But the boy and his family rarely smiled around early January, when he admitted to having severe headaches at Southern Maryland Medical Center. After two surgeries, doctors diagnosed a brain infection and canceled its source: 1 septic tooth. A few weeks later, the boy seemed to be on the mend, with physical and occupational therapists working to restore his right arm and leg while the brain infection and surgeries disrupted full utilization. But on February 25, the infection reoccurred. It was time for the Yoyo driver to make an early-morning trip to the hospital for her son.
"I don't think anyone would have thought, in 2007, that we would want a child to die from a dental disease who was in the United States," said Kathleen Ross, DDS director and president of the American Dental Association. DiMonte arrived at the emergency room with no apparent symptoms until he was rushed to the emergency room with a headache, but it's clear that he was largely dead because he didn't see a dentist often enough, who was able to catch the spread of the infection in his teeth before. Basic dental care would also have helped DeMonte's 10-year-old brother, DaShawn, who needed six teeth pulled and was in agonizing, oozing pain that made his cheeks swell with loss.
At the time, the Yew driver had five children, no job (though she was trained for engineering) and little money. When she came into contact with Norris, she had been trying for months to find a dentist who would accept medical treatment for her children.
And DiMonte's untimely death is a rare case, which is not the case with dental diseases in the United States. Untreated tooth decay in preschoolers has actually increased again since the early 1990s, according to an April report from the Centers for Disease Control and Prevention. There are nine out of 10 Americans with tooth decay, one out of 20 middle-aged adults and four out of four adults over the age of 601, without teeth.
It's well-documented that your oral health affects your entire body. Millions of Americans with periodontal disease may have a higher risk of heart disease, diabetes, lung infections and premature birth. Recent studies have shown a link between periodontal disease and pancreatic cancer. And untreated infected teeth and gums can lead to dangerous and even life-threatening neck, blood, lung and brain infections like the one a boy has.
It's clear that "without oral health, you're not healthy," says Lawrence Tabak, DDS director and director of the Institute of Dental and Craniofacial Research.
Prevention is the cheapest and best way to avoid these problems, of course. But fortunately, improving your dental health improves your overall health too. Study results published in the New England Journal of Medicine this year show that treating advanced periodontal disease lowers blood pressure, which in turn reduces the risk of heart disease. Now a wave of technological innovation is making dental treatments safer, faster and more comfortable than ever.
Stopping cavities before they start
Ten years ago, most dentists looked for cavities, and when they found one, they filled the gap. But "replacing a tooth structure with a filling is never as good as replacing your own tooth structure," says Dominic Lombardo Zero, DDS director and director of the Oral Health Institute at the Indiana University School of Dentistry. Now, dentists have begun to field cavities that stop cavities early in their tracks. Several devices help. The most popular is the Diagnodent (and the new Diagnodent pen, left). Marketed by Kraft Dental after Lake Zurich, Illinois, the instrument shines a tiny laser beam on the surface of the tooth to detect the difference in enamel-reflected light between health and decay. But plaque and sealants can also trigger the device, which can lead to overtreatment.
In just a few years, there may be a better detection method. A CAT scan, such as the technique, called optical coherence tomography, which is now in the prototype stage, will create a holographic image of an entire mouth on a computer screen. The white spots on small teeth signal microscopic pits in the enamel, which may be sealed or treated to prevent tooth decay and restore natural teeth.
Soon, dentists will also be able to kill bacteria by killing teeth harmlessly with the CurOzone device, which delivers a fast pulse of ozone to attenuate bacteria. European dentists are already using the device, in contrast to HealOzone U.S. It is not known, but the FDA's judgment remains reserved until clinical trials prove its effectiveness.
In the meantime, dentists can help avoid giving patients prescription-strength, highly fluoridated toothpaste cavities the altered chemical conditions in saliva, providing minerals that help reorganize and harden enamel. Fluoride varnishes can work well, but the Food and Drug Administration has not approved them for treating tooth decay. Other popular products contain xylitol, a sugar substitute from birch bark, which produces tooth decay from starvation mistakes. Xylitol is now available in candies, chewing gum, mints and even rags for babies' mouths. Clinical trials have shown, but not proven, that it helps rebuild enamel.
