Newark Dental Center

2012 Archived Posts

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    Posted by Gerald Au on Nov. 25, 2012

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    Implant Supported Partial Denture


    This is a partial denture.  One appliance restores many teeth.  There is a metal framework supporting pink plastic and plastic denture teeth.  The partial is removed at night to allow the tissue to rest.  You clean the partial in your hands with soap, water and a denture brush. 

     


    This partial has a clasp to one last surviving tooth.  In the past, this would not be a workable solution and the tooth would be removed.  Imagine a tray of glassware and the strain of holding it with one hand.  Two hands are the minimum, necessary.  Four hands are better.  It’s the same with partials and teeth.  Two large teeth, one on each side, are the minimum, necessary.  Four is better.  In the short term, the patient’s partial comes loose when he’s talking with friends.  In the long term, excessive pressure of the partial causes the bone underneath to disappear and bone is the key to a future denture or implant.   In this case, we do implant surgery and place three implants around the arch.  

     





    The gold tips protruding out of the gums are locator abutments.  The implant is underneath the gums like a root.  The abutment is the second stage on top of the implant.  The locators snap into the red and blue caps found underneath the partial denture, locking it into place, much like the metal snaps on a ski jacket.  Now the patient requires two hands to remove the partial. At case completion, the patient went from being a dental cripple to having a functional mouth.   




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    Posted by Gerald Au on Nov. 24, 2012

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    Dental Implant #30

    When tooth decay becomes large and it extends into the pulp or center of the tooth,  the tooth needs a root canal.  On the x-ray, looking at he lower left first molar, tooth #30, the white lines in the center of the roots is the root canal.  In this case, the root canal has failed.  Around the roots, there is a dark area which represents a chronic abscess.  The abscess is full of bacteria but the body has contained it to the area near the tooth.  Hence, there is no fever or spread of infection to other parts of the body.  Dark areas on x-rays represent air or less dense structures.  White represents dense structures like teeth or metal.  The dark area next to tooth #30 is a hole in bone.  To the right is white oval.  That is a ball bearing that is used to calibrate the x-ray so that we can digitally measure bone heights.



    The before picture shows a lot of tooth but looks are deceiving.  What you see is plastic filling material not solid tooth.  The silver dot is a steel post used for reinforcement.  From a structural integrity standpoint, the long term survival of the tooth is poor because of the risk of cracking. 


    The only solution is removal of the tooth. 


    The tooth is removed and bone is grafted to maintain the width of bone.  If not, then with time, the bone thins.  Implants require a thick mass of bone, at least 6 mm in the width and 10 mm in height.  That’s still like putting a screw inside a chopstick.

     

     


    The implant is placed. The post operative pain is usually gone in a day. We wait 4 to 6 months for the bone to heal and mature.  The image on the left is an x-ray of the implant and a healing collar or a small temporary cap that is screwed on top of the implant. Once fully healed, then a titanium abutment is screwed in and a porcelain fused to metal crown is cemented on the abutment (right image).  



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    Posted by Gerald Au on Nov. 13, 2012

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    Veteran's Day

    Yesterday was Veteran's day. Many thanks to all who served.

     

     

     

    Late last month, my daughter's class went on a field trip to the USS Hornet in Alameda. The Hornet is a U.S. Navy Essex class carrier that served in WW2, Korea and Vietnam and is now being preserved as a museum.  She was 894 feet in length, had a crew of 3400 and carried 100 aircraft.  Our docent who led the tour was a former pilot from the Hornet who flew combat missions in Korea. 

     

     

    Our guide, from 50 plus years ago, is second from the right.

     

    One lasting impression was the enlisted men's quarters. It was like a slave ship. Bunks were stacked 3 to 4 high and end to end. There was just inches separating your face from the mattress above you  and located just underneath the catapults. Good luck sleeping if they were launching aircraft at night. 

     

    The day started out overcast but cleared up by afternoon. Just those 2 hours of sunlight were enough to heat the outer wall or bulkhead. You could feel the heat on your skin as you passed by. Someone thought the heater was on. The rule for sailors was never put your hand on the outer bulkhead or else suffer burns. Now imagine being in the South Pacific with the sun out all day long.

     

     

     

    The class had lunch in the petty officer's mess. One table was permanently set up with an empty chair for the missing man or for those who didn't return back to the ship.

     

    So it was packed, no privacy, hot, loud, hard to sleep and there was a chance you didn't come home. Hard duty but these guys did it.

