Got laser?

A couple of months ago a patient visited my office for a consultation. As a teenager, he was involved in an accident and knocked out his front tooth. Now in his late twenties, he was wearing a partial denture to restore the avulsed tooth. Needless to say, my patient did not care for his partial; it was awkward, ugly and socially unacceptable. We talked about replacing his missing tooth with either a bridge or a dental implant. Seeing the obvious advantages of an implant, he selected that treatment option, and a few days later underwent a short oral surgery procedure to have the implant placed.

A few weeks after the implant surgery, my patient was in my office again for a follow-up visit. I noticed that the surgery site was having difficulty healing properly. Upon closer inspection, I realized that my patient had a frenum pulling on the tissue near the implant.  A frenum is a fold of mucosa, or skin of the mouth, that attaches the cheeks or lips to the gums near the teeth. A frenum doesn’t do much, and more often than not, they cause problems. For instance, large frenums can cause gum recession or spaces between the teeth. In my patient, his frenum was preventing proper healing. Every time he smiled, spoke, breathed or opened his mouth, the frenum would pull on the surgery site and disrupt the skin from healing completely.

My patient's maxillary frenum, preventing proper healing of a dental implant.

Small laser incision removing the maxillary frenum. No bleeding and no pain!

In the good old days of traditional dentistry, I would have whipped out a scalpel and cut out my patient’s frenum; a bloody, painful and disgusting attempt to fix the problem. Most of the time, frena removed in this fashion regenerated and grew back in a couple of months. However, my patient and I decided that we would remove his frenum with a laser. After administering a teeny bit of anesthetic, I turned my carbon dioxide laser on to a low power level (about 3.5 watts) and gently removed the frenum. I say removed, but the actual procedure actually vaporized the unwanted tissue. There was no bleeding and my patient experienced no post-operative pain. In two weeks the site will be completely healed and it will not grow back. Best of all, the dental implant will be able to heal and my patient will get a new permanent front tooth. Dental lasers? Yeah, I’ve got one of those. Pretty cool? You bet.

- Written by Bryant W. Cornelius, DDS, MBA

Zap! My Personal Experience With Laser Surgery

A couple of months ago while eating a ham sandwich, I suddenly bit down on my lower lip. The searing pain and blood from the wound completely ruined a perfectly good culinary experience. I was so disappointed! The bigger problem, however, became apparent with the development of a fibroma on my lip. A fibroma is an outgrowth of connective tissue in response to trauma or localized irritation. A fibroma is not cancer, but rather, a big ugly nodule that gets bigger and bigger every time it is irritated. In my case, I kept biting my new “oral buddy”. It seemed that just about every other meal ended in pain and frustration as I unwittingly chomped down on the ever enlarging flap of skin. Eventually, the fibroma was big enough that other people could see it when I talked. Not a great selling point for a dentist!

Lucky for me, my younger brother is also a dentist. Always searching for opportunities to cause me pain and anguish, he suggested that we “remove” the fibroma. In other words, he wanted to chop it off. Just so you know, me, my brother, and a scalpel in the same room is a disaster waiting to happen. I informed him that there was no way in heck that he was going to “remove” anything from my body with a knife!

Enter the laser. The carbon dioxide laser wavelength is absorbed by water. Since 80-90% of oral soft tissue is composed of water, it is cut very easily and very cleanly by carbon dioxide laser energy. As the laser cuts, it cauterizes all of the capillaries and nerves that it touches. This means that unlike a scalpel incision, there is very little, if any, bleeding and post-operative pain associated with a laser procedure. A laser kills any bacteria it comes in contact with; a scalpel drags bacteria through tissue as it progresses. Armed with information like that, I decided to let my brother “remove” my fibroma with a carbon dioxide laser.

Zap! Sixty seconds after the laser procedure started, it was over and my fibroma was gone. I healed completely within ten days and experienced no pain. I’ve used the laser on thousands of patients, but now I can say that I’ve had it used on me. The best part of the deal?…I can now eat a ham sandwich without biting my lip!

