Discolored Teeth

Many different factors can cause discolored teeth.  The change in color may affect the entire tooth, or just appear as spots or lines in the tooth enamel.  Your genes influence your tooth color. Other factors that can affect tooth color include:

• Congenital diseases
• Environmental factors
• Infections

Inherited diseases may affect the thickness of enamel or the calcium or protein content of the enamel, which can cause color changes. Metabolic diseases may cause changes in tooth color and shape.
Drugs and medications either taken by the mother while pregnant or by the child during the time of tooth development can cause changes in both the color and hardness of the enamel. Common causes of discolored teeth are:

• Antibiotic tetracycline use before age 8
• Eating or drinking items that temporarily stain the teeth, such as tea or coffee
• Genetic defects that affect the tooth enamel, such as dentinogenesis and amelogenesis
• High fever at an age when teeth are forming
• Poor oral hygiene
• Porphyria
• Severe neonatal jaundice
• Too much fluoride from environmental sources (natural high water fluoride levels) or overuse of fluoride rinses, toothpaste, and fluoride supplements

If you have discolored teeth or are unhappy with your smile, contact Scottsdale dentist Dr. James B. Miller at (480) 451-5435.  Dr. Miller can evaluate the discoloration, determine the cause and offer treatment options.

CEREC Crowns - Dr. James Miller, Scottsdale, AZ

CEREC Crowns.  Most dental restorative methods require more than one visit to the dentist. This means that on the first visit, you get an injection of anesthesia, your tooth prepared, an impression taken, and a temporary restoration put on your tooth. You make a second appointment for a couple of weeks later, get another injection, have the temporary pried off, and have a permanent restoration put on. Why go to the dentist a second time when you don't have to? With CEREC, the procedure is done in a single appointment, start to finish. Call our office to learn more and to schedule an appointment. 

BEFORE CEREC

AFTER CEREC

ZOOM! Teeth Whitening Promotion for the Holidays!

Give the gift of a whiter smile this holiday season!  ZOOM! Whitening $250.00!!  

Gift Certificates are available. Contact our office and we can have your gift certificate ready for pick-up or mailed for you!  (480) 451-5435

Happy Holidays from the dental practice of Dr. James B. Miller!

*Promotion through December 31st, 2013*

Dry Mouth (Xerostomia)



 

Dry Mouth, or Xerostomia, is a condition in which your body produces less saliva and can be caused by a variety of reasons:   side effect of certain medications, diseases or infections, certain medical treatments (such as radiation) and dehydration.  Dry mouth can increase a person's risk of developing gingivitis, gum disease, tooth decay and mouth infections such as thrush.  If you are experiencing dry mouth, be sure to talk with Dr. James B. Miller at your next dental visit or schedule an appointment to discuss your possible treatment options. 

 

James B. Miller, D.M.D.

9821 N. 95th Street, Suite 110

Scottsdale, AZ  85258

Office: (480) 451-5435 

Website: www.DrJamesMiller.com

Invisalign Teeth Straightening

Are you embarrassed to smile because of your crooked teeth? Have you avoided braces because of the unsightly metal brackets and wires? Great news, Invisalign can straighten your teeth without the unsightly metal. 

A series of clear "aligners" are carefully made using state-of-the-art CAD/CAM software that allows us to control how to straighten your teeth. Then clear aligners are made to those exact specifications. The result, straight teeth and no metal!

"I didn't like smiling because of my crooked teeth. I love the way my teeth look after Invisalign and I can't stop smiling!" --Stephany B., Phoenix, AZ

For more information on Invisalign teeth straightening, or to schedule a consultation, please contact the office of Dr. James B. Miller at (480) 451-5435.

    #clearbraces #orthodontics #straightteeth #invisiblebraces

Dr. James Miller is Offering a Special $250.00 Zoom! Whitening Promo for the Holidays! (thru 12/31/13)

November is National Diabetes Month

DIABETES AND PERIODONTAL DISEASE

Diabetic patients are more likely to develop periodontal disease, which in turn can increase blood sugar and diabetic complications.

