2008 Newsletter

 

NEW LASER IN OUR DENTAL OFFICE
by Dr. Beverly Presley-Nelson

We now have the Diagnodent Laser in our office to help detect decay! Advances in fluoridation of water supplies and fluoride supplements and treatments have caused much progress in making our teeth less dissolvable in the acids that plaque produces. This is a wonderful thing but secondarily this has made cavities in the pits and fissures on our teeth harder to detect. Why? Because, though fluoride has helped more fissures be closed, the ones that aren’t have an outer crust that is firmer and allows us to see and feel less of what is below. Dentin is still its old soft self and even though now less bacteria penetrate the more closed, fluoridated pits, when it does, it can spread like wildfire in that dentin. Our object is to detect decay while it is small and therefore needing only minimal repair. And now we have a way to do it! The diagnostic laser shoots a beam of laser light down into the crevices on the tooth. The laser then receives feedback when a certain decay producing bacteria is present in a pit or fissure. A digital readout displays continually and at a certain level a noise emits. The noise reaches a higher frequency as the bacteria reaches a dangerous depth. The combination of the noise and the readout helps us know how deep the decay is and if we can just observe an area or do we need to place a filling. The device is very accurate and has allowed us to merely “keep an eye on some areas,” rather than fill them. It also helps us at check up time because now we have a way to measure whether a lesion is changing or staying the same! We record and keep the laser feedback number in your chart!

This wonderful innovation is both painless and harmless. The only drawback is that it only works on crevices and not on the smooth surface of the tooth, nor in between teeth…yet. New horizons are coming. We welcome the new technology to better and more knowledgably serve you!

Happy New Year!

Picture by Javiar Arcila, Commissioned from SF School of the Arts student

 

THE GUM LINE

By Kathleen O’CoTnnor-Hanley R.D.H.

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Juice Beware!

The dental health story remains the same. If you want to maintain optimum oral health, you must disorganize all dental plaque colonies every 24 hours. When you do so, you reduce the exposure of tooth and gum surfaces to bacterial acid production, and therefore, reduce cavities and gum disease. Acid is the culprit! Besides our dentition suffering from the acids that plaque produces, we sometimes inadvisably bathe our dentition with dietary acids! As dental professionals, we are very concerned with dental erosion, which is the chemical removal of mineral from the enamel or exposed root surface of a tooth by acids.

In the U.S. there has been an increase in consumption of 100% juices and juice drinks which raises concern over the dental exposure to these acidic liquids. Fruit juice is often touted as a healthy way, especially for children, to consume vitamins and minerals. Unfortunately, along with those vitamins taken with or in juice, comes concentrated acid. At least, if they ate whole fruit, the acid (and sugar) is less concentrated plus the whole fruit contains fiber which is absent in the juice.

In a December 2007 study printed in the Journal of the American Dental Association, the pH of four different juices were listed. A pH of 7 is neutral. The lower the number, the higher the acidity.

Tropicana Orange 4.0
Motts Apple Juice 3.6
Tropicana Grapefruit 3.4
Welch’s White Grape 3.2
Wow! Those numbers are surprising. Who would have thought that white grape juice, which tastes so sweet and mild, is so acidic! The recommendations are to limit the intake of l00% juices and to water down the juice to dilute the concentration. Dr. Presley-Nelson and I would like to see acidity listed along with ingredients on packaging. This, of course, may take an act of Congress. There is also evidence that calcium fortified juice may offer some protection. So at least look for calcium fortification on your juice labels, especially for children or for those who consume a lot of fruit juice. Also please, never ever put children to bed with juice or anything but water in their bottle. The decay that results from this practice is devastating.

WHY DO WE NEED A NIGHTGUARD?

by Dr. Wendy Fung

Bruxism is the grinding of teeth, either while awake or asleep. Clenching is the result of holding the top and bottom teeth together tightly. Both clenching and bruxing are involuntary parafunctional activities that create an extraordinary amount of stress on the teeth and surrounding muscles and structures. This excessive stress can cause muscle and joint pain and abnormal and traumatic dental wear patterns. These wear patterns and stresses can be destructive enough to lead to increased tooth decay, tooth fracture, gum recession, and tooth loss.

