Dr. hackbarth's ARticles
Update: More new information on Alzheimer’s disease and oral bacteria
I recently wrote about new information regarding bacteria and its association with Alzheimer’s disease. Now a new paper has been published from the University of Louisville, where researchers report the discovery of Porphyromonas gingivalis(PG)–one of the mainpathogens behind chronic periodontal disease(aka gum disease) –in the brains of deceased Alzheimer's patients.This,in addition to what I recently reported to you about spirochetes in the brains of Alzheimer’s patients,is another clue that Alzheimer’s is caused by infections. These bacteria enter the body through infection in the mouth. The dangerous thing is that until gum disease is approaching the severe levels, there are very few symptoms that you may notice. Bleeding gums, when you brush or flossis usually the first symptom. I see people all the time who don’t really know the extent of their periodontal problems, or even know they have the disease.We do know that 50% of adults have some level of periodontal disease. As you age this percentage increases to over 70%.One positive thing is that we have simple tests that can determine the presence of PG bacteria in your mouth, so we can use this to evaluate the effectiveness of your treatment.Unfortunately, there is no test to determine if you have spirochetes present.My advice: see a dentist who can determine if you have periodontal disease, treat it and help you get back to great oral health, so you can lower you chances of developing Alzheimer’s disease.
Alzheimer’s Disease and Your Oral health
The importance of oral health and regular maintenance.Don’t ignore this, it is more important than you think.
By John Hackbarth, DDS
One horrible disease found in our aging population is Alzheimer’s dementia. Almost everyone knows somebody who is or has been affected. The results of Alzheimer’s are frightening.
So, what does Alzheimer’s have to do with oral health? According to Herbert B Allen, Rina M. Allawh, and Kavita Goyalfrom the Drexel University College of Medicine, a lot. (Curr Neurobiol 2018: 9(1): 29-32):
“The key pathological finding on routine bright field microscopy of Alzheimer’s disease brains are the presence of Spirochetes, ....”(Spirochetes are a class of bacteria.) The authors go on to detail how they think the cascade of events from the Spirochetal infection affects the brain tissues. The look of Alzheimer’s brainsand tertiary syphilitic dementia brains are like mirror images of each other the authors report.
“The spirochetes(bacteria)involved are oral treponema (T. denticola as representative), Borrellia burgdorferi(the cause of Lyme disease), and T.pallidum, the etiologic agent in syphilis.
”In post mortem studies, over 90% of Alzheimer’s patients brains show evidence of spirochetes.This was reported by Judith Miklossy in the “Journal of Neuroinflammation”, August 4, 2011.
That all sounds like a bunch of scientific talk, but now it appears that we have the “smoking gun”for most dementia cases,and it is infection, specifically infection by spirochetes.
Periodontal disease is caused by a chronic infection of the gums and bone in the mouth that involves many types of bacteria. One of the types of bacteria often involved are Spirochetes.
In light of these recent scientific reports, you can easily see that having good oral health is critical to your future. No one wants to face the effects of Alzheimer’s disease.
What is important for you to get and maintain good oral health?
Great home care is very important. One mustclean their teeth and gums on a regular daily basis anddo it well. I recommend a power toothbrush. I think Sonicare is the best. Also, daily flossing is critical. A Water Pic is a great addition to your home care routine.
Regular professional care and cleanings are important in maintaining oral health. You cannot skip those.
Cleanings are great if there is not already the presence of gum disease. If gum disease is presentit needs to be professionally treated and control of the infection achieved, so that you can be returned to health.
Along with the bone loss and infection of periodontal disease comes bleeding gums. The way Spirochetes make their way to the neural tissues in the brain is through blood. If you have an oral Spirochetal infection, when you eat, brush your teeth or floss, if the gums bleed then these bacteria can be carried by the blood stream to the brain.A good immune system is a help in preventing theses infections, but everyone should have a good home care routine and regular professional visits to the dentist and hygienist. There should be zero tolerance for bleeding gums.A good resource can befound at ZT4BG.com. Conclusion: Find out what’s happening in your mouth. Get yourself to a dentist!
