Dr. Kim’s Blog

Joint replacement surgery is a commonly performed surgery today. Seven percent of all joint replacement surgeries are revision procedures, meaning the surgeries have to be repeated. More and more, joint infections are becoming recognized as being one of the complicating factors in joint surgery failures, and new information is pointing to the systemic spread of periodontal bacteria through the bloodstream. Physicians and surgeons should work closely with dentists and dental hygienists to certify that periodontal disease is dealt with prior to joint replacement surgery, and vice versa.

Anyone considering a joint replacement should plan on a visit to a qualified dentist, beforehand. If at all possible, they should make sure their mouth is free of gum disease before they schedule for that new hip or knee. Otherwise, there is a risk the new joint will become infected.

It is commonly accepted in medicine that bacteria and infection in the mouth does not remain in the mouth, but spreads throughout the entire body. With periodontal disease, the bacteria that cause the disease travel from the infected gums, through the bloodstream, to every tissue in the body. Not only is this bacteria linked to heart attack, stroke, high blood pressure, diabetes, Alzheimer’s, lung and kidney disease, cancers and other disease states, it is very dangerous for those undergoing surgical procedures. There is no place in the body that is protected from the invasion of aggressive and injurious periodontal bacteria.  Additionally, infection anywhere in the body compromises the entire immune system.

Joint disease currently affects more than 20 million people in the United States. More than 1 million total joint replacements are performed every year, according to the American Academy of Orthopedic Surgeons. With thousands of revision procedures performed, determining risk factors is prudent before surgeries are performed.  Deep infections of the joint replacements usually result in the failure of the new joint and create the need for extensive revisions, the AAOS says.

This concern is nothing new to medicine. In a 1994 article published in the British Medical Journal, Wirral University Teaching Hospital in Great Britain reported that the mouth was a principal source of bacterial infection in patients’ prosthetic joints.

When a joint surgery becomes infected, both patient and physician question, “Why?” Commonly, the surgical procedure went smoothly.  However, the patient feels warmth around the joint. There is continued pain and swelling with the joint remaining in a chronic state of infection. Oftentimes, retreatment is necessary.

Infection caused by dental disease, (typically periodontal infection), can be prevented if surgery is postponed until dental clearance is confirmed by a dentist skilled in a proper pre-surgical evaluation.

Without a comprehensive dental screening, there’s no way to confirm whether periodontal disease is present. In some people with very advanced levels of periodontal disease, the condition may be obvious—inflamed, bleeding gums tell the story. But even life-threatening levels of gum disease can remain an invisible health risk. Alarmingly, people with dental disease often have no symptoms until the disease is in its moderate to advanced stages. The effects of the bacterial infection are not necessarily visible on the outside of the gums, but hidden on the inside surface, adjacent to the root of the tooth. People typically have no idea they have the disease, yet it is rampant in our society.

Of all American adults, 75% have periodontal disease, according to the American Academy of Periodontology. A significant number of this population also seeks joint replacements. If current trends continue, 1.4 million knee replacements and nearly 600,000 hip replacements will be performed in 2015. By the year 2030, the total number of hip and knee replacements combined is expected to exceed 4 million, according to The Kaiser Permanente National Joint Replacement Registry.

The American Academy of Orthopedic Surgeons and the American Dental Association recommend that people requiring joint replacement surgery receive a dental clearance prior to joint replacement surgery. Dentists can and should provide in-depth diagnosis and treatment for patients who are preparing for or who have already received joint replacement surgery, and to provide a dental clearance prior to surgery.

In my experience, when the orthopedic surgeon is informed that our mutual patient has a serious level of periodontal disease, the surgeon is appreciative and always postpones the surgery, unless it is an emergency procedure.

Orthopedic surgeons typically follow the recommendations of the AAOP and have their patients take antibiotics prior to future dental appointments. It is important for anyone who has had joint replacement surgery to inform their dentist so he or she can collaborate with their physician on the appropriateness of antibiotic pre-medication prior to dental care.

By postponing joint replacement and seeking a dental examination and treatment first, individuals will have both a healthier mouth and improved recovery from joint surgery.  Since the body’s immune system is not compromised by dental infection, patients’ healing will be swifter, more uneventful and more predictable.  Most critically, their risk for serious joint infection is minimized, post-surgically.

According the National Coalition Against Domestic Violence, it is estimated that 1.5 million people experience intimate partner violence each year. The American Academy of Cosmetic Dentistry’s Give Back a Smile program heals some of the most devastating effects of intimate partner violence by restoring the smiles of adult women and men who have suffered damage or lost their smiles at the hands of a former intimate partner or spouse.

