Platelet Rich Fibrin

What is platelet rich fibrin treatment?

Why would I care?

There are some surgical procedures that dentists do.  When the procedure is finished, such as an extraction of a tooth, there is a healing process.  One of the steps to healing is to get an area of trauma to clot and stop bleeding.   Blood has a lot of different things in it.   Mostly we think blood’s purpose is to carry oxygen in the red blood cells.   These red cells do very little to help wounds heal.  Platelets on the other hand do a lot to help things heal.  But platelets are a very minor percentage of whole blood.

When a tooth is extracted, there is a hole in the bone where the root of the tooth used to be.   This fills in with blood that over time clots into a fibrous mass that fills the void in the bone.  One of the first parts of the blood that helps that clot to start is the platelets.   After the clot has formed, the epithelium starts to grow over the top of the clot, which closes the wound after a few weeks.    Over time the bone fills in where this clot was, and you have solid bone after a few months of healing.

Some discomfort is expected during that initial healing time.   Mostly on the first day.  The body relies on the ingredients in blood to tell it to draw in the necessary chemicals and cells to fight infection and start the tissues to change into normal body parts.   Many of those  ingredients that trigger that reaction are in the platelet portion of blood.  If we could concentrate the chemicals that start things to heal and fill in the tooth socket with that concentration instead of red blood cells and plasma, the healing would go much faster and with much less inflammation.   And in the case of teeth, far, far less dry socket risk (which is when the clot separates from the bone).

To accomplish this we use platelet rich fibrin therapy.   Some blood is taken from a patient’s arm as if they are getting blood drawn for a blood test.   That is put in a centrifuge and spun around real fast for several minutes.  Red blood cells are heavy and settle to the bottom of the tube.   Plasma is light and comes to the top of the tube.   The platelets tend to congregate in the middle of the tube between those layers.

And after several minutes of this spinning, the fibrin in the plasma globs together and forms a clot, with the platelets sticking mostly to one end of this clotted fibrin.   By this time the tooth has been extracted, and the platelet rich fibrin clot is taken from the tube and placed in the socket where the root of the tooth was.   So right away the clot is well on its way to getting established and the platelets are there in greater numbers to tell the body to start sending in the things needed to heal the extraction site.

An oral surgeon that I refer frequently for wisdom teeth, has been using this treatment for years.   He taught me how along with several other general dentists in a class at their office a few years back.   His office was the first office in Arizona to use this new, and in my opinion, revolutionary procedure.  It sounded great.  But I have been to other lectures that make a product sound great in the lecture but then it wasn’t really that great,  so I didn’t consider doing it in my general dentistry practice.  Over time this procedure has proven to be very good, almost eliminating the occurrence of dry sockets, which if you have ever had a dry socket or know someone who has had a dry socket, you would avoid it if you could.  Other research and other oral surgery offices have validated the value of PRF since then as well.  Patients that I have sent to them have healed very nicely and without nearly the pain I would have expected them to go through after having wisdom teeth out.

I have become a believer and this year looked into what it would take to start offering this treatment on all of our extractions.   We have purchased the necessary equipment and have become trained so that now Valley of the Sun Dentistry can offer this in our office.

To learn more about this procedure from my mentors – and the pioneers who first used it after dental extractions in Arizona, follow this link:

https://azctr4implants.com/procedures/platelet-rich-plasma/

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Is Soda Bad for Your Teeth???

We’ve all heard soda is bad for your teeth. But how bad is it really? Does it matter how often you drink it? Isn’t diet soda better?

• Yes, it is bad. 
• Yes it does matter how often.
• Diet is usually not better, and maybe worse than regular sodas.

First of all let me explain why soda is bad. To explain that, let me explain how teeth decay. To get run of the mill decay you need:

• A tooth surface.  
• Bacteria to grow on that tooth surface. 
• Something for that bacteria to eat.  

The bacteria then produce acids that need to reach the tooth. These acids have to remain on the tooth long enough to dissolve the calcified enamel or dentin surface. The decalcified surface then has to be removed before it can re-calcify. 

Assuming you have at least one tooth, and it is in your mouth, then it has bacteria on it. I know of no way to totally disinfect a mouth. Teeth decay more easily in places where bacteria can accumulate the best:

• Pits and grooves on the chewing surface of the teeth.
• Between the teeth.
• Along the gum line.
• Margins of any fillings or crowns.  

In those places the lips and tongue don’t wipe plaque from the tooth as effectively and a toothbrush can’t reach easily. When enough bacteria collect, dental plaque forms from the bacterial secretions. This sticks the bacteria to the teeth even more, so heavier plaque builds up faster. With more and more bacteria present, the acids they produce are more concentrated. Bacteria can feed on any food or drink that you feed on. Things that are more easily digested and broken down to simple sugars will cause these acids to be produces faster. With soda, the sugars are easy to digest and break down. So the acid rush is on.

