How To Keep a Chipped Tooth Alive

This young boy came in with a very common trauma, a blow to the front teeth with a large chip. The nightmare of parents.
Boy with chipped front tooth

Provided the visit to the dentist is as soon as possible, and a laser is utilized, chances of the tooth surviving are excellent. The small nerve exposure along with the whole dentine surface is lasered with the Waterlase and disinfected.
Disinfecting chipped tooth with laser

MTA ( a highly biocompatible cement) is applied as a dressing over the exposed nerve. Over this layer the tooth is bonded with a self-etching bonding agent.
Dressing chipped tooth with MTA

The tooth is built up with composite …
Build up chipped tooth

… following aesthetic bonding principles.
aesthetic bonding of chipped tooth

The tooth is polished and as good as new.
Chipped tooth good as new

Three years after this procedure was done, the tooth is still alive and vital. This kid was spared a root canal.

How to get your crown the same day

We all know the procedure when it is time to get a crown or an onlay:

After the tooth is prepared an impression is taken with a tray.  This one may be needed to be taken multiple times and sometimes requires separate molds to be taken for the opposing teeth. This can be overwhelming for some patients, especially those with an enhanced gag reflex.

Not a very comfortable procedure.

Then a temporary provisional is made to cover and protect the tooth. Most of us know how inconvenient that is for the next two weeks.

The impression is sent to the dental lab. Two weeks later the final crown or onlay is back, and we make a second appointment to seat it. Time off work or family, traffic, a new shot to numb the area, painstakingly removing the provisional cover and disinfecting the tooth once again.

Wouldn’t it be great if we could come in and all this would be done the SAME DAY without the discomfort and inconvenience of impressions and temporaries?

Dr. Sarkissian can now offer you exactly that! You come in for a procedure that requires any indirect porcelain restoration and leave the same day – all done. No gagging on the impression, no mess, no second shot, no temporaries dislodging.

All this is made possible by the CEREC scanner and a milling machine by Sirona. This is German technology at its finest. Its latest model makes it appear the 21st century has finally arrived. This combination of 3D scanning and milling basically allows Dr. Sarkissian to create bio-compatible ceramic inlays, onlays and crowns during your visit – all in one day.

omnicam

The Omnicam scanner is used to digitally scan your teeth in 3D. The data collected is directly sent to a sophisticated software program that builds a digital 3D model of your jaw.  This is then used to model the crown, onlay, inlay or veneer with unmatched precision.  Dr. Sarkissian manipulates the design on the computer screen to his liking, and once the exact digital model of the restoration is designed, one click of a button sends it to a CAD-CAM milling machine a few rooms away.

4_cerec

This device mills your crown, inlay, onlay or veneer out of a block of a desired ceramic material right in front of your eyes. After some polishing and glazing, Dr. Sarkissian is now ready to bond it on your tooth. As the precision of this process is so high, hardly any adjustments will be necessary.

milling

If you are in the greater Los Angeles area you should not miss this experience. You can find the contact information for Dr. Sakissian here…

How to address Tooth Grinding and Jaw Clenching

Bruxism is the term describing nighttime tooth grinding or jaw clenching. This can result in tooth wear, gum recession, and morning headaches or stiff muscles. Most of the time we are not aware that we clench or grind at night. Jaw-joint symptoms will get worse if clenching is not addressed.

After continued bruxism the teeth will wear down and the jaw-joint can be damaged over time

After continued bruxism the teeth will wear down and the jaw-joint can be damaged over time.

A lot of times you may hear about the warning signs from your hygienists, if they are trained to look for these symptoms.

A night guard is a thin piece of hard plastic molded according to an impression of your teeth that is placed on the upper teeth while you sleep. The night guard is hard enough to be durable but it is softer than teeth and protects them from wear. A night guard protects your teeth and jaw from the detrimental effects of nighttime teeth grinding. The pressure created by grinding can eventually wear your teeth down to nothing! Other warning signs that you may be grinding your teeth at night include headaches (sometimes severe) and jaw pain when you wake up in the morning.

