All posts by Dr Harden

A Dental Christmas Time Story?

December 2009

As the Christmas season approaches there is an amazing transition that occurs in the lives of hundreds of millions of people each year. It is a time of great joy, a time when people respect each other and a time when our hearts and minds are filled with the blessing of the Holy Spirit. It is a time to savor present joys and past memories of home, family and friends, good days and hard times, and a time to reach out and give thanks to God for the richness in our lives.

This article is dedicated to human compassion and the altruism displayed by a married couple whose unselfish actions forever changed a young boy’s life, in the true spirit of Christmas.

The birth of their child was a precious gift they had long awaited and dreamed of. He was a wonderful baby and possessed all the greatness as witnessed in any child, except that his face displayed a genetic defect that greatly transformed his appearance. This sweet and precious baby, needing love and attention, innocent to his condition, was whisked away from his mother’s arms and immediately taken for immediate medical evaluation. His start into the world was abrupt and challenging. This theme would so mark the balance of his young life.

The baby was afflicted by an unsightly disorder known as bilateral cleft lip and palate.   It resulted from incomplete development and fusion of his upper jaw, lip and nose. Oral-facial clefts are among the most common congenital anomalies, and occur in approximately one out of every five-hundred births.

This child’s parents faced the most difficult decision in their young lives. Could they financially and psychologically provide for their child in this dental related need? As the child looked up at them and displayed his loving spirit through his compassionate and needing eyes, they knew then that they were not ready in their young lives to embrace the needs and demands required to care for their child’s special needs. Christopher was soon after placed in a foster home, with pending hopes and prayers of a better life.

The year was 1985, and after spending the first year of his life in a foster home in South Korea, Christopher was adopted by an American couple and brought to his new home in the United States. The unselfish decision to adopt this child was only superseded by their loving compassion to select a child possessing a cleft lip and palate, because they knew many couples might overlook him for adoption.   Looking beyond his defect this couple could identify with Christopher’s wonderful spirit even as a baby. Dedication, nurturing and support were the traits Christopher’s adoption parents knew they must possess to raise their new child to his greatest potential.

Christopher had two splits that extended from his palate onto his upper lip and extended to each nostril. It further resulted in loss of eleven of his permanent teeth. Surgery after surgery was strategically performed in order to help him develop physically. However, even after numerous operations in the United States, his condition had been altered, but not successfully corrected.

During the crucial developmental stages of his life, Christopher was constantly being stared at and ridiculed for something that he absolutely had no control over. Imagine how Christopher felt as a child in grade school, being from Korea, having a cleft lip and palate defect, and in braces. He simply wanted his physical defect to go away. The stress ultimately caused him to develop a generalized anxiety disorder characterized by not eating well, being a loner and not having a happy, normal outlook on life. Christopher became emotionally drained with virtually no self-esteem. Following a total of twenty different surgeries, his family’s financial resources were completely drained, leaving them with little hope to ever correctly repair their son’s condition. Christopher’s confidence and hope had plummeted and he resigned to accepting that his current appearance was as good as it would ever be.

Dentistry now offered the final hope for Christopher, in the form of complimentary care never needed more than for this fine young man.   A thorough diagnosis, review of his medical-surgical history, a comprehensive restorative treatment plan with six months of seamlessly staged treatment, now allowed Christopher at age twenty, to emerge as a confident young man with the appearance he had always dreamed. The wall that Christopher had built up to shield himself from the world, and the cruel stares and hurtful comments, slowly came down. The new Christopher, harboring many years of anguish, thankful for his adoption parents and the gift dentistry had to offer him, has now formally began to introduce himself to the world and he looks into his future with confidence and optimism for the very first time in his life.

The Dangers of Teeth Grinding

Fountain View Dental - Dr. Harden - Magazine Around Town CoverNovember 2009

By: Dr. Scott Harden

Once again I am awakened shortly after drifting off to dream land by a violent thud to my rib cage! “You were grinding again and I thought you were going to break your jaw!” my wife exclaims. And so it has been for more than 16 years, when we both are on our way to what we expect to be a very nice and relaxing night’s sleep, we are thrust out of our slumber by the awful sound of teeth grinding against teeth always resulting in a strategically placed elbow to my ribs.
I suffer from a condition known as Bruxism, a condition that cause people to grind their teeth while asleep or even subconsciously while they are awake, and results in serious dental problems that include cracked teeth, broken teeth and noticeable wear. In my case, my front teeth and my back teeth were worn by 30 percent and I have broken several over the years. The vice-like strength of my jaw muscles delivers unbelievable forces as I grind my teeth in all directions. No wonder my jaw aches and pops when I eat and my neck aches from this unbelievable amount of stress!

