There are a multitude of questions we are asked about dental treatment, and specifically how traditional dental therapy differs from a new era in dental therapy. Call it what you will – Alternative, Biological, Holistic, Natural – these philosophies of care have the goal to ultimately treat the mouth as part of a complex biological organism which affects and is affected by system as a whole.
This glossary is meant to provide both general dental terminology and to include “alternative” terminology for clarification. Entries are kept as complete as possible, as if the question were answered in person. It is also a work in progress as new material is requested or new therapies become available.
Dental Therapies Defined
All About Ozone
Onlays, Crowns, Fillings, Oh My!
Replace a missing tooth by holding on to the tooth structure on both sides of the space. Bridges are considered “fixed” because they are cemented into place permanently. Bridges can be made from a selection of materials, many of which are esthetic. If the supporting teeth are strong and already have restorations, it is reasonable to justify using them to support a bridge. If the supporting teeth are virgin, the preparation style and material selection are crucial.Individuals, who for personal or health reasons do not wish to have a titanium implant placed, may opt for a bridge to replace a missing tooth.
Composite fillings are bonded tooth-colored fillings used as filling, onlay and crown material. There are many brands and several types but all are a combination of fine glass or silica particles surrounded by a polymerized plastic type matrix. Composites vary widely in their wear-resistance and polish-ability. Dr. Copeland carefully selects which material is appropriate for each instance based on biocompatibility and area to be restored.
Composite material may be of two types:
- direct – indicating the restoration is placed in one appointment
- indirect – most commonly onlays or crowns, which are fabricated by a dental laboratory from an impression and bonded at a second appointment
Composite restorations are technique sensitive; the practitioner needs to prevent contamination and carefully treat each layer to ensure maximum curing of the material. Composites offer a natural looking conservative filling option. When well-placed, they compete with their amalgam competitors for durability.
They have several benefits over other materials:
- several are highly biocompatible
- they are without metal so are electrically neutral
- they are natural looking
- they allow healthy tooth structure to stay intact
- they do not stain the remaining tooth structure like amalgam
- they are durable, with low expansion and contraction after curing
- they do not wear the tooth they chew against, changing the bite over time
Composites have some issues which may complicate their placement:
- they require isolation from oral fluids to be placed well, this takes time
- they require the practitioner to be familiar with the bonding chemistry
- they must be cured in layers, requiring time sensitivity may result if bonding is compromised by excessing “weeping” of the tooth tissue(dentin) requiring the filling to be removed and re-bonded.
- these are determined by the clinician
Dental implants are used for replacing missing teeth and stabilizing prostheses such as dentures.The “implant” itself is a specially milled titanium or pressed zirconium precision post which is placed into a prepared place of the jaw bone. The bone grows around the implant to mimic the root of the missing tooth.The implant can then be restored to look and function like a natural tooth by placing an abutment and crown. Implants are made from titanium, a highly biocompatible metal.Implants have an increasingly excellent long term stability. Patients with electrical sensitivities or neural issues however, should consider all other options strongly before implant placement.
Titanium implants are most common and have excellent blood serum compatibility. However they are electrical conductors, They may give off a grey-metallic hue visible through gum tissue in esthetic (visible) areas.
Zirconium implants are rather new, but have been used in Europe for a number of years. They do not have the high biocompatibility blood serum testing rating that titanium does, may have higher fracture rates in some cases. They do not conduct electrically and may be an excellent choice for the electrically challenged. They are now approved for use in the US.
Dental implants have been used for many years and have a high success rate under the right conditions. Whether implants are right for you should be determined by looking at several factors including overall health, oral conditions and personal preferences.
A protective tooth restoration, which conserves much more tooth structure than a crown and clinically, in Dr Copeland’s experience lasts longer due to its natural cleansbility. It is technically more sensitive to prepare, is smaller and bonded rather than cemented to the tooth structure. In many cases it is undetectable from a natural tooth.
A modified cap (crown) form which conserves natural tooth structure, strength and beauty. Can be made from metals such as high noble gold alloy, porcelain or composite resin.
Porcelain crowns are cosmetic restorations which cover the entire tooth surface. Dr. Copeland carefully chooses porcelain over high noble yellow gold or porcelain alone when this restoration is the best treatment option. Due to its high abrasive nature, true porcelain should only be used when it functions against a new or existing porcelain tooth to avoid uneven wear. Other natural looking materials are also available. New advances have created these nonmetal “porcelain” like options. All have the benefit of allow the “porcelain” artist to craft really beautiful teeth!
Traditional porcelain crowns were a god send to dentist and patients alike when they were introduced, replacing gold as the only crown option. They consist of a metal cap to which porcelain layers are fired. Since then we know the metal alloys under porcelain contain elements which are not good for direct contact with body tissues such as nickel and chromium. Chronic Inflammation and bleeding of the gums around an existing crown when a client has good oral hygiene is often a reaction to the material. Replacing the crown with a biocompatible material most often improves the area dramatically.
