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CSD Dec 2011 Newsletter

Merry X’mas and Happy New Year to all.

Here is the Cosmic Smile Dental December 2011 Newsletter. I hope that you enjoy it.

Dental Trauma in Children

These consist of injuries to the teeth, gums and bone of the jaw. Most often this is a broken or displaced tooth.

Children just starting to walk are most prone to injury ie. 1.5 to 3.5 years of age. 30-50% of children experience dental injury with boys twice as much as girls. 
With trauma, teeth may be chipped, broken, loose, out of place or knocked out. The type of treatment with vary with the type of tooth and the age of the patient but here are some guidelines.

Baby Teeth

Normally it is not necessary to repair chipped teeth but broken teeth can be easily repaired with some treatment of the nerve. It is important the the tooth pulp is sealed within a day.

A loose tooth is usually left to recover on its own while observing a soft diet. A displaced baby tooth may need to be removed to prevent damage to the developing permanent tooth underneath it. A knocked out baby tooth however should NEVER be replaced. It is not uncommon for the tooth to do dark but no treatment is necessary unless there is pain or swelling. Treatment in these cases is extraction.

Adult teeth

A chipped tooth can easily be repaired with white filling material that can serve for many years. A broken tooth will require sealing of the nerve or in more severe cases root canal therapy. Loose teeth may heal on their own or splinted depending on the severity. 

If a tooth has moved inward, outward, and/or upward, try to reposition it back to its normal position with very light finger pressure. Do not force the tooth back into position. Hold the tooth in place with a tissue or gauze if it is very loose. Call our office so we can decide on a treatment plan. After an exam, we may have to numb the area and then reposition the tooth if you have not been able to move it back into its original position with light finger pressure. To keep the tooth steady, we place an orthodontic wire retainer across several teeth to stabilise the traumatised teeth. If the damage is very extensive, future root canal treatment may be needed to keep the tooth.

There is a possibility that a permanent tooth that has been knocked out can be re-implanted if handled promptly and correctly. If possible, the tooth should be rinsed and reinserted in the socket and held there until the child sees a dentist or visits the emergency room. If it is not possible to replace the tooth in the socket, the tooth should immediately be placed in milk or saliva (in the child’s cheek if possible). The tooth should be handled only by the crown and never be allowed to dry out. If a dentist can see the child within half an hour and the tooth has been preserved correctly, there is a possibility that it may be successfully re-implanted. Root canal treatment is most likely if the child is older.

In most cases, it is best to bring your child in to be assessed as soon as possible to minimise complications. We will often take x-rays to confirm what is observed and assess the region.

 Use Panadol or Nurofen for Kids to relieve pain and use ice compresses over swollen areas. Neosporin can be used to prevent infection for any external cuts or scratches. Keep your child on a soft diet for 2 weeks to prevent further damage. Mouthguards and helmets may be appropriate depending on the sport to minimise injuries.
Call the office on 9904 2880 if you have any other questions or if symptoms get worse. 

New Water Ozonation system installed

We’ve just upgraded our water ozonation system to provide continuous ozonated water on demand!

Previously our ozone device generated ozone gas to provide ozonated water at low concentration. Unfortunately it involved bubbling ozone gas into a bottle which was inconvenient and time consuming.

The new electrolytic device is a point of use unit that provides ozonated water to eliminate all known bacteria, fungi, algae, yeast and protozoa (including parasites and amoebae).

 
With the new system, we can:

• * Refill dental unit water bottles to counter biofilm build up
• * Ozonate water as a preprocedural mouth rinse
• * Use as an irrigant during ultrasonic scaling
• * Powerfully disinfect hands, surfaces, floors and instruments
• * Oxygenate drinking water to 20ppm (Normal tap water 5ppm)

“Ozone in water can kill bacteria and other pathogenic microorganisms by rapidly rupturing their cell membranes (within several seconds). The same effects occur when dental plaque is exposed to ozonated water as a rinse. Ozonated water has no side-effects such as unpleasant taste or tooth staining, which are characteristic of other biocides or disinfecting agents.”

Professor Laurence Walsh, University of Queensland

With a point of use ozonated water system we are able to take advantage of the the antimicrobial and immune stimulating properties of ozone. When used as a pre-procedural rinse, it will rapidly kill bacteria and other pathogenic organisms in dental plaque by rupturing their cell membranes (within several seconds). And it has no side-effects such as unpleasant taste or tooth staining, which are characteristic of other biocides or disinfecting agents such as chlorhexidine.

Ozonated water can also be used as a sterile irrigation solution for surgery (as it helps reduce bleeding), or as an antimicrobial mouthrinse following tooth extraction. Of interest, ozonated water when used as a daily mouthrinse has been reported to accelerate healing of oral mucosal wounds, particularly when used over the first 48 hours after surgery. The same benefits of accelerated wound closure may be seen when used in patients with oral ulcerations from chemotherapy.

The greater speed of wound closure can be explained by the known positive effects of topical ozone on enhancing the local microcirculation. Known positive biological effects of ozone include improved oxygenation of tissues, quicker healing and accelerating of the immune response to bacteria. Accompanying these effects is an enhancement of natural antioxidant defence systems.

Ozone is also known to stimulate the production of several key cytokines including interleukin 2, 6, 8 and transforming growth factor-beta, and to the attenuate the inflammation driven by bacterial lipopolysaccharides. Recent studies have show that that ozonated water as a mouth rinse can reduce gingivitis in orthodontic patients.

As a topical agent, the use of ozonated water has an excellent safety profile as ozone dissipates quickly and is converted back to diatomic oxygen.

And best of all, these units can be installed in the home to receive all the same benefits! Ask us for more information about the home systems.

