I have had several patients tell me they have discussed their dentists with friends.  So if you have used Facebook, Myspace, etc to find dental treatments or a dentist, please let me know.

Bret Dyer, DDS, MS

Eric C. Sung, DDS

Synopsis of publication appearing in the International Association of Dental Research

Periodontitis occurs when bacterial plaque infects the ligaments and bones supporting the teeth, causing them to become loose and fall out.  This disease is usually treated by removing the calcified bacterial deposits and biofilm from the surfaces of the teeth and roots.  While some of these procedures are invasive surgeries, others are minimally invasive, non-surgical treatments yielding improved results.  However, both of these procedures have serious disadvantages including excess pain and healing time and can be difficult to perform because of visual impairments from blood and impractical instruments.  An effective alternative treatment for periodontitis is through utilization of the Er,Cr:YSGG laser or “water laser”.  By employing this method, easy visual access to the affected area is achieved, less bleeding occurs, and healing time and discomfort levels are greatly diminished.  The advantages for patients are gum treatment without scalpels and sutures.  Our research showed repair of the gum tissue without recession.  When compared to common gum surgery, the laser treatment resulted in better outcomes and took about half the time.

I use low level laser therapy (LLLT) after all treatment.  It’s like shining a flashlight on the tissue, patients cannot feel anything.  Yet the wavelength of the laser stimulates the gum and bone to heal faster.  LLLT also reduces swelling.  One study was reported using LLLT to treat osteonecrosis.  I have used LLLT on patients that have been referred to me for this problem.  So far, every site has healed within weeks of treatment.  I anticipate that LLLT may become the first line treatment for osteonecrosis in the jaw. 

Osteonecrosis before treatmentHealing after LLLT

Healing After LLLT

I also taught a technique for atraumatic extractions. After the tooth is removed, it is replaced with an implant the same day.

Sometimes this process is referred to as teeth in a day. The advantages of this approach are: no denture, preserves the smile, prevents gum recession, and our approach is a minimally invasive laser procedure.

NEWS RELEASE for December 09, 2009

BIOLASE ANNOUNCES FDA 510(K) CLEARANCE OF ITS WATERLASE MD™ LASER FOR REMOVING CALCULUS IN PATIENTS WITH PERIODONTAL DISEASE

Minimally-invasive Treatment for Condition Impacting Over Half of Americans Over 55

IRVINE, CA (December 09, 2009) – BIOLASE Technology, Inc. (NASDAQ:BLTI), the world’s leading dental laser company, today announced that it has received 510(k) clearance from the U.S. Food and Drug Administration (FDA) to market its Waterlase MD™ laser system for removal of subgingival calculi to prevent and treat periodontitis, the greatest cause of tooth loss for adults over 35 and a condition impacting more than half of Americans over the age of 55, per the website of the American Academy of Periodontology (AAP).

Calculus removal is a critical procedure in successfully managing and treating periodontal disease.  Industry experts estimate the condition effects 25% to 50% of American adults at various levels.  Cleaning the surface of the root is conventionally done by scraping with a hand instrument or using ultrasonics.  However, clinical studies indicate these methods can remove a significant amount of healthy tooth structure in the process.  The YSGG laser energy used by the Waterlase MD gently removes unwanted calculus deposits while preserving healthy tooth structure.  According to experts, this offers long-term benefits for sufferers of periodontal disease, because it controls inflammation and the disease without removing the healthy tissue required for regeneration and healing.  This new application of the Waterlase MD greatly enhances the recently announced Deep Pocket Therapy with New Attachment™ using the BIOLASE-patented Radial Firing Perio Tips™ (RFPT), a minimally invasive alternative to traditional, more invasive periodontal surgical treatment.  Deep Pocket Therapy with New Attachment is the procedure where the Waterlase MD laser is applied to remove inflamed tissue that leads to re-infection, and now removal of calculus deposits to prepare the surface of the tooth for new attachment is possible.  This is the final building block in a Total Periodontal Laser Solution from BIOLASE that is unique in dentistry.

“Deep Pocket Therapy with New Attachment is a whole new paradigm in the treatment of periodontal disease,” said Dr. Bret Dyer, a periodontist in Sugar Land, TX and Clinical Assistant Professor at the University of Texas at Houston’s Department of Periodontology.  Dr. Dyer is the lead author of a soon-to-be-published clinical study supporting the long-term benefits of periodontal therapy with the Waterlase MD.  Data in Dr. Dyer’s study was reviewed by the FDA to provide this latest clearance.  “In the past, periodontics has been focused on slowing the disease process down. With this procedure, we are closer now to reversing the disease than we have ever been.”

Dyer continued, “As periodontal health is maintained over the course of patients’ lives, most will have multiple occurrences of periodontal breakdown.  In the past doctors could only follow those patients until they needed surgery. But now, if they start to have breakdowns, we can perform a laser procedure with root surface calculus removal that reverses the breakdown process so those patients can avoid more invasive periodontal surgery.”

