Category Archives: Dr. Little

“Crown in an Hour” “Same Day Crown” “High Technology”

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Is it just advertising hype or is it really as good as it seems? Let’s look at some of the pros and cons. First, let me start by saying that I started in dentistry as a laboratory technician. I graduated from lab school in 1987 and began working for a prosthodontist (Wikipedia). Having made thousands of crowns for a specialist and now having seated thousands as a dentist I am able to be a bit more critical about quality. It is the reason why I have an in house dental lab.  I’ll try to be as objective as possible but…

 ANY dentist who says he/she can make a crown as well as a well-trained dental technician ……. this may sound harsh but……. They are seriously uninformed!!

So, how does the same day crown work? The dentist gets the tooth ready in the same fashion as the conventional technique however instead of taking a mold of your teeth 3D pictures are taken and uploaded to the CAD (computer aided design) software where a virtual crown is designed. It is then up loaded to the CAM (computer aided mill) where it is carved out of a block, finished and finally put on the tooth! It is fantastic that we can even do this! I am impressed with where technology is going!  The next technology break through is already happening with 3D printing! It will soon make the CAM milling obsolete!  Go visit it on YouTube. It truly is fun and exciting stuff!!

So the question is… why haven’t we embraced the new technology?

Are we unwilling to pay the $100K+ it costs to get the CAD/CAM? Are we unwilling to train the needed staff? Am I fearful of change? If those were the excuses then I would GLADLY embrace the same day crown however, “a one visit crown compromises the esthetics and quality”, Dr. Ryne S Johnson (prosthodontist). Although it only requires ‘one visit’ it requires more office time’ for the patient.

So why is there a quality problem?

I met with a sales man in my office last month who was showing me the latest intraoral scanner on the market. We both compared the resolution of his software (digital pixels) to my own laboratory models (analogue) under our laboratory microscope. The digital resolution was nowhere near the handmade model. All of the sharp detail had been ‘rounded off’. The question is, why? Well, let’s think about this in a very simple way. The 3D image a dentist takes of your tooth is from a small camera (or multiple) on the end of a hand held wand. It goes in the mouth and taking multiple pictures. Accuracy. The software then stiches and resamples hundreds/thousands of pictures together into a 3D image. The problem? The software algorithms have to average out the multiple pictures and mesh them loosing detail. Going from analogue information to digital isn’t as easy as it would seem. This is why all of the detail had been rounded off when we were comparing it in my lab. This is fun technology when used on your current panoramic setting on your 2D camera but sadly at the 3D micron level accuracy is lost.

What does the research say??

Very few dental articles on this subject are true research articles. Most are advertisements made to look like articles until you look at the authors etc. But I have found a couple – one is by the University of Louisville published 5-2015 by Michael C. Guzelian that evaluated CAD/CAM vs handmade made porcelain veneers. The importance of this study is it is “double blinded”. This kind of study takes out the personal bias that is so common in most reports like the ones you see on the net. It has an interesting but predictable observation.

“There is a favorable perception and rapidly growing preference for digital impressions (and milling) in dental student communities compared to active clinicians!”

This is easy to understand since the generation of dental students and young doctors were born into technology and the “get it now” mentality gives way to the “old” hands on techniques. The laboratory skills required in dental school have been likewise reduced. Some schools only have a 2 crown laboratory requirement to graduate! So do you think a dentist with minimal laboratory background can evaluate the differences in quality? Of course not but it’s not their fault! They don’t know what they don’t know! Do you think that the schools go out and buy those high tech CAD/CAMS, or are they provided by suppliers who are getting the kids hooked on their technology so they need it after graduation? I don’t mean to be cynical but the writing is on the wall. Technology will win! However, as of today the conclusion of this double blind study is “digital impressions (CAD) with virtually-designed crown still underperforms against complete conventional technique, digital work flow requires substantial preparation design and milling improvements to compete with a conventional work flow involving current standards”. One further note that the research article doesn’t mention…The mills used in dental offices are not those used in the large commercial labs. Think of the dental office mill more like a hobby mill. The hand held intra oral cameras used in dental offices are also nowhere near the resolution of the fixed laser controlled environment units used in the commercial dental labs.


