by Dr. Linhart, from his 30 years of experience in the dental profession.

Other In-Office Options

Other in-office whitening systems, such as Zoom(R) and BriteSmile(R), also use gels and lights in the dental office to achieve whitening.

Time Requirements

In-office tooth whitening usually takes between 1-3 hours, and can significantly increase the brightness and whiteness of your teeth.

Post-Treatment Maintenance

Usually, in-office whitening is followed by at home gel applications in custom trays, which is used to touch-up and enhance the effects of the in-office system.

Our next post will talk about these at-home whitening systems, and talk about the negative effects whitening may have.

You see and hear about teeth whitening everywhere, in the paper, magazines, on the radio, and on TV.  Laser whitening, light activated whitening, take home whitening kits, whitening strips, whitening toothpastes, are all different ways that you can whiten your teeth.  But, there are significant differences between the different methods, and different end results.  Here I will break them down one by one, in a 4 part series, so that you can choose which is best for you.

Hydrogen Peroxide vs. Carbamide Peroxide

First, we need a bit of background though.  There are two main types of tooth whitening gels that are used in a variety of the whitening techniques.  They are Hydrogen Peroxide and Carbamide peroxide

Hydrogen Peroxide

Hydrogen peroxide is generally used for short applications, such as a 1 hour session, and comes in ranges from 5%-20% (at home) and 20%-50% (in office) gels.  

Carbamide Peroxide

Carbamide peroxide, similarly, comes in a range of strengths for different uses, but tends to be used for longer periods, like overnight use, as it breaks down to form hydrogen peroxide.

This 4 part series, over the next week or so, will be on these topics:

1) In-office professional tooth whitening (PearlinBrite Laser Whitening, Zoom, BriteSmile, etc)

2) At-home gels (carbamide peroxide and hydrogen peroxide with custom trays)

3) At-home OTC products (White strips, prefab trays, etc)

4) Whitening toothpastes (PearlinBrite, Crest, Colgate)

Stay tuned for part 1 in the next few days!

Dental school has been extremely busy, and every day I get to try new things, attempt new procedures, and learn new techniques.

I have already performed a couple of veneer procedures; however most patients that come in don’t know what porcelain veneers are.

What are Porcelain Veneers?

Porcelain veneers are thin pieces of porcelain that are laid over the visible surfaces of teeth, usually front teeth.  These thin pieces of porcelain can change a smile from one that is dreary, dark, crooked, and decayed, into something beautiful and healthy.

They are not for everyone, and they can be expensive.  But under the right circumstances, veneers are a great way to significantly modify your smile.

Post in the comments or shoot me a message if you have any specific questions about porcelain veneers.  More posts to come soon!

As described in previous posts, there are many reasons why a person may get cavities, ranging from dry mouth to sugar intake.  Below is a list of, in my opinion, 5 of the best ways to keep your teeth healthy and strong:

1. Brush Regularly with Fluoride Toothpaste

Brushing keeps your teeth clean of bacteria.  Fluoride helps to strengthen the enamel, as well as stopping bacteria from producing their decay forming acid.  We recommend PearlinBrite Mint Fluoride Toothpaste with Aloe Vera.

2. Visit your Dentist Regularly  

One of the best ways to catch cavities early and get them fixed, as well as keep your teeth free of plaque and calculus, is to visit your dentist.  Six months is the normal recall, but if you are at high risk for cavities, four or even three month recalls are preferable.

3. Reduce Fermentable Carbohydrates 

Reduce your intake of fermentable carbohydrates which includes anything with added sugar, and foods that stick in your mouth.  For example raisins are one of the worst foods in terms of causing cavities because they stick in your mouth for a long time.

4. Rinse with Water After Eating

When eating foods that do contain fermentable sugars, make sure to rinse with water soon after.  You don’t want to let the sugar sit on your teeth.  This is why children who sleep with there bottles in their mouths develop such bad cavities, the sugars sit on their teeth all night!