I had no idea what to do or what could be done about my teeth until I met with Dr. Scott Harden at Fountain View Family Dentistry and Spa. First of all, I didn’t realize the extent of the damage nor had I been aware of how my smile had changed over the last twenty or so years. I didn’t heed the warnings of my previous dentists about the damage that this condition was causing. Although I did take the suggestion of a nighttime mouth guard but found I would just spit it out in my sleep. I knew I hadn’t been the best at taking care of my teeth and suffering from bruxism made it all the more worse. Dr. Harden counseled with me on several ways to fix the problem including what would happen if I didn’t do anything. We talked about my dental treatment plan and what was necessary to restore my teeth to a normal functional level, reduce my neck aches, calm down my achy joints and a way to eliminate my grinding. His recommendation and my selected choice — a full mouth rehabilitation to reverse the damage that has occurred to my teeth over the last twenty years.

He outlined the process to me, utilizing study models, photographs of my teeth, digital x-rays and other wonderful technology that helped me totally understood each and every segment and why it was important. I had made my point clear that I was against the full mouth rehabilitation if any of it was about vanity! Rest assured, Dr. Harden advised, that vanity was a beautiful side benefit but everything he had recommended was necessary for my overall dental health. I already knew this because it was very obvious, but appreciated his reassurance. After much deliberation and prayer, I gave the go ahead on this major project.

The staff at Fountain View Family Dentistry was extraordinary and took great care with every step. The hygienist was extremely gentle and informative. The dental assistants talked t me and help me relax and were very well trained especially with the complex level of care I needed. I appreciated the business office staff working closely with me to explain the costs, payment options and then scheduling my appointments. I was anxious, not just for the process, but somehow questioned myself if I truly was doing the right thing. Vanity is not my gig! Plus, this being a major process, it wasn’t necessarily the right economic timing for a mouth disaster in our family so I needed extra assurance. Dr. Harden and I met on several occasions, always on my schedule and we decided to continue.

I won’t lie to you, there were several appointments when I was in “the chair” for a few hours at a time, but each process was carefully explained and always at my pace. I have never experienced the administration of numbing agents where there was relatively no pain. Shots and I do not get along and this was nothing for this big coward! If there is one word I would use to describe the entire process from start to finish and I had to be extremely accurate with this one word, I could only use the word “organized.” No matter whom I was there to see, what I was there to do, how long I was supposed to be there, it always was exactly what they stated. In this day and age, meeting expectations isn’t good enough…people always want the best treatment. I can honestly say that every person I came in contact with at Fountain View exceeded my expectations in fact, exceeded my heightened expectations at that!

Within a few short months, my situation had been completely corrected. Not every case takes this long but you have to remember, my condition was one of the worst you could imagine. I am thrilled with the look and feel of all my teeth, especially how well they function, and my new smile, the side benefit of the wellness process, well that’s pretty wonderful too. The cost of such a personalized and amazing transformation of my teeth was a very reasonable cost; especially compared to other dentists I spoke to in the past. I strongly recommend Fountain View Family Dentistry to all my friends and family for their entire dental needs. If they can perform this level of treatment and make is so organized, predictable and provide such excellent results, I know they can help children, adults and seniors with routine family care as well. At last my bite has been restored and I have a new nighttime mouth guard I actually wear all night long. My neck stopped hurting and my jaw doesn’t “click” any more. Hey, even my ribs don’t hurt anymore — “Sleep tight, dear!”

Does Dentistry Involve Much Artistic Skill?

November 2009

By: Dr. Scott R. Harden

Mesmerized by the vivid luminescence of twinkling stars, the captivating blue sky with its twilight mood and a bright crescent moon, I gazed at the surreal beauty magnificently captured in this beautiful landscape. The wonderful motion felt by the swirling clouds stretching across the panorama is delicately balanced by stars strategically riveted in the sky that provide a needed sense of stability. The rolling hills, with their majestic purple haze, provide a peaceful and secure feeling to the small town that lies within their borders. The tranquil glow of windows provides an alluring invitation, which is clearly dominated and contrasted by nature’s powerful vast universe full of movement and wonderment. A tall church steeple is present directly in the middle of town providing a clear connection between the town and God above. The brilliance and mastery of Van Gogh’s “Starry Night” has always intrigued me for its simplicity and extreme depth all in one painting. It has evoked my appreciation of art and has motivated me in my professional career to unify art and cosmetic dentistry.

