Patient Education Special Reports

When it comes to dentistry, as you look in the Yellow Pages you will find that every dentist claims to be a cosmetic dentist. There has been such an influx of “cosmetic dentists” that anymore, being a “cosmetic dentist” is cliché – even (yawn) passé! Why? Because these days, any dentist who does teeth whitening or white fillings can claim to be a cosmetic dentist!

Choosing the right dentist for you, one with substantial experience in complex cases, extensive hands-on training, a background in teaching other dentists the latest and the best, and who has a gentle approach that compliments your needs and wants, is critical to achieving the most successful outcome - your radiant confident new smile. Educated and discerning people realize that cosmetic dentistry properly done, is complex and precise and will dramatically affect their lives for years to come.

So what is cosmetic dentistry?
Radiant beauty IS more than skin deep! It goes down deep to your bones with an increased confidence and a smart positive image that is hard to miss and hard to ignore. And along with feeling smart and looking good, how about a more youthful smile that takes years from your face! Cosmetic Dentistry says your smile is about impressing the important people in your life with a confident positive image. It’s about whiter brighter sexier smiles and healthy fresher kissable breath. It’s about a smile that screams with confidence and a youthful exuberance that knocks their socks off!

While stylish wardrobes may come and go, your smile is one accessory you will never take off - because a beautiful smile is never forgotten!

That is Cosmetic Dentistry!

The “Hollywood Dentistry” of the past has now merged with strong space-age materials and modern techniques to restore dingy, aging worn-down smiles, to their youthful strength and glory. Durable comfortable bites and bright smiles are now the custom of our day.

Fine Smiles have become the signature mark of both the fashion conscious and the confident healthy mindset. This merging of beauty and function through advancements of modern science gives you the benefits of looking good, feeling good, and lasting forever! (Well, okay, maybe not quite forever. But having it last a long time, be healthy, and look fine is what every aging baby-boomer longs for!) This new field of dentistry is called aesthetic dentistry. It utilizes principles of modern dental technology called “adhesive dentistry.” We no longer sacrifice beauty for strength, or strength for beauty. The strength of superior porcelain and ceramic restorations are blended with the art and beauty of cosmetics that will bring your smile gracefully into the age of aesthetics.

From simple teeth whitening, to veneers, to fixing a crooked smile - advancements in cosmetic dentistry can give you the healthy smile you want and deserve.

You may learn more about whether you can benefit from cosmetic dentistry by calling Dr. Ostler at 509-946-6566 and scheduling a no-cost initial consultation. You may also see examples of cosmetic dentistry and read more on this web site in the gallery and expertise section.

What makes an attractive smile? Why are some smiles better and younger looking than others? Why are some smiles radiantly beautiful while other’s are average? While “Mother Nature” gifted some people with great smiles, many are left wishing that they hadn’t been overlooked. While you may know a nice smile when you see it, it’s harder to explain exactly what makes a nice smile.

This Smile Design Report will help you better understand why some people have a great smile while other’s don’t. It will help you analyze the state of your own smile, and will show you the principles of smile design used and taught by world class cosmetic dentists like Dr. Ostler.

There is both a science and an art to creating and restoring attractive smiles. Whether it is whiter teeth, fixing crooked teeth with “instant orthodontics”, replacing unattractive dark fillings, or restoring an aged worn out smile and taking 10 years off your face - modern dentistry can quickly and easily give you the perfect smile that exudes confidence and will let your true personality shine. In fact, when new dental materials, techniques and modern smile design principles are combined and used by expert and caring hands you can be assured that your smile will be extraordinarily radiant and your dental health outstanding.

When these basic rules of Smile Design and Golden Proportion are broken, whether by nature, yourself, or your dentist, your smile and confidence can be seriously compromised. When followed, you can enjoy a radiant smile with all the confidence, natural attraction and peace-of-mind that goes with it.

Having a pretty smile goes way beyond whiter teeth. Size, shape, alignment and proportion, (or what the Greeks called the “Golden Proportion”) are also important parameters of beauty. In fact, the Golden Proportion is in nature itself. Designers have followed these principles in designing cars, furniture, building, and clothing. When rules of good proportion are followed the result is something that is naturally attractive and pleasing to the eye! This is the one grand secret to exquisite smile design and to having an attractive smile. Attractive smiles are attractive because they follow these mathematical rules of nature to create harmony, symmetry, and proportion. Oh – and the fact that your teeth are whiter – that’s a bonus!

As you review this information, compare your smile with the examples shown. This is an easy way to take the mystery out of “what’s wrong with my smile?” By using these principles it will help you know what we can do to design and create the right smile for you, one that will let your true personality and character come out.

We encourage you to think seriously about the benefits to health, spirit and mind that comes from the confidence of having a radiant smile, a balanced bite, and healthy strong teeth. You are always welcome to visit with us further if you have questions or concerns about your smile or your dental health, or if you want to put together a plan to begin making improvements along the way. In the meantime, you may benefit by visiting these web sites to help you better understand how you can benefit from modern dentistry.

www.LVIdocs.com
www.CenterForDentalHealth.com

What are your answers to these important questions?

1. How important is it to keep your natural teeth for a lifetime?
2. How would you like your teeth to look in 15 years?
3. What is the most important thing about your teeth?
4. If money weren’t an issue and if you could change anything about your smile, what would it be?

The following list of dental problems can have an impact in the quality of your smile. Check all that apply:

Bite & Occlusion Joint Problems TMJ Tooth Movement / Mobility Teeth Grinding - Worn Teeth Tooth Notching a Gum Line (Abfraction) Headaches, Neck Pain Crooked Teeth Bite Problems Other: ______________________

Dental Condition: Silver Mercury Fillings Broken Teeth / Fillings Stains & Discolorations Crooked Teeth Gaps & Missing Teeth Gum Disease - Gingivitis Bad Breath Tooth Decay Present Old or Dated Dental Restorations

What follows is a schematic outline, description and visual example of common cosmetic problems. While not a complete list, these examples illustrate the principles of Cosmetic Smile Design, balance and proportion. You can use these examples as references to compare your own situation and appearance. You may find it helpful to use a mirror or a close-up photograph of your smile.

Central Incisor Width / Height Ratio: The W/H ratio should be 75-80%. This means the front teeth should look like a rectangle, not a square. They should appear taller than they are wide. If the height were 10.5 mm and the width 8.0 mm, the ratio would equal 76%.
Mesial Inclination: The front teeth should have a visual inclination or tilt that is toed-in slightly toward the midline (mesial). If these lines were extended downward they would meet or converge at or near the navel on the abdomen.
Color, Shading, Stains, Markings: Are the teeth a uniform bright color or shade? Is one tooth darker than the rest? Are there white or dark spots or markings on the enamel?
Midline Placement and Cant: Is the Midline between the Central Incisors centered left/right in the face, and aligned with the chin, nose, lower teeth, eyes? Is the Midline canted or tilted left or right?
Smile at Rest: Evaluate the amount of teeth showing at rest or with a slight smile. Middle aged adults should show 2.0-4.0 mm. This amount decreases with age as the window of the mouth begins showing more lower teeth.
Gum line Symmetry: Is the gum line symmetrical or matched on left and right sides? canine teeth?
Gum line Margin Heights : The gum line over the lateral incisor should be below a straight line drawn from central to canine gum lines.
Gummy Smile: How much gum tissue shows with a full smile? Ideally there should be about 1 mm above the centrals and 3 mm above the lateral incisor gum line.
Gaps or Diastema: Are there gaps or spaces between the teeth? These can be natural or due to missing teeth.
Gingival Zenith: The height of the gum line across the face of the tooth should be centered on the lateral incisors, and positioned in the back 1/3rd of the face of the tooth for the centrals and canines.
Smile Line Follows Lower Lip: The incisal edge line should follow or parallel the lower lip line in a relaxed or partial smile.
Horizontal Plane: The left-right horizontal plane of the mouth should parallel the floor or the horizon when standing. It should also parallel a line drawn between the eyes (the inter-pupillary line). The horizontal plane from front to back should also the parallel the floor when, with the upper back teeth slightly higher than the plane.
Gum Tissue Health / Bad Breath: The gums are part of the soft-tissue “frame” that outlines the teeth and smile. Healthy gums are light pink and stippled (like an orange). Healthy gums do not bleed. Bacteria causes inflammation, gingivitis and bad breath.
Flossing Contact Point: The flossing contact point between the front teeth steps upward with each tooth.
Incisal Embrasure: Between the front teeth on the biting edge, the size of the silhouette or outline shape between the front teeth, should increase in size going back away from the midline.
Mal-alignment or Crowding: Teeth should be even and straight. Crowding happens when there isn’t enough room for the teeth to fit evenly side-by-side.
Golden Proportion Ratio: Measure the ‘absolute’ width of a central incisor tooth on a photo in millimeters. Divide this number by the width of the same-side lateral incisor width. (Example: If central incisor width on photo is 21mm and the same-side lateral equals 14mm, then 21/14 = 1.5. If the same side Canine is 8mm, then 8/14 = 0.57) Ideal ratios are shown at left and are called the “Golden Proportion”.

Broken Teeth - Understanding Why Teeth Break and What To Do About It

If you have ever had the unpleasant experience of breaking a tooth you may likely relate to the common belief that it always seems to happen on weekends or after-hours. It is one of “Murphy’s Laws” – or so it seems. Like heart attacks and car accidents, it’s never planned or looked forward to. The usual explanation is “I was eating Jell-O (or a banana or something else soft) and it just broke!” Maybe if we’d of been eating ice, nuts or rocks we might have deserved it.

One might even ask “how could it happen when my last dental check up found that everything was just fine?” Good question! What causes teeth to break in the first place, especially if it isn’t necessarily due to what you chew?

Here are three things you should know about cracked teeth:
1. A tooth can crack before it breaks.
2. Some cracked teeth hurt, some don't.
3. Unlike bone, cracked and broken teeth don't heal.

Why do Teeth Break?
To better understand how and why teeth break you must look at this problem like a structural engineer. After all your teeth are structural objects powered by strong muscle forces used to crush grind and chew. They are also biological structures with a live nerve (in most cases) in the middle of them that has the ability to send pain messages to the brain. When a tooth breaks it diminishes your ability to support your bite, chew your food, be comfortable, look attractive – and it usually hurts!

Like structural building materials, a tooth is subjected to immense stresses and forces. When these stresses and forces exceed the tooth’s ability to withstand them something has to give; the stresses must be relieved. They do this by cracking or breaking away the part that is stressed. ]

Consider what would happen to a block of wood or concrete if placed under a big load. Now consider what happens if you further compromise its strength and support by cutting a deep groove down the middle of the block and increasing the load or pressure. Eventually, the stresses exceed the limits of the wood or concrete’s ability to resist, and it begins to crack or split apart usually right where the cut or groove was placed. Unless you are an engineer with a computer, you can’t predict when it happens. It’s inevitable – like a time bomb waiting to go off. But it doesn’t take an engineering degree to understand that excessive forces and stresses in structural objects can weaken and break apart those objects, especially if the object is already compromised.

This is exactly what happens with teeth that have fillings. When a tooth gets tooth decay the dentist drills it out and places a filling. However, this process is like cutting the tooth apart which leaves the sides of the tooth unsupported and without strength - yet still subject to the same biting forces as before.

If the filling just happens to be a silver-mercury filling, things can even be worse. Silver-mercury fillings (which are about 50% mercury by volume) very slowly expand over time. This means if you had a cavity filled many years ago, that the filling that was placed back hen has been expanding over these years in a very slow but steady manner.

So now there are at least two significant compromises to the tooth’s strength, one from the original problem (cavity formation), and the other from the fact that a wedge has been placed in the hole or groove which is expanding inside the tooth. So, not only is the tooth inherently weaker because of the cavity, but now we have the silver mercury filling expanding (metallurgists call this “creep and flow”).

As if that weren’t enough, mercury metal fillings expand and contract with temperature changes in the mouth (thermal cycling with food and drink). Do you remember before the days of digital when thermometers were made of mercury – because it expanded and contracted with temperature changes (rather predictably we might add)? Plus we are constantly chewing and grinding on our teeth, flexing and smashing them with pure muscle force from our jaw muscles. Whew!

The margins, or edges of the filling also eventually break down and allow leakage of oral fluids and bacteria, creating further decay and tooth breakdown. And then there is the rust (oxidation) from the silver mercury filling which corrodes the surface and edges of the filling.

No wonder teeth break! The mouth is a very dynamic environment! There are numerous forces working on the tooth to tear it apart. Once a crack is started in the tooth, ongoing forces cause the small craze line or crack to propagate deeper into the tooth until eventually the crack becomes a fracture. When weakened enough, the tooth will break, relieving the stress and creating a painful interruption to your day.

Usually broken teeth have been in the works for some time. This is what we mean when we say that a tooth can be broken before it breaks. A craze line develops and propagates deeper into a crack, which in turn fractures away a piece of the tooth. When and where is a random act of chance and you can’t predict whether the consequence will be major or minor. Murphy’s timing is perfect! Unplanned and unbudgeted, it forces a quick retreat to the dentist for inconvenient but unnecessary dental treatment.

Why unnecessary? Because even though you can’t predict when a tooth is going to break, you can predict that they probably will! Sometime, someday, somewhere, something bad is going to happen to a tooth that is already significantly compromised and has cracks in them. In the old days dentists thought it was a kind thing to wait until a tooth broke to fix it. “When this breaks, give me a call.” They often believed that it was “over-treatment” to take a tooth that wasn’t “broken” and didn’t hurt, and intentionally do a new dental procedure to it. Besides, unless it was really deserving of a more expensive restoration, it wasn’t “right” for a dentist to “fix” something that wasn’t really broken or hurting!

How times have changed! To be fair, modern materials and techniques are so much kinder to teeth today. And the culture and medical norms have changed from “disease medicine” to “wellness medicine” and from necessary to elective. Prevention and reducing risk-factors have finally upstaged disease. Seeing something coming at you from down the road is easier to plan for – but only if you can see it! And therein lays one of the problems! If a dentist (or a patient) believes that a tooth with cracks around an existing filling is not a problem because it isn’t “broken” or it doesn’t hurt (yet), then it isn’t going to be mentioned. That is why so many people are surprised when their tooth breaks apart. Truth be told, it shouldn’t be a surprise!

But again, to be fair, there may be a number of reasons why a tooth can break without warning, without knowing it is coming. Cracks in teeth usually cannot be seen on dental x-rays. And even though they can usually be seen when shining a bright light through the tooth (transillumination), sometimes they are not visible, as when they are under an existing filling. At the bottom of the cavity, in the corners of the “box” or grove made when the decay is drilled away, small stress cracks can form at these internal line angles and propagate and travel in an outward direction. They can be hidden from visual inspection, yet be present in the tooth nonetheless.

Too often, unfortunately the reasons for not seeing the cracks and disclosing them, rest in the treatment philosophy of the dentist and/or the wellness/disease philosophy of the patient. Some truly believe that “if it doesn’t hurt and it isn’t broke it must be okay”. This gambling disease-medicine mindset forestalls the inevitable and is akin to waiting for the heart attack before admitting there may be a problem or the need to begin exercising or dieting. The wellness mindset removes potential threats before they present themselves. It asks “what’s the best dentistry that can be done?” and then schedules and budgets it in over time if necessary. When proactively dealing with the problem, time can be a friend and an ally.

It is unfortunate when a patient arrives with a piece of tooth in their hand broken away from the side of a large mercury filling, saying that the dentist they saw last year before they moved, said that everything was okay, or flat didn’t tell them that it might break. I immediately know the mindset or philosophy of the dentist, the patient, or both. The problem is that “disease medicine” is still standard-of-care, meaning that it is still okay! It is driven by the thinking “Yes but - it doesn’t hurt!” or “Yes but - it isn’t necessary!” (For that matter – there are a lot of people without teeth who can successfully make the argument that teeth aren’t necessary!) This “need” thing strikes to the heart of the problem of “cracked teeth.” Some hurt. Some don’t! Those that hurt drive dental emergencies. Those that break often get root canals, gum surgery and new crowns. And just because it doesn’t hurt isn’t proof that there isn’t a problem. The absence of pain is not the evidence of health!

This leads us to discuss a better way - a “wellness medicine” mindset or health model. It dares ask different questions, such as:

• How well do you want to be?
• How much dentistry do you want after age 60?
• How many broken teeth do you want?
• How many root canals do you want?
• What if something could be done now that would prevent broken teeth, treat your teeth more conservatively, restore your peace-of-mind, and keep Murphy at bay – forever!? Oh, and make the teeth strong, attractive, and like well - normal teeth?

This kind of thinking leads you to make different decisions about how and when you proceed with your dental care. It also ultimately predicts whether you will enjoy a lifetime of healthy, attractive, strong and durable teeth.

Cracked Tooth Syndrome
Whether a tooth hurts or not depends on the depth and severity of the crack. When a tooth hurts without actually breaking apart it is called “Cracked Tooth Syndrome.” This is most often characterized by a tooth that hurts during biting pressure, and which immediately stops hurting when the bite pressure is released.

