Tuesday, December 13, 2011

Diabetes Testing--in a Dentist's Office?

Periodontal disease is a major health issue. Coincidentally, so is diabetes mellitus. Both of these disorders are reflexive in that they can create complications for each disease. Having a chronic infectious disease or inflammatory disorder like periodontitis can make glucose control difficult for diabetics. And the presence of diabetes makes a patient more likely to suffer periodontal disease; diabetes reduces the body's ability to properly regulate inflammatory responses and can delay or complicate healing.

It is rare that a patient comes to us being fully aware of a diagnosis for periodontal disease. WHen we diagnose the disease, we make sure we have discussed how influential diabetes can be in the process. If a patient has a family history of diabetes or cardiac disease, is overweight, has cardiovascular disease, hypertension, or all of the above, we are concerned that they do not suffer diabetes themselves.

Part of our dental examination may include a preliminary screening for blood glucose imbalance. A simple test can be done in our office to measure blood glucose and better inform the patient about a larger risk for diabetes. The test includes a tiny prick on the finger to acquire a drop of blood to place on a test strip that can be analyzed for blood glucose. If it is out of balance, we can then refer patients for proper diagnosis of blood glucose disorders like diabetes.

Performing this test in our office can not only help save a patients teeth, but it may lead to successfully managing undiagnosed diabetes. That alone can save lives.

Monday, December 12, 2011

Preserve--A Sustainable Dentistry Solution

Brad Hole is good friend of mine. He is the founder of Rebinder Sustainable Office Products. He has inspired me to think about my contribution to sustainable living for some time now. He has yet another pearl to share about a company who is furthering sustainability. Preserve is a company offering to recycle, as well as deliver, sustainable toothbrushes for your daily hygiene.

Preserve commissions the recycled brushes to make Trex, a sustainable decking material that has been around for years.

I like the idea of how Preserve promotes our health on a couple of levels: They provide an inexpensive brush. They help consumers reduce their carbon footprint. And they promote sustainability through new construction.

Check out Preserve at their site.

Tuesday, November 29, 2011

Preserving your teeth--with Botox?

There is a percentage of my patients who will travel a path of dental troubles their whole life. They start by restoring a broken tooth. Then they break another tooth. Ten years go by, and they have 8 or 10 crowns on their back teeth. Then they have a root canal or two. Then they lose a tooth or two because they break or they lose supporting bone and gum. I have witnessed patients who have had a crown or veneer break after we place it, and they need it replaced. And then it happens again.

Whether I see short-term problems or the slow, progressive debilitation over years, one thing is common. These recurring problems can be prevented if we recognize the destructive potential of our facial and jaw muscles. Biteguards just don't prevent the day-to-day stresses on dentistry and teeth. They mitigate the nighttime muscle activity.

Botox therapy for facial and jaw muscles can reduce the activity of the muscles that cause teeth and dentistry to be destroyed. Therapeutic use of Botox usually lasts 4 months, and can be readministered to maintain its effect.

Friday, November 18, 2011

Botox Facts

Botox:
1. Lasts 3-6 months.
2. Can be scheduled without a consultation.
3. Treatment is completed in about 30 minutes.
4. Ice is applied before the Botox to keep you as comfortable as possible.
5. Blocks the signal to the muscles that contract with certain facial expressions.
6. Body will eventually re-route that signal and return to normal function.
7. Botox is purified protein. There are no live bacteria involved.
8. Muscle activity is decreased not paralyzed. Muscles are actually relaxed.
9. Simple tiny injections are made.
10. Botox is measured in units, and the amount needed depends upon severity of the patient’s needs.
11. There is minimal post-operative discomfort.
12. It takes 3-7 days to see initial effect and about 10-14 days for the full effect.
13. Avoid alcohol, exercise and excessive sun for the 1st 4 hours after treatment.
14. At 2 weeks, Botox is at its maximum uptake. If you don’t see results, return to our office at the 2 week point. We have all our patients back in two weeks to be sure they look and feel great. Slight enhancements can be done at that time if needed.
15. Botox can make you look refreshed, relaxed and less angry. Botox can also make you feel more relaxed and refreshed, because the body releases several key chemicals after therapy.
16. Possible side effects: nausea (flu like symptoms), eyelid droop or headache. These possible side effects are minimized by proper technique.
17. Botox effects are not permanent in most cases. You will likely return to your pre-treatment state with no accumulative side effects at all.