Head and Neck Pain
Headaches and neck painsare unfortunateproblems that people deal with in life. if you have daily or weekly headaches,or days-long headaches,it is almost like robbing you of good life.Most headaches are caused by muscular tension and pain. Even severe ones. There are severalreasons for these headaches. One of the most common is oftencalled TMJ. The TMJ is the Temporomandibular joint. This is the jaw joint. Dysfunction of the jaw joint can cause pain, but the muscles that open and closeyour jaw go into spasm similar to a “Charlie horse.”
TMJ is better called TMD or Temporomandibular Dysfunction. TMD is usually related to the way the teeth fit together, as well asclenching and grinding of the teeth. The way that your upper and lower teeth come together (your bite) is part of a system of teeth, muscles and joints. If your teeth do not fit together properly (misaligned bite), the muscles and jointshave towork hard to get them together.
Teeth,when in function should work like a fine set of gears, but if one of the gears is mismatched,something is going to break. It is the same with your jaw. Jaw joints can begin to make grinding noisesand pop on opening and closing, and the muscles of the head and neck get into spasm and hurt.
Stress and tension make things worse.
Now we have what I think is the most effective way of getting folks out and this kind of pain and back into normal function. It is called neuromuscular dentistry.
Neuromuscular dentistry utilizes technology to help get the jaw into a relaxed position where the joints and muscles are happy, thus reducing or eliminating pain and headaches. This approach hasgiven consistently the best resultsso far.
Following are some of the more common symptoms that may arebe associated with TMD. If you have one or more of them give us a call. We can help.
- Sensitive teeth
- Pain in the jaw
- Pain in the neck
- Pressure in the face
- Ringing in the ears
- Locking jaw
- Restricted opening
About False Teeth—Dentures
By John Hackbarth DDS
It is wrong to believe that when someone gets false teeth or dentures, they are through worrying about going to the dentists or spending more money on their mouth.This is not true. False teeth are made ofplastic and like anything else, plastic doesn’t last forever.They break, crack and get worn over time.Also, it is normal for the boney ridge of the jaws to shrink over time and the dentures no longer fit well.
It is not true that just because you knewsomeone with false teethwhocould eat anything with his dentures,that everyone and anyone could do the same.Nothing could be further from the truth.Everyone comes in different shapes, different personalities, different types of bone, different kindsof chewing habits, etc.Having all your teeth extracted can be compared to the handicap you would have if you had both your legs amputated. Some people seem to get around well with prosthetic legs, and some can strap on those spring-like things and run around a track, but many never get out of their wheelchairs--and they would all tell you they would rather have their legs back.
It is wrongto think just because you get old, you are going to have to wear false teeth.That is not true.I have many patients in their 70’s, 80’s and 90’s that still have their natural teeth.Why?Because they took care of themand had timely repairs if needed.
It is also a false belief that all dentists are the same, especially when it comes to making an extremelygoodfitting set of dentures.Dentures are probably the most difficult of all dental services to do well, especially on a consistent basis.
It is true there are inpiduals with no teeth who can wear just about anything and make it work.They are what dentists call adaptors.There are stories of people using dentures they got from garage sales or funeral homes. I have seen tons of horrible dentures that the patients use and eat anything and everything.If you are an adaptor, you can get by with bad dentures.If you are not an adaptor, your dresser drawers may be full of plates that never worked.
If false teeth are made too small, the following can be observed:
- The lips become small and thin because they curl under toward the teeth.If you have seen women who constantly have lipstick on their teeth it is because the denture or natural teeth do not support the lower face.
- The upper lip doesn’t seem natural.It’s too small and thin and wrinkled.
- There is a crease between the bottom of the chin and the lower lip.
- When the personsmiles, you cannot see the teeth.