Why do people clench or grind their teeth? Associated factors include sleep disorders, malocclusion (problems with the way teeth fit together), excessive caffeine or alcohol consumption, anxiety, stress, and side effects of certain drugs and medications. The bottom line, however, is that though there are several theories, the exact cause is not known. We don’t know why we grind but we do know that the proper rest position for the jaws is slightly apart, whether awake or asleep. The only time teeth should come together, would be briefly while eating.

Symptoms of clenching and grinding can include headache, earache, neck ache, and sore jaw. There can also be tooth sensitivity. There is often a strong correlation with stress, and it is not uncommon for grinding to be loud enough for a sleeping partner to hear. At their worst, clenching and grinding can cause permanent damage to the jaw joint and the teeth. Tooth damage can result in severe wear or fracture that could necessitate anything from a simple filling to a crown to even an extraction. Joint damage can cause irreparable limitation of function.

Because clenching and grinding are involuntary habits with unknown causes, the focus of initial treatment is to minimize damage. The best way to achieve this is with a nightguard, which helps protect the teeth and jaw joints. A nightguard is a custom-made appliance that fits snugly against the top teeth and sits between the top and bottom teeth. Think of it as a cushion between the jaws that absorbs stresses away from the muscles, joints, and teeth. It is not a soft and rubbery cushion because that may trigger chewing action. It is firm plastic, but less firm than teeth, hence, still a cushion. Along with using a nightguard, other ways to soothe joint sensitivity from clenching or grinding include taking a non-steroidal anti-inflammatory, eating softer foods, using warm or cold compresses, and minimizing habits that aggravate the condition, such as gum chewing.

Without any protection, oral structures can suffer greatly in the long term. Damage to the jaw joint is often chronic and irreversible. Once tooth structure is worn away, it is gone and does not grow back. Teeth that have more wear are associated with greater age; in other words, a person who clenches or grinds without protecting the teeth could, over time, allow enough wear on the teeth that could make the person appear older than his or her actual age.

If you have noticed any of the signs or symptoms of clenching or grinding, it is never too early to protect your teeth. Let us know if you have experienced any pain or sensitivity in your teeth, muscles, or jaw joints. A thorough exam will determine the best course of action to protect you from damage and preserve your youthful smile!

WISDOM TEETH: How wise is it to Keep Them?

By Dr. Beverly Presley-Nelson

Is the removal of wisdom teeth just a Right of Passage for the late teens, early 20’s? Or perhaps is the common practice of surgically removing wisdom teeth tantamount to the 1940’s-50’s standard (but in retrospect often unnecessary) removal of the tonsils?

“Today we try to make decisions based on individual risk vs. benefit,” says Dr. Matthew Messina, the American Dental Association’s “expert” on 3rd molars (wisdom teeth). “What we are assessing is what is the degree of uselessness, and what is the potential harm that they can create.”
In a long look at the past, we know that pre-historic man had larger jaws and smaller brain cavities. Modern man has a larger cranium and much smaller jaws, but we are still producing 32 teeth. A trip to a natural history museum where primitive skulls are displayed will undisputedly show the difference, and exhibit 3rd molars fully erupted and in functioning position, with room to spare for healthy gingiva to presumably nest around them.

Nowadays, when 3rd molars do actually completely erupt, they often nudge in where the mandible is beginning its curve upwards towards the ramus, the vertical part of lower jaws. On the maxilla, lack of room can leave them butted out to the side. In both cases there is little space for firm, healthy gingiva around them, and they are often shrouded in soft mucosa (cheek lining) instead. This, and the inability to reach them to keep them clean, evidently predisposes them to disease. Dr. Raymond P. White Jr. is conducting an ongoing study at the University of North Carolina, and finds the highest concentrations of periodontal disease bacteria in the tissue surrounding the wisdom teeth. A high incidence of decay is also found in these molars, caused by another type of oral bacteria.