The mission of this charitable arm of the American Academy of Cosmetic Dentistry is to assist in rebuilding the lives and dignity of survivors of domestic violence through compassionate cosmetic dental services and support programs. The program provides restorative and cosmetic dentistry in the smile zone at no cost to the qualified survivors through a nationwide network of volunteer cosmetic dentists and a support team of dental laboratories and dental manufacturers.

Dr. Okamura and team are proud to be a part of this amazing program. The Give Back a Smile (GBAS) program began in 1999. Since that time, the American Academy of Cosmetic Dentistry (AACD) member dentists, dental laboratories and other dental professionals have volunteered their time and expertise pro bono to restore the damaged smiles of more than 1,100 survivors of intimate partner violence to the value of more than $10 million.

If you know of someone who could benefit from this program, I have provided a link: http://www.aacd.com/index.php?module=cms&page=616 . The GBAS patient application can be found on this page.

Chew more gum?

That’s right. In a recent study, gum chewers experienced less gum inflammation. Here’s the caveat: must be sugarless gum enriched with vitamin C. Chewing about 15 minutes releases nearly all the vitamin C. The study also indicted chewing five (5) times daily achieved the best benefit.

Look for sugarless vitamin C enriched gum at healthfood and supplement stores.

Happy chewing !!

Fairly regularly, we hear someone comment, "My gums always bleed", or, "My gums have bled all of my life!"  Our response is: "Wow, that's a big deal.  You've had that problem all of your life?" I hope that if you thought bleeding gums were a normal thing in the past, you now know that gums should never bleed when you brush or floss them (unless you just accidentally cut them with your dental floss).

The truth of the matter is, not only are gums not supposed to bleed unless injured, they also are supposed to be a light pink shade of color--not hot pink, not red, and not shiny.  Some call the color of healthy gum tissue 'coral pink.'  (A notable exception to this is that some people with naturally dark skin pigmentation will have melanin pigmentation on their healthy gums.)

Healthy, pink gums enhance the appearance of your smile just as much as whiteness of teeth.  It may not be as readily apparent to onlookers exactly what your smile is so attractive, but it is a fundamental way people see your smile as beautiful.

Notwithstanding all the health benefits to having no active gum disease in the mouth, getting pink gums is a great way to create a youthful, sexy smile! If you have noticed your gums are not pink, contact Dr. Okamura to see how we can help you get them looking pink and lovely!

Jo Braun was recently awarded BEST OF SHOW for her mosaic art. Congratulations Jo!!! There were more than 100 artists from 19 countries and Jo was one of eight international artists selected by Mosaic Art Now.  Don't know what mosaic art is? It is amazing, and when you see her pieces, you'll find yourself whispering, "Wow, how does she do that?".  Be inspired and check it out at:

http://www.jo-braun.com

On January 7th, 2011, the U.S. Department of Health and Human Services announced that it is lowering the recommended amount of fluoride in drinking water from 0.7-1.2ppm to 0.7ppm.  At the same time, the Environmental Protection Agency announced it is reviewing  whether or not it will recommend decreasing the maximum allowable level of fluoride in drinking water from 4ppm to a lower level.

Should we, therefore, be worried about too much fluoride in our water? We think not, because of the following factors:

• Research over the last 65 years has shown that communities with fluoride in their water have 20-40% lower incidence of cavities in adults and children.
• Children given water with acceptable levels of fluoride have a lower risk of developing cavities.
• Fluoride in drinking water is the most cost-effective way to treat dental decay; a lifetime's worth of fluoride in drinking water costs less than one filling.

Why was the recommendation made, then, to lower the amount of fluoride in drinking water? For cosmetic issues--not due to any health hazard from fluoride.

"The proposal...is based on an increase in dental fluorosis over the last 20 years", said Dr. William G. Kohn, director of the division of oral health at the HHS Centers for Disease Control and Prevention.

Fluorosis is a change in the appearance of the teeth from fluoride levels ingested above optimal levels in childhood while the teeth are forming.  Some describe it a s looking like "white freckles" on the teeth.  Mild fluorosis, which is by far the most common type, does not pose any significant risks to normal function, and it may actually make the teeth more resistant to decay.

So, if you live in an area of fluoridated water, please be assured you can safely drink as much tap water as you need to stay healthy, and by doing so, you will be fighting cavities!

For more fluoride info, visit:

http://www.ada.org/sections/newsAndEvents/pdfs/fluoridation_facts.pdf

Over the years we've been improving smiles, we've focused on the teeth.  It's amazing how much a whitening procedure or a set of cosmetic porcelain veneers can improve one's smile.  Now, it's time we take improving smiles one giant step further - with Botox Cosmetic.