If false teeth are made too big:
- Way too much teeth show even when not smiling.When smiling, all you see are teeth and gums.
- Both upper and lower lips protrude.
- The chin is too far from the nose.
- You might say that the person has a “piranha look.”
If a denture is properly made:
- It is so natural and beautiful, no one can tell it is a denture.
- The profile of the face is natural.
- The lips are full with fewerwrinkles.
The basic rulesof getting a proper fitting, beautiful denture are:
- Having enough bone for a denture to sit on.Implants are awonderful thing for denture wearers,but that is another article.
- Don’t expect it to happen in a day or two.It takes time to make a beautiful, well-fitting denture.
- The denture is usually made with the assistance of a dental technician.Thequality must never be compromised.
- The bottom lineis that a properlyfitting denture requiresmore work, and is more expensivethan a cheaplymade set of false teeth.
- The dentist you choose shouldbe experienced andstand behind his/herwork.
John Hackbarth: Dentures in a day are complicated
A new patient came to see me and was sick and tired of dealing with her bad teeth. Shehad three options after the removal of her bad teeth:
Do nothing,and have no teeth forever
Wait three to six months after the bone healed and get dentures
Replace the bad teeth with dentures the day the teeth are removed
The patient chose to have same-day dentures. The results speak for themselves. For almost 100 years this process has been called immediate or healing dentures. Marketing techniques have changed the term into dentures-in-a-day as you can see on TV.
The purpose of this article is for the reader to get an idea of how most dentures-in-a-day work.
First—It is important to know the denture has to be made, in its entirety, prior to the teeth being removed.
In order to have custom-made, prefabricated dentures, extremely accurate impressions need to be taken before the teeth are removed. To get an idea of what is necessary for proper impressions, take your tongue and roll it around the roof of your mouth, all upper and lower teeth, upper and lower cheeks and anything else the tongue can touch has to be recorded. The molds have to perfectly duplicate everything.
It is also important to have an accurate record of how the upper and lower jaws fit together. This is not always easy when the remaining teeth are broken and worn and have many missing. The doctor will also have to help you decide on a color and tooth style for your new teeth.
The upper jaw is a part of the skull and is fixed, while the lower jaw is the bone that does all the moving. It is connected to the skull by two joints, muscles, tendons, ligaments and the skin of your face. The laboratory technician, the one who actually makes your teeth,has to know exactly how that particular person’s jaw opens and closes. If the impressions are not accurate and the bite registration is not right, it will be a disaster for everyone.
The laboratory steps are complicated and boring, but the end result is upper and lower dentures made for the patient and to the dentist’s specifications.
On the delivery day the patient is prepared for surgery by numbing the mouth. Some patients also choose to be sedated. The teeth are then removed, the bone is smoothed, sutures are placed if needed and the dentures are inserted and adjusted.
The procedure is a very emotional experience for both the doctor, team and patient. Once the teeth are gone there is no going back. As a dentist, even with years and years of experience, there is always a small amount of worry that something has gone wrong with the denture making process. It is always wonderful to see the uppers and lowers slip right in giving the outcome you see in the photos.
Second—Not everyone is the same and notevery dentist is the same. Dentures -in-a-day should be done by experienced dentists who work with experienced technicians who are versed in making dentures. All dentures-in-a-day, in fact all dentures, are 100% customized the just that one person. If it doesn’t look right, it’s not right. If the bite is not right, the denture is not right.
Third—The immediate/healing denturehad one main purpose: to give a person teeth to smile with until all bone healing has taken place. In six to 18 months the existing denture should be replaced. The length of time depends on how the bone heals. We have also found that having dentures-in-a-day also helps a person adjust to wearing a prosthetic.
Fourth—Having a trusting relationship between the patient and the dentist is important. The patient needs to be aware of each step, and have all the benefits and pitfalls explained. In my experience, it is always best to expect to have a new set of dentures made after everything is healed.