Art, like cosmetic dentistry, both create an illusion by nature. In the case of a painting, a three-dimensional scene is depicted by a two-dimensional image. The artist uses illusions so our brains accept and rationalize an image in order to imply a realistic scene. Art has a mysterious and elusive quality being able to create a beautiful display utilizing the goal of a perfect interaction and display of color.
In the case of cosmetic fillings and crowns in dentistry, our canvas has historically been more two-dimensional borrowing the same aspects of art onto a surface. With the sophisticated achievements of science and modern dental materials, our flat canvas has expanded to a more three-dimensional blend of colors across the span of 1mm thickness, allowing impressive depth and realism as never before observed.

The introductory principles in art and dentistry share many similarities. Outline form is the most crucial element of all to master for implied realism observed as a person in a Rembrandt painting or as a tooth within the confines of a smile. In comparison to art that has introduced impressionism, never a goal of dentistry, if the outline form and three-dimensional shape of a tooth isn’t nearly perfect, it will quickly appear “fake” and not be accepted as part of the smile.

Color is an extremely complex component in both art and dentistry, as you’d expect. Color contributes depth, contrast, and realism. Color is broken down in hue, value and chroma. Hue is the actual color (i.e. blue, yellow). Value is the shades of color (i.e. lightness or darkness). Lighter colors make objects seem larger and darker colors make objects seem smaller, representing a foreground and background principle, respectively. Chroma is the saturation of color (i.e. rich or dull). Colors in art are limitless. Colors in dentistry are also limitless, contrary to most people’s opinion that teeth only possess white, yellow and gray. Actually teeth display a combination of all colors including green, orange, red, blue, or violet in order to achieve a color as additive (more emphasized) and subtractive (less emphasized), a major principle of art effecting how the eye perceives color. For example, adding violet combined with white and blue to the edge of a crown creates the illusion of light translucency and a three-dimensional appearance.

Cosmetic Dentistry borrows many elements from art that all focus on one thing, a life-like replacement of natural tooth structure. Art provides many principals that are crucial in dentistry to mastering natural fillings and crowns allowing patient’s teeth to look fantastic. Today, cosmetic dentistry is virtually involved in every aspect of restorative care. Excellence in dentistry comes from combining art and science to produce whiter teeth and beautiful smiles that ultimately creates complete satisfaction and comfort for our patients.

Why Do Teeth Experience Acid Erosion?

October 2009

By: Dr. Scott R. Harden

Recently, I have had many teenagers coming into my dental office with unusually large amounts of advanced decay, which is based upon “erosion” of their teeth.

The occurrence of this dilemma in my practice coincided with the recently aired ABC news report on “Mountain Dew Mouth” in the Appalachian area of Kentucky, which will be discussed below.

What is Tooth Erosion?
“Tooth erosion” is defined as the chemical removal of mineral from the tooth structure, a progressive condition, and involves both your enamel and exposed root surfaces. Tooth erosion becomes pathological when it leads to pain, abscesses and loss of function or esthetics. Distinctively different from “tooth decay is caused by bacterial damage of tooth structure (bacteria produce acid from sugars in your mouth), while “tooth erosion” is caused by chemical damage of tooth structure.

A thin layer of hard tissue called enamel protects your teeth. Usually your saliva can help maintain the natural pH balance (levels of acid or alkaline) in your mouth, wash away food particles, and rebuild the minerals in your teeth. But sometimes, highly acidic foods, drinks, and drugs can overwhelm saliva’s beneficial effects and soften the tooth enamel, leading to tooth erosion.

Sources of Acid Wear Tooth Damage or Erosion
How and why do teenagers and adults experience tooth erosion from acid? As noted above, highly acidic foods and drinks are contributing factors to “tooth erosion”. Bulimia or self-induced vomiting is an extreme example of “acid erosion”, which afflicts almost 100% women, but this is not the focus of this article. There are a number of other ways that a person can get acid wear tooth damage. The main cause of tooth erosion is by drinking water with high acid content. This is very typical among people who have their own wells. The other main cause of acid wear tooth damage or “erosion” is fruits and vegetables, both of which are acidic. Among all fruits, lemons, oranges, strawberries and grapefruits are known to contain the highest levels of acid. Among all vegetables, tomatoes are known to contain the highest level of acid. Certain drinks, such as sports drinks, sodas and fruit juices are also known to have notable levels of acid which may contribute to acid wear tooth damage.