“It does seem that the bacteria takes hold in the wisdom teeth,” said Dr. White, adding that once established, in his opinion, these organisms easily spread, jeopardizing overall oral health.
And if erupted, do wisdom teeth crowd the rest? Will carefully orthodontically aligned teeth, or naturally straight teeth start to overlap and crowd in front? Dr. Janice Tam, a San Francisco orthodontist, says that studies have shown that this is NOT the case. “Anterior crowding occurs at about the same rate in people with 3rd molars as in people without.” Dr. Tam relates. She adds that wisdom teeth in some positions can cause movement in the molar in front of it. “However,” she says, “this does not translate all the way to the front incisors.” A natural drift toward the midline is probably the cause of the crowding noticed over time in anterior teeth, she maintains.

So they predispose toward bacterial infection, but they don’t cause crowding. What about their use as a “spare” to anchor bridgework later in life? Studies have shown that 3 out of 4 retained wisdom teeth develop problems at some time. The advent and success of implants is rendering the often compromised 3rd molar a lesser choice in treatment planning for catastrophes down the road. It is more prudent to invest an expensive restorative venture on a more sure anchor such as an implant.

All of this about the 3rd molars that DO erupt, what about the ones trapped in the jaw bone that can’t surface? Removing erupted or partially erupted wisdom teeth is a relatively simple procedure. Removing impacted ones is a little more complicated. It becomes more so if left long enough for full root development to occur. If performed when just a crown is present it lessens the chance of damaging the nerve that runs below it that innervates the lip. Dr Dean Duncan, well known San Francisco oral surgeon says, “The absolute most ideal time to remove 3rd molars is age 18.” At that time he says that the root is only partially formed, the bone is soft and vascular, and healing is excellent. “I have never had a nerve issue in patients under the age of 25,” Dr. Duncan relates. Since leaving impacted wisdom teeth can cause the formation of jaw cysts and tumors, and can also invite painful flare ups when least convenient (i.e. during pregnancy or foreign travel) it may be best to plan early removal. “Taking out a wisdom tooth on someone who is 50 is riskier due to denser bone, loss of the ligament around the tooth which keeps it movable, and slow healing with more complications,” explains Dr. Duncan.

Of course each case must be considered individually, but it looks like the general evidence is pro-active on the wisdom tooth issue. We may be all the wiser without them.

CHISAKO’S CORNER

Please keep us informed of changes to your phone numbers, address, employer or dental insurance.

Remember dental insurance is an agreement between you, your employer, and the insurance company. We are happy to send claims to your insurance and to help you as best we can, but ultimately, the contract is yours.

Most dental claims must be processed within 1 year in order to be paid. A few cut off at 6 months. When the insurance has not paid for any claims within 2 months, please call the insurance company and inquire. They respond faster and better to the insured than they do to the dental office. Should they say they don’t have the claim in their system, call us to resubmit. If it is not followed up on, it may eventually be denied. There are lots of you and few of us. Thank you for your help and knowing a little bit about your plan.

Cancellation policy

Please give us advance notice when rescheduling or cancelling appointments. Notifying us less than 48 hours prior to the appointment will incur a charge of $30 per half hour scheduled.

This means if your appointment was one hour, there will be a lack of notification charge for $60.

Out of Area College Students come in for Dental Care

Every summer, and Christmas and Spring Break we so enjoy seeing our college students swing by for a cleaning and check up! We love to hear your stories and often stay open extra days to fit you all in at a time we’d usually be off ourselves. All of you are that important to us! Call way ahead to ensure your spot (or ask your folks to do it, they want the best for your dental health as do we!) Kudos to:

Tony Bader—UC Davis
Jay Giblin—New Mexico
Michael C. Novak—Santa Barbara
Lorenzo Robleto—San Diego
Anna Snyder—Duke, North Carolina
Seamus Tuohy—George Mason University, Virginia
Leo Vrana—UC Santa Cruz (currently completing courses in Paris)
Hannah Yanow—University of Oregon
Lillie Jeffries – Vassar College in New York
Tracy Lee—UC Davis
Lauren Brown-Cornell—UC San Diego

“If we left anyone out, please call us and let us know
so we can put you in next year…”

From My Heart to Yours

The New Year inspires one to thankfulness. I am so very thankful for my marvelous Associate Doctor, Wendy Fung, and her wonderful husband, Steve, and the healthful arrival of little Office Princess Nora. What a lovely family we have added to our family.

