Some of the Latest Results in Experimental Dentistry

This is going to be less of a traditional narrative blog post and much more like Harper's Findings: a list of several hopefully-fascinating discoveries from the annals of recent experimental dentistry. Enjoy!

• Experimenters found no difference in surface whiteness between bleaching with hydrogen peroxide vs. carbamide peroxide, but the latter did a much better job of getting into the dentin beneath the enamel and 'deep bleaching' teeth.
• A group studying electric vs. manual toothbrushes found that electric toothbrushes were significantly more effective at reducing plaque and gingivitis.
• A researcher in nanotechnology believes it may be possible to create a fluoride-ion-infused porcelain that will not only cap off a cavity, but prevent further cavities in its area.
• Swiss researchers are working on an aluminum-garnet laser that can be used to more safely 'drill' holes in patient's jawbones for the purpose of implanting false teeth permanently.
• A group of scientists is developing a method of cleaning teeth by "sandblasting" them with microscopic glass beads that hit hard enough to knock away bacteria and to smooth out the tooth (making it harder for bacteria to re-attach in the future), but not hard enough to injure the tooth.
• Much like the gold fronts of the American rap world, dentists in India have started taking requests for 'tooth jewelry' that sits atop the enamel and sparkles whenever you smile.
• Scientists studying tooth whitening bleaches have found that outside of very rare (<1%) cases, there are no side effects of bleaching that last longer than 2 weeks after the bleach treatment has finished, no matter what bleach or what system you use.
• Scientists recording people's opinions of their own smiles discovered that tooth discoloration and protruding teeth are the leading causes of 'smile dissatisfaction.

So there you have it; if you're a victim of one of the leading causes of smile dissatisfaction, get a carbamide-based tooth whitening for the 'deep bleaching', and don't worry -- the side effects almost always vanish after a week.

"Manly" Drinks & Your Dental Health - Slurpees

Free Slurpee day isn't until next month (July 11th -- 7-11, get it?), but we hope that by posting about it a little early, we might convince you to skip out on the free treat -- and every other Slurpee you might want to down this summer.

The dangers of a Slurpee? "All of the above." Slurpees might not have the same levels of acidity as a Coke (unless, of course, you're drinking a cola flavored Slurpee, which are basically made by using the same syrup that's mixed with carbonated water to make Coke, and mixing it with icy slush instead), but none of them get much above a pH of 4.5 -- easily enough to do some damage to your teeth, especially sipped slowly over a long period of time, which you basically have to do with a Slurpee unless you're mystically immune to brain freeze.

Of course, that slow-drink goodness along with the massive quantities of sugar in a Slurpee makes them even worse than iced tea for developing a good colony of Streptococcus Mutans all along your gum lines. But Slurpees don't stop there.

They may not be contributing alcohol to your oral cavity the way that drinking a beer does, but Slurpees are dropping off a huge quantity of artificial concoctions in your mouth, many of which have a variety of unknown side-effects. The flavors are artificial, the colors are artificial, the sodium benzoate they use as a preservative is a known carcinogen when mixed with citric acid (which basically all of the fruit-based flavors have in abundance), and even the bark extract they use to give the drinks a particular 'mouth feel' can leech calcium out of your body and cause kidney stones.

None of that might be directly related to your oral health, but in this case, we think it's wise to take advice from a cartoon character. As Candace of Phineas and Ferb fame once said, "Crushed ice covered in blue carbs? Lame!"

"Manly" Drinks & Your Dental Health - Iced Tea

Tea has so many health benefits that it's rare you'll find anyone disrespecting the Asian brewed drink -- but then Americans took something that's basically amazing and decided that we need to infuse it with lemons and massive quantities of sugar, make it ice-cold, and drink it that way rather than with the typical Asian respect. To be honest, much of what we refer to as 'iced tea' -- especially anything you make by mixing a powder into water -- has basically nothing to do with actual tea. It's a flavoring, and it's usually mostly artificial.

The problem with iced tea isn't limited to its extra acid from the lemon and how all that added sugar promotes the growth of Streptococcus Mutans (the bacteria that causes plaque, tartar, and gingivitis) in your mouth. It's also in how we drink it. Like all bacteria, Streptococcus Mutans has a limit to how fast it can multiply in your mouth -- and it's also limited by its supply of fuel.

Because the tradition with iced tea is to lean back on the porch or around the picnic table while you watch your son's Little League team whup its competitors, you're essentially creating a worst-case scenario in your mouth. You feed those bacteria a few sips of sugar every minute or two for an hour, giving them all of the time and fuel they need to make a huge, military-style advance against your gum line.

Now, if you make your tea by actually making real tea (Green is best unless you're strictly avoiding caffeine) and then adding ice and a small amount of added sugar, you can totally enjoy that knowing you're doing right by your mouth. But instant, prepackaged, or other iced "teas" aren't going to leave your mouth feeling its best.