Cracked Tooth Syndrome is defined as an incomplete fracture of dental tooth structures. It is usually associated with a sharp pain during chewing. During chewing functions and biting pressures, a small, sometimes undetectable, crack or fracture may allow broken tooth sections to flex or move apart slightly. This causes immediate tooth sensitivity and pain.

As the insult continues and the tooth nerve becomes more inflamed, the cracking tooth problem can progress to a full-blown toothache, pulp death, necrosis and infection (abscess). When the nerve of a tooth dies it now requires a root canal procedure or tooth extraction. What started as an innocent and innocuous little craze line adjacent to a well-meaning silver mercury filling is now the reason for a very costly and often uncomfortable outcome.

It should be remembered that cracks and fracturing can be present in tooth structure without the production of pain or other symptoms. Whether this is the case or not for your teeth, it highlights the importance of proactive “wellness” diagnosis and treatment planning. Since we know what happens to teeth long-term that have silver mercury fillings, and since you want to avoid costly and painful problems, it makes sense to restore the affected teeth to an optimal condition of health and wellness with modern techniques and modern dental materials – BEFORE they actually break apart!

No longer is it okay to explain it away with an “if it doesn’t hurt and it isn’t broke – it must be okay” excuse! No longer should it be acceptable for a dentist to know what is best and not offer better solutions. The least expensive dentistry is dentistry that avoids the loss of tooth structure. This is because it costs more to fix it later – cost in terms of money, root canals, complex restorations, lost teeth, lost function, lost dignity, unattractive worn smiles, painful chewing, and so forth. Why chance it?

Cracks in Teeth Don’t Heal
There is no blood supply or biological mechanism that allows for cracked tooth structure to heal or knit together (like a broken bone). It will never heal and be restored to its previous normal strength on its own. Never! Never! Never! It is a structural object that once cracked is forever compromised - unless it is restored with a durable dental restoration which will hold it together and restore it’s structural integrity. Therefore, appropriate treatment for a broken tooth must take into consideration the requirements for reinforcing cracked tooth structure, and to do it in a way that it can hold up in the stressful and dynamic environment of the mouth.

Anticipating future problems with a healthy “wellness” mindset allows for budgeting the dental dollars and preventing the inevitable consequences that occur as silver mercury fillings degrade, expand, and weaken the tooth. In the end, the objective of therapy is to create a stable solution that can withstand any and all forces that might be placed upon it, and which will allow it to function in comfort for a long duration, and which will allow a person to do so in a sound financial way – no budget surprises! Modern adhesive dentistry techniques practiced by well-trained and experienced dentists assure you of the best possible outcome in both durability and pleasing attractive teeth.

Cracked Teeth are predictable – not planned!
Cracked teeth are like a ticking time-bomb. If you know it is there, why let it keep ticking? Cracks propagate and deepen on their own timetable. Since the problems begin rather innocently and quietly, it is easy to ignore them until it catches your attention with a sudden twinge or jolt. By then it’s too late - you are holding the side of your tooth in your hand, or wondering what you ate that was crunchy. This is when you will know you didn’t plan well. Business activities, vacations, trips out of town, or life in general are put on hold while you frantically try to fix a problem you could have dealt with much earlier upstream. If only you would have been told! If only you would have listened! Warning: Don’t eat the peanuts on the outbound flight!

What To Do
If you have cracked teeth, old fillings, or you want to increase your peace-of-mind and confidence, you may schedule a consultation with Dr. Ostler at the Center for Dental Health. He will help you with a customized personal plan for avoiding the problems of broken teeth and enjoying comfortable attractive teeth for a lifetime. Budgeting your time and your dollars with a well thought out plan will be a wise investment in your future, your business, your health, and in your peace-of-mind.

An Open Letter To Our Patients:

From time to time we have people approach us desiring to have their teeth removed and dentures made for them. Sometimes these requests are without merit from a dental perspective and are motivated by money concerns, fear or ignorance. There are situations when we are left with no other options other than to recommend dentures due to advanced dental disease problems. However, not always are dentures the best treatment alternative.

The following factors always play into the thinking and decision process regarding dentures: advanced disease, limited finances, overwhelming dental problems to fix, influence from family and friends, etc.. Regardless of the background or the reasons, the outcomes are similar. Let's examine these outcomes for a moment, so that you will be fully informed and aware of what potentially lies ahead. We will also discuss finances, values and priorities as we believe they pertain to this issue.

In almost all situations dentures are at best a poor substitute for the original equipment we began with. They can never truly take the place of strong natural teeth anchored soundly in healthy jaw bone. For the individual without teeth or whose teeth are not savable, we recognize that dentures are necessary and are certainly better than nothing. Compared to not having teeth, dentures allow a person to maintain more of their self-esteem, and remain a part of society, as they choose to define it. They allow for reasonable function, form and esthetics, and for reasonable involvement in society, social circles, and the job market, etc.. For this we are always thankful.

However, dentures do not represent the "end-all cure-all" of dental problems. At best, since it is a poor substitute for natural teeth, having a denture merely trades one set of problems for another.

Since dentures are not a part of you (like your own teeth) they must be balanced over your bony ridges and be supported by soft gum tissue. Dentures tend to slip, lose retention, float, and rock, depending upon the anatomy of your mouth, your muscles, and your habits and experience with dentures. This is the discouraging part. Sore spots can develop, making the wearing and use of the denture very difficult at times. Bone ridges will change shape over time, making it necessary to do relines of the inside of the denture to improve the fit of the denture. Dentures have the potential to impact your social life by affecting the way you must eat, speak, yawn, and behave in public. Removing teeth definitely affects the way your face, jaws, and mouth look. While dentures can maintain the profile of the lower part of the face, the whole process usually brings about the results of a more aged appearance, to one degree or another.

To those who still have teeth and who cite the happy outcome of friends and family with dentures, we say that we are glad they are happy with their denture, because they don't have a choice. Those with teeth or the prospects of saving their teeth still have a choice in the matter. Dentures are a poor substitute for the real thing if natural teeth can be rehabilitated.

If you still have teeth and have the potential of saving your teeth, we invite you to re-examine your thinking regarding this most sensitive issue. Many times it is a financial issue. Re-examine your values and priorities. Is your new car, vacation, or Christmas, more important than your health or the ability to eat and speak? Is the quality of your wardrobe more important than your teeth, smile, or chewing ability? Are your nails or hair care a bigger priority than your good health? Discretionary income spent on tobacco, recreation, alcohol, lottery/gambling, consumer electronics, movie tickets, pet food, hair and personal care, all compete in the spectrum of values and priorities that via for our attention. The dentist's job is not to dictate people's value systems. But considering the task we are asked to participate in at times, it at least becomes appropriate to hold up the "values mirror" and ask for due consideration as to what is deemed important. After all, we only spend money on those things in life we find important. What is your commitment to your health? Compare it to your commitment to other items in your budget. We hope this discussion doesn't offend. But who else is going to say it?

Having said all this, we recognize that there are those among us, who are indeed unfortunate enough to have both serious dental predicaments and low financial resources. To these people, we acknowledge your efforts to establish priorities and to lead a balanced life. Sometimes, "now" is not the time, but let's still explore the options openly. Most of us could do much more than we are presently doing, to lower the costs and degree of involvement of our present problems, if we only knew what to do or how to do it.

Sincerely,

G. Lee Ostler Jr. DDS and Staff

Four Levels of Care

We understand that choosing a new dentist can be difficult. To help in this process, this section will assist you in understanding how our society and people in general, approaches healthcare. This may help you better determine which model of healthcare you are most comfortable with.

A final thought first. This true story was shared by a dental colleague. It is humorous – but it preaches a sermon about our values!

“A patient asked me if I would give his father, who lived in a nursing home, a cleaning. Of course, I said sure. On the day of the appointment this patient wheels his father into my office in a wheelchair. The father is wearing his pajamas, slippers, and a bathrobe. "He didn't feel like getting dressed" says the son. "No problem" I reply. The hygienist gives him the cleaning and reports to me that home care is completely non-existent. I take the son aside and explain to him that he needs to follow-up with the nursing home regarding his father's oral health. Thinking he would help me, the son goes into the hygiene room and yells "Dad, you better start brushing your teeth and taking better care of them or else the dentist is going to have to pull out all of your teeth and give you dentures... and they cost $25,000 each!!!" The father looks up at both of us and says "That's O.K., I've got the money!"

A beginning philosophy for health

We believe that most people want teeth that look good, feel good, and will last a long time. Knowledgeable dentists using modern dental materials and current science & technology can make this happen for people who want it and haven't already allowed irreversible damage to occur.

In our office the traditional health model of "disease medicine" is replaced with the "wellness model" concept. Our focus is upon desired outcomes and upon how well and healthy we can become. Therefore, we will start our relationship by asking lots of questions to learn what is important to you. Instead of telling you how healthy you ought to be, or telling you what you "need," we will help you understand your choices and then "give space" for you to make a free and informed choice to seek health (or disease) as dictated by your values. Our focus is on how healthy you want to be 20 or 30 years from now, and what you will be glad you did then, looking back.

There are four levels or categories of health care:

Level 1 - Urgent Care: 
This is for people who live in crisis or who have an emergency problem such as pain and swelling which drives them to seek care. Often these people have serious or immediate financial limitations, which limit their ability to seek treatment. Our only goal in this level is to relieve suffering and then transition into a higher level of care for long-term therapy if possible.

Level 2 - Remedial Care: 
People who choose this level of care desire treatment only when something breaks or hurts. People at this level prefer short-term abbreviated care. They usually want to correct immediate problems with as little effort and cost as possible. Treatment may be temporary, and usually is not a long-term solution. Folks at this level are not yet ready for long-term planning or comprehensive treatment. Controlling the forces of nature, on-going wear and tear, and bacterial action are not of primary importance. These people have a motto something like "If it doesn't hurt or if it isn't broke, why worry?" They may be counting on fate and luck to see them through, at least for the present. Again, the goal is to stabilize more urgent problems and then transition to higher quality and more thoughtful care.

Level 3 - Intermediate Care: 
People who choose this level of care are not ready to pursue "Complete Dental Care," as outlined below. Dental solutions chosen allow them to do piecemeal or phased dentistry beginning with higher priority concerns related to comfort or esthetics. People in this category may not see the need to deal with their dental conditions in a comprehensive manner, or feel limited in their choices due to health, family/social, or economic factors. Disproportionate emphasis is given to immediate economic factors and fears, which seem to largely determine the course of treatment.

Level 4 - Complete Dental Care: 
People at this level use a comprehensive evaluation to plan long-term goals and objectives for their oral health. Wellness and longevity are primary goals. Developing and maintaining an attractive smile may parallel these objectives. These people want to understand and control the causative agents of dental disease. They choose to have their teeth cleaned two to four times per year, with at least annual exams by the dentist. These people practice highly effective levels of oral hygiene home care and seek coaching and feedback to constantly improve upon their results. These people are ready to begin treatment right away and they want to maintain their own bacteria at healthy levels.

Now, about the biggest objection to pursuing dental wellness...

The Issue of Money
Because in the first place dental health is optional (you don't after all, have to have teeth to stay alive or enjoy your grandchildren), many people allow economic concerns to paralyze themselves into inaction. Often they justify their poor health and lack of motivation on not being able to afford it. However, in the end we know that we all spend money on those things that are important to us - we buy those things that we value. It is unfortunate when people find themselves choosing between vacations, stereos, Christmas purchases, boats - and dental health. Life is always about choices! And what we choose to spend our discretionary income on is truly a reflection upon our value system and what we find important in life. Where purchasing healthcare truly takes bread off the table after all one can do, there are usually avenues that can be pursued if only one is courageous enough to ask the right questions.

You can rest assured that we will do our best to help you receive the best value for your investment in your health. Investing in quality dental care is actually the least expensive strategy since it doesn't have to be retreated, and will last a long time. In addition, there is the peace of mind that comes through receiving good care.

We believe that the decision to pursue dental treatment is usually more about time than money. Much can be accomplished if there is a disciplined and thoughtful strategic plan. An honest and frank discussion of these issues with the dentist is often necessary and important to reach understanding, or these issues will forever stand in the way as a barrier to receiving desired care.

 

Headache Report

We Can Help You With Your Headaches
G. Lee Ostler DDS
The Center for Dental Health, 
1518 Jadwin Ave., Richland, WA 99354
509-946-6566

According to the National Institute for Neurological Disorders and Stroke, there are 45 million headache sufferers in the USA. Migraine sufferers amount to 28 million strong, with nearly everyone (90%) experiencing a general headache each year. Due to the biomechanical, neuromuscular and musculoskeletal inter-relatedness of the back, neck and head, headaches are very often correlated with neck, back and shoulder pain.

Whether the headache is daily or more infrequent, pain in and around the head, face, jaws, neck and ears, can be anything from a major annoyance and inconvenience, to downright painful, to disabling. Headaches are usually classified as either: Sinus, Tension, or Vascular (including migraines). While there are other types and variants, these major classifications represent the most common types.

Sinus Headaches

The sinuses are air-filled spaces which are located in your forehead, cheekbones, and between the eyes behind the bridge of your nose. Inflammation or problems with the lining of the sinuses can prevent the normal outflow of sinus secretions (mucus). This can build up pressure within the sinus cavities and produce pain similar to that of a headache.

Due to their location, sinus headaches are associated with a deep and constant pain in the cheekbones, forehead or bridge of the nose. The pain usually intensifies with head movement, straining, or any activity that increases pressure in the sinuses (rising in elevation while flying in an airplane, blowing the nose, etc). Other symptoms are often present such as a “runny nose”, ear congestion, facial swelling or fullness, and fever.

These types of headaches are best diagnosed and treated by a physician or ENT specialist. Common therapies would begin with medications that thin out sinus and nasal secretions, decrease inflammation in sinus tissue linings, deal with infections and inflammation, or include surgery to clean out problem sinuses and improve drainage from sinuses.

Migraine Headaches

Migraines are a particularly vexing type of headache primarily because of the severity of the symptoms and how disabling the symptoms and pain can be. These headaches are characterized by head pain that is usually one-sided (unilateral). The pain is often described as an intensely strong pulsating or throbbing pain and is often accompanied by eye pain, light/photo sensitivity, or sound sensitivity, to name a few. It is often preceded by an “aura” which alerts the individual that a migraine is immanent. Migraines are somewhat gender selective in that they are three times more common in women.

It is generally understood that migraines are the result of a vascular phenomenon of vaso-dilation, where small blood vessels in the lining of the brain dilate and produce immense throbbing pain by pressing on nearby nerves. However, it has never been certain whether the dilation was a primary or secondary event. Various triggers such as chemicals, hormones, stress, and other agents have been shown to initiate or induce a migraine headache, and migraine sufferers generally learn to avoid those trigger agents or activities. To date most medical therapies (mostly pharmacologic) have been aimed at controlling and preventing this dilation response to proven triggers.

However, new information about blood flow in the brain and about the nerve endings embedded in the lining of the brain (dura mater) has revealed that the order of events in a migraine may not be as straightforward as we once thought. It appears that the nerve endings in the brain act first, releasing proteins that cause the blood vessels to be more permeable and which “primes” the nerves to be in a ready state of alert, or to be “sensitized.”

During the course of a migraine, researchers have found that the upstream (afferent) nerve fibers of the Trigeminal nerve (carrying nerves from the face, jaws, mouth, and forehead) were very busy with sensory nerve traffic. This is to say that during a headache the Trigeminal nerve floods the brain’s cortex with a barrage of sensory (pain & proprioception) signals.

Because the Trigeminal nerve is a dual component nerve with nerve traffic going both directions (motor and sensory), this research now suggests that there is a neuromuscular component to migraines. This begins to explain how migraines get started as well as how to prevent or reduce their onset and severity. Many now believe that the elevation in upstream (afferent) sensory nerve traffic traveling to the brain is responsible for creating a sensitized central nervous system (the “ready state of alert” mentioned previously), and that this storm of nervous system activity can precede and actually set the stage for the actual migraine activity itself. With this stage set the reflexive dilation in the blood vessels of the brain’s lining occurs and triggers the vascular headache pain or migraine.

Because of this Trigeminal nerve involvement migraine headaches are now being referred to as “trigeminovascular events”. The Trigeminal nerve is the cranial nerve responsible for a major portion of the head, face, and jaws. This upstream nervous system traffic is the sensory and proprioceptive (body position) nerve signals traveling up to the brain for processing and interpretation. When this upstream sensory traffic is elevated due to chronic muscle tension, muscle spasm, and pain, it burdens the brain and its abilities, depletes neurotransmitters, and sensitizes the CNS. Then when certain aforementioned triggers come along and provoke it sufficiently, dilation results in precipitating a migraine headache episode – or trigeminovascular event.

