Dr Johnson's Blog

GERIATRIC DENTAL ISSUES – NEWTON, WELLESLEY, MA

Joseph Coupal - Friday, March 24, 2017

There’s a commonly understood recipe for living a healthy life as we get older, and it goes something like this: Exercise, eat healthy food in moderation, don’t smoke, get plenty of sleep, maintain a good social network and engage in mentally challenging activities.

Yet, according to Dr. Ryne Johnson, prosthodontist and managing partner at Newton Wellesley Dental Partners, “there’s another, largely overlooked, ingredient: oral health care”. Because our bodies become more vulnerable as we age, decay, infections and bacteria that occur in teeth, gums and mouth can grow into serious problems that impact overall health. Plus, there are issues seniors have that exacerbate problems and inhibit a senior’s ability to brush, floss or visit the dentist. Medications can create dry mouth. Arthritis limits dexterity and creates transportation and mobility issues. And a lack of dental insurance can halt regular dentist visits.

“Many of older adults are getting used to living in pain,” says Johnson. “They have active infections that have been going on for five, 10, 15 years. Poor oral hygiene is particularly harmful to seniors”.

Poor oral hygiene can increase risks for diabetes, pneumonia, infections elsewhere in the body and strokes, he says. Also, mouth cancers — which can be discovered through regular dental checkups — can go undetected. Many seniors wish they had access to better dental care. But often, after retirement, they lose dental insurance and can’t afford new coverage. Medicare, for instance, doesn’t cover most dental work. In 2012, a survey indicated that being able to afford dental care was the No. 1 health issue for seniors, even more than general medical care (38 percent to 30 percent).

Among the primary oral-health issues older men and women face are:

Dry mouth: Having a drier mouth can be part of the aging & geriatric process. But older people tend to be on more medications, and hundreds of those medications inhibit production of saliva, which protects against tooth decay and controls bacteria. “That creates an environment that is very acidic, because the saliva is not there anymore,” says Johnson, “That leads to more tooth decay, gum disease and an increase in bacteria”. Some studies have shown gum disease can lead to heart disease. And an increase in bacteria has been linked to a higher risk of pneumonia (with bacteria breathed into the lungs) and diabetes. It’s important for seniors to drink more water to battle dry mouth. Also, seniors should provide their dentist a list of medications they are taking.

Oral cancer: Rates increase with age, so if seniors skip regular dental checkups, they run the risk of cancers going undetected early. And even seniors who have no natural teeth and use a full set of dentures should continue regular checkups for mouth cancer.

Caregivers: it’s important for the people who care for seniors to help them with brushing and flossing, and to make certain they see a dentist regularly. “Very often, I have a family member telling me, ‘My mom or dad was scrupulous with their health and took excellent care of their teeth, and now they’re in horrible condition,’” says Johson. “A lot of decay, a lot of periodontal illness because they just lost the capacity to take care of themselves. It takes some active intervention on the part of their families or others.”

“The importance of education can’t be overstated. The baby boomers’ tsunami wave is coming,” says Johnson. “This is a problem that is upon us, whether we want it or not. We have to continue improving the educational process to avoid potential problems.”

The Centers for Disease Control offers a checklist for seniors to maintain good oral health that includes:

  • Drink fluoridated water and use fluoride toothpaste to protect against tooth decay.
  • Brush and floss regularly to reduce dental plaque and prevent periodontal disease.
  • See your dentist regularly, even if you wear dentures and have no natural teeth.
  • Avoid tobacco and limit alcohol to lower risk of oral and throat cancers.
  • Caregivers should provide daily oral hygiene for seniors unable to take care of themselves.
  • If medications produce a dry mouth, ask your doctor if there are alternate medications that can be substituted. If not, drink plenty of water or chew sugarless gum to keep your mouth moist.

For additional information on this topic visit the American Dental Association: www.mouthhealthy.org/en/adults-over-60. For additional blogs by Dr. Johnson or to contact the office, visit: www.NewtonWellesleyDentalPartners.com

Original article: San Diego Union-Tribune
Artwork: yourdentalpartners.com

DENTAL IMPLANTS (KNOCK OFFS & THEIR RISK) – WELLESLEY, NEWTON, MA

Joseph Coupal - Thursday, March 02, 2017

Squeezed between billboards promoting “Free Donuts” and “855-Car-Hit-U”, I recently spotted an ad for $400 dental implants. Radio also has numerous promotions for “teeth-in-a-day”. According to Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners, “This makes for a market that creates confusion for the public. There really is a huge difference between quality and cheap”!

There are dozens of dental implant companies that sell implants in the USA. However many of these companies are copies or “clones” of other successful implants. Since these smaller companies do very little research or development, they are usually 1-2 generations of implant design behind the major companies. In the many implant complication cases referred to us, we have seen a higher rate of problems in the “clone” implants…even though they look very similar to the major implant brands.

