J. Peter St. Clair, DMD Blog

If you have read these columns in the past, you have seen me write about periodontal (gum) health and its relationship to systemic health. There is a slew of scientific evidence that poor periodontal health is not good for you systemically. It has been linked to heart disease, stroke, low birth weight babies, diabetes and more.

Gum tissue health is an easy thing for patients to be lax about, or even ignore. Why? The main reason is that gum problems do not hurt, unless they are so severe that tooth loss is inevitable. It is the chronic inflammation in the gum tissue, regardless of whether it hurts or not, that has the potential to affect your teeth and your general health over time.

How many times have you been to the dentist and heard, “Mr. Smith, you have a lot more bleeding than you should around your gums”? You then respond by saying, “My gums don’t bleed when I brush.” And you hear, “You need to brush better.” Then it happens all over again the next time you are at the dentist.

If the goal is to keep your teeth and strive for good health, the scenario above is totally insufficient. We, dentists and patients, need to change our frame of mind about tissue health and really focus on the fact that chronic inflammation, anywhere in the body, is bad.  Tissue health is achievable in every single person. It is a matter of changing our views on what is acceptable and what is not acceptable that can make a difference.

Patients love dentists who say that everything looks fine. Sometimes that is the case. However, most of the time there is room for improvement. If there were things in your mouth that could be healthier, would you rather have a dentist say that everything looked okay, or one who made suggestions for better health? Keep an open mind and be willing to put the effort in to make a healthier you.

The oral cavity and the gum tissue around each and every tooth is a haven for bacteria. Everyone has bacteria. It is how well the bacteria are controlled that determines tissue health. Patients typically do not want to hear that they need treatment. If you went to the physician and you had signs of heart disease, would you rather hear, “Mr. Smith, you have signs of heart disease. Let’s wait until you have a heart attack and then treat it.” vs. “Mr. Smith, you have signs of heart disease. These are the things that you should do to help prevent the progression of the disease. Let’s work together on lowering your risk of problems in the future.”

I have said it before and I’ll say it again – the best thing you can do for yourself when it comes to your dental health is regular maintenance. Depending on a person’s needs, regular maintenance might be once a year for some, but every 2-3 months for someone else. Even if you have no dental benefits and are worried about needing a bunch of dental work, the best thing you can do for yourself is regular maintenance. Many dental offices have plans that are very reasonable to help you achieve better dental health.

The mouth is the gateway to the rest of the body – don’t ignore it.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

I attended a continuing education course a while back entitled “Hit Man or Healer?” The course was given by a well-known leader in the dental profession. The basic premise of the course was the notion that we have a lot more science, studies and data available today to be able to make better decisions about the treatment that we dentists recommend to patients. The concept is called evidence-based dentistry.

The idea is that if a very structured examination and diagnosis is done, treatment recommendations can be made based on science. The problem is, all too often the diagnosis leads to suggestions that without the proper dialogue can make the dentist look like a “hit man” (ie. patient perception of over-treatment) vs. “healer” (intervention with the intention to preserve the teeth better for the long-term).

The lecturer started by putting an image of a person’s teeth on the screen and asking the audience to guess how old the person was. My father and brother are veterinarians. They use the appearance of teeth to estimate an animal’s age. Although it is relatively easy to estimate a person’s age during transition from the primary teeth to permanent teeth, it is apparently a little more difficult when all the permanent teeth are in. I guessed the age of the patient on the screen to be between 50 and 60.

The patient had great looking teeth. You could tell the person was a mature adult by the darkening of the teeth, but there was very little wear and very minimal dentistry. The patient ended up being 94 years old, which was more evident when her full face was projected on the screen…..although she looked great in general for 94. The lecturer said, “Is this the way teeth should look at 94 or is this woman a freak of nature?”

While there are definitely genetic factors that may play a role, many of the problems we see today with teeth are 100% preventable. For example, dental decay is 100% preventable. However, it is still not uncommon today to have a patient (maybe a teenager or an older person on multiple medications with dry mouth) come in for a routine dental hygiene appointment and be told they have decay, or multiple areas of decay, which were not present 6 months ago. In that scenario the dentist would be considered the “hit man”.

