Tetric Evoceram

Amalgam (silver) filling undergoes multiple cycles of shrinkage and expansion, thereby causing cracks in surrounding tooth structures. In the left picture, you can spot a crack stretching through the floor of the cavity (the arrow points to it). In the right picture, there is a restored tooth. We used flowable composite and nanocomposite Tetric Evoceram

Damaged front teeth- there is a help

Would like to share today’s restorative case. The patient has advanced wear of the dentition due to parafunctional activity. The upper anterior teeth got 3M Lava crowns cemented today.

Optimal Hygiene for Dental Implants

Meticulous hygiene and supportive periodontal treatment are quite important for the longevity of dental implants and the prevention of peri-implant diseases. The supportive periodontal treatment includes mechanical debridement, hard tartar removal, and oral hygiene reinforcement by the dentist and hygienist. It is especially crucial for patients with chronic periodontitis. At the same time, the use of chemicals during maintenance didn’t have a significant effect on implant survival as shown in the clinical studies ( Lin et al from Chang Gung University, Taiwan). The authors suggested a recall schedule of at least once a year to maintain optimal peri-implant health.

And last, but not the least, the systematic review and meta- analysis, conducted by Wang et al from Tianjin Central Hospital, China, prove that power toothbrushes are a superior choice for maintaining oral health and preventing periodontal disease.

Can Your Dental Hygiene Be Too Good?

Our digestive system (and our mouth belongs to it)  contains trillions of bacteria, viruses, fungi, and other microorganisms, that coexist in a delicate balance to regulate everything from your mental health to your skin’s sensitivity. If something happens to disturb this balance, for example, you take a course of antibiotics, you may experience symptoms ranging from digestive issues to psoriasis. The shift to more pathogenic flora causes tooth decay or caries. Oral streptococci, such as Streptococcus mutans and Streptococcus sorbrinus, are considered to be the main etiological agents of tooth decay in children. Other bacteria, such as Prevotella spp. and Lactobacillus spp., and fungus, that is, Candida albicans, are also related to the development and progression of early child caries.

That’s why fermented foods ( like kimchi, sauerkraut, and kefir ) that are rich in probiotic bacteria get such high marks in health circles. Your mouth, as I have mentioned before, is the entry point to your gut, and contains a similar community of important organisms that help to regulate your whole body.

Of course, we are all aware of the need to maintain good dental hygiene. What is changing about that now is twofold. One, we are understanding more about how the microbiome can impact things inside and outside our mouths. And two, the idea of “clean at all costs”  is changing.  Bad breath and cavities are signs of an unbalanced gut microbiome. It is a chicken-or-egg situation. They go hand in hand and one can facilitate the other. Some infections in other parts of your body tend to coexist with bacterial imbalances in the mouth. Some ear infections, as well as gum disease, and some infections in the throat can be a sign of problems with the oral microbiome.


Keeping balance in the microbiome isn’t just about elimination bad bacteria, however. It’s also about letting good bacteria thrive, which brings us to public-health-enemy No.1 for doctors of different specialties: mouthwashes with alcohol and sodium lauryl sulfate (SLS). These ingredients absolutely blast your mouth and give you this intense feeling of cleanliness. But it is ephemeral. If you checked the bacterial balance in your mouth about an hour later, it would be skewed towards the bad bacteria.  A better way to care for your oral microbiome is to keep your tongue clean. The tongue is like a rug, bacteria get into the grooves and stay there under anaerobic (no oxygen) condition. Diet also makes a big difference: the healthier, more versatile and lower in sugar the diet is, the easier it will be to maintain a healthy oral microbiome. 

Oral Health as a piece of the puzzle in overall health during COVID-19.

Nasal rinses and mouthwashes, which directly impact the major sites of reception and transmission of human coronaviruses (HCoV), may provide an additional level of protection against the virus. In the experiment, performed by Craig Meyers and his colleagues and published in the Journal of Medical Virology (2020, Sep 17), the researchers created cells grown from human tissue and then infected them with HCoV. HCoV is a human coronavirus 229e played the role of a surrogate for SARS-CoV-2. They subjected the virus to several common, over-the-counter mouthwashes and rinses for 30 seconds, 1 minute, and 2 minutes, and measured how much of the virus was inactivated. The reported results were the following:

• Peroxide Sore Mouth (CVS), Orajel Antiseptic Rinse (Church & Dwight Co.), and 1.5% H2O2 (Cumberland-Swan) — all of which listed hydrogen peroxide as their active ingredient — inactivated less than 90% to as much as 99% of the HCoV, depending on contact time.

• Crest Pro‐Health (Proctor & Gamble) mouthwash inactivated 99.9% to more than 99.99% of the HCoV during all three contact times.

• Listerine Ultra (Johnson & Johnson Consumer), Equate (Wal-Mart Co.) and Antiseptic Mouthwash (CVS) inactivated less than 99.9% of the HCoV at 30 seconds.

• Listerine Antiseptic (Johnson & Johnson Consumer) mouthwash which, according to researchers, had the same or similar inactive ingredients as Listerine Ultra, Equate and Antiseptic Mouthwash inactivated more than 99.9% of the virus at 30 seconds.

However, per Hana Akselrod, MD, MPH, before we start telling our patients to use mouthwash to prevent the spread of the coronavirus, we still need to learn how mouthwashes, nasal rinses and sinus rinses would work in the nose, mouth and throat of individuals infected with COVID-19, not in a simulated environment. We also need to answer questions, like how long would you have to gargle with mouthwash, as well as how often would you have to gargle? Is it safe for people to use mouthwashes and nasal rinses for the purposes of preventing the spread of the coronavirus?



It is well known that dental visit expectation can be very stressful for many patients. While in the dental waiting room the mindfulness-based cognitive therapy (MBCT) can be practiced to reduce the visit apprehension.

One of the MBCT practices is a “breathing break”. Our breath is a window into knowing and regulating our mind-body. When we breathe in, our heart rate goes up. When we exhale, our heart rate goes down. By having a longer exhalation than inhalation, we can slow our heart rate more, and we can also stimulate the vagus nerve. Breathing into our lower belly ( abdominal breathing) stimulates the sensory pathways of the vagus nerve that go directly to our brain, which has an even more calming effect.

Focus narrowly on the breath, and then expand awareness out to your full surrounding. 

Here is one of the versions of the breathing break:

1) Becoming aware: Sit upright and close your eyes. Connect with your breathing for long inhalation and exhalation. With this awareness, ask yourself, ” What is my experience right now? What are my thoughts? Feelings? Bodily sensations?” Wait for responses. Acknowledge your experience and label your feelings, even if they are unwanted. Notice any pushing space for all that comes up in your awareness.

2) Gathering your attention: Gently direct your full attention to your breathing. Notice each inhalation and each long exhalation. Follow each breath, one after another. Tune in to a state of stillness, it will allow you to come from a place of being.

3) Expanding your awareness: Sense your field of awareness expanding around you. Notice your posture, your hands, your toes, your facial muscles. Soften any tension. Befriend all of your sensations, greet them with kindness. With this expanded awareness connect with your whole being, encompassing all that is you in the present moment.

Source: “The Telomere Effect” by Nobel Prize Winner Elizabeth Blackburn and Elissa Epel