An additional concern is that as smaller implant companies come and go there is a risk of not being able to get parts compatible with these numerous implants to make the crowns or bridges that attach to them. I would not put a clone implant into a family member’s mouth (not even my mother-in-law!). Innovative companies that approach implant dentistry responsibly with research and education provide quality and service are doing very well, while implant companies that compete only on price are not a good fit for any practice.

Would you want a discounted hip or knee implant? How would you feel if your dentist was charging you the regular price and giving you a cheap implant knockoff? Do you even ask or know? The consumer needs to know that all implants are not created equal, and they should ask what brand is being used at a particular office.

Here are some implant companies that Dr. Johnson has worked with over his 29 years of clinical practice and have a good track record and lots of data: Biomet 3i, Zimmer Dental, Straumann, Keystone, Astratech and Nobel Biocare.

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Original publication by Dr. Mitchell Josephs on LinkedIn
Artwork: www.oralanswers.com

DENTISTRY: A HEALTHY LIFESTYLE – NEWTON, WELLESLEY, MA

Joseph Coupal - Wednesday, February 08, 2017

Dr. Ryne Johnson, prosthodontist and managing director of Newton Wellesley Dental Partners wants his patients to lead a healthy lifestyle and have outstanding oral health. A recent article in Bicycling Magazine outlined the top ways to stay healthy and a regular visit to your dentist is critical. According to Dr. Johnson, “A visit to the dentist can make your pearly whites shine—and keep your ticker on track, as well”. In a recent Taiwanese study people who had their teeth cleaned at least twice a year for 2 years had a 24% lower risk of heart attack and a 13% lower risk of stroke compared with people who never went to the dentist. Professional teeth cleaning appears to reduce inflammation-causing bacterial growth, which can lead to dangerous inflammation, say the study authors.

Here’s the list:

  1. Eat Calcium Rich Foods
  2. Fill up on Anti-oxidants
  3. Go to the Dentist
  4. Cook with Herbs and Spices
  5. Load up on Potassium
  6. Take Blood Pressure Medicine at Night
  7. Treat High Blood Pressure
  8. Stay Active
  9. Run a Mile
  10. Eat Walnuts
  11. Feast on Fish
  12. Sprinkle Flax Seed on your Cereal
  13. Eat Dark Chocolate…in Moderation
  14. Start your Day with Oatmeal
  15. Snack on Nuts
  16. Switch to a Better Cooking Oil

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Artwork: adobe stock photos

DENTAL PROBLEMS RELATED TO SCUBA DIVING – NEWTON, WELLESLEY, MA

Joseph Coupal - Wednesday, January 04, 2017

A new survey of recreational scuba divers finds that 41 percent report dental problems related to diving. Most of the problems had to do with pain from the increased pressure underwater or from clutching the air regulator too tightly in their mouths, but a few people experienced loosened crowns or cracked fillings. Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners reports that, “over my 30 years in clinical practice, I have seen numerous patient who presented with broken or shifted teeth induced by long-time use of a regulator”. He further recommends, “The survey was limited, but suggests that people should make sure their teeth are in good shape before they go deep. An unhealthy tooth underwater would be much more obvious than on the surface. One hundred feet underwater is the last place you want to be with a fractured tooth."

Underwater toothache

Barodontalgia is a toothache caused by the increase in pressure felt underwater (it can also happen at high altitudes because of low pressure). The condition, which occurs while the person is in the high- or low-pressure environment, is most common in people who have some sort of underlying dental condition, like a cavity or poorly completed filling.

Forty-one percent of respondents of a recent study said they'd experienced dental symptoms while diving. Of those, 42 percent said they'd had barodontalgia. The second-most common symptom was pain from holding the air regulator too tightly (24 percent of those who'd had a dental symptom), and the third-most common problem was jaw pain (22 percent of those who'd had a dental symptom).

Protecting your teeth

Several people reported that a dental crown — a cap that fits over a broken or damaged tooth — had loosened during a dive. One person reported a broken filling. The dry air and awkward position of the jaw while clenching down on the regulator is an interesting mix. Dive instructors reported more pain and problems than casual divers. Instructors spend more time at shallower diving depths, where the changes in pressure are most abrupt.

Divers are required to meet a standard of medical fitness before certification, but there are no dental health prerequisites," according to Dr. Johnson. In the meantime, divers can protect themselves by visiting the dentist before scuba diving to check for decay and other problems.

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Original article: http://www.livescience.com
Artwork: www.scubadiving.com

TEETH GRINDING & STRESS – NEWTON, WELLESLEY, MA

Joseph Coupal - Tuesday, January 03, 2017

Research has found a link between stress and teeth grinding, which 70 percent have reported. Known as bruxism, teeth grinding can go undetected as the most common symptom is a headache, usually concentrated at the temples of the head. Other symptoms include sleep disorders, ear ache, and stiff muscles in the jaw, shoulders and neck. The teeth will also show signs of wear, cracks and tooth loss can result.