The good news from this information is that the neuromuscular component can be better balanced and controlled thus reducing the storm of upstream sensory traffic on the Trigeminal nerve. This is like taking more cars off the freeway during rush hour. When motor and sensory activity is calmed down on these nerves, with muscles and pain pathways relaxed from tension and fatigue, onset and frequency of headaches can be reduced.

While this science doesn’t yet explain away every migraine it does explain why we very often obtain profound results in migraine reduction when we work to balance the head, neck and dental bite, and reduce the neuromuscular tension in these areas. 

Tension Headaches

Tension headaches are the most common type of headaches among adults, and are sometimes referred to as “stress” headaches. This is because they are the result of overworked or stressed muscles in the forehead, jaws and neck.

An episodic tension headache may be described as a mild to moderate constant tight band-like pain, tightness or pressure around the forehead or back of the head and neck. These headaches may last from 30 minutes to several days. Episodic tension headaches usually begin gradually, and often occur in the middle of the day. The severity of a tension headache increases significantly with its frequency. Chronic tension headaches can come and go over a prolonged periods of time. The pain is usually throbbing and affects the front, top or sides of the head and is often described as though there were a tight band or vice putting pressure around the head. Usually, there is an associated amount of discomfort and tension also present in other areas such as the neck, shoulders, back, and jaws. Although the pain may vary in intensity throughout the day, the pain is almost always present. Chronic tension headaches do not directly affect vision, hearing, or balance, each of which is more indicative of a vascular type of headache.

Causes of Tension Headaches:

Much has been written about the causes of tension headaches, which in and of itself reveals there is still some debate on the topic. Traditionally the medical model that many physicians have used to explain the varied causes of tension headaches have included:

• Unknown cause
• No single cause
• Inherited trait that runs in families
• Not caused by tightened muscles
• Tightened muscles in neck and scalp
• Inadequate rest
• Poor posture
• Emotional or mental stress
• Depression or Anxiety
• Hunger (hypoglycemia)
• Overexertion
• Environmental stress
• Internal stress (family, friends, work, school)

This confusing array of explanations is made worse when the medical model for treatment has traditionally been limited to over-the-counter and prescription pain relievers, muscle relaxants, antidepressants, and stress management counseling, biofeedback, etc.

As is evidenced by the very name of this headache, muscle tension is the hallmark characteristic or common denominator of this headache. Ironically, few have been able to understand or explain it, as is evidenced by their using signs and symptoms as etiologic or causative factors. Even fewer seem to know how to go “upstream” with a line of questioning that asks the basic question “Why are the muscles tense in the first place?”

It is therefore helpful to ask “What is a tense muscle?” and “What causes a muscle to be tense?” Understanding the answers to these questions will help better understand where pain comes from and what can be done about it other than resorting to a temporary drug-induced relief.

First – to better understand muscle tension and muscle health let’s discuss muscle physiology (how muscles work). Muscles are made up microscopically of small muscle fibers. When a nerve signal arrives at a muscle, muscle fibers are stimulated to contract which brings the ends of the muscles and the bones they are attached to, closer together. This works because these small muscle fibers are composed of small protein muscle filaments called Actin and Myosin (see Figure 1). These filaments can slide tight past each other much like interweaving your fingers and pushing your hands/fingers together. When triggered with a nerve signal and supplied with molecular energy (ATP), these filaments ratchet or slide together, and in turn contract the muscle tighter. The molecular energy for doing this muscle work comes from an energy molecule called ATP (adenosine triphosphate) which is created from the glucose sugar molecule in what biochemists call ‘Krebs Cycle’. (It is at this simple molecular level that all energy in the body and our muscles comes from.) But, in order to generate ATP molecules from glucose for use as energy to power a muscle, a ready and steady supply of oxygen is needed, which in turn is delivered by red blood cells.

With elevated muscle tension devouring up the available oxygen and reducing the blood flow due to tight compressed muscles, there is a metabolic shift from aerobic to anaerobic metabolism within the muscle itself. This shift to an anaerobic condition results in the build up of metabolic waste products such as lactic acid. The result is pain!

In fact, in the vast majority of cases, pain comes from muscles which have lactic acid in them! Most people have experienced this in their muscles when they over-worked them in the garden or in the gym or on a bike ride. It takes a day or two before lymphatic drainage and normal blood flow in the muscles washes out the painful toxic metabolites and restores the muscles physiology and comfort to normal.

With this basic understanding of muscles, you can now understand why healthy muscles are such an important part of dealing with headaches. The biomechanical and neuromuscular models of posture, muscle balance, and healthy muscle physiology are represented in many common everyday experiences which touch your life. Workplace ergonomics and repetitive motion injuries are common and costly problems we must deal with. Using muscles to support poor body posture, forward head posture, and to generally support your body above a flat floor in a world of gravity, requires considerable muscle activity and coordination and balance (see Figure 2). When improperly overworked, especially over prolonged periods, the muscles exhaust themselves, find themselves fatigued, and can begin to cause pain and suffering in the offending muscles and body parts thus affected.

So how does all of this apply directly to headaches? Consider this: The way the mandible (lower jaw) is postured or positioned against the base of your skull can be the reason for tense muscles. If these postural muscles can’t relax or refresh themselves (get rid of lactic acid build up), if they are unbalanced and overworked because of a bad bite or chronic poor posture, muscle metabolites will build up producing pain which can refer and generate the headache we call a “muscle tension headache.”

This is to say that these muscles that control the posture and movement of the jaw and neck can become very uncomfortable if the dental bite is not balanced or if the jaw joint is strained or injured. Often clenching and teeth grinding results, causing damage to the jaw joint and to the teeth themselves.

The jaw-to-skull relationship is determined by the teeth or dental bite. How the lower jaw fits against the base of the skull is determined by the tooth-to-tooth relationship of the upper and lower jaws. Muscles tendons and ligaments that connect the two jaws together must “go along for the ride”, as it were. They are subservient to the dental bite or occlusion. When the muscles get tired of holding a certain mandated posture, they can fatigue to one degree or another, resulting in problems. Depending on individual adaptive or compensatory capacity, the muscles can exert themselves to grind the “pegs” (teeth) together in an attempt to create more harmony between the jaws. Obviously, the muscles and teeth don’t do anything in and of themselves, but what the nervous system is involved. Muscles can’t fire or work without a nerve impulse. This is why the Trigeminal nerve is so intimately involved in both muscle tension headaches as well as the aforementioned migraine headache scenarios.

To extend this conversation further, other postural aspects must be considered when dealing with headaches. Ascending (bottom to top) posture affects how the “top block” is held or balanced on the top of the “stick” (spine), and muscles must work all the way up the physical frame in a bracing fashion to keep the skeleton body upright and opposed to the effects of gravity so as to insure effective function. The nervous system is integral to this process as nerve signals are constantly whizzing up and down the neural network at lightning speed telling the brain where the body is in relation to the world around it, and sending back instructions on which muscles must be contracted, and how much, in order to assure a smooth ride without injury or noxious insult (a process called proprioception).

These ascending and descending postural influences, driven by the central and peripheral nervous system, keep us functioning and help us to avoid trouble. However as far as the jaw position against the skull is concerned, if the muscles don’t like the jaw position that the teeth put the jaw into, then these muscles will be stressed, tense, strained, and overworked. This can result in abusive muscle forces which can damage the jaw joint, grind down or damage the teeth themselves, and create the pain and discomfort that leads to or creates headaches.

Example of excessive tooth wear from hyper-active muscles

Because of how the muscles work together on the skeletal frame to allow function and movement, muscles rarely if ever work in isolation. This explains why the neck, shoulders and jaw muscles work together as a unit, and why they so often wind up tight and sore. Neck and jaw muscles brace each other and work together to support head posture.

This is why the muscles of the head, scalp, neck, and jaws can become so tender and sore, and such a strong generator of headache pain. Again, jaw problems, unbalanced muscles, stress on the jaw joint (TMJ), or a bad bite (misalignment or malocclusion) all can play a significant role in headaches. They can also create facial pain, ear problems, and pain that extend to the neck, back and shoulder.

Due to the effects of this muscle tension and the referred pain patterns it creates, other symptoms can be created. A partial list of other symptoms include: ear pain and congestion, dizziness, ringing in the ears, facial pain and pain behind the eyes, neck and back pain, teeth sensitivity, nighttime teeth grinding, broken teeth or fillings, loose or missing teeth, malocclusions like overbite or deep bite, depression, anxiety and insomnia, and so forth. Any or all of these signs and symptoms can be an indication that there is instability in the jaw joint, and that muscles are in spasm due to an unbalanced bite or neck posture.

It should be apparent why depending on or using medications can’t solve this problem alone. Medicines that obtund the pain, or relax the muscles, or calm the nerves, or induce sleep, can’t resolve problems that are fundamentally neuromuscular, bio-mechanical, and muscle-skeletal, and which require treatment to get at the “roots” rather than the “branches and leaves” of the problem.

For best effect, proper dental care often requires the use of other “physical modalities”. Because posture is an up-and-down affair, limiting treatment to spinal adjustments, foot orthotics, or dental bite corrections alone, will often leave the problem short-changed. Chiropractic adjustments and physical therapy will never “take” or “hold” as muscles fight them due to a faulty dental bite. The opposite is often true as TMJ and dental bite therapies will often fail if the contributing or concomitant postural problems in the ascending spine are not addressed.

The bottom line is that muscles which are chronically under stress and in tension can cause muscle tension headaches and other disorders. This will not stop until something is done to lower the muscle tension and restore balance to the postural equation.

This is why consulting with a properly trained dentist is so necessary! No other health professional has the training to reposition the mandible so that the muscles of the head, neck and jaws can remain in a physiologically rested, aerobically healthy, metabolically stable state.

Regardless of the source or reasons for headaches it is important to determine whether there are dental factors that contribute to headaches. What we know for sure is that if muscles are sore or are tense, that means they have lactic acid in them which results from anaerobic muscle tension. Very often this degree of muscle tension is created secondary to postural imbalances in the dental bite and the jaw muscles that brace with the neck to support head and neck posture. This is a never ending viscous cycle that must be stopped in order to gain relief from pain and to provide protection to the teeth, jaw joint, neck vertebrae, and all the associated soft tissues.

Those ready to find relief are encouraged to consult with a dentist trained in dental occlusion, neuromuscular dentistry and TMJ treatments. Remember that not all headaches are caused by unbalanced muscles. Sometimes systemic factors such as hormones, environmental chemicals, diseases, and tumors can be the cause. This is why a comprehensive evaluation is so important. The facts are that the vast majority of headache sufferers have a neuro-muscular component which can only be treated in a multi-disciplinary approach that stabilizes and balances muscles of the head, neck and jaws. Our consultation time together will begin to determine the best route for you to go based upon your situation and your medical history.

If you find that you are tired of living in pain and are ready to begin on the road to healing, you are invited to speak directly to a neuromuscular dentist trained in the complexities of treating these problems. Remember, that by putting the jaw joint and mandible back into alignment and stabilizing the muscles you can alleviate most headache problems related to TMJ, muscle tension, nerve and jaw joint disorders.

How to Choose a Dentist - 8 Keys to Choosing the Right Dentist

Today more than ever, the choice of a dentist for you and your family is a critical decision that should be made with the utmost care. So how do you choose a dentist? There is more to selecting a good dentist than simply throwing a dart at a listing. The truth is that there are a number of factors that must be considered in making the right choice for the right dentist.

Just like in choosing other professional services, many things influence the quality of this decision for you. Not the least of these is the philosophy and beliefs of both the dentist and the person seeking care. For example: Do you deal with problems as they arise (“disease medicine), or do you seek to prevent problems before they arise? Is it more important to get the cheapest dentistry, or is your smile and dental health important enough to seek higher levels of complete care?

When it comes to dentistry, as you look in the Yellow Pages you will find that every dentist claims to be a cosmetic dentist. There has been such an influx of “cosmetic dentists” that anymore, being a “cosmetic dentist” is cliché – even (yawn) passé! Why? Because these days, any dentist who does teeth whitening or white fillings can claim to be a cosmetic dentist!

Choosing the right dentist for you, one with substantial experience in complex cases, extensive hands-on training, a background in teaching other dentists the latest and the best, and who has a gentle approach that compliments your needs and wants, is critical to achieving the most successful outcome - your radiant confident new smile. Educated and discerning people realize that cosmetic dentistry properly done, is complex and precise and will dramatically affect their lives for years to come. All this is to say that

… Not all dentists are alike, and not all patients are alike!

What follows is some advice that comes from years of observations, which our clients have found helpful in their selection process.

How to Choose the Right Dentist for You:

1. A Caring Approach and Great Communication:
Find a dentist with a good chairside manner who cares about you as a person as well as a client. Find a dentist who will take the time to listen, answer your questions and treat you with respect. Since communication goes both directions, it is as important that your dentist understands what you want as that you understand what they are explaining. This goes along with the adage “seek first to understand then to be understood.”

2. Post Graduate Continuing Professional Education:
It may surprise you to learn that the vast majority of dental schools don’t teach courses in cosmetic dentistry and smile design. Those that do only offer introductory courses. We believer that your mouth is not the place for on-the-job-training, in spite of the idea that it is a “dental practice.”

Find a dentist whose committed to continuing education, and whose strengths and areas of special focus are a good fit with your interests and needs. To perform complex dental procedures at the highest level requires the best in modern dental materials, and an artistic eye for the finest in smile design, and a rigorous program of post-graduate training in cosmetic and neuromuscular training.

Because of the rapidly changing world of medicine and dentistry, it is critical that your dentist keep abreast of the latest techniques and materials. The importance here is not only in developing expertise in clinical judgment and technical skill, but also in demonstrating a commitment to the highest levels of excellence.

Places of post-graduate continuing education such as the prestigious and world renowned Las Vegas Institute for Advanced Dental Studies (LVI) teach the finest dentists from around the world, in hands-on courses in modern dental techniques of cosmetic and neuromuscular dentistry.

Dr. Ostler, has not only trained and graduated from the Las Vegas Institute for Advanced Dental Studies, but he has been a clinical instructor at LVI teaching dentists from around the world the fine art and science of smile design and complex dental reconstruction. Imagine what he can do for your smile and peace-of-mind!

For more information about LVI, or to find a dentist in your area who has been trained at LVI, you can go to www.lvidocs.com and www.leadingdentists.com.

3. Wise Treatment Planning:
You deserve an honest report of your problems and an understandable plan for fixing them. Integrity is not just the best, but the only policy. And wise planning prevents painful dental emergencies. Choose the best options and work to create a long-term plan for healthy teeth and a pleasing smile. Many people operate on the principle that if it doesn’t hurt and isn’t broken, it must be okay. Too often, nothing could be further from the truth.

Many dentists simply treatment plan the most urgent needs, or allow their patients to talk them into just taking care of the emergencies. Wiser planning includes a comprehensive evaluation of your present needs and wants, and an assessment of where you will be in 10, 20, or 40 years. If you want your teeth in your old age, then the time to start planning is today. Wise planning allows for wise budgeting, peace-of-mind, and a healthy radiant confident smile. This is not a time to compromise by being “too cheap,” or to claim that because it doesn’t hurt it isn’t “necessary.”

4. Financial Options:
The number one reason given for delaying or denying dental care has to do with the costs of dental treatment. (More will be said below about insurance.) Like everything else in life, what makes the world work today is making what we want and need, affordable.

Making treatment affordable should also be important to your dentist. Obviously, the treatment planning and budgeting will take into consideration the urgency of needed care. Shortchanging quality and accepting lower levels of care are never good outcomes, even if dictated by economic reasons. Dental care always costs more later, and poor quality always costs more in the long run. Financial options allow you to budget appropriately and help you use your financial credit wisely.

5. Have the Right Personal Philosophy About Money:
Money is a very sensitive subject for everybody involved, and it’s best to be up front and honest about it from the start. There is no question that dental services today are expensive. It seems they’ve always been that way and will continue to be such. That is why it is important to be clear about your reasons, motivations, and values that underlie your decisions and attitudes toward your smile and your dental health. The costs of dental care will never be less than yesterday’s fees. Rising dental costs make wise planning and financial strategy very important.

Every dentist has seen people who claim to not have the money for dental care but who persist in smoking, having two cars, taking vacations, enjoying expensive recreation, making boat payments, etc. (And at the same time they won’t brush and floss as they could prevent problems from becoming worse and more expensive to fix later.) Now, it’s not saying these things we spend discretionary money on aren’t important or enjoyable – but unless it is about taking food out of children’s mouths, it is just that – discretionary – a choice that arises from one’s values. That is why your personal philosophy is important to understand.

The philosophy of the dentist is also important. Your dentist shouldn’t do more treatment than is best for you, but if the dentist’s goal is to save you the most money, he/she will only offer what is the cheapest care without regard to what is the best or longest lasting.

6. Don’t Get Caught in the Dental Insurance Trap:
The “insurance trap” is a game that is often played by the both the dentist and the patient. Look for a dentist who won’t let your insurance plan dictate their treatment planning. The insurance will only pay a minimal amount of your dental care anyway. It is not a “Major Dental” policy like major medical health plans. It is designed for preventive care and minor or maintenance dental care. Don’t expect more from it than it can deliver, and don’t ask your dentist to compromise what is best for your health because of unreasonable expectations or misplaced values.