All About Mercury
Mercury safe is not the same as being mercury free. As a mercury safe practitioner, Dr. Copeland adheres to a strict protocol when removing fillings containing mercury. These protocols protect the client, the dental office personnel who are potentially exposed to high levels of mercury vapor. As an accredited member (AIAOMT), Dr. Copeland has studied the biological effects of mercury, and the safest removal methods which include supplemental support, negative ion generators, oxygen therapy, natural local chelators such as chlorella, air filtering and barrier protection. She knows that the single largest exposures to mercury from dental fillings is upon placement and removal, and considers protection from exposure to be high priority along with patient comfort and material selection and placement.
Dr. Copeland does not use any mercury, amalgam, or silver filling materials, and follows a strict protocol during their removal. Mercury is a known neurotoxin, and is the largest component of amalgam(silver fillings). Amalgam is not bonded to the tooth structure, so requires a natural (or dentist made) undercut of the tooth structure to stay locked in the tooth. The expansion and contraction of amalgam cause tooth structure to fracture. Some amalgam formulations have a physical property known as creep describing how the material changes shape subtly over time. Amalgam is a metal composite which along with the saliva, completes the circuitry for a simple battery, producing small but significants amount of electricity in the close vicinity of the most important electrically run organ of the body – the human brain. Last, but perhaps least, it is less attractive than alternative materials which are tooth colored.
Are an effective, important part of being a responsible dental practitioner and community member. Mercury from “silver fillings” in teeth goes into our community waste water lines from dental offices who place or remove “silver” amalgam fillings.Mercury is the most toxic non radiation emitting metal. Much more toxic than arsenic or lead. A molecule of mercury is rated LD100 – at it’s lowest level it is expected to kill 100% of test animals under equal conditions.Baywise.org of San Francisco sties that 52% of mercury reaching waste water treatment plants is from dental offices. Waste water treatment facilities are not designed to remove heavy metal such as mercury and silver. Amalgam separators are mandatory for dental offices in some communities – San Francisco, Seattle, Milwaukee, and Wichita for example.An amalgam separator in a device placed within the plumbing system of a dental office which captures mercury and other heavy metals produced by dental procedures tightly within, eliminating their passage into the the waste water lines outside of the dental office. The separator units, when full, are sent sealed to recovery facilities who extract the mercury and recycle it instead of discarding it as hazardous waste refuse.
Our office mercury separator, is above 95% efficient. We are the only office in Santa Barbara using a separator, that we are aware of. I consider my separator as an essential part of my practice, like sterilizing instrumentation, and the use of ozone and recycling. Each is a part of the whole protecting patients and staff. The separator allows our office to responsibly protect the community of Santa Barbara as well.
Biocompatibilty testing determines which dental materials such as fillings, crowns, implants, denture plastics, are least likely to react negatively with a client’s immune system. As any dental material is a foreign object, it has the potential to cause an inflammatory or immune reaction. Dr Copeland uses only those materials which consistently have the highest level of biocompatibility based on numerous actual client testing results. For clients wanting to ensure their own results, personalized testing is the best option.
How is the testing accomplished?
- Obtain prescription from the Dr for blood serum collection from a local laboratory
- Obtain a testing kit from our office or directly from BiocompLabs in Colorado
- Take the frozen testing kit to the local collection laboratory on a Mon or Tuesday
- Send the serum sample to BiocompLabs using the provided FEDEXenvelopeWhat is the cost of testing?
- about $50 for the serum draw, $275 for the biocomp testing, $35-55 for interpretation
Dr Copeland then interprets the test results to determine which biocompatible materials are appropriate for use based on the clients dental needs. The process takes about 2 weeks from serum draw to final interpretation.
Is the proper term for the common term of tooth decay. It is an infection of the living dentin of the tooth by Streptococcus mutans and Lactobacillus bacteria.It begins with the breakdown of the enamel by acids which destroy it’s crystal structure. Acids are the waste products of decomposing debris and bacteria in between and, in the crevasses of teeth.Unless stopped, the destruction progresses through the second (dentin) layer, and finally to the third (pulp) layer. Though common, dental caries is entirely preventable. Proper acid balance of the saliva helps to repair the tooth surface through remineralization.Treatment of caries ranges from assisting remineralization to removing the infected portion of the tooth and restoring the tooth to proper shape and function with an appropriate filling material.
It is important to determine the reasons for the infection, and remove the hiding places of the infection in order to keep from infecting the other teeth in the oral cavity. Proper use of ozone can stop dental caries and reduce the amount of tooth removal prior to filling. Keeping the tooth intact and eliminating infection are the goal of treating dental caries at Whole Health Dentistry.