A conventional hard BPA-free nightguard, which is our favorite.

A conventional hard BPA-free nightguard, which is our favorite.

The Food and Drug Administration (FDA) has recently approved the NTI Tension Suppression System (NTI) as a drug-free alternative to reducing headache pain and migraine-related episodes that affects 28 million Americans. This safe and effective device is simple to use, requires no surgery and has no side-effects.

The NTI is much smaller, and where indicated, works great for bruxism when associated with headaches.

The NTI is much smaller, and where indicated, works great for bruxism when associated with headaches.

In a multi-center trial of the NTI device, 82% of sufferers had a 77% reduction within 8 weeks. Just a single visit to our office could make migraine suffering a thing of the past.

Sleep Dentistry

Obstructive Sleep Apnea and Sleep Dentistry

There is probably, in my opinion, no other condition that impacts general health as much as sleep apnea does. Imagine that during your sleep someone chokes you for a whole minute, and repeats this every 5 minutes throughout the whole night. Worst of all, you are not aware of this happening.

In our office we take sleep apnea very seriously, mainly because it seems to be an underlying factor for many conditions. Furthermore, I have noticed that most of my patients who have had braces as teenagers after having had four sound teeth extracted for the purpose of “creating space,” invariably suffer from a multitude of deleterious effects, such as excessive tooth wear, orthodontic relapse, stunted jaw growth, jaw-joint dysfunction, a mid-face deficiency, flat face with lack of proper lip support, insufficient jaw sizes to accommodate proper tongue position, snoring, and sometimes sleep apnea. Many times sleep apnea is an accompanying condition in these patients, due to the fact that the smaller jaws will just not accommodate the tongue, which tends to fall back and obstruct the airway during sleep. As dentists we have to be able to identify the incidence of this serious disorder, and offer treatment after obtaining a diagnosis by a physician.

ADULT SLEEP APNEA FACTS:

  • Obstructive Sleep Apnea, or OSA for short, afflicts 20 million Americans. 9% of men and 4% of women have OSA.
  • Statistically, most heart attacks happen in the early morning hours. Many of these can be blamed on O.S.A.
  • The Anales Medicina de Interna reported in 1999 that patients with untreated sleep apnea have a 37% chance of dying within 8 years.
  • Nasal breathing and an ample oxygen supply encourages nasal and sinus epithelium to produce Nitric Oxide, a tissue mediator which prevents the blood from clotting, protects arteries and dilates blood vessels.

 

CHILDHOOD SLEEP APNEA FACTS:

  • Most growth hormone is produced during the first few hours of sleep.
  • 90% of growth and tissue repair happens during NREM stage 4 sleep.
  • According to the American Academy of Pediatrics, all children should be screened for sleep apnea and treated immediately.
  • Chronic tonsil and adenoid enlargement is the most common cause of childhood sleep apnea
  • Since enlarged tonsils and adenoids are a major cause of sleep apnea and mouth breathing in children, consequentially smaller jaws and dental crowding are also common findings.
  • A survey in the journal Pediatrics from 2001 determined that children who snored during early childhood tended to show poor performance in middle school.

HIGH RISK FACTORS FOR O.S.A.

  • Being overweight
  • Snoring (not all snorers are sleep apneics)
  • Small or underdeveloped jaws
  • Lower jaw too far back in relation to the upper jaw.
  • Narrow upper airway diameter
  • Increasing age
  • Alcohol/tobacco/sedative use

SIGNS OF O.S.A.