"Manly" Drinks & Your Dental Health - Beer

Beer is one of those things like red wine -- it's great for you in moderation, but bad in large amounts. Beer may not have the heart-protecting Resveratrol that makes red wine so popular, but it does have something that few other foods have in great quantities; dietary silicon. Yes, the human body uses silicon to help grow and firm up your bones.

If you're a menopausal woman worried about osteoporosis, for example, drinking a less-processed beer like ale (as opposed to a lager) every day can do huge amounts to keep your bones strong. Beer also has a surprising amount of bioavailable calcium, though nothing like a glass of fresh milk.

On the other hand, for your oral health, beer isn't the best thing to finish a meal with. Beer is acidic, much like cola, and has similar -- if weaker -- effects. To put a technical side on it, acids start demineralizing your tooth enamel at a pH of about 5.5. Coke comes in at a very acidic 2.5. Depending on the darkness of the malt, beer can check in around 5.4 for a weak brew like Budweiser all the way down to 3.2 for a true sour like Rodenbach Grand Cru.

Beer, however, compounds the acidity problem by adding alcohol and sugars to the mix. If you think about it, beer is created by bacteria that consume the barley and hops, fermenting it and turning it into alcohol. Of course, then, it's a great environment for bacteria to grow in, especially once it gets warm in the mouth. Now, not much beer remains in the mouth for hours at a time, but on the molecular level, if it's the last thing you eat or drink before you start working or get otherwise distracted, the alcohol and sugar that's left behind will promote the growth of 'bad' oral bacteria quite readily.

"Manly" Drinks & Your Dental Health - Coca-Cola

Coca-Cola

Coke is perhaps the worst possible thing that you can do to your teeth -- shy of getting into a fight with a motorcycle gang -- and it's one of those rare occasions where brushing your teeth afterwards does more harm than good. The reason why is right there in the ingredients label; phosphoric acid. That sounds like an industrial chemical instead of a food ingredient, and the fact of the matter is that it is indeed an industrial chemical.

When you drink phosphoric acid, a lot of things happen. Things deep in your intestines and in your bones and all over your body; my nutritionist tells me that a can of cola is essentially an anti-multivitamin. It actually causes your body to urinate out a whole pile of vitamins and minerals that it should otherwise have kept and used. That lack of micronutrients really does affect the health of your teeth in the long run -- but it's nothing compared to the short-term impact.

The short-term impact is that the phosphoric acid severely weakens your enamel, especially if you keep the drink in your mouth for any considerable period of time. That's why brushing your teeth after you drink Coke is a bad idea. Even a medium-hard toothbrush will literally scrub the weakened enamel away, and leave you in dire need of Dr. Johnson.

Now, we do have to put a bit of a lid on the hysteria, because we've done the research; cola will not, in fact, dissolve a tooth overnight. It takes a few weeks, and fresh-squeezed orange juice will actually do the job faster. But that doesn't mean it's necessarily safe to drink regularly if you want to avoid a trip to our office.

If you must drink a sugary, manly, bubbly drink this summer, we encourage you to check the label. If it lists any kind of acid that isn't citric, you should probably switch drinks. According to one study, root beer is generally best for your teeth if you must have a soft drink.

Just One of Many Things Men Can Learn From Women: Oral Health

We've known for years that women outlive men — and we've known for years that good oral health translates rather directly into good overall health, including a longer life. What we've found out relatively recently is that those two facts might actually be related.

A study published in the April 2011 Journal of Periodontology examined the oral health habits of men vs. women, and discovered that one of the best ways to improve your oral health habits is to have a second X chromosome. On average:

• Men brush their teeth 1.9 times per day — women: 2.5
• Men lose 5.4 teeth by age 72 — women: 3.2
• 53.1% of men said they have concerns about visiting the dentist — women: 41.1%
• 57.6% of men said they only went to the dentist when they had a toothache — women: 46.9%
• 61.2% of men said they "brush each tooth carefully" — women: 77.7%

The list of statistics goes on and on, but the implicit truth is clear; women pay more attention to their oral health than men. While no one is saying that the extra attention they give their oral health leads directly to women's longer lifespans, it certainly has merit as a contributing factor.

Among other things, that's because oral and throat cancer (caused by gum disease) is significantly more common in men than in women. Again, there's no evidence that the difference in cancer rates is directly related to the lack of attention the average man pays to his oral health, but it's a fairly easy conclusion to draw.

Some experts have argued that the extra care women take with their teeth is largely undone by the effects that progesterone has on increasing one's vulnerability to gum disease. The ladies at Dr. Johnson's office, on the other hand, think it's an opportunity for the men in our lives — one of many ways that, if they were just a little more like us, they might be a bit better off.

In Honor of Mother's Day...

In honor of Mother's Day this month of May we would like to celebrate some important women in the history of dentistry.

