A black line at the gumline or a tooth that looks fake because of a flat or bright unnatural color or a tooth that is too bulky compared to the adjacent teeth are sure indications of a crown that is an esthetic failure. With appropriate materials, procedures, and skill lifelike crowns will blend in naturally with adjacent natural teeth. A black line at the gumline of a crown is caused when the underlying metal framework supporting the porcelain shows through. A properly done crown with an acceptable margin should have no black line. A crown that appears too large or out of scale for the adjacent teeth is caused by inadequate reduction of the tooth before the crown is fabricated. Flat and superficial looking crowns that don't match the adjacent teeth are often caused by inadequate reduction and preparation of the crowned tooth. The use of a quality dental lab is also critical for natural looking crowns.

Beauiful, natural looking crowns (commonly referred to as caps) are a hallmark of skilled dentistry. If you would like a consultation regarding a more natural smile, contact our office.

If you have been told you do not have enough bone for tooth implants or you chose not to do implants for financial considerations, mini implants may be exactly what you need.

The bone underlying a denture deteriorates because there are no longer teeth present. This results in dentures slipping and wobbling which lets food underneath the base and can create sore areas especially a with lower denture. The lips have to work harder to keep the denture in place, and this makes a natural expression difficult and can even affect speech. The loss of jawbone results in an aged facial shape. These problems rob many denture wearers of their confidence in social situations.

Conventional implants have been used to provide stable denture anchorage and maintain remaining jawbone. However, they require sufficient bone volume in order to be placed, and it will take three to six months for bone to grow around the fixture before the denture can be anchored to the implants. These restrictions used to mean that not everyone was a suitable candidate for implants.

A mini implant is only 1.8 millimeters in diameter (about the size of a toothpick) which means that there is always enough bone in the front of the jaw to place them and much less surgery needed to accomplish the placement. In addition they have been designed so they can be secured to the lower denture during the same office visit. Mini implants are placed in the morning, the denture immediately attached, and the patient will be comfortably eating lunch that same day. As an added bonus, the simplicity of attachment components and reduced surgery means lower costs compared to the conventional implant process.
Mini implant technology means everyone can have a well fitting, comfortable lower denture. Contact our office for a consultation.

Last month I discussed some ways of making dentistry more affordable and this month I want to add ideas for those who don’t have dental insurance. Again, I cannot emphasize enough the value of prevention--you save 100% of the cost of any dentistry that doesn’t need to be done because you've taken care of your teeth regularly. Teeth must be regularly cleaned on all four sides; that means using floss daily. If treatment is needed, get it done in a timely manner, as dental problems tend to grow in difficulty and costs with time. Avoidance is only more costly later.

We are fortunate to have two dental schools across the bay, UCSF School of Dentistry and UOP Dental School. All dental schools have clinics where dental students in their last two years treat patients under supervision of their dentist instructors at reduced costs. While students strive to do good dentistry and pass their requirements, treatment will often take longer and require more visits than in a private setting. Also, students may not be the best place for treatment of complex problems or patients that are extremely fearful.

Many dentists have financing available through outside sources. Lately finance companies have been marketing to dentists for consumer loans to patients. As incentives they may offer “teaser” rates that will keep interest costs down. Lastly, if you have a long term relationship with your dentist, ask if they will allow you to extend payment over a couple of months by putting payments on an automatic credit card deduction.

In many ways maintaining your teeth is no more expensive than maintaining an automobile, and with basic preventive care you don’t have to replace your teeth every few years like you would an automobile.

These days everyone is looking to manage health care costs. According to a recent New York Times article, more than 100 million Americans do not have dental insurance. Dental plans are not typically available to individuals because the only people who would purchase such plans would have expenses beyond the cost of the premium. All employer-based plans have limits because they are intended to help defray only a portion of your dental costs. These plans are not really insurance in that they are generous with twice-yearly checkups, usually only cover a fraction of higher cost procedures, and often provide no coverage for common dental procedures like implants. Cost is one of the reasons why 35 percent of Americans have not visited a dentist in the last 12 months according to a March 2009 Gallup poll.