  • Snoring, intermittent, with occasional gasping for air
  • Excessive daytime sleepiness
  • Non-refreshing sleep
  • Fatigue and irritability
  • Morning headaches
  • Gastro-esophageal reflux

CONSEQUENCES OF O.S.A. – sleep apnea is considered an independent risk factor for the following conditions

  • Poor memory
  • Increased auto and work-related accidents
  • Poor performance
  • Depression
  • Decreased quality of life
  • Heart problems, increased chances for developing high blood pressure, arrhythmias or stroke
  • Increased risk for adult type II diabetes

Diagnosis of OSA

Because OSA is a life-threatening medical condition, a multidisciplinary approach is necessary to address it. A physician should be involved in diagnosing the presence and degree of sleep apnea. A physician should also conduct an examination to determine if other correlated health conditions exist, such as hypertension, cardiovascular disease, diabetes and chronic fatigue.

Watch-PAT100

We are proud to carry this FDA approved, compact and ambulatory system of sleep monitoring.

In the comfort of your own home, it is a welcome alternative to a stressful and expensive hospital-based sleep study. Based on the results of this study, an on-line pulmonologist’s diagnosis is obtained which allows us to implement treatment much sooner.

Treatment of OSA

For mild to moderate cases of OSA, a dentist may fabricate an oral appliance to allow the airways to remain open for sufficient air to flow into the lungs during sleep. This treatment is far more tolerable than the conventional CPAP machine, which many patients of OSA find very cumbersome to use. (A CPAP is still a requirement for severe sleep apnea cases). In our office, we conduct a thorough evaluation of the multiple contributing factors and signs of sleep apnea, including daytime sleepiness and nighttime sleep evaluation scores. Homeopathic and naturopathic treatment many times provides additional support in improving sleep quality or addressing the hormonal, biochemical and physiological ravages of this condition.

Sleep hygiene

Among other things, the following habits should be implemented to improve sleep quality.

  1. Do not eat dinner within 3 hours preceding bedtime.
  2. Follow a regular sleep routine by not staying up late and not oversleeping.
  3. Cut back on alcohol, soda and caffeine.
  4. Take an herbal supplement or a hot herbal relaxing tea half an hour before bedtime.
  5. Take a warm bath before bedtime.
  6. Do not eat snacks, watch TV or read in bed.
  7. Follow a light and individualized exercise routine, preferably in the morning, and one hour before dinner.
  8. Do not engage in activities that are stressful or mentally challenging before bedtime.
  9. Shut off all lights.

Teeth Bleaching (internal/external)

A tooth may discolor after trauma, if the nerve dies, or even some time after a root canal treatment.  It looks unsightly, especially if it is a front tooth.

The office of Dr. Sarkissian offers a procedure to bleach a tooth simultaneously externally and internally. During the procedure the chamber is opened to allow the bleach to be applied from the inside as well as the outside.

An unattractive tooth like this

Internal-External-Bleaching-01

can be transformed into this Internal-External-Bleaching-09allowing the patient to show a wide smile again.

Get more details about the procedure to whiten a discolored tooth elsewhere on this blog.

Jaw Orthopedic – Bite Opening In Adults

Bite and Normal Jaw
The lower jaw (pink) is a double-hinged bone that is suspended between two joints. Its distance from the skull is technically determined by the height of the teeth, just like columns holding up a roof. The “columns” are high, the jaw-joint is healthy and the tongue has room to fit inside the mouth.

Normal jaw relationship

Bite and Normal Jaw – Facial Profile
The esthetically pleasing profile usually reflects the healthy jaw and teeth with full lip support, and a forward positioned mouth. The face reflects harmony.

Bite and Normal jaw (2)

Collapsing Bite
The teeth are worn down (the columns are shortened) and the jaw has approached the skull. The TMJ (jaw-joint) is under strain and the lips have collapsed inwards.

Collapsed bite adult tx ( 0)

Collapsed Bite
The Jaw-joint has been jammed deeper and backwards into the skull. The delicate disc is usually popping in and out of place every time the mouth opens and closes, creating that characteristic “click”.

Collapsed bite adult tx (2)

Collapsed Bite – Reposition Jaw
An orthotic that fits over the lower teeth will allow the jaw to vertically reposition itself and function in a physiologically corrected position. It takes at least 3 months for the jaw-joint and the muscles to adapt to this position. During this phase certain symptoms such as muscle spasms, tenderness, and headaches will generally improve.