Facts About Facial Esthetics, Botox, and Dentistry

Some patients (and even other doctors) have asked us, "why should patients have a dentist provide therapeutic Botox and dermal filler procedures?"


1. Dentists study the facial, head, and neck muscles extensively during dental school. Dr. Rafoth is an expert in understanding these muscles and how they work.

2. Botox and dermal fillers are therapeutic service to treat deficiencies of the smile. Not all smile issues can be addressed when restoring teeth. The lips, cheeks, chin, and areas surrounding the mouth are an important part of smile design and balance. We are certified to perform this service, and covered under the Dental Practice Act to deliver this care.

3. Botox is therapeutic for chronic facial, head, and neck pain. We are certified to perform this service, and covered under the Dental Practice Act to deliver this care.

4. Many medical doctors are trained by dentists on how to give painless injections. The comfortable numbing Dr. Rafoth provides for dentistry is the same for Botox and dermal filler treatments.

5. A lot of plastic surgeons hire aestheticians to treat their patients instead of seeing the doctor. Our patients will always be treated by the doctor, which means expert-level care by a board-certified provider.

6. Botox and dermal filler appointments can require anesthesia. These treatments can be combined with dental appointments, thus saving time and travel to multiple appointments.


Thursday, November 17, 2011

Botox for Craniofacial and Dental Pain Treatments

Grinding and clenching teeth is caused by a number of disorders. It is usually difficult to stop without intervention.

For most patients, a custom biteguard solves jaw (and sometimes head) muscle pain, eliminates restricted jaw movements, and reduces damage and sensitivity to teeth. In my experience, about 30% of those patients treated with biteguard appliances have continued pain (either migraine- or tension-related head, jaw, and neck pain), dental sensitivity, and continued destruction of teeth and dental restorations.

In our practice, we notice that many patients have daytime tooth clenching or grinding disorders that are difficult to treat with oral appliances; they have to speak with the public or clients, and wearing a daytime device isn't realistic. Other patients we see suffer from sleep breathing disorders. They may have continued jaw, head, and neck pain after undergoing C-PAP or oral appliance therapy. Some patients have chronic migraine headaches pain that aren't relieved by oral appliance alone. All of these types of patients continue to take medications, try other therapies (hypnosis, acupuncture, massage, chiropractic care), and continue to have frustrating pain.

Another category of patients are continual tooth clenchers and grinders without tooth, head, or neck pain, but they repeatedly break dental restorations or teeth. No matter what they do to wear a biteguard, they still destroy things.

There are common threads uniting all of these types of patients. They have a complex disorder called parafunction. (see the preeminent site for information about it here.) Another similarity in all of these patients is how they can treat the problem beyond a biteguard appliance. That therapy involves using botulinum toxin, commonly known as Botox.

Botox has been FDA-approved for use in head and neck pain and dental therapies for years. One of its many benefits is that it reduces the amount of muscle function responsible for head/neck/jaw pain and destruction of dentistry. The other effect of Botox, is that it reduces the long-term activity of these overactive groups of muscles, and can stimulate specific body chemistry associated with healing tissue and likely helps prevent the return of the muscular disorder. (one of many research references may be read here.)

Patients who undergo Botox treatments do not lose muscular control or have total paralysis and loss of motor control. Botox does not make people numb. There is no loss of sensation to touch or feel. The effect of Botox is to temporarily reduce the activity of a group of muscle fibers just enough to prevent the traumatic activity of the muscles from occurring.

Patients who undergo the treatment rarely need anesthesia. They may undergo several treatments, or may choose to have ongoing therapy. It has been found that many patients will undergo several treatments, and find that they do not have pain or destruction that returns after a few treatments. The average amount of the drug for each treatment is about 40-50 units of Botox. Patients can expect to have at least 3-4 treatments. The cost per unit in our practice is $11-13/unit.