The “healer” may have taken a different approach, and may have done a more thorough evidence-based evaluation and made recommendations based on diet, homecare habits and maybe even familial history that could prevent the decay in the first place. Dentists have gotten good at telling patients how they can “fix” the problem, but need to consider changing their thinking and get more training in how to “prevent” the problems we see today in dentistry.

Many of the basic principles learned in dental school are used on a routine basis. However, there is continuous new data emerging that we as health care providers need to expose ourselves to and decide on what and how to implement for the benefit of our patients. I hope to see major advancements in our approach to oral health care in my career. There is no reason you can’t live to 94 and have a great set of teeth.

As I have said numerous times over the last few weeks, and you will hear it again next week too: Unfailing routine professional maintenance is a key factor in achieving and maintaining dental health. Don’t just hope you’re a freak of nature.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

If you missed Part 1 and/or 2 of this series, you can find it at www.thetowncommon.com.

I have been writing the past couple weeks about the growing evidence that links oral and systemic disease, and the need for more collaboration between dentists and physicians. All of this, of course, is in the best interest of the patient.

The discussion has been primarily about gum disease and its relationship with systemic disease. The body is a complex system – and everything is connected. In addition to the need for dentists and MD’s to collaborate more on the oral/systemic connection, we also need to collaborate better about our patient’s sleep problems. 

As part of a comprehensive approach to care, we screen for sleep issues with our patients. it amazes me how many people have issues with their sleep. It amazes me even more when I learn that many of these people have never even had a conversation with their doctor about sleep. Experts in sleep medicine agree that there is much room for improvement in this vital part of our health care.

Periodontal issues and sleep are just two areas where more information should be shared between dentists and physicians. We have to be open to the fact that everything is connected, and needs to be taken into consideration when we are trying to diagnose, monitor, or solve our patient’s problems.

For example, I had a patient in last week who has been a patient of mine for about 7 years. I noticed in the patient’s notes that bruxism/grinding had been discussed at most hygiene appointments in the past, due to the noticeable wear patterns on the patient’s teeth. There was also a quote in the notes several times stating that the patient would never wear a dental appliance at night.

As I did my exam I kept thinking to myself that there must be more to the story behind this patient’s dental issues. It happened to be around our lunch break, so I asked the patient if she had a few minutes for us to talk. She seemed interested in what I had to say. I photographed her teeth to compare them with photos taken 7 years ago. We talked for an hour.

Aside from learning that the patient was on 7 medications for the past SEVEN years and had never reported any of them to us, I also learned that the reason she was also resistant to wearing something to protect her teeth at night was because she had sleep issues. She felt there was no way she could handle the extra stuff in her mouth. I also learned that both of her parents are treated for sleep apnea.

So, here are some bullet highlights from the past 3 weeks:

1. Periodontal (gum) disease is bad. Just because it doesn’t hurt doesn’t mean you don’t have a problem. If you care about your general health, you must take care of your mouth.
2. Delaying care of dental problems always leads to more treatment and more cost.
3. Don’t leave information out when discussing your health with your doctors. Everything is important.
4. For better patient care, doctors and dentists should have more collaboration.
5. Time is the most precious gift a health care provider can give their patients.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

If you missed Part 1 of this series, you can find it at www.thetowncommon.com.

I ended last week with a statement that I have used numerous times before – just because it doesn’t hurt doesn’t mean there isn’t a problem. We keep learning more and more about the link between the mouth and the rest of the body. It is essential that dentists and physicians do a better job at co-managing patients, and learn more about the relationship between oral and systemic disease.

It is clear that if you want to take better care of yourself, you need to take better care of your mouth. Familial history is very important. If you know of any family history of dental problems, you are at higher risk. Higher risk individuals need to be treated differently, and may need a more aggressive preventive protocol to help ward off progression of disease. In addition, an otherwise healthy person who presents with a sudden increase in gum inflammation should possibly be evaluated by their physician to rule out any systemic causes if there is not a simple explanation for the change.