Dr. Ryne Johnson, prosthodontist and managing partner at Newton Wellesley Dental Partners has been treating teeth grinding and TMJ therapy for over thirty years. “Many people grind their teeth at night and we used custom-made, hard appliances (with a softer, resilient liner) to lessen the impact of this significant force” says Johnson. “The night guard is designed to absorb the impact and spread the force out over all the teeth instead of allowing it to wear away the enamel”.

What the doctor says: ‘If you suspect that you are suffering from Bruxism, it is important to see your dentist who can provide a proper diagnosis”.

“Grinding your teeth can be triggered by several factors including an underlying sleep disorder, stress and anxiety or a result of dietary intakes such as alcohol and caffeine”.

“Your dentist will recommend a guard specially made for your teeth to create a protective barrier from friction to prevent increased tooth wear and reduce discomfort of the jaw muscles.”

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original article: http://www.dailymail.co.uk

artwork: http://www.arizonafamilydental.com/

DENTISTRY AFTER ROOT CANALS IMPACT TOOTH LONGEVITY – NEWTON, WELLESLEY, MA

Joseph Coupal - Friday, December 16, 2016

“In a recent longitudinal, retrospective analysis, researchers found that what one does AFTER a root canal procedure directly influences the longevity of that tooth” says Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners. “Teeth with endodontic therapy have been hollowed out and need internal and external protection to prevent fracturing. This cannot be accomplished with fillings, according to this study” says Dr. Johnson. “After 30 years of restorative dentistry, I can attest that the best means to improve longevity on a root canaled tooth is with a dental crown”.

Methods

Computerized analysis was performed for all patients who received posterior RCT from 2008 to 2016 in the graduate endodontic department. Data collected included dates of RCT, type of post-endodontic restoration, and time of extraction if extracted. Teeth that received crown after RCT were also divided into 2 groups: receiving crown before 4 months and after 4 months after RCT. Data were analyzed by using Kaplan-Meier log-rank test and Cox regression model (α = 0.05) by using SPPS Statistic 21.

Results

Type of restoration after RCT significantly affected the survival. Those that received composite/amalgam buildup restorations were 2.29 times more likely to be extracted compared with those that received crown. Time of crown placement after RCT was also significantly correlated with survival rate. Teeth that received crown 4 months after RCT were almost 3 times more likely to get extracted compared with teeth that received crown within 4 months of RCT.

Thus, according to Boston’s best prosthodontist, “it’s best to protect the tooth as soon as possible to avoid problems”.

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Original article: http://www.ada.org
Artwork: www.OswegoSmiles.com

USING COMPUTERS IN IMPLANT DENTISTRY – NEWTON, WELLESLEY, MA

Joseph Coupal - Thursday, December 08, 2016

There is archeological evidence that humans have attempted to replace missing teeth with root form implants for thousands of years. Remains from ancient China (dating 4000 years ago) have carved bamboo pegs, tapped into the bone, to replace lost teeth, and 2000-year-old remains from ancient Egypt have similarly shaped pegs made of precious metals.

In 1952 the Swedish orthopaedic surgeon, Per-Ingvar Brånemark, was interested in studying bone healing and regeneration. During his research time at Lund University he adopted the Cambridge designed “rabbit ear chamber” for use in the rabbit femur. Following the study, he attempted to retrieve these expensive chambers from the rabbits and found that he was unable to remove them. Brånemark observed that bone had grown into such close proximity with the titanium that it effectively adhered to the metal and the birth of current day implants was seen.

Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners, whom many consider a pioneer in using computer in implant dentistry, has developed a synergistic technique to remove many of the early pitfalls seen in implant placement and dental prosthetics. He has been performing implant reconstructions since 1989 with the assistance of computers. His current approach is outlined below:

1. Initial examination and work up to simulate the final design of the dental prosthesis (think architectural plans when building a home).
2. Create a three dimensional representation of this plan (either a denture or some other means to position teeth for the patient & doctor to evaluate form, aesthetics, phonetics
3. Convert this into a X-ray scanning guide (to wear during the CT scan) or to scan the mouth with CAD/CAM appliance
4. Merge the digital data into software that creates a 3-D image of the newly designed plan overlaid onto the existing bone contours
5. Evaluate bone and other anatomical structures related to planned implant placement
6. Determine implant angulation, length, diameter, position, etc
7. Create a surgical placement jig
8. Place implants using placement jig
9. Place dental prosthesis (often at same visit as implant placement)

Dr. Johnson uses this approach on most of his dental implant cases and states, “I can’t imagine why more clinicians are not following this protocol as it has diminished our complications and often allows our patients to go home with a ‘tooth’ the same day implants are placed. Why accept less?

