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August 2017

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Root Canal

Root Canal. If a tooth dies or is dying, it can create a very painful problem. A root canal basically removes the problem which is typically a bacterial infection, allowing the patient to retain a tooth that would otherwise be lost. Typically, root canal success rates hover around the 90% mark as strange anatomy, unusual bacteria and various other factors can complicate the outcome. The pulp, or “nerve” of the tooth can be thought of as a river system leading to the bone, which can be thought of as the ocean. The purpose of a root canal then, would be analogous to cleaning out a river system all the way to the ocean.

 

Final Xray of root canal and CEREC crown on lower molar

 

Root Canal Procedure

After numbing there tooth, a rubber dam and clamp are used to isolate the tooth in the need of therapy, to isolate and prevent contamination.

After isolation with the rubber dam, the canals are identified. This tooth had 3 canals in total which need to be cleaned out and sealed.

Root canal files of increasing diameter are used to traverse all 3 of the canals all the way to the end of the respective roots, basically to bone.

An apex locator is used to electronically measure the difference in resistance between the root and bone tissue. This is used to ensure access all the way down to the end of the root canal.

After widening the canals manually to approximately 0.2 mm in most cases a hand-piece can be used to more effectively drill out the inside of the canal walls, removing remaining nerve tissue and bacteria.

After cleaning and widening all 3 canals sufficiently, a Piezo ultrasonic is used to allow the disinfectants and chelators used in root canal therapy to more efficiently remove vestiges of tissue and bacteria, even in the “feeder creeks” of the “main river” that is the root canal.

Then, all 3 canals are dried using sterile paper points.

A rubber-like material called gutta percha of the appropriate size and shape is then selected to seal off and fill the root canal spaces. A paste sealer (the mortar) is applied to each of the gutta percha points(the brick) as they are used to obturate (fill) the root canal spaces.

Pressure and heat are applied to hydraulically plug all 3 canals.

The root canal therapy is now complete, an hour has elapsed, and most importantly the patient is now “out of Pain.”

 

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TMJ Cure Video Proof

Jaw muscle spasms, terrible headaches, shoulder & neck pain, terribly hypersensitive teeth, difficulty swallowing… A patient flies from L.A. to Rogers Arkansas to seek help from Dr. Nick Yiannios as a last resort, as she had seen numerous other health care professionals including neurologists, chiropractors, naturopaths, homeopaths & multiple other dentists. Watch as Dr. Nick applies the principles of “Neural Occlusion” to alleviate her muscular TMD problems in a single visit! Watch her history, treatment, and a 4 day recall as she explains the profound changes she has experienced as a result of her treatment…

 

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1 Visit Crowns

A SECRET MOST DENTIST’S DON’T WANT YOU TO KNOW….

IT’S INEVITABLE, sooner or later we all hear the words, “…you need a crown”.  CROWNS are placed on front or back teeth for many reasons. The purpose of the crown is to hold or “cap” what little is left of the tooth together, allowing the patient to retain a tooth that would not be predictably restorable otherwise.

Traditionally, permanent crowns are made in an off-site dental laboratory after the dentist grinds down much of the top, and all 4 sides of the tooth to the gum line, effectively leaving a “stump”.  A mold is then taken, a temporary restoration is placed on the tooth for several weeks, and the mold is sent to the lab.  Some weeks later, the crown is returned to the dental practice at which time the patient is called back in to evaluate the fit, function and cosmetics of the new restoration.  Occasionally, the crown needs to be returned to the lab yet again, and the temporary replaced. Eventually, the crown is finally cemented in place… Talk about frustrating and inefficient for all of those involved!

In contrast, CEREC CAD/CAM permanent crowns constructed in the dental office provide patients with a much more efficient, desirable, and timely alternative, THE SAME DAY.  Since no temporaries are involved, the CAD crown usually requires less tooth removal. The restoration is capable of being bonded very strongly in place regardless of the geometry.  This is in contrast to the traditional crown, where the retention of the crown is dependent upon radical removal of tooth structure to allow the crown stay on top of the “stump”.   A special camera is utilized to obtain a digital impression rather than a physical mold.  The experience is much more efficient and comfortable for the patient.  Also, the instantaneous feedback that this digital image produces on the computer monitor for the dentist affords your doctor the opportunity to modify the tooth preparation in the event that things are imperfect.  If imperfect, your dentist may simply re-image moments later.  Since these all-ceramic crowns are bonded directly to the tooth structure within hours, this usually eliminates the need for radical removal of all the walls to the gum line.  This allows the retention of MORE NATURAL tooth structure. Sensitivity issues relating to bacterial leakage and seal are also reduced, as there is NO TEMPORARY that will leak over time.  This also decreases the likelihood of a subsequent root canal following the crown procedure.  CEREC CAD/CAM crowns are made from beautiful porcelains that are not only totally customizable by a knowledgeable operator, but also allow the penetration of x-rays so that your dental professionals can visualize what is underneath the crown over the years.  This again, is in contrast to laboratory crowns, which are usually constructed of core materials that do not allow x-ray pass-through, effectively masking subsequent problems that might arise over time…  And let us not forget that this single visit convenience also allows this procedure to be accomplished with just one anesthetic injection!

And why don’t more dentists take advantage of this amazing technology for their patients?  Due to the enormous economic and educational sacrifices necessary for integration of CAD/CAM technology into a dental practice.  In addition, many of the concepts involved in this technology are contrary to concepts of traditional dentistry…

BOTTOM LINE:  WHEN THE PREPARATION AND FABRICATION PRINCIPLES OF SINGLE VISIT, ALL-CERAMIC CAD/CAM CROWNSARE APPLIED PROPERLY, THE CAD/CAM CROWN WILL TYPICALLY FIT MORE ACCURATELY OVER A LESS INVASIVELY PREPARED TOOTH THAN A TRADITIONALLY PREPARED CROWN.    CAD/CAM CROWNS TYPICALLY PROVIDE A LESS SENSITIVE AND MORE BEAUTIFUL ALTERNATIVE TO LABORATORY FABRICATED CROWNS.

