Wedding Smile : Consultation

“Megan came to me to talk about her smile with her wedding about 3 months away.  She was quite self-conscious of her smile and struggled to smile in a relaxed way.  We looked at some of her social media images and video and noticed that she didn’t show her teeth or smile in photos, despite being a vibrant and confident media personality.   

I saw a beautiful woman heading to the biggest day of her life and I wanted her to have a smile with so much confidence that you couldn’t help but smile back.  There is nothing more infectious than an uninhibited smile – my job was to create something for Megan that she would love, and hiding her smile became a non-issue.  We started by taking videos and photos, and scanning her teeth to make 3D models, and then sat down and collaborated on the things that were important to her.” 

Planning in 3D

Our first step is a high resolution digital scan. This is comfortable, fast and no x-rays or impressions are needed.   Lumino City Dental is one of the first practices in the group to install a digital scanner.  This takes thousands of images and stitches them together in 3D to create a highly accurate model.  There is no need for traditional impressions – filling a tray up with gel and the whole process is streamlined, clean and comfortable with no gagging or mess.

Once we have 3D models we used specialised dental design software to create the ideal smile.   We start with facial analysis and place teeth in the correct position in the face, maintaining symmetry and harmony with facial features.  The analysis shows proportions of teeth, ideal gum positions and the need to lengthen teeth, move them forward, lift the gum or bring them out to create a fuller smile. 

Once our analysis is complete we take shapes from nature – scans of hundreds of perfect teeth, and reproduce natures algorithms into the smile.  The result is extremely natural with shapes and textures that are extremely realistic.     

We design in conjunction with the Digital Smile Design Planning Center in Madrid, global experts in facial and digital dental aesthetics. This generates a prototype that becomes the blueprint for all treatment going forward, giving Megan a preview of her wedding smile. 

DSD Mock-Up

We create a 3D printed model and transfer a working mock-up to the mouth.  The patient can see and feel the result in your mouth before starting treatment. Sometimes it is surprising how our feelings constrain our smile, and the video shows that Megan was quite constrained in her smile, until she saw the mockup. 

This is an exciting stage and can be quite emotional, as smiles are transformed instantly with a tailor-made result.  Small changes can be made to the mockup before starting any treatment.  Most patients want to wear the mockup home.  It is, however, removable at the end of the appointment.

This stage is also important for planning delivery of the final work.  It gives the patient an end point, without having started treatment.  We have choices now – to move teeth using Invisalign or braces, to place porcelain or composite veneers, to lift the gum and to alter the bite.  Everything becomes precise and predictable. 

“Megan’s mockup was a stunning change.  Teeth were aligned, the shapes were perfect for her face, the smile curve was ideal and little side teeth became properly proportioned teeth.  We filled out the ‘buccal corridor’ – the side of the smile that was hidden in shadows before.  Using Digital Smile Design planning , as a dentist I can be confident that what I show a patient at this stage will be the final result.”   

Final Treatment

Once decisions have been made and all treatment options traversed, the treatment plan and costs are finalised.

“In this case we elected extremely conservative composite veneers for Megan, after whitening with in-office Zoom.  The main reason was to preserve enamel and give Megan choices in years to come.  Porcelain veneers would have involved more tooth removal, and after discussion neither of us were keen to do that.  We knew we had a wedding deadline and decided this was the most effective way to get a perfect wedding smile, whilst allowing the option of Invisalign in years to come.   

Read Megan’s experience here: ZM Wedding Blog

“We are encouraging mothers to be conscious of their own dental health because it is clearly shown now to be a family affair. Testing for this bacteria is a simple test which allows us to alert parents to the potential risk of decay. I can take a swab and tell my patients within 15 seconds if they are at risk from this kind of tooth decay. Then we’re well armed to help them counteract it. We offer a wide range of products for all ages to mitigate the risk.”

The new study warns that the bacteria that cause tooth decay can be transmitted from person-to-person, including mother-to-child. Almost half of the mothers studied and more than a fourth of the children and adolescents had untreated tooth decay.

One means of transmission could be from a mother tasting a child’s food and then using the same spoon to feed her child.

