Dr. Garrett here!  Many of us have what is called “gum recession.”  This is when the gum tissue covering the roots of our teeth begins to migrate down the surface of the root.  Recession can be caused by many things, but the main causes are: clenching and/or grinding your teeth, brushing too hard, and periodontal disease.  When we clench and grind our teeth together, there is micro-movement of the tooth.  This causes pressure and inflammation in the bone holding our teeth in place.  As a result, the bone resorbs down the root surface.  Tissue follows bone, and thus you get a recession defect.  Brushing our teeth too hard physically wears away the gum tissue around our teeth, and also causes inflammation of the supporting bone.  Lastly, periodontal disease is a bacterial process where the inflammation caused by the presence of pathogens in and around our gums causes the supporting bone to essentially dissolve away.  As said before, the gum tissue follows where the bone is going and recession results.  We typically do not see the actual recession in patients with active periodontal disease because their gums are inflamed and puffy.  When the disease is removed however, the now healthy gum tissue recedes to where the bone is.

Treating these various sources of recession is the most important aspect of resolving receding gums.  This may include wearing a night guard when sleeping to prevent grinding and clenching.  It may also include changing our brushing habits and/or using a softer toothbrush.  A Sonicare toothbrush is my favorite solution for those “aggressive brushers.”  For patients with periodontal disease, a deep cleaning to remove the inflamed tissue and bacteria is essential.  Followed by quarterly visits until healthy tissue is re-established.  The addition of antimicrobials and antibiotics may even be necessary.

Once the source of the recession is treated, it is time to consider covering these exposed root surfaces.  Why cover them?  Well, exposed roots can cause severe sensitivity to cold food and air.  Additionally, the thin tissue that remains around a tooth with recession is often thin and prone to further disease.  So how can we cover these roots?  The best method involves grafting new tissue to the exposed root surface.  This is done in two different ways.  The first has been around for a long time, and can work quite well.  It involves removing a slice of tissue from the roof a patient’s mouth, and then transplanting that tissue to the exposed root surface.  The advantage of this procedure is the graft rejection is rare due to the fact that we are reusing the patient’s own tissue.  There are two large disadvantages to this type of grafting, however.  First, the donor site on the roof of the mouth is extremely painful!  Many patients state that the pain in this area is worse than any mouth pain they have ever experienced. Second, the color and texture of the grafted tissue is much different than the normal tissue the covers the root surface.  We usually call these grafts “tire patches” due to their appearance (see below).  In many situations, this can be a cosmetic issue.

<– Tire Patch!!

The second method for covering exposed root surfaces is through the use of donor tissue.  This is called an allograft.  This is human tissue harvested from carefully selected human donors that has been thoroughly sterilized.  No person has ever been found to have transmitted a disease from one of these grafts!  The allograft is surgically placed over the exposed root surface in a similar manner as the first method.  The main difference being that no donor site surgery is performed, completely eliminating the pain and morbidity associated with this surgery.  The area where the tissue is grafted will have some slight soreness, but most patients report the discomfort to be quite minimal.  The tissue, when healed, is indistinguishable from the surrounding gum tissue.  Thus, it is an excellent procedure for areas where esthetics would be a concern (see below for example).

Before 

After  

I am pleased to say that I am now performing this procedure in the office and have been very excited with the results.  We have been able to eliminate cutting out tissue from the sensitive palate area of the mouth, thus making it a much more comfortable procedure.  In addition, by avoiding the referral to a specialist we are able to keep your costs down significantly.  If you have any questions or comments about this surgery, please do not hesitate to ask any of us!

Biofilms and Your Mouth

What are They?

Bio = living

Film = a sticky layer.

Biofilms are groups of bacteria that live in a moist environment. Biofilms can be helpful or harmful, depending on where they are found. They can be helpful on rocks in a stream because it can form the base of a food chain. A harmful example is when you get an antibiotic resistant infection around a prosthetic hip joint. In the mouth, biofilm is a fancy word for plaque. There are good bacteria in your mouth that help compete with fungus and bad bacteria. In a biofilm, bacteria are more protected from things like Listerine and antibiotics. We don’t want the bad bacteria to be protected, so we need to encourage good bacteria and properly disrupt biofilms (plaque).

How can it affect me?