A recent periodontal patient of Dr. Dyer, who had been through several rounds of conventional periodontal surgery before having Deep Pocket Therapy with New Attachment, described his experience, “I had this procedure done about four days before Thanksgiving. I was concerned about recovery time, because I was having people over for the holiday. This procedure was a breeze. I had no problems, no complications. It was a surprise that it took less time to do the procedure and less time to get over it. I had a great Thanksgiving dinner.  I didn’t have any pain whatsoever, and I’m kind of squeamish about dental appointments. I didn’t even use the prescription for pain killers the doctor gave me.  The procedure only took minutes. That was a pleasant surprise in itself.”

Dr. Mark Schlesinger, a periodontist in New York, NY, explained, “This not only enhances results in the hands of a periodontist using the Waterlase MD for regenerative procedures, is also an alternative treatment for the general dentist who is treating mild to moderate periodontal cases.  Patients are also more likely to accept treatment when they hear that it is minimally invasive and patients who have accepted treatment are getting positive results and avoiding the side effects that they have heard about from conventional treatment.”

Dr. Dara Rosenberg, Director, Department of Dentistry for the General Practice Residency, St. Barnabas Hospital, NY said,  “This Therapy changes the environment in the periodontal pocket through removal of inflamed tissue and root surface calculus to promote healthy tissue regeneration.”

BIOLASE Chief Executive Officer David Mulder said, “This represents yet another significant increase in the day-to-day utility of the Waterlase MD in periodontal and generalist offices alike.  Doctors using the Waterlase MD have already been getting more treatment acceptance and more patient referrals for their standard procedures, and for specialists and generalists who want to do more, we offer a growing list of procedures to help their patients and their practices.  Our recent efforts have been very focused on periodontal disease treatment and prevention.  Periodontal disease is a growing problem in an aging population, and is now being linked to greater health concerns including cardiovascular disease.  For an aging population, we are very pleased to assist doctors in providing an efficient, effective, and more comfortable solution for treating periodontitis.”

The Waterlase MD system is marketed, sold and serviced to dental professionals by the Company’s exclusive North American distribution partner and growing international partner Henry Schein, Inc. (NASDAQ: HSIC).

About BIOLASE Technology, Inc.

BIOLASE Technology, Inc. (http://www.biolase.com), the world’s leading dental laser company, is a medical technology company that develops, manufactures and markets lasers and related products focused on technologies that advance the practice of dentistry and medicine. The Company’s products incorporate patented and patent pending technologies designed to provide clinically superior performance with less pain and faster recovery times. BIOLASE’s principal products are dental laser systems that perform a broad range of dental procedures, including cosmetic and complex surgical applications. Other products under development address ophthalmology and other medical and consumer markets.

This press release may contain forward-looking statements within the meaning of safe harbor provided by the Securities Reform Act of 1995 that are based on the current expectations and estimates by our management. These forward-looking statements can be identified through the use of words such as “anticipates,” “expects,” “intends,” “plans,” “believes,” “seeks,” “estimates,” “may,” “will,” and variations of these words or similar expressions.  Forward-looking statements are based on management’s current, preliminary expectations and are subject to risks, uncertainties and other factors which may cause the Company’s actual results to differ materially from the statements contained herein, and are described in the Company’s reports it files with the Securities and Exchange Commission, including its annual and quarterly reports. No undue reliance should be placed on forward-looking statements. Such information is subject to change, and we undertake no obligation to update such statements.

For further information, please contact: Jill Bertotti, of Allen & Caron, +1-949-474-4300.

A Dental Shift: Implants Instead of Bridges

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By JANE E. BRODY

Published: November 16, 2009

If I have one serious regret about my age, it is that my permanent teeth developed before New York, my hometown, got fluoridated water. I first lost a permanent molar to decay in my early 20s, and the resulting bridge has had to be replaced several times in subsequent decades, ultimately as a four-part apparatus.

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Mouth: Dental Calamities That Can Truly Hurt (May 13, 2008)

First Mention: Fluoride, 1931 (November 17, 2009)

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Now that has to go as well. Because I could not floss and clean properly under the bridge and between the supporting crowns, I developed a severe periodontal infection.

Dr. Michael Zidile, the young periodontist I consulted, took one look at my mouth and said: “This is not how we do restorations nowadays. A bridge is not a permanent solution and makes it too hard for most people to keep their gums and underlying bone healthy. Now we do implants and individual crowns where needed.”

More out of curiosity than distrust — and before I invested thousands of dollars and countless hours on new teeth — I did my own homework and got a second opinion. Dr. Zidile, I learned, is correct. In an overwhelming majority of cases, implants to replace lost teeth are by far the best long-term solution for maintaining a healthy mouth. Also, because they rarely need to be replaced, in the long run they are more economical than bridges.

