Smiles by Payet Dentistry – Beautiful Smiles. Lifetime Care

Family, Laser, and Cosmetic Dentistry by Charlotte dentist Dr. Payet.

Sleep Apnea, Snoring, and Dentistry

There is a rapidly growing area of dentistry concerned with treating sleep apnea and snoring.  There’s an important reason for this, too….people who snore and/or experience sleep apnea on a regular basis are at SIGNIFICANTLY higher risk of certain health issues.  I am going to relate a very personal story that I hope will help drive the point home, as well as give you a link to a website that will provide you with FAR more detail than I can provide in this blog.

THE STORY:

My dad turned 63 in March ’08.  Up until that time, he had always been a very healthy individual with no particular health problems.  He regularly traveled the world for his job and had been doing so for many years; he and my mom enjoyed an active life, involved with their church and the arts.  The only problem that had plagued him for a couple years was a nagging cough that simply would not resolve, no matter what he took.  Not just a nagging little cough, but a deep, powerful, and often painful cough that would sap his energy, leaving him drained.

(To interject a bit of dental history: I’d been telling my dad for a number of years that he clearly has a history of grinding his teeth, and coupled with the fact that he had always been an EXTREMELY LOUD SNORER (to the point my mom often kicked him out of bed or slept in another room herself), I’d also recommended he get a sleep study done.  With his travel and work schedule, though, it had just never quite worked out.)

Well, in early 2008 he’d finally had enough of the cough and went to see a pulmonologist.  During a routine visit to see how well a certain medication was working, they noted that his heart rate was at an alarming 140 beats per minute!! Naturally, they immediately sent him to the hospital!  He ended up staying for several days for evaluation.

It ended up taking many months of testing, trying several medications, and undergoing several procedures for his heart and to drain some disgusting and nasty fluid, before they finally got things under control.  One of the most crucial tests of all, though, was a sleep study.  Remarkably, his sleep apnea was SO BAD that the doctors woke him up halfway through the night to put him on a CPAP machine.

Long story short: the doctors determined that his sleep apnea was one of the largest contributing factors to his heart problems, which had led to the lung problems.  Since he started using a CPAP machine to help him breathe at night, he is a different man.  Dad says that he now wakes up and feels amazingly well; he actually feels like he slept well!  He no longer has the rapid heartbeat; his lungs are no longer filling with awful fluids; he sleeps well; my Mom sleeps well; and he’s healthy again!

If you know that you snore loudly; if you’re a man and your neck size is 16.5 or greater; if you often wake yourself up with “snorts” at night; if you always wake up and feel you’ve slept poorly no matter how many hours you were in bed……..these are some of the risk factors/warning signs that should tell you to see your doctor and your dentist.

I’ll talk more about treatments and how dentists can help in the future, but for now, here’s a link you should follow to learn a lot more — QUITE LITERALLY, THIS COULD SAVE YOUR LIFE, AS IT HAS MY DAD’S.  DON’T TAKE A CHANCE:

SnoringIsn’tSexy.com

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January 18, 2009 Posted by | Bruxism & Parafunction, General, General dentistry, Sleep Apnea, Snoring | , , , , , , , , , , , , , , | 1 Comment

Six-Month Braces – Great Results — FAST

We just finished up this case today — doesn’t need much explanation, just that it took about 6 months and the patient was thrilled.  🙂

six-month-braces-case

A dental patient of Dr. Charles Payet in Charlotte, NC, who's thrilled with her smile after 6-Month Braces.

January 12, 2009 Posted by | Cosmetic dentistry, Short-Term Orthodontics | , , , , , , , , , , , , , , , , , , , , , , | 1 Comment

What hides under old silver fillings?

As I’ve mentioned, there are 2 basic “philosophies” of dental care, although I didn’t really spell them out.  They are (approximately, please understand!):

1) Watch and wait until it it actually hurts or breaks,

OR

2) Diagnose and recommend treatment BEFORE it actually hurts or breaks.

As a general rule, at Smiles by Payet Dentistry, we follow the second philosophy.  The key to remember, though, is that it is ALWAYS up to YOU to decide when to actually proceed with treatment.  I’ll show you what I see by digital photography and x-rays, give you my recommendations, and then it’s up to you to decide what to do about them.  We understand that the treatment has to fit into your life – your budget, your schedule, your priorities.  I give you my word — I will NEVER pressure you into doing any treatment.  I MAY make some very strong recommendations and urge you to proceed with treatment so that you avoid pain, loss of teeth, or other complication, but it’s still your decision, and we promise to respect that.

One of the tricky parts of dentistry is this: we can’t see through old fillings and crowns and bridges, not even with digital x-rays, digital photography, not even with the Zeiss PICO dental microscope that I use.  We can only see things AROUND them.  And quite honestly, as much as I believe silver amalgam fillings are a perfectly acceptable treatment, I also believe that they hide a multitude of evils.  I already showed you the cracks that are often associated with big, old silver fillings, especially in patients who grind their teeth.  What I didn’t show you, though, is how much decay (cavity) can be hidden from us by old silver fillings.  They may not hurt, but it is not uncommon for there to be so much decay under them that a root canal becomes necessary when it’s all removed — and often times it can not be seen on x-rays!  This makes it frustrating for patients, can’t understand why we recommend replacing a filling with a new filling or a crown.

So along with examples of the beautiful dentistry that we provide, I’ll also regularly show you the problems we often encounter when treating teeth, which should help you, the patient, better understand the WHYs of our recommendations.