Salivary biomarkers are among the tools being researched to help determine the particular disease path that a person is on. Although in their infancy, this precision approach to the prevention and treatment of periodontal disease accounts for variability in a person’s genes, environment, and lifestyle. Because it is more personalized to the individual, it results in more accurate treatment planning, as well as improved outcomes for the patient.

Considering the aging population, periodontal (gum) disease has the potential to become the most prevalent dental disease in the near future. It is more important than ever for dentists to take the time to develop and incorporate a comprehensive periodontal examination and treatment protocol for adults.

As with most diseases, delaying the treatment of periodontal disease until the advanced stages results in treatment that is more expensive, more complex, and less predictable. Most early to moderate stage disease can be treated in a general dental office if the inflammation is easy to control, the patient doesn’t have numerous systemic issues, and is determined to do their part at home. If all these things have been done without resolution, or if the periodontal disease is more severe, it may be in the patient’s best interest to be referred to a like-minded periodontist. A periodontist is a specialist who treats disease of the gums and bone that support the teeth.

When half of the US population is still affected with periodontal disease, despite decades of research and treatments, something is still missing. That missing key is a more collaborative approach involving, dentists, periodontists and physicians.

….and remember, just because it doesn’t hurt doesn’t mean there isn’t a problem. To be continued.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

The connection between oral health and systemic health is well-established and ever-evolving. One thing we know for certain; we are living longer, but with more chronic diseases and medication than ever before.

The latest statistics are alarming. Forty-seven percent of US adults who are age 30 or older – an estimated 64.7 million Americans – have either mild gum disease (8.7%), moderate gum disease (30%) or severe gum disease (8.5%). As the population ages, the prevalence rises with 70% of individuals over the age of 65 exhibiting some level of gum disease. And, since we are on statistics, by 2030, it is estimated that the number of people over 70 years of age will have doubled from 35 million to 71 million.

So, as we age, our risk of developing disease increases. Interestingly, there is also a direct correlation between the regions of the US with the greatest concentration of gum disease, and those that have a high incidence of cardiovascular disease and diabetes. Although a direct cause-and-effect link is still in the process of being established between gum disease (periodontitis) and other systemic diseases, inflammation is often a common denominator. And it is always important to remember that the mouth is the gateway to the rest of the body.

We used to think that if people didn’t brush their teeth well, or didn’t visit a dentist often, they would automatically get gum disease. However, there are patients who have poor home care who never develop gum disease, and there are also patients who have great home care, visit a dentist regularly, and continue to experience breakdown from gum disease – albeit at a slower rate than they would if they had poor habits.

We now know that managing gum disease and other chronic inflammatory diseases like cardiovascular disease, diabetes, respiratory disease and arthritis are more patient specific based on an individual’s “inflammatory mediators”. These are molecules released by immune cells and are largely responsible for individual responses to disease susceptibility and progression. This is why probiotics are likely to play a significant role in treatment of chronic inflammation in the future.

As we wait for research development for different ways to combat chronic inflammation, it is without dispute that people should do all they can to minimize inflammation in the mouth. The mouth is very accessible and with proper training, coaching and monitoring, a healthy mouth is better for your whole body.

Although some may say that the associations between gum and systemic diseases are statistical by nature, not causal, the data is fairly strong that there is a link between gum disease and cardiovascular disease – such as heart infarction and stroke.  This supports diagnosing and treating oral infections, including lifelong professional maintenance and good home care.

Remember – just because it doesn’t hurt doesn’t mean there isn’t a problem. More next week.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Our lives are a series of choices. If we feel we don’t have a choice in a particular situation, think again. We usually do have a choice because our actions are based on how we think. How we think is a choice. While not necessarily easy, we can choose to think differently. 