Nick Yiannios DDS, FACCD, AACCD

Fellow & Accredited Member the Academy of CAD/CAM Dentistry

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Don’t Dare Skip (DDS)

A Dentist proudly serving Rogers, NWA & Beyond! Dr. Nick provides comfort, passion and technology to get you the smile you always wanted. Make your smile your best asset! Call 479-876-8000

Why does everyone need the dentist?

by Dr. Nick Yiannios, DDS

From toddlers to teenagers, young adults to retirees.  What do all of these age brackets have in common?  They all need to see their dentist.  Why?  What happens if one simply forgets, or decides it isn’t a priority?  Over 20+ years of practicing dental medicine, I have come to experience, first hand, the plethora of reasons to see your DDS regularly (Don’t Dare Skip).  After all, we all need to eat, and a healthy diet requires teeth.  In this article, I will be sharing many of these valuable pearls with our readers…

BASIC DENTAL BACKGROUND INFORMATION:

If you remember nothing else relating to these articles, memorize the following tips.  These tips will save you and your loved ones time, trouble, money and potential toothaches throughout a lifetime…

Dental plaque = food particles + bacteria (germs)

Plaque + sugars = acid

Acid = eats away at teeth, much like rust eats away at metal

Carbonated beverages (sodas) = acid (sodas themselves are acidic by virtue of the carbonation process; they possess a low pH)

Brush 3  5 times/daily, 1  2 minutes at each setting with a soft bristled toothbrush (NEVER hard)

Floss every night before bedtime (to knock the bacterial dental plaque lose BETWEEN your teeth that your toothbrush cannot reach).  When we sleep, our saliva flow decreases; hence our teeth are most vulnerable to the decaying action of the attached bacteria when our mouths are the driest.

Bacterial plaque can lead not only to decayed teeth, but eventual breakdown of the supporting structures of teeth.  This is known as periodontal disease or gum disease.  Recent scientific research has implicated a correlation between periodontal disease and an increased risk of heart disease as well as many other serious systemic maladies.

A modern dental professional incorporates an oral cancer screening into every dental checkup examination.  Oral cancer statistics are on the rise, and these diseases are some of the most debilitating types of cancers.  Every person should be screened on a regular basis, whether or not high risk factors such as alcohol and tobacco are involved.

TODDLERS:

Cardinal rule:  don’t put your baby to bed w/ juice, milk, or especially sodas.  The sugars from these beverages can quite easily lead to what is termed “baby bottle decay”.  Brushing the little ones teeth and gums with digestible pediatric toothpastes are a great idea from month 1.  Ignoring this advise can lead to the premature loss of baby teeth, which can not only lead to an unsightly and functionally hampered dentition, but almost certainly to a crowded situation for the permanent teeth. This will potentially lead to a situation where braces might be needed when they might not have been required otherwise…  Certainly take your child to the general dentist by age 5, or even earlier if your child’s physician recommends it.  For very young children, it would be a good idea to seek out a dental specialist known as a pediatric dentist who is specially equipped and trained to handle these youngest of dental patients.  Be sure and follow your physician’s advice relative to pediatric vitamins containing fluoride, regarding whether to avoid the systemic dosage of fluoride or not…

CHILDREN:

By the age of 5, most kids have a full complement of baby teeth in function, and permanent ones on the way.  This is a crucial time…

Consider sealants for their baby teeth, but absolutely insist on sealants for their permanent teeth.  What are sealants?  Sealants are plastic-like liquid materials that are additively flowed into the grooves of teeth and subsequently hardened to keep bacterial plaque out.  As the grooves are the parts of the tooth that are most prone to decay, cavities have a hard time establishing themselves on sealed teeth.  The result?  The child and the parent both win since these are non-invasive (no drilling, no anesthetic injections), relatively inexpensive, and most importantly, no tooth structure is removed.

 

At this age, the dentist looks specifically for crowding of the teeth as well as orthopedic/skeletal issues.  Before puberty, the human maxilla and mandible are still “pliable” as they are still forming.  It is imperative to catch any skeletal or jaw discrepancies prior to puberty, as this is when bony changes begin to cease and things become permanent.  As an example, catching a child with an unhealthy and unsightly skeletal cross bite prior to puberty may be very simply fixed by using a retainer to move the bones.  Catching this problem after puberty will most likely require surgery to accomplish the same objective.

Why not pull badly decayed baby teeth?  As eluded to in the toddler section, this isn’t a good idea, unless the permanent tooth that is coming in place of this particular baby tooth is almost out of the gum.  Ignoring this advice invites future orthodontic/braces issues.

Do not pull permanent teeth in the event of a toothache at this age!  NEVER do so unless directed by your child’s dentist or orthodontist for a valid reason.  Removing permanent molars in particular at this age is a life-long problem that will cost you and your child tons of money, and things will never be quite the same.  Trying to save a few dollars for an oversight today by extracting a permanent molar tooth will never benefit anyone!

What about amalgam/silver fillings for my child’s permanent teeth?  Aside from their unsightly appearance and the presence of mercury in the amalgam fillings, most modern dental practitioners tend to agree that it is not a great idea.  Amalgam fillings do nothing to hold the tooth together.  They are simply dovetailed in place, and only serve to fill the hole, putting extra stress on the remaining tooth structure that will one day fail and lead to major dental procedures such as crowns.

What about white or composite fillings for my child’s teeth?  Composites are a good, attractive fix, without the mercury that not only fills the hole but also serves to help bond/hold the remaining tooth structure together.  Although these won’t last forever, the composite option, when properly done, can serve to function for many years depending upon the size of the filling, the patients bite, and the skill of the operator providing the service.

Word of wisdom, it is important that your child’s dental provider use proper isolation techniques to ensure the longevity of sealants as well as white fillings, ergo equipment that promotes a dry field such as the rubber dam or an instrument called an Isolite®.  Modern bonding technologies are dependent upon a dry field free of saliva and other oral fluids, as well as the humidity within the oral cavity.  A mouth full of cotton is hardly adequate in this day and age!

By this age it is imperative that parents routinely bring their children to the dentist twice a year for many reasons.  Dental issues caught in a timely manner are almost never a big deal, and big deals are what tend to frighten patients.  Establishing a routine for your child early on will encourage a healthy lifestyle and a beautiful smile for a lifetime!

PRE-TEENS

Usually the 1st permanent molars erupt by age 6, and 2nd permanent molars erupt by age 12.  Variations are common, but this is the statistical norm.  As mentioned in the last section, see to it that your child’s permanent molars (all 8 teeth) have sealants placed in the grooves, ideally just after they erupt.  Fillings of any sort are never permanent since they will fail eventually.  As we all know, during these years children typically begin their rebelious stages, looking at authority figures as a nuisance, ignoring such requests as, “…brush your teeth and floss underneath your braces!”.  Though they do not last forever and are not a panacea, sealants make it harder for decay to take place.  The eight permanent premolars erupt in the early teen years.  In the ideal world, the premolar teeth get sealed as well.

As the permanent teeth erupt, they usually fit tightly together (in contrast to the baby teeth which usually have spaces between them). Now is the time for the pre-teen to begin the habit of flossing  every night before bed to remove the plaque between their tightly-fitting teeth.  Quite honestly, this is possibly THE most important habit to pick up for a lifetime of good oral health.  Understand that the vast majority of the time when a cavity develops between the teeth (which flossing of course helps prevent), the dentist must remove tooth structure from the top of the tooth just to gain access to the problem which lies between the teeth.  This weakens the tooth structurally to a much greater degree than a normal cavity on top of the tooth in the grooves.  Over the years, these can fail and lead to more serious and expensive issues such as crowns.  The best  way to prevent this problem is to FLOSS from this age on!