Like Amalia Assur, who in 1852 became the first female dentist in Sweden; she was given special permission from the Royal Board of Health (Kongl. Sundhetskollegiets) to practice independently as a dentist, despite the fact that the profession was not legally opened to women in Sweden until 1861. The infamous Emeline Robert Jones, who in 1855 became the first woman to practice dentistry in the United States. She married the dentist Daniel Jones when she was a teenager, and became his assistant in 1855. These women and so many more helped pave the way for women's role in the field of dentistry so that in recent times, Kathleen T. O'Loughlin, of Medford, Mass., became the first female executive director of the American Dental Association in 2009.

Women have always played an important role in history and dentistry is no exception. The office of Drs. Johnson and Risbrudt are appreciative and humbled by the impact these dentists, women, and mothers have had on the field of dentistry.

Pre 20th century

• 1523: The earliest known dental engraving, made by Lucas van Leyden in copper, depicts an itinerant dentist and his female assistant.
• 1866: Rosalie Fougelberg became Sweden's first female dentist after the profession was opened to both genders. In
• 1861, the dentist profession was legally opened to women in Sweden. Fougelberg tried twice to get her dentist's certificate; the second time, she was approved by the medical examiners but not by the dentistry representative. During her third try in 1866, the examination was supervised by the press. She was still turned down by the Collegium Medicum, but given a royal dispensation by the monarch, Charles XV of Sweden.
• 1866: Lucy Hobbs Taylor became the first woman to graduate from a dental college (Ohio Dental College).
• 1869: Henriette Hirschfeld-Tiburtius, born in Germany, became the first woman to take a full college course in dentistry, as Lucy Hobbs Taylor received credit for her time in dental practice before attending dental college. She graduated from the Pennsylvania College of Dental Surgery in 1869. She later returned to Germany and became the first female dentist in Germany.
• 1874: Fanny A. Rambarger became the second American woman to earn the degree of Doctor of Dental Surgery in 1874, when she graduated from the Pennsylvania College of Dental Surgery. She worked in Philadelphia and limited her practice to women and children only.
• 1886: Margarita Chorné y Salazar became the first female dentist in Mexico.
• 1890: Ida Gray Rollins became the first African-American woman to earn a dental degree in the United States, which she earned from the University of Michigan.
• 1892: The [American] Women's Dental Association was founded in 1892 by Mary Stillwell-Kuesel with 12 charter members. Annie T. Focht, secretary, listed 32 members in her report on March 4, 1893, and stated: "the women interested in dentistry [met] in Philadelphia in March 1892, to organize a society by which they could strengthen themselves by trying to help one another." At monthly meetings of the association essayists presented scholarly dental papers. Their mailing list grew to include about 100 female dentists. No reports of the association exist after 1898.
• 1895: Lilian Lindsay became the first licensed female dentist in Britain. She was also a leading dental historian, and the Lindsay Society for the History of Dentistry, established in 1962 (after her death) was named for her.
• 1898: Emma Gaudreau Casgrain earned her license to practice dentistry and thus became the first female dentist in Canada.

20th century

• 1907: Frances Dorothy Gray became Australia's first female Bachelor of Dental Science upon graduating from the Australian College of Dentistry, University of Melbourne, in 1907.
• 1916: Gillette Hayden became the first female president of the American Academy of Periodontology.
• 1920: Maude Tanner became the first recorded female delegate to the American Dental Association.
• 1921: During the annual meeting of the American Dental Association (ADA), 12 female dentists met in Milwaukee and formed the Federation of American Women Dentists, now known as the American Association of Women Dentists (AAWD). AAWD's first president, M. Evangeline Jordan, was one of the first to limit her practice to children and was a founder of pedodontics. She graduated from the University of California School of Dentistry in 1898.
• 1923: Anita Martin became the first woman inducted into the American dental honor society Omicron Kappa Upsilon.
• 1933: Grace Rogers Spalding was appointed the first formal editor of the [American] Journal of Periodontology, a position she held until July 1949.
• 1946: Lilian Lindsay became the first female president of the British Dental Association.
• 1951: Helen E. Myers of Lancaster, Pa., a 1941 graduate of Temple University, was commissioned as the U.S. Army Dental Corps’ first female dental officer in 1951.
• 1975: On July 1, 1975, Jeanne C. Sinkford became the first female dean of an American dental school when she was appointed the dean of Howard University, School of Dentistry.
• 1977: The American Association of Dental Schools (founded in 1923 and renamed the American Dental Education Association in 2000) had Nancy Goorey as its first female president in 1977.
• 1988: In 1988, the American Student Dental Association elected its first female president, N. Gail McLaurin of the Medical University of South Carolina.
• 1991: Geraldine Morrow became the first female president of the American Dental Association.
• 1997: Hazel J. Harper became the first female president of the [American] National Dental Association.

