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Periodontal Disease: New Treatment Methods

Chester Clark Jr.

Presenter

Chester Clark Jr.

President of Ouachita Hills Ministries

Conference

Recorded

  • November 1, 2013
    3:15 PM
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I am just required just to give a little background I finished Loma Linda in nineteen seventy six and moved back to my home conference of Arkansas Louisiana and practicing never thirty six years I was tired of studying and I was going to start a practice in a big city of Vince hundred and eighty five I think it was and no maybe seven hundred and fifty nine that anyway I spent the first six months helping to build my practice of the office was a scratch practice and although their data Dennis therefore thirty five years prior had retired about five years before and so there was a lot of lot of people that hadn't seen a dentist for those many years back down we also felt the Lord let us therefore purpose and the reason we found this place was because we were looking for a place that needed an Adventist witness and so the first few years we started a church in our county seat market LP about twenty five miles away and then not a few years later the Lord led us to start an academy so my wife and I started little Academy in our home that grew and grew and down we won't go into those stories at this point that's it has been thrilling to work with that many young people from all of the United States and other countries as well that's my dental practices been a lot of fun and over the years I have always been looking for things that would make life simpler for me and my treatment for patients more effective and one of the things so is rather frustrating for years with periodontal disease you know we can encourage people to brush and floss in and see some improvement but it seemed like over time there was always a lot of regression and if we didn't see them for a few years without go back into the deep scaling in the cleaning and so on and it was until about probably five or six years ago that I learned about it program called centers for dental medicine and it's kind of a bridge between dentistry and medicine and I wish that we had provided CME credit for this hour to because there should be a lot of physicians here because they will see some ways in which they can serve their patients better I think that attack by the end of this lecture but sound the the thing that attracted me was that there was a way of actually measuring and defining the disease is still likely as well as just paranormal probing and measuring the gum crevices but let's go through the slides now have a few other comments and information and then we will have some class time for questions at the end they oral systemic connections are so many about five or six years ago if you googled oral systemic connection you would come up with about four hundred thousand hits and I'm sure it's more than that now because the research has been so extensive so many areas and people around the world doing research that show how things happening in the mouth are related to things happening in the body as well and done so if we asked the question what increases the risk of diabetes by fifty percent heart disease seventy two percent and certain can't service by fifty percent and of course the question is I mean answer is periodontal disease and down let's go to those again fifty percent diabetes heart disease seventy two percent and some cancers by fifty percent those are some significant percentages are thing if you're hiking program worked to help me lose weight lower my blood pressure lower my CPR eliminate medications lower HBA one see our cholesterol and triglycerides to normal I would be here raving fan and this is the the opportunities that we have right now in treating her dog disease we can do every one of these things and in helping people be achieve a healthier state a growing body of evidence indicates that week as dentists can help people in all of these areas of their health parameters medical history reports that the FAFSA assets have been king of Assyria was constantly plagued with rheumatism and did not respond to any conventional method of treatment his doctor was quoted as saying on the order of my Lord and King to tell him the true diagnosis I have told him the diagnosis in one word inflammation he whose head hands and feet are inflamed suffers this trouble due to the condition of his teeth the teeth of my Lord have to be removed for this reason the internal organs are inflamed so not only a lot of the current reason thirteen information but it looks like it goes back quite a few centuries that was that's standard sixty A.D. something like that and about a hundred years ago and ninety seven years ago now Charles Mayo who noted over ninety years ago when the Smith's actions long that the people who keep thirteen live an average of ten years longer than people who do not and this was just an observation I don't know if it was based on scientific study or not but at least its prominent position recognize this and about fourteen years ago there was a special report by the Department of Health and Human Services every year they published a big thick volume dealing focusing on one area of health and your two thousand it was oral health and Donna Shalala said in her dress back then are the introduction of this book the terms oral health in general health should not be interpreted as separate entities oral health is integral to general health this report provides important reminders that oral health means more than