The findings underscore the need for family dentists to ask about the oral health of other family members. The authors stress that dentists should encourage all family members to get treatment, especially if a child already has tooth decay, and provide the family with the preventive measures, knowledge and skills to help prevent future disease.

Although it’s an area of our body which we cannot feel or see very easily, the gravity of periodontal disease and its implications on the rest of the body should not be ignored.

Most bacteria which causes gingival and periodontal diseases reside in areas which has poor oxygen flow, yet plenty of nutrients to feed off. This is why most gum disease start in these areas.

Brushing alone will only reach 3 out of 5 tooth surfaces. Brushing cannot reach the interproximal surfaces, and this is where most periodontal diseases are present mouth.

Daily use of interproximal cleaning tools (i.e dental floss, interdental brushes, Waterpik™, and Airfloss™) is essential in preventing and stabilizing active periodontal disease.

The correct steps for basic daily oral care:

1. Floss/ interproximal cleaning
2. Brush
3. Mouthwash

Ask your Dental Hygienist at your next appointment to discuss with your which interproximal cleaning tool is the best for you. And remember , “you don’t have to floss all your teeth… just the ones you really want to keep!” ☺

Some changes occur as part of the natural progression of aging, such as reduced saliva flow, and others can be controlled by the lifestyle choices we make. The effects can be profound, leading to an escalation of dental decay or gum disease, and sometimes tooth loss. To understand how these changes might be affecting you, let’s discuss the chemical milieu that is your mouth.

Your Pearly Whites – The Teeth

Teeth form the hard structures in the mouth and they are covered in a strong glassy layer called enamel. Enamel gives teeth their white colour and is generally quite strong when it is intact. Tooth enamel is affected in 3 ways – decay (acid-producing bacteria eat holes in teeth), fracture (teeth weakened by big fillings get brittle with age), and erosion (dissolution of enamel in acids). Tooth enamel is highly susceptible to acid attack and can dissolve easily in many acids.

Acids are found widely in our diet:

• Citric acid: Juices, fruits, herbal tea and wine, lollies, flavour enhancer
• Ascorbic acid: Naturally occurring Vitamin C. Added to food to preserve it, added to bread to as an enhancer. Also includes powdered or liquid Vitamin C as a supplement.
• Acetic acid: Vinegars, pickles and sauces, flavour enhancer and preservative.
• Phosphoric acid: Added to many foods to enhance flavour and found in soft drinks, energy drinks, sauces
• Lactic Acid: Milk and milk products.

Some acids attack tooth enamel more readily – citric acid is one of the most effective at destroying tooth enamel, and ascorbic, acetic and phosphoric acids are a close second. These acids dissolve enamel making it thin and weak. Stomach acid also causes a great deal of damage. The obesity epidemic has increased the presence of stomach acid in the mouth through reflux.

The goal of modern dentistry is to keep enamel intact. We know that if a tooth is well covered with enamel it will last much longer.

The Bugs

The mouth is a very dirty place, with more varieties of bacteria than the bowel. Not all bacteria are bad – some are protective and are engaged in digestion and immune protection.

We’re born without any decay-causing bacteria and usually inherit these bugs from a parent, typically the mother. Transference and infection occurs through exchange of saliva when we first start to eat solid food or through loving contact such as kissing. Not everyone gets decay – partly because they don’t carry many of the decay-causing bacteria. Within families one sibling might have an active decay rate, mimicking a parent’s pattern, while others may develop little of no decay and resemble a parent with a healthy mouth. The reason is entirely related to the bacterial mix in the mouth of the individual. Bad bacteria thrive in sugar-rich, dry and acidic environments. Create an acid environment with a very acidic diet and bad bacteria will dominate, causing decay. Layer in a dry mouth and sugar – the bacterial fuel – and the mix is a lethal cocktail for teeth. Change the bacteria and decay goes away. Change the acidity, and both erosion and decay can disappear. Change the dryness and sugar, and decay doesn’t happen.