Good dental health is always a good investment! Personal confidence and peace-of-mind are priceless. It is always wise to maximize your benefits each year. If you don’t use your benefits you lose them at the end of the year. It’s like taking money out of your pocket and giving it to the insurance company. But be careful not to get caught in the “insurance trap” thinking that you can only do what is covered. Your insurance will only pay $1,000 (on average) in a year’s time anyway.

Understand that dental insurance really isn’t insurance because there isn’t any “risk” to insure. This is because they have a stop-loss or maximum yearly benefit built into the policy. They will only pay out up to the maximum yearly amount allowed. It doesn’t matter how much dental work you decide to do, the “insurance” company will only pay up to the maximum limit, after which you are on your own. Therefore, you must think of your insurance benefits not as a “pay-all” but as pre-paid dentistry which helps you do what you would do anyway if you didn’t have “insurance”, (you would just budget differently).

If your strategy is to only do what the insurance company will pay for, that means someone else is making decisions about your health and quality of care. Remember that their motivation is not that which is in your best interest – rather for them it is about making money for themselves. They accomplish this by denying, delaying and deferring (the three “D’s”. After all, it isn’t their disease or unattractive smile!)

Dentists frequently hear new patients say that the reason they haven’t had dental work is because they didn’t have insurance. It is always a curiosity to wonder how they could afford hair care, clothing, holiday gifts, vacations & recreation, car and boat payments, pet care, tobacco/alcohol/gambling, computers & electronics, and so forth – since they didn’t have any insurance to help pay for it. The point is it’s about values and budgeting! It says something about people’s values when they choose discretionary lifestyle expenditures above needed health care, and would be willing to shed body parts and allow disease to worsen rather than discipline their basic values and budgeting.

7. Career Success and Social Standing:
Sometimes your best friends won’t tell you that you have bad breath or an unattractive smile. After all, friends are supposed to accept each other as they are. A better philosophy is to expect your dentist to completely present all possible dental work and then let you decide what is appropriate or not for your situation.

Find a Dentist who understands that career success and social confidence require a healthy attractive smile. Bad breath, broken teeth, and unbecoming smiles, should receive top priority.

Because dentists are people too they can often under-diagnose and under-present dental care because of a fear of rejection or because they risk offending or alienating their patients. This is especially true if the dental care is not urgent or is more related to cosmetic issues. They can wind up only presenting basic or minimal clinically acceptable care, but overlooking the importance of elective image-enhancing procedures and practices that can improve your self-confidence, increase your career success and improve your social standing.

8. Headaches and TMJ/TMD:
Headaches, migraines, jaw problems “TMJ” and bite problems can be very vexing problems indeed. If you suffer from these or have facial pain, it is essential that you find a dentist who is trained and experienced in diagnosing and treating problems related to the dental bite and the temporomandibular joint (TMJ).

You may notice that you have worn-down or crooked malaligned teeth. Perhaps your jaw pops or snaps as it opens/closes, or you get periodic migraine or muscle tension headaches. If your bite or jaw or posture is out of balance, it is important to have a proper and thorough diagnosis. Routine dental training for the general dentist falls short of what’s necessary to adequately treat these complex conditions. General dentists or specialists who have undergone additional training in diagnosing and treating temporomandibular dysfunction (TMD), problems of the jaw joint, occlusion, and neuromuscular dentistry, will be able to help you understand the true nature of your problem and also to provide suitable treatment solutions to help you better manage your problem. For additional information, you may find the information on this web site helpful, or go to www.leadingdentists.com .

In summary:
Choosing a dentist is a very important decision. Well trained dentists are more than “tooth mechanics” or “tooth carpenters.” They are doctors of the mouth. They should be interested in your comfort and well-being and in helping you to accomplish your goal of having a confident healthy and radiant smile – for the rest of your life. They will understand how important it is to you to keep your social presence bright and your self-confidence strong. And they will respect your values and treat you with the respect you deserve. They will also speak honestly with you about your health and cosmetic situations and help guide you in putting a plan together that will maintain your wellness and protect your pocket book.

How to Choose a Great Cosmetic Dentist

It takes more than slick marketing, cute slogans, and “cosmetic dentist” listings in the Yellow Pages to be a skilled cosmetic dentist. To make sure your smile is in the best hands, consider the following guidelines for choosing a great dentist:

1. Start by making sure that whoever you select has specific training in aesthetic dentistry. Great cosmetic dentistry is accomplished by dentists with advanced training and regularly attends continuing education courses. Ask the doctor or staff or consult the practice web site to learn of special qualifications regarding expertise and training and if they have experience in teaching, clinical instructing, or with professional study groups.
2. Your first visit should be a consultation to discuss your desires and to determine the best solutions for your situation. A complete evaluation of your teeth will be necessary so you can discuss how any treatment will affect your bite, your gums, and the general function of your teeth. A good dentist will take the time to listen, answer your questions and treat you with respect. A good cosmetic dentist will generally insist that you resolve underlying biological and functional problems before pursuing elective cosmetic procedures.
3. Ask to view a photo book of patient before-and-after pictures so that you can have a good idea of the type of results you might expect or request. A good cosmetic dentist knows how to take great patient pictures. You should expect to see pictures of the dentist’s own work as well as to have your own dental photos taken, so that you can see your own smile and better co-develop an appropriate plan for treatment.
4. It is helpful to have a good idea about what you like or dislike about your smile and teeth. Be prepared to discuss this at your consultation visit so you can match this with the skills and experience of the dentist.
5. A good cosmetic dentist understands and follows the rules of Smile Design and will go over these with you so that you will understand how your smile can be made its very best. Their web site should have information on Smile Design or Smile Analysis that will help you understand how to better evaluate your smile.
6. Ask what laboratory ceramist the dentist uses to make your porcelain restorations. Good cosmetic dentists are very particular about the quality of laboratory ceramist they use. First-class lab support is crucial to you receiving a quality result. A good dentist is willing to pay (and charge) for the quality and peace-of-mind that this expertise brings to your smile.
7. Generally, cosmetic procedures are elective and tend to be more expensive by nature. Wise planning, good financial strategy and the availability of financial options can make this dental care affordable. You should be suspicious if a dentist is offering something far below the industry cost range. Remember that dental insurance is not a “pay-all”, is generally reserved for routine dentistry, and normally will not cover cosmetic procedures.

Mercury Fillings Report - Silver Mercury Fillings

[Disclaimer: Please note that a dentist is not a medical doctor and thus isn’t licensed to diagnose or treat medical problems or predict medical consequences, good or bad, for his/her patient related to this topic of mercury toxicity. They put their license to practice dentistry at risk, or at least will be required to submit to correction and censure from peers if they cross the line and begin “practicing medicine” when it comes to issues related to this subject. What is said herein is not meant to diagnose or set forth specific diseases or pathologies, nor to claim that mercury in dental fillings cause medical related problems. There are many books available in the popular and scientific press which better address this subject which you are encouraged to read if you wish further information. Any such discussion or decisions related to medical issues related to mercury toxicity should be discussed with a competent physician knowledgeable on these issues.]

There is little debate today that mercury is a potent neurotoxin and a significant problem in both biologic systems as well as in the environment. But in dentistry the use of mercury in fillings represents one of the most hotly debated subjects. Those opposed to using mercury in dental fillings claim that mercury is released from fillings and can be toxic to the human biological system. Defenders cite its 150+ years in use as evidence of its safety. Those opposed to using it in fillings say that the debate should be settled by medical toxicology, and defenders easily dismiss any toxicology information as irrelevant, claiming that the mercury is “bound” in the amalgamated filling material, and again citing its “long successful” track record and the fact that more people aren’t “sick.”

Those defending the use of mercury allow that 1% of the population is “allergic” to the material, which tends to minimize or discount the severity of the problem for those who do have problems. (This would mean that they believe it’s okay for 2.5 million people in the US to be affected! Ironically, if 1% of the people were ill-affected by the use of a toothpaste, it would immediately be removed from the market.) Additionally, the defenders of the status-quo with mercury filling use cite the fact that it would be nigh impossible to meet the needs of our populations around the world if mercury fillings were not employed as a dental restorative material. This is because mercury fillings are inexpensive, readily available, and easily placed.

But the question still remains begging – with such a huge debate and such serious allegations being leveled, why is it still used and defended, especially with the advent of modern dental materials that do not have mercury and have so many other advantages. Good question! Indeed, there is a growing movement politically, legally, and scientifically, that is trying to discredit the use of mercury fillings. Perhaps the jury is still out on this issue, at least as far as public policy is concerned.

Those opposed to its use are adamant that no mercury of any form should be implanted or used in the body. And the arguments can be compelling. If a HAZMAT unit has to clean up a broken mercury thermometer, if the dentist has to handle the mercury filling material in a special way before it goes into the tooth, if there are special environmental methods for handling mercury filling waste products after use, how could it be safe while in the mouth? In other words, why is the human mouth the only safe place for mercury? On the surface of the argument it doesn’t make sense. Why is it that older generation scientists used to calibrate their mercury sensing equipment by chewing gum?

So much has changed in dentistry. One of the biggest revolutions has been the arrival of modern materials. Silver Mercury Amalgam fillings have been around since the early 1800’s when mercury was combined with metal filings to form a type of metal cement or amalgamation that was easy to handle and readily available. Without question, if silver mercury fillings weren’t seen as being “grand fathered” in, there would be no way even the same modern scientific processes that are used to justify its continued use, would allow it to become a “new” medical/dental material.

Some of the disadvantages of silver mercury fillings include expansion, corrosion, and esthetics. In short silver mercury filings expand in size over a lifetime of use in a tooth. This creates stresses in a tooth structure that propagate through the tooth structure and generally must be relieved at some point in time, resulting in fracturing and cracking of enamel and tooth structure. When a tooth does break apart, it can necessitate a root canal or gum surgery. Silver mercury fillings do not seal shut or tight against a tooth interface. Ironically, due to its toxic properties, bacteria don’t tend to thrive well and hence less decay will occur and be slower growing over time, than around similar defects in non-silver fillings. Silver mercury fillings oxidize or “rust” in the wet environment of the mouth. This tarnishing or corrosion further breaks down the filling materials especially at the “margins” or edges of the filling materials. Added to this is the dark gray or black color of the fillings and the graying it produces in the filled teeth. (For further information on cracked teeth, see the report on this web site about Cracked Teeth.)

“Amalgam” is the word used to describe the mixture of various metals like tin, silver, copper, and zinc, along with elemental mercury (a liquid at room temperature) to form a dental filling. Fifty percent of the filling is mercury, and when these metals are mixed together it becomes hard and is referred to as a “silver filling.” Silver mercury fillings have been used since the early 1800’s when barber-dentists began using them in America after their introduction from Europe. To their credit, they are quick, cheap, easy to handle, and readily available – all which have paved the way for the historical and universal use of this dental material.

Because of its unique physical properties, Mercury metal has many uses. Because of its high density, it is used in barometers. Because it has a high rate of thermal expansion which is fairly constant over a wide temperature range, it is used extensively in thermometers. As a liquid at room temperature, Mercury is used as a contact material for electric switches. In mercury-vapor lamps, it emits a light rich in ultraviolet radiation; (street lighting, sun lamps, "black lights"). It has been used as an insecticide, pesticide, fungicide and in rat poison, and as a disinfectant. It can mix with scrapings or powders of other metals (silver, tin, copper, zinc) to form a special type of alloy called an amalgam, which is used in dentistry for filling teeth.

However, as mentioned above, few subjects have polarized the profession of dentistry like that of amalgam mercury fillings. From a potential health point of view, the concern is that mercury interferes with the tissues and nerve cells of the body. Mercury vapor comes out of the fillings and is breathed into the lungs. This is the main way dental mercury gets into the body. Once inside, it is mainly stored in fat tissue, including the brain and central nervous system.

Mercury has long been known to be toxic; the phrase "mad as a hatter" refers to the 19th-century occupational disease that resulted from prolonged contact with the mercury used in the manufacture of felt hats. Despite evidence and experience to the contrary, proponents of its use in dental fillings claim the mercury is “locked up” with the other metals and therefore is harmless in humans. The truth is that mercury vapor escapes for the life of the filling, especially when chewed on or heated.

Mercury poisoning occurs when biological tissue is damaged resulting from exposure to mercury, or its compounds. Elemental mercury, like that found in thermometers and dental fillings, is the most common occupational and medical source. Exposure typically comes from inhaling mercury vapors. Elemental mercury can be converted into methylmercury by microorganisms (which can then enter the food chain, i.e. contaminated fish), and by gastrointestinal bacteria. This more toxic organic compound can easily cross cell membranes.

Mercury poisoning can cause severe neurological and kidney damage. In acute cases of gross exposure, Mercury can cross the blood-brain barrier and cause irreversible nervous system and brain damage, e.g., loss of motor control, numbness in limbs, blindness, and inability to speak. Some studies have connected maternal mercury exposure to fetal damage. Acute mercury poisoning can be confirmed by urine tests, and chronic exposures show up in hair analysis. For more long term exposure (such as with dental fillings) the manifestations can take longer and be more subtle, if at all. In most people the effects are negligible or at least minimal due to a variety of reasons which include: healthy host defense system, strong immune system, “good” genetics, etc. For others who are affected, the effects can be devastating. They can be “primary” (mercury toxicicity itself) or they can be “secondary” – meaning that they manifest only after an already weakened immune system or host defense mechanism is in play. An amount that may be “safe” for one person, may “pull the rug out” from another person.

They are also thought by many to “trigger” other medical problems. While as many claim, the jury may still be out on all of mercury’s effects on the body, we can at least say that it is unwise to use it in or around the body. At a minimum, there is simply too much question and debate. At worst, it must be recognized for what it is – a toxic neurological poison!

In summary:
It is well known that silver mercury dental fillings are still the predominant filling material. Their use is staunchly defended by a large contingent of dentists including the American Dental Association. While the trend is shifting away from its use, 60-70% of dentists still use it in their practice. There is no question that mercury is toxic to humans and can cause tremendous problems. The debate is whether dental fillings are a source of mercury contamination.

While this debate rages, and without going over the edge into medical diagnosis or treatment, many dentists including Dr. Ostler, have decided to focus on higher quality dental restorative procedures such as porcelain ceramics and resins, newer zirconium substrates, and gold (although gold or other metals are seldom used or needed anymore). In our considered opinions, these are superior restorations which provide a more durable and strong solution to repairing the tooth and holding it together in a strong fashion. While using modern dental techniques and materials are highly technique sensitive and require advanced training to be successful, they completely avoid the mercury debate, and instead offer dental restorations which are stronger and more durable, more esthetic and more natural looking. Because of the ongoing debate, and the extreme negative consequences of potential mercury toxicity, it seems unconscionable to place or implant mercury containing materials in the human body which have at least the potential of causing problems, instead of using modern alternatives available.

For a article on Mercury Amalgams in the Chicago Tribune click here.

For more information about mercury fillings in dentistry, including summaries of clinical research, visit:

www.amalgam.org

The Perio/Heart Connection Report

The evidence linking periodontitis to heart disease began in 1989 by a study in Finland, which observed that patients who had heart attacks had more severe oral conditions including periodontal disease and tooth decay. Several studies since then there have shown that a preexisting periodontal disease results in an increased risk for a heart attack or stroke.

These studies suggest that periodontal disease is not only associated with cardiovascular events like heart attack and stroke, but it is also associated with subclinical evidence of atherosclerosis including thickening of the vessel wall. These controlled studies indicate that periodontitis remains an independent contributor to heart disease. Caution is in order because these associations do not establish causality.

Recent evidence shows the relationship between gum disease and heart disease by demonstrating the presence of periodontal pathogens (bacteria & microorganisms) within the atheromatous plaque lesions of the vessels. We have long known that gum disease is associated with transient exposures of the bacteria into the blood (bacteria) and this is the reason why antibiotics are used as a prophylactic prevention prior to dental treatment for patients with heart murmurs and valve problems. New evidence is suggesting that these organisms can lodge in the vessel walls and persist. Thus the bacteria is associated with the plaques within the vessels themselves.

Other new information links gum disease with systemic inflammation, as measured by the production of liver proteins such as C-reactive protein. This protein has been known to be a risk factor for myocardial infarction or diagnosis of peripheral artery disease in otherwise healthy individuals. Mild elevations in C-reactive protein appear to confer risk for these cardiovascular complications. New research links gum disease as one potential cause for these elevations in this protein, thus suggesting another link between gum disease pathogens and heart disease risk.

There is also an association with known cardiovascular risk factors that are involved in systemic inflammation, and there is also evidence that the organisms are within the plaques. This represents a body of circumstantial evidence suggesting that this may be directly involved in the pathology associated with cardiovascular disease.