Studies Regarding Acid Erosion of Teeth
Returning to the recent televised report of “Mountain Dew Mouth”, this program sited that a 20 oz Mountain Dew contains 19 teaspoons of sugar and contains the critical ingredient of acid that erodes your teeth. A University of Maryland study showed that after soaking teeth in various sodas, (a great science fair project – hint hint), Mountain Dew eroded teeth 2-5 times more than regular colas equating to as much as 6% of the teeth.

Based upon another recent 2008 study of all popular beverages in the United States, “tooth erosion” was measured on tooth enamel and tooth roots, and this study sited that tooth destruction from acid erosion was greatest for Gatorade, Red Bull, Coke, Diet Coke and 100% apple juice from most to least.

Other studies have focused on the pH or acidity of soft drinks and shown that any pH below 4.0 is statistically associated with “tooth erosion”. Shown is a table of actual pH values for various soft drinks that is quite interesting.

Dental erosion, which is associated with consumption of acidic beverages, is a potential oral health concern. The best advice is to decrease your intake of sodas to prevent this problem from occurring. If your dentist states you have signs of “demineralization” or “tooth erosion” make sure you rinse well with water following any intake of colas or juices since exposure time is a key factor or simply drink more water in place of soft drinks. Brush and floss regularly and consider a good daily fluoride rinse along with routine check ups every six months at your dentist.

The Tooth and Nothing But the Tooth

September 2009

By: Dr. Scott R. Harden

Teeth form by an amazing complex process of embryonic cells that develop and interrelate to ultimately form the tooth, its roots and connection to the bone. The top of the tooth forms first and then the roots form second. The tooth has four key elements. The outside armor coating of “enamel”. The next layer is what causes your tooth to appear yellow, called “dentin”. The nerve supply of your tooth is the “pulp”. Lastly, the tooth connects to the bone through a thin layer on the root called “cementum”.

Enamel is the hardest substance of the body, and is composed of proteins not found anywhere else in the body. Mature enamel has no cells and is not alive. Enamel is made up of a high concentration of minerals (calcium salts mostly) that cause it to be very hard and resistant to bacterial attack. Enamel provides an amazing defense to bacteria. The weakest areas of enamel are the grooves and pits in our teeth (especially back teeth) that are best protected by good daily brushing, fluoride and sealants.

Dentin forms prior to the formation of enamel and is initiated by dentin-producing cells called “odontoblasts” located in the pulp. Unlike enamel, dentin continues to form throughout life and can be initiated in response to stimuli, such as tooth decay or attrition. Dentin consists of microscopic channels, called “dentinal tubules” (like little straws) that spread outward through the dentin from the pulp to the exterior cementum or enamel border. These tubules contain fluid and therefore cause dentin to have a degree of permeability that can increase the sensation of pain and the rate of tooth decay. Dentin consists of “primary dentin” that forms most of the tooth when you are young, “secondary dentin” that forms after root development and much slower than primary dentin and “tertiary dentin” that is an on-going reparative process throughout life in response to decay and other damaging etiologies.

The pulp is what we term the “nerve” in our teeth and is comprised of arteries, veins and nerves. God gives each tooth a root canal system to transport the pulp through (as seen in the photo above). The slang “root canal” actually refers to root canal therapy, which is performed by a dentist, and involves the removal of the nerve because it has died and become infected from bacteria. When there is a problem involving a tooth, the pulp transfers feeling from your tooth to your brain to let your know there is a dental problem. Tooth decay does not always create a toothache, because tooth decay is very slow and gradual, the body adapts to the problem and often disguises the pain so we do not get a signal. This explains why severely broken down teeth sometimes never hurt.

Cementum is a thin layer of bonelike material covering the roots, that helps your tooth attach to the bone. It is yellowish and softer than either dentin or enamel. Cementum is similar to dentin in the fact that they are both produced by the body throughout your life, especially in response to stresses. In humans, as your teeth wear down from chewing or grinding, new cementum is deposited on the roots (down in the bone area) so that the tooth gradually rises higher and maintains good tooth function.