This is the age when most people begin their orthodontic treatments, if needed.  It’s a great idea to see to it that the general dentist takes a panoramic (whole head) x-ray  of your child well before they hit puberty, usually around ages 9 or 10.  One of the goals is to  identify any congenitally missing (genetically missing) teeth, which requires orthodontic planning to ensure a proper bite and a beautiful smile as well.  Remember, without a proper bite,  your child will not be able to eat the healthy, fibrous, proteinaceous foods which help build a healthy body.  The panoramic x-ray will also identify whether or not all four wisdom teeth are forming, and this plays into strategic treatment planning in regards to potential orthodontic issues.

TEENAGERS

By now , most all of the permanent teeth have erupted, except for the wisdom teeth which normally show themselves by age 18 or so.   Many people don’t have enough room for the wisdom teeth to fully erupt into their jaws.  This is why many people have their wisdom teeth extracted, due to a lack of room.  Some are lucky and have congenitally missing wisdom teeth (they never formed), and some are lucky enough to have enough room; however most do not.   Ignoring wisdom teeth that need to be removed can lead to several issues, including potential crowding of the rest of the teeth as the wisdom teeth continually try to erupt, pushing everything forward.  This forward movement can quite readily botch years of orthodontic treatment, not to mention inviting cavities and even gum (periodontal) disease later in life.  Half-erupted wisdom teeth can lead to a condition known as pericornitis, where the gum tisssue that is covering the partially erupted tooth becomes acutely inflamed and infected.  Pericornitis will hurt, and it will recur unless the wisdom teeth are definitely removed.  Antibiotics and pain killers are typically prescribed, but the final treatment needs to be removal.

YOUNG AND MIDDLE-AGED ADULTS

During young adulthood, everyone seems to be busy.   Busy building a career, busy targeting a mate, busy raising children, busy trying to stay in shape, busy paying the bills and making ends meet…  Who has time to think about their teeth and gums?  Make the time, trust me, as letting your teeth go by the wayside is NOT condusive to building that career, finding that special mate, spending more time with the kids, spending more time at the gym, or saving money.  Think about it…

In early adulthood, we tend to have few dental problems to speak of if we received regular dental care as a child, including orthodontic straightening, wisdom tooth removal, and if we were REALLY lucky, sealant placement by our parents.  However, over time, the fillings that were placed in our teeth tend to wear out, leak, and potentially crack our teeth.  How many times have you changed the tires on your car in your 20’s & 30’s?  Have you ever considered how many chews those old fillings from Jr. High School have endured until a tooth suddenly cracks New Year’s Eve just before that special date with your certain someone?  Regular dental checkups usually stave off such unpleasant surprises…

When 35 to 40 hits, we tend to notice a change in our bodies, our eyes, and our immune system in general.  We just can’t do what we used to!  What we DON’T notice is a change in our gum or periodontal tissues of the mouth, as such changes are generally gradual, painless and insidious.  What I am alluding to is periodontal or gum disease, which is statistically one of the most ubiquitous diseases to plague  mankind.  Until the advanced stages, signs of this destructive disease process tends to escape detection unless diagnosed by a competent dental health care provider.  Periodontal disease culminates in the loss of bony support of the teeth (think of bone as a strong foundation & losing bone as a very undesireable occurrence).   So, losing bone from periodontal disease decreases the likelihood that you will take your teeth to the grave.  As if THAT isn’t bad enough, research has linked gum disease to an increased propensity of other major undesireables such as heart disease, stroke and diabetes…  Always insist that your dentist or dental hygenist perform regular probing examinations at your dental checkups, and fire them if they don’t.  If diagnosed with periodontal disease, expect frequent exacerbations of the disease process which include “deep cleanings” where your hygenist or dentist must remove bacterial plaque and their accretions in the unhealthy pockets that surround the teeth, since, unfortunetly, there is no cure for periodontal disease.  Prevention is the best defense, so see your dentist on a regular basis ESPECIALLY from age 35 on!

A useful tip relating to your gums.  Brush in circles using a soft-bristled toothbrush, not back and forth in a sawing motion.  Why?  Gentle circles and softer bristles are less abrasive to the gum tissues, and this matters since ignoring this advise accelerates gum recession, exposing the roots of the teeth.  Have you ever heard the phrase “long in the root”?  This euphemism accurately refers to a natural process associated with aging, as our gum tissues shrink away with age, leading to more exposed root surfaces becoming visibly apparent.

In regards to our teeth, typically between 40 and 50 even the most dentally blessed of us tend to experience the need for a crown, or possibly even a root canal.  Those teeth that have been filled and refilled, eventually may leak decay and bacteria into the nerve, or the fact that so little of nature is left, there is a good chance that the tooth will fracture over time.  If the decay or fracture involves the pulp or nerve of the tooth, a root canal will be required to save the tooth.  If the nerve is spared, a crown or onlay (a more conservative, less invasive alternative to a crown) may be all that is required to bring the tooth back to health and full function.

SENIORS

Ah, the golden years! So what’s in store for us during these years, dentally speaking?  It all depends on how well things went for us earlier in life, just like the rest of our health is concerned.  For instance, if we avoided major trauma to the face and jaws, taken the time to brush, floss and saw our dentist regularly, we can expect to have retained most of our teeth at 60+.  Nonetheless, many of these lucky seniors have experienced a root canal or two, and can speak proudly of the 2 or 3 crowns (or caps) that they have in place; especially that ugly gold one that’s been there since around 1990…  Most have experienced a fair amount of recession where the gums have fallen back, exposing much of the root surfaces.  Again, these are the lucky ones…

Given that modern dental hygiene practices were not widely disseminated until the 1970’s, many seniors are not this fortunate.  Many seniors have experienced a mouth restored with old silver amalgam fillings, several missing teeth, a bridge or two, a touch of gum disease coupled with the associated bone loss, and possibly several root canals.  These folks are maintainable if they are doing a good job with their brushing and flossing.  If they are diligent with their dental checkups, they can expect to keep most of their remaining teeth for the rest of their lives.

And then, there are those seniors who have been in dentures for as long as they can remember.  Most of us had grandparents like that, who claimed, “I can eat fine with my false teeth.”  Unfortunately, that’s not entirely true.  Individuals with dentures adapt to what they can eat comfortably, and tend to consume the softer, starchy, fattening, and carbohydrate-rich foods that tend to pack on the pounds, and clog the arteries.  Once in dentures, gone are the days that they can properly chew and consume the healthy, fibrous, protein-rich foods that our bodies require to maintain optimal health.  After all, we are what we eat.  Besides, dentures are not a replacement for missing teeth, they are simply a poor and loosely fitting prosthetic upgrade in lieu of having no teeth.