- Written by Bryant W. Cornelius, DDS, MBA

Realizing My Boyhood Fantasies With… A Laser?

 

 

When I was five years old I saw the movie, “Star Wars” on the silver screen for the first time. I was absolutely mesmerized by all of the lasers in the film, especially the laser that fired from the Death Star. All that power in a beam of light! I knew that someday I would have to own one myself (a laser, not a Death Star). Well, that was 1977, and now here we are over thirty years later and my dreams have come true; I have owned many lasers of many different wavelengths, and I use them in my profession on a daily basis. Luckily for the universe, I haven’t blown up any planets yet…I just use them for dentistry.

My favorite laser is the carbon dioxide laser; an invisible laser wavelength that at highest powers can cut through solid steal, but at therapeutic levels can incise delicate tissues or fight bacterial infections. The word “laser” is an acronym that stands for Light Amplification by Stimulated Emission of Radiation. Basically, lasers work by exciting the molecules of a certain substance (like carbon dioxide) contained in a special tube with mirrors at either end. At a certain point, the excited molecules emit light particles, called photons, which are released from one end of the tube. Because the photons are all the same and traveling in the same direction, this laser light can do special things that ordinary light can’t. Like cut things.

When a doctor uses a scalpel to make an incision, several adverse things happen. One is that it creates a painful inflammatory response in the surrounding tissue and causes a lot of bleeding. Another is that it drags bacteria through the tissue as it cuts.  Another is that the blade dulls quickly and can potentially tear or damage the tissue. The beauty of an incision made by a laser is that it does none of those things. Laser incisions experience faster healing times and less post-operative discomfort. They kill bacteria instead of spreading them and coagulate blood vessels instead of making them bleed profusely. Laser procedures are usually much faster too. For many soft tissue procedures, using a laser has become the gold standard of care in dentistry.

I may not ever wield a light saber or a laser blaster, and I hope for the sake of all of humanity that I never get my hands on an actual Death Star. Luckily for me, I’m able to fulfill all of my boyhood fantasies with the simple carbon dioxide laser that I wield every day in my dental practice. Ask your dentist about dental lasers at your next checkup, and may the force be with you.

- Written by Bryant W. Cornelius, DDS, MBA

 

I’m Siding With Dr. Evil

Remember in the 1997 movie, Austin Powers, International Man of Mystery, where Mike Myer’s character, Dr. Evil, threatened to destroy Washington D.C. with a laser mounted on the moon? It was funny as heck, but not really very realistic. About that same time, I was in dental school and I remember one of my professors telling me the same thing about dental lasers. “No ethical dentist would ever use a laser on a tooth,” he pontificated, “it would fry the nerve!” Well, it’s been more than a decade since, and I have to tell you honestly, I’m siding with Dr. Evil on this one.

I’ve been using dental lasers in my practice for almost five years now. I use them to assist me in nearly every aspect of patient treatment from fillings and root canals to gum surgery and biopsies. I use them to treat adults, teenagers and children. Why? Because dental lasers, for the most part, are more effective than dental drills and they certainly hurt a lot less.

Take a typical cavity, for instance. When you go to the dentist to have a cavity filled the traditional way, you have to get a painful shot in the mouth. When you have a cavity treated with a laser you do not need a shot. Seriously, no shot. When a dentist uses a drill on your tooth it puts micro fractures in the enamel. This is because the drill turns at 400,000 rpm and uses mechanical force to break down tooth structure. With a laser, there are no moving parts touching your tooth, therefore, no mechanical forces at work to cause micro fractures in the enamel.

As for the concern that my professor had about overheating the tooth’s nerve, well, that just isn’t the case. My erbium laser has a digital free running pulse. What that means is that the laser only fires for 0.000110 of a second at a time. This “pulse” of energy is short enough to allow the tooth to dissipate any heat build up before the laser fires again. This protects the nerve of the tooth and provides a virtually painless procedure.

