root scaling and planing

[kelli]

I had had some tooth pain on my lower left rear molar for some time,i
made an appointment to see if i could just get the tooth removed since
it was cracked and hurting,well the dentist tells me i had 2
options,either remove it..the cheapest option,which later on would
cost more to replace,or get a root canal to save the tooth and crown
as well..well he started the process but only was able to do the post
and core,due to my gums being more inflamed than they figured,he also
told me he suggested me getting a root planing and scaling,before
putting the crown on as it coiuld get infected and thus break
off..well earlier this week i got the root canal done by a
endodontist,and now just need to know if it's really necessary for the
root scaling and planing,which is more money for the dentist, or can i
just go ahead and get the crown?

[Steven Bornfeld]

I'm a bit confused--it seems you're saying the post and core were made
before the root canal treatment--should be the reverse.
As to your question, the root canal treatment has no bearing on whether
or not you should have root planing. If you have heavy calculus you
certainly should have it removed prior to preparing and impressioning
the tooth for the crown. If you don't, you may have a beautiful crown
with a gorgeous smooth margin ending on tartar, rather than the tooth
surface--not a good idea.
As to whether the amount of tartar calls for a root planing I of course
cannot say. If however the gums are inflamed due to plaque and tartar,
it can be difficult to impossible to make a good impression of the tooth
after being prepared for a crown.

Steve

--
Mark & Steven Bornfeld DDS
http://www.dentaltwins.com
Brooklyn, NY
718-258-5001

[Maier Yancov]

I found this old article

http://articles.mercola.com/sites/articles/archive/2001/07/25/dentist.aspx

"Purifying the saliva and mouth can be speeded up today with new
"state of the art" products. A rinse of a solution of highly
concentrated calcium and phosphorus ions (with a remineralizing
catalist) has recently been developed by a biochemical company here in
this country.

To combat the build-up of bacterial colonies (producers of toxic waste
products) a new teeth cleaning substance has been developed to retard
the bacterial colonies from growing in the first place. Yet another
rinse is available to kill off high concentrations of bacteria when a
saliva test has shown them to be excessively high."

...did anything ever come of this ?

[Steven Bornfeld]

The first paragraph may be referring to "Recaldent" which claims to aid
in remineralizing of early carious lesions. I frankly haven't seen
studies to support their rather extravagant claims.
Not sure what the second paragraph refers to--perhaps chlorhexidene
gluconate rinse, which has been available for about 20 years in the U.S.
and in parts of Europe for perhaps 50 years. It has a limited place,
but is certainly no panacea.
Disclaimer: I don't find much in Mercola's paranoid world view that I
find helpful.

Steve

[Ankur]

* Steven Bornfeld <dentalt...@earthlink.net>

> The first paragraph may be referring to "Recaldent" which claims to aid
> in remineralizing of early carious lesions. I frankly haven't seen
> studies to support their rather extravagant claims.

Which extravagant claims do you consider unsubstantiated?

As far as I can tell, there seems to be little doubt that CPP-ACP does
remineralize teeth.
I am, however, biased and not yet a dentist, so I'd appreciate your thoughts.

--
Ankur

[Steven Bornfeld]

There is insufficient evidence (in the view of independent researchers)
of CLINICAL efficacy. Such evidence generally PRECEDES the introduction
of a medication, it does not follow it.
I am not rejecting Recaldent's efficacy out of hand; it just needs to
demonstrate itself.

http://adr.sagepub.com/content/21/1/83.full

I can't claim to be totally non-biased, but in this case I have no
specific animus one way or the other. Why are you biased? Are you
connected to the research/production/marketing of Recaldent?

[Maier Yancov]

On Nov 8, 11:35 pm, Steven Bornfeld <dentaltwinm...@earthlink.net>
wrote:

> On 11/8/2011 5:15 PM, Maier Yancov wrote:
>
>
>
>
>
>
>
>
>
> > I found this old article
>

> >http://articles.mercola.com/sites/articles/archive/2001/07/25/dentist...