People with diabetes are more likely to have periodontal disease than people without diabetes, probably because people with diabetes are more susceptible to contracting infections. In fact, periodontal disease is often considered a complication of diabetes. Those people who don't have their diabetes under control are especially at risk.

Research has suggested that the relationship between diabetes and periodontal disease goes both ways - periodontal disease may make it more difficult for people who have diabetes to control their blood sugar.

Severe periodontal disease can increase blood sugar, contributing to increased periods of time when the body functions with a high blood sugar. This puts people with diabetes at increased risk for diabetic complications. perio.org

If you have diabetes, be sure to schedule regular appointments with your dentist and well as your physician.  If you'd like more information or would like to schedule an appointment in our office, please call Dr. James B. Miller at (480) 451-5435.  We look forward to meeting you.

Improving Gum Health May Reduce Heart Risk

Researchers at Columbia University in New York suggest that if you look after your gums, you could also be reducing your risk of heart disease. They claim that improving dental care slows the speed with which plaque builds up in the arteries.

Writing in a recent online issue of the Journal of the American Heart Association, they report a prospective study that shows how improving gum health is linked to a clinically significant slower progression of atherosclerosis, the process where plaque builds up in arteries and increases a person's risk of heart disease and stroke death.

Lead author Moïse Desvarieux, associate professor of Epidemiology at Columbia's Mailman School of Health, says:

"These results are important because atherosclerosis progressed in parallel with both clinical periodontal disease and the bacterial profiles in the gums. This is the most direct evidence yet that modifying the periodontal bacterial profile could play a role in preventing or slowing both diseases."

For their study, the researchers followed 420 adults aged between 60 and 76 from northern Manhattan who were taking part in the Oral Infections and Vascular Disease Epidemiology Study (INVEST).

Measuring Artery Thickness

All participants underwent oral infection and artery thickness exams at the start of the study and at the end of follow-up, which was a median of 3 years.

The oral infection exams retrieved a total of over 5,000 plaque samples. For each participant, the samples came from several teeth and under the gums.

The oral plaque samples were analyzed for the presence of 11 strains of bacteria known to be involved in periodontal disease and seven control bacteria.

Samples of fluid from around the gums were also taken and assessed for levels of Interleukin-1β, a marker of inflammation.

The extent of atherosclerosis, was assessed using high-resolution ultrasound scans to measure artery thickness or intima-medial thickness (IMT) in both carotid arteries.

The results showed that both improved gum health and a reduction in the proportion of bacteria linked to periodontal disease correlated to a slower progression of atherosclerosis, as measured by IMT.

These results did not change significantly when adjusted for factors that could influence them, such as body mass index, cholesterol levels, diabetes and smoking.

Previous studies have linked an increase in carotid IMT of 0.033 mm per year (about 0.1 mm over 3 years), to a more than double increase in risk of heart attack and stroke.

In this study, the participants whose gum health got worse over the 3 years showed a 0.1 mm increase in carotid IMT, compared with the participants whose gum health improved.

Co-author Panos N. Papapanou, professor at Columbia's College of Dental Medicine, says:

"Our results show a clear relationship between what is happening in the mouth and thickening of the carotid artery, even before the onset of full-fledged periodontal disease. This suggests that incipient periodontal disease should not be ignored."

Atherosclerosis and Periodontal Infections

Although the researchers did not look into how bacteria in the mouth can lead to atherosclerosis, one theory suggested by animal studies is they increase inflammatory markers, which can trigger or worsen the inflammation in atherosclerosis.

In a previous study that took measures at one point in time, the team had already found that higher levels of disease-causing bacteria were linked to thicker carotid IMT. This new study builds on those results by looking at the participants over time.

Prof. Desvarieux adds:

"It is critical that we continue to follow these patients to see if the relationship between periodontal infections and atherosclerosis carries over to clinical events like heart attack and stroke and test if modifying the periodontal flora will slow the progression of atherosclerosis."