21th century

• 2001: Marjorie Jeffcoat became the first female editor of The Journal of the American Dental Association.
• 2003: Rear Admiral Carol I. Turner became the first female Chief of the U.S. Navy Dental Corps.
• 2004: Sandra Madison, of Asheville, N.C., was elected as the first female president of the American Association of Endodontists.
• 2005: Michele Aerden became the first female president of the FDI World Dental Federation.
• 2007: Laura Kelly became the first female president of the American Academy of Cosmetic Dentistry.
• 2008: Beverly Largent, a pediatric dentist from Paducah, Ky., became the first female president of the American Academy of Pediatric Dentistry.
• 2008: Valerie Murrah became the first female president of the American Academy of Oral and Maxillofacial Pathology.
• 2008: Paula Jones became the first female president of the Academy of General Dentistry.
• 2008: Deborah Stymiest of Fredericton was elected as the first female president of the Canadian Dental Association.
• 2008: Susan Bordenave-Bishop became the first female president of the Academy of Dentistry International.

Info courtesy of Wikipedia.

The Cancerous Effects of Marijuana

Cancer of all kinds happens when cells in your body begin to operate incorrectly, due to either physical or chemical stress. Wounds that fail to heal for one reason or another are one of the more common causes of cancer, as are pesticides and other chemicals that affect your cells' functions. Marijuana brings both of these threats to the table.

Cannabis and Your Immune System

Marijuana dampens the immune system, especially in those areas directly affected by the smoke; your mouth, throat, and lungs. That means that pot smokers are much more likely than the average person to get oral infections, and those infections don't heal quickly, either. Cannabis also causes xerostomia -- a malfunctioning of the salivary glands that leads to dry mouth -- which makes your mouth tissues more vulnerable to injury.

Marijuana and Oral Cancer

Eventually, chronic pot smokers are much more likely than others to develop something called oral leukoplakia -- thick, white patches on the mucus membranes of the mouth. Oral leukoplakia is often considered a pre-cancerous growth, meaning it's quite likely to turn into cancer. The most common cannabis-related oral cancer is on the back of the tongue or on the floor of the mouth under the back of the tongue.

Please call the office of Drs. Johnson and Risbrudt for an oral cancer screening at 949-493-9311.

The Warning Signs of Oral Cancer

Early detection and treatment is the number one way to prevent death or recurrence in cancer cases -- all cancer cases. The 5-year survival rate of oral cancer, for example, is more than 80% when it's detected before metastasizing. Afterward, it drops to less than 50%. Fortunately, while oral cancer doesn't cause pain in most cases, there are other warning signs that you can detect if you're paying attention.

• Tissue changes -- including texture, color, and heat sensitivity -- within the mouth and gums.
• Lesions of red, white, or mixed red and white, especially those lasting more than two weeks. Red lesions are the most likely to become cancerous, but any long-lasting lesion can trigger a tumor.
• A lump or thickening of the soft oral tissue in the back of the throat.
• Soreness or the feeling that something is caught in your throat.
• Difficulty chewing or swallowing or difficulty moving the jaw or tongue.
• Numbness of the tongue or back of the throat.
• Any open wound in the mouth that doesn't heal within two weeks.
• Swelling of the jaw or pressure under the jawbone.
• Ear pain or constant need to 'pop' your ears.

None of these by themselves indicate that you have oral cancer, but they indicate that you may need a checkup. The majority of oral cancer cases involve one or more of these symptoms in conjunction with one or more of these risk factors:

• Smoking or chewing tobacco.
• Heavy alcohol drinking.
• A poor diet, particularly one lacking in raw fruits and vegetables.
• Lack of exercise.
• Old age (60+ years of age.)
• HPV of the throat.

If you belong to one or more of these categories and you have any of the symptoms above, call our office today and schedule an oral cancer screening for yourself. Don't hesitate -- if it is cancer, time is absolutely of the essence!

Don't Blush: Oral Sex and Oral Cancer

It's a bit of a tender subject, but one that needs discussing; oral sex. For decades, the practice of oral sex has been on the rise, with many people -- especially teenagers -- considering it 'safer' than 'normal' sexual intercourse. It's certainly less likely to result in an unwanted pregnancy, but scientists are discovering a link between oral sex and oral cancer later in life.

The link, some scientists theorize, is due to the Human Papillomavirus (HPV). HPV lives in the genital area of both men and women, and is known to cause cervical cancer in women (leading to the development of Gardasil and other immunizations against HPV). It turns out that during oral sex, HPV can take up residence in the mouth, where it lives for decades, eventually resulting in some form of oral cancer, most often in the tonsils or the base of the tongue.

How can you limit your risk of oral cancer due to HPV? Fortunately, the vaccines that work against HPV are starting to become available for men as well. As of this writing, only Gardasil is actually on the market for men, but other brands are following suit quickly. If you're under the age of 26, you can get the vaccine injection and dramatically reduce your risk.

Mount Sinai Medical Center came up with an excellent infographic that says it all:

If you see yourself somewhere in that chart above, feel free to ask us for an oral cancer checkup. We'd rather our patients be safe than find out too late that they need massive surgery to remove a deeply embedded tumor we could have found years earlier. 

Let's Talk About Oral Cancer

This year alone, nearly forty thousand Americans will be diagnosed with oral or pharyngeal (back of the mouth) cancer -- and more than eight thousand people will die from it. That's about one death per hour, twenty-four hours every day, all year long. Of the forty thousand Americans who receive the diagnosis, only half of them will be alive in five years.