>
> > "Purifying the saliva and mouth can be speeded up today with new
> > "state of the art" products. A rinse of a solution of highly
> > concentrated calcium and phosphorus ions (with a remineralizing
> > catalist) has recently been developed by a biochemical company here in
> > this country.
>
> > To combat the build-up of bacterial colonies (producers of toxic waste
> > products) a new teeth cleaning substance has been developed to retard
> > the bacterial colonies from growing in the first place. Yet another
> > rinse is available to kill off high concentrations of bacteria when a
> > saliva test has shown them to be excessively high."
>
> > ...did anything ever come of this ?
>
>         The first paragraph may be referring to "Recaldent" which claims to aid
> in remineralizing of early carious lesions.  I frankly haven't seen
> studies to support their rather extravagant claims.
>         Not sure what the second paragraph refers to--perhaps chlorhexidene
> gluconate rinse, which has been available for about 20 years in the U.S.
> and in parts of Europe for perhaps 50 years.

ok, I thought maybe he was referring to CloSYS...

> It has a limited place, but is certainly no panacea.
>         Disclaimer: I don't find much in Mercola's paranoid world view that I
> find helpful.

yes, he does seem to have something to say about everything :-)

[Steven Bornfeld]

On 11/9/2011 1:55 PM, Maier Yancov wrote:
> On Nov 8, 11:35 pm, Steven Bornfeld<dentaltwinm...@earthlink.net>
> wrote:
>> On 11/8/2011 5:15 PM, Maier Yancov wrote:
>>
>>
>>
>>
>>
>>
>>
>>
>>
>>> I found this old article
>>
>>> http://articles.mercola.com/sites/articles/archive/2001/07/25/dentist...
>>
>>> "Purifying the saliva and mouth can be speeded up today with new
>>> "state of the art" products. A rinse of a solution of highly
>>> concentrated calcium and phosphorus ions (with a remineralizing
>>> catalist) has recently been developed by a biochemical company here in
>>> this country.
>>
>>> To combat the build-up of bacterial colonies (producers of toxic waste
>>> products) a new teeth cleaning substance has been developed to retard
>>> the bacterial colonies from growing in the first place. Yet another
>>> rinse is available to kill off high concentrations of bacteria when a
>>> saliva test has shown them to be excessively high."
>>
>>> ...did anything ever come of this ?
>>
>> The first paragraph may be referring to "Recaldent" which claims to aid
>> in remineralizing of early carious lesions. I frankly haven't seen
>> studies to support their rather extravagant claims.
>> Not sure what the second paragraph refers to--perhaps chlorhexidene
>> gluconate rinse, which has been available for about 20 years in the U.S.
>> and in parts of Europe for perhaps 50 years.
>
> ok, I thought maybe he was referring to CloSYS...

I couldn't find any information about their ingredients on their
website--even next to a note about "ingredients".
However, it happens that at some time in the past we received a sample
of their rinse and toothpaste. The apparent active ingredient is
chlorine dioxide.
You've got to know that since there is no specific therapeutic claim it
does not require the same burden of demonstrable safety and
effectiveness as do pharmaceuticals. I have seen no research on either
the safety or effectiveness of chlorine dioxide when taken internally.
I would guess (based on my rapidly diminishing residual store of
knowledge from my chemistry degree) that chlorine dioxide would not be
terribly stable. I have no reason to believe it would remain in the
mouth long enough to keep sulfurous compounds at bay (though meticulous
oral hygiene might).
Personally, I wouldn't put chlorine dioxide in my mouth.

Steve

>
>
>> It has a limited place, but is certainly no panacea.
>> Disclaimer: I don't find much in Mercola's paranoid world view that I
>> find helpful.
>
> yes, he does seem to have something to say about everything :-)

[Ankur]

* Steven Bornfeld <bornfe...@dentaltwins.com>
> Why are you biased?

CPP-ACP was discovered at the dental school which I attend.

People here invariably think it's wonderful.