You don’t want your dentist or their assistant making a crown any more than you want a lab technician prepping your tooth. The time ‘lost’ and cost of equipment means no savings to the patient or improved  quality. It is true that it can be a ‘one visit crown’ but at what cost? That is up to the patient to decide when they are objectively informed. I use digital 3D x-rays and software all of the time for surgery and I love the technology but even the best technology has its place it just doesn’t make a good crown…yetJ When it does it will be proudly be on display in our office!!!

Sleep Breathing Disorders

A common misconception many people hold regarding dentistry is that dentists only treat teeth. While teeth are certainly our primary focus, your dental care team is also trained to detect oral conditions like sleep apnea. Symptoms such as large tonsils, uvula (the dangly thing in the back of your throat), tongue, and other airway obstructions, as well as a narrow pallet (roof of the mouth), wearing of front teeth, and a jaw that sits too far back can all point the way to a sleep apnea diagnosis. Additionally, your medical history form and leading questions from your dentist or hygienist may unearth a history of snoring, high blood pressure, obesity, and dry mouth; all of these symptoms have been associated with sleep breathing disorders. Clearly, sleep breathing disorders have a strong correlation to oral health!

The most well-known sleep breathing disorder is sleep apnea; apnea means literally “lack of air” and it is a term used when the sufferer actually experiences moments when they are unable to breathe during sleep. Other sleep disorders are equally common such as hypopnea which indicates very slow or shallow breathing; hypopnea does not allow a significant enough flow of oxygen to sustain healthy body functions. When the body enters a state of apnea or hypopnea it eventually has to trigger the sympathetic nervous system (fight or flight) which essentially *jolts* the body back into normal breathing. This compensation that the body naturally performs certainly sounds convenient, but consider the fact that triggering the sympathetic nervous system partially arouses the sleeper and speeds up the heart rate, a condition clearly not ideal for a restful night of sleep. Sleep studies have indicated that sufferers of sleep breathing disorders can be *jolted* like this up to thirty or more times per hour depending on the severity of their condition. If every night is characterized by the body continually fighting for survival in this way and never experiencing true rest in sleep there should be no surprise that secondarily to sleep disorders many sufferers find themselves exhausted, experiencing high blood pressure, and gaining weight.

Unfortunately, serious breathing disorders can be fatal if untreated as they can lead to strokes and heart attacks, and worse still, most breathing disorders are only experienced in deep sleep, making them nearly undetectable to the individual experiencing them. Your dental team plays an important role in recognizing signs and symptoms of sleep breathing disorders. We can provide referrals, recommendations, and some dentists can discuss alternatives to the C-pap such as appliances which adjust the oral cavity to create room for increased airflow. The positioning of the jaw, tongue, palate, and even alignment of the teeth can influence risk for sleep breathing disorders; any anatomical variation which creates a crowded space in the oral cavity can increase the likelihood that an individual will experience a sleep breathing disorder. Many dentists and hygienists are very well qualified to recognize potential symptoms associated with sleep breathing disorders, and they will not hesitate to recommend a sleep study if it seems warranted. Talk with your medical doctor or dentist about your risk if you suspect that yourself or a loved one may be experiencing a sleep breathing disorder.

Flossing Under Fire

Flossing has come under some heavy fire in recent months. This article is intended to inform anyone who is curious as to why dental hygienists will still be encouraging their patients to floss. In the interest of accuracy, I’ll be referring to “cleaning between teeth” rather than “flossing”; after all, there are more ways to clean between teeth than just using floss.

Daily “cleaning between teeth” is incredibly relevant and will continue to remain so to your ethical dental hygienist simply because hygienists, given the nature of their profession, are strategically placed to observe evidence which supports their recommendation. Patients who are reluctant to make a habit of “between teeth cleaning” consistently demonstrate more severe gum inflammation, gum bleeding, and off-putting breath odor than their eager-to-floss counterparts. All of the previously mentioned symptoms stem from some level of gum disease.