I am also thankful for Kathleen and her husband Patrick who are my children’s Godparents and for their children, Ryan and Emily, James’ and Gary’s God Siblings. What a precious gift they are to our lives and Kathleen is to our dental practice.
Chisako’s dedication and Danielle’s energy remind me daily, along with the presence of my college interns, of what a beautiful staff I have. Their excellence and competence and caring helps me create the best darn little dental office west of the Mississippi, and maybe further.

I am also thankful, grateful, and humbled by the opportunity to serve and care for all you wonderful patients. Thank you, each of you, for giving me the privilege and the honor of taking care of your oral health.
Happy New Year,

Dr. Presley-Nelson

The “Comes From Afar” Box

Often, when people move away, they still remain as patients in our practice and travel one or more times a year to receive their care from us. We so appreciate their efforts and their loyalty that we want to honor them here.

Bill Bender from Hayward
Rob Waring from Palo Alto
Darwin Albers from Paradise, California
Jennifer Ruzek from “Sunny” Oakland, CA
Lenore Cohen from Sunnyvale
Pon Piamchon from Thailand
Mary Johns from Piedmont (about seven years travelling from Piedmont to the avenues)
Mary Switzer from Mill Valley
Melanie Walas from Livermore
Elisabeth O’Connell from London (thank you for that book from The London Museum where you work! Maybe you should meet the Pabst family!)
Helena O’Keefe from Ireland
Theresa and Jeff Pabst from London
Paul Chamberlain from South Peninsula
Rex Golding from South Peninsula
Steve and Jo Moorehouse from north of Marin
Tanya Kauffman from Alameda
Arthur Sussman and Cheetah Llanes – Richmond
Molly Mundell Bass and John Bass – Marin
Carole and Gerald Leikam – North of Marin

The “Comes the Farthest” Award this year goes to Diane Mibach from Antarctica, where she works as a firefighter.

If we forgot anyone, please forgive us and let us know for next year!

Weddings

Long time patient Emily Hanson wed Luis Medrano on July 29th, 2007. Wes Little married Mitchelle Bek on November 27, 2007. Mary Switzer and Bill Haardt tied the knot on June 30, 2007. Long standing patient Rob Waring wed sweetheart, Elizabeth Miles on September 15, 2007. And Jeff Troupe made that trip down the aisle with Patricia Waldhaus in June, 2007. We also have an engagement, Dylan Snodgrass to Racine Christensen.
CONGRATULATIONS TO YOU ALL! REMEMBER, THE COUPLE THAT FLOSSES TOGETHER….GLOSSES TOGETHER… or something like that.

Babies

Dr. Fung and her husband Steve Heath welcome baby Nora, born on December 27, 2007.
John and Elizabeth Regalia welcome baby Dominic, born on October 21, 2007.
Gwyn Gordon and Damian Marhefka welcome baby Mariana, born on December 17, 2006.
Laura Fankushen and Paul Mansky welcome baby Jonah Nathaniel Mansky, born on July 2, 2007.
Julie and Stephen Maguire welcome baby John Maguire, born on July 30, 2007.
Reva Vrana and Greg Longacre welcome baby Sebastian Eugene Longacre, born on August 25, 2007. Two long standing patient families united by love – and they didn’t know they had us in common!
Debbie and Mike Lowther are proud grandparents of Scarlett Rose, born on February 19, 2007, who joins her older brother Benny, age three.