5. Drink Fluoridated Water

Yes, I know all the Internet lies that claim it is dangerous.  As a doctor to be, I can tell you there are mountains of scientific evidence showing the benefits of fluoride, and little to no scientific evidence showing any dangers when administered properly.  So stop living off bottled water and drink that good old fluoridated tap water to keep your teeth strong and healthy.

Ok, so you have had a mouth full of cavities since you were a kid, yet your friend, husband/wife, brother/sister, has never had a cavity in his/her life!  WHY!?!  Multiple factors go into forming cavities.

Cavity Forming Factors

1. Acid

carious lesion (cavity) is formed by acid eating away at the tooth structure.  This acid is produced by oral bacteria, usually Streptococcus Mutans or Lactobacillus Casei These bacteria are in most, if not all mouths.  However their quantity differs by person. The amount of these bacteria in the mouth is thought to be transmitted from mother to child.  However this link is a bit shaky.  One way or another though, certain individuals have more of these bacteria in their mouths, and are thus more susceptible to cavities.

2. Saliva

Saliva serves multiple purposes.  Digestion of food, keeping the mouth moist, buffering the saliva, and others.  The ion concentration and buffering capacity of saliva are essential in the formation, or lack thereof, of cavities.  The basic properties of saliva can counteract the acid produced by the bacteria, which prevents cavities.  Some people’s saliva is more basic than others, and therefore more effective in preventing cavities.  In addition, the more basic the saliva, the more it is able to remineralize and keep tooth enamel strong.

3. Genetics

As with most bodily problems, genetics has an influence on oral health, including cavities.  Certain people are more susceptible, whether it be by weaker tooth structure, oral and tooth anatomy, or from other factors.  One way or another, genetics plays a role in the number of cavities a person has or will have.

4. Sugar

One last factor, and probably the most discussed, but possibly the least important, is the amount of sugar in the diet.  Sugar, particularly sucrose, is the food oral bacteria needs to create the acid that causes cavities.  This is a commonly accepted idea, and most all dentists will tell you not to consume lots of sugar if you don’t want cavities; especially stick sugars (ie caramels).  However some studies have contradicted this idea and showed that sugar is certainly not the only factor. In the groundbreaking Vipeholm study from Sweden in 1948, they found that:

  • Although all the patients consumed the very popular caramels, which were served between meals in 4 portions of 5 or 6 caramels each, 20% of them had not developed one single caries lesion after one year.
  • About 20-30% of the patients did not develop any new caries lesions at all, although they had a frequent intake of between-meal sweets for long periods.

This is far from a detailed, or complete list of reasons why some people get more cavities than others.  But hopefully it will help you when understanding the caries process, and how they can somewhat be prevented.  Stay tuned for my next post, how to reduce your chances at getting cavities!

I am currently up in VT with a bunch of friends, and every hour or so, most of the group heads outside for their ritual cigarette. Smoking, although a declining trend , is still prominent in the USA, especially among my generation, those in their 20’s.

No matter what people claim, if they smoke, they are addicted. I know this because EVERYONE knows that smoking can kill you, yet if they still do it, thus they must be addicted.

Smoking causes lung cancer, which is the most common cancer in the USA and has one of the highest mortality rates of any cancer. If you get lung cancer from smoking (15x greater chance than a non-smoker), you have a 50% chance of being dead within 5 years . In addition to the obvious systemic dangers, smoking also has serious effects on your dental health such as:

1.) Oral cancer – this dangerous cancer has a higher death rate than cervical cancer, skin cancer, and others, making it extremely dangerous. Cigarette smoking has been directly linked to oral/pharyngeal cancer, so why smoke?

2.) Staining – smoking can cause serious, ugly staining of your teeth. This staining can ranger from a slight yellow, to brown, to black, and can become permanent if the smoking continues and oral hygiene is not sustained.

3.) Cavities – Long term smoking can lead to dry mouth, which is a high risk factor for cavities. We all know that you don’t want cavities.

Dentists today employ many means of smoking cessation, ranging from nicotine replacement therapy to providing information regarding the risks of smoking.

If you smoke, seriously think about and try quitting. Not only will it improve the health of your mouth, but it may well save your life.