Biofilms in your mouth (plaque) protect the more destructive forms of bacteria associated with gingivitis and periodontal disease. Left undisturbed, your plaque becomes more organized, sticky and harmful. Biofilms are harmful because they cause destruction of your gum tissue and bone surrounding your teeth, both directly and through the reaction caused in your immune system. Many studies have shown the link between chronic inflammation in the mouth and its association with inflammation in other organ systems, such as in diabetes and heart disease.

How can I affect it?

One of the main goals with careful daily home care, ie, careful and thorough brushing and flossing, is for you to disrupt the growing bacteria so that it cannot get to this organized stage (biofilm) that leads to problems. Regular visits with your hygienist allow us to remove the hard tartar that is harboring these  disease-causing biofilms. New products on the market try to weaken the biofilm in different ways. There are now probiotic lozenges that use natural competition to crowd out the bad bacteria. GUM PerioShield is a mouth rinse that coats the teeth and tissues and targets the bacteria’s ability to secrete the sticky substance that helps form the biofilm. Waterpiks help remove biofilm in deep pockets, where they are most protected.

Dr. Garrett here!  The recent report of an oral surgeon in Oklahoma who had been practicing for decades using unsanitary equipment on his patients has brought to light many issues in how we as health care providers treat our patients.  More specifically, how we are able to maintain a safe environment for our patients.  One in which they can have confidence they are being treated in a sanitary way.   Washington state has set legal guidelines which all dental offices are required to follow (click here for specifics).  The main concern here is cross-contamination.  This refers to the passing of microorganisms, bacteria, or other harmful substances from one patient to another through unsterile or improper equipment, procedures, or products.   Not only does cross-contamination put our patients at risk, it can also potentially harm our employees.  There are many infectious diseases that can be passed via blood and/or saliva, thus the proper sterilization or disinfection of equipment used must be a priority.

Fortunately, there exists technology capable of killing even the most resilient bacterial spores.  The main machine relied upon to perform this is an autoclave.  In a nutshell, an autoclave works by increasing the temperature in a sealed container that has had all the air removed.  This high pressure environment allows steam to be heated to temperatures above 120 degrees Celsius for a sustained time period.  This highly heated steam completely kills any pathogens exposed to it.  An autoclave must legally be tested every single week to ensure that it is operating effectively.  We ensure this by using spore strips.  These are paper strips impregnated with Bacillus bacteria, which are the most difficult bacteria to kill.  We place a strip in our autoclave every single week that we are open, and send the strip to a company to process it.  They send us back a report letting us know if we are killing all of the bacterial spores.  If the report comes back with evidence of spore activity still present, the autoclave must be fixed or replaced.

The autoclave is a great machine allowing us to completely sterilize most of the equipment used in our daily procedures.  There are other aspects of sanitation that are just as important to us.  This includes disposable plastic barriers on non-removable equipment.  Everything in each suite is wiped down thoroughly with a disinfectant wipe after every single patient, no matter what procedure was done in the room.   An ultrasonic cleaner is used on all small instruments to remove any organic matter prior to autoclave sterilization.  Gloves, hand-washing, eye protection, masks…the list goes on!!  We treat every patient before, during and after their appointment as though they have an infectious disease that could harm us or others.  This is not a negative thing!! This is to maintain our high standards that our patients and employees expect and deserve.

Please feel free to ask us for a tour of our state-of-the-art sterilization center.  We are always proud to show it off!!

Girl Rising Movie Premiere Spurs Action For Worldwide Philanthropy

Submitted by Mary Ellen Jones, for Fisher Jones Family Dentistry

Recently, I attended a showing of the newly released film, Girl Rising.  At the time I accepted a friend’s invitation to purchase a  $10 ticket, I knew little about the film.  It was described to me as a must see film about girls and education.  I trust my friend and dutifully bought a couple of tickets, gathered with a few friends before the movie and arrived promptly on time.  It is a groundbreaking film, directed by Academy Award nominee Richard Robbins.  It tells the stories of 9 extraordinary girls from 9 countries, written by 9 celebrated writers and narrated by 9 renowned actresses. Girl Rising showcases the strength of the human spirit and the power of education to change the world. Explore the film in detail at www.girlrising.com. This film is inspiring and a call to think, share, discuss, and act.