Yet another strong theory lies in the arena of nutrition. They suggest that the health of collagen protein fibers in vascular walls determines the course and progression of vascular disease. With vascular wall damage occurring as a consequence of 1)- homocystein (an amino acid), or 2)- oxidative damage from molecules called “free radicals,” and with a concomitant nutritional deficit of vitamin C, it leaves the vascular wall unstable and in disrepair. The body’s natural response is to “repair” the vascular wall lesions by using sticky lipoprotein(a) and LDL cholesterol to patch these “holes” or lesions, much like a scab would repair a wound on the external skin. Over time, and uncorrected or uncontrolled, this builds up to produce athersclerosis and heart disease. Antioxidant vitamins prevent oxidative damage to cell walls and cholesterol molecules. Vitamin B protects against homocystein damage. Vitamin C builds strong connective tissue which keeps in good repair the vascular wall.

Because the health of periodontal tissues also depend upon having strong connective and elastic fiber proteins, and Vitamin C is critical for the hydroxylation of proline amino acid (the primary amino acid of collagen) is stands to reason that perhaps another connection between gum disease and heart disease rests in the nutritional status and repair of the connective tissue components that are inherent within both gum tissue and cardiovascular system tissues.

Regardless of the root causes for cardiovascular diseases, it stands to reason that good nutrition and good oral hygiene control of bacterial inflammation in the mouth, are essential ingredients to help lower risk factors and prevent heart disease and its complications. Removing the oral bacteria meticulously well on a daily basis, and having regular periodic professional cleanings and dental checkups, as well as providing oneself with a diet high in necessary nutrients, will help reduce unnecessary risk factors that can lead to heart disease and stroke.

Resin Sealants

Note the unsealed grooves on this photograph.

These developmental grooves and pits are a normal part of the tooth. They are formed as a result of how the tooth develops inside the jawbone. These grooves and pits can and will attract bacteria and debris which will cause staining and/or decay to form deep down in the grooves and pits of this tooth. When this occurs it becomes necessary to drill out the decay and to "remove" the groove with a dental drill.

In its place is put a dental restorative material. When this cut groove is filled with silver mercury amalgam filling material, it can have destructive consequences to the structural integrity and durability of this tooth. As the filling material expands, ages, and experiences wear & tear, the tooth can break, new decay can form around and under the filling, and the tooth can become discolored from the by-products of corrosion (rust) staining the tooth structure.

Note the resin sealant has sealed shut the grooves and pits.

A "sealant" is a plastic or resin material that is thin enough to flow into the grooves of the biting surface of these chewing teeth.

First the tooth is cleaned and the debris and staining is removed from the grooves. The surface is then carefully etched using an acid. This allows the bonding of the resin to seal shut and occlude the grooves. Now it is impossible for bacteria to enter the groove to cause damage or to create the unfortunate situation where the tooth will have to be restored with a filling.

After having sealants place, it is important to have them checked periodically by a dentist to assure that they haven't been chipped away and are still doing the job they were meant to accomplish. Obviously, chewing ice or other such substances can cause injury to the sealant and may make it necessary to "repair" or replace the sealant. This is far better than remaining at risk for more invasive measures.

The sealant material is seen flooding the grooves after the grooves are cleaned out and debrided of all bacterial plaque, decay and stain.

Even a toothbrush bristle is too large to fit into, and clean out, the small grooves on the biting surface of chewing teeth. These grooves are cleaned out and sealed shut with the resin sealant material.

Sedation Dentistry

Most people can manage a trip to the dentist with not much more than a little anxiety. After all, it isn’t like a picnic in the park! But for some people, going to the dentist can be very stressful. Whether this is because of a bad experience at the dentist as a child, or because of other issues, dental phobia is a fear that often makes it very difficult for some people to properly take care of their dental needs and to protect their oral health and their beautiful smile.

[Click here to see what patients say about their experience with sedation dentistry.]

Dental fears can often be very embarrassing. In addition to the pain or anguish long ignored dental problems can bring, there is a potentially high social cost to having bad breath, broken teeth and fillings, dingy stained smiles, and missing teeth.

People who avoid treatment due to excessive or unmanageable fears or anxieties, don’t get the care they want and need. They don’t have a nice or confident smile and their dental problems spiral out of control continuing to get worse. In addition to the mounting costs for this extra treatment if ignored, it can also impact you in your career. Most people in America today believe that a bad smile can hurt career opportunities.

But today the answer can be as simple as …

“TAKE A PILL”

At the Center For Dental Health, we understand that these fears are real. We believe that dealing with people’s concerns is as important as fixing their cavities and broken teeth. That’s why we offer “Sedation Dentistry.”

Sedation Dentistry is done by taking a safe sedative medication prior to dental treatment. While it doesn’t really put you to sleep (hence the reason why we don’t refer to it as “sleep dentistry”), it does produce a profound sense of relaxation and amnesia (can’t remember). Even though it has proven to be very safe, instructions must be carefully followed for “sedation dentistry” procedures, because you will definitely be sedated.

Because of this, you will be asked to have an escort – someone to bring you to the dental office and to drive you home at the conclusion of the appointment. Additionally, they will need to remain at the office waiting, or make themselves available with a cell phone or pager. Even though you will be sedated, you will be awake and responsive and very relaxed. You might be woozy or disoriented, so you cannot walk alone or unassisted.

Following your visit, you will discover that you won’t be able to remember very much about the appointment. Even though you may think you feel okay, we will insist that your escort take you home and keep an eye on you for the next few hours. We suggest that you take it easy for the rest of the day.

At The Center for Dental Health, we want to do everything we can to make your visits as pleasant as possible.

Dr. Lee Ostler and Staff

"Does Your Spouse Snore"

Did you hear about the newly discovered link between snoring and rib bruising? It’s long been a puzzle until recently when one spouse admitted to the doctor that her husband’s bruises were from her efforts to stop the snoring! Mystery diagnosis solved!

With 200 million (estimated 67%) snorers in the United States the odds are that everyone will have numerous opportunities to be “entertained” or annoyed by a snorer. Whether it is someone in the next tent, in the next room, or lying next to you in bed, snorers oblivious to their own plight can make life miserable for anyone trying to sleep around them.

Consider the impact of the following noises:
• Jackhammer = 85 decibels
• Lawnmower = 95 decibels
• Airplane = 118 decibels
• Loudest recorded snorer = 93 decibels (Kare Walkert of Kumla, Sweden is listed in the Guinness Book of World Records)

Snoring can be very hard on marriages, causing many couple to sleep in different rooms of the house. It can have other unintended consequences such as daytime tiredness, falling asleep while driving, and impaired mental clarity.

Humor aside, snoring is no joke for those who have to put up with it. But there is a darker side associated with this annoying nocturnal sound effect.

As annoying and problematic as snoring is, it is only the tip of this noisy and deadly iceberg. Snoring is the beginning of a health-disease continuum that researchers now link with many of life’s most challenging diseases, and even to death itself.

As snoring deepens or persists, its cousin Sleep Apnea can raise its ugly head. Apnea is the Greek expression for “without breath” or “want of breath.” The numbers for this are equally staggering. With an estimated 17-20% of the population suffering from some form of sleep apnea, (from American Academy of Sleep Medicine) that means upwards of nearly 60 million Americans suffer nightly oxygen deprivation (shallow breathing or hypopnea), and episodes of no breathing - which sets in play a host of risk factors connected to many troubling medical disorders.

Modern medical research has now shown that sleep apnea has terrible health consequences, nearly all of which can lead to eventual death for the sufferer. The reduced air flow lowers oxygen saturation in the blood and can lead to learning and memory problems, irritability, depression, accidents and productivity problems at work or school. More importantly, sleep apnea is linked to such medical conditions as heart attacks and heart disease, stroke, weight gain, headaches, high blood pressure and kidney disease.

According to the National Sleep Foundation people with untreated sleep apnea have been estimated to be three times more likely to have motor vehicle accidents. It is estimated that roughly one in four truck drivers suffer sleep apnea and experience excessive daytime sleepiness.

To be sure, oxygen is king! Without it we die. But what happens when there is subtle and chronic deprivation due to persistent nightly obstruction or narrowing of the windpipe that carries precious air to the lungs and bloodstream?

Why is this minor alteration in breathing so consequential when it comes to your health?

Consequences of Sleep Apnea:

• Excessive daytime sleepiness
• Increased risk of motor vehicle accidents
• Neurocogniive deficits
• Increased risk of hypertension
• Increased risk of cardiovascular disease
• ncreased risk of insulin resistance and diabetes
• Increased risk of metabolic syndrome
• Decreased quality of life

Because of the constant cyclical nature of this repetitious arousal phenomenon, people who suffer from obstructive sleep apnea can’t get a good nights sleep. Other than the impact that snoring has on partners, this is the most annoying part of sleep apnea. They often experience excessive daytime sleepiness and tiredness, along with neurocognitive deficits. Because people with sleep apnea are prone to fall asleep easily and at inappropriate times, they risk experiencing more motor vehicle accidents and pose a greater danger to others on the road. (It is calculated that one in four commercial truck drivers suffer from sleep apnea). Additionally, when impaired work performance from excessive tiredness is factored into the equation, it is easy to imagine the many other social and economic costs sleep apnea presents to society.

Along with the generally decreased quality of life, they also experience an increased risk of hypertension, heart disease, stroke, metabolic syndrome, insulin resistance, impotence, cognitive dysfunction, and depression. Many people with sleep apnea are obese. However not all obese people are apneic, and there are many non-obese people who experience sleep breathing disorders.

Other common findings in people with sleep apnea are enlarged tonsils, elongated palate, uvular lengthening and edema, and thick necks. Sleep apnea is more common among men and among people in the African American and Hispanic populations, according to the National Institutes of health. Others at risk include anyone with a family history of sleep apnea, people who are overweight, have high blood pressure, possess small airways in nose/throat/mouth, etc.

The Science of Sleep Disordered Breathing

Sleep Disordered Breathing (SDR) occurs along a continuum, stretching from snoring all the way to breath cessation, or complete apnea. Its most innocent manifestation is snoring which occurs when the tissues of the throat (soft palate, uvula, and back of the tongue) relax and vibrate against each other during breathing. Its worst manifestation is the complete cessation of breathing with its concomitant lowering of blood oxygen levels (hypoxia).

During sleep or relaxation, the muscles of the mouth and throat relax and the size of the airway decreases. This narrowing of diameter in the airway increases the rate of airflow traveling through the throat. This creates a low pressure environment (Bernoulli’s Principle) and an opportunity for the flexible soft tissue airway walls to collapse into the opening. This is similar to sucking hard on a thin flexible milkshake straw and seeing it collapse on itself. As these tissues at the base of the tongue and soft palate (oropharynx) collapse and approach each other, rapidly moving air speeding past these structures creates a vibration in the tissues heard audibly as snoring.

When the airway collapses completely, all airflow stops, creating an apnea (which means “stopped breath”). This occurs despite repeated efforts to breathe (“paradoxical breathing”) where diaphragmatic and chest wall muscles continue to struggle almost violently to take a breath. Without free flowing oxygen to enrich the lungs, blood levels of oxygen decrease and carbon dioxide levels increase. These changes in blood oxygen levels and blood chemistry stimulate an arousal or partial awakening in the brain, which in turn increases motor activity to drive the muscles around the airway to open the airway so breathing can resume. The sleeping person then gasps and chokes as the airway opens and they take in a breath or two. They then quickly settle back into a more relaxed state only to see the entire cycle repeat itself again, and again, and again.

Severity of sleep apnea is rated or diagnosed by the AHI or “Apnea-Hypopnea Index”. This measures the number of times each hour there is an episode of altered breathing.

There is now an escalating amount of information from the medical research that frequent nighttime arousals (which occur when the oxygen level in the blood drops and the need to breathe overpowers sleep), set in play insidious biochemical processes which produces subtle yet serious injury to the body.

It is now believed that sleep apnea is an oxidative stress disorder. The plausible biological mechanism is through a “deox/reox mechanism”. During moments of cyclical intermittent hypoxia, an enzyme is activated which creates a burst of free radicals which increases inflammatory biomarkers and adhesion molecules (C-reactive protein) which leads to endothelial dysfunction and atherosclerosis or heart disease and stroke. People with sleep apnea can have elevations in CRP levels, and treatment for SA have shown reductions in inflammatory mediators which are implicated in cardiovascular disease and endothelial dysfunction.

Treatment for Obstructive Sleep Apnea

Strictly defined, Apnea is the cessation of breathing – which by interpretation is the lack of oxygen entering the body. Hypoxia is an incremental decrease in oxygen saturation in the blood stream, meaning it carries less oxygen in the blood cells. Therefore, treatment for sleep apnea is aimed at keeping the airway open so that normal breathing occurs through the night and hypoxia can be avoided. This is commonly accomplished via a pneumatic splint (CPAP therapy), or through repositioning the mandible forward either through the use of oral appliances or through surgical methods to advance the lower jaw forward.

Other surgical methods characterized by surgically removing portions of the soft pallet (UPPP), or stiffening the soft through the use of implants or creating scar tissue, have enjoyed very mixed results and poor patient acceptance. Many other less invasive strategies are also employed such as positional therapy (sleeping on side), and weight reduction.

A relatively new strategy for supporting the airway is accomplished by pulling the lower jaw forward, much as a paramedic would do to open the airway when dealing with an unconscious person. Oral dental appliances made of plastic trays, anchor on the teeth and help hold the lower jaw in a forward position and thus keep the tongue from falling on the back of the throat when relaxed. Oral appliance therapy is currently enjoying a wide surge in popularity due in large part to the inability of many people to tolerate CPAP therapy.

Traditional pneumatic splint therapy (CPAP) has enjoyed mixed patient acceptance. While its success rate is clearly good among those who can put up with the therapy, there are a lot of people who are CPAP intolerant, or whose condition is mild enough that an oral appliance is preferable.

Due to the effective use of oral appliance therapy for repositioning the mandible and pulling the base of the tongue forward, a landmark publication occurred in 2006 which opened the door for dentistry to become involved in sleep medicine. A position paper published by the American Academy of Sleep Medicine in 2006 has now established that oral appliances are indicated for mild to moderate obstructive sleep apnea. This is a very significant happening.

Dental Sleep Medicine

As mentioned, oral appliances which hold the lower jaw forward, have recently gained considerable popularity. The staggering numbers of people who are non-compliant or intolerant of a CPAP device, and who face a life-time of problems without nightly therapy, now have an acceptable alternative therapy. It is generally well tolerated and quite often preferred over a CPAP device. However its use is generally limited to treating mild to moderate sleep apnea. When CPAP can be tolerated and/or there is a severe sleep apnea diagnosis or other extenuating circumstances, the CPAP is preferable.

Oral Appliances thus serve a very important role in treating today’s epidemic of obstructive sleep apnea. This has created a new sub-specialty in dentistry, called “Dental Sleep Medicine. The American Academy of Sleep Medicine and the American Academy of Dental Sleep Medicine have come together to develop standards and protocols for the joint effort to treat sleep apnea as it relates to the use of oral appliances.

The American Academy of Sleep Medicine has recently published its Practice Parameters regarding Oral Appliances for Obstructive Sleep Medicine. In part they read:

“Oral appliances (OAs) are indicated for use in patients with mild to moderate OSA who prefer them to continuous positive airway pressure (CPAP) therapy, or who do not respond to, are not appropriate candidates for, or who fail treatment attempts with CPAP. …Oral appliances should be fitted by qualified dental personnel who are trained and experienced in the overall care of oral health, the temporomandibular joint, dental occlusion and associated oral structures.” – American Academy of Sleep Medicine, Practice Parameters

The bottom line is that sleep apnea is a medical condition. The standard-of-care requires a proper diagnosis by a sleep physician through appropriate testing at a sleep lab. Should a dentist inadvisably initiate anti-snoring treatment on a snoring patient who also has sleep apnea, they have made a presumptive diagnosis which could turn out to be fatal. Modern standards-of-care and accepted practice parameters discourage dentists and physicians from unilaterally treating snoring without proper sleep analysis by a sleep physician. Likewise, people should not elect to self-treat their snoring without a proper evaluation by someone trained in such analysis.

These conditions of fact require that dentists and patients be exceptionally wary of agreeing to fabricate and deliver snoring and sleep apnea appliances without the involvement of a physician and a sleep lab. This is because they must suspect an occult or hidden sleep apnea problem until it is ruled out. To make a snoring device without proper evaluation would be to make a presumptive diagnosis ruling out an underlying sleep apnea problem, which would and could leave many parties open to problems.

Dental sleep specialists and sleep physicians are now working together to provide an expanded array of options to help many people who suffer from sleep apnea. They are also helping tens of millions of people who must live and sleep with a snorer, or worse yet – with a loved one who stops breathing during the night – over and over and over again!

Indeed – snoring is no joke! For those who do it, and for those who must suffer sleeplessly through it! Finally there is another way out of the nightmare. For dentists, physicians and their patients – there’s another life to be saved, another relationship to mend, and more good night’s sleep to be achieved!