> There is insufficient evidence (in the view of independent researchers)
> of CLINICAL efficacy.
>
> Such evidence generally PRECEDES the introduction of a medication,
> it does not follow it.

That's true.

I have seen it used for remineralization of early caries
lesions, so it does appear to work in certain cases, but as you imply,
the research hasn't been done to determine the protocols for its use.

--
Ankur

[Pouta]

Dr. Bornfeld, first I would like to thank you for your contributions
to this forum, they are greatly appreciated.

>> ok, I thought maybe he was referring to CloSYS...
>
> I couldn't find any information about their ingredients on

> their website -- even next to a note about "ingredients".

http://www.closys.com/our_products/ingredients.html

and, from a bottle that I have :

purified water, trisodium phosphate, stabilized chlorine dioxide,
citric acid.

the additional dropper of "flavor control" contains: natural mineral
oil, peppermint oil.

> However, it happens that at some time in the past
> we received a sample of their rinse and toothpaste.
> The apparent active ingredient is chlorine dioxide.

when the solid phase of a compound is not stable at room temperature,
it has to be prepared in such a way, with proper solvents, so that it
is stable at room temperature... it is "stabilized"... so with their
stabilized ClO2, there is something else in addition to the ClO2 that
they are not telling us about... their formulation is patent-
protected, which is why they won't disclose.

> You've got to know that since there is no specific

> therapeutic claim, it does not require the same

> burden of demonstrable safety and effectiveness
> as do pharmaceuticals.

"...kills 99.9% of harmful bacteria in 10 seconds..."

> I have seen no research on either the safety or effectiveness
> of chlorine dioxide when taken internally.

does rinsing (without swallowing) equate to "taken internally"...?

> I would guess (based on my rapidly diminishing residual store of
> knowledge from my chemistry degree) that chlorine dioxide would not be
> terribly stable.  I have no reason to believe it would remain in the
> mouth long enough to keep sulfurous compounds at bay (though meticulous
> oral hygiene might).

as an aside, similar doubts are popping up regarding alcohol in
mouthwashes. Professor Michael McCullough (chair of the ADA's
therapeutics committee, and associate professor of oral medicine at
the University of Melbourne), has said that alcohol-containing
mouthwash should be reclassified as prescription-only, and carry
written health warnings.

Prof McCullough is calling on the ADA to urgently re-assess its seal
of approval on mouthwashes containing alcohol. "We see people with
oral cancer, who have no other risk factors than the use of alcohol-
containing mouthwash, so what we've done in this study is review all
the evidence that's out there,'' he said. "If it was a facial cream
that had the effect of reducing acne, but had a four- to five-fold
increased risk of skin cancer, no one would be recommending it.''

> Personally, I wouldn't put chlorine dioxide in my mouth.

I wonder if the term "stabilized chlorine dioxide" is a misnomer,
referring simply to sodium chlorite, not chlorine dioxide.

[Steven Bornfeld]

On 11/10/2011 2:26 AM, Ankur wrote:
>
> CPP-ACP was discovered at the dental school which I attend.
>
> People here invariably think it's wonderful.
>
>> There is insufficient evidence (in the view of independent researchers)
>> of CLINICAL efficacy.
>>
>> Such evidence generally PRECEDES the introduction of a medication,
>> it does not follow it.
>
> That's true.
>
> I have seen it used for remineralization of early caries
> lesions, so it does appear to work in certain cases, but as you imply,
> the research hasn't been done to determine the protocols for its use.
>
> --
> Ankur

Well, I hope it pans out. Some of our rampant caries patients--nothing
seems to work. It can be very frustrating for everyone involved.

