Got laser?

•September 5, 2011 • 4 Comments

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

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Zap! My Personal Experience With Laser Surgery

•August 29, 2011 • 8 Comments

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?

•August 21, 2011 • 7 Comments

 

 

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

•February 9, 2011 • 4 Comments

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!

•December 23, 2010 • 3 Comments

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

•December 15, 2010 • 4 Comments

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

•December 5, 2010 • 4 Comments

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

 
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