AI in Dentistry – A Good Thing.

Posted on Jul 05, 2023 by William J. Claiborne, DDS MS

I remember when microwave ovens first appeared on the market. My mom wouldn’t even go near one in operation. Now, we know how to use them and the good things that come from their use.

Shoot forward 50 years and, like it or not, AI (artificial intelligence) is here. Self driving cars and round vacuums that move along floors are no longer Jetson-like imaginings. They’re blending into our lives in ways that are beneficial and non-threatening.

Like the microwave oven easing its way into day-to-day living, it’s logical that some people fear AI as a bad thing. After all, movies made decades ago prompted a vision of robots meandering among the human race as a new, threatening species.

As an Asheville periodontist, I’ve already seen – and incorporated in use – the positive aspects of breakthrough technology. Understanding its detection capabilities and accuracy, I’m particularly excited about the potential AI brings to the medical and dental fields.

You may be surprised to know that dentists are already beginning to turn to AI technology to quickly and accurately detect and prevent periodontitis, decay, bone loss and other gum health issues.

For example, a medical technology company in Boston has developed an AI platform that can assess X-ray images to an extent of over 50 times what can be detected by dentists through visual reviews. This allows dentists to give more effective treatment recommendations for patients while supporting the potential to avoid (or minimize) existing problems from developing or worsening.

For patients, AI assessments can also be reassuring. For those who anticipate particular treatment needs – a root canal, for instance – these assessments can zero in on exact issues so treatment planning is as conservative and as minimal possible, while being fully effective for the particular need.

Not just in medical and dental offices, but we’ll likely see AI used mainstream in many sectors. It can optimize accuracy in organizational materials, financial and budget projections, construction, farming, etc. For those of us in the periodontal dental field, AI has a vast potential to greatly improve the oral – and overall – health of our population.

Gum disease affects over 47% of American adults. With the help of AI, we can identify a higher percentage of cavities in earliest development stages while cutting the rate of misdiagnosis in half (thus curtailing over-treatment, in some cases). AI analysis will also aid in early detection of abscesses, lesions and oral diseases. It can prove to be a remarkable asset in catching oral cancer, helping to increase its poor survival rate or minimize the severity of treatment.

Through decades of research and extensive studies, keeping good oral health has been shown to be a supporting factor in good overall health. By keeping the “bad” bacteria in the mouth to manageable levels, the immune system operates more efficiently. Too, risk of medical complications from diabetes, heart disease and other illnesses can be significantly decreased.

It is suspected that many people are unaware that they even have periodontal (gum) disease, mainly because gum disease often begins with no obvious symptoms of its presence. Then, once symptoms appear (such as seeing blood in the sink when brushing), people may shrug this off as normal, or merely a sign they are being thorough in their brushing technique.

Gum disease is a particular problem for our aging population. The normal aging process dries out our hair, skin, and yes, the mouth. When the mouth is dry and saliva flow is insufficient, bacteria accumulation is more likely. This, in turn, provides a more welcoming environment for bacteria growth.

Too, many medications on the market – both prescription and OTC – have a side effect or oral dryness. This is double trouble for seniors, who already have “dry mouth” to combat. However, for people who smoke and/or are consumers of caffeine, they fall into this risk group as well.

Caffeine is present in coffee, tea, most colas, and (darn!) even chocolate. It can be in high concentrations in things like energy drinks and “power” bars. Caffeine-fortified foods can surprisingly include marshmallows, some cereals (and breakfast bars), jelly beans, gummy bears and frozen waffles.

Although AI will be an added perk to diagnosing oral health problems, it is the dentist and the patient together who have much more important roles. While regular dental check-ups help to remove existing buildup on teeth (known as plaque, which can harden into tartar), at-home care is what helps to prevent problems between visits.