So what does a progressive dentist typically do for the senior population in his or her practice?  Firstly, the dentist should check for oral cancer at every checkup.  Do you think your physician looks for this?  Your dentist is the primary care physician of your mouth.  Nail beds, the whites of your eyes, your oral cavity; these are three readily accessible areas of the body that allow health professionals to assess overall physical health.  Secondly, he or she checks your gum and bone levels both clinically and radiographically, looking for periodontal disease.  Treatment and retreatment of periodontal disease is paramount when it exists, as there is definitive proof of a link between our gum health and the rest of our health.  Realize that once you acquire periodontal disease, it is like being diagnosed with diabetes; there is no cure, only maintenance.  3 – 4 month recalls are mandatory.  Lastly, a modern dentist should check  your old fillings, crowns and root canals for signs of leakage or failure and takes corrective measures to maintain what you have in a state of health and comfort, so that you may CONTINUE to eat the healthy, fibrous, protein-rich foods that our bodies require to maintain optimal general health.

But what about those seniors who are already in dentures?  What can be done to improve their function?  Collaboration with an oral surgeon for the strategic placement of dental implants into the jaw, and subsequent construction of what’s called an implant overdenture that “snaps” into place, helps solidly attach the denture prosthetic to the jaw. The denture actually snaps into trailer-hitch like attachments that stick above the gum line, allowing greatly improved chewing ability.  Say goodbye to loose dentures, say hello to eating steaks, salads, fruits and the rest of the good stuff!

One final point in regards to seniors; this age group tends to be on more medications than any other.  Consequently, side effects relating to the drugs such as xerostomia (dry mouth) tend to profoundly affect dental patients.  Dry mouths are especially prone to new cavities along the edges of the old fillings and crowns due to a lack of substantial salivary flow.  Timely identification of leakage can greatly decrease the cost and trouble associated with the repair of these problems.  In addition, recessed and exposed root surfaces are far more prone to decay, ESPECIALLY in abnormally dry mouths.  Saliva is necessary to not only help us begin to break down our foods, but it discourages acid attack by cavity-causing bacteria.  Take away our “spit”, and you take away our ability to keep our own mouths cavity free…

To you and your families oral health,

Dr. Nick Yiannios DDS, AACCD, PC

Fellow and Accredited Member ACCD

Dr. Nick is a general dentist, not a specialist in pediatric dentistry, orthodontics, periodontics, oral pathology, prosthodontics, endodontics or oral surgery.

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Mercury Free & Mercury Safe Dentistry

“The mercury-free dentist does not PLACE amalgam, period, instead relying on gold, zirconia (a white, powdered metal oxide), composite (white filling), or ceramic (porcelain) alternatives. Some even go as far as to completely eliminate all metal containing alternatives when possible.”

                                         Dental Amalgam/Mercury Fillings, Friend or Foe?    

Invented by an English chemist in 1819, dental amalgam was, at the time, a revolutionary and cost-effective way of filling teeth after the removal of decay. When first introduced into the U.S. in the 1830’s, the dentists of the time branched from 2 separate camps, the dentist-physicians, and the dentist-barbers. The former camp sought to prohibit the use of dental amalgam in humans and formed the American Society of Dental Surgeons, citing the toxicity of the heavy element mercury, which typically makes up 50% of the dental amalgam material. The ASDS prohibited its membership from using the amalgam material, advocating the use of the more technique sensitive gold instead. The latter camp, embraced the dental amalgam filling as a cost-effective, and much simpler way of restoring teeth. Over time, economics prevailed and pro-amalgam dentists formed an organization that ultimately became known as the American Dental Association, which supported the use of the mercury fillings, and to some degree, does to this day.

In 1926, a German chemist identified that the amalgam fillings in his mouth emitted mercury vapor. In 1957, a Swedish scientist concluded that when saliva covers an amalgam filling, mercury vapor is no longer released. In 1976, the FDA grandfathered acceptance of amalgam fillings due to its long history of usage. In the late 1970’s, research began to emerge claiming that brushing, chewing, grinding and the intake of hot liquids encourages the release of mercury vapor from these amalgam fillings. In the mid-80’s, autopsy research demonstrated that mercury levels found in brain tissue could be quantifiably linked to the amount of dental amalgam fillings in that cadavers teeth. Around the same time, a Canadian Medical School demonstrated that mercury could be found in the fetus of a mother within weeks of conception. In 1991, the World Health Organization declared that human beings glean more exposure from dental amalgam fillings than from seafood, air or water, combined. Recently, Norway, Sweden and Denmark have implemented a total mercury ban in their countries, which included a ban of dental amalgam fillings. Canada, Germany and Austria have recently recommended against placement of mercury amalgam fillings in pregnant woman, children, and those with renal dysfunction. So is there a problem or not?

In my 20 years of dental practice, I personally have REMOVED tens of thousands of amalgam fillings, as normally a large percentage of the teeth in need of treatment present to me with old amalgam fillings. Many patients feel that these fillings have served them well for decades, at least until the amalgam is removed, at which time the cracks, dark stain, and recurrent dental decay usually found underneath convinces them otherwise. In dental school I was taught that substantial amounts of mercury vapor are released when one PLACES the amalgam and when one REMOVES it, and that there are definite neurological ramifications linked to chronic mercury exposure. Knowing this, I have always avoided amalgam PLACEMENT like the plague. After all, I am the guy who is hovering above the oral cavity breathing in those vapors day after day. Not surprisingly, over the past 15 years I can count the number of amalgam fillings that I have PLACED on my fingers and toes, instead relying on very effective non-mercury alternatives.

Now briefly, some terminology in regards to a dentist’s philosophy in regards to amalgam is in order. There are mercury-safe dentists, mercury-free dentists, and then of course, there are dentists that are neither.

The mercury-safe dentist feels that the vapors that mercury fillings emit when they are being REMOVED from the oral cavity demands special attention. Various protocols are in place, including rubber dams and/or elaborate intraoral vacuums (not just the normal hi-volume vacuums that dentists always use) that are designed to whisk away the vapors from not only the patient, but the dental staff as well. Special dental burs combined with a technique known as chunking is employed to remove the old amalgam as quickly and in as few pieces as possible, thereby preventing overheating and discouraging mercury vapor release. On occasion, a supplemental breathing source may even be provided for the patient. Some mercury-safe dentist’s may even go as far to recommend nutritional and chelating regimens to help patients purge their bodies of the elemental mercury that may have penetrated their organs and tissues. A very small percentage of dentists in the U.S. are mercury-safe dentists.

The mercury-free dentist does not PLACE amalgam, period, instead relying on gold, zirconia (a white, powdered metal oxide), composite (white filling), or ceramic (porcelain) alternatives. Some even go as far as to completely eliminate all metal containing alternatives when possible. Keep in mind though that few mercury-free dentists can actually be classified as mercury-safe as well. Approximately 50% of the dentists in this country are mercury-free dentists.

