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

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

The Psychological Issues of Poor Dental Care

Having bad teeth can bring with it a lot of psychological issues, such as insecurities and lack of self esteem. Can repairing your teeth improve your mental health as well? The answer seems to be a resounding “yes.”

Your Mouth and Your Body

For years, medical professionals have warned that poor dental health can affect your overall physical health. They have established links between poorly-maintained teeth and heart problems, as bacteria from your mouth can slip into your bloodstream. They have also uncovered links between gum disease and pregnancy complications, like premature birth. Immune system disorders are another common concern for people with oral health problems.

Researchers have even started to explore how poor dental health can affect the brain. The Columbia College of Physicians and Surgeons in New York discovered that there may be a link between bad teeth and cognition ailments. In their study, elderly people who suffered from gum disease performed worse on memory tests than those without gum trouble. That same group also struggled more than the rest with subtraction tests.

Your Mouth and Your Mind

Beyond physical problems, having bad teeth can cause psychological issues. After all, your mouth is usually a point of focus when socializing, whether you are talking, flashing a smile, or twisting a scowl. Given the mouth’s importance, it makes sense why feeling self-conscious about your teeth can be especially damaging. Here are some ways bad teeth can trigger psychological issues.

• 
  
• Anxiety, Especially when Socializing:

If you’re self conscious about one of your most important communication tools, it can ravage your ability to socialize comfortably. People who think they have bad teeth may want to avoid doing anything to expose them, which can start an unhealthy cycle of self-monitoring and criticism. It impedes a person’s ability to speak clearly, and it eliminates one of the most effective nonverbal ways to strike up rapport: cracking a genuine smile.

• 
  
• Low Self-Esteem:

Confidence stems from feeling good about yourself. If you are always worried about your teeth, it is difficult to feel confident, and that can seriously strip away at your self esteem. Having bad teeth can also trigger self esteem issues that extend beyond how others think; in some cases, people begin to feel guilty about the state of their teeth, engaging in a lot of self criticism about their ineffective oral hygiene habits, which can exacerbate issues about self image.

• 
  
• Depression:

Anxiety, poor social experiences, low self esteem, and guilt are a recipe for depression. Not only can they all contribute to isolation, which comes with its own share of problems, but they establish a psychological state that is both self-loathing and reluctant to engage with the world. While not everyone will experience all those symptoms, those who do could sink into deep depression unless they get help.

Studies from different countries in Europe suggest that poor dental care and psychological issues can develop into a vicious cycle. Those with high self esteem tend to take better care of their teeth, and the resulting bright smiles contribute right back to the high self esteem they hold. On the other hand, people with low self esteem tend to brush less often, and then the poor state of their teeth can make them feel even worse.

That means it is important to get serious about dental care. Not only does commitment to oral hygiene contribute to better physical health, it seems to significantly influence mental health, too.

publichealthbugle.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.

Chewing Gum Improves Concentration

Chewing a piece of sugarless gum after lunch can not only help you protect your dental health, but also help focus to avoid that afternoon slump in productivity, according to researchers at Cardiff University in Wales.

 

The study, published in the British Journal of Psychology, evaluated the concentration of 38 participants who were given a short-term audio memory test.  Half the participants were instructed to chew gum during the 30-minute test. All of them listened to a list of numbers from 1-9 being read in random order and were scored on how accurately and quickly they were able to detect a sequence of odd-even-odd numbers. Participants also completed questionnaires on their mood before and after the test.  Researchers found that participants who chewed gum had quicker reaction times and more accurate results, especially during the later part of the test.  “It’s been well established by previous research that chewing gum can benefit some areas of cognition,” said Kate Morgan, the study’s lead author.” In our study we focused on an audio task that involved short-term memory recall to see if chewing gum would improve concentration; especially in the latter stages of the task.Interestingly, participants who didn’t chew gum performed slightly better at the beginning of the task but were overtaken by the end. This suggests that chewing gum helps us focus on tasks that require continuous monitoring over a longer amount of time.”

 

According to MouthHealthy.org, the ADA’s consumer website,clinical studies have shown that chewing sugarless gum for 20 minutes following meals can help prevent tooth decay.

Chewing sugarless gum increases the flow of saliva, which washes away food and other debris, neutralizes acids produced by bacteria in the mouth and provides disease-fighting substances throughout the mouth. Increased saliva flow also carries with it more calcium and phosphate to help strengthen tooth enamel.

 

Only sugarless gums have the ADA Seal, and are sweetened by non-cavity causing sweeteners such as aspartame, xylitol, sorbitol or mannitol. Of course, chewing sugar-containing gum increases saliva flow too, but it also contains sugar, which is used by plaque bacteria to produce decay-causing acids. Further research needs to be done to determine the effects of chewing sugar-containing gum on tooth decay.

 

Don’t let chewing sugarless gum replace brushing and flossing. It’s not a substitute. The ADA still recommends brushing twice a day with fluoride toothpaste and cleaning plaque from between your teeth once a day with dental floss or other interdental cleaners.

Look for chewing gum that carries the ADA Seal. The ADA Seal is your assurance that the sugar-free chewing gum has met the ADA criteria for safety and effectiveness. You can trust that claims made on packaging and labeling for ADA-accepted products are true, because companies must verify all of the information to the ADA.