Those are some powerful numbers, and yet oral cancer is one of those kinds of cancer that people most often discover too late -- after it's metastasized into the lymph nodes of the neck or some other area in the body. By the time that's happened, the primary tumor has had the opportunity to grow deep into the local muscle and bone structures, all without causing any real pain or discomfort.

Risk Factors

Cancer is a strange disease because it doesn't have one big risk factor. Rather, it's an accumulation of small factors that work together. Alcohol use, tobacco use, HPV, an unhealthy diet, heavy metal exposure, carcinogen exposure, and many other factors all contribute, as does the most obvious culprit; poor oral health.

Detection


Much like breast cancer and regular mammograms, almost the only way to detect oral cancer is to deliberately look and feel for it with your eyes and hands. Or, more likely, have your dentist or doctor look for it with his/her eyes and hands. If you have a sore or discolored area in your mouth and it doesn't heal within two weeks, have it examined by a professional. Similarly, any difficulty speaking, swallowing, or chewing that persists for more than 14 days needs professional attention.

If you have even the vaguest notion that you belong to a few of the risk-factor groups mentioned above, contact our office and schedule an appointment for an oral cancer checkup immediately.

Keeping Your Teeth Whiter Longer

One of the 'hidden dangers' in having your teeth whitened is that, no matter what method you use, your teeth are actually more susceptible to stains for a few days after they've been whitened. The reason why is simple and unavoidable.

Normally, your teeth are fairly smooth on the vertical surfaces, even on the molecular level -- but (as we discussed last week), almost every whitening method essentially amounts to a chemical attack on your stains, and those attacks can't help but cause microscopic levels of damage to your enamel as well. Now, tooth enamel is stubborn stuff, and it'll replenish itself quite quickly. Until it has, however, those extra-rough, freshly-whitened surfaces will accept new stains more easily than your church accepts offerings.

That means that for a few days after you get whitened -- no matter what the method, but with Zoom! this is especially true -- you'll want to avoid staining activities. That includes smoking, eating brightly colored foods like tomatoes, curry, and even chicken noodle soup (it has turmeric in it just like curry!) It also means avoiding coffee, tea, colas, and similar darkly-colored drinks especially, because drinks uniformly coat every surface of a tooth as they wash over it, virtually guaranteeing a loss of whiteness.

But what about the longer term? What about weeks after your whitening? Well, one of the big benefits of Zoom! over its competition is that Zoom! lasts for quite some time if properly maintained. Drs. Johnson and Risbrudt will give any patient who comes in for a Zoom! treatment their own personalized post-Zoom! stay-white regimen, usually consisting of a combination of at-home whitening kits, a daily routine of tooth-cleaning exercises, and sometimes even something unique like a new toothbrush that will help to keep those pearlies pearly.

If you follow the regimen and you avoid the obviously staining activities and foods when possible, you can expect your smile to stay bright and happy for about a year -- and even if you don't, six months isn't unreasonable with Zoom! That's why we at the office are proud to offer Zoom! whitening.

Unlocking the Mysteries of Zoom! Smile Brightening

It's one thing to tell our clients that Zoom! is a heat sensitive tooth whitening system. It's another to tell them that it uses a special whitening gel to make your teeth bleachy-keen in a matter of hours. But it doesn't really answer the burning question; what the heck is all that chemical and intense light power actually doing inside your mouth? Here's where you'll get your answer.

The Gel

The whitening gel is actually a mixture of hydrogen peroxide -- yep, the same stuff you buy at the drug store -- in a viscous fluid. It's designed to remain stable at room temperature, but to become reactive as it gets hotter. As it gets hotter, the hydrogen molecules break away from the oxygen forcefully, driving the oxygen molecules into and through the stains that sit atop your tooth enamel. It's actually much like using OxyClean, but instead of activating with water, it activates when hot.

The oxygen molecules are much smaller than the complex molecules that make up biological stains, and act like a tiny chemical sandblaster, with thousands of oxygen molecules pushed at a high rate of speed (at least, on a molecular scale) into the stain. They literally shatter the stain's molecules and separate them from the tooth enamel. The enamel, on the other hand, is dense enough and strong enough to withstand the oxygen barrage with zero noticeable damage.

Light Activation

The light activator, while it gets all the credit, is actually the least interesting part of the whole setup -- its function is to heat up the gel quickly and thoroughly without burning your lips or gums. In other systems, green intense lights are used to accomplish this goal (green being the type of light your tissues are least sensitive to), but in Zoom!, the light combined with chemical activation is much like the heat coming from your Nu-Wave oven. That makes it stronger than its competition, but requires that the dentist put a protective covering over your gums before turning the intense light on your teeth.

And that's that -- Zoom! is a mystery no longer.

What Whitening Is Best For You?