Sterilization and Safety

An open letter to our patients and friends,

The past several years has seen a significant upsurge in interest and activity in the area of infection control in medical and dental offices. Tuberculosis, hepatitis and the AIDS virus have taken center stage and have caused the medical/dental establishments to focus on infectious diseases like never before.

We are especially concerned about protecting you and us from infectious diseases. We know you place a very special trust in us when you receive care. Your peace of mind is important to us. That is why we are committed to providing maximum protection against any kind of infectious disease. We have invested much time and energy into the design of an infection control system, and we are constantly evaluating and updating our state-of-the-art procedures and systems. This makes prevention and protection a way of life at your dental office, and adds greatly to your peace of mind.

Among the precautions we take are:

1.) Autoclave – steam sterilization 
All instruments capable of withstanding high heat are autoclaved (sterilized) which kills bacteria and viruses. This equipment is tested weekly by an independent outside laboratory to insure that they are operating properly.

2.) Chemical disinfection 
All items that cannot tolerate high heat, such as plastics, are disinfected in a chemical solution formulated to kill infectious bacteria and viruses.

3.) Handpiece sterilization 
All handpieces ("drills) and related instruments are autoclaved (steam sterilized) after each use.

4.) Single-use and disposable items 
Where possible we use single-use and disposable materials and supplies. These are disposed of as special medical waste after each single patient use. This includes properly disposing of all syringes, needles, cotton & paper products, and disposable hygiene polishing instruments, etc.

5.) Barrier protection and surface decontamination 
Where possible, barriers (paper and plastic covers) are used to protect against contamination and making it easier to keep a clean treatment area. All surfaces are disinfected with a chemical solution formulated to kill infectious bacteria, spores, and viruses. This includes counter tops, sinks, dental chairs, light handles, etc.

6.) Clothing and on-site laundering 
Special clothing and covers (surgical scrubs) are worn by office staff involved with patient care. While we don't work in a sterile operating room like the hospital, we take every precaution to assure that you and the treatment staff are safe. We utilize convenient on-site laundering to assure that we are properly caring for this clothing.

7.) Surgical masks, disposable gloves, and eye protection 
Surgical masks and single use gloves are always worn! This works both ways to prevent transmission of disease in either direction. Glasses are always worn to protect eyes from contamination as well as injury.

8.) Updating & continuing education 
We continually monitor our procedures for compliance with OSHA, CDC (Centers for Disease Control), and the American Dental Association

There is only one way to create the peace of mind needed about this timely subject and that way is to follow exceptional and uncompromising standards for infection control. This is accomplished with modern methods of sterilization, surface barrier techniques, the use of accepted universal precautions, and safe work place practices. Since it is a matter of life for both the health care workers and the people coming to us for care, we remain pledged to providing you with excellent dental treatment in a manner where the very finest in infection prevention practices and safety are top priority.

We're confident that by helping you become more aware of the measures that are taken here on your behalf, that your trust and confidence in your dental office will be high, making your visits a lot more comfortable.

Sincerely - and to your peace of mind,

G. Lee Ostler Jr. DDS and Staff

Teeth Whitening

General Overview
Over the past few years there has been major advancements made in the science and techniques for teeth whitening. Originally, it was discovered quite by accident that certain chemicals had the ability to whiten enamel tooth structure. This discovery quickly evolved into what is now a very sophisticated industry involving both professionally directed techniques and over-the-counter methods for whitening teeth. Almost all whitening products whether over-the-counter or professionally performed or supervised, contain the active ingredient carbamide peroxide.

Contra-indications to teeth whitening (reasons you shouldn’t), include: existing cosmetic dental restorations (fillings won’t lighten in color), gum inflammation, periodontal disease, and ‘dirty’ teeth. Prior to teeth whitening it is best to have your teeth cleaned and to discuss recent or planned dental work.

All teeth whitening methods utilize an oxygenating agent (such as carbamide peroxide) in varying concentrations to whiten tooth enamel. Factors that influence success include the beginning intrinsic shade of the teeth, the degree of oral/dental cleanliness, past dental injuries, oral habits, history of tetracycline antibiotic use, the native hue and color of tooth structure, and the general state of dental health. Yellow-brown tooth colors generally whiten easier than gray-blue teeth colors.

Teeth bleaching procedures are mainly of two types: 1)- commercially available over-the-counter OTC, and 2)- professionally supervised. Of the later, there are in-office and at-home versions, each with its advantages and disadvantages.

What follows is a brief summary of each method and their applications.

1. OTC (over-the-counter) products: These methods are widely available in grocery stores, pharmacies, shopping malls, TV and internet, etc. They consist of strips, paint on gels, or general purpose (one-size-fits-all trays which attempt to hold bleaching gel against the teeth.

2. Professional Supervised

a. Tray Systems: Thin custom made plastic trays are fabricated from stone models of your teeth. These trays fit intimately to the teeth and allow for smaller quantities of prescription strength (higher concentrated) whitening agent to be used. Trays are used for a few hours each day (or night) or until the desired degree of whitening is achieved. Trays can then be stored and used later for touch-ups as desired.

b. Power Bleaching: New technology has brought “one-hour” whitening techniques. The advent of more powerful bleaching gels and special accelerating lights (to accelerate the action of oxygenation with the bleaching gel), now gives a significant whitening result while comfortably reclined in the dental chair watching your favorite movie or TV program.

	Advantages	Disadvantages
1 - O.T.C.	Less expensive Readily available Good for touch ups at home	Difficult to leave bleaching gel in contact with teeth for prolonged time periods Weaker gel concentrations Self-diagnosed bleaching my overlook serious underlying dental problems Results are generally short-lived
2a - Professional: Trays	Enables prolonged contact times and higher gel concentrations Professional supervision discovers any underlying problems and prevents unwanted problems Long lasting results Trays can be used for follow-up touch ups	Requires one or two (or more) weeks for treatment Requires lab time and trained lab technician to fabricate trays Loss of, or damage to trays requires making new trays
2b - Professional: Power Bleach	Same as for Trays plus... Very quick and time efficient	Results may not be as dramatic as utilizing longer time periods, such as with trays

Teeth Whitening Theory
Everyone’s teeth have a natural biologic limit of how white they can get. Once you have reached this limit, no amount of additional bleaching would whiten teeth further. However, by the time this limit has been reached, the results are not very becoming or cosmetically desirable. In other words, it is possible to carry bleaching too far – too much! The results can look opaque, “refrigerator white”, and mono-chromatic (one color throughout, and without the subtle natural gradations of coloration). This is another important reason why professional supervision is very desirable.

Time in contact with bleaching gel is one of the key factors for success. It is the principle reason why weaker over-the-counter techniques are largely unsuccessful or short-lived with their results. It also explains why tray systems are so successful and popular. However, when custom trays are used in conjunction with in-office “power bleaching” lights, the results are synergistic and profound.

Combination or “Deep Bleaching”
Having reviewed the mechanism behind bleaching and the methods outlined above, there is one more teeth whitening technique that has been developed to get teeth their absolute whitest. This method, called “Deep Bleaching” combines the two professional based methods listed above to create an even more stunning and brighter smile. This Deep Bleaching technique generally consists of three steps: 1)- an initial in-office “power bleaching” session, followed by 2)- one to two weeks of home tray treatments, followed by 3)- a final in-office power bleaching session. Some modifications of this process now eliminate one (or more) of these steps depending on the concentration and type of bleaching agent used, and the degree of difficulty anticipated in obtaining the results desired.

Regardless of the specific steps involved, combination bleaching achieves a much brighter and whiter result than any other bleaching technique that has been developed or invented to date.

The key to these better results is in understanding that tooth enamel responds best to whitening efforts when it is first “conditioned”. This means that the enamel surface of the teeth is first conditioned or prepared to absorb the oxygen molecules of the peroxide bleaching agent more readily. The subsequent whitening efforts with custom trays and the final in-office Power Bleaching session allows the oxygenating effects of the whitening gel to be more pronounced and work deeper, resulting in longer lasting and more pleasing results.

The first session of Deep Bleaching will start with a one-hour power whitening session done in the dental office. This conditions tooth enamel to absorb oxygen. Do not expect a tremendous color change from this first ‘conditioning’ visit. Following this visit, custom whitening trays will be worn for a number of nights, usually two weeks. After about two weeks of at-home Deep Bleaching, the final Deep Bleaching session will be performed back in the dental office. This will provide significant additional whitening over what has already been accomplished. The result will in most cases be a significant WOW!

Bleaching of the teeth with at-home trays is accomplished by wearing bleaching trays with bleaching gel in them. The trays are made of a clear thin flexibly vinyl or plastic. They are custom fit to precisely fit over your teeth, with a space or reservoir made directly over the tooth enamel surface (to hold an extra amount of gel), and custom fit to safely protect and follow your gum line. Most patients find these trays very comfortable to wear.

Too often “normal” bleaching trays made in dental offices do not seal in the bleaching gel at the gum line to prevent leakage and dilution from saliva. The result is very little depth of bleaching. Properly made custom trays will decrease dilution and will keep the whitening gel in contact with tooth surfaces for longer periods of time.

Summary
Teeth Whitening is an efficient and cost-effective way to achieve a new whiter smile and take a few years off your face. Please feel welcome to contact Dr. Ostler’s office and make an appointment for a free cosmetic consultation to see if you are a good candidate for whiter teeth.

Teeth Whitening Summary

What You Need to Know
The popularity of teeth whitening has become something of a phenomenon around the world. What at first started out as a tightly controlled in-office professionally applied cosmetic procedure, is now widely available in many over-the-counter (OTC) products, and in most dental offices today.

The strong media and cultural spotlight on white teeth has brought with it an abundance of good information as well as some mis-information. Contrary to popular marketing there is no such thing as a fast over-the-counter or one-visit bleaching technique that whitens teeth to their very whitest. Teeth vary from person to person in their ability to become whiter, and not all bleaching attempts or results are predictable.

Then...

...and Now!

What many fail to remember is that once teeth are whitened they will continue to slowly darken, mainly due to the effects of aging, dental habits and diet. Dark teeth are dark for a number of reasons, including: age, genetics, diet, hygiene practices, smoking, coffee, wine, medications, and soda pop consumption. 

There are many whitening procedures that will yield beautiful results. Teeth whitening or “bleaching” reverses the natural darkening in teeth. It has become one of the simplest and most popular cosmetic procedures in dentistry today. This revolutionary dental technique effectively provides a fast and easy way for patients to achieve a beautiful white smile.

Teeth whitening methods generally are divided into 1)- non-supervised, and 2)- dentist supervised. Non-supervised methods include a variety of over-the-counter products which can be purchased on the internet, in grocery stores, at mall kiosks, etc. Dentist supervised methods include using custom trays to be worn at home, and bright lights or lasers used in the dental office to enhance and speed the whitening process.

Dentist supervised at-home techniques using custom trays require more time but often deliver superior results. When custom trays are combined with in-office power bleaching methods using bright lights, the whitening effect is even more profound – the so called “deep bleaching” technique described below. 

Numerous over-the-counter brands have also become available. Being OTC products, they are limited in their degree of strength. Since they are awkward to apply and hold in place they suffer from retentiveness to hold them in place on the teeth. While OTC methods lack the success and whitening power that professional versions have, they have nonetheless educated the marketplace and can be a good “touch-up” technique.

So, a little whitening and presto, you’ve got more confidence, more laughter and most important, more reasons to smile. Teeth whitening isn’t for everybody and it must be performed properly to be successful. Certain discolorations are very difficult to correct, in which case patients will benefit from porcelain veneers.

TMJ/TMD Report - TemporoMandibular Dysfunction

• Does your jaw ache?
• Do you get headaches?
• Does your jaw pop?
• Any ringing ears or other ear problems?
• Sore or tense neck muscles?

If so, you may have TMD or Temporomandibular Disorder.

This disorder of the jaw joint (TMJ) can occur when the joint is stressed or damaged from injury, teeth grinding, or from tense unbalanced muscles because of a “bad bite”. The jaw joint can become damaged if your teeth are worn down or missing, or if your chewing motion is unnatural.

When jaw or neck muscles become tense and tired and sore, they become hypertonic with lactic acid build up. Abnormal jaw posture and head/neck posture can make this problem worse.

Here's a partial list of symptoms liked to TMD:

• Headaches - migraine & tension
• Facial pain
• Ringing in the ears
• Ear congestion
• Pain behind the eyes
• Jaw joint noises (popping & clicking)
• Inability to open mouth completely
• Visual disturbances
• Neck and back pain/problems
• Clenching/Grinding teeth
• Uneven tooth wear
• Gum line tooth notching
• Forward head posture

It is not uncommon that people with these problems have already seen many doctors and have tried many remedies in an attempt to find relief. If you have a problem with your jaw joint or dental bite, or experience any of these symptoms, your road to relief begins with determining the extent and source of your problem. A dentist specially trained in the science of managing problems of the jaw joint can offer invaluable help.

This special report will give you some valuable information on this troubling, painful, and potentially disabling problem called temporomandibular dysfunction (TMD), sometimes referred to as “TMJ” (for temporomandibular joint). As always, in order to properly diagnose and treat your specific problem, you must consult with a dentist who is experienced and properly trained in treating headaches and jaw problems.

Towards a better understanding of TMD:

The temporomandibular joint is located in front of the ear and is the place where the lower jaw (mandible) connects with the skull (temporal bone). You can easily located this on yourself and feel the joint in motion by placing your finger on your skin directly in front of your ear - then moving your jaw. As you open and close your mouth, you will feel the joint move forward and backward.

The TM Joint is one of the most unique and complicated joints in the entire body. The lower jaw bone is the only freely functioning bone in the body that crosses the midline. This is important because problems on one side can directly affect the function and health of the joint on the other side. Whether chewing, swallowing, or talking, the joint is constantly working. And for some, it is even working at night during sleep.

Because it is close to the ear, joint problems and muscle spasms are often felt as discomfort in the ear. Ear problems such as ear congestion, pain and ringing in the ears are common complaints with people who have jaw problems or headaches. Frequently people will say that they can’t clear their ears, or that it feels like their ear is full of fluid, or that their hearing sounds muffled. This is due to a spasm in two tiny accessory chewing muscles named the tensor veli palatini and tensor tympani.

Because of excessive muscle tension and stresses placed on the jaw joint, pain can radiate to other areas nearby causing tension headaches, neck, back, or shoulder tightness and pain, eye pain or visual disturbances, teeth and sinus aches, etc.

Migraine headaches are a common finding with people who have jaw problems and neck pain. This is now thought to be the result of high activity levels in the Trigeminal nerve, the major cranial nerve which innervates the head and neck and jaws. When there are high levels of pain and proprioception nerve impulses overloading the nervous system due to chronic tension and pain, vascular headaches like migraines are considerably more likely to occur. Proper balancing of the bite and wise correction of posture will allow this nerve system traffic to lower and reduce the occurrence and severity of head and facial pain and associated problems.

Proper treatment of TMD and headaches requires understanding the dynamic inter-workings of the triad consisting of the jaw joint, the teeth and the muscles. We must work together toward balancing the bite so that the muscles remain relaxed and in balance, and to minimize stress on the jaw joint itself. To better understand these three components, let’s discuss each in turn.

Function of the Jaw Joint

The lower jaw or mandible is “U” shaped bone which crosses the mid-line in front, holds the lower teeth, and turns upward at the angle of the jaw, extending up toward the ear. This top end next to the front of the ear where the lower jaw hinges, is called the condyle. It articulates with the skull in a small depression (the glenoid fossa) on the underside of the temporal bone. Hence the joint is called the temporo-mandibular joint.

When the mouth opens the condyle moves or slides forward as it rotates in the joint or fossa. You can feel this motion by placing the tip of your little finger inside your ear, with pad side pressing forward, and opening your mouth. You will feel the movement of the joint moving away from your finger as the mouth opens and the condyle slides forward away from the ear.

The jaw joint is held together by an assortment of ligaments which form a capsule or space filled with lubricating joint fluid. In the middle of this joint capsule is a protective disc which acts as a shock absorber and prevents the bones from directly grinding on each other. This disc normally sits atop the condyle. Together they move forward during opening which keeps the two bones from rubbing on each other during function.

When there is chronic stresses placed on the joint due to bad bite or jaw posture, the ligaments that secure the disc can become damaged. Often the jaw begins to make noise – you will hear and feel an audible pop or click as you open and close your mouth, sometimes accompanied by pain. Noises in the jaw occur when these ligaments are stretched, and the disc becomes displaced toward the front of the joint. The pop or click noise occurs as the condyle “pops” or moves back onto the displaced disc.

We grade these pops or displaced discs, as being either early, middle or late depending on which part of the open/close cycle the popping event occurs. Generally, the later the click or the more open the mouth when the pop occurs, the worse the prognosis. Some people may indicate that their jaws used to pop in the past, but not any more. We worry for these because this can mean the ligaments are irreparably stretched or torn. Even though there may be an absence of pain or other symptoms, we still insist on treatment because the same basic parameters which started the problem are still present and operational and can continue to do damage to the joint, teeth and muscles.