Dental lasers are a reality. They are an indispensible part of my daily practice. My patients love the dental laser because of the benefits that it offers them; no shots, no pain, no cracked teeth. I love the dental laser because I know that by using it, I am providing the most up to date, highest quality and most conservative treatment possible. Plus, it satisfies my inner Dr. Evil.

-Written by Bryant W. Cornelius, DDS, MBA

Beware the Christmas Fruitcake!

Johnny Carson once joked that there was only one fruitcake in the entire world…it just kept getting re-gifted every year. That doesn’t seem too far from reality considering what the freakish frankenfood is made of: nuts, mystery fruit and alcohol-soaked spice cake. The stuff is so scary, no-one really eats it, in fact, the oldest holiday fruit cake is over 130 years old. It lives in Michigan.

Did you know that fruitcake has been classified as a national security threat? Yep. In 2005 the US Government banned the nasty confection as a carry-on. Apparently, you can hide a weapon inside a fruitcake. Personally, I think that fruitcake would be more deadly as an object with which to inflict blunt-force trauma than as a surprise suitcase in which to stash a knife or a gun. Either way, you can’t bring one on an airplane.

Every January, residents in Manitou Springs, Colorado, hold a contest to see who can toss a fruitcake the furthest. To date, the record is held by a team from Boeing who launched their fruitcake 1,425 feet! Finally, someone has invented a viable use for the disgusting dessert: artillery ammunition.

Dentists despise fruitcake because of what it does to your teeth. I can’t tell you how many patients walk into my office after Christmas with a cracked tooth or filling. Chomping on a chunk of fruitcake is often the culprit. The human jaw can bite down with forces in excess of 150 pounds per square inch. When hard nuts or sticky candies are bitten with those kinds of forces, the teeth often times come out as the loser.

As the holidays come this year, and you are re-gifted with that one Christmas fruitcake that no-one seems to want to eat, please be careful. If you choose to sample the strange holiday concoction, chew slowly and with caution, you could be putting your oral health in jeopardy. I, for one, will be avoiding the Christmas fruitcake altogether!

- Written by Bryant W. Cornelius, DDS, MBA

Hey Mister Stinky Breath, Try Flossing Your Teeth

Everyone has that great uncle on their mother’s side whose breath smells like death. He’s the guy who always corners you at the family reunion and stands too close while sharing “funny” stories. I once nearly passed out while holding my breath during an extended conversation with my stinky Uncle Skunkenstein. His wafting vapors could peel the lacquer off of the furniture.

Halitosis, or bad breath, can be caused by many different problems; post nasal drip, gastric reflux disease, smelly foods and poor brushing habits are just a few. There are all sorts of things that you can do to cure or cover up bad breath. One of the most effective things that you can do to rid your mouth of the stench is to use dental floss.

“Doc,” my patients muse incredulously, “you mean to tell me that if I floss my teeth every day, my breath won’t stink?”

“Yep,” I confirm. “Flossing your teeth is one of the most important things you can do to fight bad breath.”

When you eat, small pieces of food get lodged between your teeth. Because your mouth is a moist, warm environment, bacteria immediately began to break down the food particles. Unless the debris is removed in a timely manner, it starts to stink. Think about your refrigerator…the reason that left-over ham sandwich from last Thursday smells so bad is because it is rotting. That is what happens to the food between your teeth; it too is rotting.

You should floss your teeth once a day. Flossing is, in effect, like cleaning out the smelly left-overs from your fridge. Getting all of the food particles out from between your teeth will also remove the bacteria that is in the area; bacteria that causes cavities and gum disease. In addition to getting rid of the stench, you will also be fighting oral disease. To be most effective, you should floss first, brush second and use your choice of mouthwash last.