An organization called 10×10 has partnered with Gathr, a new web-based service that enables people to request and attend theatrical screenings of a movie that otherwise would not play locally. Gathr will unite you with Girl Rising, right in your neighborhood.

Anyone can host a local screening with global impact.
 All captains pledge to rally their communities by filling local theaters – the more ticket requests you secure, the bigger the audience, the greater the attention.

I know there are upcoming shows scheduled in the greater Olympia area. I agree that this movie is a must-see for every woman, girl, man and boy in our community.  We are truly a global community and education, empowerment and equal treatment will benefit every person whether living in a third or first world nation.

We own a business, Fisher Jones Family Dentistry, and decided years ago, that we wanted to give back to our community by directing our charitable dollars to support families and education in our local community.

Our focus has been primarily on public education programs that support the kids and families most in need.  Giving to the programs established through the Olympia School District Education Foundation and the North Thurston Education Foundation have the most local impact on helping kids come to school ready to learn and helping teachers and administrators provide the very best educational experiences.

It hit particularly close to home to find myself sitting in a theater with other local women, girls and a few men and boys watching and listening to the stories of girls from around the world in their struggle for access to education.  Suddenly my view broadened beyond Thurston County in recognizing the needs of so many for the very educational privileges we often take for granted.

Our Fisher Jones Family will continue to support families and education but now with a greater awareness of the global impact of supporting education for all kids.  As we dedicate funds for our children here in Olympia, Lacey and Tumwater, we keep in mind the fact that the educational opportunities enjoyed in the United States and other first world nations are not available for children elsewhere.  Our world can only become a better place when the right to be educated is offered to every child, boy and girl.

There is a movement happening around us – a movement bringing women and men together to support education for all.  It is the reality that the girls of this world are those with the least opportunity.  In so many countries, girls are being oppressed, exploited and neglected.  We must fight for them.  They are our path to a world built on value for every person and equal opportunity regardless of gender or national origin.

I encourage you to see this movie.  It will only take a few hours of your time but its words, images and message will likely stay with you for a very long time.  Maybe it will be one of us, here in Thurston County, who will make the difference for these girls, for every child’s access to education and to a world that empowers all to follow their dreams.

For more information, visit www.girlrising.com.

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Dr Matt here,  Patients ask me everyday, Hey are you putting on weight? or Hey you are getting losing weight?  This is all in the same day.  They ask me do I work out?  Where do I work out?  What kind of diet do I have?   Am I on a diet?

So here is what I like to do.  I like to be able to do anything at anytime.  If I want to run, I run.  If I want to walk, I walk.  If I want to ride a bike, I ride a bike.  I work on staying flexible.  Stretching.  I like to throw myself on the floor and get up as fast as I can. I play all sports and I have my favorites.  I play catch.  I kick a ball around.  If there is sporting equipment I pick it up and use it. Tonight after dinner my son Madison and I went out and Longboard skateboarded (check out the video below!).  The feeling of the free ride downhill or pumping up the hill.  The wind in your face as you are carving turns going faster than you can run.  Yes, I wear a helmet.  I wear whatever protection is required for the given activity.  I don’t worry so much about how much I weigh but how much I can do with what I currently weigh.  I don’t have a formal workout.  I do like free weights, I have two. I like the big ball to stretch my back and abdomen.  I like how it feels on my core.  I like pushups, sit-ups, and just dancing around to music.  I like to be moving.  I park far away from stores to enjoy the walk. I often walk to work. I am not on a diet but love to eat everything and have a variety.  I tried millet for the first time tonight and farro last year.  I enjoy making my food that I eat from scratch. I like meat and vegetables, all kinds.  Sometimes I feel heavy and sometimes light.  If I find that I cannot do something I work at it until I can.  I hope this dispels the mystery and gives you some ideas to get up off the couch and enjoy the Pacific Northwest rain or shine.

Dr. Garrett here!! At Fisher Jones Family Dentistry, we pride ourselves on creating a comfortable and relaxing environment for all of our patients. Despite the lengths we go to in order to make every patient’s experience a pleasant one, there are still those who fear a dental visit. Studies demonstrate that dental fear and phobia exist in 15% – 30% of the general population of the US. For many, this fear prevents them from even stepping into a dental office. As a result, many people live every day of their lives with chronic oral pain, which leads to poor overall health. They may also lack confidence as their smile has been ravaged by years of untreated disease. Thanks to a service called “Intravenous Moderate Sedation” (IV sedation) many of these people are able to receive the care they desperately need.