I am going to use dental insurance as an example, since this is supposed to be a dental column. Dentists hear all the time, “My insurance only covers ____”, or “My insurance says they don’t cover that”, or “My insurance company says I can only see a dentist on their list”, or “I can’t do that because I don’t have insurance.” The response that most dentists think, but are usually afraid to say is, “Who is in charge of your dental health, you or your insurance company?”

The first thought you may have when you read this is about money. “If my insurance company doesn’t cover it, I guess I can’t do it.” While you may think you cannot “afford” something, it is a choice. There are varying degrees of dental health. Maybe everyone can’t “afford” optimal care; crowns on teeth that need the protection, esthetic enhancements, replacement of missing teeth, etc., but basic dental care to improve your health is available to everyone. If you are committed to better dental health but have not found that to be true, you are not looking in the right place.

The money barrier to getting the care you need evokes emotions. Emotions in and of themselves have no real value; they are neither good nor bad. They are just sirens alerting us to something we should pay attention to. If we learn to listen to them instead of blindly obeying them, they can be very good teachers. If money evokes a negative emotion when it comes to dental care, it is because you know your dental health is important. You need to make the choice for better dental health, and find the place to help you overcome the barrier of money, or anything else that is holding you back.

I am sure you are aware, especially if you have read these columns over the years, that medical insurance and dental insurance are totally different. Both are broken systems, in my opinion. The fact of the matter is, we (who are ultimately responsible for our own health), have to see it like it is now. We can’t “afford” to wait for politicians and insurance bureaucrats to “figure it out.” Dental insurance has continued to get worse since its inception over 40 years ago. What are we waiting for?

I certainly do not have the answers to fix the problem.  While we wait for everything to miraculously change, you have the freedom to choose what is best for you. It would be nice if you had dental insurance that allowed you to go to whoever you wanted, and get the things done that you need (or want) without asking permission from the insurance company. Can you wait for the system to change? Regardless of insurance, whatever is holding you back, you can change the way you think about dental health.

I am sure this column produces different “emotions” for different people. I would love to hear your comments so I can address them in another column.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Contrary to what many denture-wearers believe, dentures require regular maintenance, including relines, repairs, and replacement. In fact, the average denture should be relined every two to three years and replaced every five to seven years for the most optimal fitting prosthesis. There are many reasons for this maintenance interval and for regular dental examinations, whether or not the patient perceives any problem.

The first problem has to do with the basic function of the bone surrounding natural teeth. Natural teeth are held in their sockets by thousands of “cables”, called the periodontal ligament that tug and pull on the supporting bone during function. The bone is designed to be strengthened and stimulated in this manner. When the teeth are removed, the bone no longer has appropriate stimulation, and shrinkage occurs unless it is directly loaded again with dental implants. Bone atrophy is accelerated by inappropriate forces caused by loose and ill-fitting dentures.

Relining, or replacing the tissue surface of the denture, helps preserve bone by adapting dentures to the gums as they shrink, but it is only helpful for dentures that are otherwise in good condition, which includes a proper bite relationship. Relining also helps to encourage health of the soft tissues because dentures plastic is porous and becomes heavily laden with bacteria and yeast over time. Relining refreshes the tissue surface of dentures with new acrylic. Sometimes a more advanced type of relining, called rebasing, is the treatment of choice when all of the pink portion of a denture is in poor condition and needs to be replaced.

New dentures should be made when relining or rebasing of dentures can no longer re-establish proper fit and function. Often this is obvious by wear or fracture of the denture teeth. When dentures contribute to headaches or when the patient’s face begins to look “collapsed” or “old”, the need for new dentures is likely.

Lastly, but certainly not of least importance, denture wearers need to stay current with regular dental examinations for inspection of not only the dentures but the tissue for pre-cancerous lesions. Since most people feel they do not need to go to the dentist once they have dentures, many early pre-cancerous lesions are missed.

Everyone is at risk for oral cancer, whether they have teeth or not. In fact, the constant “trauma” and lack of blood circulation caused by chronic denture wear increases the risk for oral cancer development. For this reason alone, annual dental examinations are recommended for denture wearers.