Virtually every patient who undergoes Botox therapy needs to have undergone biteguard appliance therapy before Botox is considered. Contact us today to have a free consultation regarding your chronic pain and repeated dental damage.

Tuesday, October 25, 2011

Are Immediate Implants For Me?

Some doctors advocate immediate implant placement and immediately-loaded implants as a predictable and successful option for tooth replacement. Although many patients have had success with immediate implants and immediate tooth replacement, I wanted to clarify a few tings about the definitions and real-world success.

An implant is a titanium screw that is placed in the jawbone. An implant serves as a platform on which a replacement tooth (called a restoration) can be connected. A tooth replacement requires both an implant and an implant crown restoration, or in some cases, an implant-supported denture restoration.

An implant can have primary stability in the bone, which is where the threads of the implant screw are wound tightly within bone, much like a wood screw in a 2x4. Primary stability can be immediate. Implant success is truly based on how it integrates with the bone. Integration requires months to develop. Osseointegration is a growth of bone along the implant surface. This happens even if primary stability is not achieved.

Implants placed immediately after a tooth is removed require both primary stability and a healing period for osseointegration. Without good integration, there is a risk that the implant will fail when the restoration is placed on the implant.

The implant surgeon must manage how the restoration works with the bite. If the implant and the restoration is immediately loaded, that means the implant is subject to the pressures and forces of biting. And without good integration and stability, The chances of premature implant failure are higher.

So it is difficult to predict how immediately placed and immediately loaded implants will do over the long term unless the implant surgeon allows for uninterrupted osseointegration. My real-world experience has shown that implants loaded too early can fail.

There are a wide variety of factors that come into play about how and when an implant can fail--medical conditions, tobacco use, periodontal disease, biting forces, the list goes on--but I have come to realize that the best approach to placing and restoring implants is to be patient and allow for integration. Then the final results will likely be predictable and long-lasting.

Wednesday, October 5, 2011

October is Cancer Awareness Month

Typically, October shines a light on the victories as well as the challenges women face with breast cancer. But this month also provides an opportunity to become better informed about all types of cancer, including the prevention, screening, and treatments for countless other forms of the disease.

The American Cancer Society is a great resource for learning more about the efforts you can lmake to prevent the disease, as well as support ongoing research for cures.

In dentistry, our professionals have a unique opportunity to examine and screen patients more than once a year for oral cancer. Dental professionals have more contact with patients than most physicians, which makes dentists and hygienists better suited to perform a regular oral cancer screening. But more importantly, your dentist will likely be the first to diagnose the onset of oral cancer. And that's where the best part of today's dentistry comes in.

The Identafi 3000 is a state-of-the-art screening tool that uses visible light to identify abnormal changes to skin of the mouth, tongue, and parts of the upper airway. The tool was introduced to improve early detection of oral cancers. And with early detection, treatment options are more successful, and outcomes are better for patients.

The risk of oral cancer has increased in recent years due to the prevalence of the human papilloma virus, or HPV. Both women and men are at higher risk for oral cancer due to certain strains of HPV. Along with tobacco and alcohol consumption, HPV is now an important consideration when screening patients for oral cancer. The Center for Disease Control has an information page about prevention of HPV.

For the month of October, Cascadia Dentistry will offer the Identafi 3000 oral cancer screening at no cost to patients. Call us to reserve your appointment today.

Tuesday, September 27, 2011

Have You Checked Your Breathing Lately?

Poor breathing during sleep is a concern for 1 out of 4 adults. It is clled sleep-disordered breathing, and it can be responsible for sleep apnea. Kids are becoming increasingly more common patients with the disease.

The most popular emerging issues I am seeing in my practice are obstructive breathing disorders. A blocked airway can occur because of obesity, or anatomic differences in the head, jaws, neck, and/or throat. When breathing is not optimal, it creates a cascade of medical problems.

Obstructive airway disease is life-threatening. It can lead to high blood pressure and congestive heart disease. It increases a person's risk for stroke and heart attack. And sleep breathing disorders can complicate other diseases and their management.