 

*Visit MouthHealthy.org to see and compare a list of sugar-free chewing gums that have the ADA Seal.*

Tooth Decay: The Primary Cause of a Toothache

Tooth decay is the primary cause of toothaches for most children and adults. Bacteria that live in your mouth thrive on the sugars and starches in the food you eat. These bacteria form a sticky plaque that clings to the surface of your teeth.

Acids produced by the bacteria in plaque can eat through the hard, white coating on the outside of your teeth (enamel), creating a cavity. The first sign of decay may be a sensation of pain when you eat something sweet, very cold or very hot. A toothache often indicates that your dentist will need to work on your teeth.

Self-care tips
Until you can see your dentist, try these self-care tips for a toothache:

• Rinse your mouth with warm water.
• Use dental floss to remove any food particles wedged between your teeth.
• Take an over-the-counter (OTC) pain reliever to dull the ache.
• Apply an OTC antiseptic containing benzocaine directly to the irritated tooth and gum to temporarily relieve pain. Benzocaine has been linked to a rare but serious, sometimes deadly, condition (methemoglobinemia) that decreases the amount of oxygen that the blood can carry. Don't use benzocaine in children younger than age 2 without supervision from a health care professional, because this age group has been the most affected. Never use more than the recommended dose of benzocaine. Direct application of oil of cloves (eugenol) also may help. Don't place aspirin or another painkiller directly against your gums, as it may burn your gum tissue.

Call your dentist

• When you have signs of infection, such as swelling, pain when you bite, red gums or a foul-tasting discharge
• If the pain persists for more than a day or two
• When you have fever with the toothache

mayoclinic.com

Humans May Evolve To Grow An Endless Supply Of Teeth

 

In the future, you--like the pufferfish--could have so many teeth that you'll wear necklaces made out of your spares. It'll be weird.

Friendly Pufferfish Wikimedia Commons

The pufferfish is a very curious animal for lots of reasons; it swallows air or water to make itself larger and more threatening, it combines its combining pectoral, dorsal, anal, and caudal fins into one set of fins (like a seahorse), and it is often super poisonous. But Dr. Gareth Fraser of Sheffield University is focused on the puffer for a different reason: its teeth.

The puffer, like lots of bony fish (meaning, not cartilaginous), constantly regrows its teeth. The puffer doesn't have delineated teeth like most other fish, though; instead, after its first set of teeth have fallen out (like human baby teeth), it grows a solid structure that looks like a beak. This beak is made of horizontally growing layers of dentite, the usual tooth material for fish, but appears as a single band.

Fraser managed to map the specific cells responsible for the constant regrowing of teeth in the puffer. That's of great interest to us, because humans, unlike lots of other animals, only grow two sets of teeth. Your baby teeth fall out, then you grow your adult teeth, and then...that's it. That's all you get. And that's less than ideal, as most any professional hockey player can tell you (through gaps in their teeth).

Interestingly, Dr. Fraser thinks humans may evolve, in millions of years, the ability to regrow teeth past that second set. "With our extended lives and modern diets, the limited supply of human teeth is really no longer fit for purpose," he said. By figuring out exactly how fish regrow teeth, he may be able to accelerate that process of evolution.

So play hockey without fear! A fix for your broken grill may be in the works.

By: Dan Nosowitz
July 12, 2013

Now Offering the Newest Teeth Whitening System with ZERO Sensitivity - GLO!

Receive $100.00 Off on GLO Dual!

Call our office to schedule your consultation.

(480) 451-5435

TYPES OF GUM DISEASE

Untreated periodontal disease can eventually lead to tooth loss and other health problems.

GINGIVITIS

Gingivitis is the mildest form of periodontal disease. It causes the gums to become red, swollen, and bleed easily. There is usually little or no discomfort at this stage. Gingivitis is often caused by inadequate oral hygiene. Gingivitis is reversible with professional treatment and good oral home care.

Factors that may contribute to gingivitis include, diabetes, smoking, aging, genetic predisposition, systemic diseases and conditions, stress, inadequate nutrition, puberty, hormonal fluctuations, pregnancy, substance abuse, HIV infection, and certain medication use.

PERIODONTITIS

Untreated gingivitis can advance to periodontitis. With time, plaque can spread and grow below the gum line. Toxins produced by the bacteria in plaque irritate the gums. The toxins stimulate a chronic inflammatory response in which the body in essence turns on itself, and the tissues and bone that support the teeth are broken down and destroyed. Gums separate from the teeth, forming pockets (spaces between the teeth and gums) that become infected. As the disease progresses, the pockets deepen and more gum tissue and bone are destroyed. Often, this destructive process has very mild symptoms. Eventually, teeth can become loose and may have to be removed.

There are many forms of periodontitis. The most common ones include the following.

• Aggressive periodontitis occurs in patients who are otherwise clinically healthy. Common features include rapid attachment loss and bone destruction and familial aggregation.
• Chronic periodontitis results in inflammation within the supporting tissues of the teeth, progressive attachment and bone loss. This is the most frequently occurring form of periodontitis and is characterized by pocket formation and/or recession of the gingiva. It is prevalent in adults, but can occur at any age. Progression of attachment loss usually occurs slowly, but periods of rapid progression can occur.
• Periodontitis as a manifestation of systemic diseases often begins at a young age. Systemic conditions such as heart disease, respiratory disease, and diabetes are associated with this form of periodontitis.
• Necrotizing periodontal disease is an infection characterized by necrosis of gingival tissues, periodontal ligament and alveolar bone. These lesions are most commonly observed in individuals with systemic conditions such as HIV infection, malnutrition and immunosuppression.

perio.org

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