So floss! Floss every day! Floss and you will smell great! And while you’re at it, send that great uncle on your mother’s side some dental floss…you’ll be amazed at how enjoyable your next family reunion will be!

-Written by Bryant W. Cornelius, DDS, MBA

Saliva, Spit and Slobber: Sundry Sobriquets for a Sacred Secretion

When you ask a dentist what really gets them excited, you can bet good money that teeth are what makes their world turn. However, chances are that saliva is a darn close second on the list. In the dentist’s view, good ‘ole spit is one of the most important secretions in the body; when the salivary glands are working properly, oral health and the general health of the body are benefited. When the various saliva secreting glands in the body are impaired, many dangerous and undesirable consequences usually occur.

Xerostomia is the term applied to various levels of dry mouth. Patients who experience a dry mouth often suffer from a wide range of afflictions including mouth sores, bad breath and digestion difficulties. Saliva, that wonderful slippery stuff in your mouth, protects against gum disease and cavities, fungal infections and cracked and peeling lips. It also aids in swallowing and speaking. It is what causes dentures to stay in place and not fall out.

It is estimated that nearly 30% of the population experiences xerostomia at some level; a statistic that is most likely higher in geriatric populations. Dry mouth can be caused from radiation treatment to the head and neck region and from chemotherapy. Systemic diseases like Sjögren’s syndrome and rheumatoid arthritis are common causes of xerostomia. Smoking and alcohol use increase dryness in a person’s mouth and therefore compound the effects of hyposalivation.

Probably the most common cause of xerostomia in people today is the use of anticholinergic medications. These drugs include antihistamines, antihypertensives, antidepressants, and narcotics. In fact there are over 400 commonly used drugs on the market today that cause dry mouth to one degree or another.

If you are suffering from xerostomia, it is absolutely essential that your dentist examine you as soon as possible. There are many things that your dentist can help you with including specialized oral hygiene instructions, daily topical fluoride administration and administration of saliva stimulants or substitutes. Ask your dentist about a drug called pilocarpine; it stimulates the body to secrete more natural saliva.

Saliva. Spit. Slobber. The ancients called it Adam’s ale. Whatever you want to call it, you must recognize it for what it is: an essential bodily secretion that you cannot live without.

-Written by Bryant W. Cornelius, DDS, MBA

Would You Like a Nice Refreshing Glass of Acid?

I have this re-occurring nightmare where I am back in my college chemistry class from the early nineties. In the dream, my professor relentlessly drills me about stoichiometry and chemical periodicity in front of a room full of laughing classmates. I’m also in my underwear.

I don’t remember a whole lot about college chemistry; I think I was dating my soon-to-be-wife during that semester. To be honest, I have very little recollection of anything from that semester. However, one thing that has somehow managed to stick with me from that subject is the topic of pH.

What is pH, you ask? Well, pH stands for “potential of hydrogen” and is the scale by which we measure how acidic or alkaline a solution is. Based on a scale of 0 to 14, really acidic substances fall on the low end of the chart while alkaline, or basic, substances fall on the high end. Neutral substances are located right in the middle at about 7.

The reason this bit of chemistry has stuck with me is because it has significant value to the dental profession. You see, tooth enamel starts dissolving when it comes in contact with substances that have a pH value of 5.5. This may surprise you when you consider that tap water and saliva have a pH of about 6.8 to 7.4. The important question, then, is “where do most of the substances that I put in my mouth fall on the pH scale?” You might be even more surprised to find that several of the things that we consume every day have a pH below the magic 5.5 level where tooth enamel erodes. For example, beer has a pH of 4.5, tomatoes have a pH of 4.2 and orange juice has a pH of 3.3. Most soda and energy drinks have a staggering acidity level of about 2.5. That is pretty scary when you take into account that stomach acid’s pH is nearby at 2.0 with battery acid close behind with a pH of 1.0.

