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March 7, 2015

It is imperative that dentists adopt to what is known as two distinct, separate causes of oral cancer. Tobacco / alcohol use which is traditionally identified as a leading risk factor for the development of oral cancer and the infection of HPV-16 which is rising rapidly especially in the younger ages that are non-smokers between the ages of 25-50.

Oral cancer is on the rise in all age groups regardless of tobacco and alcohol decline due to the spread of the spread of a particular strain of human papilloma virus, HPV-16. In fact, “HPV may contribute to the development of approximately 20% to 30% of all oral cancer case” worldwide and 40 to 80% of all oral cancer case in the US.

Because there are two distinct causes for oral cancer, and therefore are two different important protocol for detecting them. For example, recent data tells us the HPV related oral cancer is more elusive than the tobacco / alcohol related cancer. Unlike tobacco and alcohol which occur mostly in the anterior floor of the mouth and the lateral borders of the tongue, HPV lesions are buried deep within the tissues, possibly below the basement membrane barrier at the base of the tongue, in the tonsillar area, and in the oropharynx.

For this reason HPV cannot be detected with traditional tools. Moreover, HPV can cause oral cancer with no signs until the disease is very advanced.

Most Americans will have some version of HPV in their lifetimes.  The HPV virus infects at least 50% of all people who have had sex at some time in their lives. It is “likely that changes in sexual behaviors of young adults over the last few decades and which are continuing to spread HPV and the oncogenic versions of it.”  This, while distressing, are not surprising because there are 130 strains of HPV viruses.  Only a handful are oncogenic (correlated with cancer growth), and HPV-16 is the one that causes cervical cancer in women and oral cancer as well.

Of this HPV-16 most of us (99%) possess an immune system. Because HPV related oral cancer develop via transmission of HPV-16 over moist epithelial cells, sexual contact, including but not limited to open mouth kissing and genital-oral contact, is a risk factor for HPV-related oral cancer. Other risk factors are lichen planus and other auto-immune, inflammatory diseases of the mouth; periodontal disease: diets lower in fruits and vegetables; and genetic predispositions such as inherited defects in genes contributing to DNA repair.

In order to do a thorough oral cancer screening it’s imperative that your doctor do at least the following;

  1. Extra-oral visual and tactile examination, including but not limited to the palpation of the neck.
  2. Intra-oral visual and tactile examination.
  3. Use of screening tools.
  4. Asking patients appropriate and revealing questions and waited for their responses.
  5. Patient education, particularly provision of information on benefits of vaccinating against HPV

The following should be included in your dentists protocol:

  1. Can you tell me about any swelling or pain you’ve experienced in your face, mouth, neck, tonsils or throat?
  2. Any painless, non-moving firm bumps on your neck?
  3. Mouth sour lasting more than two weeks?
  4. Any oral bleeding?
  5. Changes in taste?
  6. Changes in voice sounds?
  7. Changes in the surface of your mouths?
  8. Problems with eating or swallowing?
  9. Recent changes in weight?
  10. Numbness or tingling in your face?
  11. Recent changes in vision?

An answer to any of these questions may indicate a viral infection with HPV, and needs a further investigation.  “The HPV positive group is the fastest growing segment of the oral population.” One hundred people are diagnosed with oral cancer every day. Screening for oral cancer is all about saving lives.  Telling your patients how much you care about them by telling them about HPV-oral cancer.

Call The San Marcos Dental Center at 760 734-4311 and make an appointment today!
Simple oral cancer exam

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January 12, 2015

Traditional Impression Technology

In 1984 the first “digital” impression was introduced into the world of dentistry.  This meant that instead of having to fill a patients mouth with impression materials, digital images could be taken with a miniature camera and once stitched together, could be used to fabricate a model on which a crown or bridge could be made. This was a real advantage because the patient wouldn’t be drooling and/or choking on the impression material waiting for it to set up,  a process normally taking 3-5 minutes!  On the other hand, the scanners at the time were very expensive and many doctors felt these first prototypes were not as accurate at the impression materials were.

