Please use this page to review information about areas of recommended treatment that you and Dr. Menke have discussed.
» New Methods to Fight Dental Disease
» Osteoporosis Medications and Dentistry
» Implants - Care After Placement
» Baby's First Teeth - Prevention Advice
» Your Child's First Dental Visit
New Methods to Fight Dental Disease
Our practice goal is not to continually fight the effects of dental disease after
damage has occurred but rather to work with patients to provide methods to prevent
damage and reduce the need for patients to have repairs made to their teeth and
due to gum disease.
The two most common dental diseases have some new effective techniques to combat
Gum Disease (Perio Protect®) http://www.perioprotect.com
Gum disease is caused by the presence of a very few bacterial types. Some people
have these in their mouths and continually battle progressively worsening gum
disease. Some people don't seem to have these bacteria and have no active gum
disease problems at all. Wouldn't you like to be in the second group?
Trying to keep the harmful bacteria at bay has been the problem. Chlorhexidine
rinses can help to accomplish this goal, but they stain the teeth and make
food taste bad. Its also hard to get the rinse deep into the pockets formed
by gum disease. Recently new techniques have been shown to be more effective.
A custom-fitting clear plastic tray and an antibacterial solution loaded in
the trays are worn for a few minutes several times per day, similar to the
home bleaching method. The results are more effective than rinsing because
the trays confine the solution around the teeth and actually help move the
solution down along the teeth into the pockets formed by gum disease, thereby
eliminating the harmful bacteria in their most difficult to reach and damaging
In particularly deep pockets, your dental hygienist can place a medicated
chip or granules that slowly dissolve and releases medication that helps heal
We also use a specific laser that targets the inflamed tissue in the pockets
and eliminates it by vaporizing the diseased tissue, leaving the deeper healthy
tissue alone. It also effectively sterilizes the pockets by vaporizing bacteria
at the same time.
This combination of immediate removal of diseased tissue along with the harmful
bacteria and the follow up of long term bacterial control has shown an impressive
reversal in many gum disease cases.
Smoking is the biggest contributor to poor gum health and virtually guarantees
the continued progression of gum disease damage even with the above treatments.
However, with treatment the damage makes much slower progress, even with active
smoking, than it does without intervention. And as you'll eventually stop smoking,
minimizing the damage until you do is your best bet.
Stop Getting Cavities
(MI Paste®) http://www.gcamerica.com/mipaste.html
Decay is caused by a few select bacteria that some people host, causing them
to continually fight recurrent cavities.
Decay is a rather complex chemical process that involves both demineralization
and remineralization of calcium from the tooth structure. As teeth are exposed
to bacteria that cover tooth surfaces, the calcium in the tooth is dissolved
by the acids that the bacteria produce. The key is to tip the scale away from
calcium loss and move it toward calcium gain.
CariFree System http://www.carifree.com
One of the first important issues to address is the film of bacteria (biofilm)
that develops on the tooth surfaces and creates the acid layer that causes
decay. This biofilm is commonly called plaque. The longer the film remains
on the teeth, the more acidic the layer becomes and the more it favors the
growth of the two most acid producing bacteria involved in decay process.
It is important to identify the presence of the most harmful bacteria and this
can be done with
the use of a quick simple caries susceptibility test (CariScreen) in about
When that test indicates a moderate to high decay susceptibility, a two week
treatment rinse (CariFree Treatment Rinse) is prescribed to be used daily to
reduce the biofilm on the teeth and reduce the cavity causing bacteria present
in the mouth.
That treatment is followed by a maintenance rinse (CariFree Maintainence
that maintains a reduced biofilm and prevents the regrowth of the harmful decay
Due to individual biologic differences, some patients may require more than
one cycle of CariFree products to reduce and control the cariogenic biofilm.
Controlling the bacteria that causes decay is the first step to fight the
occurrence of tooth decay.
An equally important part of controlling decay is preventing the loss of calcium
from the tooth surfaces and/or replacing the mineral lost from incipient or
early decay damage.
