(360) 629-7229

7204 267th St. NW, Suite 102
Stanwood, WA 98292

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E-Cigarettes and Vaping


The extensive research on tobacco-based products has provided irrefutable evidence as to the potential harm they may cause. I find that patients of course understand that smoking is damaging for your general health. They may not be as familiar with the ways in which smoking presents risks to your dental health.  For example, it is the number one controllable risk factor for periodontal disease, which is a major cause of tooth loss in your adult years.  Avoiding smoking will also help prevent conditions like dry socket, which occurs after extraction of a tooth, as well as other conditions, such as delayed healing. Nicotine, the active ingredient in both cigarettes and tobacco vaping products, causes your blood vessels to constrict and lessens the blood flow to your mouth as well as other vital organs.  This restriction in blood flow, as well as the release of a multitude of toxic chemicals, results in both delayed healing and increased risk for oral infections, especially after oral surgery.

In recent years, smoking alternative options, specifically e-cigarettes and vaping, have become widely available and have been touted as a better option for smokers. Although studies are still underway, what we do know based on early data is that these smoking alternatives still present significant risks.  A recent study published by the National Institute of Health found that the heating coils in many e-cigarettes result in some very toxic substances, such as arsenic, being aerosolized and inhaled into a users’ lungs (https://ehp.niehs.nih.gov/ehp2175/). Additionally, the substances, such as propylene glycol, that the tobacco, marijuana and other chemicals are distilled into have not been studied for their effect on inhalation.

The lack of regulation by the FDA regarding e-cigarettes and other vaping products means that there is no standardization of these products. While we do know that cigarettes are dangerous for our health, e-cigarettes may not be as bad – or they may be far worse.  Without regulation and further studies, the jury is still out as to which is more harmful for your health.  Ultimately, the best transition away from cigarettes is still nicotine-based products like gums or patches, and may even be supplemented with medications that may help to curb your cravings.

In short, until these smoking alternatives are regulated, the health effects will continue to be misunderstood or poorly communicated.  Any users of vaping-based products should each make their own informed decision, which includes accounting for the lack of information at this time.  If you have any questions about this topic or how it relates to your dental health, please feel free to reach out to us at 360-629-7229 or bring it up at your next visit.  We are always a resource to our family of patients on topics like this.

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Teeth Whitening

There are a multitude of products out there offering whiter teeth from toothpastes to whitening strips to in-office, light-based products.  If you are uncertain as to which product is the best choice, you are not alone. There is a huge market behind whitening products and many of the studies showing their effectiveness are paid for by the same people selling the product(s). I would like to discuss these to help provide some insight

If you are considering whitening your teeth, you may recognize a number of benefits to whitening.  The biggest downside to whitening is temperature sensitivity, which is typically transient and tends to go away on its own.  You can also use desensitizers and other fluoride-based products to aid with this sensitivity issue.

There are two main approaches to achieve whiter teeth.  The method relied on by toothpaste manufacturers is to remove the stains on the outer surface of your enamel. However, although whitening toothpastes, activated charcoals, etc. may remove staining, they are very abrasive to the point that you may actually brush away micro amounts of enamel or the outer layer of your teeth.

Another alternative to whiten is by using a peroxide-based product, although these products are not all the same.  When it comes to peroxide-based products, there are both in-office and over-the-counter options.  The big over-the-counter product you may have heard of is the Crest Whitening Strip system.  I find that the Crest system is both expensive over time and only around 5% peroxide leaches away from the strips.  Crest also sells a “professional strength” version of these strips, but I would also suggest against them.

In general, we recommend the gold standard of whitening products: dentist-produced whitening trays with a 15-20% carbamide peroxide gel.  Carbamide peroxide works to whiten the outer layer of your enamel, but does so without causing abrasion or loss of tooth structure.  Depending on how often you want to whiten, additional tubes of gel can be purchased to be used with the same trays.

It is also important to touch on the light-based, in-office whitening products like Xoom whitening.  In addition to being a peroxide based system, these systems also use a light application.  Multiple studies have been performed to examine the effectiveness of incorporating light in these systems and have been shown to have no effect on how well the peroxide works.  What these systems rely on is higher strength peroxide in the range of 30%, which can become very painful very quickly.  Additionally, because it is typically a one shot deal, the effects wear off much more quickly than the at-home systems where you can continue as needed.

If you have any questions regarding whitening or any other dental concerns, please do not hesitate to contact us at 360-629-7229.

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“Single Day Crowns”

CAD-CAM and Milled Crowns

Discussing dental technology is something dentists often enjoy. There have been many technological advancements in our field focusing on improving the patient’s experience while also easing the process for the dentist. Along those lines, you may have come across “single-day crowns” offered by some dentists.  This is a relatively newer technology that allows dentists to take a digital impression and send that impression over to an in-office milling machine that fabricates your crown as you wait.  I have had the opportunity to work with this technology and would like to take a moment to discuss its pros and cons.

Digital scanners – the devices that Cascadia and many other modern dental offices offer – are used to take digital impressions.  Before digital scanners, when a patient had a crown or bridge completed, we would use a material that was loaded onto a tray to capture a negative image or impression of the work we wanted to replicate outside of the mouth.  Today we use a handpiece that works to take a 3D image to save that same work digitally.

The biggest player in the game of “single-day crowns” is Sirona, a company that makes a unit known as CEREC.  One of the biggest differences with CEREC is that they offer an in-office milling unit that some dentists are utilizing to fabricate crowns in office in “one visit”.  The obvious benefit of a one-stop dental visit speaks for itself – the idea that you would only need to come in and get numb once and leave fully satisfied with a brand new tooth is certainly compelling.