Saliva

This watery lubricating layer is the good guy in the mix. It helps good bacteria to grow, maintains a chemical balance in the mouth and is filled with many minerals that help to keep teeth strong and reverse decay on a daily basis. Saliva flow reduces with age. It also reduces markedly with stress, caffeine, and medication. Saliva reverses the damaging effects of acid foodstuffs and helps good bacteria to thrive.

Midlife Women

The changes seen in this age group revolve around saliva, and the loss of it, coupled with caffeine consumption, eating on the run and general busy-ness. Most women in their 40’s and 50’s are very busy. We fit in jobs, career development, families, marriage, aging parents and community activities. Finding time for ourselves can be a challenge. I have observed many patients in recent years who are chronically dehydrated with very dry mouths. This leads to an increase in decay or erosion, sensitive worn teeth and a hefty need for substantial dental work. Initially I thought that changing hormone levels were influencing saliva production but I couldn’t find a direct correlation between dry mouth and reduced hormone levels in the dental scientific literature. The changes were so blatant that it seemed to go beyond just normal aging. It wasn’t until I picked up Dr Libby Weavers book “Rushing Woman’s Syndrome” and it became obvious what was happening…Sympathetic Nervous System (SNS) Dominance as described in Dr Weaver’s book.

What is SNS Dominance? When we are so busy our body produces high levels of hormones such as cortisol and adrenaline. These hormones are responsible for the “urgency reaction”, often referred to as ‘fight or flight’. We all remember a time when we had butterflies in anticipation of a nervous moment – a stage performance, a job interview, a difficult conversation. Elevated adrenaline also left us with a dry mouth in those moments. Dr Weaver identifies that many women are in a perpetual state of urgency, explaining the dry mouth symptoms I have observed.

Mitigating The Risk

Those patients who present with active decay or evidence of acid erosion are advised of the problem. For many it is the first time they have had their issues diagnosed. It can be life changing to discover that decay is an infectious disease that can be treated, or that eating strategies can be damaging to saliva production and teeth.

The first stage of treatment is a comprehensive questionnaire to find out the factors that are detrimentally altering the chemical environment. We take a swab of bacteria to check the dominance of bad bacteria. We check saliva flow, quantity, quality. We ask about eating and drinking habits, caffeine intake, medication, sports – a wide range of lifestyle influences. We then help our patients to enjoy a balanced lifestyle with an understanding of how to alter the chemistry to avoid damage. Our approach doesn’t deny patients many things that they enjoy. It does provide tools, knowledge and products to tip the chemical balance back in favour of teeth.

Clearly the cost of dentistry is an issue for many in NZ and I applaud colleagues in Christchurch who are providing a service to those already struggling with day-to-day living post-earthquake. Dentists are a compassionate bunch who are cognisant of the struggle that some households face in meeting their dental bills.

Is the cost of dentistry a real concern or is it that we simply don’t prioritise spending in this area, seeing it as a discretionary expense rather than an essential investment in our future health.

Dr David Crum, Executive Director of the NZ Dental Association reported that the average dentists hourly rate is $455/hour. What you see on your bill reflects the true cost to run a practice in an advanced economy and have a skilled individual do it for you.

Dentistry is the only healthcare sector in NZ that reflects the true cost of healthcare delivery to the public.

Healthcare, including dentistry, is expensive to provide. We simply don’t see it. Medicine is largely funded by our tax dollars and the real cost of healthcare delivery is masked within the tax take.

Why Does Healthcare Cost So Much?

Contrary to the view that dentists live an extravagant lifestyle and are overpaid, most are conservative people with integrity who are driven to the career by a strong desire to do good. In recent years many dentists have seen their incomes deflate, as rising costs and pressure to contain them, impact their productivity.

Healthcare costs in general suffer from a number of factors that influence the high cost of care:

• Skilled people do the work and this is labour intensive. Skilled people cost money.
• Technology costs lots of money. Technology assists in determining faster, more accurate outcomes, more thorough diagnosis and the public demand it – wanting accuracy, less morbidity, faster recovery times.
• Medical dental supplies are expensive. Largely imported products, anything used in your body has been rigorously tested over many years of development in ethical clinical trials by manufacturers. That’s how we like it – trusted drugs, trusted filling materials, non-toxic, biocompatible products. Years of development is translated to costs at the chairside.