The dentists that are neither, believe that the mercury vapor poses little if any risk, and that placement of the mercury amalgam is of no immediate harm to the patient. They REMOVE and REPLACE without any specific protocols or precautions. Approximately 50% of the dentists in this country practice this way.

Are the metal alternatives safe? In general, yes, especially in regards to the gold containing alloys. Gold is hard to beat in regards to biocompatibility and lifespan. It goes downhill from there though, as the non-gold containing metal alloys can cause allergies in some patients. Using these metal alternatives, one can restore a tooth in a variety of ways. From least invasive to most invasive, they are inlays, onlays, and finally crowns. Many times dentists have their outsourced laboratory fabricate metal crowns with porcelain overlays. Have you ever seen someone with a white crown smile and you can see a dark ring around the gumline? Chances are excellent that you were observing a porcelain fused to metal crown. But what kind of metal? Be sure to ask. The dentist may not be using gold alloy based metals, but the cheaper, more allergenic base metals containing materials such as nickel instead. The biggest problem that I see with the metal variety though, is that they are simply not minimally invasive, meaning that more tooth structure was removed than was necessary in contrast to other viable alternatives.

Part of our mercury-safe protocol involves the use of an Isolite® intra oral vacuum, which serves to whisk away toxic mercury vapors from the patient and staff as amalgam fillings are removed. This apparatus is connected to a powerful vacuum.

 

Part of our mercury-safe protocol involves the use of a Jerome Mercury Vapor Analyzer, an extremely accurate mercury vapor detection device that has taught Dr. Nick what REALLY HAPPENS in regards to the removal of mercury amalgam fillings.  He has, and continues to use this expensive technology to hone his amalgam removal protocols, doing as much as possible to protect his patients, his staff, and the environment from the related toxic effects.

White fillings or composites are great for smaller cavities, if they are placed properly, and under a dry field. They are very conservative and tend to mimic Mother Nature quite well. Zirconia is a very strong material, but over the years I have found that when porcelain is fused to this white substrate, as it usually is, the porcelain has a propensity to shear given that the properties of the two materials are quite dissimilar and that the tremendous forces generated in the oral cavity during mastication (chewing) can break the junction of the two layers over time. Ceramics are arguably the most beautiful, predictable, biocompatible and non-allergenic alternatives provided that the occlusion, or bite, is given meticulous attention. A modern dental practice uses digital occlusal analysis to perfectly dial in the bite, rather than relying solely on the old-fashioned ink bite ribbons that dentists traditionally used to check the bite. In our office, we use primarily composites for smaller restorative situations and computer-aided design, computer-aided milling (CEREC CAD/CAM) ceramics for larger situations. Properly fabricated composites and ceramics work wonderfully, predictably, and beautifully in the vast majority of situations. In addition, these white, tooth-colored restorations are minimally invasive, meaning that the patient loses less tooth structure than with the traditional amalgam or metal containing restorations.

So are amalgam fillings safe? I would say not, especially for children or expectant mothers, though it is not recommended that pregnant individuals expose themselves or their future children to the acutely toxic mercury vapors generated from placement or removal during pregnancy. As with most health matters, prevention is key, so if you are planning on becoming pregnant, at least refrain from having amalgam fillings placed, and instead consider composite, ceramic or gold alternatives. Elective removal of present mercury amalgam fillings is something that you should research and discuss with your oral health care provider. Do I consider mercury amalgam fillings safe? Not for myself or for my family. As with all controversial health care subjects, do the research for yourself and you decide.

To your health,

Dr. Nick Yiannios – A Mercury SAFE Dentist

  • Fellow & Accredited Member, The Academy of CAD/CAM Dentistry
  • Member, International Academy of Oral Medicine and Toxicology
  • Member, International Association of Mercury Free Dentists
  • Accreditation Candidate, the Academy of Cosmetic Dentistry
  • 1993 Graduate The University of Texas Health Science Center at San Antonio Dental School
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Infection Control

Having earned a BS in Microbiology, Dr. Nick Yiannios is acutely aware of the importance of maintaining a clean and sterile environment for both the patients and the staff. When designing and building his new office, great measures were taken to address the infection control issue. The physical facility from the walls to the ceilings to the door handles were designed to be readily cleans-able.

Spray-Wipe-Spray-Wrap

In the treatment rooms, all contacted surfaces are covered with cellophane after having been sprayed with a tuberculocidal disinfectant, wiped dry, then sprayed again so that those surfaces are wet (to further kill any remaining germs or pathogens). The plastic barrier provides a protective function since after every patient, all of the plastic is discarded, and the spray-wipe-spray-wrap procedure is repeated.

Sterilization

All instruments are cleaned ultrasonically, then scrubbed manually, dried, wrapped and sterilized in a steam autoclave that is routinely tested to ensure that it’s in excellent working condition. A totally separate counter with cabinets is then used to store and protect these sterile items, far removed from the non-sterile wall and counter.

Preventing Cross-Contamination

Masks are worn by all staff members directly involved in patient care. Electronic, hands-free wash stations are used before seeing other patients of course. Disposable gloves, of the non-allergenic, non-latex variety are used and discarded after each patient. All disposable items used in patient care are disposed of after each and every patient. For your safety, all clinical area sit on top of seamless, heat-welded, antimicrobial flooring which even extends up the walls. This very expensive flooring material is exactly what is used in hospital operating rooms.

Latex-Free

Nitrile rather than latex gloves are used by all of us at Dr. Nick’s to help ensure that our patients don’t become exposed and develop an allergy to components of rubber latex.

In summary, our office meets or exceeds the infection control standards set forth by both the American Dental Association and the Centers for Disease Control.

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Sensitive Teeth Have Solutions

A Dentist proudly serving Rogers, NWA & Beyond! Dr. Nick provides comfort, passion and technology to get you the smile you always wanted. Make your smile your best asset! Call 479-876-8000

Are you having trouble drinking ice water?  Or perhaps hot coffee?  Maybe when you chew something just right you get a twinge that you feel down the back of your spine?  So what causes these symptoms, and what can be done about them?