healthy teeth and that you cannot be healthy without oral health beauty and so their partnership against inflammatory disease that's actually what were talking about the hurt on the disease is a much of it is inflammation of the gums and if Karen will talk about what the cause of that is that inflammation as many of you physicians probably know that better than the dentist even is related to almost every condition in human body and this shows how many areas at the top we see cardiovascular diseases it was there diabetic complications chronic inflammatory diseases bone muscular the skeletal diseases cancer of a number of kinds and metabolic disorder complications and neurological disorder and I think that probably covers just about the whole gamut except that maybe gynecological disorders but it anyway that is rather all-encompassing you'll hear me okay in the back plenty to talk louder okay stand in front of the screen here in Asian wellness letter from several years ago this comment was made acute inflammation is characterized by the redness heat swelling and pain that is the immune system 's normal response to infection or injury immune cells congregate at the site so that they can overwhelm and dispose of infectious organisms or debris from injury last healing takes place but there's another kind of inflammation low-grade chronic and systemic it's been getting a lot of attention lately and then just a little bit here in the it says the reason you hear so much about this kind of inflammation is that it may underlie a kind of unified field explanation of disease that is some researchers now believe that low grade inflammation is associated with everything from heart disease and diabetes to Alzheimer's and arthritis and may even be the cause of most chronic diseases this is not an entirely new theory inflammation was implicated in cancer many years ago and at the prominent insurance agency did a study of hundred and forty five thousand of their members their insured and both dental and medical with both dental and medical coverage showed that periodontal care reduces the cost of medical care and treating paired all disease lowers Aetna's cost of treating members with diabetes coronary artery disease and cerebrovascular disease of course with the changes in insurance who knows what they will be covering in the next year to vet them on another insurance company CIGNA will pay one hundred percent of out-of-pocket oh expense for members with diabetes cardiovascular disease I ADR and ideate ADR study shows lower medical costs for diabetes and cardiovascular patients when treated prepared all disease so another insurance to found recently the same thing as Aetna and University of Michigan researchers found that individuals who receive regular nonsurgical hair doll care during the term of the study also demonstrated lower diabetes related medical care costs of more than ten percent per year more than twenty percent lower and medical lower annual medical costs for treatment related to cardiovascular deep disease in individuals with both diabetes and heart disease more than thirty percent lower annual medical cost for kidney disease treatment for individuals with diabetic diabetes and kidney disease and forty percent lower medical care costs for treatment related to congestive heart failure wouldn't that lead you to think that there is a connection between disease in the mouth or all disease and heart disease diabetes certainly there is strong evidence CRP creat creatinine reactive protein meanwhile to to get that out that's then that's a test that many physicians are realizing he is as predictive of heart disease as cholesterol anymore they had us high CRP it's its assume there is there some inflammation going on somewhere in the body and interestingly enough patients repaired all the disease often have almost always have high CRP and that CRP goes down when the treatment is successful and this for so many dentists if you're like me a few years ago you weren't familiar with CRP but if the value is one or alas then that it is very little risk that's that's good most of you probably have a CRP of one or less if it's three one to three minutes in moderate risk in the above three it it gets more serious and predictive of of heart disease okay her doll disease can increase CRP recent research demonstrates that link between gum disease and systemic inflammation was Québec that paranormal therapy lowers levels of heart disease inflammation markers treating paired all disease with scaling and root planing combined with a topical antibiotic gel can significantly lower the levels of two inflammatory proteins associated with heightened risk of heart disease and this is from a two thousand four report in the ADA news blood drawn from hundred and two subjects repaired all the disease showed elevated levels of both C-reactive protein and fibrinogen proteins associated with increased risk for heart disease and blood clotting all disease and diabetes that's the glycated hemoglobin is a task that and probably some of the physicians could explain better than I can but when you give a blood glucose test is there a twelve hour fasting blood glucose it records the amount of Lucullus in the blood during that period of time but the glycated hemoglobin A-1 C test shows the amount of glucose it's been in the blood for two or three months so it treatment okay I see so it it has been ligated with a red blood cell in an effort for ninety days and a high will the average glucose that will like you said two to three months and the extra glucose links up with the hemoglobin so if you're on a high sugar