Funds from the National Institutes of Health (NIH), the National Institute of Neurological Disorders and Stroke (NINDS), the Institut National de la Santé et de la Recherche Medicale (INSERM), among others, helped finance the study.

In 2010, UK researchers reported that gum bacteria can increase risk of heart attack and heart disease, because the same bacteria that cause dental plaque can escape from the mouth into the bloodstream and trigger clots.

medicalnewstoday.com

Tooth Anatomy

What Are the Different Parts of a Tooth?

Crown— The top part of the tooth, and the only part you can normally see. The shape of the crown determines the tooth's function. For example, front teeth are sharp and chisel-shaped for cutting, while molars have flat surfaces for grinding.

Gumline— Where the tooth and the gums meet. Without proper brushing and flossing, plaque and tartar can build up at the gumline, leading to gingivitis and gum disease.

Root— The part of the tooth that is embedded in bone. The root makes up about two-thirds of the tooth and holds the tooth in place.

Enamel— The outermost layer of the tooth. Enamel is the hardest, most mineralized tissue in the body — yet it can be damaged by decay if teeth are not cared for properly.

Dentin— The layer of the tooth under the enamel. If decay is able to progress its way through the enamel, it next attacks the dentin — where millions of tiny tubes lead directly to the dental pulp.

Pulp— The soft tissue found in the center of all teeth, where the nerve tissue and blood vessels are. If tooth decay reaches the pulp, you usually feel pain.

What Are the Different Types of Teeth?

Every tooth has a specific job or function (use the dental arch in this section to locate and identify each type of tooth):

Incisors— The sharp, chisel-shaped front teeth (four upper, four lower) used for cutting food.

Canines— Sometimes called cuspids, these teeth are shaped like points (cusps) and are used for tearing food.

Premolars— These teeth have two pointed cusps on their biting surface and are sometimes referred to as bicuspids. The premolars are for crushing and tearing.

Molars— Used for grinding, these teeth have several cusps on the biting surface.

Arthritis Sufferers May Find Some Relief in Periodontal Therapy

It may seem strange how some diseases are linked, but as more and more research is done, we find those links do exist. Take rheumatoid arthritis, an autoimmune disease. 
Symptoms include pain, swollen joints and stiffness. Several studies examining the relationship between rheumatoid arthritis and periodontal disease have been made in the past ten years. Perhaps the strongest statement made by any of the studies was from Australia and reported in the Journal of Periodontology, "The results of this study provide further evidence of a significant association between periodontitis and rheumatoid arthritis." The researchers measured for periodontitis using probing depths, attachment loss, bleeding scores, plaque scores, and radiographic bone loss scores. Their measurements for rheumatoid arthritis included tender joint analysis, swollen joint analysis, and pain index, physician's global assessment on a visual analogue scale, health assessment questionnaire, levels of C - reactive protein (CRP), and erythrocyte sedimentation rate.

In both diseases, the inflammation destroys the soft and hard tissue. The inflammation is caused by the toxins from bacterial infection. Even historically, some treatments for arthritis were to pull teeth or give antibiotics to the patient to relieve their arthritic pain. Once the inflammation from their teeth was controlled, the patients got better. More recently, two studies in 2012 found that the fewer the teeth and individual had, the more severe the arthritis. Out of a normal 32 teeth, those with fewer than 20 teeth were eight times more likely to have swollen joints.

As with periodontal disease and other systemic diseases, rheumatoid arthritis is a chronic inflammatory disease. Chronic infection shows up in the blood by increased levels of CRP. One inflammatory disease that produces high levels of CRP exacerbates the other. And this is also true with arthritis. And those with rheumatoid arthritis tend to have more periodontal disease. Treating the periodontal disease often gives relief to the arthritis. And treating the arthritis with antibiotics often improves the gum disease. More studies are being conducted to ascertain more quantitative data on the association between the two diseases. The once thought of as myth, is slowly being proven as fact, that periodontal disease impacts total health.