So how can people reduce their dental expenses? Prevention is the most effective means. A small cavity detected on a routine check-up can cost $100 to $200 to treat, but allowed to further weaken a tooth; and a crown will cost around $1000. Wait until it hurts when a root canal will be required, in addition to the crown, and it will add roughly another $1000 in dental repair costs. Just like your car, routine maintenance is less expensive in the long run than driving until the car breaks down. An even better strategy is to avoid the need for dental repairs with daily flossing to keep the gums and supporting bones healthy. Additionally, products like Cari-Free can prevent new cavities. Of course consistent cleanings at the dentist can prevent gum disease--the leading cause of tooth loss.

Dental treatment can often be done in phases. Sometimes this may mean doing temporary treatment now and later doing a more definitive treatment when finances permit. There may be a downside, however, in esthetics (appearance), risk of something breaking, or additional costs. Most dentists are willing to spread the work over time if it is appropriate. Discuss the pros and cons with your dentist before phasing extensive treatment.

Next month I will write more about controlling dental costs for those people without dental insurance benefits.

James R. Hinkle II DDS MAGD
Advanced Dental Excellence
2229 Santa Clara Avenue
Alameda CA 94501
www.alameda-dentist.com
521-3344

Last month I discussed the concept of “dental age” vs. chronological age. The key to keeping dentally young is to change the process of dental diagnosis. It must move from tallying up disease present and treatment to reading signs of beginning disease and taking preventive measures. This can be simplified by considering that there are just four basic processes by which dental health breaks down. The four processes are: decay, aging dentistry, loss of tooth structure, and loss of foundation. Each one of these areas needs to be taken into consideration during examinations. If breakdown is beginning, intervention can prevent further damage. For instance if tooth surface is being lost, the cause needs to be determined in order for prevention to be effective. Loss due to heavy-handed tooth brushing would be treated differently than loss due to acid erosion. Worn teeth due to uneven bite forces might require straightening to evenly distribute forces, while wear from grinding might be managed with a night guard.

By using a dental examination to evaluate for various risk factors a dentist can largely predict your dental health in twenty years, for example. By using modern preventative dentistry we can then change the likely outcome to healthier (more youthful) teeth in twenty years. In the long run, this will minimize dental treatment and costs. Decay and gum disease are almost completely preventable. Wear and aging can be evaluated and taken care of before becoming significant. As we age, we don’t have to see more and more dentistry, ever-increasing expenses, and dentition aging. With appropriate intervention, the aging of teeth and reparative dentistry would be minimized.

James R. Hinkle II DDS MAGD
Advanced Dental Excellence
2229 Santa Clara Avenue
Alameda CA 94501
www.alameda-dentist.com
521-3344

Dr. Hinkle is a Fellow of the International Congress of Oral Implantology and is in private practice in Alameda, California.


The loss of a tooth can cause a series of irreversible changes in your mouth if left untreated including the risk of additional tooth loss. Dentistry reduces these effects by replacing the missing tooth. There are three basic methods: removable bridge, fixed bridge, and dental implant.

The removable bridge is the least expensive, but this option may be esthetically unappealing because the clasps that hold it in place are often visible. There is a also a tendency for food to get underneath the removable bridge. A fixed bridge is cemented in place and has no clasps. However, the downside of this method is that teeth on either side of the gap must be cut and crowned to anchor the fixed bridge. The major drawback to both types of bridges is that without a tooth root the jawbone shrinks ultimately leading to significant changes in the facial structure and resulting in a premature aging affect.

A dental implant is a small anchor inserted in the bone that replaces the missing root. A crown is built on this anchor and no clasps or cutting and crowning of neighboring teeth is necessary. Once an implant has been placed in the bone, it will maintain the jawbone and facial structure just the same as a natural tooth. An implant feels and looks like a natural tooth. A dental implant must be done while the patient has adequate bone left in which to place the anchor. If the bone is not adequate (perhaps because an implant was not done soon after a tooth root was lost) a tiny amount of bone is grafted to the site and then an anchor is implanted and a crown built. For additional information go to Dr. Hinkle’s blog: www.alameda-dentist.com/blog.

James R. Hinkle II DDS, MAGD
Advanced Dental Excellence
2229 Santa Clara Avenue
Alameda CA 94501
www.alameda-dentist.com
510 521-3344

Dr. Hinkle is a Distinguished Mentor with the Kois Center for Advancing Dentistry Through Science in Seattle, Washington and is in private practice in Alameda, California.