We take healthcare for granted, forgetting that it will simply be a matter of time before it is severely rationed. The financial burden of diabetes, obesity, heart disease, and orthopaedic needs of an aging population will deplete our diminishing tax base.

Our Massive Healthcare Burden

The IMF published the World Economic Outlook in April 2012. NZ sits with other advanced economies that report debt in relation to GDP. Like many nations with burgeoning social support such as funded healthcare, the bill is huge ($14 billion in 2012) and we will not be able to afford it in its current form in coming years. An OECD Report in 2009 on the state of NZ’s health liability reported that it will double as a percentage of GDP by 2026. Medical inflation outstrips general inflation and the likelihood of adding more dental costs to our state funded liability is unlikely.

In the wake of the Star Times survey, and Oral Health Survey results about access by younger New Zealanders, Associate Health Minister Tariana Turia rightly passed the dental responsibility back to the consumer.

She pointed out that our children receive free care up to age 18 to leave school dentally fit. She is right that our children should be leaving school dentally fit. We have a team of capable dentists and therapists working passionately to reach that goal. The reality is that many children do not emerge dentally fit – the modern diet takes it toll on young teeth, full of food acids and high in sugar.

We don’t rate teeth as important, and our desire to look after ourselves in every way is buffered by our access to subsidised medical care. We are out of the habit of paying for medical and dental care and that needs to change.

An insurance based model or state funded dental scheme is often touted as an option for NZ. We have that already – it’s called free care for under 18’s and ACC repair of dental injuries. The cost of delivering dentistry is reflected in these services and anyone who has availed themselves knows that not everything is covered. Children can only get amalgam fillings, not white ones. ACC won’t fund your care to the same degree if you have tooth decay or gum disease. You wont get dental implants if you smoke. The expectation is that you will play some part in maintaining your own health.

There is a move away from funding repair and rebuild costs in dentistry in those nations that do have insurance schemes. The delivery cost to either state or insurer is high. In the USA it is becoming increasingly common for employers to provide dental insurance where preventative care is fully reimbursed. A visit to the hygienist, fluoride treatments, xrays and examinations are covered but fillings and crowns are not. The onus falls back to the patient to look after themselves. Premium discounts are provided for patients who attend regularly for preventive care. Naturally the actuaries have done their sums. Looking after ones self does pay off. Neglect does not.

Yes, the reparative nature of dentistry can be costly, particularly if you are part of the amalgam generation who face structurally compromised teeth that need to be protected with porcelain crowns, or missing teeth that need to be replaced with implants. Planning and budgeting for these structural repairs is sensible. Often they are treatments that can be staggered over several years.

If you’re younger than 35 in New Zealand then there really is no excuse but to stay well. Wellness dentistry is cheap. Really? Compared to what?

An iphone or ipad. Bars on Friday nights. Sky TV subscriptions. A cut and colour at the hairdresser. Labelled clothing and footwear. Vet bills. A ticket to Lady Gaga?

A visit to a hygienist twice a year might cost $350. A dental examination and x-rays approximately $140 once a year to have the peace of mind and advice to stay well. That equates to about $45 per month, less than half the cost of a daily cup of coffee. Your teeth will last a lifetime if you look after them. Unlike an iPad.

Many dentists will also offer credit options. Lumino for example offers 18 months interest free – up there with the best appliance retailers have to offer.

However projecting future benefit is hard for the young who have difficulty calculating their own long term economic interest. Parents would be well advised to assist in preventative dental costs through tertiary years when the risk of dental disease is high.

I agree that young families and low wage earners will find it difficult to find spare funds for dentistry and there are mechanisms in place to assist those patients.

I believe its time NZ shifted its view of healthcare spending, including funding dentistry. We simply do not appreciate the cost of healthcare as a nation and it is time to wake up. We want the best the world has to offer and we expect it for free. Shifting our perceptions about our own responsibility in the importance of healthcare could start with dentistry. Dental disease is, afterall, entirely preventable.