Many patients with older dentures report their dentures fit fine. You can relate this to the fit of shoes. Shoes get broken in over time and seem comfortable. However, the fact is, over time shoes lose their ability to provide proper support. Even though they may be comfortable, they may be causing other problems due to this lack of support.

If you are a denture wearer and have not seen a dentist in a year or more, it’s time to consider a dental visit. Learn about how your dentures are fitting and whether relining or replacing them makes sense. For most, it is also never too late to consider the benefits of dental implants to help preserve bone and secure dentures in place.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Disease is defined as, “a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.” Symptoms are those which are felt and signs are those which are seen. Disease may show signs but no symptoms. Two areas dentists see signs of, often without symptoms, are bruxism (grinding)/clenching and GERD or gastroesophageal reflux disease, causing chemical erosion of the teeth.

Some people present with symptoms relating to these two issues, but more often than not, people do not have symptoms. Dental patients who present with signs of tooth wear or acid destruction are riskier to treat. Riskier because the “issues” are often times, and maybe even most often, not treated. This is a significant reason for tooth structure breakdown and shorter life-span of dental work.

However, that’s not really what I wanted to highlight in this week’s column. There are many reasons why people have these two issues. Sometimes these problems are preventable with simple lifestyle changes; other times they need more aggressive treatment because they are coming from the central nervous system or related to something else going on in the body. They can also be caused by certain medications.

In today’s world, everyone is being pushed to their limits in just about every aspect that you can imagine. More is demanded with less time to accomplish. All this can become a source of stress, anxiety and even depression.

This “epidemic” spurred the development of newer medications with fewer side effects to help manage these conditions and hence, the SSRIs (selective serotonin reuptake inhibitors) were born in 1988. Since then, recent reports show that the use of the SSRIs (i.e. Paxil, Zoloft, Prozac, Celexa, Effexor, etc.)  has increased more than 400 percent!

Dentists see the signs of bruxism or clenching/grinding of the teeth on a regular basis, and some of it is the result of stress and anxiety. But another factor that we have to keep in mind is that patients are now taking more anti-anxiety and antidepressants than ever before in history. It is often overlooked, but the SSRIs and even some of the SSNRIs (Selective Serotonin Norepinephrine Reuptake Inhibitors) often increase bruxism or clenching and grinding effects at night.

This leads to patients having an increased frequency of headaches, jaw pain and other symptoms of clenching/grinding. I have seen many patients who have presented with increased frequency and intensity of symptoms shortly after the patient starts on these medications. I have found that sometimes a change in medication or reduction in the dosage with the help of the prescribing medical doctor can help.

Sleep can also be affected by all this clenching/grinding going on. Again, symptoms may or may not be present. Dental splints, or orthotics, which are custom-made to treat specific issues, are very underutilized. Often times, patients try generic mouthguards or nightguards with poor results. The right appliance, splint, brace, or orthotic, can make all the difference in the world. 

You should certainly discuss any symptoms you have with your dentist and physician. If you don’t have any symptoms but your provider can show you evidence of disease, be open to digging deeper to try to determine the underlying cause. Everything is connected.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

There have been lots of changes over time in the materials used to restore teeth. Many of the materials I use today were not in existence when I started to practice. The most significant changes have been to materials that are tooth-colored.

There are very few patients who ask for gold or silver fillings any more. And, while some of these newer materials are tooth colored, there are factors which need to be considered in determining what material is appropriate for each individual situation. The longest lasting restorations I have ever seen are gold done by dentists who really knew the art of working with gold.

As I said last week – The best dentistry is No dentistry. Prevention of decay and other factors that require teeth to be restored is the best defense to not needing restorative dental work. Keeping up with maintenance cleaning appointments and listening to your dental team’s recommendations regarding diet, homecare and other forms of prevention, such as nightguard use, is key to avoiding many dental problems.