[Steven Bornfeld]

On 11/10/2011 9:45 AM, Pouta wrote:
> Dr. Bornfeld, first I would like to thank you for your contributions
> to this forum, they are greatly appreciated.
>
>
>>> ok, I thought maybe he was referring to CloSYS...
>>
>> I couldn't find any information about their ingredients on
>> their website -- even next to a note about "ingredients".
>
> http://www.closys.com/our_products/ingredients.html
>
> and, from a bottle that I have :
>
> purified water, trisodium phosphate, stabilized chlorine dioxide,
> citric acid.
>
> the additional dropper of "flavor control" contains: natural mineral
> oil, peppermint oil.
>
>
>> However, it happens that at some time in the past
>> we received a sample of their rinse and toothpaste.
>> The apparent active ingredient is chlorine dioxide.
>
> when the solid phase of a compound is not stable at room temperature,
> it has to be prepared in such a way, with proper solvents, so that it
> is stable at room temperature... it is "stabilized"... so with their
> stabilized ClO2, there is something else in addition to the ClO2 that
> they are not telling us about... their formulation is patent-
> protected, which is why they won't disclose.

Actually, if it's protected there is no reason to hide the
ingredients--and to my mind significant liability if any of the
undisclosed ingredients cause any kind of adverse reactions.
When a pharmaceutical enters the approval process with the FDA, all
materials active and otherwise, solvents and excipients must be
disclosed. Once the approval process is completed disclosure of
contents is required.
If this company is not classified as a pharmaceutical it of course has
a lower regulatory burden.

>
>
>> You've got to know that since there is no specific
>> therapeutic claim, it does not require the same
>> burden of demonstrable safety and effectiveness
>> as do pharmaceuticals.
>
> "...kills 99.9% of harmful bacteria in 10 seconds..."

I'm no legal expert, so I don't know if this can be considered a
therapeutic claim. I do know that there is pending legislation to
increase regulation of all new ingredients in OTC supplements.
Specifically as to the claim of 99.9% kill of harmful bacteria, I would
love to see the specifics of how that data point was reached. There are
several intraoral antimicrobials in rinses and mouthwashes. Their
effectiveness is variable, and the whole concept of routine use of
topical antimicrobials has been called into question.

>
>
>> I have seen no research on either the safety or effectiveness
>> of chlorine dioxide when taken internally.
>
> does rinsing (without swallowing) equate to "taken internally"...?

Naturally, the amount of any substance placed in the mouth that is
actually ingested or otherwise absorbed will vary from time to time, by
use and application, and from person to person. So I don't think asking
for evidence of safety is an unfair burden.

>
>
>> I would guess (based on my rapidly diminishing residual store of
>> knowledge from my chemistry degree) that chlorine dioxide would not be
>> terribly stable. I have no reason to believe it would remain in the
>> mouth long enough to keep sulfurous compounds at bay (though meticulous
>> oral hygiene might).
>
> as an aside, similar doubts are popping up regarding alcohol in
> mouthwashes. Professor Michael McCullough (chair of the ADA's
> therapeutics committee, and associate professor of oral medicine at
> the University of Melbourne), has said that alcohol-containing
> mouthwash should be reclassified as prescription-only, and carry
> written health warnings.
>
> Prof McCullough is calling on the ADA to urgently re-assess its seal
> of approval on mouthwashes containing alcohol. "We see people with
> oral cancer, who have no other risk factors than the use of alcohol-
> containing mouthwash, so what we've done in this study is review all
> the evidence that's out there,'' he said. "If it was a facial cream
> that had the effect of reducing acne, but had a four- to five-fold
> increased risk of skin cancer, no one would be recommending it.''

This is a very old story. Alcohol has long been known to potentiate
the carcinogenic properties of tobacco in the mouth. Whether it is
carcinogenic by itself is a bit more controversial, but I agree that
there is no good reason to use an alcohol-based mouthwash.

>
>
>> Personally, I wouldn't put chlorine dioxide in my mouth.
>
> I wonder if the term "stabilized chlorine dioxide" is a misnomer,
> referring simply to sodium chlorite, not chlorine dioxide.

I wouldn't think so--that would be clearly deceptive, and would imply to
me a much greater level of risk.
There are indications for the use of sodium hypochlorite during root
canal treatment, but this is in a much more controlled environment than
an OTC rinse. Even then, there has been trouble on occasion.

Steve