Some quick dental anatomy is in order.  The top, white part of the tooth is called enamel.  It’s not alive, it is simply a mix of organic and inorganic substances that serve as natures armor.  Enamel also happens to be the strongest substance in the human body.  That figures, since we expect the enamel to crush a lifetime’s worth of food!  As one travels down along the tooth to the gum line, the enamel thins out and forms a butt joint (remember this butt joint) against our roots, which is comprised of something called cementum.  Now, this yellowish cementum is not nearly as hard as enamel, and is completely buried under the gum line, at least in our younger years. Underneath both enamel and cementum, lies the softer dentin, which traverses the entire length of a given tooth and serves to house the living pulp of the tooth.  The dentin has little tunnels filled with fluids that actually communicate with the pulp of the tooth.  The pulp is very much alive and is comprised of blood vessels and nerves.  Enamel is akin to the bark of a tree above the ground, and cementum is akin to the roots of the tree, a bit more vulnerable but covered by the earth (or the gum line in relation to teeth roots).   Our teeth are formed from the inside out when we are very young.  The pulp creates all of the dentin, enamel and cementum outwards from itself.  Once that role is complete, the pulp really has completed its purpose in life, and serves only to warn us about thermal changes (hot/cold) and excess forces on the tooth.  One last thing, the cementum covered root of all teeth are connected to the jawbones via very tiny little fibers known as periodontal ligaments, or PDL’s.  These tiny “cables” suspend the roots in their bony sockets and have exquisitely sensitive nerve fibers that have a direct connection to our brain.  When stimulated, the PDL’s actually have a role in the coordination of the muscular output that is generated by our teeth as we chew our food, via communication between the PDL’s and the brain.  Have you ever bit into a seed or a hair in your food?  Chances are you quit crushing your food pretty rapidly and in the blink of an eye you expelled the foreign substance without even thinking about it.  That’s your PDL talking to the brain, and the brain telling the muscles what to do about it; “…get it OUT!”-all in about 0.006 seconds..!

So, now why are teeth sensitive?  Well, it depends.  The outer enamel of the tooth could have a crack in it, allowing the tooth to flex while chewing.  A crack might also allow hot or cold fluids to percolate closer to the highly sensitive pulp.  Bonding or crowning the tooth should solve this problem.  In a worse case scenario, the crack has gone vertical into the roots below the bone and nothing can save the tooth.  This is a quite rare occurrence…

It’s possible that the butt joint between enamel and cementum is partly open on a given tooth, exposing a bit of the underlying dentin, which is quite sensitive.  If acidic, hot or cold substances touch this open joint, the little tunnels or tubules in the dentin let the pulp know that an irritant is present.  Bonding or desensitizing agents are sometimes used to clog those tunnels, making communication to the pulp less likely.

Another possibility involves gum recession exposing much of the root cementum.  This may or may not be due to periodontal, or gum disease.  A dentist needs to determine whether or not you have this problem.  If not, gum grafting to cover the exposed, sensitive root can solve that problem.

Sometimes the above treatments do not work on a permanent basis.  If you have a sensitivity issue that has not resolved after exhausting the above treatments, be aware that new research suggests that this may be due to that tooth bearing an excessive load in the overall bite while chewing.  This extra force can cause the tooth pulp to become chronically inflamed, and far more susceptible to overreacting to stimuli.  Precisely adjusting the bite using digital sensor technology known as the Tscan® that measures timing and force, not just the traditional ink ribbon that dentists routinely use to check the bite (which only identifies where things touch, not when or how much), can identify the exact miniscule “rub” that does not belong, allowing effective elimination of the sensitivity issue by precisely adjusting the interference and allowing the inflammation to subside.

Lastly, if all else fails, it is possible that the pulp of the tooth has died for whatever reason.  If this is the case, root canal therapy might be indicated.  This involves removing the pulp of the tooth, which removes the nerve tissue so that the brain can no longer recognize the problem.  If a tooth is still sensitive after a properly performed root canal, it is possible that the PDL’s of the tooth are picking up excess force. Again, a very precise bite adjustment might just be the ticket!

Sensitive teeth can be a debilitating problem that you may not be able to ignore.  Traditional treatments for the reduction of tooth sensitivity may not always be effective.  Dr. Nick has recently identified, studied, named, and published novel information in the dental scientific literature relating to the genesis and treatment of hypersensitive teeth in the 1st edition textbook, “The Handbook of Research on Computerized Occlusal Analysis Technology Applications in Dental Medicine”.  Within a chapter of that textbook, he statistically validated a concept which he described to dental medicine known as Frictional Dental Hypersensitivity, or FDH, and explained that precise, objective, and digitally directed manipulations of the human bite with concurrent muscular responses (resultant of digitally-directed bite adjustment therapy), may readily be manipulated to eliminate hypersensitive teeth in patients with objectively confirmed stable and adapted TMJs.  The usage of the Tscan® technology is required to identify these minuscule discrepancies in the functional bite in order to accomplish this task, and is often very effective when everything else fails.

Step into the future of dentistry,

Dr. Nick Yiannios

To view YouTube videos that Dr. Nick has created to compliment this article on tooth hypersensitivity, refer the the drnickdds homepage on YouTube, or watch this sample video:

“Curing a dentist’s sensitive teeth”

https://youtu.be/dhraMhcoE_w

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Jaw Pain After Braces

A Dentist proudly serving Rogers, NWA & Beyond! Dr. Nick provides comfort, passion and technology to get you the smile you always wanted. Make your smile your best asset! Call 479-876-8000.

A beautiful smile is meaningless if a patient cannot use their teeth to chew and function normally.  Typically, patients seek out orthodontic treatment to correct crowding, tipping, and other unattractive issues with their teeth.   Braces usually do a very effective job of correcting these issues, in space, but not always in function.    This can be due to a potential imbalance of forces between the top teeth and the bottom teeth, in regards to an asymmetrical distribution between the right and left side, or perhaps between the front and the back teeth.  So after braces, the teeth might look great and appear to be in the right place, but if one were to measure the amount of muscular force generated between, for example, the right half of the patient’s mouth and the left half, things could potentially be out of balance.  This imbalance can lead to numerous problems such as headaches, muscle fatigue, popping joints, trouble opening the mouth or chewing, TMJ dysfunction, excessive tooth wear & tooth hypersensitivity, This article assumes that the orthodontic patient had relatively healthy joints before the orthodontic treatment began, and describes what could cause such untoward problems from developing after orthodontic treatment.  The answer is not simply about teeth by the way…

MUSCLES

First of all, realize that the only jaw that moves is the lower mandible, and that the mandible is held in place and moved by a sling of numerous muscles known as the muscles of mastication (MOM’s).  These muscles all have a function, and when they are most efficient, they are not working very hard at all.  Remember this key point: when the arrangement of the teeth are not conducive to efficient function, the MOM’s usually work too hard, and they generate excess lactic acid which over time, can lead to problems.

LIGAMENTS

On a related note, every tooth is connected to the jawbones by fibers that are exquisitely sensitive known as periodontal ligament fibers (PDL’s).  These fibers transmit the tiniest pressure and force signals via nerves directly to the brain, allowing the brain to precisely regulate the consumption of foodstuffs through the variable use of the MOM’s in thousandths of a second increments.  Have you ever bitten into a hair in your food?  How long did it take for you to push it out?  Almost instantaneously, right?  How often do you bite your cheek or tongue in a day’s time given the thousands of daily chewing cycles we all undergo?  Not very often thank goodness.  Thank your PDL’s, your brain, and the MOM’s for their unbelievably fast ability to detect and synchronize proper function within your mouth!