Dr. Oz on the Oprah Winfrey Show talks about Real Age in which our behaviors affect our wellbeing. For example, we all know that what we eat and regular exercise can improve our vitality and lifespan while smoking or not wearing seat belts can reduce the quality or even shorten our life. For years I have talked to my patients about the concept of chronologic age vs. “dental age”. Chronologic age is based on our birth date, but dental age is based on our level of dental health. A twenty year old typically has a full complement of teeth, with minimal repairs, unworn, good bone level below the gums, etc. It would be highly usual for a twenty year old to have dentures, but not so unusual for a seventy year old to have dentures. But, a seventy year old could very well have all of his teeth, in good repair, with minimal wear, and firm in the jawbone which would make his “dental age” closer to the twenty year old. The goal of modern preventive dentistry is to minimize the destructive forces that age the dentition instead of just repairing problems after they have occurred. This means that dental examinations need to be geared to determining which components are susceptible or beginning to break down and intercept to keep the teeth as close to the youthful parameters as possible. While our bodies will fail over time (Dr. Oz’s recommendations can only affect the rate of failure to a degree) our teeth can literally stay youthful until we die. Our goal as your dental professionals is to help keep you dentally as young as possible.

James R. Hinkle II DDS MAGD
Advanced Dental Excellence
2229 Santa Clara Avenue
Alameda CA 94501
www.alameda-dentist.com
521-3344

Shots! I would say that this one word alone is the reason nearly 50% of the population does not go to the dentist on a regular basis. Yet, I will ask young adults with piercings if it hurt when they had it done, and I am usually told “no” or “not much”. Although a body piercing needle’s bore is huge and considerably more pain inducing compared to an anesthetic syringe.

Without good anesthesia, some dental procedures would be too uncomfortable for the patient. With knowledgeable finesse, anesthesia can be delivered to a patient with little or often no discomfort. The most honest feedback I receive comes from children who often ask at the end of procedures in which anesthesia was used “Am I going to get a shot today?” How is this possible? The answer is good equipment and good technique.

Don’t let fear of “shots” keep you from receiving regular dental care. We can provide you with all the benefits of modern dental treatment in complete comfort. For more information go to my dental blog at www.alameda-dentist.com/blog.

James Hinkle II DDS MAGD
Voted one of the Best Dentists in America
Advanced Dental Excellence
2229 Santa Clara Avenue
Alameda CA 94501
www.alameda-dentist.com
521-3344

Tooth decay is the number one childhood disease in the US. Although it is largely preventable, it is five times more common than asthma. As our knowledge of this disease process deepens, it is clearer that this is a complex disease. However, in order to prevent decay, it is obvious that simply fixing cavities does nothing to effectively treat the disease process.
Decay is an infectious disease located in the biofilm on teeth. Since teeth are the only non-shedding surface on the body, the biofilms on teeth tend to be more diverse and complex than previously understood. A healthy mouth will have around 113 different bacterial species present, while a person with high risk for decay will have an average of only 94. Why the lower number? It appears that mouths with lower pH (more acidic) will push the biofilm to destroy harmless species, cause harmful bacteria to multiply, and even cause some bacteria to change metabolism to become harmful and multiply in a more acidic environment. Thus fewer (but more harmful) bacterial species is a function of pH not sugar availability. The lower pH can come from type of diet (external), acid reflux (internal), or lack of ability to buffer the pH to prevent its lowering. The goal of raising the pH of the saliva may be the simplest, most broad sweep approach to preventing decay, overcoming the complexities of other methods like vaccines, gene therapies, or antimicrobials. Carifree.com is the only company to bring products to the market designed to improve the pH of the mouth to alter the composition of the biofilm. Their site has more in depth information on assessing your risk and the research behind the validity of this approach to reducing our most common disease.
The dental profession is beginning to recognize the value of diagnosing the disease risk as opposed to simply repairing teeth. Identifying individuals at risk and altering the pH of the susceptible to prevent decay is future of preventive dentistry.

James R. Hinkle II DDS MAGD
ADVANCED DENTAL EXCELLENCE
2229 Santa Clara Avenue
Alameda CA 94501
www.alameda-dentist.com
510 521-3344

Penny Wise and Pound Foolish With Your Health

More research has come out recently showing significant cardiovascular disease risk for those with gum disease. “We’re not talking about people with advanced periodontal disease,” said Dr. Kowolik of University of Indiana, “we’re talking about healthy people who simply neglect oral hygiene.”