Digital Imaging Impressions Today

Fast Forward to today.  Along with the advances in computer technology, computer imaging has progressed by leaps and bounds.  Along with this, the number of competitive dental imaging companies has exploded.  Now, instead of taking images of just one tooth, we can scan full arches.  Two methods are now in use and competing with each other.  One, takes still images and “stitches” together these images into a data base that can be transmitted over the internet to the lab for model fabrication to make a crown, bridge or denture. The other method uses video capturing and essentially does the same thing with regards to stitching and transmitting that data to the lab.

Both systems whether it be a series of still pictures or a video capture of the image, produce accurate replicas of your mouth and from the models produced, can allow the laboratory to fabricate beautiful restorations.  Past systems required fairly large units, called cart systems, that represented look a likes to R2D2 when used in the dental office, and required special software programs (closed systems) specific to their particular manufacturer in order to communicate that information to the lab (i.e. proprietary software).  If your lab didn’t have the right software, you were out of luck! However, now most newer systems are “open” and all labs can take them.  In addition, the newest systems have traded the old mobile units (sorry R2D2!) for USB connections that can be used on any computer!

How It Affects You

So, the next time you’re in your dentist’s office you might be surprised if you need a crown, bridge or even a denture (coming soon!).  The “early adoption” phase of digital impressions is moving into the “becoming widely accepted” phase.  With more manufacturers entering the market and more competitive pricing as well as wider acceptance and use, you may be pleasantly surprised to find your dentist “scanning” your mouth without the old impression materials and enjoying a much more comfortable experience!  Looks like 2015 will be a great year to see your dentist after all!


Dr. Gregory Hurt D.D.S

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January 28, 2014

Everyone loves a bright white smile, and there are a variety of products and procedures available to help you improve the look of yours! The best place to start is with a healthy mouth.

Begin with a Dental Checkup

Your dentist can diagnose and treat any pressing oral health conditions and determine which whitening procedure will work for you. Once the dentist determines the reason for discoloration – injury, food or tobacco stains, childhood or teen antibiotics – a suitable whitening method can be selected. Without this you could be wasting time and money using whitening products that aren’t effective for your kind of stain.

Sinsational Smiles Log

Logo for Sinsational Smile, our in-house teeth whitening system

Have Your Whitening Done in a Clean and Safe Environment

Teeth whitening chemicals if not applied properly can damage your teeth and gums resulting in burns or infections, and “kiosk” whitenings are done by people wearing “scrubs” or laboratory coats who are made to look like “health care professionals”, but aren’t. Dental offices use licensed professionals and strict disinfection protocol including washing hands, changing examination gloves and disinfecting work surfaces after each patient.

Choosing the Right Procedure

There are three ways to whiten your smile: 1)Chairside Bleaching, 2) At–Home Bleaching and 3) Whitening Toothpastes. After examination, your dentist will offer you the option of either 1 or 2 because the 3rd choice, Whitening toothpastes are not as effective but are frequently prescribed as an after treatment way of maintaining your whiteness.

Teeth Whitening via Chairside Bleaching

Crest 3D Whitening Toothpaste

Whitening Toothpaste, typically used to maintain already-whitened teeth

This treatment uses a concentrated form of peroxide and requires the application of a “rubber shield” to protect your soft tissues (lips, gums, etc.) prior to active whitening. A special light and/or laser will be used to enhance the whitening process (i.e. Zoom Whitening Systems). Chairside Bleaching has the advantage of allowing multiple applications to remove the more stubborn stains in your mouth.

Teeth Whitening via At-Home Bleaching

These products are gels or strips containing different concentrations of carbamide peroxide (10%, 16%, 22%). The gels are most effective and used with custom-fitted mouth guards which hold the gels against the teeth while during whitening. Usually they are worn overnight for 1-2 weeks. They are less concentrated than the Chairside gels and usually don’t cause as much irritation, but the process for whitening does take longer. The percentage of gel selected depends on many factors including the type of stain being removed, the thickness of your enamel, the condition of your gums, and the “color” of your teeth just to name a few.

For Best Results – Have a cleaning before your whitening. You’ll have a Brighter Whiter Smile!

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