So what really triggers gum disease? Research has produced evidence which indicates that single bacteria are NOT responsible for gum, tooth, and structural damage in the mouth. Instead, it is when these individual bacteria form a colony – termed a “Biofilm” – with numerous other bacteria, that destruction really sets in. Biofilms – essentially a bacteria slime layer – have far more destructive potential than an individual bacteria. A Biofilm will release collective bacteria by-products which are highly acidic. It is this acid which “melts” tooth structure (creating cavities), and which has a level of potency which triggers strong inflammatory responses from our own bodies resulting in gum puffiness, soreness, and eventually, collapse of the supporting structures of the tooth (if inflammation is allowed to continue unchecked).

Like a castle fortress, Biofilms, once established, are incredibly difficult to infiltrate and remove (unlike individual bacteria). Such tools as high-frequency sonic instruments, high-pressure water, and sharp manual instruments are some of the few appliances which can successfully eradicate Biofilm. How then can Biofilm formation be prevented? Consistent disturbance of oral bacteria on every surface of a tooth (including between) will effectively reduce the chances of Biofilm establishment. Individual bacteria have been found to require two to three days in an undisturbed environment to create a stable Biofilm; this is why hygienists encourage all of their patients to find a comfortable “between the teeth cleaner” and to use it daily! It’s all about disturbing bacteria!!

Please don’t let hatred of floss stop you from caring for your teeth and gums – there are plenty of alternative “between cleaners” out there to try! Ask your hygienist for his/her recommendations!

Dr. Little Likes Drugs


Penicillin is made by the blue and white penicillium molds

Ninety percent of North American adults consume coffee on a daily basis. Caffeine (in coffee) is the most
widely used psychoactive drug in the world but we don’t think of it as a drug. How about Penicillin? It opened the way for the treatment of microbial diseases. Without it, 75% of the population today would not be alive because their parents/grandparents would have succumbed to infections. Before penicillin if you had a serious infection… you died!!

What’s the difference between a medicine and a drug?

A ‘medicine’ is ANY substance that is designed to prevent or treat a disease but, a ‘drug’ is designed to produce a specific action in the body. That can be confusing. I guess Sigmund Freud was just using ‘over the counter’ medicines (cocaine) for a disease called depression??! Oh wait depression wasn’t a disease back then…it was a psychosis caused by….but I digress! What is not confusing is that used under the correct supervision drugs can be a fantastic way to help prevent diseases! That’s right!! Periodontal diseases, cavities, dental abscesses etc. are all health risks that need treatment. If a sedative allows you to get treatment to cure a disease then I say that a drug is a medicine…in a safe environment, confusing??

What is not confusing is the fear of the dentist! IT’S REAL!!

drugsblog330 to 40 million people in the United States avoid the dentist because of fear. This fear is understandable. The dental experience is not inherently pleasant. Think about it this way…. You are in a private room with a light in your face! You are leaned back into a vulnerable position. Your mouth is propped open and may even have water sprayed in it…your gag reflex may be triggered not unlike the reflexes during waterboarding!! Further your mouth is examined with sharp tools and maybe drills. To make it worse you are going to have a very private place (mouth) ‘judged’! I am surprised the fear of the dentist isn’t higher! We all here in this office understand how traumatic this can be for some patients. We have been performing IV sedation for over 10 years and it has changed lives! 40% or more of our patients have suffered dental anxiety at one time or another. You’re not alone! Besides, research shows (Journal of American Dental Society of Anesthesiology) that a sedative prior to anesthetic is safer than no sedation. Think about it….if you are relaxed your adrenalin/anxiety/blood pressure are down requiring less anesthetic. Also, the calmer you are the calmer the doctor is! The more the doctor can stay focused on dentistry the better quality the work! The ultimate win win!