     

    A thrill to meet an American hero and a moment to remember those who did not return.





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    Posted by Gerald Au on Nov. 5, 2012

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    An Implant from Home Depot

     

    I wanted a new whiteboard in the staff room.  To install, we had to drill holes in the sheet rock. There are a variety of implements to attach items to sheet rock; molly bolts or those plastic bullet shaped plugs that go into a hole.  I throw out the included hardware and get the Twist n Lock, available from the big orange hardware store down the street.  They have a specified retention rating, are easy to install and I have not seen one fail yet.  They are my first choice when it comes to hanging something on a wall.  Make a hole with an electric drill.  Screw in the Twist n Lock.  Use the included conventional metal screw to secure your item into the twist and lock.  Four Twist n Locks can hold a 200 lb. item.




    As Pheng was installing the screws, I noticed that the Twist n Lock was shaped just like an implant.  The screw contour allows for more surface area or more boney grip against the metal.  Dental implants are plasma sprayed with molten titanium giving the implant a frosted texture i.e. even more surface area. 

     

    Why is there such big difference in dental implant prices?  There is a big difference in the cost of an implant depending on whom and where the manufacturer is.   Little players typically undercut the bigger companies on price.  A typical implant case may involve 3 pricey components:  a titanium implant, a membrane, and human cadaver bone.  These things are buried inside the jaw bone.  Things like patient bibs, a single use item, I don’t care what color they are or where they’re from.  Get the cheapest one.  Implants, membrane and bone, I do care.  We buy American.  I’m willing to pay more for reputation and by inference, quality control. I don’t want to put a lemon inside someone body.

     

    During work, I wear a facemask:  the blue cone shape one with an elastic that goes around my head.  With patients, I wear them over my mouth, and when I’m talking I pull the mask out a bit and drop the mask around my neck. This summer, all the masks were breaking during this motion.  All at the same place or where the elastic is joined to the mask on the right side.  Some sort of searing action secures the elastic. With visible inspection, there is no difference between the defective right side and the normal left side. We’ve used the same supplier for years.  We switched; the new mask looks just like the old one but no more problems.  I do not want any of my implants to be in a similar situation: everything seemingly ok at first glance but fails with use.  I want quality control at the factory; follow all the steps, dot the i’s and cross the t’s.

     

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    Thanks to those who responded to our October Patient Satisfaction Survey.  The winner to the drawing is patient Anne S.  Anne is going to have a good dinner at the Elephant Bar.  The odds of winning was 1 in 52 so now you know your odds for the next time.



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    Posted by Gerald Au on Oct. 25, 2012

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    Taking a bite of knowledge

    Last week, I went to the ADA Dental Convention in San Francisco.  It’s an opportunity to listen to a few lectures and get smarter.  I’ve been practicing dentistry for 25 years so the learning curve has flattened out.  Still, there is always something new. In a way, we are teeth geeks.  By knowing more, we hope to fix teeth better, faster, cheaper, and with more durability and more predictability.  With the human body, there’s always a chance that things don’t go according to plan but we hope to shrink that chance to a smaller and smaller number.  As we employ new technology or new research, the work we do today is better than the work we did last year.

     

    The children’s dentistry and the implant surgery talks were good but the talk that was enthralling was the occlusion or “bite” lecture.  The presenter, Dr. Lee Ann Brady, is an expert and that rare, gifted communicator.  A few light bulbs went off when I understood some obscure concepts from a different perspective.  That two and a half hour lecture is going to lead to a twenty hour review as I reread more about occlusion.

     

    Elementary concepts for patients

     

    When you bite, all your teeth are supposed to hit together at the same time with the same amount of force.  After a filling, we sit you up and ask, “How does it feel?”  If you say it feels high, then your bite is off and we sit you back and adjust the filling.

     

    When you‘re at a cheap restaurant, the table wobbles and it’s driving you crazy.  A rational person might bend over; slip a matchbook under the short leg thus stopping the wobble.  (The dentist in the group would have pulled out a drill and ground down the taller leg.)

     

    Again, the teeth are supposed to hit in an even fashion.  If they don’t, there could be trouble like toothache or headache.   The headache might be labeled TMJ dysfunction – temporomandibular joint dyfunction or TMD – Temporomandibular dysfunction or just TMJ.  In the majority of cases, the source of pain is the muscles associated with the joint rather than the joint itself. 