It is first important to know the signs and symptoms of the various stages of gum disease. Warning signs include:

• Red, swollen, or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or eating hard food
• Gums that recede or pull away from the base of teeth
• Loose or separating teeth
• Pockets of pus between gums and teeth
• Sores in the mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

The dentist-patient relationship can never be replaced by AI. Once you find a dental office where you feel respected, comfortable, and have total confidence, technology itself is merely an add-on.

If you have not had regular dental care or feel you have symptoms of gum disease (as listed above), it is recommended that you renew your commitment to your smile and your overall health with a complete periodontal dental examination.

During this time, your periodontist will note any areas that are diseased or at risk of developing such. He or she will explain recommended treatment and discuss a comfortable pace for your individual needs. Payment plans can also be discussed after determining the type of treatment most appropriate for your care.

If dental fear or anxiety has kept you from regular dental care, our NW Carolina periodontal dental office has a reputation for helping adults overcome the obstacles it can pose. Please share your concerns prior to or during your examination appointment. We offer several comfort options (in addition to our reputation for a gentle touch) and can explain what may be best for your care. We offer oral and IV sedation (twilight sleep), which are administered safely and with advanced monitoring equipment.

Too, our vast array of advanced technology often helps to minimize treatment while optimizing comfort. Please learn more about these features at: BiltmorePerio-Technology

We can’t stop progress, nor should we resist it. While most anything can be used with ill-will, I see AI in dentistry as a positive part of providing exceptional oral health to our patients – and our adult population!

But first, we must get you into the office. And that’s your decision. We don’t have technology to coax you in and hope you will take that step on your own before problems force you into a dental chair (which is often the case, unfortunately).

Call 828-274-9440 for an appointment or to have your initial questions answered.

Sources:

https://www.perio.org/for-patients/gum-disease-information/

https://www.foxnews.com/health/ai-helps-dentists-catch-cavities-gum-disease-unbiased-gives-more-accurate-diagnoses

 

Amazing Technology In Treating Gum Disease

Posted on May 09, 2023 by William J. Claiborne, DDS MS

Recently, an episode of the CBS News’ television program “60 Minutes” provided an in-depth update on the development of prosthetic limbs. Now “robotic” in description, advancements are making it possible for people with spinal cord injuries and amputations to control prosthetic limbs with their minds, including grasping objects.

What is miraculous, however, is how these advanced prosthetics can also restore a sense of touch to their brains. The decades-long project is due in most part to the Defense Department.

https://www.cbsnews.com/news/advancements-in-prosthetics-limb-technology-allow-feeling-control-60-minutes-transcript-2023-03-26/

https://www.gao.gov/products/gao-22-106118

Technology today is remarkable. Advancements are moving forward at an impressively accelerating pace. We are witnesses to the the repair and rejuvenation of bodily parts in almost a “good as new” state. This is also true in the area of dental technology.

A periodontist is often a “behind the scenes” dental specialist, working with general dentists and various other dental specialists. While periodontists may be in the background, they stay busy. In addition to treating all stages of gum disease, these specialists have advanced skills in the placement of dental implants.

It is estimated that over 47% of American adults have some level of periodontal (gum) disease. This disease is the nation’s number one cause of adult tooth loss. However, gum health needs to be seen by the general population as a vital player in one’s overall health.

The destruction of periodontal disease is not just confined to the mouth. It spreads. Gum disease destroys bone structures below the gums. These structures are the upper and lower jaw bones, which support natural tooth roots.

The jaw bones are actually kept healthy by the presence of tooth roots. These roots provide stimulation to the bone as well as nourishment that feeds through the tooth’s interior.

By holding their roots securely, the jaw bones provide natural teeth with a sturdy foundation. This enables the ability to bite and chew comfortably and dependably.

However, when a natural tooth is lost, so is the stimulation and nourishment to that area of the jaw bone. Without it, the bone begins to shrink. As it declines in mass, the adjacent teeth are more vulnerable to loss. Statistics show that teeth adjacent to areas where natural teeth are missing will be the most likely to be lost next. This creates somewhat of a domino effect.