In addition to regular brushing and flossing at home, good oral hygiene requires regular dental exams and teeth cleaning. The frequency of teeth cleaning (hygiene appointments) depends on the individual patient’s needs. Some patients require cleanings every six months. Many patients, however, require appointments more frequently due to the existence of other issues, i.e. health issues (like reflux), crowded teeth, a tendency to build up bacteria (plaque), or the existence of gum pockets. These patients require cleanings as often as every three months to keep their gums and heart healthy.

Unfortunately, some patients with dental insurance policies that only reimburse for cleanings every six months become “penny wise and pound foolish”. By foregoing the minimal out of pocket costs of additional cleanings or more extensive hygiene procedures, some patients may run the risk of a heart attack or stroke. The impact on the patient’s health, quality of life, and pocketbook can far exceed the lifetime costs of an effective regularly scheduled hygiene program.

James R. Hinkle II DDS MAGD
Advanced Dental Excellence
2229 Santa Clara Avenue
Alameda CA 94501
www.alameda-dentist.com
521-3344

Sensitive teeth is sometimes caused by erosion--the dissolving of the enamel or dentin by a chemical process. A recent multicenter study found dental erosion is on the rise, with a surprising 30% prevalence among 10 to 14 year olds.

Erosion is often caused by the acids found in soft drinks, some fruit juices, sports drinks, and some herbal teas. When consumed in excess these beverages can easily strip the enamel from teeth leaving them brittle and sensitive to pain. Other sources of erosion can be medicines and some underlying medical conditions such as acid reflux disease and disorders associated with chronic vomiting, including bulimia, that bring stomach acids into the mouth.

If erosion is determined to be the cause of the sensitivity, the first step is to determine and control the source to prevent continued destruction. The eroded surfaces then may be replaced with appropriate materials to stop the sensitivity. Without first managing the cause, the reparative dentistry may also be destroyed.

An accurate diagnosis of why teeth are sensitive is the key. Hypersensitive teeth caused by erosion is just one of the possible causes. More serious conditions could be decayed or cracked teeth which also require preventative and restorative dental procedures.

Do you avoid ice in your drinks? Are you fearful of having a certain area cleaned by the hygienist? Teeth that are sensitive to temperature, touch, or even air are one of the most common complaints dentists hear.

There are many reasons for sensitive teeth, including cavities and cracked teeth. Fortunately, most sensitivities are a result of a less serious cause.

Underneath the strong outer layer of a tooth is the dentin layer, which is less dense. Dentin has microscopic canals leading to the pulp of the tooth. When these miniature tubes lose their protective layer, they allow temperatures, sweets, touch, or drying to transmit a stimulus to the nerve fibers located in the pulp. These nerve fibers signal the pain of a hypersensitive tooth. Fortunately, the painful stimulus does not cause permanent damage to the nerve of the tooth, but it can be extremely unpleasant. Most sensitivities occur near the gumline as a result of toothbrush abrasion, acidic erosions, or compressing and flexing forces of clenching. There are over-the-counter desensitizing toothpastes available that help block the canals from transmitting sensations to the nerves. These toothpastes are often the first step to managing the problem; but if they do not provide adequate relief, let your dentist know. There are several other professional approaches available.

As with most things in dentistry, accurate diagnosis is the key to relieving sensitive teeth; or more importantly, to separate hypersensitive teeth from more serious conditions such as decayed or cracked teeth that get worse with delay.

Next to “getting a shot” do you hate leaving the dental office with numbness, wondering if you are drooling on yourself or afraid you will bite your tongue when you eat? Help is on the way.

Novalar Phamaceuticles of San Diego has just won approval for OraVerse from the FDA. In clinical trials OraVerse cut the time it took for full sensation to return to the numbed area by more than half. The basis for the drug is a decades old anti-hypertensive drug. After a dentist finishes a procedure where anesthesia is used, the dentist would inject OraVerse into the same site. It doesn’t literally “reverse” the anesthetic, but utilizes an indirect approach. Here's how it works: When a dentist administer local anesthetics it is usually combined with another drug called epinephrine that acts to constrict the blood vessels. This keeps the blood from carrying away the anesthetic too quickly. OraVerse does the opposite, dilating blood vessels so the anesthetic can be carried away faster.