     
     

    Teeth are connected to two joints and muscles around those joints.  You may get “bite” problems if there are bad teeth, bad joints, or bad muscles.  Unfortunately, as you age, things happen, and once great teeth, joints or muscles may undergo changes.  Our job is to keep an eye on those joints and muscles as well as the teeth.  Often, when things go wrong, and there isn’t an obvious reason, it’s a bite problem.  For example, a toothache with a normal x-ray and normal cold test; it might be referred muscle pain to the tooth.  Or porcelain that cracks after a short period in the mouth may be the result of an unbalanced bite. 



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    Posted by Gerald Au on Oct. 22, 2012

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    A Gloomy Day

    One of our staff members is on bereavement leave.  A close relative passed away at the age of 54, suddenly and without warning.  Our condolences to the family. 

     

    A death is a great tragedy to a family, permanent and unchangeable, full of sadness and fears for the future.  The shock of an unexpected death makes you worry, what happens if death visits us?  Are we ready?  Are we prepared? 

     

    In the book of Ecclesiastes: 

     

    The heart of the wise is in the house of mourning,
    but the heart of fools is in the house of mirth.

     

    The house of mourning is that family suffering through a death.  And in that suffering, wisdom might be found.   Funerals are awful with too much sorrow, too many tears.    We hush up the news and shield the event from the children.   However, when sitting through a service, you have no choice but to ponder death and life.

    This year,  a distant uncle passed away.  He had lived into his nineties. He had a good long life:  WWII vet, 2 daughters, 4 grandchildren,  loved fishing.  Remembered by his family for being helpful and handy.  A young granddaughter spoke through tears at his memorial, “he was the best.  He took me fishing and after cleaning the fish, he once let me play with the still beating heart with the gutting knife.”  Isn’t that a great achievement?  A life that passes along on a heartfelt memory to the next generation.     

     

     

    Again in Ecclesiastes:

     

    Rejoice, O young man, in your youth, and let your heart cheer you in the days of your youth. Walk in the ways of your heart and the sight of your eyes. But know that for all these things God will bring you into judgment.


    So in remembrance of those who have passed before us, let us seize the day.  Rejoice and be cheerful.  Let us walk and see the beauty of creation.  Let us value the important things.  And let us consider our life’s purpose deep within our own heart and forget, for a second, Syria, the unemployment rate,  Dancing With The Stars and the weekly sales.   



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    Posted by Gerald Au on Oct. 15, 2012
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    Pretty Teeth for a Pretty Woman

    Here is a gratifying  case that makes you feel  good about being a dentist.  The before and after pictures shows a big difference.  Our rule is if it shows up in your pictures then consider cosmetic dentistry.  Many little defects do not.  These flaws were dramatic:  pointy fangs on a young woman.   Even my colleagues at the implant study club were impressed. 

     

    Emax porcelain veneers from  tooth #7 to #11.  #6  is actually a baby tooth and veneered with composite resin.  She’ll need an implant later. 

     

    Dentists use a numbering system for teeth.  #1 is the wisdom tooth on the upper right side, the next one is #2 and so on until you reach the last tooth on the upper left side, #16.  Go down to the bottom tooth, left side, that’s #17.  Going tooth to tooth,  from the patient’s left to right to the last tooth,  #32. 

     

    Traditionally, the cosmetic zone, or the teeth that people see the most, are the top front 6 teeth or teeth #6 to #11.  Presently, some people may have higher cosmetic requirements and want the top front 8 teeth to be big, white and without gaps.  The wide smile of Julia Roberts needs all her top teeth covered in porcelain. 

     

    The all porcelain restorations are strong and cosmetic.  Even close up photography can be fooled by Emax:   which tooth is natural and which is porcelain?  In dentistry, there is tension between 2 opposing properties, durability versus cosmetic.  In the front, all porcelain restorations are a good choice because of superior esthetics.  In the back, there is more stress or higher chance of cracking the porcelain.  A good choice for back teeth are PFM or porcelain fused to metal crowns.  Brittle porcelain is reinforced with a layer of metal underneath to counter stress and resist cracking.  PFM’s are stronger, are the most durable, good enough to fool portrait photography and still the gold standard for back teeth. 

     


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    Posted by Gerald Au on Oct. 11, 2012

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    Recession. Not the Economic Kind.