diet and your body is not able to handle all of the sugar in the blood mother begets striking at Griffin hemoglobin the more glucose in the blood the more human hemoglobin gets glycated the normal is five percent and a diabetic is usually around seven percent and it's increased by paranormal pathogens in the bloodstream it's reduced by paranormal treatment in this study from January of oh five it says those with severe paranormal disease had a twenty eight four percent death rate and those with no or little paranormal disease had a three seven percent death rate so it sounds like diabetes is a serious condition as I have well had been treating the heard all the disease one of the challenges we had his dentist is convincing people that they have a disease when they have no pain and sometimes no bleeding and they come into the dentist and they thought it was just last year they saw you but it was three or four years ago and when you show them or tell them about the swollen and puffy looking gums and maybe a little accident here and there and asked them about their brushing habits sometimes people get a little offended with your suggesting they have a disease process going on in their body that you know there's no symptoms why nothing hurts and so what can we do to help show them and convince them that maybe there is something going on and I will talk more about this the centers for dental medicine process but part of the process is leading people through this discovery phase to an interest level to a concerned level to a committed level and realizing that there can have to do something and have to spend a little money you can have to have some time with the dentist and hygienist to get this disease process taken care of and one of the first tools that we use is to call the Florida probate dentists here how many of you have are familiar with the Florida probe okay what it's like three three of us are it's a means for helping the patients co- discover their disease process and as you know seeing is believing it connects with your computer system it is instead of relying on a notched stick as we sometimes call the paranormal probe for measuring if three hygienists measured your gums the same day the readings would be quite different because the pressure that they're putting into that damn crevice would be different and they would show different readings but the Florida probate is a computer aided device that energizes if ten people dead in on probes your gum tissue they would come up with exactly the same thing every time and so it also is set up where when the hygienist is going around the patient's mouth they can see on the screen right above their phase the results and when that number is over three three and getting three millimeters of their pockets there is a level in our little sound that indicates there's a problem there and doctors bleeding spot then should push a different button on the fifth control it will show a bleeding spot by that tooth and SOA it is really a not only a scientific way of determining the level of disease that it ought is also a means of educating the patient in the process this is what that the probe looks like that is used and patients discover the state of the health with you visually and audibly and through this shared experience and all in all if patient has a film outset of teeth there would be a total of a hundred ninety two points of data that would be recorded for all on that probing and just by comparison of different means of treatment on the left shows the depth of the part all pockets and the total number of sites to hear it on the first row is third the R three oh to three nine and total number of sites is forty five and before the average site depth of his three three seven after treatment average site depth was two oh four and then well the percentage of sites that were reduced was ninety three three and so on and you can see each as the pockets get deeper there the the percentage well I've tried there weren't any above six six millimeters that's it is a very effective way of seeing those pocket depth heel and restored now just a comparison of different types of treatment the first column is the CDM treatment they are wrote rather than the next one here is SRP 's scaling and root planing plus Arestin and SRP only with and the final percentage down here with the CDM treatment we see eighty two five percent reduction to three millimeters which is ninety five percent with SRP and arrests and it was only fifty one percent and with just SRP was forty two two percent and so this treatment is extremely effective in seeing that tissue heal and just there it's kind of a two-point program one of the key part seven is the laser treatment without the laser treatment this system would not work like it does would not be so successful but it's not just the lasers the patients have to own the disease and they have to have a commitment to two working on their home care as well and at the end I'll show some of the different products that the patients use as well as the different tools that the business is using this question is is is is is is him and no don't think so I don't know too much about Harry or protect in the two oh yes yes I think there is I have seen some of the effectiveness but it's not as thorough and didn't seem to be as long-lasting as as this system is that one of the things that this program does is convince the patient that her dog disease is not a disease caused by poor brushing or is not a disease caused by lack of flossing her doll disease is a bacterial disease take away the bacteria the disease goes away whether