Our recommended technique uses a custom fitted tray made for each patient.
A gel (MI Paste® - http://www.gcamerica.com/mipaste.html) is used under
the custom fitted tray. The gel contains ACP (amorphous calcium phosphate),
a product of milk, that has been proven to greatly aid the chemical reversal
of calcium depletion by decay. By using the ACP to tip the balance of chemical
reaction toward mineral deposition and by concurrent use of fluoride, the teeth
can rebuild themselves and, in theory, be stronger than the original enamel
due to the inclusion of the fluoride. Candidates for this process include:
- Patients that have gum recession and extensive exposed root surfaces. Decay is much more active on softer root surfaces.
- Patients with decreased salivary flow due to medications or Sjogrens and suffer increased decay rates. They might also have recession and exposed roots greatly increasing their decay problem.
- Patients wearing orthodontic braces. They can have difficulty cleaning effectively and frequently have damaged tooth surfaces following brace removal at the completion of treatment.
- Patients who have or need to invest in significant repair of their
teeth and wish to ensure the best longevity and health of their care.
- Patients that have a large number of areas of beginning decay from poor brushing or flossing habits that are not in need of fillings, just decay control.
- Patients that suffer from generalized cold sensitivity that continually bothers them.
- Patients experiencing sensitivity to the bleaching process.
Xylitol ( http:/www.xylitol.org )
Xylitol is a white crystalline sweetener that looks and tastes like sugar. It
has received official endorsements from six national dental associations.
Xylitol is a natural substance found in fruits, berries and other organic matter.
In fact, our bodies produce xylitol from other food sources.
It has been shown to offer a dramatic reduction in new tooth decay. It also enhances
other existing prevention methods.
It is found in Trident gum, can be purchased from health food stores in place
of sugar, and it used in candy products that are actually good for you!
The exposure to xylitol must be on a daily basis to provide its best benefit,
but, only in a very
Continued patient compliance with thorough brushing, flossing and dietary
sugar controls are paramount efforts to assure success with these therapies.
If you, a friend or family member suffer from any of the above problems, contact
us to discuss the use of these advanced oral health products to help control
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Osteoporosis Medications and Dentistry
etidronate (Didronel), pamidronate (Aredia), alendronate (Fosamax), risedronate (Actonel), zoledronate (Zometa), ibandronate (Boniva)
Bisphosphonates are used to treat age-related bone loss and are often given intravenously along with chemotherapy related to cancer treatment. Their benefits related to bone density have been significant in reducing fractures and injuries. Very recently however, a new and very serious side effect has begun to be documented.
Patients who have had intravenous bisphosphonates or those who have taken oral doses of these meds for 3 or more years are suffering from necrotic deterioration of the jaw bone that is exposed during extractions, implant placement, or even from denture sores. Orthopedic doctors are also seeing negative effects on such procedures as hip replacement surgeries.
The exposed bone seems to have lost the ability to heal. Treatment for other forms of necrosis do not seem effective in healing and reducing these wounds. Gum tissue does not heal over the dead bone and the necrotic bone easily becomes infected, increasing the wound size. A very thorough routine of hygiene must be used to prevent infection and stabilize the wound.
There are millions of patients who have been taking these medications and we are only beginning to deal with the tip of a very large iceberg of future complications affecting patients' ability to receive routine dental care. The situation is so recent that there are few answers to a host of questions about long term effects.
If you are a patient that has been taking these medications, please do not undergo any dental treatment without advising your dentist about these medications. You need to maintain an extremely high level of hygiene and dental health to avoid the need for surgery or extractions. If you have periodontal disease that is threatening your ability to maintain your teeth, it may be necessary to splint the teeth, perform root canals to reduce pain or infection and maintain the teeth until they basically fall out on their own.
You should discuss your current bone density and the need to continue these medications with your M.D. It may be possible to seek more organic nonprescription means of maintaining bone density without these medications.