JOINTS

Understand that we all have two temporomandibular joints (TMJ’s) that allow our lower mandible to HINGE with our skull, with a “pillow” made of cartilage between the bony top of the mandible and the bony bottom part of the skull.  These “pillows” or TMJ discs prevent bone from hitting bone, and in a healthy state these TMJ discs are very slick, quiet, and essentially a pair of hinges that allows the lower jaw to do the crushing, clenching and swinging left and right, against a stationary upper jaw, or maxilla.

MASTICATORY OR CHEWING SYSTEM

Be aware that these bones, discs, muscles and teeth are alive, and that they have an amazing capacity to adapt to change, within reason.  Realize that there IS a bit of self-adaptation in this chewing system, allowing most of us to tolerate some discrepancies in our bite without causing signs or symptoms in our teeth, muscles or TMJ’s.

Now, functionally speaking after braces, if the tops of the teeth are not in a harmonious position to accept the forces of chewing in a balanced manner and the patient’s self-adaptive capability is exceeded, then the PDL’s signal the brain that things are not quite right.  The brain then sends signals to the muscles to grind at the interference and make that “speed bump” go away.  The problem is, often the muscles cannot eliminate the interference, and the muscle tries and tries, but to no avail.  Over time this can lead to a tired, spastic, and biochemically imbalanced situation that often expresses itself as:  PAIN!  The excessive grinding can lead to broken and sensitive teeth, muscular headaches, and even TMJ issues over time as the TMJ disc cartilage gets worn out…  Think orthopedic medicine here.  Think knee problems, missing cartilage, knee replacements.  When one is bone on bone that is not good…  Technically, these issues can be traced to excess lactic acid buildup in the spastic and overworked MOM’s over time.

With all that being said, what can be done if the orthodontic patient experiences problems such as these?  Well, if the origin of the problem is a result of muscular hyperactivity of the MOM’s, which it typically is, paying closer attention to the precise refinement of the bite and forces generated by the MOM’s usually leads to resolution.  Most orthodontists and dentists rely exclusively on ink ribbon to mark the bite after treatment.  This practice simply shows where teeth touch, doing nothing to effectively show the force generated in a given area over time.  There exist digital technologies in dentistry that measures BITE FORCE distribution per unit TIME known as the Tscan®.  There also exists a complimentary technology that allows one to measure muscular activity of the MOM’s known as surface EMG.  Interpretation of these two tools together allows a knowledgeable dentist to very accurately finalize the balance of the bite and muscles after braces in a much more precise manner than with the ink ribbon alone, thereby eliminating many of the potential issues that can arise.  Just how little of a discrepancy can cause a problem?  Remember that human hair in your food?  It’s about 1/10 of a millimeter, and you felt it through your PDL’s and spit it out courtesy of the MOM’s that were directed by your brain to eliminate that tiny little foreign “speed bump”.

So does everybody have problems after braces?  No.  Why not?  Thank the adaptation in our amazing living system that is our masticatory, or chewing system, which is comprised of muscles, ligaments, nerves, joints and teeth.  Problem is, not all of us have enough self-adaptation to cover the potential discrepancies that orthodontic movement can introduce into the system.  Is it a good idea to have your bite and MOM’s digitally balanced after braces, or any other dental work that could potentially alter your masticatory system?  You decide….  And if you decide to do so, know that our practice routinely applies these technologies in patient care.  Bottom line:  sometimes bite ribbon alone is simply not enough to ensure a predictable, healthy outcome.

To you and your families health,

Dr. Nick Yiannios

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Muscles in Dentistry

What is EMG and what does it have to do with dental medicine?  EMG is an acronym that stands for ElectroMyoGraghy.  All muscles generate electrical activity whether at rest or in function, and EMG is used in dental medicine to measure this.  Active muscles show much greater electrical activity levels than do resting muscles.  So what do muscles have to do with dentistry?  In one word: EVERYTHING.  Every one of us has about a dozen or so pairs of muscles that posture our skull and move our lower jaw, the mandible, up and down, left and right, forward and back, etc.  These muscles allow us to chew, drink, swallow, clench, grind, talk, sing, cough, sneeze, whistle, and well, you get the picture.  Our mandible is one marvelous piece of living and moving “machinery” that we all take for granted, until something goes wrong!

Muscles do many things but in the simplest sense they move bones across joints.  Extend your left arm.   If you contract your bicep, you pull your arm towards your body across the joint that is your elbow.  During this activity, your tricep is relaxed.  If you contract your tricep on the back of your upper arm, you would extend your arm away from your body across your elbow joint, while your bicep conversely relaxes.  So the biceps and triceps are opposing muscles in this example.  Now, what happens if you try to contract your bicep and your tricep simultaneously? Both muscles would become hyperactive, one fighting the other, and you would not be able to move your arm.  That would not make for a very efficient “arm machine”.  Understand that one muscle needs to contract in one direction while the other opposing muscle needs to relax, allowing for an efficient motion to occur across the elbow joint.   It is possible with EMG to measure the electrical activity that muscles generate while in function and at rest.  This is akin to watching the tachometer of your automobile as you accelerate your engine and subsequently lay off the gas.  Tiny electrodes are placed on the skin over the jaw muscles to objectively and painlessly measure the amount of activity that muscles generate both at rest and whilst in function.  This is a basic description of what dental EMG is all about, measuring the electrical output of the jaw and supporting neck muscles both at rest and in function.

So what exactly does EMG allow us to do in dentistry?  Quite simply, it allows us to study if the jaw muscles are working efficiently or not.  There are known electrical activity levels that these muscles should operate within, and whenever the measurements are either too high or too low, an astute practitioner can begin the process of understanding why this is occurring and how exactly to treat the problem, especially if there is pain or signs of destruction occurring in the patients teeth, TMJ’s or jaw muscles.  Modern, complete dentistry deals with more than just teeth and gums.  Any evaluation of a dental patient should also take into consideration the health and stability of muscles and the temporomandibular joints (TMJ’s), not just the teeth.  EMG allows us to evaluate the health of many of the muscles that move the lower mandible across the two hinges known as the TMJ’s, which are the two jaw joints just in front of our ears.  The TMJ’s are basically the hinges of our lower jaw across which the jaw muscles move, akin to the elbow joint in the arm.

The right Temporomandibular joint (TMJ) illustrated, which is the junction between the skull and the lower jaw bone/mandible.