there's brushing or not but gum disease is caused by the bacteria and when we can show them the actual bacteria and I'll show you just a little bit how we do that it yet it's impressive and they know that they got to do that brushing and got to use the Hydro floss or the the closest mouthwash on a consistent basis that anyway this will will go out and see some of the rest of it another test that we use this is done right a chair side it's a is called the Banner design test brigade that is called the banner test has a little love a little reagent strips here and we put a couple of five down here at the bottom we take the paranormal probe or Explorer go into the deep gum crevice deepest and grocery one looks that the worst end and put a couple little but that plaque down here and then a couple drops of 's sterile sterile water I believe it is up here and then you told that over against each other and you slip it in in one of these little openings here that incubates it for about five minutes and while were doing that we hand the patient one of these one of these brochures and ask them to start looking through that and that these are cut several samples that you can take these afterwards that really helped to educate the patient as well as to what were doing and that the complex disease process going on here and what they need to do and then we come back and if you know and that's it's a perfectly clean now there's almost always a little bit of blew up here on this this had hear too little splotches of a blue and that indicates that they have the three most pathological bacteria in those gum crevices and so what we're doing is is gradually building their interest in and understanding and and showing them and then another thing that is done at this first appointment is we do a very thorough health history of themselves of the patient and a family history we asked him some questions about their mother and their father and they go through in and check if their mother had heart disease if the mother had diabetes her father Ed and stroke or cancer and then we come back and show them some of this and some of the other tasks they you know we can call correlated very closely with what we see in their mouth and share with them that they have a high risk of also having heart disease if their father died of heart disease state and if they had gum disease oh yes my then losses think you know when he was forty five or something like that so all of this plays into this the parameters of their disease as well okay this CI this is just explaining what I just did facing distilled water on it and and then putting it in the in the test another test we do is peridot heard on Titus susceptibility and research shows that thirty two percent of leave the of the population United States have interleukin VI think now that this besides your a few years old I think they're using interleukin six instead of interleukin one which is maybe even a little more accurate determines inflammatory response to stimulus and thirty two percent of the population is susceptible to excess inflammation what this means is if this test is positive then you have a greater risk of gum disease than the other sixty eight percent of the population and that means they were going to have to be a little more aggressive and intriguing it and work a little harder perhaps in returning your gums to normal they had a six to seven times greater risk of her dog was these it's increase an increased risk of failed implants increased risk of arthritis and heart disease as well and increased complications of diabetes and also risk of lung cancer especially in smokers well this is what the might carry your ID result looks like and we've had a fair number of these are not all positive that this says IL a one genotype and the result is positive if so this this is just a generic thing but later on us reason actual patients which just has their name at the top and also showing its positive and information for them to understand a lot more about the test and then there's parallel pathogen tests and this is a test where it is a very simple thing done by oral DNA and you just have them take a little the liquid that is in this little violent swish it around in their mouth for thirty seconds and spit it back into the cup and put lid on it send it in and they do the task and to find out what the patients how many of the eleven most common pathogens in the mouth are in their gums all disease is a bacterial infection as we've said it requires understanding of the cause existing damages does not predict future risk it allows patient to understand their specific situation and also frequently need to confer with their MDs to help them understand the infection and that it's good a systemic disease not just a problem in those gum pockets and defines the need for specific systemic antibiotics at times okay this is again Canada generic a result of those eleven pathogens and I don't know if I can read all the names Panera left for Sydney at Treponema then the cola and nine others there is printing is so small that you can see that some of these were present some of them were above the threshold sum up more below the threshold down here but any time the level of those bacteria are above the threshold then it's us serious and if it is well in the later show you our actual reported is can be a little bit easier to see of a larger print that time CDM results and these are some that we saw in our patient this is that the Florida probe print out and out looking C in the back there how many of these red lines there are a sorry I was pushed the wrong button this