Dental implants were designed to recreate the presence of natural teeth both above and below the gum line. Because teeth attached to dental implants are supported by the jaw bones, the study foundation as was had by natural teeth is restored, along with the ability to bite and chew without movement or embarrassment when dentures (or partials) slip.

In addition to tooth loss, gum disease is a serious health threat. Although people are often aware of the issues that come with wearing dentures and partial, many are not familiar with the health problems associated with gum disease bacteria.

This infectious bacteria of gum disease are capable of causing inflammatory reactions elsewhere in the body. Systemic inflammation is the now-known epicenter of a number of major health problems, including heart disease, stroke, high blood pressure, diabetes, arthritis, impotency and more.

Whether the patient’s need is the restoration of gum health or the replacement of missing teeth, the advanced skills of a periodontist can be highly advantageous. Through their unique understanding, they can help to minimize treatment time and complexity of treatment.

In our Asheville NC periodontal dental office, we feature some of the most advanced imaging and computerized technology available in the industry. These include:

LANAP Protocol Using PerioLase MVP-7: Efficiently and effectively treats periodontitis (advanced gum disease) with laser technology. It causes very little discomfort and has a quick recovery time. This has also been found to stimulate bone regrowth in damaged areas.

Dental Radiology With 3-D Cone Beam Technology: This imaging is ideal for diagnosis and treatment planning. The imaging covers the entire dentition area with clear views of the mandible and maxilla (upper and lower jaw).

CareStream Cone Beam Computer Tomography Imaging: This computerized tomography provides imaging in exceptional detail and range.

CS 3600 intraoral scanner: Patients no longer have to endure having impressions made with bulky, gloopy trays held in their mouths! This quickly and comfortably scans the mouth’s interior for digital impressions using a small, handheld scanner. It can also reach difficult–to–access areas in the patient’s mouth with improved patient comfort.

Simplant Dental Software for Computerized Dental Implant Placement: This system helps in pre-surgical positioning of dental implants on the computer, using a 3D model of the patient’s jaw. This aids in the selection of the implant type that ensures a precision fit.

Intraoral Camera Technology: This provides outstanding quality of images within the mouth. These images are sent to screen for a clear, crisp view so we can confer with patients on specific treatment issues.

Computer Imaging In Treatment Suites: Treatment suites are equipped with computers for convenient image sharing with patients.

Advanced Sterilization: Our custom sterilization unit adheres to (or exceeds) CDC guidelines for instrument processing protocols, particularly in the cleaning of instruments.

Fully-Equipped Surgical Suites: Relax during treatment while surrounded by beautiful mountain views of Asheville.

My staff and I also take great pride in providing patients with optimal comfort, along with an environment of respect. Some adults comes to us embarrassed by the condition of their oral health or missing teeth. Here, we strive to make patients feel they are not only in the right hands, but they are in the right place.

Comfort is supported by our sedation options. These include oral and I.V. sedation. Also referred to as “twilight sleep” or “sleep dentistry,” these sedatives are administered by skilled professionals who utilize advanced safety monitoring equipment.

I believe that the rampant number of people who have gum disease in the U.S. is largely in part due to being unaware of the symptoms. Some are easily ignored or “brushed off” as normal.

This is why it is important to be familiar with the signs and symptoms, which include:

• Red, swollen or tender gums or other pain in your mouth
• Bleeding while brushing, flossing, or when eating certain foods
• Gums that are receding (pulling away from the teeth) or make the appear teeth longer than normal
• Loose or separating teeth
• Pus between your gums and teeth
• Sores in your mouth
• Persistent bad breath
• A change in the way your teeth fit together when you bite
• A change in the fit of partial dentures

If you have any of these, you are urged to seek periodontal care as soon as possible. This disease will only worsen without treatment.

Call 828-274-9440 to schedule a consultation in our state-of-the-art Asheville periodontal dental office.