Laser Improvements
Lasers can also be used to examine teeth easily. Two types of soft-tissue lasers were used right from the early 1990s to minimize minor gum bleeding and infection during the procedure. Hard tissue lasers, while approved by the FDA in 1997, can vaporize damaged dental tissue within the cavity while leaving the healthy tissue unchanged, thus keeping the teeth more accessible than dental drilling. Lasers, and experimentation, can do more along the way, said Donald Coluzzi, DDS director, San Francisco, Calif, and dean of the College of Dentistry at the University of Laser Dentistry in the past.
A method called photoactivated disinfection (PAD) can help dentists treat tartar by removing clean tissue, periodontal disease, and hard destroying bacteria that come into contact with the teeth below the gum line. First, they will add a blue dye to the space between the teeth and gums, which will make the bacteria sensitive to light. Then they would glow a red laser beam, leaving only 10,000 standing in the wrong one. British company Denfotex this technology is already being marketed to prevent root canal infections from recurring. Dr. Coluzzi predicted that soon will help periodontal disease can be gum, teeth and bones without surgery.
Broken tooth restoration
The business of dentistry rarely takes place in a garage. But California racing engineer Craig Juhl needed new teeth fast. Juhl and the mechanics team are working with Jesse James, host of the Discovery Channel show Monster Garage, to pull off the show's trademark mechanical facelift 1, which converts a 1964 Lincoln Continental into an open road racer. While Drew altered the car's body, a fast-spinning mill caused his top to ride up to his face and break his incisors. The team had just finished refurbishing the car in seven days, making Drew stick to working on a problem that called his injury "a trauma through Jack" - a ghostly lantern smile.
In a daylong look, Gary Glasband, the Drain Commissioner, crossed into the garage at Long Beach to end up with a small camera that took a picture of Drew's mouth.6 He then sat in front of a computer watching a piece of dental equipment on wheels, eavesdropping at the keyboard and reviewing on the screen a three-dimensional image of three-quarters of Drew's broken tooth.
A few minutes later, he designed a crown that would fit over Drew's completely broken tooth. Fifteen minutes later, an additional milling engraved a solid, tooth-block-colored ceramic with the crown. Dr. Glasband fine-tuned the shape, put on a mask and gloves, and glued the crown to Jules' tooth in less than a minute. Good mechanics go. The technique used by Dr. Glasband is called Cherek.
The new method to reattach teeth that have been knocked out, broken or loosened by falling means they can be saved more often and replaced more easily. Traditionally, dentists have just two broken teeth with similar options to Joule. They can attach it if the patient has been lucky enough and smart enough to recover the broken tooth by sticking it in milk or saliva and desperately fleeing to a dentist. More often than not, they will replace temporary crowns, then permanent crowns months later.
Today, though, a dentist can rebuild a broken tooth in a single visit, using composite materials, hard plastic resins that contain minerals and recreate the color and hardness of the real tooth. The fastest way may be the GlasSpan single-use first-aid kit, introduced last February, which uses woven fiberglass and plastic resin to splint a loose or broken tooth neighbor, allowing it to reattach. It takes the dentist less than 10 minutes than two hours to secure an old-fashioned wire with an orthodontic method to the tooth. Jonathan Scharf with DMD of Exton, Pennsylvania, a dentist who founded GlasSpan, utilized the kit to help a 7-year-old girl whose four front teeth appeared to be falling loose when she faced a rush of pedestrians first.
Making implants easier
Implants are tooth root replacements for teeth that have lost their decay or periodontal disease. Each is in a screw titanium screw. The outer screw is implanted in the jawbone (lower) or maxilla (upper). The inner screw supports the crown after the way to support the mailbox.
Traditionally, the dentist cuts the bone into the open gingiva, drills, and sometimes grafts the bone (the patient's own, from another area such as the hip, from a bone bank; or artificially implanted) in order to have adequate anchorage on the implant. Mini implants such as IMTEC's MDI and Maxim's Traveler implant reduce the need for bone grafting, which is painful and invasive, because their diameter is only half the width of a full-size implant, or that of a wooden toothpick.