The issue is more complex than just stating that arthritis causes periodontal disease or that periodontal disease causes arthritis. However, it is evident that there is a link. And more importantly, providing the best oral care possible and getting periodontal therapy if you have the disease, will also positively impact your arthritis and potentially reduce your pain.

Dr. Piero, a Holland, MI dentist for over thirty years, is the inventor of Dental Air Force® (http://www.dentalairforce.com). Articles published are on periodontal health related to heart disease, respiratory health, diabetes, strokes, and other systemic diseases. He is the Executive Editor for Journal of Experimental Dental Science, a contributing author to Hospital Infection Control: Clinical Guidelines and soon-to-be published book, Put Your Money Where Your Mouth Is.

1888pressrelease.com

Implant Supported Dentures

An implant-supported denture is a type of "overdenture" that is supported by and attached to implants. A regular denture rests on the gums, and is not supported by implants.

An implant-supported denture is used when a person doesn't have any teeth in the jaw, but has enough bone in the jaw to support implants. An implant-supported denture has special attachments that snap onto attachments on the implants.

Implant-supported dentures usually are made for the lower jaw because regular dentures tend to be less stable there. Usually, a regular denture made to fit an upper jaw is quite stable on its own and doesn't need the extra support offered by implants. However, you can receive an implant-supported denture in either the upper or lower jaw.

You should remove an implant-supported denture daily to clean the denture and gum area. Just as with regular dentures, you should not sleep with the implant-supported dentures at night. Some people prefer to have fixed (permanent) crown and bridgework in their mouths that can't be removed. Your dentist will consider your particular needs and preferences when suggesting fixed or removable options.

How Does It Work?

There are two types of implant-supported dentures: bar-retained and ball-retained. In both cases, the denture will be made of an acrylic base that will look like gums.  Porcelain or acrylic teeth that look like natural teeth are attached to the base. Both types of dentures need at least two implants for support.

• Bar-retained dentures — A thin metal bar that follows the curve of your jaw is attached to two to five implants that have been placed in your jawbone. Clips or other types of attachments are fitted to the bar, the denture or both. The denture fits over the bar and is securely clipped into place by the attachments. 

• Ball-retained dentures (stud-attachment dentures) — Each implant in the jawbone holds a metal attachment that fits into another attachment on the denture. In most cases, the attachments on the implants are ball-shaped ("male" attachments), and they fit into sockets ("female" attachments) on the denture. In some cases, the denture holds the male attachments and the implants hold the female ones.

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(480) 451-5435

Office of Dr. James B. Miller - 
Offering Oral DNA Testing (Salivary DNA Testing) 

Our office is pleased to announce the availability of 3 laboratory tests relating to oral health. We think that some of our patients may benefit from these tests, but they are usually not covered by your insurance. Therefore, we will only perform them at your request. So, it’s important for you to understand the tests and their related conditions.

One of the conditions is gum disease, which can result in loss of your teeth. Bacteria and inflammation cause gum disease. More than 50% of Americans have gum disease. The other condition is oral cancer. Oral cancer can be caused by infection with a virus called HPV and by tobacco and alcohol use. HPV-related oral cancer occurs most often in people who don’t smoke or drink very much. A different kind of oral cancer occurs in smokers who drink a lot. About 36,000 Americans get oral cancer every year.

The MyPerioID^Ò PST^Ò test can tell if you have specific changes in your DNA. These changes might mean that you have a greater risk of getting gum disease.

The MyPerioPath^Ò test is for patients who actually have gum disease. It finds out which bacteria are triggering the gum disease. Once we know which bacteria are in your mouth and at what amount, we can come up with a treatment plan that’s right for you. For example, this information can help us select the right antibiotic for you. We highly recommend this test if you have gum disease that has not responded to previous treatment.