Nothing To Fear To Accomplish Healthy Smile Here

Posted on Apr 16, 2023 by William J. Claiborne, DDS MS

As a dental specialist, I find that many people are unfamiliar with exactly what a periodontist does. Yet, when they are recommended to see me (typically by their general dentist), it is because they need specialized care that falls under our unique set of skills.

A periodontist has advanced skills to help patients with a variety of needs that involve the gum tissues. These include:
– Treatment of all stages of gum disease (gingivitis, pregnancy gingivitis, periodontal disease, periodontitis)
– Reshaping gum tissues for esthetic enhancement (crown lengthening, gingivectomy for ‘gummy smiles’, repairing areas of gum recession)
– Diagnosis and placement of dental implants
– Treatment of lesions or cysts in oral tissues

Let’s begin with gum disease.

Because the majority of care I provide has to do with the treatment of all stages of periodontal disease, it may be helpful to understand how this develops. Although many people delay or avoid regular dental care (mistakenly thinking “if nothing hurts, then nothing must be wrong”), I have a close-up view of its destructive nature. Its formation creates cavities, periodontal (gum) disease, and leads to eventual tooth loss.

Even people who are committed to a regimen of thorough at-home oral hygiene (twice-daily brushing, daily flossing), can be doing an insufficient job of removing the daily buildup of plaque. Plaque is a sticky film of bacteria that accumulates in the mouth. When not thoroughly removed, it can harden into a mass that attaches to the base of, or in-between, teeth.

In the form of tartar, this cement-hard mass of bacteria cannot be brushed or flossed away. Once tartar forms, it can only be removed by a dentist or hygienist using special tools. Without removal, it will continue to amass and attack gum tissues, working its way beneath the gum line.

Below the gums lie the support system for natural teeth, consisting of tissues, ligaments and bone. When the bacteria reach an uncontrollable level, they become infectious. As these infectious bacteria accumulate further, symptoms of gum disease become more apparent, such as tender or swollen gums or seeing blood in the sink when brushing teeth. Breath odor may be bad on a regular basis.

As symptoms worsen, the gums become red with infectious and loosen their grip around the base of teeth. The gums may become spongy and pus pockets may form. Breath odor at this point is persistently putrid. Eventually, the structures that support teeth are compromised and teeth may loosen. Gum disease is the leading cause of adult tooth loss in the U.S.

Research has found that certain strains of oral bacteria from gum disease create reactions in the body that can trigger systemic inflammation. Thus far, research findings have shown a correlation between periodontal disease bacteria and some cancers (including pancreatic and lung), Alzheimer’s disease, pre-term babies, heart disease, stroke, diabetes, arthritis and erectile dysfunction (ED).

As if all that weren’t bad enough, one study suggests that gum disease relates to a reduction in one’s quality of life: “Periodontal disease has been linked to lower quality of life.” “Quality of life encompasses several domains, including psychological functioning and social relationships among others. Oral health-related quality of life has been shown to be reduced in patients with periodontal disease.” (https://www.hindawi.com/journals/prm/2017/5491923/)

While estimates show about 75 percent of American adults have some degree of dental fear or anxiety, over 47 percent have some level of periodontal disease. As a periodontist, both are alarming numbers. Nearly half our nation is walking around with a potentially life-threatening disease in their mouths.

Treating this may sound like it would be pretty intimidating. However, Although there are many treatments offered and at various levels, our main goal is to provide patients with comfortable and positive experiences at every visit. One way we accomplish this is through the advanced technology featured here in our Western North Carolina periodontal dental office. We feature some of the most advanced in dentistry, much of which is not available in dental offices elsewhere. Some of these features include:

LANAP With PerioLase MVP 7: Laser-Assisted New Attachment Procedure is an advanced protocol that efficiently and effectively treats advanced gum disease with the added advantages of a dental laser. This offers a non-surgical alternative for patients with moderate to severe periodontal disease. LANAP treatment leaves very little discomfort and has a quick recovery time. It has also been found to stimulate bone regrowth in damaged areas.