The Role of Teeth in TMJ Problems

Obviously, we couldn’t complete a discussion about jaw problems without recognizing the role that our teeth play. Of the three components mentioned above, the teeth are the visible partners. You can easily examine teeth and see problems with alignment and cross bites, crowding, spacing, ground off cusps and flattened areas, notching at the gum line, etc.

Often “teeth” problems are inherited or genetic in nature. We tell affected people that they didn’t pick their parents very well – which serves to tongue-in-cheek underscore that these are often complex and difficult cases to figure out. Environment, strength of enamel, diet, presence of fluoride in teeth, access to dental care – all serve as factors that will determine our dental fortunes – (or how many fortunes we may spend in keeping them healthy). Likewise, your inherited genetic adaptive capacities determine how well you can tolerate abuses and stresses to your joints and muscles before they begin to suffer damage or develop symptoms.

Anatomically, the position of the teeth dictate the position of your two jaw bones as they relate to each other. Said another way, your teeth position your “home biting position” which determines the lower jaw’s posture as it relates to the base of the skull. This is important because the lower jaw hangs in a “sling”, suspended below the skull in a sling of muscles and ligaments holding the two parts together. When muscles contract, the lower jaw moves upward to chew or press against the teeth of the upper jaw. This happens several hundreds or even thousands of times each day as we swallow, bite, chew, brace, and otherwise function.

Because teeth are the visible partners in these discussions, it is often easy to see the damage done to the teeth as our teeth grind together. Some people don’t realize that the reason for this wear and tear is due to the hyperactive muscles that power the jaw, and not with the teeth themselves - which brings us to the all important muscles.

The Role of Muscles and Muscle Fatigue

Perhaps you may remember some strenuous exercise or hard work in the garden or yard and waking up with sore muscles the next day. You can also witness the quick pain that comes from holding your arm out straight for several minutes, or ‘sitting on a wall’ with your knees bent. Whether done quickly or slowly, the burn or hurt comes from metabolic activity and waste products built up from stress in the muscle. This happens when the muscle shifts from aerobic (oxygen) to high demand anaerobic (without oxygen) metabolism, which produces lactic acid in the muscle.

When lactic acid and other muscle metabolites build up in muscles, soreness results. It usually takes a day or two of rest to re-fresh the muscle and wash-out these harmful by-products. Long-term sustained chronic muscle tension can lead to damage to the muscles and the establishment of ‘trigger points’ which can be the sources of pain both local and referred to other areas in the region. Even when at “rest”, muscles have at least a minimum level of tonus or electrical muscle activity. Imagine what could happen to a muscle if it remained in constant chronic hyperactivity or stress. This can occur at will (exercise) or involuntarily with regards to maintaining posture.

Another important principle with muscle health has to do “with avoidance conditioning.” Really it is more of a neurological problem. Our nervous system doesn’t like pain or noxious stimuli, and works to do whatever is necessary to avoid or protect us from further noxious, painful or nociceptive sensory input. If you’ve ever had a foot blister or walked with a pebble or sticker in your shoe for awhile, you may have experienced this principle of avoidance conditioning. Work is shifted to other muscles as you try to avoid the hurtful stimulus during function. In this example, your muscles are trying to compensate and adapt for something not being “in balance.”

These basic rules and principles of muscle physiology and posture apply throughout the body. The difference is that the shorter skeletal muscles of the jaws, neck and shoulders, can go much longer and sustain more damage, before the ill effects begin to add up or be noticed. All muscles require rest in order to recover and regain their energy and ability to function in a healthy manner. They need periods of physiologic rest (low electrical firing activity – resting muscle tonus) in order to wash out lactic acid and regenerate. The jaw and neck muscles are no exception, but are often denied the opportunity because of unbalanced postures, forward head positions, and bad dental alignments – all of these being triggers that cause muscle spasms in the jaw and neck muscles.

Postural Adaptations:

Problems of posture are probably the biggest threat to the health of our jaw and neck muscles. If you think of your body as a mass with a center of gravity line extending from the floor up through the top of your head, you can understand that if any weight were shifted away from the center of gravity line, that the mass (your body) would have to fall in that direction due to the forces of gravity, unless muscles were used to act upon the body’s skeletal frame to resist this off-centered force. Muscles attached and anchored to your skeletal frame, brace and hold your body’s weight so that you remain upright and functional. And herein is the rub.

Imagine what happens when you move your head forward into a forward head posture. This 13 pound ‘ball on a stick’, now positioned forward, must be held up by the muscles of the neck and shoulders – or the head will fall forward with eyes looking downward. Due to the natural arighting reflex to lift your head so eyes are even with the horizon, your neck muscles will become tense and fatigued from trying to maintain “proper” upright head position. And because of principles of leverage, for every inch forward your head is postured, gravity adds roughly the weight of the head to what the neck and back muscles must hold up and sustain.

Many people comment that they ‘carry’ stress in their shoulders/necks. What they are really trying to say is that their neck and shoulder muscles are tired from holding a forward head posture. Muscles become fatigued and spent working overtime to hold the weight of the head and then some. You will also notice that he head posture is naturally married or coupled with shoulder position. Where the head goes the shoulder goes, and vice-versa. The key to good head posture is in pulling the shoulders back so that the ears, shoulders, hips and ankles all form a straight line from the floor up.

As an aside, but still part of this posture puzzle, ascending or upward postural problems of the legs, hips, spine, and shoulders, can and do affect the position of the head as it sits balanced on top of this postural chain. Problems below can translate upward to problems in neck and shoulders and jaws as the body tries to adapt or compensate by using muscles to keep the skeletal frame with the weight it is carrying, upright and functional in this world of unrelenting gravity.

Also coupled together in the interconnected world of posture, is the postural position of the mandible and the neck. Neck or cervical posture dictates mandibular posture, and conversely mandibular jaw posture affects neck posture. Problems in one are translated to the other and vice versa. This is where the dental bite plays such an important role because the status of the dental bite dictates the position of the lower jaw as it relates to the cranial base. It also helps explain why in many cases, physicians, chiropractors, physical and massage therapists and other health professionals are unsuccessful in resolving headaches and other postural and neurological problems - because only a properly trained neuromuscular dentist can properly restore the mandible to its proper and relaxed relationship to the base of the skull. This happens through proper diagnosis and properly repositioning the mandible with a repositioning appliance, to a position where the muscles of the jaw and neck can assume a physiologically relaxed muscle state, and the jaw joint can be decompressed and adequately protected.

The same principles of muscle physiology and function that plague the rest of the body apply to the muscles of the head and neck. For example: What happens if the muscles that control the jaw and neck are not ‘happy’ with the unbalanced positioning of the jaw as dictated by the teeth or dental bite? What happens to the muscles of the back, neck and shoulders if the head is positioned forward and the jaw muscles are always clenching or grinding the teeth? If the muscles of the head and neck are tense and fatigued and build up lactic acid by-products from being overworked, the stage is set for the myriad of problems we see in people with TMD. Furthermore, when the joint itself becomes affected or damaged, it can become a primary source of pain which can also cause a reflex heightening of muscles problems.

As we’ve said, muscle tension and pain is a common occurrence with TMD. That is why it is important to deal with, or at least rule out problems of posture if they exist. Successfully managing TMD often involves a multi-disciplinary approach using physical therapists, massage therapists, and/or chiropractors to help with the ‘physical modalities’ of our biomechanical and neuromuscular systems. It is essential to understand that muscle problems can result when the joint is injured, or if the bite is not balanced, or if there are posture problems with the head, neck, or jaws.

In summary, poor posture always results in shifts away from a relaxed and balanced position. This necessitates the use of muscle action to adaptively compensate. This principle applies directly to the jaws through an imbalance in the jaw position or bite due to poor dental alignment, improper skeletal growth patterns, injury or other problems of growth and development.

Forward head posture and mouth breathing resulting from airway problems can cause the head and shoulders to shift forward. When the center of gravity shifts, muscles will be called upon to hold and balance our bodies and keep it functional. Sustained or uncorrected, this increased muscle tension can cause muscles to go into spasm which produces pain, local and referred.

So what are the symptoms again of TMD?

TMJ problems or TM Disorder, refers to a variety of problems associated with a misaligned bite, and jaw and neck posture. Facial pain, shoulder and neck tension and pain, as well as migraine and ‘garden-variety’ tension headaches, are among the more common symptoms.

The list of symptoms and signs linked with TMJ problems is long and complex. This is because of the complex intertwining of the nervous system, muscles, posture, bite arrangement, and function.

The signs and symptoms of TMD include:

• Ringing in the ears (Tinnitis)
• Ear pain, ear congestion
• Dizziness (Vertigo)
• Numbness and pressure in the ear
• Jaw clicking and popping
• Pain behind the eye, and sinus pain
• Facial pain
• Neck and shoulder pain
• Headaches - migraine and tension
• Teeth pain or sensitivity
• Periodontal bone loss (made worse)
• Broken and worn down teeth
• Gum recession
• Insomnia/Depression

Self Analysis:

If you were to examine your own posture here are some principles and keys to look for:

• Look in the mirror standing normally and without posing. Are your shoulders level and parallel with the hips? Are they level or parallel and with the floor? Do you see your shoulders level and parallel with the hips? Is the head tilted or leaning toward one shoulder?
• When viewed from the side, does your ear, shoulder, hip and ankle make a straight line? Is there a normal “S” curve with the shoulders neither forward nor rearward with the head straight up and not leaning front or back?
• When standing upright and natural, are your feet parallel to each other and pointing forward, or is one or both pointed or angled outward? When standing, is there room between the floor and your bare foot for someone to place a finger under the arch of your foot? If not perhaps you have a ‘fallen arch’ or flat foot. This will cause one leg to be shorter to the floor which causes the pelvis to be tipped, and sends compensating postural issues upward as the body tries to stay balanced. You will not likely walk around like a Leaning Tower but will try to compensate upwards by arighting yourself and pulling higher body parts back to center or a more upright position.

Dental posture can be quickly evaluated when looking at your jaw position and your teeth.

• Do you have an overbite? Does your upper teeth cover much or most of your lower teeth when biting together?
• Do you have a cross-bite? Your upper teeth should be outside of your lower teeth. If not, there is a cross-bite.
• Do you have crooked or malaligned teeth?
• Do you have an open bite where you can stick your tongue between your teeth when closed together?
• Do you have ‘abfractions?’ Are there notches in the side of the teeth at the gum line?
• Are your teeth worn down from grinding?
• Do you have missing or shifting teeth? Are there spaces between your teeth?
• Does your jaw feel tired or exhausted often? Does your forehead or temple area feel tight, full of tension or painful?
• Do the muscles in your jaws, over the temple area, and under the jaw feel tired or sore?
• Is there a pop or click in the jaw joint during opening or closing movements?

In Summary - Posture and TMD

A comfortable balanced bite results in even and equal pressures across the jaws and bones of the skull. The muscles are able to enjoy a relaxed posture and generally avoid the discomfort that accompanies muscle spasm and pain. Muscles, joints and teeth must work together in harmony and with a balance that prevents the nervous system from causing the muscles to overwork trying to avoid an unpleasant posture or position.

The muscles that control chewing, talking, and swallowing are all connected through a “postural chain” to your neck and back muscles, and must work together in balance and without stress. When this balance is interrupted, muscle tension increases as the nervous system tries to avoid further hurt or injury and at the same time allow the normal function to proceed.

When muscle imbalance occurs in the jaws because of a bad bite, there is a natural, compensatory chain reaction through the connected postural muscle groups of the head, neck and shoulders. Soon, these other muscles can be called upon to help balance any offsetting force. The result? Poor posture, back aches, muscle spasms, and headaches.

As a footnote you might be asking “Well okay, if this is true, then why doesn’t everybody else have problems?” Or, “Why are my problems so much worse (or better) than someone else’s?” The answer: Everybody has different “goalposts”, different hereditary capacities to adapt. If you have narrow tolerances you have less tolerance for stress and are more readily affected by even slight variations from “normal.” Wide “goalposts” mean that you can tolerate or withstand a lot and not have it spill over the edge to become symptoms or problems.

However, the absence of pain or problems does not in and of itself mean that you don’t have an underlying problem. Also, when symptoms stop, as in - “my jaws used to pop but not anymore” - this does not mean that the problem has gone away.

Proper Diagnosis – A Neuromuscular Approach

There are many hidden and underlying factors that can influence a proper diagnosis and treatment of headaches, TMD and jaw joint problems. To avoid unnecessary expense and sometimes a lifetime of needless misery, we believe it is very important that you receive the correct diagnosis and are treated by the right expertise and training. This often requires a well coordinated multi-disciplinary team approach, with the dentist “quarterbacking” the process. This is because only a dentist can properly evaluate, change or treat the dental and jaw relationship. Only a dentist can change the relationship of the jaw to the base of the skull, and thus affect the comfort and balance of the muscles which hold it in a sling and link it functionally with the neck.

Neuromuscular Dentistry is the term which accurately describes the training necessary to identify and treat these complex disorders of the jaw joint and associated muscles of the jaw, head and neck. The question can be put “Where would the muscles and jaw joint want the jaw and teeth to be positioned when the muscles are in their best physiological rest position?” Ignoring this question and its answer has profound implications. When your individual adaptive abilities are exceeded, or when the affected structures suffer cumulative stresses to the point they can’t take it any more and start breaking down, then symptoms and disability can set in.

The neuromuscular approach to dentistry goes beyond the examination of teeth, and gums. It goes beyond “tooth carpentry”. It recognizes the role that posture, muscles and the nervous system plays in the comfort and function of the jaw, the neck and the head. It is about being a “doctor of the mouth.”

Like gears in a machine, the teeth must fit together comfortably and in a balanced position with the muscles and jaw joint, so that when everything is fit together, the muscles are not tense or in spasm, and the jaw joint is not strained or compressed.

The lower jaw must fit or relate properly with the base of the skull. This important relationship is often overlooked by traditionally trained dentists and health professionals. Rather than asking the muscles what they “think” of the dental and jaw relationship, they rather focus on the teeth and expect the muscles to adapt and accommodate to the dental relationship. From the neuromuscular position, nothing could be further from the truth.

Similar to gears working together in a machine, the teeth and the jaw joint must be in harmony with each other and with the muscles that hold them together with the skull. It is when this balance is disrupted, or when the neurology gets “excited”, or when damage occurs to the joint, or when the muscles are not “happy”, that problems arise.

The Diagnostic Method

Neuromuscular dentistry uses modern computerized diagnostic methods to accurately read the muscle activity of our neck and jaw muscles, and to find that jaw position which is most ideal for keeping the muscles comfortable and the jaw ideally supported.

Most people’s dental bites are not perfectly balanced, to one degree or another. In most TMD cases there is a tug-of-war between teeth, muscles and the jaw joint. Teeth want to fit together in one position and your muscles and jaw joint want a different position. When there is a difference between what the teeth want and what the muscles want, the muscles wind up with a higher level of electrical activity (muscle tonus) as it struggles to find a stable position. This electrical activity can be measured and evaluated on a computer. Electronic instruments provide important information and clues about the true nature of your muscle and your jaw position, and have only recently been improved enough to allow these measurements to be seen on the computer in real time.

It requires long and sophisticated training to understand the many faces and nuances of TM Joint problems, and it requires having the latest of modern computer and electronic instrumentation to fully diagnose and optimally treat complex muscle and jaw posture problems. It is important to also have accurate and thorough information that comes from a hands-on evaluation of the jaw joint and the dental occlusion or bite, and from understanding the history of the problem.

For further information you can visit www.leadingdentists.com or call Dr. Ostler and schedule a visit to determine what more can be learned about your condition. With this information you will be able to make the right decisions about effective treatment options and hopefully begin a new life of pain free living.

Understanding Dental Insurance - 
A Patient’s Guide to Understanding Dental Fees and Insurance

Is dental insurance a good thing?

Yes! Insurance has helped millions to achieve a higher level of dental health. But it must be used correctly. Some people believe that if they don’t have insurance that they can’t afford dental work. Some people with insurance believe that if their insurance won’t pay for dental procedures, then they must not need it, or they believe it isn’t important. Others won’t spend beyond its limitations.
THE TRUTH is that dental insurance provides help with getting dental work you would do anyway (you just budget differently). Not having insurance doesn’t make your teeth less important or necessary for health, social/career success, or self-confidence. Besides, you only get a limited amount of coverage anyway! Dental insurance is a good thing if you don’t let the insurance company make your health decisions for you, or think that without it you can’t afford dental care.

What is dental insurance?
Insurance is a way of controlling risk and protecting yourself against a financial loss by spreading the risk of loss across a large population. Common examples include auto, home and life insurance. Premium rates and costs are determined by adding up the calculated costs of benefits paid out, plus overhead and administrative costs, plus the profits desired by the insurance company. Like any other insurance, better benefits are obtained by paying higher premiums.