Why Has White Filling Material Revolutionized Dentistry?

August 2009

By: Dr. Scott R. Harden

Just recently, I had the privilege and honor to treat a 94 year-old dentist as a new patient in my office. His name is Dr. William Book. Now blind, he is an absolutely delightful person, still possessing a very a sharp mind and a keen remembrance of dates during his illustrious dental career. To avoid running behind in my schedule, since I quickly learned he likes to talk, I set up a dinner with him and his daughter along with my wife and I to travel down memory lane. In standard fashion, he walked to our table directly behind his daughter, his hands on her shoulders, in a train-like manner. Dr. Book commanded great respect as he recounted his career and the great developments in dentistry over the last sixty years. The more Dr. Book spoke, the more it became very clear to me just how far dentistry has truly advanced.
It was clearly the not-so-distant past when dentistry was associated with very few options for dental materials and dental procedures that conjured up many of the phobias still seen by dental patients today and that have unfortunately been passed down through several generations. The exclusive use of “amalgam” (silver fillings) and gold was all that was available for dental restorations. If you were to take a guess, how many silver fillings are still placed every year in dentistry? The answer is staggering; one hundred million.

One of the greatest advancements in dentistry today is the use of “composite” (white filling) material. Composite has become the new standard of care for dental fillings, in place of amalgams. Composite has many advantages over amalgam. It is tooth colored and preferred by patients for it’s esthetic properties. Composite is more similar to actual tooth structure and therefore undergoes more similar hot and cold dimensional and more similar wear resistance, as observed with natural teeth. It chemically bonds to teeth allowing more conservative tooth preparations for fillings. Dental “Composite” fillings also bonds the walls of the tooth together making the tooth stronger than amalgams, which tend to create a wedge affect inside the tooth that can promote fractures from chewing on them. Composite fillings can be placed on both back teeth and front teeth.

The chemical bonding to tooth enamel is rather fascinating because it all takes place at a microscopic level. This was clearly shown back in dental school by microscopic pictures demonstrating how tooth enamel has thousands of little pores that allow the dental bonding agents to get down into the pores and become mechanically anchored in them when a “curing light” is placed over the adhesive chemistry. Now the sticky surface is ready for the composite (white filling) material and creates an amazingly strong bond that can withstand chewing forces without coming loose. The composite is placed in the tooth and shaped to achieve the same contour and appearance as the natural tooth and then it is also cured with the light. This is another advantage of the composite fillings because they harden instantly under the light while the amalgams need a day to set before the patient can chew on them.

Composites have advanced tremendously in recent years and now are available in many shades that can be combined together or layered to achieve almost any desired cosmetic look possible.

Composite performs amazingly well during complex dental reconstructions that are needed for patients with a history of mismatched dental work over the years including missing teeth, broken teeth, worn teeth and large old fillings. This process is commonly seen in middle age patients and elderly patients and often begins by using composite to reestablish a patient’s bite level back to where it was originally prior to heavy wear. The composite can be meticulously applied to the teeth recreating the original contours of teeth, instantly rejuvenating the patient’s teeth, function while reducing stress placed on jaw muscles and jaw joints (“TMJ” problems) associated poor tooth position and tooth wear.

The other day, I used composite to modify the color of a patient’s tooth on an old partial denture that did not match the person’s natural teeth. This was a great benefit for the patient and saved her lots of money by not having to have expensive lab work or a new denture.

Composite is great for placing on the front surfaces of teeth and allows amazing esthetic transitions for patients. New composite has a principle called a “chameleon” effect and not only permits the material to match better and easier than ever before, but can also accommodate changes in tooth color following a whitening procedure without having to replace the composite. Convenient.

Composite is such a wonderful gift to dentistry and one I appreciate every day. Composite fillings are much more detailed that amalgams and require many more steps to place them. The additional effort is certainly worthwhile for the patient because the outcome is beautiful and as close to natural teeth as possible.

It has been many years since Dr. Book graduated from Atlanta-Southern Dental College down near Grady Hospital in 1944. Life is full of amazing coincidences, and in true fashion as I discovered during our dinner, Dr. Book represented the first class to ever graduate Emory Dental School in 1944 and ironically I represented the last class to ever graduate Emory Dental School. How fantastic to realize on a day in June 2009 in Woodstock, GA that an alpha and omega Emory Dental School graduate separated by fifty-five would meet and create a bond of their own.