3D Cone Beam Imaging: Ideal for diagnoses and treatment planning, these images provide a clear view of the upper and lower jaw, used for: intricate review of endodontics; periodontics; orthodontics; implantology: TMJ; and prosthodontics, as well as dental and maxillofacial surgery. Because cone beam radiographs show sagittal, axial, and coronal planes, locating and tracking nerve canals optimizes implant placement. The process is quick, painless and at minimal levels of radiation.

CareStream Cone Beam Computer Tomography Imaging: This enhanced tomography works with 3D imaging for exceptional detail and range.

CS 3600 Intraoral Scanner: Rather than make impressions with bulky, goopy trays, this scanner quickly and comfortably captures digital impressions accurately and easily for creating precision models or appliances (crowns, inlays, onlays, bridges, orthodontic appliances and aligners, custom abutments). The scanner can also reach difficult–to–access areas in the patient’s mouth for superior results with improved patient comfort.

Computerized Dental Implant Placement: This advanced system for pre-surgical positioning of dental implants uses a 3D model of the patient’s jaw. Once the implant type is selected, a template is developed for optimal treatment success, even for complex cases.

In addition, we offer a unique environment for comfort. We understand how dental fear or anxiety can cause people to delay or avoid having dental treatment, sometimes for decades. We believe that every patient deserves respect, a gentle touch and knowing they are in a “lecture free” zone. For those who have high fear levels, we offer several sedation options, including oral and IV sedation.

Oral sedation is a pill that helps patients relax. It also has an amnesiac effect, leaving most with little or no memory of treatment afterward.

I.V. sedation (also known as ‘twilight sleep’) places the patient in a deeper sleep state and erases memory of the procedure. It is administered by a doctor of anesthesiology for optimal comfort and safety. In our Asheville office, anesthesia is overseen by a Medical Doctor (MD) who is a board certified Anesthesiologist.

With both sedation options, patients are closely monitored with advanced safety equipment throughout treatment.

I hope I’ve given you a helpful and positive picture of what a periodontist does and how he/she can help you with some challenging needs; all the while keeping you comfortable, minimizing treatment time, and shortening treatment time.

Although most of our patients are referred to us by other dentists and dental specialists, a referral is not required for accepting a new patient. Call 828-274-9440 if you feel we can make recommendations for your specific needs or provide helpful information.

Helping To Curtail Opioid Misuse

Posted on Mar 23, 2023 by William J. Claiborne, DDS MS

No one wants to be in pain. In the dental office, dentists and dental specialists see many patients enduring a great deal of pain, some of which increases in time to excruciating levels.

To resolve the pain, treating the affected area is the first step. Healing can take time and may involve a period of continued discomfort. While a dental profession wants to help patients avoid problems and pain that can arise from them, helping you get through painful periods with ease is certainly a priority.

Like others in the health care field, the field of dentistry has become rather resistant to prescribing harsh and addictive painkillers. The opioid epidemic in the U.S. is running rampant and we want to do our part in curtailing the availability of these meds.

I felt it may be helpful to share some statistics and research findings on the opioid use in America. Hopefully, this information will reassure that the dental profession is not being “stingy” with prescribing painkillers. We are trying to help control what can easily be misused or over-prescribed.

Drug overdose deaths involving prescription opioids rose from 3,442 in 1999 to 17,029 in 2017. From 2017 to 2019, the number of deaths declined to 14,139. This was followed by a slight increase in 2020, with 16,416 reported deaths. In 2021, the number of reported deaths involving prescription opioids totaled 16,706. These numbers are headed in the wrong direction, obviously.

Although physicians, dentists and others in health care have been under close scrutiny for the number of opioids prescribed, dentists are also being more diligent in limiting patient access to pain medications. Yet, there is still a concerning number who make access easier than it should be.