A Growing Option

Implants for replacing lost teeth have come a long way in the 25 years since I last wrote about them in this column. Better materials, procedures and professional experience result in far fewer problems than occurred in the early years of implants.

Critical to their success, however, is proper selection of both patients and practitioners — and, after the implant, a commitment to good oral hygiene. Dental implants must be treated like natural teeth: kept clean and free of plaque through proper brushing, flossing and periodic professional cleanings.

“Bridges are not the standard of care anymore,” Dr. Lawrence J. Kessler, a periodontist and associate professor of surgery at the University of Miami School of Medicine, told me in an interview. “For most people who lose teeth, implants are the treatment of choice.”

Implants do not decay, and adjacent healthy teeth do not require crowns to support them. And because it is easy to clean and floss between implants, the gum tissue and underlying bone are more likely to remain healthy.

With a bridge, if one of the supporting crowned teeth breaks or develops decay or nerve damage, the bridge and its three or more crowns must be removed and replaced.

Implants can replace individual lost teeth or many teeth in a row. For those who have lost most of their teeth, implants can be used to anchor a full or partial denture. About half a million implants are placed each year in this country.

On average, the total cost of an implant to replace a single tooth is $3,500 to $4,000 (more if other procedures are required), or about one-third more than the cost of a bridge. But while bridges have an average life span of 10 years, an implant can last a lifetime.

Many insurance companies now cover implants, but most people do not have dental insurance and must pay out of pocket. If cost is an issue, consider treatment at a dental college, where implants may be available at reduced rates as part of the teaching process.

Not a Quick Procedure

The basic technique involves surgically inserting a titanium screw — the implant — into the supporting bone, which can be done under local anesthesia in less than an hour, and attaching a small fake tooth called an abutment, followed by a crown. The resulting tooth looks and feels like a natural one.

The procedure is a lengthy one. Unlike a bridge, which can be completed in two weeks, implants usually take about eight weeks for the screw to become firmly attached to bone before the final crown can be placed. “A patient’s health, not age, determines suitability for an implant,” Dr. Kessler said. “I just did implants for a 93-year-old who needed them to fit a partial denture. I put two implants in a man when he was 85 and five more when he was 88, with no problems either time.

“If cases are chosen well, implants are very successful — 96 to 97 percent successful. And they rarely fail down the road.”

A most important element is having enough bone in the jaw to support the implant, although in some cases bone cells removed during drilling for the implant or taken from elsewhere in the mouth can be used to fill in gaps.

“If someone has diabetes or is a smoker,” Dr. Kessler said, “the chances of success are reduced because a poorer blood supply diminishes the fusion of bone cells to the implant.”

Also important is healthy gum tissue, free of periodontal disease. Before I could undergo an implant procedure, I had to have periodontal treatment to get rid of the plaque, tartar and infection on the tooth roots and gum tissue around my bridge and supporting crowns.

In some cases when a tooth must be pulled, an implant can be placed right after the extraction, with the advantage of limiting bone loss in the area. When bone is not being stimulated, it tends to break down. I consider myself lucky that although I’ve had this troublesome bridge for many decades, my underlying bone has remained healthy enough to support an implant.

Choosing a Doctor

Just as any physician can legally perform surgery, any dentist can legally do implants. Be sure to choose someone thoroughly trained in the technique. Taking a weekend course in implantology is rarely adequate. There are risks involved in placing implants, including damage to a nerve or sinus cavity, which are magnified when the practitioner lacks adequate training.

Implants were once done mainly by oral and maxillofacial surgeons, most of whom operated independently of dentists. Now at least as many implants are placed by periodontists who are schooled in the technique and who coordinate their work closely with the patient’s dentist. Ideally, the periodontist should be board-certified.

Just as you might ask for referrals for a prospective nanny or house cleaner, consider asking to speak with other patients of the practitioner before deciding to proceed with an implant. Though every case is different, at the least you can determine how well you are likely to be cared for.

More Articles in Health » A version of this article appeared in print on November 17, 2009, o

Bacteria from gum disease has been found in the plaques that cause atherosclerosis.  It also turns out that when the bacteria from gum disease get in the blood stream (which they do continuously in patients with active gum disease) the blood vessels swell.  So by possibly stimulating plaque formation in the arteries and making the arteries swell so that the lumen becomes more narrow, patients with gum disease have a higher risk for heart attack and stroke. 

Good news though.  Two studies have shown that by treating gum disease, a patients risk for heart attack and stroke go down.  In the studies, they measured C reactive protein – a measure for swelling of the blood vessels.  When patients with gum disease and an elevated C reactive protein were treated for their gum disease – the C reactive protein levels dropped!!!

We use lasers to treat gum disease with a minimally invasive approach.  Then we use different lasers for low level laser therapy – a technique that reduces swelling and inflammation and accelerates wound healing.

Bret