Hey Everyone!

It has been a while since I last posted a blog so here it goes:

Recently I have had quite a few patients wrestle with having to choose between a fixed (non-removable) bridge or an implant to replace a missing tooth or teeth.  Both choices can look and feel great and are not removable by the patient. They but both require consistent maintenance  (brushing, flossing, water pik) at home and regular cleaning at our office.  Both are great solutions to the problem of missing teeth and your choice will be dependant upon many factors.  Typically I will review all the factors and help you make the most appropriate choice for you as an individual.

Factor 1:  Amount of bone available to support an implant:  One of the huge advantages of implants is that after an extraction an implant will slow the disappearance of  the bone in the extraction site since the implant stimulates the  body to maintain the bone levels locally.  However if your teeth have been missing for a while so there is little bone left or the quantity or quality of bone is lacking then we must do a bone graft (surgery to add bone) before placing the implant. In addition,  if the implant will be too close to your sinus or nerve canal then grafts need to be considered or a fixed bridge which doesn't have the same bone requirements is indicated.  Healthy patients with jaw bone which is wide and deep are great candidates for dental implants.

Factor 2:  Quality of the neighboring teeth:   A fixed bridge requires that the neighboring teeth support the replacement teeth.  If the teeth on either side of the space are not strong enough to support a bridge (due to loss of bone from gum disease) then implants make more sense.  However, if the neighboring teeth are sound enough but they have big fillings or existing crowns, then a bridge is a logical choice since the tooth (or teeth) can be replaced and the neighboring teeth re-restored in one step

Factor 3:  Location of the missing teeth:  Is the implant replacing a front or a back tooth?  In the front of the mouth, sometimes gums are thin  and the metal implant may show through the gums.  If the papilla (the tiny triangular piece of gum that is in between the teeth) is missing then implants may leave a "dark triangle" between the teeth.  Back teeth are much more forgiving esthetically when considering implants.

Factor 4:  Cost:   Typically you will spend more for implants than for a bridge.  Replacing one tooth with a bridge can run $2700 to $3500 whereas  implant replacement of a single tooth (includes the implant, abutment and crown) is closer to $4000.  This difference in cost becomes more exaggerated the more teeth that are replaced (i.e., replacing 2 teeth with a bridge runs $3600 to $4800 whereas 2 implants (implants, abutments and crowns can approach $8000).  Patients on a budget may need to choose a bridge.

Factor 5:  Time considerations:  Implants generally take 3-4 months after placement before teeth can be attached to them. If bone grafts are needed, this can add an additional 3-6 months. For certain patients and special situations,  implants can be loaded immediately, but this doesn't work most of the time.  Bridges can be done immediately after extraction (typically we place a "provisional bridge" the day of the extraction to replace the tooth, then wait 3 months for healing before making the "final" bridge).  If you are in a hurry, bridges are a better choice.

Factor 6:  Personal preferences:   Many patients have a strong aversion to surgery (even though is extremely straightforward and quick) and so are uncomfortable with implants.  Other patients have a strong aversion to prepping adjacent teeth for crowns (especially teeth that have no previous restorations or fillings) and so are uncomfortable with bridges.  Neither is "right" or "wrong", it simply depends on individual choice and preference.

Summary:   Many factors will weigh in when choosing between a bridge or an implant.  These factors will usually determine the logical choice that is the superior option for that particular patient and the particular circumstances.  There are no rules, but I encourage you to discuss your dental situation with me. I am experienced in both treatments and am always available to help you make the best possible choices for your best dental health.

That's all for now,  wishing you a joyous and healthy holiday season!

Mark W Langberg, DDS, FAGD

Hi everyone!
Today's blog is written by my daughter, Laura, a nursing student at U of M.  She spent her February break volunteering at a maternity clinic in Honduras and the following are her reflections on her experience:

The Maternity Clinic

Saturday morning I stood outside on the dirt road looking at the turquoise house I called home for the past eight days and I honestly wished the day hadn't come so soon.  I've done a lot of traveling, and although coming home to a warm shower and clean sheets is always comforting, traveling to another country and being completely immersed in a new culture and a beautiful welcoming family is exciting and wonderful.  My experience in Honduras was a positive one–It was a much-needed escape from the world as I know it in Ann Arbor, and I felt genuinely happy for the entire week.  As a woman, a nursing student, and with a career goal of nurse midwifery, I enjoyed being with a group who was supportive and encouraging, and in many cases inspiring.