A perfect example: This lady had these fillings for many years, probably over 20.  The molar had just recently started bothering her a little with sensitivity to cold and sweets, but nothing serious.  The main reason she wanted them replaced was for appearance, though — the greyish color really showed through on the front of the teeth.  You’ll see that they don’t actually look all that bad to an untrained eye.  After seeing thousands and thousands of them, though, I had some idea of what to expect……..but even I didn’t expect the problem to be so extensive.

whats-hiding-under-old-silver-fillings-11

Oh YUCK!  See all that black crud?  That’s decay — mushy, soft, and definitely NOT healthy.  And this is fairly normal to find under 20+ year old fillings, to tell the truth.

whats-hiding-under-old-silver-fillings-21

whats-hiding-under-old-silver-fillings-31

whats-hiding-under-old-silver-fillings-41

Just some food for thought: maybe your dentist has recommended some treatment, perhaps to replace those silver fillings that have been there for 20-30 years, and maybe they’re not even bothering you, so you think, “Nah, I’ll just wait, doc.  Thanks but no thanks right now.”  Consider this: another 6 months, and this lady probably would have needed at least 1 root canal, maybe even 2.  Not only would that have required more time, possible a lot of discomfort, but probably would have added another $1500-2000 in treatment costs.

Do you really want to wait?

January 12, 2009 Posted by | Dental Philosophy of Care, General, General dentistry, Restorative dentistry, Why Dentistry Fails | , , , , , , , , , , , , , , , , , , | Leave a comment

Digital photography & patient communication

In today’s world, when dental patients are increasingly savvy about dental care, but also increasingly worried that they’re being taken advantage of, developing the critical trust between a patient and our team is occasionally difficult.  This is where the power of digital photography is so evident, and why I recently wrote about it on my photography blog (http://cdpayetphotography.wordpress.com), because communication is so much easier, and trust is so much easier to establish when you – the patient – see everything that we see.  That’s one of the reasons that we document our work so extensively with Canon Digital Rebel XTi’s.  Of course, the other reason we do is because we are proud of our work and love to show off what we can do to serve you and help you keep your teeth for your life.  🙂

Yesterday was a perfect example (although this patient has been with us for some time and we’ve already established that trust, plus she was having some pain).  This old silver filling had provided many years of use for Mrs. X, but she was having off-and-on soreness and throbbing and wanted it looked at.  When we took the picture and showed her the tooth, it was easy for her to understand why it was bothering her, as well as why we recommended a crown to save it; a root canal may well be needed, too, but we’re keeping our fingers crossed for her that she won’t.

Remember my last post about cracked teeth?  Take a look at this tooth — SEVEN CRACKS!  No wonder it was hurting.  It’s almost a miracle that the tooth had not split in 1/2, to be honest.

another-cracked-tooth-1

another-cracked-tooth-2

And this is how the tooth looked after we’d shaped it for a crown (which we’ll make with our CEREC CAD/CAM system); the crack extends well below the gum line and very deep into the tooth from both sides.

another-cracked-tooth-3

If you ever have questions about the treatment that’s being recommended — ask to see pictures.  X-rays are often very inadequate in diagnosing these problems.  The cracks that are so evident here do NOT show up on x-rays; they’re too small.

Digital dental photography — the PATIENT’S friend.

January 8, 2009 Posted by | General dentistry, Why Dentistry Fails | , , , , , , , , , , , , , , , , , , , , , | 2 Comments

Silver (amalgam) fillings: still a good choice in 2008

For many years, the dental profession has been moving away from gold and silver restorations to composite (plastic) and porcelain/ceramic restorations.  However, they are not always the smartest options for certain circumstances.   While there is a lot of misinformation out there about the alleged dangers of (mercury) silver fillings, here’s the simple truth: Silver fillings are perfectly safe, and there is not ANY reputable research by any reputable organization that has shown that the mercury from the fillings causes ANY harm.  PERIOD.  All that misinformation is simply that – misinformation.  ‘Nuff  said.

When do I recommend silver fillings?  There are just a couple circumstances in which I actually recommend silver fillings instead of a tooth-colored restoration (composite or porcelain):

1) Patients who have high rates of decay; IOW – anyone who seems to get cavities frequently no matter how hard they try to care for their teeth.  These include patients with acid reflux, who drink a lot of sodas, who are on medications that dry up their saliva, who have recently been through radiation treatment of the head/neck, or similar conditions.  In my experience, while there are steps that can be taken to reduce that risk, silver fillings last longer with fewer problems.

2) Patients who grind their teeth and who do not wear a nightguard.  Again, in my experience and in a fair amount of current research, composite fillings do not last as long.  While the ability of composite fillings to withstand significant wearing forces is definitely improving, in the teeth of patients who really grind, they’re just not there yet.

3) Patients who need a lot of work and need to stage it over time: in our practice, silver fillings are still less expensive because the material is less expensive.  We still take just as much time as necessary to restore the tooth as with a composite filling, but we believe it is fair to pass on the savings in cost to our patients, because that helps make dentistry more affordable.

And the thing is, while old silver fillings can look pretty ugly and flat, properly-placed new silver fillings can look extremely natural, just not tooth-colored.

Here’s an example of a silver filling that’s probably been in place 20+ years:

old-failing-amalgam

Here’s what 2 shiny new amalgams can look like:

amalgams-are-good-too

So while  most patients still prefer tooth-colored restorations, there really isn’t anything wrong with silver fillings, and under some circumstances, they can be a better solution for some patients.

December 22, 2008 Posted by | General dentistry | , , , , , , , | 13 Comments

   

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