Replacing ions removed by a highly acidic environment thereby healing the surface of the tooth of the unhealthy patient. This can occur naturally as with a change in the body chemistry through diet and/or with the help of remineralization agents such as MI paste. Can be used in place of fillings in shallow “cavities” if used along with disinfection(ozone), to reduce sensitivity of exposed root surfaces and prevention therapy during periods of susceptibility(orthodontic braces, illness, pregnancy, high stress, non-brushing children and elderly adults)
The uptake of minerals by the tooth surface resulting in repair. Saliva is the buffering liquid with free minerals which does this naturally. Perfect saliva alone is can not overcome the stresses of untreated tooth decay, food debris, poor hygiene, deficient diet, low systemic pH, poor saliva, dry mouth, mouth breathing, silver fillings, metal restorations and failing fillings or crowns.
Are growths in the mouth that continue to grow when they should not. They can be fast growing or not, left untreated they can invade other parts of the body. If removed late, they may lead to scarring and sometimes disfigurement.They are too often detected when they require more aggressive attention and are vastly more disturbing to deal with. Whether a dyed in the wool traditionalist or alternative therapy advocate, prevention and early detection are still the best methods to combat oral and other forms of cancer. Dr Copeland follows a rigorous, routine cancer exam policy to help detect oral cancers early. Prevention includes responsible use of radiography (x rays) and identification of risks such as, alcohol, tobacco and chemical use.An oral cancer exam is a part of the initial and subsequent periodic exam. It is both a visual and tactile exam. Brief look in the mouth is not enough to visualize the common areas oral cancer are found.It used to be that men far outnumbered the ladies, and that the older segments of the population far outnumber those under 50. The gap is now narrowing and fast. The fastest growing group of persons with oral cancer are the nonsmokers under the age of 50!
Risks that we associate with an increase of oral cancer include the old standbys tobacco and alcohol, which are considered “lifestyle” factors and physical factors such as exposure to ultraviolet radiation.
Another physical factor is exposure to x-rays. Radiographs regularly taken during examinations, and at the dental office, are safe, but remember that radiation exposure is accumulative over a lifetime. It has been implicated in several head and neck cancers. We recognize both the great diagnostic tool that radiographs provide, and the need to weigh the risk/benefit of repeated exposure. Dr Copeland judiciously recommends radiographs as necessary.
According to the Oral Cancer Foundation, one of the real dangers of oral cancer, is that in its early stages, it can go unnoticed. It can be painless, and little in the way of physical changes may be obvious. The good news is however, that your dentist or doctor can, in most cases, see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages. Because there are so many benign tissue changes that occur normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change, it is important to have any sore or discolored area of your mouth, which does not heal within 14 days, looked at by a professional. The only way to know for sure if it is something dangerous, is to do a biopsy of the area.
Any changes in salivary flow, difficulty in swallowing, mouth sores (painful or not) which do not resolve, areas of repeated trauma, patches of white, red, or both, should not wait till your next dental exam. Please avoid second guessing, by reserving an appointment for Dr. Copeland to examine the area. We make every effort see you quickly and efficiently.
Are a hard plastic device worn on the upper teeth, that provide a comfortable and free position for the lower teeth and jaw to rest. They are sometimes called nightguards as they are most often worn at night, though they don’t have to be.Orthotics can save tooth structure by alleviating the affects of grinding and clenching, diminishing muscle pain and fatigue of the head, neck and face. They can soothe painful jaw joints by providing them with a best position for better health through better sleep.
Nightguards are an important tool to plan fixing the bite surfaces of the back teeth. In all instances, they have the ability to improve the health beyond the mouth.Some reasons Dr Copeland may recommend a nightguard (orthotic) include:
- Jaw pain or symptoms that may or may not be painful -to protect the jaw joints
- Irregular tooth wear because of a poor bite
- Poor natural bite that was never corrected
- Poor unnatural bite due to dental work done over a period of time that no longer “works together”
- To help determine a bite problem before planning dental work of the back teeth
- To prevent wear of the teeth for a person who has a joint in good position, but still grinds out of “habit”
- by the way, sleep studies indicate that we produce typically 10 times more pressure on our teeth/jaws while sleeping than awake!
- To protect cosmetic restorations of resin, porcelain, zirconium or glass
Nightguards are prescribed most commonly for jaw joint issues (TMJ or TMD), tooth pain or wear, and to diagnose occlusal (bite) issues prior to restoring the chewing surfaces of back teeth. For all of these reasons, the term orthotic is especially appropriate here, and must meet very specific criteria
To accomplish this takes study, understanding and expertise by the practitioner. Dr Copeland in addition to her residency and clinical experience has completed a 2 year course of study on occlusal (bite) and joints issues at FACE with Dr Tom Basta, Dr Jerry Preiner, and Jeff Brucia.