Delivery Room

Visiting the hospital in Morazan was an intense and thought provoking experience for me. Putting on the surgical scrubs and going into the birthing center was so interesting, especially seeing the two women who had just given birth. They use no analgesia or medication.  The hospital was fully functioning, but by American standards, with its crumbling ceilings and patients in the hallways, it was in shambles. The hospital was amazing though, seeing thousands of patients and working with what it had.  This was one of the experiences on the trip that led me to set a personal and professional goal for myself.  No matter the circumstances, I want to always be dedicated to providing the best care to my patients. It shouldn't matter if I'm working at the U of M hospital, with its endless supply of sterile supplies and advanced technology or if I were working in a clinic with less than adequate resources.  I was able to provide care to many patients at the health center, and used what I have learned and all available resources around me to make sure the patients received the best care the could- from giving an injection, to cleaning a wound, to client teaching about a variety of topics.

Rural House in Honduras

My experiences on Tuesday were the most eye opening of all in Honduras.  After doing preclinicaat the Morazan health center, I found out that two of the health promoters were going to a community about ten minutes away; There had been a case of Denge fever and they needed to check out the other households. So instead of giving injections in the clinic all day again, I went out with the two health promoters.  After a brief consultation with the promoters to get a better understanding about Denge fever, its causes and symptoms, we were on our way. I guess by living with the middle class families in Morazan I had an incomplete and distorted image of the actual poverty in this area. The health, education, social, and housing disparities I saw, for lack of a better word, were nauseating. We walked house to house for four hours. The houses themselves ranged from small homes made from clay blocks to four wooden posts with plastic and fabric composing the walls. We would go in and ask to look at their water supply. We looked at square cement pilas, tall tin bins, and halves of tires-all places used to collect water. Anywhere water collects and sits out, mosquitoes can lay their eggs in the water and may carry denge fever.  If people were home, we would explain our purpose and be directed to the water supplies in the home and in the yards. If people weren't there we walked into their backwards anyway, yelled to make sure there were no dogs, and then took samples of the water.  It was really interesting work and I enjoyed being with the two young health promoters all morning.  But then the poverty level got worse and worse-a house with 2 kids and no parents in sight (suddenly I was not so hungry for lunch and gave my Luna bar to them to split) and then another women, who showed me her leg while we were checking out the water and she had two giant wounds that she said she's had for 5 years and couldn't get to a doctor.  That was really hard for me to hear, I suddenly was overcome with emotion and had to step away for a minute.  I talked to the health promoters, explaining in Spanish that it made me sad to see so much poverty. I love being in Honduras and helping out, but it sometimes made me really sad that there is not more that I can do, or that we do.

Volunteers -- I'm on the right!

As for my spring break experience in Honduras living with a wonderful family, life was for the most part is rhythmic and beautiful in its simplicity. One thing I realized was that being in a developing country can be exhausting; to be stripped of daily conveniences makes every step of ones day that much more of a challenge.  Some things that seem like a necessity to me at home, like a washer and dryer, dishwasher, internet, cable, and warm water, were no where to be found in Honduras.  There are so many material privileges that we take for granted every single day. I think it is important for people to travel and have experiences like this because it helps bring you back to reality and realize what is important to you. One of the most enjoyable experiences for me was the hikes we took up the mountains.  It was fun to start as a group of five Americans and by the time we got down the road to have an additional fifteen Honduran children screaming and laughing and running along with us.  Some of the best conversations I had also took place on these hikes.  The views were beautiful and I felt so refreshed and renewed at the top of the hikes.

Me and the kids I stayed with

On this trip, I learned so much from the personal experiences and advice of other group members, from the discussions we had about huge issues in global health, power and gender relationships, and social class, and from the hands-on experiences I had. Many of the complex issues I've studied in class were confronted head on in a new environment.

I have wonderful memories of the week, and have met individuals, learned lessons, and seen things that have affected my personal and professional life in a profound way.