Let’s cite an example of muscles that are firing excessively or in other words, are hyperactive.   A patient just received several fillings and two crowns.  The patient finds that they cannot close properly, and that the jaw muscles around one or both of the TMJ’s are tender to the touch.  The tooth might also be exquisitely sensitive.    So why are the muscles tender?  Because the brain senses that the closing muscles will eventually damage the teeth since the bite is off, so the opposing opening muscles will contract to protect those teeth while the closing muscle is contracting as well.  Both muscles effectively cancel each other out, expending much biological energy in doing so, and they excrete a metabolic byproduct known as lactic acid, which in excessive levels is toxic to the muscles.  So why was the tooth sensitive?  Because the tooth has ultra sensitive tiny ligament fibers connecting the root(s) of the tooth to the jawbone that have a direct connection to the brain, screaming “…stop it!” to the brain.  These fibers, specifically periodontal ligament (PDL) fibers, are what tell the brain now to direct muscle firing in the first place.  In this example, a practitioner can begin to isolate the exact position of the “high” spots, and usually alleviate the problem with a precise alignment of the dental work.  Once accomplished, the inappropriate muscle activity will instantly decrease, as the PDL’s no longer detect a problem with the bite, thereby relieving the discomfort.

Other examples of EMG use in dentistry would be:

  • Aiding in the evaluation of a proper bite position in a dental patient that coincides with the most relaxed muscular position.
  • Confirming that the bite adjustment of a patients teeth led to a more relaxed, comfortable, and healthy muscular state
  • Helping to rule out pain as originating from the muscles rather than say the teeth or the TMJ joints

EMG software data from a live patients closing muscles of mastication, the bilateral masseters and temporalis muscles.

EMG software readings can even be slaved to digital bite technology, allowing the dentist to simultaneously record timing of the bite, bite force, and muscle activity information, in thousandth’s of a second increments.  In a very practical sense, the ability to finely tune the bite with a relaxed set of muscles leads to one outcome, that of predictable comfort!  Once only possible in research laboratories, this technology now exists for clinical practice, and the benefits are beyond spectacular!

Step into the future of dentistry…

Dr. Nick Yiannios DDS, PC, AACCD

Please refer to the following YouTube video of a live patient treatment using EMG and digital bite analysis that Dr. Nick has created for this article:  https://youtu.be/vs9RznhH3zs

Dr. Nick’s handle on YouTube is drnickdds.

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TMJ Screening Tool: The JVA

A Dentist proudly serving Rogers, NWA & Beyond! Dr. Nick provides comfort, passion and technology to get you the smile you always wanted. Make your smile your best asset! Call 479-876-8000.

After 20 years of practice, it never ceases to amaze me how patients, and even fellow health professionals, refer to jaw joint problems as “TMJ”.  The reality is that we all have two temporomandibular joints, just like we have two ears, two knees and two elbows.  Do you ever hear someone say, “I’ve got knee…”?  The TMJ is simply anatomy: pathology of the TMJ’s should be referred to as temporomandibular disorder or TMD, and this is only a broad classification of numerous maladies under one all-encompassing term.  TMD involves disorders and overlapping signs and symptoms of noises, vibrations, limitations of lower jaw/mandibular movement, and pain in the areas around the TMJ’s, often related to muscular imbalance or problems with the cartilage surrounding the temporomandibular discs.

TMJ or TMD Screening

TMJ or TMD Screening

An illustration demonstrating both temporomandibular joints, represented by the yellow “disks” interposed between the lower mandible/jawbone and the upper skull/temporal bone.  

Traditionally, TMD problems are diagnosed by physicians or dentists based on medical and dental history, palpation, radiographic interpretation, CT scans and/or MRI diagnostic modalities.    The former imaging methods, though helpful, all lack one fundamentally important capability; they only glance at the joint at one moment in time, not over time.  This is significant in that the jaw joints are moving as we speak, chew, talk, etc.  They don’t remain static in one position as recorded with an MRI or a CT scan.  What happens in one position may not be happening an instant later as the cartilage-laden temporomandibular disc moves or slides along the skull.  In recent years, a company called Biopak has developed a computerized technology called JVA, or joint vibration analysis, that allows a special software program to basically “listen” and record any vibrations produced by the TMJ’s as they function.  The data generated by the software program is used to correlate any aberrant vibrations produced with specific problems of the joint, which allow more accurate diagnoses to take place, leading to appropriate treatment plans as needed.   This technology is quick, painless, non-invasive and a very reliable indicator of TMJ health.  Resembling a simple headset, the apparatus rests over the patients TMJ’s just in front of the ears and records any aberrant vibrations generated within the joints as the patient opens and closes.

The Joint Vibration Analysis headset which detects frictional interactions between internal cartilaginous surfaces in the TMU disks and converts the information into quantifiable data in software which can be cross-referenced and used as an indicator of TMJ health.

TMJ Joint Vibration

A patient opening and closing for the Joint Vibration Analysis headset, designed to “listen” for aberrant waveforms emanating from the bilateral TMJ’s.  The headset picks up data that is transferred to a software program that quantifies, numerically, the output from both TM joints which is cross-referenced with statistically researched data that correlates the given numerical values with surgically confirmed joint issues, or lack thereof.

This technology is based upon the simple principle that a healthy TMJ disc has abundant cartilage separating the bones between the skull and the mandible.  This lack of vibration during function is indicative of cartilage health, which in turn is an indicator of TMJ health.  In other words, one should ask two questions when assessing TMJ health:  1)  are the muscles and ligaments in the proper position and functioning normally?  2)  is the cartilage around the TMJ disc between the lower jaw and the skull intact?  If the answer to both of these questions is yes, the JVA will measure only very small vibrations, signifying joint health.  The patient should not only be asymptomatic and capable of functioning normally, but capable of undergoing needed dental treatment if necessary with an expectation of a totally normal, pain-free joint afterwards.  This is the advantage of using JVA as a screening tool in dental practice.

Vibrations in JVA Software

Vibrations in JVA Software

JVA software data which can be used to quantify and screen for bilateral TMJ health. 

Our office has found that this technology is a very useful screening tool for TMD.  We have found that its integration is essential for establishing a baseline condition for our patients’ TMJ’s in a practical and relatively inexpensive way.  We have integrated this technology into our checkup and cleaning examinations and have found a surprisingly large percentage of aberrant TMJ’s that would have gone undiagnosed without the use of this technology.  Do we always act on aberrant JVA data and treat TMD conditions identified with the JVA?  No, not always, because there are millions of people out there who have less than optimally healthy TMJ’s that function just fine.  The key is to ensure that the patient’s joint’s are in a STABLE and UNCHANGING condition, capable of functioning normally and undergoing PREDICTABLE dental or orthodontic treatment should the need arise.  Should everyone open and close their mouths 5 or 6 times for the JVA every 6 months at their normal dental checkup?  Ideally, yes.  Because after all, ignorance is not bliss when it comes to oral health matters!

Step into the future of precise and predictable dentistry,

Nick Yiannios D.D.S., AACCD, PC

Note:  Please note that TMD is not a specialty per the guidelines of the American Dental Association, and that Dr. Nick Yiannios is a general dentist.

 

 

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