If you experience bruxing, grinding, jaw pain, muscle soreness especially in the morning. Or if you notice that your teeth are experiencing uneven wear, Dr recommends and initial exam to determine whether a nightguard or orthotic is beneficial.
When a tooth becomes infected, but has enough remaining structure to restore, root canal therapy may be an option. It is not a recommended option for everyone.During therapy the nerve and blood supply of the tooth are removed from the intricate canals of the roots. Sodium Hypochlorite is used traditionally to disinfect and clean the canals which are then filled with a natural latex material called gutta percha.The tooth is finally reinforced with a restoration. Root canal therapy was seen at one time to be the best alternative to keeping a tooth.The improvement of dental implants, data on the disinfection and filling material, and what occurs within the tooth and surrounding area after therapy has placed this therapy on some notice.
Concerns are adequate removal of living tissue and complete disinfection. Root canals have been discovered to contribute to blockage of the energy meridians affecting the associated organs.
Lasers are being increasing used in the living tissue removal and disinfection, but can only travel in straight lines, and root canals are never straight. Whole Health Dentistry opts for disinfection with ozone gas, which knows no barriers due to it’s small molecular size, is microcidal properties, non-chemical, and tissue healing enhancing.
Immune reaction has been known to seen toward both gutta percha due to it’s organic compounds, and to MTA (mineral trioxide aggregate) due to it’s aluminum content.
When root canal therapy is selected as the option of choice, it should only be done by a highly qualified specialist known as an endodontist. Patients may choose ozone therapy midvisit to enhance the long term prognosis the area.
Is a complex and necessary fluid essential to good oral health.. Low saliva flow is called xerostomia, and is a common side effect of many prescription drugs. Clients with xerostomia have difficulty eating, swallowing and a greater risk of tooth decay, dental erosion, mouth sores, and bad breath.Saliva lubricates the tissues of the mouth. It contains minerals that repair the tooth surface constantly and enzymes help produce antibodies that prevent gingivitis. Saliva is far more important than any toothpaste or oral rinse. Saliva’s ability to do repair is determined by how acidic it is and what ions are available. Monitoring acidity is a good way to determine one’s susceptibility to disease which we perform routinely. It is often overlooked in the traditional dental office.High acidity can be an indication of systemic imbalance (dysbiosis), gastroesophageal reflux disease (GORD), gum disease and gingivitis, dehydration, a high number of oral pathogens in addition to having active tooth decay . As with all things, when we connect the dots and discover the root cause of things, we can also enhance our overall wellness.Consider the client who presents with bad breath, 3 cavities, and a highly acidic saliva. This client had his medications changed 4 months ago, He also noticed that he was getting a lot more canker sores recently, and his mouth felt a little drier. A change in this client’s med by his primary care physician improved everything.
Preventive intervention of cleanings with ozonated water to remove the pathogens that had overgrown due to the high acidity, and remineralization therapy prevents further tooth decay, gum disease and bad breath and even tooth infections and loss, not to mention the expense of more dental fillings.
MD’s are unlikely to look at teeth and saliva and make these connections. This is why we take an extensive health history which also includes important lifestyle questions like diet, water intake and exercise and changes in habits.
Along with a genuine smile, light shaded teeth contribute the most to attractiveness, and practically gushes well being. Tooth whitening consists of removing hard deposits, polishing away surface stains and the use of carbamide peroxide or hydrogen peroxide gels to lighten discolorations deep into the enamel.Although bleaching is perceived by some as too aggressive, it remains the most conservative method to improve a smile.Natural teeth without restorations lighten most effectively. Because old composite restorations do not lighten, they should be replaced after enamel lightening to ensure a shade match. Dr Copeland prefers using custom made trays and gel lightening which is done at home and monitored. There are several reasons:-the sensitivity that may accompany lightening can be self monitored
- the lightening endpoint can be self monitored to avoiding an over-bleached look
- the trays may be reused for future touch ups at will, reduced the overall cost
Enamel shades lighten differently. Like pearls enamel has various natural “casts” such as yellow, ochre, pink and blue. Yellow shades respond the best whether using over the counter, home remedy or professional lightening from our office.
Those clients experiencing heavy spot discoloration or tetracycline (antibiotic stain) staining may get best results with light microabrasion, or “spot” composites.
In some instances a client feels certain they would like veneers(see veneers). Lightening is always a first step in planning veneers as they are so thin that the tooth color shows right though. Sometimes the results are so good with lightening alone that veneers are not needed. The goal should always be to conserve and minimally restore to obtain the optimal esthetic result.