What is Botox? Botulinum toxin A (Botox) is a protein extract from a bacterium that has has been used in clinical trials since around the 1950's.  In 1989, the drug was FDA approved for use in several different medical therapies.  By 2002, it was FDA approved for cosmetic use.  Botox works by relaxing the treated muscles, so that they do not pull on the skin with as much force, which over time creases and folds the skin, forming wrinkles.  Botox lasts approximately 3-6 months, after which time patients gradually return to their original state of wrinkling.  Long term, regular use of the product obtains the best results. It is a tested, safe product with a good track record.

Botox can also be used to treat TMJ, or jaw joint pain. It is an FDA approved initial therapy for treating migraines. There are lots of useful applications.

Dr. Okamura is fully licensed and trained to administer Botox, and she is a member of the American Academy of Facial Esthetics.  If you have been wondering just what Botox can do for you, come in and consult with us.

There's a few nasty colds going around our area, affecting young ones and old ones alike.  What can you do to avoid getting it? Consider these tips, taken from Encyclopedia of Natural Medicine, by Murray and Pizzorno:

1. Lose weight.  Obesity is associated with decreased immune status.  People who are overweight suffer from more infections and colds than do people of normal weight.

2. Do not smoke.  This one is good for all around wellness.

3. Sleep 7 hours or more each night

4. Exercise regularly

5. Take multi-vitamins daily.  Many Americans are nutrient deficient in some way without knowing it.

6. Consume enough protein each day.  The book recommends .8g protein intake for each 2.2lbs body weight.

7. Consume less then 100g sugar daily, either in form of glucose, fructose, sucrose, honey or orange juice.  The average American eats 125g of sucrose alone each day, plus 50g of other sugars.

8. Wash your hands with soap frequently and avoid touching your mucus membranes with your hands.

If you get sick, remember to rest, ideally in bed, drink large amounts of fluids, and limit simple sugar intake to less than 50g per day. Cover your cough if you have to go out in public.

Some hold that taking nutritional supplements, such as Vitamins A and C, Bioflavonoids, Zinc, and Thymus Extract will help with your immune function during viral colds and flus.

Whenever you stroll down the dental care aisle at the drug store or the supermarket, aren't you amazed at the variety of toothpastes available?!  All of them promise the world - whitening, sensitivity protection, anti-gingivitis, cavity protection, etc.  What you may not know is that many of the toothpaste products on the market actually are more abrasive than they need to be.

The particles in toothpaste that are the primary abrasive are generally harder than enamel, and microscopically the particles are jagged in shape.  If you buy a toothpaste with too high of a concentration of those particles, or if you use too much toothpaste (more than a pea-size portion), you run the risk of doing damage to your teeth and dental restorations over time.  Especially susceptible to the damage from over-abrasive toothpastes are root surfaces exposed from gum recession.  Those root surfaces can then become more sensitive to extremes in temperature.  Tooth-colored dental restorations can also become damaged and lose their tooth-like luster when the wrong toothpaste is used. Some dental restorations made of porcelain can even stain more easily when too abrasive of toothpaste is used for more than a few days.

What should you use?  As a rule, you should be wary of long-term use of any toothpaste product that promises "whitening", as these toothpastes are generally more abrasive.  And, remember that "less is more." Don't use too much toothpaste when you brush.  A little, pea-sized amount is all you need.

In case you're wondering, our personal favorite toothpaste is CloSYS.  It has low abrasiveness, and it is excellent in fighting gum disease.  If you have a moderate to high risk of developing cavities, we recommend using Clinpro 5000 toothpaste at least once per day, which is available in-office or by prescription.

We recommend steering clear of any toothpaste product with abrasiveness rating (RDA) over 100. Here is a list showing the abrasiveness of different toothpastes:

When a tooth is decayed, split, or damaged to a point that simply replacing the defective part with a filling would not work well or last very long, a crown is recommended. Many people today have one type of crown or another.

Crowns have been around for a long time. The ancient Etruscans are acknowledged by many historians as the fathers (and perhaps mothers) of dental crowns. They used gold to fashion new teeth that were superimposed over the old, broken ones. Examples of their work dates back to 166 of our Common Era.

Although gold is still a much-used material for crowns, many people today are looking for an option that more closely reproduces the natural tooth look. Therefore, engineered ceramics and various resins are widely used in making crowns today.

Some of the latest and most reliable materials in use today include crowns that are milled or pressed from a very hard, dense material, such as lithium disilicate or zirconia. After the base is made, in some instances, dental technicians add layers of advanced ceramics to further reproduce the look of a tooth and match the surrounding dentition. The result is a very durable, visually-pleasing tooth that only an expert could discern from a real tooth.

A custom-made dental crown today not only looks beautiful but should last a long time. If you're looking for a durable, attractive replacement to a broken or badly decayed tooth, come see how we can help you improve your smile with crowns.