My Blog

By Gary W. Machiko, DMD
January 13, 2020
Category: Dental Procedures
Tags: gum disease  
AreLasersforGumDiseaseTreatmentinOurFuture

One of the most important revolutions in healthcare in recent decades is the increasing use of lasers. Now, laser technology is making a showing in dental care for the treatment of periodontal (gum) disease.

Lasers (an acronym for "Light Amplification by Stimulated Emission of Radiation") narrowly focus and amplify light within a small area. First developed in the early 1960s, laser technology rapidly advanced in the ensuing decades with more compact and precise devices that were eventually safe and effective for many types of medical procedures. Its remarkable features are now available for the primary focus of gum disease treatment—removing bacterial plaque.

Plaque is a thin, built-up film of bacteria and food particles on tooth and gum surfaces that serves as a haven for the bacteria that cause gum disease. The continuing presence of plaque and calculus (tartar) enables the infection to thrive and advance within the gum tissues, ultimately damaging them along with supporting bone. As the tissues weaken and bone volume diminishes, the teeth are at greater risk for loss.

It's necessary, therefore, first and foremost to remove all detectable plaque and calculus to stop the infection. This is traditionally done with special hand tools called scalers used to manually remove plaque, or with ultrasonic equipment that vibrates plaque loose to be flushed away with water. These procedures can take numerous sessions and may result in some minor post-procedural discomfort and bleeding during the cleaning.

But lasers specifically designed for plaque removal can minimize tissue damage and resulting discomfort. Because the particular laser light used reacts only with plaque and diseased tissue, it can remove them without disturbing nearby healthy tissue usually more efficiently than traditional scaling. Dentists who've used the technology frequently report less bleeding and higher patient satisfaction.

But before lasers for gum disease treatment are widely adopted, the procedure must undergo further scrutiny. Reports from dentists notwithstanding, not enough research studies have been performed to date that meet the necessary scientific criteria. But if the evidence so far from the field holds up, it's quite possible lasers will one day become a regular part of dental practice for treating gum disease.

If you would like more information on treating gum disease, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Lasers Versus Traditional Cleanings for Treating Gum Disease.”

CleftDefectsCanBeOvercomeThankstoAdvancedSurgicalProcedures

One in 700 babies are born each year with a cleft lip, a cleft palate or both. Besides its devastating emotional and social impact, this common birth defect can also jeopardize a child's long-term health. Fortunately, incredible progress has occurred in the last half century repairing cleft defects. Today's children with these birth defects often enter adulthood with a normal appearance and better overall health.

A cleft is a gap in the mouth or face that typically forms during early pregnancy. It often affects the upper lip, the soft and hard palates, the nose or (rarely) the cheek and eye areas. Clefts can form in one or more structures, on one side of the face or on both. Why they form isn't fully understood, but they seem connected to a mother's vitamin deficiencies or to mother-fetus exposure to toxic substances or infections.

Before the 1950s there was little that could be done to repair clefts. That changed with a monumental discovery by Dr. Ralph Millard, a U.S. Navy surgeon stationed in Korea: Reviewing cleft photos, Dr. Millard realized the “missing” tissue wasn't missing—only misplaced. He developed the first technique to utilize this misplaced tissue to repair the cleft.

Today, skilled surgical teams have improved on Dr. Millard's efforts to not only repair the clefts but also restore balance and symmetry to the face. These teams are composed of various oral and dental specialties, including general dentists who care for the patient's teeth and prevent disease during the long repair process.

Cleft repairs are usually done in stages, beginning with initial lip repair around 3-6 months of age and, if necessary, palate repair around 6-12 months. Depending on the nature and degree of the cleft, subsequent surgeries might be needed throughout childhood to “polish” the original repairs, as well as cosmetic dental work like implants, crowns or bridgework.

In addition to the surgical team's skill and artistry, cleft repair also requires courage, strength and perseverance from patients and their parents, and support from extended family and friends. The end result, though, can be truly amazing and well worth the challenging road to get there.

If you would like more information on repairing cleft birth defects, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cleft Lip & Cleft Palate.”

By Gary W. Machiko, DMD
December 24, 2019
Category: Dental Procedures
Tags: cleft lip   cleft palate  
LiporPalateCleftscanbeEffectivelyRepaired

About one American baby in 700 is born with some form of lip or palate cleft—and the percentage is even higher in other parts of the world. At one time this kind of birth defect sentenced a child to a lifetime of social stigma and related health issues. But thanks to a surgical breakthrough over sixty years ago, cleft defects are now routinely treated and repaired.

Oral and facial clefts happen because a child’s facial structure fails to develop normally during pregnancy. This causes gaps or “clefts” to occur in various parts of the mouth or face like the upper lip, the palate (roof of the mouth), the nose or (more rarely) in the cheek or eye region. Clefts can have no tissue fusion at all (a “complete” cleft) or a limited amount (an “incomplete” cleft), and can affect only one side of the face (“unilateral”) or both (“bilateral”).