Call us and ask about your options, some might surprise you but either way…there is no reason to fear the dentist. It should be Fear Free Dentistry….Sorry, I had to get that one in.

Dr. Steven Little

The dangers of a dry mouth (and how to reduce your risk)

The most common occurrence of dry mouth in humans is a result of dehydration – a condition easily remedied by the intake of fluids. Unfortunately, for many people who experience what is known as Chronic dry mouth, their condition is not always so easily improved. There are many possible instigators of a chronically dry mouth including: stress, anxiety, depression, smoking, alcohol consumption, mouth-breathing, caffeine consumption, autoimmune diseases, chemotherapy, and radiation treatment. There are also a variety of medications which include dry mouth as a side-effect.

What many people do not realize about saliva is that it has properties which protect and maintain the oral environment. Without such protection, bacteria are allowed a safe, movement-free place to colonize, acids are not reduced effectively (thus leaving teeth susceptible to rapid decay), and food is not broken down sufficiently before passing into the lower digestive system (often causing acid reflux which can damage teeth and tissues even further). Lack of saliva in some individuals has even led to a condition known as “dysphagia” (difficulty or inability to swallow).

If you are suffering from chronic dry mouth it can be very helpful to consult with your physician to find out if there are any medications which can be reduced or changed, or to ask your dentist if there are any lifestyle changes you can make to improve your oral health. Although there is not always a clear resolution to the problem of chronic dry mouth there are a variety of products which can help diminish the severity of the associated symptoms:

Toothpastes which do not contain a foaming agent (Sodium Laurel Sulphate) will not exacerbate dryness like traditional toothpastes often do:

-Breath Rx toothpaste

-Toms of Maine toothpastes

-Closys toothpaste

-Spry toothpaste with fluoride


Natural saliva stimulators can reduce dryness during the day and night:

-Biotene (

-Ice chips xylitol candy (

-Oral Relief from “Med Active” (

-Orasoothe (

-Salese (

-Act Dry mouth (

-Neutra Sal (

-AllDay mouth spray (

-xylimelts (


pH balancing chews which can reduce the damage dealt by acids in the oral environment:

-Basic Bites (

Steps to a Healthy Mouth and a Healthy You

Most people know the routine hygienists recommend for keeping your teeth and gums healthy: “Brush and floss!” But what many people may not know is that the health of your teeth and gums is very much related to how healthy the rest of your body is, and it goes the other way too; your body can become unhealthy as a result of serious gum inflammation or tooth decay. There is evidence for success behind our traditional mantra of “brush and floss”, but how can you really optimize your routine to ensure your whole body, mouth included, stays healthy? Here are some straightforward tips from your friendly hygienists at West Hills Dental:

Keep gum inflammation at bay
Every time you are in the dental office ask if you have any inflammation below the gumline. You can have it and not even know it. If you do, take whatever steps are necessary to eliminate the inflammation and then to keep it at bay.

Know your BMI
Your body mass index (BMI) can tell you if you are clinically overweight. If you are overweight, you are at increased risk for gum disease and other serious diseases like heart disease and diabetes.

Sleep well
Seven to eight hours of high-­quality sleep seems to be the ideal amount. If you are told that you are or notice that you snore, wake frequently, feel tired in the morning, or clench/grind your teeth, get screened for sleep apnea; these symptoms can indicate that your airway is obstructed at night. If you test positive for sleep apnea, get treatment for it! Sleep apnea is a very serious condition that can lead to early death.

Exercise regularly
Current recommendations are thirty minutes of moderate exercise five days per week. If you are pressed for time, you can get similar results in shorter time using high intensity interval training. Exercise regularly, moderately, and with variety in your routine. Regular exercise improves salivary function, and general health by cleaning up the immune system.

Check your blood sugar regularly
Gum disease can be the first sign of diabetes. Detecting diabetes early lessens the chance of developing the serious consequences that can result from untreated diabetes. Everyone over 45 should have an HbA1c ​ test at least every three years – more frequently if you have gum disease or other risk factors for diabetes.