Many patients, who have faced a lifetime of dental disease with an air of resignation and despair, are suddenly able to contemplate a disease free oral environment. Personal profiling, called the Dental Fingerprint, allows us to highlight an individual’s risk of disease, and plan strategies to avoid it. Some of your susceptibility relates to your genetic makeup, while other factors relate to your ability to fight disease and the bacteria that occupy your mouth.

Simple screening tools, coupled with detailed lifestyle questionnaires, open a fountain of hidden risk factors. Most patients are unaware of these risks and are surprised to find their oral state is not their fault, or a function of their neglect.

How Does It Work?

Unlike the standard dental check up, a Dental Fingerprint Analysis will involve detective work, a review of past and current disease patterns and technology.

For example, we know that decay is an infectious disease caused by a dominance of bad bacteria in the oral biofilm. The mouth is a very dirty place, with more varieties of bacteria than the bowel. Not all bacteria are bad – some are protective and are engaged in digestion and immune protection.

We’re born without any decay-causing bacteria and usually inherit these bugs from a parent, typically the mother. Transference and infection occurs through exchange of saliva when we first start to eat solid food or through loving contact such as kissing.

Not everyone gets decay – partly because they don’t carry many of the decay-causing bacteria. Within families one sibling might have an active decay rate, mimicking a parent’s pattern, while others may develop little of no decay and resemble a parent with a healthy mouth. The reason is entirely related to the bacterial mix in the mouth of the individual.

The inherited mix of bacteria will be influenced by the chemistry of the mouth too. Bad bacteria thrive in sugar-rich, dry and acidic environments. Create an acid environment with a very acidic diet and bad bacteria will dominate, causing decay. Layer in a dry mouth and sugar – the bacterial fuel – and the mix is a lethal cocktail for teeth.

Here’s the good news – change the bacteria and decay goes away. Change the acidity, and both erosion and decay can disappear. Change the dryness and sugar, and decay doesn’t happen. That can be life-changing for many patients who have contemplated a pathway to endless dental treatment, expense, and possibly tooth loss.

Science allows us to sample the bacteria with a simple test. In less than a minute we can predict the risk of decay in an individual – based on ATP Bioluminescent screening. Used widely in other industry, this test model shows the extent of bacterial activity in the mouth. The mouth may look very clean, but when there is a dominance of decay-causing bacteria the screen will read high. We can quantify the risk of decay, and measure reducing risk through a variety of treatments.

The patient can be alerted that they carry a risk of active decay. We can predict disease before it has happened clinically – a remarkable concept that allows early intervention, rather than ‘band aid’ treatments once it is too late.

Patients have the choice to:

• Intervene and eliminate the risk, coupled with appropriate lifestyle changes
• Do nothing, continuing to carry the risk of disease and a lifetime of treatment.

The Dental Check Up – Why Bother?

The dental checkup is far from a needless expense when it embraces a Dental Fingerprint Analysis. Ignoring the dental checkup makes no long term financial sense. It is the best investment you can make for your health.

A dentist focused on Risk Management will always view your mouth as a dynamic, changing environment that needs constant and careful re-evaluation and testing. The frequency of your ‘check up’ or Dental Fingerprint Analysis will vary, according to your personal profile. Some patients may not need to see a hygienist more often than annually. Others may need review four times a year.

Oral health is increasingly linked to overall health. The mouth is a mirror to many systemic disease and inflammation through bacterial infection in the mouth is linked to cardiovascular disease (CVD), diabetes, premature and underweight birth. The biotech world is moving rapidly toward a Point Of Care Device which will allow the dental checkup to be a forecast of systemic health. Readings taken on high-tech sensors from saliva samples will be able to predict many other sustemic disease risks. The dentist will be the primary diagnostician of the future, creating a first point of contact for directing the patient to a physician.

To find out more about a Dental Fingerprint Analysis click HERE.

Read the Market Watch article here…

Oral squamous cell carcinoma (OSCC) is the most common form of oral cancer. It is the sixth most common malignancy worldwide and is a major cause of morbidity and mortality. Statistics provided by the New Zealand Health Information Service in 2002 showed that OSCC accounted for approximately two per cent of all malignancies in New Zealand – a similar incidence to cervical cancer.