As I continue my education and membership in the American Academy of Dental Sleep Medicine, I have learned there are only 2 ways for patients to address this disease: You treat it and live longer, or you don't treat it, and you live a shorter life with complications.

I have started to attend grand rounds with the local sleep medicine specialists at North Sound Sleep Center in Everett, I see the impact breathing disorders have on various patients; these patients who suffer have common characteristics. I compiled a self-test anyone can take to identify their risk for sleep breathing diseases. Here it is:



I have been told that I snore.
I have been told that I stop breathing when I sleep, or I have challenges with breathing efforts.
I am sleepy during the day even if I slept throughout the night.
I have high blood pressure.
I have been told that I sleep restlessly, I am always "tossing" and "turning" while asleep.
I tend to sweat excessively during my sleep.
I frequently awaken with headaches or jaw pain in the morning.
I have been known to fall asleep/nod off behind the wheel or other inappropriate times.
Others and/or I have noticed a recent change in my mood or personality.
I am consistently fatigued during waking hours.
I am overweight.

If any of these items apply to you, you need to see your primary physician or call our dental office for a more complete evaluation. Working together, we can get you the right care.

Thursday, August 18, 2011

Inaugural Patient Appreciation Day!











Last week, we had our first celebration for our patients here at Cascadia Dentistry. Add 2 bouncy houses, a pizza truck, a hot dog bar, a micro-brew garden courtesy of Patrick, a karaoke station, and some great patients, and you have the recipe for a great party.

We gave away some great prizes all afternoon with our raffle: Power whitening, certificates for discounts on dental treatment, and Cadillac-version electric toothbrushes.

Thanks To Tony McNulty and Howie of Papa Murphy's Pizza in Mukilteo, and Jeremy and Bobbie Mooring of Jumping Monkey Bouncy Houses in Arlington. We'll definitely have them all back.

It's truly fun to celebrate with our patients. We never get the chance while we're in the office all suited up for dentistry. Thanks to all who attended. We hope to see a great turnout again next year!


Wednesday, August 17, 2011

Oral Cancer Update

In their latest issue, The Journal of the American Dental Association features multiple articles about the connection between human papilloma virus (HPV) and oral cancer. HPV has been recognized as a significant factor in contracting certain forms of oral cancer.

Cancers in the back of the throat, around the tongue and tonsils are the most common cancers caused by HPV. According to literature reviews, HPV-positive cancers have a lower incidence of death and recurrence as compared to HPV-negative cancers.

HPV has been most commonly associated with cervcial cancers, and several vaccines against that form of HPV, as well as other HPV types, has been available for several years. However, the types of HPV associated with oral cancers have no effective vaccine at this time. Currently, there is no test for detecting HPV infection. Prevention of HPV infection is the best approach to reducing oral cancer risk.

Oral HPV is thought to be acquired during oral sex, and also passed on by kissing. More research is needed to clarify the specific means of transmission.

Even though preventing HPV infection is effective at reducing the risk of oral cancers, it is also important to understand that tobacco and alcohol are significant risk factors in contracting oral cancer. About 75% of all oral cancers are related to smoking and alcohol use.

Cascadia Dentistry has been using the most effective oral cancer screening tools available for the past 2 years. The Identafi 3000 is a tool that uses visible light to detect abnormal oral tissue. It is valuable in early detection of oral cancers, and can help patients seek treatment earlier, and in many cases help them avoid more significant treatment. Detecting cancers earlier can reduce deaths in many cases.

Call us today to have an oral cancer screening as a part of your routine dental visits.


Thursday, May 19, 2011

Cancer Awareness!

In memory of Jeanne, our Dental Assistant who sadly lost her battle with Cancer in 2010, Dr. Rafoth and staff invite you to join them in the fight to cure cancer in our lifetime. For each “Like” on the Cascadia Dentistry Facebook page received through June 5th Dr. Rafoth will donate $1 to the American Cancer Society. The impact we can make together is much greater than what any of us could do alone!

Cascadia Dentistry thanks you in advance for your support.

ORAL CANCER SCREENING is one of the most important examinations we provide at your dental visit. We utilize the best technology, courtesy of Trimira, to uphold the highest standard of care for you. Contact our office for more information.