is a patient that showed up sporadically for appointments we were amazed at the results we got with his infrequent it as he kept his appointment but you can see up here it's about five or six millimeter pocket and looks like the deepest one was in nine millimeter pocket here I don't think that fully resolved that the follow-up here was the looks like about seven and healed on one side but not the other that you see a whole lot less pocketing their then now I'm previously another patient also had a nine millimeter pocket and amazingly her whole mouth healed up to pretty much she had some pocketing when we finish the treatment right here which has since been restored a result we use the laser a few more times and that it is cured this is one of my assistants actually who grew up in Mexico no England El Salvador that's anyway her mouth is perfectly healthy today no pocketing it all and no gum surgery and a mostly painless receipt year of the take care of her guns kept me eliminating the bacteria in her mouth and restoring healthy situation another patient this lady is a lab technologist sullenly bacteria cannot see him having more about it than we did she really was in it I got excited and and followed through probably as well or better than any patient we've had with her gum treatment and she went from that condition to that condition not a single pocket in her mouth and interesting thing when patients have gone through this process they become faithful patients I think almost every patient that we have cured a disease like this still comes in every six months in fact the hygienists that I work with for four years forty F years after started this program last December tell me sure her husband wasn't happy they were moving back to Washington state 's leaving the end of the month and I was a real blow to me because since then we've had to find another hygienists and get her train and were actually were in the process right now of getting whole staff trained again in the CDM program and there's some decent newer things now that we didn't have them back down nonetheless she was excellent in and communicating all what needed to be done with the treating this disease this was a another patient they didn't show up real well for his appointments that he had a very good improvement still some pocketing their and this lady lives God is about ninety miles away and she had an excellent result as well I see just a few three in four millimeters pockets there but in fact this is her material path pathogen test that she had to start with CM actually had looks like one two three four bacteria above the threshold and then and well this is little closer together T F here tenor LF for Cynthia and he in you bacterium known datum and a few others there any way it on the second page of this report it tells about each one of these bacteria and whether they are in the high risk if their high-risk pathogens and more in fact we're more concerned with and then in the moderate in the low risk pathogens and another and this was the follow-up the she did have a real highway near TF still some there but not its below threshold these two are unchanged they are in the moderate range but we're seeing this lady every six months in her mouth continues to be clean and no no pocketing each time we check with the Florida probe and this is her Mike Perio idea in other words the test to see if she's among the thirty two percent that have a higher risk of care Donald disease of inflammation and she did come out as positive with that and then her CRP and A1 C cast I couldn't find that the report of her initial one but her initial readings are on H GA once he was seven eight the follow-up was six six still a little bit over higher than what we'd to see this you know if she didn't have such a clean mouth and I knew she had a pretty healthy diet I've might consider her a pre- death prediabetic that there probably is not a problem her one two CRP has is unchanged before and after her her treatment and for you dentists who may be concerned about drawing blood for this is not a real invasive procedures just a little device you just popular finger in and out tiny type that need to draw little blood out so it's something your hygienist can be trained to do if you don't want to do it in fact I have only done it once or twice hiking hygienist seems to enjoy itself anyway that little of blood you will give you both of these readings we ate a one C and that CRP okay just couple of and I'm sorry didn't have more slides to before and after I don't I'm not as high-tech as as previous speaker here are great can I don't seem to find time to take pictures but this is young lady obviously had some gum issues with some cleaning and laser cutting maybe just one laser treatment for her this is what her gums looked like a few weeks later that and that's both of them okay now just a brief listing of the tools for treating her goal is these for the patients out we have the Hydro floss unit which is cut like the WaterPik but seems to work better with paranormal disease and then there's a hider brush this is what the company came out with first is really unique little brushing device has these two brushes it worked back and forth like this and you put in your mouth was moving back and forth and try to bite into it and it brushes all six surfaces of your teeth upper and lower or the same time poster is kind and bring it around like this and anyway those were those nifty little tools but they didn't seem to hold up and after your people bringing them back in and rather frustrated with the next and so now we recommend the sonicare it