The OraRisk^Ò HPV test can tell if you have an HPV infection in your mouth. If you do, you might have a greater risk of getting HPV-related oral cancer. Like most cancers, it’s important to detect oral cancer early. If we know you have an HPV infection, we can watch you very closely for signs of oral cancer. We suggest you consider having this test if you are a non-smoker and don’t drink a lot.

All 3 of these tests are performed using a saliva sample, which is collected in our office. The sample is easy and fast to collect. Simply swish a sterile saline (salt) solution in your mouth and spit it into a container. The sample is then sent out for testing.

When the results come back, Dr. Miller will tell you what your results are and what they mean to your oral health.

If you are interested in Oral DNA testing, please contact our office at (480) 451-5435 for more information or to schedule an appointment.

Periodontal Disease and Heart Disease

The biggest problem with the American Heart Association's report is that it is based on previous studies over the last 60 years that do not have a uniform definition of Periodontal Disease. Let's remember that Periodontal Disease has been defined the same way for over 50 years: a simple observational, just looking at it, measuring with a probe that is often misread. But actually we now are assessing this subject in regards to "oral inflammation, genetic variability, verified testing, and microbial burden," none of which were taken into account in the studies used in the discussion. 

For example I will use my own health situation: I have no traditional signs of Periodontal Disease: no pocketing, no bleeding. I'm a dentist and a son of a dentist. And yet I test Il-1 positive, meaning that I am a hyper-responder to oral inflammation. And, even though I do not present with a traditional observational view of Periodontal Disease, I had a microbial burden that is associated with oral inflammation and systemic disease. Also, I'm physically active, have a reasonable diet, healthy weight, and have controlled cholesterol numbers. I should be in the less than 50% risk for Cardiovascular disease....and yet I have a buildup of plaque in my carotid. I "had" elevated Lp-PLA2 (a huge marker and player in Cardiovascular Disease) and was at large risk for a Heart Attack and/or Stroke in the near future. In the studies reviewed by the American Heart Association, I would have been missed because they were not looking for anything but a "simple traditional observational view of Periodontal Disease" rather than the advanced tests that more advanced healthcare providers are incorporating, including leading healthcare facilities of the world. 

So if we use the old way of evaluating Periodontal Disease, we are not addressing what the leading preventive cardiology approaches are suggesting. 

Also, the American Heart Association's recent report states that upon reviewing the past 60 years of research there is no definitive proof that a traditional view of Periodontal Disease is THE Cause of Heart Disease. They say that larger prospective studies are needed to prove causality. They are correct. These studies are extremely expensive and will not be able to prove causality in my lifetime. With that said, they fail to emphasize that no study
disproves the theory that oral disease is one of the many causes of vascular disease. The American Heart Association acknowledges that there is an association between oral disease and systemic disease. They even acknowledge that treatment of periodontal disease reduces systemic inflammation and endothelial dysfunction, both known risk factors for cardiovascular disease. 

In my opinion and in the opinion of many of the Physicians involved with preventive cardiology, the AHA is irresponsible by making a statement that deceptively leads people to believe that oral disease does not contribute to vascular disease. Although Cause has not been proven, there is strong evidence to suggest that certain high risk bacteria may be an under-identified cause of heart attacks, strokes, and progression of atherosclerosis. 

I applaud the American Heart Association for their noting that "oral health is important for overall health." And I formally thank the American Heart Association for their extensive literature review which confirms our recognition of the oral/systemic association. According to Bale/Doneen, the nation's leading preventive cardiology educators, "We believe that a strong association of periodontal disease and vascular disease exists with the trend for reduced systemic inflammation and improved endothelial health when effective periodontal therapy is achieved. We also recommend that the evaluation and treatment of periodontal disease along with appropriate medical care be included in any strategy for the prevention of cardiovascular disease. Both the medical and dental communities should realize that there are positive health benefits when both fields of medicine work in harmony for the prevention of atherosclerotic vascular disease." 

Dr. Dan Sindelar Director, Foundation for Oral Systemic Health 
Co-founder, American Academy for Oral Systemic Health