The link between oral cancer and the human papilloma viris (HPV) is clear and the incidence amongst young males is growing, largely through orogenital sexual activity. New Zealand has made major steps toward offering vaccinations for young women over the age of 13 to help reduce the impact of HPV on cervical cancer rates. There is some argument worldwide that vaccinating boys is also relevant in light of these findings.

Early detection can have a profound impact on mobidity and mortality and dental visits are are an important part of detection.

The Oral Cancer Exam should be conducted at all new patient visits, as part of a comprehensive assessment, and at each subsequent continuing care assessment. All dentists, hygienists and therapists are trained to carry out the oral cancer exam.

How Do I Know If I’m Having An Oral Cancer Exam?

Clearly a sore on your lip will be obvious to everyone, even you. The oral cancer exam is a distinct part of the dental examination process. Your dental professional is using both visual and tactile techniques to look for oral cancer which can take many forms.

Some signs are quite subtle, such as less flexibility in movement, asymmetry, slight reddening, hardness and rolled edges on ulcers. Palpating (touching and feeling the soft tissues) is important and your dentists will often use some soft gauze to pull out the tongue and look at the sides, top, back and base.

In addition, he or she will look at the roof and floor of your mouth, as well as the back of your throat and the tonsillar pillars on each side. When viewed directly from the front, the opening to the back of your mouth and throat should appear symmetrical and not swollen on either side.

A well-done visual and tactile examination , when conducted by a trained professional, will do a good job of finding oral cancer early if it is done annually.

Gum disease sets up a host response that delivers a cascade of inflammatory chemicals and markers into the bloodstream. These have been well recognised to influence heart disease, cause premature birth and miscarriage and now evidence points to their influence on conception.

The team followed 3737 women in Western Australia and measured pregnancy outcomes. Women with gum disease took an average of 7 months to conceive compared with women with healthy gums who took only 5 months. The figures were less positive for non-Caucasian women who took over a year to conceive.

Professor Hart said “Until now, there have been no published studies that investigate whether gum disease can affect a woman’s chance of conceiving, so this is the first report to suggest that gum disease might be one of several factors that could be modified to improve the chances of a pregnancy.”

The report concluded that gum disease exerts a negative influence on fertility that is of the same order of magnitude as obesity. This study also confirms other, known negative influences upon time to conception for a woman; these include being over 35 years of age, being overweight or obese, and being a smoker. There was no correlation between the time it took to become pregnant and the socio-economic status of the woman.

Our advice for those planning to conceive – seek advice from a dentist or hygienist. They will be able to assess very quickly whether you have gum disease or not and will propose a range of strategies, from treatment to homecare advice and prescription of products that will help reduce harmful bacterial counts.

If you think you might be at risk of gum disease we’d be happy to advise. You can phone us on +64 9 9192660 or email us on info@citydental.co.nz

Read more at /services/dental-hygienist.aspx

Read the full article in Science Daily at http://www.sciencedaily.com/releases/2011/07/110705071548.htm

Yet another patient sat in my chair recently, arriving in my office for news they knew, but didn’t want to hear. An implant bridge placed in Thailand was causing bleeding and inflammation, risking the loss of the implants themselves.

Many of my cynical colleagues would argue that this a case of ‘buyer beware’, that the client got what he deserved – a very expensive cocktail by the pool. It broke my heart to say “I’m sorry, I can drive a truck through the gap under your implant supported restoration. It doesn’t fit and will need to be remade”.

So who owns the problem here? The patient who should have done the maths: Quality + Dental Tourism = Oxymoron.

The tourism operator?… somewhere in their business plan, as they clip the ticket, there is unlikely to be an unspoken code of ethics, something embedded in the psyche of any NZ or Australian health professional.

What about the dentist providing the care? We don’t know the circumstances regarding the delivery of care – the timeframe is certain to be limited – but somewhere along that treatment path the dentist would have known that the outcome was compromised. Either their impressions were inaccurate, their technicians lacked attention to detail, they didn’t take a verification xray to check the fit before cementing. These are all standard protocols that any reputable dentist undertakes to deliver a successful outcome. This was clearly a case of geographical success. The patient hops on a plane to another country and the dental failure disappears with them.