seems to be a much more until the last longer and were just good and then that there is a couple of products of the first thing in one of the most important things his closest mouthwash stabilized chlorine dioxide and down that eliminates a lot of the bacteria doesn't get into the gum crevice and that's why we need to irrigate and use laser treatment and an sort laser and deep scaling frequently and then they have two supplements one is physicians paired Allport formula which is a and I don't have the slides right here in this presentation to show all the minerals and vitamins that are inadequate each of them are designed to help in in inflammation and reduce inflammation and heal the gums and an Aussie Genesis formula is especially for post menopausal women that may have some known issues as well and that seems to really help him in clearing up the gum disease the doctors tools as you mention a health history in the family history is where we start and I you didn't include the banner test here in this list but that's another thing that we do it on the first point about a test in the Florida probe and then I also have in this it wasn't actually part of the CDM program but a few years before I learned about this I just a phase contrast microscope and will take a little smear of the bacterial plaque and put them on a slide of the microscope which has a video camera on the top open so they can see on the monitor and within just a few minutes millions of bacteria and course with more advanced disease you see get sometimes see some amoeba and a lot of other things and this is one of the most motivating tools you could ever purchase when people see in their own bugs they say we've got to do something about that it may want to do it right now if they can't get those bugs out of out of their mouth fast enough that's and that's another tool that I found very helpful in and we often take intraoral pictures of their their conditions well and the the laser that we use is the diode laser and there is a most all the lasers on the market today are affected with soft tissue have a setting for soft tissue you know I've seen some of the hard tissue lasers and they look really interesting and I like to go into that someday but down right now for and when I bought this laser was like thirteen thousand dollars now with a lot of cheaper lasers coming out that product the price of that same laser is about eight thousand but you can buy up on nice soft tissue laser now for three to five thousand but that did not solely S twenty four hundred so it's there's really not much excuse for not using lasers in dentistry today because they are so fantastic in not only killing the bacteria and there's two procedures that we used use our do with the laser one is called laser bacterial reduction L BR and it's a simple procedure we just without activating the tip we just go around each gum Kravis staff kind of painting with a little tiny probe into the sulcus there in that accident kills the bacteria and flushing it out afterwards I got you patients I guess it feels so good they were they want that you know with the regular cleaning every time and then in pockets that are deeper than three millimeters we do laser assisted paranormal therapy which is the same tip but it's activated which means it has some of the more power to it and will just go into this gum sulcus in China painted back and forth and actually the last this are new hygienists we just had certified in with her laser use a few months ago and the lady who is a trainer for the Academy laser dentistry action came to our office and stated they would ask and she'd taught us a different procedure that is even more effective and simpler to use and I was amazed I unite icon of bungled up bungled around with a little bit trying to figure out how she was showing us that my hygienist is the first time despite she done it for twenty years when in an and picked up the technique but it's even more effective and easier than what I was taught five years ago but and this is an eight hundred ten nanometer there's other lasers that have different wavelengths that's many quite a few products soft tissue lasers and of course we have to have hygiene services for thorough sulfuric debridement got to remove the tartar buildup on the root surface and it appears what you kill that bacteria you have a clean road surface and the lasers actually stimulating the body 's healing response as well and we see reattachment of the gum tissue to the tooth and that's how without surgery eight six seven or eight millimeter pocket can heal to three millimeters and remain healthy for years afterwards endeavor tools as we mentioned that a blood test for CRP and A1 C and oral DNA test for my aerial pathogens and the mic ID and so is he is as far as paying I know you thought I was I know of no we don't recommend anything in patients usually have had no pain afterwards no payments required it's the laser is so is is not as well actually the way the system that we were taught and I'm learning there may be some advances that would make it even worse temple in this but if a person had a six millimeter pocket with each treatment of the laser the laser assisted Colonel therapy the pocket reduced by one millimeter so we would see them back again in two or three weeks do another treatment and it would heal up another millimeter so it would take three treatments of a six millimeter pocket to see a three millimeter result and so what we do is we had three different treatment plans one for mild disease and I kept I think it's a certain number of or millimeter pockets would be a three month