Joke Box

We do love our “jokers”! We must mention that dear Walter Meservey, one of our most prolific jokers, has actually begun to offer a little softer variety of jokes lately. Now that is not to say we don’t still have to clear the Nuns and Clergy, but the wall paper isn’t bursting into flames lately. Hats off to you, Walter, we love it when you come in and make us laugh! And Michael Novak still keeps Doc chuckling at her desk with hand outs slipped under the door. Bianca Hirsch keeps us well fed and giggling. The Moorhouses drive a long way and provide a tag team of hilarity while here. The Leikams come together from up north and make us smile. Dr. Reidbord, our motorcycle riding psychiatrist roars up on his bike and entertains us. Harold Yanow spent a lot of time with us this year and his humorous banter kept us on our toes, we are all thinking of you, Harold. Danny and Anne Yanow both bring jokes and laughter, as do Richard Jann, Tom Beeks, Siobhan and Bill Ruck (Siobhan, those viola and cello jokes were great!) Marilyn Brown and Steve Cornell always crack a smile, as does Ski Tostanoski. Barry Hanson always makes us glad he came in with a joke that he delivers with a straight face. If we forgot anyone, let us know right away!

The Printable Dental Joke Award goes to:

JOE RAZON who is one of my consultants for bargain wines and taught me about “two buck Chuck”.

AND THE WINNING JOKE IS: (drum roll please…)

Did you know that there is a new wine
for older men?

They call it Pinot Moir!

We welcome new patients!
Remember, when two of your referrals
become patients, we will thank you with a free
automatic Rotadent toothbrush.

This is a non-retroactive offer.

Did you know that you have complete cell turnover in the gums touching your teeth every 4-7 days! That means they will stop bleeding and heal in a few days if you keep the plaque off!

STAFF PERSONALS

Dr. Presley-Nelson and husband Gary are being entertained by teenaged comedian sons, Gary Clarke, senior at School of the Arts High School (on cello) and James, sophomore at School of the Arts (on viola). The boys, who keep the parents laughing, are both big and tall and very into music. Besides their stringed instruments, both play piano, and Gary Clarke plays bass guitar and James the drums. They both enjoy Skeet Shooting and Rifle Range and enjoy going target shooting with family friends Darwin Albers or Dr. Fung’s husband, Steve Heath. Both boys are also involved in Mock Trial and are spending many hours a week downtown at law offices with attorney volunteers, preparing for the upcoming court competition. Also, naturally, the house is littered with college applications. The Presley-Nelsons are enjoying the teenage phase of parenting more than any so far, though it is hard to keep up with the boys AND the busy dental office, plus Gary’s career at Hewlett-Packard. The family is hoping to carve out some time together and plan a trip to Italy this summer. Any suggestions?

Kathleen O’Connor Hanley is starting her 21st year as part of the practice. She enjoys seeing each and every one of you and loves to hear those stories! She wants those photos also! Babies, weddings, trips…..places you have used a Rotodent (like on a mountain top!) She and husband Patrick are busy with Ryan (12) and Emily (10). Ryan is playing in the school band and is in Drumline, a marching percussion drill team. As you can imagine, his mother is driven slightly bonkers by his constant drumming, not only legitimate practice, but the fidgety kind with pencils, fingers, or anything he has at hand. Still, in spite of living with caucophony, the parents are proud of his performances. Emily is very involved with her Girl Scout Troop and is happy and singing most of the time. She loves The American Girl Dolls and hit Santa up for some fancy accoutrements! Besides some damage to the house and fence from the recent storm, all is fairly well and they are looking forward to a great 2008!

2007 was another great year for Dr. Wendy Fung and husband, Steve. The icing on the cake for the year, however, was the arrival of their daughter, Nora. She was born on December 27, and they look forward to watching their precious little girl grow and get to know the person that she is. Dr. Fung wants to thank everyone for all the advice and words of encouragement. She enjoys hearing everyone’s tales of parenthood…it sounds like she will have to hang on for an incredible adventure! In the meantime, they are trying to enjoy every moment, sleep deprivation and all. As they look forward to 2008, they are excited to see what the New Year brings!