One of my favorite quotes in dentistry comes from a pioneer dentist who was killed in a plane crash back in the 1970’s named Bob Barkley. Aside from being the one who said “The best dentistry is No dentistry”, he also said, “The goal of dentistry is to make the patient worse at the slowest possible rate”. I think about this quote all the time when making recommendations and treating patients. Sometimes it leads me to recommend more extensive treatment, and other times it leads me to not recommend any treatment at all, even despite apparent need. It really depends on many factors.

Dr. Barkley also coined the phrase “co-diagnosis” which refers to the patient taking an active role in their dental health. It is the role of the dentist to not only educate the patient on their specific situation and different options for care, but to also extract (pun intended) from the patient their goals for their dental health. It is so important to think beyond the immediate fix sometimes. Taking the time to talk to patients about why things are happening, and about their choices for prevention and treatment, allows patients to become active participants in their health.

There are barriers to this model. One of the biggest issues facing both dentists and patients today is the role of patient’s dental benefit companies. The trend is less costly plans with fewer benefits and restrictions on providers, because to get the maximum (or sometimes any) benefit, the patient must seek a participating dentist provider. I would encourage staying away from any dental plan that forces you to see specific providers. You should always have a choice.

My simple suggestion is to take a more active role in your own dental health. Think forward and ask your dentist or dental hygienist about things that can make your situation worse at the slowest possible rate. You very well may be doing fine, or just need a couple of tweaks to your home care regimen. Find a dental team that listens to your concerns and takes the time necessary to establish a plan that makes sense and you are on board with.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Dentistry is full of old, new, and emerging technology. For example, the different ways to use dental implants over the last 30 years has been a major game changer in the field of dentistry. Likewise, CAD/CAM technology (computer-aided design and manufacturing of dental restorations) has seen steady growth over the same 30 years. Here is a little background on the some of the reasons this technology is here to stay.

Let me start by saying that the best dentistry is NO dentistry. Prevention of decay and other destructive things that happen to teeth is the best line of defense. Having said that, the fact of the matter is, there are many people who need things done to their teeth to preserve them for their lifetime.

Dental amalgam (silver filling) was introduced to dentistry well over 100 years ago. It proved to be one of the major contributors to saving many teeth that were in need of repair. Dental amalgam is a very hard material which can last for many years. However, there are many aspects of dental amalgam that are undesirable. It is ugly, tooth preparation needs to be more aggressive to retain it, the material breaks down over time, and it contains mercury. Dental amalgam is not used in most of Europe and has been dying a slow death in the United States over the last 30 years.

Progressive dentists, who were interested in providing better, longer-lasting dentistry, learned the skill of using gold. Despite the way you feel about gold in your mouth, done well, gold is still one of the best, most biocompatible and longest lasting materials used to protect teeth. Gold has also been dying a slow death mainly due to the fact that patients prefer tooth-colored restorations.

Then composite resin was introduced. It started as a filling material used to fill cavities on front teeth and eventually evolved enough to be used in back teeth. Dental composite, an ultraviolet light-cured resin, is the main direct restorative material used in dentistry today. It has become the amalgam replacement. It is relatively esthetic, chemically bonds to tooth structure, and allows for much more conservative tooth preparation. However, it is much softer than natural tooth structure and therefore has its limitations.

Dental amalgam and composite are what we in dentistry call direct restorative materials. This means that a cavity preparation is made and the material is directly placed in the tooth. This is different than gold or porcelain which are considered indirect materials. These are manufactured and then cemented or bonded to tooth structure.

When a tooth needs a larger filling, specifically one that needs to cover the cusp of a tooth due to fracture, risk of fracture due to cracks, or has undergone extensive destruction due to decay, direct materials like composite are not indicated due to wear factors. Indirect materials are more appropriate and are much longer lasting.

The advantage of CAD/CAM is the ability to provide stronger, esthetic, indirect materials in addition to being more conservative in tooth preparation. Next week I will continue this subject with the specific uses of this technology.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com