Another new approach to implantation for patients is quicker, with fewer office visits and less use of scalpels. Until now, getting an implant has meant at least two surgeries and a dental patient months: one screwing the device into the bone, another 3 months after taking the impression of a denture and finding another surgical implant and adapting a denture or crown. Nobel Barkai loves the widely publicized Dental Fit 1 Hour System, introduced in the United States in 2005, which still requires some preliminary visits, but the implant and denture are placed on the same day, sometimes within an hour.
It all sounds great to Hady Koraym, 47, of Baltimore. Koraym, an electrical engineer at the time, showed up at the University of Maryland Dental, where he lost everything but six of his teeth to advanced periodontal disease. At the dental school, Deborah Almerini, the DDS director, raised Koraym's mouth to be taped off for replication and used to make a definitive plastic replica of the denture he would eventually wear. Koraym then underwent a recently introduced type of dental catheterization called a scanning cone beam CT. the three-dimensional images of the three patients' mouths were far more accurate than traditional X-rays, reducing radiation exposure too.
Dr. Almelini sent the images to Nobel Balkai Love's laboratory in Gothenburg, Sweden, where technicians made old-fashioned plastic molds of Koraym's chewing gum to pinpoint the holes in order to guide the surgeons in their exercises. Dr. René Almerini and Molly, DDS, installed Koraym's upper implant and teeth on February 22, a week after his lower implant and teeth. For the first time in years, Koraym has a full mouth of teeth. "I'm looking forward to good and I feel more confident," he said.
Some dentists are concerned that dentition with 1-hour implants, which lacks the initial 3-month healing period of traditional implants, may not bond the bone well enough to stabilize them, said Eugene Antenucci, director of the Department of Drainage Services, a spokesman for the Academy of General Dentistry. "The technique is not time proven, but the results seem to be good," he added.
About Something Smiling
Implants help anchor crowns and bridges to the mouths of millions of Americans. But because gum disease eats away at bone, there isn't enough left over often in which to place implants. In the future, dentists could add a patient's own bone marrow.
The FDA recently approved two compounds that stimulate bone regeneration in March: 21-second bionic therapy from GEM in 2005 and Medtronic's injectable bone graft. Soon, the dental implants will release their own growth factors to help build bone. Ulf Wikesjo, a collaborator with DMD, a professor of periodontology at the Medical College of Georgia, and his collaborators at Wyeth Pharmaceuticals Ltd, Nobel Balkai love the safety of developing one such implant and conducting small-scale clinical trials.
Can we develop our own teeth one day? The National Institutes of Health is optimistic: This summer the agency launched a $5 million effort to build a human tooth from scratch. Scientists have already made some significant progress. Last year, a team of researchers led by Matsutoshi, director of the Drainage Services Administration at the University of Southern California Dental School, used stem cells to engineer a human wisdom tooth in a ligament between a pig's jawbone and the root of the tooth. Similar grass-roots techniques of tissue engineering could replace implants, and eventually scientists hope he will be able to replace teeth that we can use for the rest of our lives.
Dentistry for a better life
Composite is just one of several materials that offer lifelike tooth replacement for patients. All-ceramic crowns have replaced the old model of porcelain, which tended to make krone gray shades of metal. The latest ultra-thin, customized wrong aspects of porcelain veneers do nothing to hide worn-out, chipped or discolored teeth and make them look better. Veneers usually require a dentist to grind enamel from the teeth, so don't be too bulky, but Lumineers, a field cushion company launched in 2005, is half as often as veneers are thin in width without enough mounting to grind.
Cosmetic-like Lumineers are exploding in popularity, with nearly 40 percent of general practices reporting a fifteen percent increase in the number of cosmetic dental procedures performed, such as porcelain veneers, bleaching and bonding smiles. This means that people are surprised by the number of people traveling to the dentist not because they want to, but because they want to. Who, did not expect?