The biggest problem with a single-day crown is its limitations for the types of material available to dentists.  Although a separate milling unit for a harder material known as bruxir is available, most dentists choose not to invest in a second, far pricier, milling unit and glazing oven.  What I typically see from single-day crowns is a type of material called emax or lithium disilicate.  Although this is a great material, it makes for a very poor material choice for use on posterior teeth (molars and premolars).  In my experience, I have seen these crowns fracture frequently and it’s my recommendation that patients avoid this material on posterior teeth.

It has also been my experience that the visits required to complete a single-day crown are excessively long, which can be arduous for the patient and may also result in a rushed final product.  Unlike a dental lab focused on producing thousands of a crowns a month, a single dentist may produce up to a couple a day (at most).  Dental labs tend to produce great work and they do it quickly and efficiently but even they can run into issues.  In instances where something is not perfect, such as the color, shape or glaze, the production process needs to be started over again and this can be very time consuming and rushed when the dentist is under a time crunch.

It is my opinion that the benefits of digital dentistry are significant and I employ them daily.  However, the downsides of then trying to produce crowns, in office, in a single visit, is not something that I see as maximizing the quality of care for my patients. If you would like more information about this topic contact our office at 360-629-7229

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Dental Insurance

With the end of the year rapidly approaching, it’s a good time to discuss dental insurance as you may be considering enrolling in a new plan or looking to maximize your dental benefits.

Generally speaking, with the exceptions of Medicaid, Medicare and Apple Care plans, patients have a choice between PPO and HMO plans. If you are considering a new plan, you should know that PPO plans offer the most flexibility. These plans allow you to choose whichever provider you want to see, as opposed to HMO plans, which require that you choose from a list of their pre-approved providers.

Although you can choose any provider you would like with a PPO plan, you will get the best value and lower rates if you select a dentist that is on your insurance providers’ list of “preferred providers”. This is because a preferred provider has agreed to a lower reimbursement from your insurance company than what they might otherwise charge someone that does not have insurance or does not have that same plan.

Now, dental insurance tends to be fairly limited. It functions very differently than medical insurance. Medical insurance, for instance, can have a much higher deductible that must be reached before your plan really begins to assist with coverage. Dental insurance, on the other hand, usually has very low deductibles (if any) and will pay a much bigger percentage of procedures up to a much smaller maximum. This is a general outline, of course, and does not include the dental plans that are only meant to cover hygiene visits and nothing else.

Most dental insurance plans offer maximum coverage of approximately $1,500-$2,000 annually. These maximums have not increased for many years, although premiums have continually increased. When it comes to dental work, especially if you have extensive work, this maximum is used up fairly quickly. This has led many patients to consider whether dental insurance is even worth having. Although the answer to that question depends on your personal situation, something to consider is that preferred provider rate mentioned previously. Even if you reach your dental insurance maximum, if you are under a PPO plan with a preferred provider, you still will receive lower fees for services – which can amount to thousands of dollars in savings!

Having dental insurance also creates an incentive to seek regular dental care which, hopefully, will help you to avoid small concerns from becoming much larger and costly dental issues. However, dental insurance companies know that many patients may avoid dental visits and will have multiple problem areas. While an emphasis on routine care is important, we can also focus on scheduling your treatment into more manageable phases to minimize the cost impact and maximize your insurance benefits. If you have any insurance-related questions, please do not hesitate to call us. Our team is highly skilled in helping answer any questions about the best insurance for your needs.

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Candy Season 2017

It’s holiday season again, or as my hygienist calls it, “cavity season”.  Because candy is so ubiquitous this time of year, I thought I should give some helpful advice for all of us (dentists included) that appreciate something sweet every now and then.

 

  • Try your best to avoid those stickier candies like taffies and Sour Patch Kids. The key is getting the sugar out of your mouth as quickly as possible and these sticky sweets tend to stick around a lot longer.
  • Eat your candy quickly. Sucking on Jolly Ranchers, for instance, for an extended period of time never lets your mouth cleanse itself and will predispose you to a higher risk for cavities.
  • If you have to choose a candy that is best for your teeth, chocolate is a good choice. Although any amount of sweets is hard on your teeth and your diet, there are compounds in chocolate that are antimicrobial and even helps fight plaque!  Additionally, chocolate rinses away quickly and doesn’t linger.
  • Try and avoid hard candies. They stick around longer and you will not be tempted to bite into them which can break your teeth.  Sometimes we can fix broken teeth but sometimes they break so badly that there is nothing a dentist can do for it.  Additionally, if you have existing dental work in your mouth, hard candies are very rough on existing dental work.
  • Rinse after you eat sugar! Try and avoid brushing right away as your teeth will be sitting in an acidic environment and brushing softened tooth structure will erode your teeth a lot quicker.
  • Sugar free gums (especially with xylitol, an alternative sugar) will help bring your risk for tooth decay down! It even works great as a trick or treat bag stuffer.
  • Lastly, a friendly reminder for patients with multiple items on their treatment plans: if you have any outstanding insurance benefits left over at the end of the year, it is use it or lose it season. Most patient’s insurance rolls over at the end of the year so keep that in mind to help maximize your insurance reimbursement!

If you have any questions or would like to schedule an appointment to discuss your personal situation, please give us a call today at 360-629-7229.