This procedure is one of the most rewarding as well as one of the most complicated dental procedures.
Did you ever wish your teeth were straighter? You may have heard about ClearCorrect, or Invisalign, or even seen the advertisements on TV suggesting that you could straighten your own teeth with their product. Many folks look at their teeth and wish they could easily straighten them, but they are not interested in having braces. Aligner orthodontics is often a great answer for them. This however, is not something you should attempt yourself, any more than doing your own appendectomy.
Aligner orthodontics use a series of clear plastic traysto make incremental changes in the alignment of teeth. This procedure has been around for a long time. Initially models were altered manually to change the position of teeth. This was a slow process and was used only to make minor corrections to a few teeth.
Aligners came into their own when computers were first used to digitally move the teeth in small increments and then models were made of each increment which could then be used to make aligners. At that time many more advanced cases were possible. Aligners cannot do everything that can be done with braces but are a good alternative for many people.
They are not easily seen and are more comfortable to wear than braces. Many aligner cases can be accomplished in less than one year.
If you wish your teeth were straighter, see an experienced dentist who works with aligners and see if you are a candidate for this kind of treatment.
Teeth are meantto last a lifetime
By John Hackbarth, DDS
Of the three basic problems one can have with their teeth, two are infections.The third is the way the teeth fit and work together.
Today, I am going to discuss the infections. Decay eats up and destroys teeth. Gum disease infects the gumtissuesand can eat up the bone surrounding the teeth. Both decay and gum disease can spread infection all over the body.
If food debris is allowed to stay on the teeth for days, then bacteria can flourish anddestroy both the teeth,gumsand bone. These disease processes are slow and progressive. They are non-painful until it is too late.
Whether you are 6 months old or 90 years old, clean teeth and gums do not rot.
Starting with infants, a baby should have their mouth swabbed with a damp towel after they eat. This will start creating the lifelong habit of cleaning their mouth. As the teeth come in, the parents should go from the towel to a child toothbrush. Brush their teeth after each meal. Toothpaste is not necessary.
Toothpaste is only good for the flavor and for making brushing more pleasant. The key is to get all the food particles and residual bacteria off the teeth and gums.
Children should visit the dentist by their first birthday. Mom or dad should bring them so they can begin to feel comfortable in the dental office environment and have a positive experience.
Too often parents wait until the child has a toothache before they take them to the dentist. This usually involves treatment and shots,so the dentist can treat the cause of the pain. It is often a very traumatic first experience for a child and can set up a life long fear of going to the dentist. I’m sure many of you can relate.
There are studies that showthe children of dentists have very few to zero cavities during their lifetimes. This is not because the child has access to dental care, but because the parents are adamant about their children keep their teeth clean at home. This is something every parent can do.
The transition frombaby teeth to adult teeth starts around 6 years old and lasts to around 12 years old.
If the teeth are kept perfectly clean, then there will be no decay. Of course, there are always exceptions.
The more dental work you have, the harder it is to keep yourteeth clean. Natural teeth are the easiest to clean, but that can be more difficult if the teeth are crooked or crowded.Your hygienist should be your hygiene coach for the needs for your specific conditions.
Our office loves seeing children in hygiene,so that we can do thorough evaluations not only for disease but also for proper growth of the jaws.If we find problems that require the care of a specialist, we will refer them to the proper doctors.
The purpose of this article is to educate the public and medical community on dentistry. Dentistry can be confusing both to the lay public and to other health care providers. That is not a good thing. If you have questions, please call my office.
Do you know about the “3 Ways”?
Besides the circumstances of trauma or tumors, there are three ways people get in trouble with their teeth and oral health.
Two of those are infection.
First is decay. Decay is bacteria that eat holes in your teeth and make cavities. The bacteria make byproducts that leach the minerals out of a tooth, and then invade and infect the tooth. If decay is not stopped and treated, it will lead weakened hurting teeth and eventually to abscesses.