What does this mean for the average person? Well, it means that soon after you consume these highly acidic foods, the enamel on your teeth start to dissolve. If you consume too much acidic foods and beverages or don’t take the necessary precautions to raise the pH levels in your mouth, cavities start forming very quickly. My recommendations for all of my patients are these: first, be aware of the acidity of the foods and drinks that you consume. Second, try to have a diet that stays away from excessively acidic things (like soda and energy drinks). Third, try using oral health care products that incorporate xylitol and fluoride; substances that raise the pH in your mouth. Fourth, brush your teeth often…there is no substitute for good old fashioned healthy hygiene!

-Written by Bryant W. Cornelius, DDS, MBA

Tooth Decay is a Disease?

Did you know that when your dentist informs you that you have a cavity that he or she is telling you that you have a disease? The definition of a disease is, “an impairment of the normal state of living” (http://www.merriam-webster.com/medical/disease). Dental caries, or tooth decay, is caused by acid producing bacteria, and like other bacterial diseases such as anthrax or cholera, it results from the unchecked spread of the bacteria in your body.

In order to understand caries disease most accurately, you should know that your mouth is a delicate ecosystem in which good bacteria and bad bacteria coexist in a harmonious balance. Changes to this ecosystem can cause the good bacteria to die off and promote the overgrowth of the bad bacteria, resulting in a disease process. Factors such as a poor diet or medications that cause dry mouth can cause this change to take place.

Some people tend to have a very acidic mouth. Bad bacteria thrive and multiply in an acidic environment. Also, tooth enamel starts to dissolve in acidic environments. People who have excessively acidic mouths will develop more cavities at a quicker rate than people who have less acidic mouths. I often have patients complain that they have a new cavity every time they come for a checkup, regardless of their oral hygiene efforts. The reason may be because the acidity of their mouths promotes the growth of bad bacteria…it predisposes them to an oral bacterial infection.

What can be done to prevent cavities? Well, the answer is simple: prevent the growth of bad bacteria in your mouth. Effective oral hygiene, a healthy diet and fluoride treatments are helpful in preventing the ravaging effects of an oral bacterial infection. Make sure that your saliva flow is adequate, especially if you take certain medications, and use a medicated mouthwash that helps maintain a healthy pH (non-acidic) level in your mouth. For more information about these preventative measures, contact your dentist or dental hygienist.

 

- Written by Bryant W. Cornelius, DDS, MBA

 

A Bigger Waist Means Fewer Teeth

Being overweight is defined as having a body mass index (BMI) of 25 or higher. According to the Journal of the American Medical Association, 68% of adults living in the United States are overweight or obese; a statistic that has steadily increased among both genders, all ages, all racial/ethnic groups, all education levels, and all smoking levels from 1960 until the present time.

People who are overweight often fall victim to terrible systemic diseases. Type two diabetes, high blood pressure, high cholesterol, gall bladder disease, cancer, osteoarthritis… all of these maladies occur in higher rates in the overweight and obese. It is estimated that obese people pay 42% more in health care costs than normal weight individuals.

In recent years, scientists have found that overweight people are also more likely to suffer from periodontal disease. This is especially true in younger individuals aged 18 to 34 years old. Researchers from Case Western Reserve University have suggested that the unhealthy dietary trends in young people probably contribute to the correlation between obesity and periodontal disease. Eating habits of young people reveal a significant lack of raw fruit and non-potato vegetables, which are good sources of vitamin C. Also, young adults and adolescents have decreased their calcium intake and increased their intake of soft drinks and non-citrus juices. Low dietary intake of calcium and vitamin C are associated with periodontal disease.

It has been shown that with every 5% increase in body fat, the risk of periodontal disease increases 1.3 times. There are many reasons for eating right and exercising; it is a fact that being fit will help us to live longer, happier lives. Now, it seems, it will help us to have better smiles too.

- Written by Bryant W. Cornelius, DDS, MBA