Chisako Tanaka, our office manager, is still making sure everyone is where they are supposed to be, when they are supposed to be there. Between the staff and the patients, it’s no easy task to keep track of it all but she handles us all smoothly. She works hard dealing with the insurance companies trying to get the most out of your benefits for you. We certainly appreciate her leadership and help around here.
Chisako would like to congratulate the college interns – Jen for entering UC Davis (UCD) and Denise for graduating from UCD.

Danielle Uttley-Rodriguez, our Chairside Assistant, heads our Sterilization, Assisting, and Maintenance team. Also known as La Tarantula (La Taran “CHULA”), she is a member of the World Famous San Francisco Bay City Bombers. The well known Roller Derby team clenched the World Championship Title this past October against the Brooklyn Red Devils. This year the season opener resumes on Saturday April 19th @ 8:00 pm at the Kezar Pavillion in San Francisco. Danielle would sure love to see all of your smiles at this or one of the many home games. Danielle is also the proud mother of wonderful 10 year old twins, Xianna and Andres. The twins currently study music. Xianna studies the flute, while Andy is learning the bass and guitar. Last June the family spent time in Napa at an amazing camp for the visually impaired, Enchanted Hills Camp, where the twins learned skills using all their senses. It was a great experience for the family, and all are looking forward to another visit there in the coming summer.

Our college interns keep our late shift young and perking. Usually pre-dental majors, they each may work only a few hours a week to allow Danielle, our main dental assistant, to leave in mid afternoon and pick up her twins from school. The college students are bright, easy to train, entertaining, and a delightful addition to our office. Their “Staff Personals” are as follows:

Daniel Gee is a new office intern this year. He learned very quickly and is eager to help in any way. He majors in Biology at SFSU and he studies and teaches Kenpo Karate, which he has been practicing for ten years. He recently returned from spending Christmas in Hawaii where his sister lives. You can meet him around the office a couple of afternoons a week.

Also new to the team, another college intern, Tessa McGregor is active in the Pre-Dental Students Club at San Francisco State University. She is helping Chisako with paperwork and phone duties while learning about dentistry. She is around about 15 hours a week and can be seen in the computer room or at the front desk. When not at school or the office, she enjoys playing the piano, running, and walking her dog, Dee Dee Ramona, along the beach near her home in Pacifica.

Jennifer To is a Junior in college this year and is transferring to UC Davis for winter quarter. She decided to major in Microbiology and plans to eventually apply for dental school. She came years ago as a high school intern to help around the office in the late hours. She has been a blessing and we will miss her until she pops in during summer and school breaks to “fill-in”. She says she misses the patients and staff already (it has been one week!).

Denise Tong, we are proud to say, graduated from UCD in Genetics last June and now has a full time job at UCSF in the Cancer Center. She only comes in a few hours on the weekend to do data entry and she is still kind enough to put together our office newsletter, INCLUDING this one. She is our longest standing youth staff as she came to us in high school. We are lucky to have had her in our lives.

Linda Dang is a senior at SFSU this year majoring in Physiology. She’s been with us several years now but this semester she has so many classes she can come in only to close on Fridays. She hopes to graduate in June and then maybe she’ll have more time for the office and to help Doc hold down the fort at home on Halloween, where she helped greet 327 trick or treaters last fall! If you are in late on Friday, be sure to ask her about her hobby of cooking.

Liza Bisquerra was a great find! She is a recent graduate of UC Davis in Biotechnology. She is currently taking some time to prepare for Dental Aptitude Tests and ready herself for application to Dental school. We are fortunate to have her help us out at the office. She is very capable and while she is becoming familiar with the Dental field we are enjoying some good laughs with her constant humor. Her hobbies include singing karaoke and performing hula and Tahitian dances.

Bleaching and Cosemtic Dentistry Done Right in Our Office! JUST ASK!