Treating White Spot Lesions

 Preventive Dentistry  No Responses »
May 222013
 

White Spot LesionsWhite spot lesions are very common both in kids and adults. One of the challenges with these lesions is how to treat them. There are several approaches from trying to bleach the surrounding tooth structure to make the color difference less noticeable to repairing the area with a composite restoration. The challenge with the bleaching approach is most often these areas are decalcified and need mineral support to the tooth structure. On the other hand taking away the lesion with a bur and restoring seems overly aggressive. In recent years I have been treating many of these lesions with MI paste and seeing great results.  I recommend taking before and after photos to document the improvement. Here are the recommendations for using Mi paste to treat white spot lesions.

• Apply etchant (phosphoric acid)to the white spot lesions for 10-30 seconds. Be careful not to over-etch the teeth. 1 minute is the maximum exposure time to the etchant. Only etch the white spot lesion, not the entire tooth.

•Pumice the tooth for 10 to 30 seconds, non-fluoridated, non-glycerin flour of pumice and then rinse.

• Dry the tooth. The tooth will appear frosty after the etch/pumice application. Sometimes it is necessary to etch/pumice a second time.

• Apply layer of MI Paste on the etched tooth surfaces with a prophy cup and leave on the tooth surface a minimum of 5 minutes. More time is better and improves remineralization.

We send our patients home with custom trays to continue to apply the MI paste for 5 minute sessions, twice daily for a week before we will see them to evaluate the results. Post-op instructions include nothing to eat or drink for 30 minutes after leaving the office, and to avoid foods that are likely to stain their teeth like wine, coke, coffee during the remineralization process. We schedule to evaluate the results in 1-2 weeks, and repeated treatments can be done to improve the results.

 

Practice Profitability Levers

 Practice of Dentistry  3 Responses »
May 202013
 

11430606-music-mixer-slidersA week ago in Connecticut while lecturing I was asked how to make anterior esthetic dentistry work if you are a provider for dental insurance fees with set fee schedules. This is a complex question at many levels, and each of us has to determine based on our preferred business model whether being an insurance in network provider is workable. This decision and many others on the business side of dentistry depend on understanding the finances of your office and being in control of them. Continue reading »

Are You Talking About Benefits or Benefits?

 Practice of Dentistry  4 Responses »
May 142013
 

communicationThanks Mary Osborne for the following post!!

I’m tired of talking about insurance benefits. So much is being said today about “changes in health care,” but the conversation really tends to be more about changes in insurance benefits. I think the time is right for those of us in dentistry to lead the way into a different conversation; a conversation about health.
We have a lot to learn about health; a lot to explore with our patients. Beyond education there is a place for authentic dialogue; an exchange of ideas in which there is learning on both sides. Beyond a mechanistic model of health is a true understanding of vitality, of what it means to thrive. Continue reading »

Direct Composite for Repairing Worn Incisal Edges

 Occlusion/TMD, Restorative Dentistry  No Responses »
May 092013
 

Incisal edge Matrix Lower webIt is routine to see patients with lower incisal edges that are worn into the dentin. The wear can be from attrition or from erosion, and is often a combination of the two. When dentin is exposed and the wear is progressing at a rate that is not age appropriate I want to do something to protect these teeth and slow the progression of the damage. When I think about possible restorative options I want to do what is appropriate, stay conservative if possible and manage the restorative challenges that are present with lower incisors due to their size and shape. These factors combined with the fabulous properties of our new composites have me using direct composite more and more in these situations. Continue reading »

When is Appliance Therapy Complete

 Occlusion/TMD  1 Response »
May 082013
 

Anterior Bite Plane Lateral View WebLast week teaching a hands on equilibration course one of the participants told a story about a new patient to his office who was in active appliance therapy and frustrated because the former dentist wouldn’t move to the next step of the treatment plan and the patient felt “stuck” in the appliance. His question to me was whether it was wise to move ahead with definitive restorative therapy. So when is appliance therapy complete? The answer to that question hinges on your reasons for placing a patient in an appliance. Continue reading »

When Patient’s & Dentist’s Concerns Don’t Align

 Practice of Dentistry  2 Responses »
May 012013
 

BW EarToday I had the privilege of seeing a new patient who came in concerned about an area of gingival recession that appeared to her to have been getting worse. She shared with me a story about having recently seen a general dentist, to whom she had been going routinely, who told her she didn’t need to be worried about her gums. As the rest of the story unfolded she shared that she was looking for a new dentist because she had felt her concern was dismissed, even assumed to have been silly. I have been practicing dentistry for long enough that I can imagine in my mind’s eye what happened at the other office. I can even see and hear myself doing something similar over the years.