The second infection is bacteria that attack the gums, bone and supporting structures to your teeth. Bacteria that are not sufficiently cleaned off the teeth, especially in between the teeth will make byproducts that cause inflammation and breakdown of the gum tissues. Then the bacteria can invade the gums and begin to cause bone loss. If this is not stopped and treated it will lead to the loosening of teeth and periodontal abscesses.
Worse than that is the fact that periodontal (gum) disease is an overall health risk. It is associated with a wide variety of systemic problems including cardiovascular disease, heart attacks, strokes, preterm births, and even erectile dysfunction in men. Every time you eat or brush your teeth, you are sending millions of bacteria and their inflammatory byproducts directly into your bloodstream.This creates a constant immune challenge for your body, and one doesn’t have to be a doctor to know this is not good.
The third way you can get in trouble with your teeth involves the way the teeth hit together. The bite, to function properly, must be aligned like a set of gears. If it is not, one gets excessive tooth wear, broken and cracked teeth and even headaches and TMJ problems. These things increase the longer an incorrect bite persists.TMJ, jaw joint, problems can be really debilitating to anyone who suffers from these problems. Fortunately we have developed increasingly sophisticated ways to help people who are suffering from these issues.
It is always better to avoid these problems, or to at least correct them at their early stages. That is what we are here for, and why regular exams and hygiene visits are important.
Likely,we can help you prevent these problems, but if you already have any of these issues, we dentists are here to help you.
John Hackbarth, DDS
Unintended consequences of insurance
As a 2nd generation dentist I fear for the dental profession. I am also worried about how the public’s dental needs will be served in the future.
Dentistry is a very special profession for many reasons. Dental fear is part of our history, whichhas barbaric roots. Amazingly enough,the major breakthroughs in anesthesia have been created by dentists.
When we were first able to numb teeth and mouths,in my grandfather’s time, most dentists charged for the new procedure. It usually cost $1 for anesthesia. Given the option, many parents chose to save $1 and not get the shots.
Dentists and teams held achild down and drilled and pulled without anesthesia. These horrible experiences created dental cripples for life. I still hear this story from older patients. Today, some dentists are still hurting people. Something I just don’t understand.
Dentistry is and always should be a service profession where the doctor takes time to listen to the patient’s wants and needs. This includes listening to and respecting true concerns like anxiety, claustrophobia, gagging, etc. Being in partnership with your dentist is a win-win situation. Everyday, we work in mouths that are connected to living, thinkingand feeling human beings. Some are easy to work on, but many are terrified and would rather be in a fist fight than in our dental chairs.
In 2019, thereshould be extremely few painful dental experiences, hopefully none. If you arehurting and being ignoredat your dentist’soffice, you should find another dentist.
There is a growing trend to make dentistry a common commodity, much like a fast food restaurant where food is fast and cheap. When dentistry becomes fast and cheap, but without the human touch that the service industry demands, dental fear and disappointment will become more rampant. What a horrible outcome for our patients and profession.
If you are on a dental plan that requires a Preferred Provider, you are part of the process of the decline of dentistry as a personal service. The same holds true in medicine. A Preferred Provider is not someone whom the insurance company has vetted as a superior dentist. Preferred Provider simply means a dentistor dental corporationhas agreed to take a discount of up to 40 % of their normal fees. That’s correct, 40%. Dentists sign up due to the fear of losing patients. This is not an imagined fear: it’s real.
Being on a plan is the same as pacing bids on a job. And company policy is to accept the lowest bid. This happens in everyday business.It especially happens in government entities and is perfectly legitimate. It is perfectlylegitimate in dentistry as long as the patient knows they are going to the lowest bid, which will affect the quality in some form or fashion.
The good part of being a dentist is spending time with patients and solving their dental problems. The bad part is working in the mouth. Fighting the tongue, saliva, cheeks, gagging, etc., is not an easy thing to do all day. Whena dentist signs up with these plans, they either mustget people in and get them out in a hurry, or they losemoney. The more hurried they are, the more frustrated everyone is including the dentist, team and patients. Patient dissatisfaction or bad dental experiences are unintended consequences of these kinds of dental insurance plans.