     



    Here's a lower tooth or first bicuspid with a cracked silver filling. Notice the divot at the gumline.  That's from years of brushing too hard.  Gums recede or disappear because of injury from brushing too hard or from irritation from the bacteria in plaque.   When the gums disappear, the bone underneath disappears as well.  We're in the tooth business but without bone, there is no tooth. 

     

    There are two kinds of gums next to teeth.  The closest gums right at the neck is pink and tough just like the roof of the mouth.  Farther away are red  tender gums similar to the inside of the cheek. On the right image, see the white line of dashes below the tooth.  That is the  reflection of the flash and it is right on the border of tough gums and tender gums.

     

    In this case, the first bicuspid, because over brushing,  has a limited amount of tough gums. Once the height of tough gums is 2 mm or less, recession happens quickly.   Then  bone loss is more rapid.  

     

    The tough gums here is at 2 mm.    He needs a gum graft, or more precisely, a free gingival graft later.  The after picture shows the composite or white filling I did to repair the biting surface and the gumline.    


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    Posted by Gerald Au on Oct. 10, 2012

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    Squished Pennies

     

    Last weekend was a big weekend in the Bay Area.  The Blue Angels, yacht racing in the bay, Justin Bieber and Madonna, the Giants and the A’s in the playoffs, the Forty Niners creaming the Bills, a concert in Golden Gate Park and more, everyone was here.  The newspaper was talking about traffic Armageddon.   Amidst all that excitement and glamour, we, my family and friends, went to the ……….. zoo. 

     

    From that previous list, the zoo would not be my first, second, third or tenth choice but the big girl wanted to go to the zoo so the San Francisco Zoo it is.  I drove with limited expectations. 

     

    Lunch before the zoo was outstanding.  At the restaurant, we ran into some other friends and the father said “I’m from Shanghai and the food is just like home.  It’s good.”  That pretty much sealed the deal.  The food was five stars good.  So if you want authentic dumplings like they make them in Shanghai and want not expensive, not fancy, tasty, chili sauce on your shirt kind of place then you need to go to the Dumpling Kitchen on Taraval in San Francisco. 

     


    At the end of day, the Zoo was pleasant.  Large magnificent beasts like the rhino, rescued wounded animals that have found shelter,  hungry pelicans catching thrown mice, a sunny day in the Outer Sunset, no crowds, happy people,  being outside made it a worthwhile day.  A highlight (THE highlight were the dumplings) were the squished penny machines.   For 51 cents, 2 quarter and a penny, turn the crank and the penny gets squished into a souvenir to last a lifetime.  It’s better to use a penny older than 1982.  In those days, the pennies were 95% copper.  Now the new pennies just have a coating of copper.  The rest is zinc.  That’s why you might see gray streaks in the squished pennies.   So now the girls have 6 new pennies to add to the 5 pennies from Disneyland and the one from Legoland.  What a country!
     




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    Posted by Gerald Au on Oct. 8, 2012

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    Patient Satisfaction

    This is the inaugural entry for the blog of Dr. Gerald Au.  The point is to provide our patients with a bit more information about why we do things at our dental practice.  As the leader, I spend a fair amount of thought considering new dental techniques as well as managing the office.  New techniques and materials are always exciting to dentists.  All dentists gravitate towards the latest and greatest. The other, albeit necessary, part is the maintenance of our business systems.  Hey, I’m a fix it guy.   It’s neat to see an implant help a person eat and function better.  The business side to that implant is not as fun.



     

     
    In today’s economy, I am looking a little closer at the business of dentistry.  I want the practice to be efficient so we can be here tomorrow.  Hence, I look at articles on marketing, branding and search engine optimization – very foreign stuff.  Reading is easy.  Implementation is hard work.  Sort of like flossing.  Flossing is not that hard, has a big payoff but people still put it off.  Business and flossing - it’s all rather dull but doable,  I suspect I might just end up doing reviews of local restaurants instead.

     
    One new thing we are doing, this month, is a patient satisfaction survey.  It’s one page long.  Patients who participate are entered in a drawing at the end of the month for a $100 gift card to the Elephant Bar restaurant.  Surveys are common with internet stores.  I never fill them out.  It’s unusual to have a survey at the dental office.  Actually, I’m afraid someone will say something bad.  But I hope to use the comments being generated as  a means towards the greater goal which is to build the most  caring, trustworthy and skilled dental office in town.   Actually, the response has been surprisingly good,  there has been a bunch of surveys completed in the first week.  I will announce the winner later on this blog but because of HIPAA privacy law, I will only reveal first name and last name initial. 

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