Take a look at this video from Biotek about how the system can benefit everyone –  Mint Devices Water Ozonation

Dr. Jason Pang meets Snap-On Smile inventor

This week I was fortunate enough to meet with Marc Leichtung the inventor of the Snap-On Smile. He was giving a lecture for advanced Snap On Smile providers and I was invited along. He is wholly committed to making the product as successful as it can possibly be and was giving us insights into the new manufacturing techniques and materials that make the product even better than before.

One of the new products that was made available was Snap-It! This is a product that only spans 6 teeth or less. It can be used in any area of the mouth to replace even a single tooth. It has been designed so that it does not cover the palate in any way and both protects and enhances the area where the missing/damaged/implanted tooth may be. It is manufactured with an advanced milling technique on computer so that the fit is perfect. The new material is even more flexible than before making it more durable and comfortable to wear.

He showed us many cases where the patients had been using their Snap-On Smile for over 5 years! When they come back to the practice for their periodic hygiene visits, he just gives the appliance a polish and it looks brand new again! He has his own Snap-On Smile appliance that he has worn on a daily basis for over 3 and a half years! Not only does it look great but he looks great with them on too.

While in the past it was only recommended to make the Snap-On Smile to one or two teeth past the last tooth in the arch, with the advent of mini-implants it is very easy to make a Snap On Smile with molars for chewing. And for patients that need something to improve the aesthetics while their standard implants are healing, the Snap-On Smile or Snap-It! covers them until they’re ready to be restored. For those interested in dental implants, please visit one of our Implant Open Days. 

The Snap-On Smile is monochromatic ie. the entire appliance is made of the one selected colour, and while that looks great for most people, Marc showed us how to characterise the device. Individual teeth on the appliance can be made to look like a previously extracted tooth or made more yellow near the gum line for a more natural look. Some people have very distinctive teeth, and want to maintain that look as before. That’s all possible now in just a short time.

 Other new things are the Lumi Smile which digitally simulates whitening, LUMINEERS and replacing missing teeth with the Snap-On Smile to show what your new smile will look like. I can’t wait for that to be available here!

There really are some exciting changes ahead so stay tuned!!

Cancer Treatment and the Mouth

Having recently had three people, a colleague, a friend and a patient each go through the woes of chemotherapy / radiotherapy, it is important to realise that not only can dental health can affect cancer treatment but cancer treatment affects oral health as well. 

An unhealthy mouth can increase the risks of side effects from cancer treatments and may interfere with the therapeutic regime.

With chemotherapy, many parts of the body are affected, most frequently resulting in hair loss, gastrointestinal problems and others. With radiotherapy, almost all head and neck radiation patients will have oral complications.

Ideally, we would like to schedule a pre-cancer treatment examination about a month before treatment begins with the following objectives:

• Establish a schedule for dental treatment.
• Complete invasive procedures at least 14 days before head/neck radiation therapy starts; 7 to 10 days before myelosuppressive chemotherapy.
• Postpone elective oral surgical procedures until cancer treatment is completed.
• Identify and treat sites of low-grade and acute oral infections such as caries, periodontal disease, endodontic infections and lesions of the muscosa.
• Identify and eliminate sources of oral trauma and irritation such as ill-fitting dentures, orthodontic bands, and other appliances.
• Identify and treat potential oral problems within the proposed radiation field before radiation treatment begins.
• Instruct patients about oral hygiene.
• Educate patients on preventing demineralisation and dental caries.

By improving the oral health of the mouth, the aim is to:

• Reduce the risk and severity of oral complications
• Improve the likelihood that the patient will successfully complete planned cancer treatment
• Prevent oral infections that could lead to systemic infections
• Prevent or minimise complications that can compromise nutrition
• Prevent, eliminate or control oral pain
• Prevent or reduce the incidence of bone necrosis in patients receiving radiation therapy to the head and neck
• Preserve or improve oral health
• Improve the quality of life
• Decrease the cost of care

General Oral Complications of Cancer Treatment include:

• Oral mucositis/stomatitis – inflammation and ulceration of the mucous membranes
• Xerostomia/salivary gland dysfunction – dryness of the mouth because of thickened, reduced, or absent salivary flow
• Infection
• Xerostomia-associated cavities
• Taste alterations
• Nutritional compromise
• Functional disabilities
• Abnormal dental development in children 

 Specific complications from - 

Chemotherapy:

• Neurotoxicity
• Bleeding

Radiation therapy:

• Radiation caries
• Trismus/tissue fibrosis – loss of elasticity of chewing muscles that restricts normal ability to open the mouth.
• Osteonecrosis -blood vessel compromise and necrosis of bone resulting in decreased ability to heal if traumatised and in extreme susceptibility to infection. 

Together these can mean that it is painful to brush and floss and food may not be able to be removed from around teeth resulting in a greater chance on decay. Products like Biotene Oral Balance, Dry-mouth gel and Tooth Mousse/Plus, fluoride rinses amongst other natural therapies can help to wet the mouth and improve clearance of food and help to protect the teeth.

 To maintain a health mouth:

• brush teeth twice daily with a fluoride toothpaste; 
• clean between your teeth every day with dental floss;
• stop the use of tobacco products;
• rinse after vomiting with a quarter teaspoon of baking soda in a cup of warm water;
• moisten a dry mouth by drinking water; sucking on ice; chewing sugar-free gum or sucking on sugar-free candies; avoiding mouthwashes that contain alcohol; use a product mentioned above

Always keep in mind that we are just a phone call away and can help advise on treatment or products that will help keep your mouth healthy. Good luck with your treatment. Keep your chin up and stay positive!