-Laura Langberg   March, 2009

I am really proud of Laura and her commitment to nursing and social action!

Until next time,

Mark W Langberg, DDS

Hi everyone!

    This last Thursday, Friday, and Saturday,  Laurie (my assistant) and I took an amazing and exciting class in the surgical placement of dental implants to replace missing teeth.  The course was given by the Ladera Ranch Implant Institute  ( www.laderaimplants.com ) and provided an opportunity for us to learn dental implant surgical placement techniques, first hand, under the direction of several top implant dentist mentors.  It was a live “hands on” course that allowed us to spend two pre-surgery days learning strategies about safe and predictable implant placement, followed by an actual patient surgical procedure on day three. This was a mentoring approach to learning, and provided one mentor to every three attendees. The highly trained and skilled instructors assisted us one on one all the way through our pre-surgical work-up and step by step live surgery, and culminated in my safely and successfully placing an implant in a middle aged Ford engineer.  The setting was a local “state-of-the-art” dental office,and the quality of the learning experience was awesome!     

    In the past, we have referred patients to implant surgical specialists to actually place the implants and have focused our efforts on restoring (attaching crowns) to the implants after they have "fused" (integrated) to the jaw.  Up to now, this relationship has worked very well and we have become quite skillful in restoring implants as well as natural teeth.  However, placing implants directly in our office will save patients the additional time, cost, and hassle of going to another doctor's office and give me additional control over the restorative outcome that is unavailable when the surgery is referred out.  In the beginning, we will focus on simpler and predictable cases and will continue to refer more complex or involved cases to more experienced specialists.  Dental Implants are a great way to replace missing and hopeless teeth without relying on fixed bridges or removable teeth.  I am really proud to incorporate dental implant placement into our practice and I am continually committed to improve my knowledge and skills so we will always be on the cutting edge of technology and service!

    Gotta go, so until next time,

    Mark Langberg, DDS, FAGD

Hi everyone!                                                            

    It's been a couple of months since I last wrote and during that time my family and I had the opportunity to visit Thailand over the holidays.   We had a wonderful time together and learned a lot about a part of the world that is so different from what we are used to in the West.   While we were there, we traveled to the mountainous regions of northern Thailand and visited  several hill tribe villages.  The term hill tribe refers to ethnic minorities who migrated to Thailand within the last 200 years from China (Hmong and Yao peoples), Tibet (Akha, Lahu and Lisu tribes), and Burma/Myanmar (the Karen tribe, the ones with the long, ringed necks).   All of the tribes live an agricultural life, cultivating rice, corn, vegetables, fruit and opium, and some some raise livestock.  Unfortunately, we were not able to visit the Karen tribe.   The villages we visited had limited electricity and little indoor plumbing  and their homes were mostly made of bamboo and thatched roofs.  They face many challenges: poverty, limited education, drug abuse, prostitution and AIDS are common.   Their traditional clothing was awesome, lit with brilliant bold colors which they enthusiastically displayed to draw attention to the handcrafts for sale.    Many of the older folks had red-stained or black stained teeth and gums and the effect was quite startling!   Their grins were a result of residue from chewing the betel nut, a mild hallucinogen.  They are quite nonchalant about it, and I chuckled to myself thinking what my before/after album would look like if one of them would agree to even a minimum of modern cosmetic dentistry!   I am including a few photos in this blog.  It is quite amazing how arbitrary and random our cultural cosmetic preferences are!

That's my youngest son, Andy, on the left in the far right picture.   I'm not sure which of the two of them thought the other one was stranger!

Well, that's all for today.  I will try to write more often! 

Until next time,    Mark W Langberg, DDS

            Hi everyone! 