There was little that could be done up until the early 1950s. That’s when a U.S. Navy surgeon, Dr. Ralph Millard, stationed in Korea noticed after reviewing a series of cleft photos that tissue needed to repair a cleft was most often already present but distorted by the defect. From that discovery, he developed techniques that have since been refined in the ensuing decades to release the distorted tissue and move it to its proper location.

This revolutionary breakthrough has evolved into a multi-stage approach for cleft repair that often requires a team effort from several dental and medical professionals, including oral surgeons, orthodontists and general dentists. The approach may involve successive surgeries over several years with dental care front and center to minimize the threat of decay, maintain proper occlusion (the interaction between the upper and lower teeth, or “bite”), or restore missing teeth with  crowns, bridgework or eventually dental implants.

While it’s quite possible this process can span a person’s entire childhood and adolescence, the end result is well worth it. Because of these important surgical advances, a cleft defect is no longer a life sentence of misery.

If you would like more information on treatment for a cleft lip or palate, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Cleft Lip & Cleft Palate.”

By Gary W. Machiko, DMD
December 14, 2019
Category: Oral Health
Tags: celebrity smiles   retainer  
MargotRobbieKnowsAGreatSmileIsWorthProtecting

On the big screen, Australian-born actress Margot Robbie may be best known for playing devil-may-care anti-heroes—like Suicide Squad member Harley Quinn and notorious figure skater Tonya Harding. But recently, a discussion of her role in Peter Rabbit proved that in real life, she’s making healthier choices. When asked whether it was hard to voice a character with a speech impediment, she revealed that she wears retainers in her mouth at night, which gives her a noticeable lisp.

“I actually have two retainers,” she explained, “one for my bottom teeth which is for grinding my teeth, and one for my top teeth which is just so my teeth don't move.”

Clearly Robbie is serious about protecting her dazzling smile. And she has good reasons for wearing both of those retainers. So first, let’s talk about retainers for teeth grinding.

Also called bruxism, teeth grinding affects around 10 percent of adults at one time or another, and is often associated with stress. If you wake up with headaches, sore teeth or irritated gums, or your sleeping partner complains of grinding noises at night, you may be suffering from nighttime teeth grinding without even being aware of it.

A type of retainer called an occlusal guard is frequently recommended to alleviate the symptoms of bruxism. Typically made of plastic, this appliance fits comfortably over your teeth and prevents them from being damaged when they rub against each other. In combination with stress reduction techniques and other conservative treatments, it’s often the best way to manage teeth grinding.

Orthodontic retainers are also well-established treatment devices. While appliances like braces or aligners cause teeth to move into better positions, retainers are designed to keep teeth from moving—helping them to stay in those positions. After active orthodontic treatment, a period of retention is needed to allow the bite to stabilize. Otherwise, the teeth can drift right back to their old locations, undoing the time and effort of orthodontic treatment.

So Robbie has the right idea there too. However, for those who don’t relish the idea of wearing a plastic appliance, it’s often possible to bond a wire retainer to the back surfaces of the teeth, where it’s invisible. No matter which kind you choose, wearing a retainer can help keep your smile looking great for many years to come.

If you have questions about teeth grinding or orthodontic retainers, please contact our office or schedule a consultation. You can read more in the Dear Doctor magazine articles “Teeth Grinding” and “The Importance of Orthodontic Retainers.”

ProfessionalWhiteningOffersanEffectiveWaytoRestoreYourSmilesLuster

Your teeth were meant to shine! Tooth enamel’s polished translucence, framed by the dentin layer beneath it, has a way of vibrantly catching the light when you smile. But tooth wear and structural changes as you age can dim that shine. Add to that staining caused by foods and beverages or disease and your smile could further lose its luster.

On your supermarket or pharmacy oral hygiene aisle you’ll find dozens of products promising to restore that lost luster, including toothpastes, whitening kits or even chewing gum. While such products work to some degree, our dental office may have the right solution for you: a safe and effective treatment for whitening teeth.

Why see us for teeth whitening? For one, professional whitening solutions contain a higher concentration of bleaching agent (usually 35-45% hydrogen peroxide) than home kits. We usually apply it in a gel form directly to the teeth while using barrier devices like dams to protect the lips and other soft tissue from irritation. We may then apply heat or light to the applied gel to enhance the release of peroxide into your enamel.

This professional procedure can often give you a brighter smile in fewer sessions than a home whitening kit — and it may last longer. What’s more, we can control the level of brightness to produce only a subtle change or a dazzling “Hollywood” smile — whatever your preference.

Like a home kit, this procedure bleaches staining on the outer surface of enamel, known as extrinsic staining. But you can also have discoloration deep within a tooth, known as intrinsic staining, caused by a variety of reasons like tetracycline use early in life or complications from a root canal treatment. Home kits or even the professional treatment described above can’t whiten intrinsic staining.

For intrinsic staining you’ll need a special procedure that places a bleaching agent inside the tooth. Depending on the extent of staining the procedure could require more than one session.

To find out what kind of discoloration you have, visit us for a full examination. We’ll then be able to give you your options for putting the shine back in your smile.

If you would like more information on teeth whitening, please contact us or schedule an appointment for a consultation. You can also learn more about this topic by reading the Dear Doctor magazine article “Teeth Whitening.”





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