We actually get a surprising amount of requests for our Zoom! whitening service here at the office, and the one thing we never get tired of seeing are those occasional clients that we have to say 'no' to. Not because we like saying 'no' to people, but because they're always happy to have a less involved procedure suggested to them.

Why does this happen? It's simple, actually -- it has to do with how white your teeth already are. Tooth whiteness is measured on a common shade scale of 1 (just had fresh porcelain veneers put on) to 20 (seriously yellow or brown.) Even Austin Powers would come in at about a 13 -- twenty is really really dark. A typical client of ours comes in with somewhere between a 4 and a 10.

Here's the thing -- Zoom! treatments are powerful stuff. They're meant to take that 10 and make him a 3. If you walk in the door and your teeth are already at a 3, you're probably going to to go through everything the other guy did and walk out the door 1 1/2 to 2, because there's only so much whiter that your teeth can possibly get -- and you'll get about the same results from a different, faster, less expensive whitening procedure. (If you have a 3 and you insist on reaching all the way up to a 1, we're going to tell you that you may want to get porcelain veneers to achieve the optimum white color that you want.)

So what other whitening options do we suggest for people who already have near-perfect teeth, but aren't going to shoot for the perfection that is veneers? The classic; we'll give you a take-home kit that uses dental trays and a bleaching gel that you wear either overnight or for a short period each day that will give you the results you're looking for in a couple of weeks for a little less than Zoom!

Zoom! is awesome -- but it's not necessary for everyone, and we don't want to charge you for something you don't need.

Introducing Zoom! And Other Smile Brightening Options

Drs. Johnson and Risbrudt would like to help usher in the season by reminding everyone that spring is the season of new life, growth, and new friendships! It's time to shake off the winter blahs, do some spring cleaning, and get ready to reconnect with life. That makes it a great opportunity for teeth whitening (or 'smile brightening' as we prefer to call it around the office.)

Our office has recently gotten a brand new whitening system installed -- the Zoom! system by Phillips. Zoom! is a laser whitening system that takes about an hour. A special wax is placed on your gums to protect them, then put a whitening paste on your teeth. Finally, you'll get an implement in your mouth to keep your lips open and teeth slightly apart, and we'll shine a big old laser onto the whitening paste.

You repeat the processes a few times in a single visit, and then spend 48 or so hours avoiding foods and drinks that might stain your teeth. Once the new whiteness has 'set', you're good to go and you can resume eating and drinking normally (though we encourage you to continue avoiding the most staining foods and drinks like coffee, tea, curry, and so forth.)

Of course, Zoom! isn't the only whitening option that our office has to offer. We have a variety of whitening options that range from the industrial-strength versions of the kinds of kits you get at the local drug store all the way up to our porcelain veneers, which can turn almost anyone's teeth into pearly beauties.

If your smile is keeping you down this Spring, don't keep it locked away -- get it beautified and turn it loose! It's so much more fulfilling to smile with all your heart in it.

Why New Chairs?

In our newsletter this month, we mentioned several things that we've done around the office to improve the quality of our patient's visits, and the first thing we listed was 'new chairs'. We've had a few people inquire as to why, on a list that includes several high-end new dental machines and other improvement, we chose to put new chairs first on the list.

The answer is simple: it's a matter of dental ergonomics.

The Dentist's Perspective

For Drs. Johnson and Risbrudt and their hygienists, the difference in chairs is important for a few reasons:

• The headrests and narrower shoulder areas allow for better maneuvering around you during a procedure, keeping things moving during a longer, more complex operation.
• Height adjustment on the chair allows the dentist to sit comfortably and work without having to strain upward or downward.

The Patient's Perspective

While you only spend a few — maybe twice that at the maximum — hours in the chair vs. the thousands of hours the dentist will spend maneuvering around the chair, we nonetheless bought these chairs with your comfort in mind:

• Adjustable head/neck rests ensure that you're never supporting the weight of your head or contorting yourself to let the dentist get to whatever he's working on.
• Lumbar and pelvic support mean that you won't get up with a stiff back no matter how long you've been sitting — and even if your muscles do start to feel a little tense, the built-in massager will take care of that in a hurry.
• Highly adjustable head and footrests allow us to adapt our chairs for almost anyone (though if Sultan Kosen comes back for another visit, we'll probably still need a special chair for him.)

Sure, to a degree, it's "just" new chairs — but when you're striving to make your patients comfortable and calm, every difference counts.

Going Green Is Better For Everyone NOW — and Later

The ecological movement is nothing new — people have been worried about the fate of our nation's wildlife since back when Roosevelt first moved the Division of Forestry from the Department of Agriculture to the Department of the Interior. But for much of the past several decades, the complaint has been that being ecologically conscious was expensive and not worth the effort.

Several recent developments in green technology have proven that 'wisdom' quite wrong, and they've given us at Dr. Eric Johnson's office the ability to make life better for our patients (and the world) at the same time.