The challenge is that as dental professionals we become very comfortable with both dental disease and with common dental issues that are not problematic. This comfort often gets in the way of our ability to remember that for each patient their concern is real, it is their mouth or teeth, and they do not have years of experience to tell them something is routine or easily treatable. From things like amalgam tattoos to recession, craze lines and decalcification spots patients get curious and worried over things they notice in their mouths. Often a misplaced smile, or lighthearted attempt to dismiss concern can be inappropriate in response to a patient.

The most important thing I have learned over the years it to first listen fully. The second step is to acknowledge what you heard including the emotional subtext, and ask for verification. I will always take the time to examine the area in question making sure to be thorough. Lastly I will share with the patient my beliefs about what is happening and the information necessary for them to move from fear or concern to comfort. Whether the patient today decides to move forward with grafting or to simply allow us to monitor the area of recession, what I know is she left feeling heard and respected for being proactive about her health.

Are You Recommending Xylitol for Caries Control?

 Preventive Dentistry  2 Responses »
Apr 292013
 

gum and mintsThere are numerous artificial sweeteners on the market that report to be zero calorie and are added to “sugarless” gums, mints, candies and foods. Xylitol not only fulfills the diet requirement but helps prevent cavities. Xylitol has 9.6 calories per teaspoon compared to 15 for sugar, however it has 0 net carbs as it is a sugar alcohol and does not alter glycemic index. It has been understood for many years that xylitol is beneficial for patients at risk of getting cavities. This fact has made it very popular in the dental hygiene community. It is estimated that 80% of all hygienists discuss xylitol with patients and over 50% use xylitol products themselves on a daily basis. Continue reading »

Are You Using Checklists?

 Practice of Dentistry  8 Responses »
Apr 242013
 

checklistmanifestoThe concept of checklists has become very popular over the last few years. I first became familiar with it when the book “Checklist Manifesto” by Atul Gawande was recommended by a fellow dentist and friend. It struck home with me as I have always been a fan of lists. Over the last few years more and more of the dentists I have spoken with have begun implementing checklists as a way to improve efficiency and successful execution of complex tasks in the dental office. Recently my friend Kirk Behrendt posted a video on the use of checklists which is worth a few minutes to watch.

Continue reading »

Air Abrasion For Margin Repair

 Esthetic Dentistry, Restorative Dentistry  No Responses »
Apr 172013
 

e.max WebFrom time to time we can help our patients extend the lifespan of an indirect restoration. Today was one of those days. On a lower left first molar all ceramic crown a patient presented with a marginal discrepancy on the buccal. The gap had begun to pick up stain and a very minor amount of decay. Fortunately for the patient the lesion did not extend under the all ceramic material and was confined to the buccal and did not go past the MB line angle so was easy to access. Based on the clinical situation I shared with the patient the ultimate need to replace the restoration and the option for :extending” it’s lifespan a short amount by repairing the margin. Continue reading »

“Permanent” Restoration

 Practice of Dentistry, Restorative Dentistry  3 Responses »
Apr 152013
 

communicationOver the last few months in lectures and articles I have discussed the concept of managing patient expectations about the longevity of restorative dentistry. Multiple times during these conversations a dentist has pointed out that we have coined the phrase “permanent” crown or restoration or filling. What does the use of the word “permanent” communicate to our patients, and is this misleading. These are great points and something worth addressing. I am clear that words are powerful and I pay close attention to their impact. In truth it is not just our patients that are impacted and create beliefs because of the words we use, but our teams and our own behavior. Continue reading »

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