What will my dental insurance cover?
Unlike major medical, there is no such thing as “major dental”. Few, if any dental insurance plans are a “pay-all”. Some insurance companies pay a fixed amount, others a percentage of pre-determined limits. Any plans that claim to or actually do pay the entire dental bill can only do so because of agreements or choices that discount services, or offer low quality or cheaper treatment.

What dental services are covered? What aren’t?
Like any other insurance, your insurance coverage is only as good as the policy that was purchased. Many people are surprised to discover that many dental services are not covered. If you are dissatisfied with the amount or limits of your coverage it is important to discuss this with your employer and insurance company.

In an attempt to decrease their costs, dental insurance companies tend to reward prevention and limit reimbursement for complex or more involved care. In short, while they may pay well for wellness checkups and cleanings, they tend to discourage higher quality services. Higher quality and “major” treatment services may not be covered as well, or at all. The coverage available to you is solely determined by the profit structures of the insurance company and the quality of insurance purchased by you or your employer. Better insurance coverage costs more!

Why won’t my insurance pay more?
Unlike major medical plans which may cover complex treatment and protect against “catastrophic loss”, all dental plans have a “stop-loss” or “Annual Maximum” which typically ranges from $1,000 to $1,500 per year. This means that regardless of your need or situation, the insurance company will not pay out more to you than this annual limit. Thus there is no risk or downside to the insurance company, and it hardens or stabilizes their profits. For you, “dental insurance” equates to nothing more than having “pre-paid dentistry” which you must use or lose each year. Additionally, complex and convoluted rules and formulations for payment of benefits are created and used by your insurance company to deny, delay, and defray the reimbursement of covered services.

Do insurance companies exist to pay for dental care? 
There is only one purpose for dental insurance companies – to make a profit. Ironically, while insurance premiums have steadily increased over the past 35 years, the average insurance coverage is still the same as it was 35 years ago when it started - $1000. Inflation alone should certainly have increased the available benefit to over $5,000-10,000 today. Your insurance company gives you increasingly less coverage and charges you more for it. It is why they can pay their CEOs extraordinary salaries and continue to own and acquire real estate and stock market holdings as they do. (Why would they want you to get cheaper dentistry, or deny payment for quality care?)

How does my insurance company make money?
Income minus overhead equals profits! In other words - Your insurance company collects the premiums, administrates the benefits plan, and makes a profit on the difference. Complex rules for annual limits (“stop-loss” maximums), utilization of services, coverage percentages, and UCR fee schedules, aid the insurance company in their quest to take in more money and give out less in the way of benefits. They are typically very slow to adopt modern treatments, they disallow alternative based therapies, they usually disallow coverage for functional based problems and they cover other high quality procedures poorly, and they use their own internal fee schedules (U.C.R. dictated by zip code geography) that are not the same as your dentist’s fee schedule, and which is determined solely on the profit motives of their company. 
“Deny, delay, and defer” are watch-words that infamously characterize the insurance industry and frustrate both doctor and patient in trying to be made whole after care is rendered. Pre-authorization and pre-determination rules complicate and hinder the timely and effective delivery of care – all unnecessary and designed to delay and second-guess the doctor-patient relationship and increase the profits of the insurance company. We are all grateful for what insurance can and does afford us. All insurance companies are contractually obligated to pay benefits to which you, their insured, are entitled. The “game” lies in getting there.

Who is responsible for payment?
When you present for care and agree to treatment, you accept direct responsibility for paying the dental bill to the dentist, regardless of third-party coverage or assignment of benefits. Remember that your dentist works for you, not your insurance company. Our staff will assist you in filing insurance claim forms, but we can’t guarantee any estimated coverage.

What should I do if I don’t have insurance, or run out of insurance coverage?
Approximately 60% of our population does not have dental insurance coverage. When it comes to their own dental needs, they simply budget their discretionary dollars so as to afford dental care. If needed care exceeds your insurance coverage (a very likely scenario) you will do the same.

It is more about what you value than the amount of money available. Proof exists in the fact that we buy cars or boats, go on vacations and travel, buy pet food, cosmetics and hair care, do recreation and dinner out (and not always at the cheapest restaurant), tobacco, alcohol, etc. – in essence, have a lifestyle – all without using insurance reimbursement to fund it. The truth is that little if any of this “lifestyle” spending is “necessary!” It is all discretionary! Unlike heart attacks and broken legs, almost all of dentistry is discretionary as well. (How many broken smiles have you seen lately?) The key is to understand and change your values, to make better discretionary spending choices, and to make it affordable with financial options - before you suffer irreparable damage.

Should I use my insurance coverage to determine my dental treatment?
In a word – “No!” It is understandable that you might want to make treatment decisions based on how much coverage you have. You may even assume that your coverage will pay for all of your costs. Regrettably, this is not the case! Just as you would never choose to leave portions of your cancer untreated, you shouldn’t choose to ignore dental decay, broken teeth, toothaches, abscessed teeth, and maybe even unattractive unflattering smiles that hurt you socially or in your career. This would be true whether you had or didn’t have third-party coverage, or had limitations of coverage therein. Your insurance company doesn’t care if you have disease or ugly! Their primary interest is not you. It is in protecting the difference between their income and their outgo. Period!

What does it mean when my insurance company tells me my dentist’s fees “exceed usual, customary and reasonable”? What is “UCR”?
It usually means that your insurance benefits are too low. Better insurance plans will often pay a higher amount. With dental insurance, you get what you and your employer pay for minus the overhead and profits of the insurance company.

“UCR” stands for Usual Customary and Reasonable. The insurance industry uses this term to try to standardize fees and to make a commodity out of professional services. They would have you believe that a dentist is a dentist is a dentist, and a crown is a crown is a crown, regardless of the training, care, skill and judgment required to accomplish it. There is no UCR fee that truly represents “usual, customary or reasonable” that isn’t created internally by the insurance company based upon its own internal overhead and profit calculations.

Will my dental insurance pay for my dental care?
Yes – up to a point. And that point is determined by the limitations and exclusions in your insurance policy, and the type of plan it is.

Why does my insurance company not pay for some procedures?
The determination of whether certain procedures are covered or not is dependant on what type of policy and how much your employer pays for it. Typically, insurance will not pay for “elective” or “functional” problems that do not have their basis in trauma or pathology. Some modern dentistry and newer cosmetic procedures are likewise not covered. The purpose of dental insurance is not to be a pay-all or make you look beautiful, but to help defray the expenses associated with prevention and minor reparative work.

What is the relationship between dental fees and insurance coverage?
When an insurance company policy states it will pay X % of a procedure, it is using its own fee schedule, not the dentists. Usually insurance companies fee schedules are lower than the dentists. These fee schedules are internal to the insurance company, are determined solely by the overhead and profit motives of the insurance company, and have no relationship with the actual fees charged by the dentist. Additionally, these fee schedules will vary from area to area, despite the uniformity of the standard-of-care in our country. Insurance companies would have you believe that you can get something for nothing.

What’s the best way to deal with problems related to my dental health benefits?
You are best advised to discuss issues that may arise with your employer or his human resources manager, and/or your labor union. Remember that the “richness” of your benefits package is determined by how much is paid for the insurance policy in the first place, as well as the internal policy rules that regulate the ease and availability of getting the benefits paid out.

What are the different kinds of insurance plans?

There are three main types of insurance:

1. Traditional indemnity insurance plans
2. Preferred provider organizations (PPO)
3. Health maintenance organizations (HMO)

Traditional indemnity plans offer the greatest freedom of choice in services and health care providers. PPOs and HMOs, sometimes referred to as “alphabet” and “managed care” plans, frequently result in less freedom of choice for the patient , fewer available appointments, cheaper dental materials and lab quality, and have more restrictions and exclusions in what they cover.

Do I have to go where my insurance company says? Am I required to see a certain dentist?
No! But if you have a closed or restricted plan, you may not receive the meager benefits purchased unless you see their preferred doctors who have agreed to discount their services and who offer cheaper care. If you have one of these plans and if you decide you want better care for yourself or your family than what your insurance policy will pay for, you are always free to choose higher levels of services and higher quality of care from private fee-for-service offices such as The Center For Dental Health. Traditional indemnity insurance plans are representative of the better plans and do not have prohibitions or restrictions on who you may or may not see.

Why Choose Us?

What makes a great dental office? Choosing a dentist in this modern age of dentistry requires a bit more care and concern than simply throwing a dart at an open Yellow Pages book. Yet that is often all that some people rely on. Other people use their friend’s recommendation who believes their dentist is simply the best. Others research the internet learning what they can about their dentist. Perhaps this report will give you some additional information that will build perspective and give you the ability to make a better and more informed choice for yourself and your family. You may also find the report “How To Choose a Dentist” available on this web site in the reports section, to also be helpful in knowing what to look for in choosing the right dentist.

So – with all the many decent choices out there, Why Choose Us? What makes The Center for Dental Health the right dental office to meet your needs and to protect and enhance your health for the years to come? Knowing a little about us and our style of practice may help you make the right decision for yourself and family. Knowing why others choose us may also be of value.

Read what other patients have said about Dr. Ostler and The Center for Dental Health.

“Dr. Ostler and his staff have been exemplary in their service and meeting our needs. Appointments are made quickly and efficiently and the level of care I’ve experienced is superb. I have always appreciated the caring atmosphere and wonderful staff, and the kind way in which dental services are rendered.

Before

After

“My improved dental health has given me the opportunity to be more out-going and less self-conscious about my smile and how my teeth look. I don’t have to worry any more about how others see my smile in public, which gives me improved self-confidence and peace-of-mind. With my new veneers I smile more. People who know me can’t quite figure out what is different about me. My self-confidence has definitely increased. To anyone wanting to improve their smile or confidence, I say – just do it! I waited over thirty years. Wish I had done it sooner! Dr. Ostler takes pride in his work and makes sure his patients are satisfied with the results. Thank you, Dr. Ostler!”

–Bettie Jones, Tri-Cities

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“When your jaw cracks every time you chew and it hurts, something must be done. My physician said "you have TMJ - go see a dentist!" Fortunately, Dr. Ostler was my dentist! Extensive testing was done and a special dental splint was made for me to wear on my teeth. In time my jaw improved, my teeth quit hurting, the edema in my eye improved, and my neck quit hurting as much.

“The staff with Dr. Ostler was such a blessing in answering my many questions. They understand what it was all about. After finding out what it was like to not be in pain all the time, I choose to have my bite and teeth rebuilt. I knew this would be a challenge to any Doctor, because I needed bridges, caps, crooked teeth and missing teeth, but thanks to his fine caring and knowledgeable training, Dr. Ostler did a wonderful job. Now I not only have a comfortable bite, but beautiful teeth. I'm grateful for the kind way his staff were caring and knowledgeable throughout the treatment. The phone calls to see if I was doing okay after each visit were very much appreciated. Anyone doing this procedure and choosing to work with Dr. Ostler and his staff, will be more than pleased with the results."

- Carole Lehfeldt, Tri-Cities

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Overview

They have different skills, different training, different technology and different philosophies. Likewise...

Not all patients are alike! They have different wants, needs, fears and values.

Understanding YOU is important to us. To maintain your dental health or to create a more attractive smile, we will create your own customized plan for wellness. We know that trust, rapport and peace-of-mind are priceless. So first...

...we listen! We’ll hear your concerns and fears and your needs and wants. We’ll talk about values - that which drives your decision to be healthy, attractive, productive and confident.

Like you, we believe that beauty is more than skin deep! You smile with your soul, not just with your teeth. This means your increased confidence, good health and a radiant smile are hard to miss - difficult to ignore. When you feel good about yourself, people are naturally attracted to that. Confident beautiful smiles are never taken off - never forgotten.

In short, we specialize in helping those who want wellness. This is more than disease management. It’s about having teeth for a lifetime, free from disease, looking your best and loving the journey. At The Center For Dental Health we transform lives daily by helping you create the health, vitality and peace-of-mind that evokes trust and builds confidence.

Biography

Dr. Ostler completed his undergraduate education at BYU and his dental training at U. of W. Dental School in Seattle. He lives with his wife in Richland and is spared from the “empty nest” by the last of five children. Six grandchildren (for now) drop by frequently with lots of love and giggles, reminding all of the truly important things in life.

Dr. Ostler has had a career-long commitment to continuing education. His general practice emphasizes cosmetic dentistry and smile makeovers, neuromuscular dentistry, treating TMJ/TMD, headaches, facial pain and complex dental reconstruction. He has been a clinical instructor at the prestigious Las Vegas Institute of Advanced Dental Studies where he has taught dentists from around the world-advanced techniques in cosmetic and reconstructive dentistry. He brings this expertise home to the benefit of his patients.

For the past 22 years he has developed expertise and a practice which combines art, science and technology, with personalized care. His experience as an instructor, lecturer and study group mentor, combined with the expert skills of his experienced staff, assures you that your decision to trust your smile in his hands is a wise decision indeed.

Tri-Cites DreamMakeover Dentist

What do you have when you bring together a highly recognized cosmetic dentist, plastic surgeon, modern laser hair removal specialist, personal fitness training, hair styling and cosmetics, and do a makeover on four people - and then present it all at a televised Gala Unveiling? Some might call it a miracle, but we call it DreamMakeover Tri-Cities.

This is the brainchild of Dr. Lee Ostler who recognized that what is done in Hollywood and the big cities happen every day in his office. (After all, he has taught many of the big city doctors how to do this!) With the help from other Tri-City specialists and many other community supporters Dr. Ostler will showcase local talent and modern image enhancement procedures, raising public awareness and supporting the worthy charity Sexual Assault Response Center / Kids Haven.

As the Tri-Cities’ “DreamMakeover Dentist”, you can be assured that your dental care will present you with the finest that modern dentistry has to offer. It is further evidence of the training and experience that you would want to choose for your own dental care.

You can learn more about DreamMakeover at: www.DreamMakeovertc.com

Gentle, Personalized, Expert Care and Services

Dr. Ostler places special emphasis on providing gentle, personalized care for your complete dental needs. We offer a full range of techniques for your total comfort during office visits. If you are the least bit anxious about dental visits, this is the office for you!

Modern Dental Services:

• Crowns & Bridges
• Tooth Colored Bonded Fillings
• Periodontal Gum Treatment
• Cleanings
• Teeth Whitening & Deep Bleaching
• Porcelain & Metal Free Restorations
• Porcelain Veneers
• "Instant Orthodontics"
• Digital Intraoral Photography
• Neuromuscular Dentistry
• TMJ/TMD Treatment
• Laser Assisted Dentistry
• Nitrous Oxide ("Laughing Gas")
• Oral Sedation

Neuromuscular Dentistry

Temporomandibular joint disease (TMJ) is a chronic degenerative disease affecting 60 million people and may take years to develop. Any underlying muscle/skeletal imbalance of the jaw to the skull may result in pain, muscle tension and spasms in the head, neck or jaw. Worn teeth, broken fillings, and jaw popping can result from a mal-aligned bite relationship or joint strain.

• If you have any of these signs or symptoms:
• Headaches (tension and migraine)
• Worn, chipped or cracked teeth or fillings
• Face, neck, shoulder or back pain
• Painful or clicking jaw joints
• Ear pain or ear congestion
• Limited jaw movements
• Crooked or missing teeth

We may be able to help you!

While traditional general dentistry works with teeth, gums and bones, neuromuscular dentistry adds an understanding of the complex relationship of the muscles and the nervous system, to create more harmony and comfort to create balanced muscles and a comfortable durable bite.

We Believe…

We believe our patients appreciate the up-to-date philosophy that pervades each aspect of this practice. As a clinical instructor at the nation’s most prestigious center for advanced esthetic/restorative dentistry continuing post-graduate education, Dr. Ostler’s patients benefit from having expert clinical skills and judgment. His considerable experience in practice, plus his experience as an instructor, lecturer, and study group mentor, combined with the expert skills of long-term experienced staff, assures you that your decision to trust your smile in our hands is a wise decision indeed.

We believe in treating people – well – like friends! We know that respectfully helping our new friends in a kind and warm manner builds confidence and trust. We believe people want smiles that are healthy, radiant and socially acceptable. That is why our patients want to keep their teeth healthy. It is not okay to have teeth and breath odor that detracts from appearance or causes embarrassment in public. We believe people want teeth to look good, feel good, and last a long time.

We believe that less dentistry is better than more dentistry. Prevention is the cornerstone of long term success. Our patients thus become partners in active programs to treat and control their own problems. This is why our patients and friends are happy to assume ownership of their own treatment plans and healthy outcomes.

We believe our patients want excellent, comprehensive and respectful treatment. Our patients know they are receiving comfortable care in a modern dental office. They are secure in appreciating state-of-the-art treatment rendered by experienced and caring hands. This is also why your new dental team strives so hard to make each visit a positive and healthy visit.

Please feel welcome to schedule a no-obligation complimentary consultation, or a regular new patient examination with Dr. Ostler and The Center for Dental Health, by calling 509-946-6566. We look forward to helping you with your dental and oral health needs and wants.