• The process does not damage the teeth. The worst side effect is possible temporary sensitivity.
• It is impossible to predict the degree of whitening prior to treatment.
• Active gum disease, decay, or dental pathology must be corrected prior to beginning the whitening process.
• The teeth must be clean. If it has been more than 3 months since your last professional dental cleaning, we advise that this be done first. The cleaner the teeth are, the better they will lighten.
• If you have tooth-colored restorations (fillings), porcelain crowns (caps), or a removable partial denture with teeth that are visible, note that these materials will not change color as your teeth will. It is possible that these restorations will need to be replaced or modified after the whitening is completed. 
• The more yellow your teeth are initially, the more color change (lighter/whiter) will be noticed after whitening. Research indicates that teeth can only get “as white as they can get.” The color is a function of the physical properties of the teeth. Further whitening beyond that point will not have a noticeable effect.
• Teeth with tetracycline discolorations will take a lot longer time to lighten, sometimes months of tray use.
• If you have whitened your teeth before (with professional solutions and trays), there will be a less noticeable color change.
• In-office whitening (ZOOM) is very quick, but seem to lighten teeth only 60-75% of their potential whiteness. It uses high intensity light and stronger bleaching solutions than tray bleaching. The in-office procedure takes 1-2 hours; the at-home technique is slower and requires more time commitment on your part. The at-home technique has the potential to whiten teeth beyond what can be achieved in-office, but you must be willing to be patient with the process. The best results are always achieved with a combination of the 2 techniques.
• The lightening process continues for 2 days after the in-office whitening. You should not drink tea, coffee, cola beverages, or smoke for those 48 hours (the 48 hour rule).
• There is a “rebound” color change possible after the whitening is completed. It is between one-half and one shade as noted on the commonly used shade color guides. In the combination in-office/at-home tray technique, this rebound is minimized or eliminated.
• Some people experience sensitivity after the procedure. This sensitivity is not permanent and will quickly disappear. Fluoride gels may be prescribed in this event.
• The color change remains satisfactory for approximately 2-5 years. Your eating/drinking lifestyle habits contribute to future yellowing of the teeth, but touch-ups can easily manage this staining..
• Teeth can have the whitening process repeated when they again darken.  Usually this takes the form of touching up the bleaching at home for 1-2 hours after each hygiene visit, but it can be done more or less, depending on your preference.

Well, that's about all for today.  If you have any questions about whiter teeth,  please feel free to ask me or my staff!

Until next time!

Mark W Langberg, DDS, FAGD

Hi Everyone!

    National health studies estimate that up to 57% of people in the U.S. don't see a dentist regularly.  The Washington Department of Health states that 164 million hours of work are lost each year in the U.S. due to dental disease.  These lost wages and the overall effect on the nation's economy runs into the billions of dollars.  Additionally, according to a study by Western Reserve University, 51 million school days are lost by students due to tooth/oral pain.

    I have have been highly trained to make adult oral sedation dentistry treatment available at my office to help treat the estimated 30% of the population who avoids dental care due to fear.  Most of these people can be safely and effectively treated with the assistance of oral sedatives.  Patients who were once anxious and fearful — and put off having their dental work completed — can receive their dental care while they are totally relaxed and comfortable.

    Oral sedation dentistry can help reduce the mounting economic costs and repercussions of untreated dental disease.  It enables patients to overcome their dental fear and allows them to receive care in the most comfortable and efficient way possible.  Additionally, oral sedation enables me to perform more dentistry in a single visit, meaning fearful patients don't have to return as many times to complete their treatment, saving time, money, and anxiety!

    Feel free to contact me for more information if you or someone you know is staying away from the dentist due to fear or anxiety.  There is a growing number of adults who have conquered their dental fears through the calming and relaxing effects of oral sedation dentistry, and we are ready and able to help!

    Until next time,

    Mark W Langberg, DDS, FAGD

Hi everyone!

    Today's blog is about the recently publicized link between gum disease (periodontitis) and such illnesses as diabetes, heart disease, stroke, and pneumonia.  The agent of this connection is a spillover of bacteria and inflammatory agents from the mouth into the bloodstream and then on to the rest of the body.

    Diabetes diminishes the function of our immune system and also affects circulation so it can restrict blood flow to the gums as well.  This provides ideal conditions for periodontitis to occur.  In addition, the bacteria and inflammatory from the periodontitis are released into the bloodstream to travel elsewhere in the body where the diabetes compromised immune system is also ill equipped to handle them.  Research has shown that treating gum disease can improve blood sugar control in diabetics, in fact some insurances like Blue Cross or Delta Dental are paying additional periodontal treatment benefits for diabetics.