Some procedures, such as extractions, where longer anesthesia will keep the patient more comfortable would likely not be advisable for OraVerse use. Since an additional dental procedure will come with some cost to the patient, OraVerse may may be too costly for routine use. However, for patients concerned about being able to eat or speak without numbness after a dental procedure, the availability of this new dental procedure, may be worth the additional incremental cost.

Next to “getting a shot” do you hate leaving the dental office with numbness, wondering if you are drooling on yourself or afraid you will bite your tongue when you eat? Help is on the way.

Novalar Phamaceuticles of San Diego has just won approval for OraVerse from the FDA. In clinical trials OraVerse cut the time it took for full sensation to return to the numbed area by more than half. The basis for the drug is a decades old anti-hypertensive drug. After a dentist finishes a procedure where anesthesia is used, the dentist would inject OraVerse into the same site. It doesn’t literally “reverse” the anesthetic, but utilizes an indirect approach. Here's how it works: When a dentist administer local anesthetics it is usually combined with another drug called epinephrine that acts to constrict the blood vessels. This keeps the blood from carrying away the anesthetic too quickly. OraVerse does the opposite, dilating blood vessels so the anesthetic can be carried away faster.

Some procedures, such as extractions, where longer anesthesia will keep the patient more comfortable would likely not be advisable for OraVerse use. Since an additional dental procedure will come with some cost to the patient, OraVerse may may be too costly for routine use. However, for patients concerned about being able to eat or speak without numbness after a dental procedure, the availability of this new dental procedure, may be worth the additional incremental cost.

The primary bacteria responsible for tooth decay, Strep. mutans, has the specialized ability to survive in acid. Unfortunately, the breakdown of carbohydrates creates an acid environment that reduces other less harmful bacteria while the Strep. mutans can thrive and cause tooth decay. One of the reasons is the ability of Strep. mutans to make the fatty acid enzyme called FabM, which protects it from acid attack. When researchers shut down the production of FabM the Strep. mutans became almost 10,000 times more vulnerable to acid damage. Further research has shown FabM or close relatives may be responsible for all Strep. and Staph. bacteria’s resistance to the body’s defenses. These families of bacteria are responsible for meningitis, pneumonia, “flesh eating infections”, as well as infections around heart valves and stents.

The University of Rochester Medical Center has received a grant from the National Institute for Dental and Craniofacial Research to investigate FabM and other bacterial proteins. These studies could lead to our ability to develop a multi-prong attack on bacteria instead of the current single-prong antibiotic therapies. “Our goal is to force the major bacterium behind tooth decay to destroy itself with its own acid as soon as it eats sugar,” said principal investigator Robert G. Quivey, PhD. In addition to helping prevent cavities, it may also lead to new antibacterial combination therapies for other types of infections that have become resistant to currently available treatment.

If you have been told you do not have enough bone for tooth implants or you chose not to do implants for financial considerations, mini implants may be exactly what you need.
The bone underlying a denture deteriorates because there are no longer teeth present. This results in dentures slipping and wobbling which lets food underneath the base and can create sore areas especially a with lower denture. The lips have to work harder to keep the denture in place, and this makes a natural expression difficult and can even affect speech. The loss of jawbone results in an aged facial shape. These problems rob many denture wearers of their confidence in social situations.
Conventional implants have been used to provide stable denture anchorage and maintain remaining jawbone. However, they require sufficient bone volume in order to be placed, and it will take three to six months for bone to grow around the fixture before the denture can be anchored to the implants. These restrictions used to mean that not everyone was a suitable candidate for implants.
A mini implant is only 1.8 millimeters in diameter (about the size of a toothpick) which means that there is always enough bone in the front of the jaw to place them and much less surgery needed to accomplish the placement. In addition they have been designed so they can be secured to the lower denture during the same office visit. Mini implants are placed in the morning, the denture immediately attached, and the patient will be comfortably eating lunch that same day. As an added bonus, the simplicity of attachment components and reduced surgery means lower costs compared to the conventional implant process.
Mini implant technology means everyone can have a well fitting, comfortable lower denture. Contact our office for a consultation.