Of course, employers like discounted plans because it makes the dental benefit costs cheaper. Patients like it because it helps with dental bills. Most dentists hate it and feel as slaves to the insurance companies. Physicians feel the same way. Burnout is a huge problem in all medical fields and is and unintended consequence of discounted plans.
Dentists who own their own solo practices are also victims of the unintended consequences of dentalinsurance. In order to compete with the chains whose business plan is based on the plans, they too feelpressureto sign up as preferred providers.
This creates a circumstance in the practice. Do patients who are members of the “plan” get the same care as patients who pay full price? It’s an ethical dilemma any way you look at it. If the doctor doesn’t provide the same care, then he is creating a two-tieredpractice and not providinghis best care to all his patients.If he does provide the same care, then the private patient, who is paying full price, is being asked to subsidize an insurance company.
You, as the patient, need to know exactly what your insurance plan provides. If you are on a plan and your trusted dentist is also on the plan, with frank discussion, the two of you can work together in a way that will be beneficial to all. At least, if you have a Preferred Provider plan, you can still get benefits at a dentist’s office who is not a member. In this case, the benefits may be reduced a bit, but you can be sure that the dentist will not be cutting your time or treatment short. In any case, you need to understand the system, and that is the purpose of this column.
The worst unintended consequence of discounted dental insurance, and my fear for the profession, is the best and brightest of our younger generation will scratch off dentistry, and possibly medicine, asa profession
Why brush your teeth?
By John Hackbarth, DDS
A great question to ask your kids is “Why do you brush your teeth?” Answers can range from “You make me,” “I don’t know,” “To keep my breath fresh,” it is not usually “So I will not get cavities.” This is a great mealtime discussion and you should try it.
So, reader, why do you brush your teeth? Do you do it without thinking about it? Is it just a habit? Do you figure thatas long as you brush once or twice a day, you are good? Is it mindless, like buttoning your shirt? Or, could you be one of those who are determined to remove every bit or food or debris, dental plaque and calculus after you eat something?
I just asked that question to the last patient of the day and the young man told me, “So my girlfriend will kiss me after lunch.” No brushing, no kissing! That is a very clear rule and easy to follow, and it works.
Last week we filled a tooth for a young lady in high school. We did an exam a few weeks ago, and listed the decay, talked about plaque andgingivitis and showed her photos of both. Once we gave her mom the treatment plan, for budget reasons, she is doing one cavity at a time.
We have now filled four different teeth infour visits. I asked her why brush and she stated that before she started getting the fillings, she would have said to keep her breath fresher, but now she knows to brush them to keep her teeth healthy. I was happy to hear that. We could tell she has been working very hard over the last few weeks because her mouth was very clear, healthy, no swelling, no bleeding and in perfect health.
It is amazing how many people come in to see us with teeth that are not really clean even though they spent extra time brushing before they came in. They know we are going to check their teeth. We can tell who cleans and who does not.
Dentists can live in their own isolated world and think teeth should be cleaned so they don’t get disease. We can be so wrapped up inwhat we were trained to do, that it is hard to look at the situation from a layman’s point of view.
The public thinks more of fresh breath and white teeth; something others notice. I never admonish a patient for having plaque and calculus. We just point it out, and the damage they cause. My job is to teach not to judge.
You have heard me say before,that clean teeth don’t rot. If there is no food left in the mouth to feed bacteria, there is no infection, no deep scaling, injections, no drilling, no fillings or crowns and no high dental fees.
That is a logical statement, but logicdoesn’t always change behavior. As an emotional plea, I can promise that once you are taught how remove allthe debris from your mouth each and every time you eat something, and you make a habit of doing that, you will not be able to tolerate a dirty mouth, and you will eliminate infection and cavities.