IV sedation uses a combination of safe, effective drugs administered directly into the bloodstream to provide a predictable level of sedation. This is much different than the administration of sedatives through an oral route, which has unpredictable and less effective results due to the time required for the drugs to reach the bloodstream. This oral route of administering sedatives requires no extra licensure at this time and can be a very risky procedure for the untrained dentist to perform.  In order to perform I.V. sedation, a dentist must obtain an extra license through the state requiring countless hours of lecture and dozens of actual patient cases.  I frequently have patients referred to me from dentists in the area that have attempted and failed at sedating them through the oral route.  Through IV sedation the effects of the drugs used are seen within 15-30 seconds. As a result, the drugs can be given in small, safe increments to achieve the perfect level of comfortable, relaxing sedation for each patient. The patient remains conscious, but is sedated to such a level that most will fall asleep. Most patients experience profound amnesia, and thus have very little to no memory of the entire appointment. At the end of the appointment the patient is gently awakened and driven home by a responsible friend or family member to spend the rest of the day relaxing in the comfort of their own home.

I personally perform a lot of surgery in the office (from dental implants to bone grafts to wisdom teeth extractions), and two of the most common questions I encounter are: “Do I need to be sedated?” and “Why should I be sedated for this procedure?”  I tell my patients that sedation is a method of relieving anxiety during a difficult or stressful procedure.  When one encounters a stressful situation, their “flight or fight” response is naturally engaged.  This involves the release of stress hormones, also known as catecholamines, that are known to effect our bodies in profound ways.  Not only do they increase our heart rate and blood pressure, but they also delay healing and actually contribute to the breakdown of tissues.  During a surgical procedure in particular, the less of these stress hormones we have floating around in our bloodstream, the better.  In addition, for those patients who have poor cardiac health, decreasing this stress during a dental appointment can potentially decrease the risk of a serious cardiac event.  For some patients, the stress of simply having their teeth cleaned can prevent them from visiting a dentist.  Stress is a serious foe!!  Luckily, we have a solution to overcome it.

IV sedation is a wonderful service that has improved the lives of many patients in our practice. If you or someone you know has been putting off seeing the dentist because of fear or anxiety, do them the favor of informing them of this option that is now available. I am happy to meet with anyone for a consultation to discuss whether IV sedation is a viable option.

Patient getting ready for IV sedation with Dr. Garrett

Every February, the dental community comes out in full force to raise awareness of dental health.  At Fisher Jones Family Dentistry we are highly active in the community every month of the year, but in February we become very active!  We will be visiting at least seven classrooms throughout the month to educate youngsters on their mouths.  In addition, we will be present for free screenings at the Hands-On Children’s Museum in downtown Olympia.  The focus is mainly on our youth, because we all know that starting with a solid foundation leads to long-term success.  If proper oral hygiene routines can be established early in a child’s life, they have a much better chance of avoiding dental problems down the road.  So feel free to celebrate Dental Health Month with us by making phenomenal oral health a priority for the entire month!

Dr. Garrett volunteering at Gloria Dei Lutheran Preschool

It’s Valentine’s Week at Fisher Jones Family Dentistry and our tradition is to hand out candy to our patients who pay us a visit. Candy, you say? Well it’s not to create more work for ourselves, that wouldn’t be right. It is actually a way to help you achieve a healthier dentition. That’s because we hand out dark chocolate. It turns out dark chocolate has many properties that help fight tooth decay. The benefit lies in the cocoa bean. And the darker the chocolate, meaning the higher cocoa percentage, the closer the chocolate is to the cocoa bean. Cocoa beans contain tanins, polyphenols and flavenoids, all antioxidants that benefit your teeth and gums.. Tanins, which give chocolate its bitter taste and dark pigments, help prevent decay causing bacteria from adhering to your teeth. Polyphenols limit the effects of bacteria, which helps your breath. Flavenoids help slow the tooth decay process.

So choose the darkest chocolate you can find. We recommend at least 70%. There are many great options today because there are so many small companies making high quality dark chocolate. Purchase some for your Valentine and you are telling them that you love them and you want them to have a healthy smile. And if you get the opportunity, stop into the office and we will be happy to send a little chocolate love your way!