There are other ways to get acids on teeth that can break down enamel and dentin and cause cavitation. Did you ever take a bite of a lemon and feel the less than shiny surface your teeth now have?  Do they feel a little squeaky for a while when you bite and grind on them? The acid has roughened the surface of your tooth slightly.

What is in soda? Water. That’s OK. Sugar, which we just talked about. But that takes a few minutes to cause harm. Bubbly. What is the bubbly? Carbonate. Carbonated drinks have carbonate, which is Carbonic acid. So, instead of the bacteria producing the acids, soda just washes the whole mouth in acid! It is a mild acid, but it is still enough to slightly dissolve the surface of a tooth. 

What about diet soda? That’s OK, right? No sugar? Well, not so much. Instead of sugar, there are other sweeteners, but they don’t taste quite like sugar. So, other flavor enhancers are often added. Some of which are other mild acids! A few of these are citric acid, phosphoric acid, malic acid, benzoic acid, and erythorbic acid.

Sports drinks? Lots of acids in those ingredients.

Orange juice? Citric acid. Very acidic. Not as acidic as grape juice or cranberry juice, though.

How much is too much? Well, it is not how much, it is how often. If you drink a swallow of soda the sugar and acids are on your teeth for several minutes. If you drink a quart of soda all at once, the acids are on your teeth for several minutes. Either way, it takes the teeth 30 minutes to an hour to return to its normal condition. If you have a container of soda and every few minutes take a sip from the straw, then the acids are on your teeth for several minutes every time you take a sip. That is a lot more time eating away at enamel.  

So, what do I do?

I realize that we are all going to continue to drink beverages that can erode the enamel from teeth. Very few people will stop drinking all these things. What can be helpful, then is to limit the frequency we ingest these drinks. And don’t take so long to drink it, just get it done.  There are other drinks that don’t hurt the teeth. Water is great. Milk is a good one. Also, there are ways to make your teeth more resistant to acids. The easiest and proven to be a very effective way is to always use a toothpaste with fluoride.  Our dental office can prescribe a paste that is prescription strength fluoride. Please call our office at 602-942-4260 so we can answer any questions you may have.

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What Toothpaste should I use??

A common question we get is “what is the best toothpaste?”. My usual answer is “that depends on what you want it to do!”. When I was in college my dentist told me toothpaste was just soap. I quit using it for a while. But I changed my mind and started using it again. Toothpaste is a key part of our daily routine. Along with your toothbrush and floss it helps to clean your teeth and gums. But all are not all the same.

My second answer is to use whatever you like the taste of. I grew up with one major brand. I like the taste of it. Probably because that is what I was used to. Another brand gives us more free samples nowadays, so now I usually take that home. But I don’t like the taste of it, to the extent that I avoid using it. It makes my mouth burn.

Then there are the toothpastes that claim to do something extra for you. And they usually do. But there are usually some side effects.

Whitening toothpastes usually do make your teeth whiter than they would be if you did not use them. All teeth darken over time, so you may not see them get whiter, but they may not darken as fast, and so it would have been worse. To really lighten your teeth, we do offer bleaching, which usually makes a big difference.

But, the whitening ingredient is usually hydrogen peroxide, and will make you teeth more sensitive to cold. For most people that is not a big deal, but if you already have teeth sensitive to cold, it may be noticeably more sensitive.

The same goes for tartar control toothpaste. It does help the calculus to not build up as fast. But it also makes teeth more sensitive to cold.

Some patients have sensitive mucosa. The epithelium in your mouth sometimes gets sores due to some ingredients in toothpastes. Sodium Lauryl Sulfate is used to help toothpaste foam. But in some people it gives them apthous ulcers on the skin in their mouth. These canker sores last about two weeks and can be very sore. So sore they make people think they are getting an abscessed tooth they hurt so badly. But once they heal and go away, then the toothache goes away, too.

There are toothpastes that are designed to make teeth less sensitive to cold. And they usually work quite well. They may take 2-4 weeks to work. But I recommend these almost daily.

Another good product are toothpastes for those with dry mouth. Sometimes for various reasons, usually some medical treatment, salivary glands just don’t produce as much saliva as they used to. These toothpastes coat the mouth and make it feel wetter.

The one important ingredient that I do tell patients to look for is fluoride. There is no question that fluoride will lessen the rate that teeth decay. I know there are those who are convinced that fluoride is poison. And that is their choice to not use it. But they will experience more cavities.

For those who have reached a point in their life where teeth are decaying rapidly, there is a prescription strength toothpaste that has a higher fluoride content than can be dispensed over the counter. It really helps cut down on the amount of decay we see.

So, my final word is: If you like your toothpaste, you can keep your toothpaste. But if you want to try something different, experiment and see what works for you. Again, though, if you don’t like the taste and you don’t use it because of the taste, it isn’t helping. Use something you like the taste of.