program and would have their disease condition pretty well cleared up the next was for certain number four five millimeter pockets and that would be a six-month Graham and a advanced case would be a twelve month program we wouldn't see them every two weeks during that time we would do a concentrated time every two to three weeks and then we would see them every three months until years up and then we would take the follow-up oral DNA tests to see if you have other pathogens look like and usually their mouths were looking so much better the people every one of them said they were feeling better had more energy and the CDM program is has a follow-up program which we really haven't taken the time to do much with but it leads people into a wellness type program and course their picture of wellness is little different than ours would like to see them move into a spiritual wellness program as well and we do see some some interest but that just a few days a few weeks ago I had a patient asked me if there was Adventist Church in her community who might he be seen for a number of years and anyway that's that's our goal of course these are a couple of resources County laser dentistry is the largest group of promoting lasers they have an annual meeting I think in February into February it's in Arizona this year that's they have a very well-developed system for accreditation and for learning how to do lasers if you do a one hour online course and get some of the basics and then if you tend their meeting in today's daily you be certified for the next level and then if you wanted to teach it or something like that didn't go on and and go to the next level of certification and anyway these this is the website for the centers for dental medicine and how this can benefit physicians is that if physicians would just look in people 's mouths and look at their gum tissue invasive inflammation they'll likely see correlation with some of their health symptoms as well and there's something over a hundred hundred and twenty I think CDM offices around the country and if you go to this website you can find a check and see if there is a CDM office a dentist in your area that is following this protocol in in treating their patients prepared all disease and you can refer your patients there or you can have patient's contacted CDM themselves in and you know and in a be vacant encourage find a dentist in their area that would learn this this system but that is only a yes yes right and you you know this attending the Academy of laser dentistry 's conference and being certified will give you a lot of the tools and think it's like forty nine thousand dollars or something the CDM program to get the training with a sense in which your office to three days and and that includes the Florida probe and some of these other and the laser and a lot of the other equipment that you would need need for it okay if I disapprove of the time here I described pretty good shape let me just close with this quotation it since I'm been doing a lot of different things outside the scope of my dental training to some people wonder how how sane I am but I thought this is an interesting quote from the a famous person back in the late eighteen hundreds is that all men women assumptions traditions current opinions etc. which are in the third or fourth derivative from the truth no man ever penetrates behind these to get at the truth in more than one domain namely that which he makes his specialty he is always next to hear the uninitiated talk about his specialty because they treated always from the standpoint of the third or fourth derivatives but he who didn't but he does the same with their specialties handsome man who goes remorselessly to the bottom of things will never have wide influence and will appear to be an extremist so you know when you would you step out of the bounds of the way you are taught in treating patients you might be considered an extremist but I think there's some a lot of satisfaction and going to the bottom of things and learning to treat disease in a way that is measurable definitive and people feel better and are better able to respond to our witnessing in and influence of the Holy Spirit as well any questions is my backyard by the way no not really him to him too I was in fear and will him to the chlorhexidine is a good antimicrobial it tends to have some brown staining people like this close is because it tends to which the keep a little bit and I mean it's not that they're not use it for the rest of their life that it that you don't have the problem with the Brown stains is a fellow halitosis yeah because it's it's actually killing those bacteria is very few and yes with the LAPD we do have to use the mad anesthetic although this technique that the trainer just a few months ago taught us she was amazed how much she was able to do with without anesthesia we have a little EpiPen out of the unity of ever used that a little blunt tip that you can squeeze a talk on anesthetic gel type solution into the sulcus and that provides adequate anesthesia for most of the laser treatment without having to do a block that people that are the one to feel anything or know what's going on you know they will love just for your benefit you might want to do a block and helped any of the questions we are actually ten minutes early so this media was brought by audio nurse the website dedicated to spreading God 's word to read sermon audio and much more if you would like to know more about hothouse is good life is more certain than the visit www. audio tours .org

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