Here are a couple of great examples:

Digital X-Rays

Digital X-rays have pretty much every advantage over traditional X-rays. They don't require developing, which means less nasty chemicals out there (and in our own cupboards). They require less radiation to get a clear picture, which is better for our patients and our techs. They allow for instant previews of the X-ray, which means less waiting around for the slides to develop. And they're cleaner and easier to read, meaning more accurate and quicker assessments of what's actually wrong with your teeth.

With digital X-rays, everyone wins; you, us, and the Earth. Read more about digital X-rays on our web site.

Green Cleaning

There are a few basic categories of cleaners out there, but one thing that they almost all share is that they're quite toxic and bad for the environment. The one that doesn't fit in, however, is the one that we use: the colloidal micelle-based cleaner. This stuff is awesomely powerful, because it's made of molecules that are smaller than the grease and other biological molecules that they clean up. The effect is like a microscopic sandblaster separating the molecules from whatever surface they're clinging to for easy wiping up. The real benefit, though, is how incredibly safe they are; so much so that you could drink the stuff without issues.

Colloidal micelles let us clean the office often without doing anything to your system except making it glad for the cleanliness. Again, it's a three-way win.

Happy Valentine's Day! Let's Talk About Your Kids' Candy

All those little candy hearts your child gets at school for Valentine's Day are mildly frightening for some parents — and some dentists! But with a little bit of attention, it's OK to allow your kid to enjoy his/her Valentine's Day candies without ruining their future oral health. Here are a few tips from Drs. Johnson and Risbrudt:

• Dole Out the Candy Sparingly: You should be in control of when your child has access to candy, and you should be careful of how much they eat at a time. Not only can 'boom and bust' candy eating result in a fussy kid, but you might also be setting them up for insulin resistance and its concurrent obesity and risk of diabetes.


• There's A Reason Behind 'Dessert': The classical wisdom of eating real food first and dessert afterwards has a lot of value. Eating sweets just after a meal does a couple of things. First, your saliva is still flowing easily and will have an easier time cleaning the teeth of extra sugars. Second, the sugar will mix with the meal in your child's gut and thus you won't get the same kind of blood-sugar spike and resultant 'high' you get if you give them candy in the middle of the afternoon.


• Watch the Ingredients: It's a strange time we live in, when 'sugar' is considered to be one of the least offensive ingredients on a candy's list, but it's true. If you have the ability to steer your child away from fructose (including agave, which is actually higher in fructose than HFCS), do so — but that said, if you're following the first two guidelines and you can't avoid it, a little corn syrup or Red #40 isn't going to have a noticeable effect on your average kid. The important part is your awareness and attention — that way if something does set your child off, you'll at least have a notion of what it may be.

Happy Valentine's Day — enjoy yourself!

Responsibility, Concern, and the Power of a Third Party

Adding a third party to any transaction can have any number of interesting effects on how things work out. In an ideal situation, a third party can act as a facilitator, making certain that details work out in everyone's favor — so much so that it becomes a no-brainer to have a third party on hand to make sure that everything happens smoothly.

At Drs. Johnson and Risbrudt's office, we believe that there are some ways in which having a third party responsible for things is enormously beneficial to our patients. We always acknowledge that we're responsible for everything that happens inside these walls, and we work hard to keep our clients foremost in our minds — but there are some things that are better placed in other people's hands.

For example, we don't do the maintenance and sterilization of our own equipment anymore. Not because we disliked the task, and not because we're lazy or even that we had any problems in the past — but simply because having equipment that is clean, fully-functioning, and ready to use is important enough that we feel like we should have someone assigned to the job full-time.

Equipment cleaning and sterilization isn't the only job we outsource to other companies, either — we have experts come in and refill our bathroom soap beakers, clean our front door mats, and so on as well. We choose to leave those details in the hands of people that are professionals in their respective fields, because it lets us focus on the things that matter most — serving you.

Just like taking responsibility for your child sometimes means hiring a baby sitter, or taking responsibility for your home sometimes means hiring a painter, taking responsibility for your patients sometimes means hiring experts to take care of the details that help make our office a healthier and friendlier environment.

Excellent Smile Designers are Made, Not Born

If you want to upgrade your smile, you need a cosmetic dentist — and pretty much any cosmetic dentist will do, right?

Hardly — a truly skilled smile surgeon can be hard to find, but of course no one will advertise that they're not as experienced or knowledgeable as another. Cosmetic dentistry is only half about space-age polymers, digital imaging and manipulation, and other high-tech wizardry — it's just as much about having an eye for what looks right, and the steady hand necessary to make what you're working on look like the picture you're designing toward.

Smile designers have to understand how each of your physical traits — your height, lip and skin color, the shape of your cheeks and lips, your bone structure, and so on — interacts with your smile to create a grin rather than a grimace. Smiles don't exist in a vacuum; every aspect of your appearance plays in to how well your smile shows itself off.

The problem is that there aren't any legal statutes that determine which dentists are allowed to call themselves 'cosmetic' and which aren't. Anyone with a DDS can claim to be a cosmetic dentist. So how do you know which smile designer you want to work with? Experience.