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Implants - Care After Placement
Implant success is usually stated in a percentage of those that heal properly immediately after surgery. This percentage has always ranged in the high 90's, depending on patient's age, health, and location of implants. However, another important number is the long term success and stability of implants measured in years after placement.
One of the common causes of loss of successfully healed implants is over-stress due to the patient clenching and/or grinding where too few implants may have been placed or the bone is too soft to withstand the stress of even normal function.
Also very important is the failure of implants due to lack of adequate patient hygiene to prevent loss of bone and eventual loss of the implant. More implants are lost due this issue than any other.
Just as patients can get periodontitis (inflammation around teeth) they can also get periimplantitis (inflammation around implants). Periodontal disease usually progresses without noticeable symptoms until teeth become loose or deep pockets become infected. Periimplantitis progresses in exactly the same manner and the implant can have lost significant bone before it gets sore or loose. At that stage of progression, the implant may need to be removed.
Of critical importance to the long term success of implants is the patient's compliance with careful and specific hygiene efforts around the implant. This may include specific cleaning tools in addition to brush and floss and the use of antibacterial rinses or gels to reduce the opportunity for bacteria to colonize the implant surface. Use of Perio
Protect® may be a perfect method to maintain healthy implants.
Irregular or inadequate care around an implant seriously compromises its long term success.
Also, regular check ups and frequent x-rays to observe bone levels are critical to success in maintaining healthy implants.
Please come see us regularly if you have dental implants and ask for and use any additional aids suggested to maintain good health and longevity of your implants.
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Baby's First Teeth - Prevention Advice
As soon as teeth erupt into the mouth they are immediately susceptible to decay. Diet and early hygiene can play a big role in preventing dental disease in your baby's teeth.
Things that you should keep in mind to help promote your baby's best health include:
- Do not let anyone add anything sugary to your child's bottle.
- Clean your baby's teeth as soon as they appear. Cleaning can be done with
a small toothbrush or a face cloth.
- Use a very small amount (smaller than a pea) of fluoride toothpaste.
- Hold your baby when feeding, then lay the baby down to sleep: if the baby
wakes, give him or her water, not milk or juice.
- Limit the time your baby spends sipping and snacking, because the longer he or she takes, the greater the chance of decay.
- Use a cup.
- Offer snacks no more than two or three times a day.
- Bring your child to the dental clinic at least twice a year so the dentist can protect the baby's teeth by painting a safe fluoride medicine on them.
- See that your child has supplemental fluoride (drops or tablets) from ages 1 - 14 if there is not already fluoride in the water supply.
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Your Child's First Dental Visit
Every child is different when experiencing a new environment for the first time. Many are open and inquisitive while some are very shy and insecure.
What makes a child most comfortable on his or her first visit to a dental office is having Mom or Dad accompany them to the treatment chair. An introductory visit between the dental staff and the family members is also helpful. The parent can most often return to the reception area after reassuring the child that they will be well cared for and that Mom or Dad will be available if the child needs them.
Having a parent show confidence in the dental team's care for their child is immediately sensed by the child and increases their confidence. Reassuring comments like "these are nice people and they will take good care of you while we check your teeth," gives the child the sense that they are in good hands and no harm will occur.
Parents that seem to be "standing guard" over their child or who exhibit any sense of lack of trust, signal a non-verbal message that increases the child's anxiety in this unfamiliar environment. Most children act out more in the presence of such parental behavior than they do if they are interacting one-on-one with the dental team member.
Parents should avoid all comments about "pain" related to a dental visit even if they state
that "it won't hurt," as it opens the child's mind to the issue. Painful events are avoided
by all dental team members as we enjoy making happy, comfortable patients out of our young visitors.
Detailed descriptions of appointment procedures should also be avoided, allowing the dental
team to introduce our instruments and procedures in terms we know maintain a child's
We have many years experience treating children and keeping them comfortable and successful in their dental visits. Many of our young patients genuinely look forward to their visits, even after they've needed care beyond exams.