Oct 222014

Recently I have been having my patients with severe dry mouth utilize a prescription that relieves their symptoms and restores some of the balance to the oral cavity that saliva provides. Pilocarpine is a cholinergic medication and is commonly given to patients with severe dry mouth. Many patients have dry mouth that is not significantly helped with topical solutions like Biotene or AOvantage, or they have to use these products so often that it becomes a challenge. Recently our GCAmerica rep came in for a lunch and learn and mentioned using Pilocarpine in a lollipop for this group of patients. I was intrigued enough to do the research. Compounding pharmacies can fabricate a lollipop that contains pilocarpine in either a 5mg or 2mg dose, they also can add Xyltiol as a caries preventive and flavoring agents.

Patients are instructed to suck on the lollipop for 3-20 seconds as needed up to 5 times per day. The length of time they use the lollipop and number of times per day is easy for them to discern based on the feeling of saliva in their mouths. The medication increases salivary flow for about 3-5 hours. The pharmacy dispenses the lollipop in a plastic pill holder with a hole in the lid that supports the stick and allows the pop to be used over and over again until it is gone while being kept clean. Pilocarpine can also be given as a pill and is available in 5 and 10mg formulations, but I was amazed at how much more patients like the lollipop then having to swallow a pill. When I did my research I was amazed at the variety of instructions I came across, from 3-30 seconds in the mouth, and 3 times per day to every 2 hours and even use as needed.

I am fortunate enough to have a compounding pharmacy right down the street so I called and spoke to the lead pharmacist.  He explained that unlike a pill the dose will be variable with the lollipop, however it will take a lower dose to get the same oral effect versus a systemic application, and this accounts for the variable instructions. The most common side effect will be too much salivary flow and the patient will use this to reduce the length of time the pop is in their mouths or the number of uses per day. Pilocarpine can also cause increased sweating, but the pharmacist explained this should be uncommon at the does of the lollipops. He also shared that although it is available in many flavors, Root Beer seems to cover the flavor of the Pilocarpine the best, and he strongly recommends the formula with Xylitol.

It has been great to have one more thing to offer our patients to help them be comfortable and keep their mouths healthy.

Sep 302014

Joint Palpation to detect palpable soundsJoint Noises are evidence of a change in the relationship between the disc and the head of the condyle int he Temporomandibular joint. Disc position is an important diagnostic finding that assesses joint stability, and ultimately the stability of the occlusion. In this video I talk through and demonstrate both the sounds we feel and hear on an exam, what they tell us about disc position and how this information relates to stability and occlusal risk. Continue reading »

Sep 232014

Lips At Rest WebThe “Lips at Rest” or “Emma” photograph is a foundational image in dental treatment planning. This image along with the patient’s age and gender is used to determine the proposed position of the incisal edges of the maxillary centrals. Once the centrals have been positioned int he face the rest of the maxillary teeth are set to create a level occlusal plane. This video demonstrates a predictable way to obtain a lips at rest image.


Clinical Mastery Hands On Photogrpahy


Sep 162014

Joint Palpation to detect palpable soundsOne of the pieces of diagnostic information I look at during a joint & muscle exam is whether the patient can open widely, smoothly, and straight up and down. A deviation on opening is a significant finding and makes me ask the question why? When a patient’s opening and closing movements meander right and left there is an underlying cause. It could be as simple as muscle tightness, contraction and a sign of an occluso-muscle disorder.  Alternatively, the cause could be the position of the disc in relationship to the head of the condyle. A disc displacement often causes the patients muscles to learn a programmed series of contractions so they can move around it instead of being “locked” behind it. The following video demonstrates looking at deviation on opening and two patient examples of a deviation, one that is muscle based and the other that is a displaced disc. Continue reading »

Sep 082014

Custom Impression Coping WebCustom anterior implant provisionals allow us to alter the emergence profile of the abutment from the top of the fixture to the free gingival margin so we can optimize the pink esthetics during tissue maturation. Once this process is accomplished it is imperative to capture this shape so that the lab has a soft tissue model that is identical on which to copy the emergence profile of the final abutment/crown. The instant you unscrew the temporary restoration/abutment the tissue shape begins to slump. No matter how quickly you think you can move to put an impression coping in place and take the impression the changes are significant enough to mean the lab has to sculpt their soft tissue model. This sculpting is a guess and after the hard work that goes into a custom provisional guessing is counterproductive. The implant provisional has a second job and that is to allow you to create an exact replica of that emergence profile on a custom impression coping. Continue reading »