According to International Association for Dental Research findings shared from two studies amongst dentists and oral-maxillofacial surgeons (OMFS) (presented in March 2023), the goal is to identify high prescribers of opioids. The study, conducted at the University of Pittsburgh, used data to detect actively prescribing dentists between 2015-2019.

The study found that during this period, 2,741,030 opioids were prescribed by 199,145 dentists/OMFS. Researchers noted that over 35% of prescribers prescribed at low rates in 2015 with this percentage falling to nearly 18% in 2019. In this period, those who were “moderate” prescribers of opioids also decreased prescribing by over 82%. A slightly more active group of prescribers also decreased their number of these prescriptions.

However, 3.5% of prescribers found to be consistent in opioid prescriptions decreased in number, yet with minimal decline. For these, the rate in 2015 averaged nearly 55%. In 2019, the average was only down to 44.7%.

A particular concern in prescribing opioids is that of prescriptions submitted for children. While total opioid prescriptions have decreased in patients under 25 years of age, trends in opioid prescribing for children, adolescents, and younger adults (under 25 years of age) remains a concern.

In a study from 2013 – 2018, researchers found the opioid dispensing rate for younger patients decreased annually at a rate of approximately 15%. The largest decreases were noted for patients ages 15 to 24 years. Among children aged 0 to 5 years for whom an opioid was dispensed, the investigators observed annual increases from 2011 to 2014. For high-dosage prescriptions, these decreased from 2014 to 2018 although high-dosage, extended-release or long-acting remained at a concerning rate — nearly 28%.

Even amid an epidemic of abuse, opioid painkillers are still commonly prescribed to teenagers and young adults for conditions like tooth and back pain. Between 2005 and 2015, opioids were prescribed to teens and college-age adults at nearly 57 million visits to doctors’ offices and emergency departments.

Although more common in an ER, 15% of visits concluded with an opioid prescription with only a small decline over the 10-year study period.

A report on opioid prescription misuse by the University of Michigan shared another concern that contributes to the problem. When people get a prescription for opioid painkillers to ease pain, it is assumed that the patient has it filled right away. However, there are now findings that show some of these prescriptions are being filled more than a month later, long after acute pain should have subsided.

In 2019, 1% of opioid prescriptions from dentists and surgeons were filled more than 30 days after writing. Although the number is low, that percentage equates to more than 260,000 opioid prescriptions a year in the U.S.

This indicates to prescribing surgeons and dentists that the medications are being used for other than intended. Whether over-prescribed by the doctor or misuse by the patient, this adds to the risk factor for opioid overdose.

These delayed-fill findings have led to call for state and federal laws to better regulate the expiration periods for filling these prescriptions. Changing the systems of monitoring along these lines has been slow in coming. In 2019, 18 states allowed prescriptions for opioids and other controlled substances to be filled up to 6 months after writing with 8 states allowing dispension up to 1 year after the prescription date.

The entire team at our Asheville periodontal dental office is highly committed to providing patients with optimal comfort throughout treatment. Here, we make oral sedation available as well as I.V. sedation (“twilight sleep”). These help patients to relax fully or snooze during treatment, erasing most (or all) memory of treatment afterward.

We also want our patients to heal comfortably after periodontal treatment or dental implant placement. As a periodontist, this is helped by being respectful of gum tissues and all areas in the mouth DURING procedures. We work with each patient to help them remain comfortable during their post-procedure time. Often, this can occur without the need for heavy medications with many patients only requiring OCT pain meds.

When it comes to your treatment, our advanced imaging technology helps us to pinpoint precise areas for incisions, which helps to minimize discomfort and speed healing time. Additionally, performing treatment at an easy pace allows for minimal disruption to sensitive gum tissues.

A periodontist has advanced skills in the treatment of all stages of gum disease, the re-contouring of gum tissues, and in the placement of dental implants. This dental specialist can help provide an optimal result while helping you enjoy the highest level of comfort – during and after treatment.

Please call 828-274-9440 if you have questions about comfort, treatment, or dental fear. New patients are always welcome and a referral is not always needed.