    Gum disease also increases your risk of heart and coronary artery disease.  Folks with high levels of some oral bacteria have thicker carotid arteries, a predictor of heart attack and stroke, and it has been shown that people who have angina and heart attacks have higher levels of certain oral bacteria.  These oral bacteria provoke inflammation which increases levels of white blood cells and C-reactive protein, which has been linked to heart disease. A New England Journal of Medicine study found that treatment of periodontal disease was linked to improved circulation.

    Poor oral hygiene and gum disease has been shown to contribute to fatal pneumonias in hospitals and nursing homes.  In these settings, poor oral hygiene fosters the buildup of bacteria so a patient on a respirator, for instance, is susceptible to breathing those bacteria, causing infection.

    There is good evidence to support the assertion that healthy gums will literally add years to your life, as well as enhance the quality of the years you have.  It is NEVER too late to start taking care of your mouth and you should know that  bleeding gums are NEVER a good thing and are NOT normal!  We are here to help you with the latest treatments for gum disease which both predictable and comfortable. Remember, HEALTHY GUMS DO NOT BLEED! 

Well, that's enough for today.  Thanks for reading!

Until next time,

Mark W Langberg, DDS, FAGD

Hey Everyone!

This week's blog is written by my daughter, Laura, a 20 year old nursing student in Ann Arbor:    

   This summer I participated with anorganization called the Quito Project, a non profit group of University of Michigan students who travel to Ecuador to help the disadvantaged children and adults of southern Quito.  This summer, the program set up and operated a medical clinic, a dental clinic, social work service and tutoring center, all free of charge to the local people.  I spent five weeks living with an Ecuadorian family and tutoring six to fourteen year olds in math and language.  We also helped out quite a bit in both the medical and dental clinics.  For many of the patients, these free clinics are the only type of medical are they will receive all  year.                 

    I was also very happy to be able to help out by distributing toothbrushes and toothpaste from my dad's office to the Ecuadorian kids, most of whom had none.  Check out the pictures and their beautiful faces.  Although the clinic with its wooden benches and dirt floors didn't look like my dad's office, we were able to provide valuable and needed services and teach the children the basics of oral health.                                                                                  

       I was really lucky to have the opportunity to meet some wonderful people, practice my Spanish, and most importantly be of service to some great kids that happen to live in a place that desperately needs all the dental and medical help we can give!

Thanks for reading!

                                                                        Laura Langberg  8/18/08.

Hi everyone!

Well, once again it has been too long since I've written in this blog.   Recently, a patient form Farmington Hills who came in for some cosmetic dentistry mentioned he was using a CPAP and I remembered that I had neglected to follow up on my visit to the American Academy of Dental Sleep Medicine ( http://aadsm.org/index.aspx ) meeting in Baltimore in early June.  I was privileged to be able to take part in 3 days of scientific sessions, classes and forums relating to the dental treatment of sleep disorders.

In a previous blog, I mentioned TAP and SOMNOMED appliances.  In Baltimore, I had a chance to work with many other removable appliances such as the SILENCER, the HERBST appliance, the KLEARWAY appliance, the SUAD DEVICE, the EMA, the OASYS, and others.  They all do essentially the same thing, that is move the lower jaw and floor of the mouth (tongue, etc.) forward slightly to open up the collapsed airway in the pharynx (throat) that causes the obstruction to breathing.   In additon I had the opportunity to personally try out some sleep monitoring devices that provide a means of documenting the presence or absence of apneas (stopped breathing events during sleep) at home, such as the WATCH-PAT 100. the EMBLETTA,  the Respironics STARDUST II, the ARES, and the MEDIBYTE.  Although diagnosis of Obstructive Sleep Apnea Syndrome (OSAS) is best done by  Polysomnography (PSG) done at a certified sleep clinic and interpreted by a pulmonogist, these are ideally suited to be used as follow ups to determine the effectiveness ot the dental appliances and to monitor treatment outcomes. The appliances are adjustable (titratable) and they may actually stop snoring but not stop apneas until the jaw is advanced further.  These at-home diagnostic appliances can tell us if we are done titrating or need to advance the mandible (lower jaw) additionally to stop the sleep apnea.  

More on this later.  Until next time,

Mark W Langberg, DDS, FAGD