One of my mentors said “do the right thing at the right time for the right reasons”. Every dentist is trained with this motto – an ethical virtue that stems from the conscious desire to do the best work possible for the patient. An ethical dentist will halt a procedure that is not going according to plan, or where time and biological constraints limit the delivery of quality care. When financial limitations prohibit the best care the patient will be carefully advised so that they can make a choice to accept a limited outcome.

It’s a wonderful balance of scruples and competence that gnaws away at every doctor or dentist. While competence and experience can vary, and every dentist should know their limitations, most understand the difference between scrupulous and unscrupulous decisions. When financial reward drives the treatment decision the outcome is invariably compromised in some way.

Quality comes at a price – that price is a dentist with an ethical backbone. So does the peace of mind that, when failure occurs, comeback is available in a developed society in the form of consumer legislation and peer review outcomes. I can’t compete with a business model that provides questionable care in a part of the world that is hardly a model of consumer rights. But I can keep doing the right thing at the right time for the right reasons.

The response is commonly ”Well, I’ve got lots of fillings and no matter how well I brush my teeth I’ve always got something to do when I go to the dentist.”

Typically, on review of their mouths, the picture looks like this:

A relatively clean, well maintained mouth.

• Lots of fillings
• New decay
• Root fillings
• Possibly missing teeth

The traditional response in the dental industry has been to take a surgical approach to the problem, cutting out decay and filling a hole, with little emphasis on treating the underlying infectious disease.

Enlightened dentists have been treating the cause of decay for some years, with a global view that dental decay (caries) is a bacterial infection or imbalance. New, fast and cost effective screening tools, and treatment regimes have been developed to eliminate decay. For the the first time, patients discover that their customary experience of dental care can change.

To understand more about the modern concept of dental decay as an infectious disease, watch this You Tube clip from Carie Free…

Future proofing oral health is real… imagine knowing that this might be the last filling you require, apart from simple repair and replacement as old fillings wear out. Even better, imagine knowing through a simple bacterial screen that you are at risk of developing decay before you have decay.

The latter concept is hard to get one’s head around. It means that when environmental influences are in balance (mostly what we eat and drink) the chance of expressing decay is lower, even with a high bacterial risk. However, as soon as the patient becomes exposed to different environmental selection pressures, the decay process begins rapidly and the results can be costly and destructive.

Take this example:

The teenager who has attended the dentist diligently through school years with parental insistence and guidance, completing orthodontics and arriving at 18 with no more than a few fissure sealants. Mum or Dad have been shopping and cooking and eating habits have been moderated by parental influence.

Returning home in November after a year at university, Mum organises a visit to the dentist. Both parent and student are shocked to discover that 6-8 fillings are needed at a substantial cost. Parents often face disbelief or worse – mistrust in the dentist making the diagnosis. A dentist who has failed to diagnose the bacterial risk is placed in a difficult position of defending a diagnosis that seems contrary to past observations.

So what happened here? Our student adopted a diet and lifestyle that created selection pressures that tipped the bacterial balance into the danger zone, creating so much loss of tooth mineral on a consistent basis that multiple cavities formed. Those changes can be quite subtle. In the presence of a cariogenic biofilm even small changes such as increased caffeine intake, producing a drier mouth with less saliva, will be enough to tip the balance in a high risk individual.

We know that the dominance of a cariogenic biofilm (bad bacteria) is inherited. Children are infected in infancy by oral contact with a parent, typically the mother. This transmission of infection is called vertical transmission. We have mixed evidence to support horizontal transmission – the transfer of bacteria from genetically dissimilar individuals such as partners. Intimate contact invariably involves transfer of saliva and there are case reports of specific strains of bacteria being transferred between spouses with a resultant increase in decay rates.

Current treatment modalities involve a regime of high pH mouthrinses to manipulate the biofilm content, allowing dominance of good bacteria. Regular screening and monitoring is an important part of decay prevention, as well as lifestyle awareness on the part of the patient.

Find out how you can measure your risk and future proof your mouth with us here