Collapsed bite adult tx (3)

Collapsed Bite – Teeth Build-Up
As symptoms improve, and the patient is comfortable functioning in the open position, the bite is restored to the new vertical dimension. The orthotic is sequentially cut back and the teeth built up with onlays or overlays.

Collapsed bite adult tx (4)

Collapsed Bite Restored
Eventually all the teeth are restored and the orthotic is discontinued. The jaw-joint is in a physiologically corrected position and the teeth have been restored to full anatomy.

Collapsed bite adult tx (5)Collapsed bite adult tx (6)Collapsed bite adult tx (7)

Licorice Root

Licorice root

Licorice root (Glycyrrhiza glabra) is a yellow root that is one of the main ingredients in Chinese medicine. It is described in Shao-Han-Lun (established during the later
Han Dynasty, in China) that Licorice

  1. harmonizes all drugs and detoxifies the adverse effects of herbs,
  2. is used as a flavoring agent to mollify various drugs and to treat coughs and sore throat,
  3. works synergetically with other drugs, and
  4. has a liver detoxifying action.

Two compounds in licorice, licoricidin and licorisoflavan A, were found in a study to be very effective in inhibiting the growth of bacteria that caused cavities and gum disease. (see Reference)
Licorice is a potent liver cleanser and a tonic for the stomach. It is a very valuable remedy in treating Hepatitis C, GERD, eczema, colds and coughs.  It is a natural stimulant of the body’s own natural cortisone, which makes it beneficial in treating infections as well as allergies. It is, however, contraindicated in those who have high blood pressure.
Deglycyrrhizinated licorice (DGL) is used as a remedy for peptic ulcers and oral canker sores. (see Reference)

Recipe for licorice tea by Dr. Sarkissian

Ingredients: 7-10 slices of actual licorice root, half a teaspoon  of fennel seeds, 5 pods of cardamom (crushed)  and a small slice of ginger root, 2-3 leaves of sage.

Simmer the above except the sage in a pot of water over a light flame for 10 minutes. Add the sage, cover and let steep for another 20 minutes. Drink throughout the day. Add organic honey to taste, unless diabetic or treating gum disease (we don’t want more sugar bathing plaque.) Useful for stomach upsets, detox, for colds, and for mouth ailments.

Nattokinase – Enzymes From Fermented Soy

A staple in the Japanese diet, natto is made from boiled soy beans fermented with a bacterium called Bacillus natto. It’s a natural blood-thinner which dissolves abnormal blood clots, improves circulation, reduces triglycerides and prevents strokes.

Dr. Hiroyuki Sumi discovered its actual extract, nattokinase, which can be taken as a supplement.

Nattokinase - Food

In dentistry I like recommending it as an adjunct in treating abscesses, improving bone circulation and in reducing inflammation.

Lumbrokinase – Enzymes from Earthworms

Dried earthworms and ground-up earthworm powder, believe it or not, were (and probably still are) used in traditional oriental medicine.

Today, Boluoke® is a product containing purified enzymes extracted from earthworms.

Earthworms Boluoke

Just like polyphenols in green tea, and curcumin in turmeric, the group of enzymes called lumbrokinase is now known to be the most valuable ingredients in earthworms. It is, currently, one of the most potent natural blood-thinners for those suffering from heart disease.

Birth of a Tooth

birth of a toothJust like the birth of a child, the “birth” of a tooth, or as we call it its ERUPTION through bone and skin, is an awe-inspiring and miraculous phenomenon in nature. It is an interplay of such complex physiology, that the true and exact nature of what guides eruption of teeth has eluded scientists to this day. Truly, how can an entity of such architecture and beauty, made up of all 3 embryonic layers, form out of virtually nothingness, grow inside a protected “bud”, bore its way through bone and tissue, emerge into an outer-world environment so hostile, and yet be designed to survive a whole lifetime??? (Doesn’t that sound familiar?)