Drs. Johnson and Risbrudt each have decades of dental experience and years of smile design under their belts, and they can show you hundreds of photos of the patients that they have designed new smiles for — that is the mark of a smile designer you want to work with.

What's the difference? Education. Drs. Johnson and Risbrudt are both devoted to keeping themselves up with their fields, and each one vastly exceeds the state-mandated minimums for continuing education every year. There's a steep learning curve with cosmetic procedures, and only continuously improving your skills — and then applying them — can make a dentist a truly great smile designer.

Smile Aesthetics and Looking Younger through Smile Design

When you look at the human face, the upper lip and everything below it make up about a third of the face — and it's the third of the face that contains the vast majority of the muscles in the human head. Those muscles mean that it's the lower third of the face that conveys the most emotion and expression — but it also means that it's the lower third that is the most affected by aging.

As you get older, the corners of your mouth sag, giving you a very serious appearance when your face is relaxed, even if you're feeling perfectly chipper. The cheeks also sag slightly, throwing off the smile lines at the corners of your mouth. Other small changes to the firmness of your facial flesh show aging quite obviously as well.

That's why, when Drs. Johnson and Risbrudt work on smile design for a patient, they pay close attention to how their operations affect the 'aesthetic age' of their client. Cosmetic dentistry is part science, but it's also part art, and in addition to caring for chipped teeth, malocclusions, and other dental problems, smile design is at its core intended to make you look better — and at least in the USA, better usually means younger.

With a smile design plan, you can make your cheeks firmer, your smile more symmetrical, your teeth whiter, and generally shave years off of your appearance all without the use of potentially harsh chemical treatments. Cosmetic dentistry can reverse the sagging of the lips by building up the teeth, giving you fuller and firmer lips in a single procedure (and without actually messing with your lips at all!)

If you're considering something like Botox or other treatments to bring a youthful look to your face, consider smile design first — because anti-aging treatments should all come with a beautiful smile and healthy teeth!

Porcelain Veneers: The Easy Street to Smile Perfection

Porcelain veneers are thin ceramic 'shells' that are bonded to the front of your teeth. If your incisors and canines aren't as gleamingly white as you'd like them to be, whitening your teeth is a great option — but if they're permanently stained by long-term coffee or tea drinking, smoking, or other discoloration, veneers can be your best bet by far.

Porcelain veneers not only mask discolorations, but they can also be used to brighten teeth, to close gaps between teeth, to lengthen teeth that are too short, or even to repair broken teeth. Wafer-thin veneers are delicate when handled, but once bonded to a tooth are quite tough, also providing a stain-resistance that no other smile design option can give.

Most modern cosmetic dentists, including Drs. Johnson and Risbrudt, consider veneers to be the leading conservative approach to 'perfecting' a tooth's color and size. If your teeth have been exposed to tetracycline, have been broken in an injury, or even have discolored fillings that taint your smile, veneers are likely the answer.

Getting veneers is a multi-step process:

• Your first appointment will be for diagnosis and planning.
• Then you'll come back to get a mold of your teeth taken, upon which the veneers will be based, and have your teeth prepared for the veneers.
• Finally, once the veneers have been sculpted, you'll come back for one last visit during which they'll be bonded to your existing teeth.

Veneers have been shown to stand up to 7-10 years of constant, regular use before needing to be replaced.

Your first appointment will take at least an hour, possibly a few hours depending on the scope of your smile issues. The second involves a minor procedure in which about a millimeter of your enamel is removed before the mold is taken. The laboratory takes 1-3 weeks to fabricate the veneers, after which in the final appointment, the veneers are bonded. That takes a couple of hours. Once you're done, you walk out with the best smile of your life!

Smile Color and How It Changes

One of the most fundamental elements in smile design is making sure that your smile is as sparkling and white as it can be — but that's not always as obvious as simply bleaching your teeth. That's because there's a lot more to a tooth's color than just its color. When we take our first digital photograph of your smile for our Smile Design process, we take a look at several aspects of your smile's color composition:

• The overall color of the teeth.
• The gradient (how the color changes) as the teeth progress toward the gums.
• The relative brightness of each tooth.
• The opaqueness/translucency of your teeth and how it changes.
• The absence or presence of white vertical lines in your teeth.

The reason we measure all of these attributes is that when we do a smile design, we have to make sure that, in addition to every individual tooth coming out beautiful, the entire smile matches beautifully as well — and that's actually somewhat difficult.

That's because teeth aren't ever one color. Most teeth have more yellow tint toward the top because the underlying dentin is showing through the translucent enamel (nothing to do with plaque or tartar, it's all inside the tooth.) Similarly, most incisors and canines have an almost entirely translucent area at the very tip of the tooth where it's entirely enamel. Matching those subtle color changes can be quite a challenge.

Color-matching issues are one of the major reasons why cosmetic dentists often suggest that people who want a truly stunning smile get porcelain veneers — they're easy, they're all the same color, and that color happens to be the stunning white that everyone wants to have peeking out from between their lips.