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Original content: www.wikipedia.com
Artwork: www.perfectdentalimplant.com, www.wikipedia, www.texasimplant.com

DIGITAL DENTISTRY IMPACTS HOLLYWOOD – NEWTON, WELLESLEY, MA

Joseph Coupal - Tuesday, December 06, 2016

Digital models of humans can be uncannily accurate these days, but there’s at least one area where they fall short: teeth. Unless you’re willing to scan the inside of someone’s mouth, you aren’t going to get a very faithful representation of someone’s pearly whites. Dr. Ryne Johnson, a prosthodontist and managing partner of Newton Wellesley Dental Partners has been considered a pioneer in the use of CAD/CAM technology in dental restorations. He notes that, “Disney Research and ETH Zurich have just developed a technique to digitally recreate teeth beyond the gum line using little more than source data and everyday imagery. The team used 86 3D scans to create a model for an “average” set of teeth, and wrote an algorithm that adapts that model based on what it sees in the contours of teeth in photos and videos. Unlike the $40,000 CAD/CAM unit that’s used in my office, this new approach allows sufficient accuracy to be captured from regular digital photographs”.

The technology doesn’t require any special capture equipment outside of the initial scans (the camera on your phone will do). Also, you don’t have to purposefully bare your teeth: it can work with the incomplete information from a smile or grimace. A movie crew could generate models based on a brief, natural motion capture session.

This being Disney, the most obvious use is for digital actor models in animated movies and video games. You could see uncannily realistic characters whose details pass muster even in close-up shots. However, there are plenty of medical uses as well. The scientists see dentists using the tech to previsualize a patient’s mouth before they sit in the operating chair, and it’s easy to imagine this leading to more authentic-looking dentures. As silly as the notion of accurately rendered teeth may be, they could be important for your well-being.

Dr. Johnson feels that this new technology will help the film and media production companies but will not be incorporated into a dental office any time soon. However, he reminds everyone that, “digital dentistry is here and should be a part of your dental reconstructive and implant work”.

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Original article: www.engadget.com
Artwork: Chenglei Wu, Derek Bradley et. al.

DR. RYNE S. JOHNSON’S GREATEST HITS! – NEWTON, WELLESLEY, MA

Joseph Coupal - Monday, December 05, 2016

Watch the video below and see why Newton Wellesley Dental Partners and Dr. Ryne Johnson has the reputation as “Boston’s Best Prosthodontist”, “World Class Dental Aesthetics”, and “Cutting Edge Implant Dentistry.”

CERAMIC DENTAL IMPLANTS – NEWTON, WELLESELY, MA

Joseph Coupal - Wednesday, November 30, 2016

Are dental implants made from ceramics ready to consider as a viable alternative to metal?

Since their introduction over 40 years ago, dental implants have become an established treatment modality that had revolutionized the concept of replacing missing teeth. Dr. Ryne Johnson, prosthodontist and managing partner of Newton Wellesley Dental Partners has been considered a pioneer in computer-assisted implant dentistry. His first implant case was in 1988. According to Dr. Johnson, “The recent material of choice for manufacturing dental implants is commercially pure titanium, because of its excellent biocompatibilty and mechanical properties However, the gray colour of the titanium may be disadvantageous and give rise to esthetic problems, especially if the soft tissue situation is not optimal and the dark colour shines through the thin peri-implant mucosa. The profession has been looking for options to address this concern. Some implant companies are wrapping a pink material along the collar of the implant while others are developing ceramic implants.”

Zirconia ceramics (yttrium-stabilized tetragonal poly-crystals) seem to be a suitable material for dental implants because of their tooth-like colour, their excellent mechanical properties and their good biocompatibility. They have extensively been used as ball heads in total hip replacements with remarkable clinical outcomes. Recent animal studies have also shown successful bone healing of dental zirconia implants under both unloaded and loaded conditions. Dr. Johnson has been using zirconia to fabricate his dental crowns for many years without outstanding success. As the conventional fabrication of zirconia rods usually results in realtively smooth surfaces, only few studies have investigated rough surface modifications of zirconia implants. This is a critical aspect, since it has been already demonstrated that surface roughness and topography also influence osseointegration of zirconia implants.

A recent study by Rita Depprich, et al, in Head and Face Medicine, looks at the comparison of titanium and zirconia implants on pigs and concludes that, “zirconia implants with modified surfaces display features of osseointegration similar to those of titanium implants. These results are promising for using zirconia implants for dental applications in the future”.

“It’s still early in the game” according to Dr. Johnson, “but it may be available in the next few years after clinical trials are complete. Until then, titanium implants are sill the gold standard. ”

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Original article: https://head-face-med.biomedcentral.com
Artwork: www.southerdentalimplant.com