Dr. Eberts:

Okay, so the first service we want to address is your comprehensive exam and diagnosis. What would you say the major purpose of that is? What are the problems that are addressed?

Dr. Sambataro:

We conduct the exam so we can gather important information about you, such as your medical history and the current status of your oral health. Based on that, I can give you feedback and design a plan that is personalized for you.

Dr. Eberts:

Okay. And the comprehensive nature; what is it that makes it comprehensive?

Dr. Sambataro:

Well, because we cover every aspect of your oral health, including X-rays, a visual exam and an exam using an intra-oral camera that magnifies the mouth, just to make sure that we don't leave anything undetected.

Dr. Eberts:

So, in a sense, you're not just looking in my mouth and looking at my teeth. There are some specific things that you do to go above and beyond just a simple cursory examination of what my teeth look like and my gums look like.

Dr. Sambataro:

Right. We'll want to look for any irregularities. We'll want to look for things that may be contributing to overall health problems, or things that are already showing up in the early stages as a consequence of oral disease or systemic disease.

Dr. Eberts:

Okay. And, what's good about this? Why would I want to do it?

Dr. Sambataro:

A number of reasons: One, to provide enough information to design a plan to move you into a position where you have long-term oral health. And, as a consequence of that, some longevity in terms of your overall health.

So, rather than just fixing or patching as you go along, here's a treatment plan specifically designed for you. And we can't do that if we leave anything out.

So, whether it's looking at the gums, looking at your bite, looking at the teeth, looking at the soft tissue... if we leave anything out, it could be detrimental in terms of creating this long-term oral health and general health.

Expected Results

Dr. Eberts:

Okay. So, in essence what you're saying is that the results that I'll get out of this comprehensive exam is a fairly extensive picture, or a mapping, of the state of the health of my mouth, which also then represents the state of my whole body, my general health.

And in mapping out this process, the extent of whatever may or may not need to be done, that I can expect that if I follow those procedures, if I get this work done, not only will my teeth be better and my gums be better, but that I'll actually have improved health.

Dr. Sambataro:

Right. This is because there is a direct relationship between your oral health and general health.

Process

Dr. Eberts:

And, tell me just a little about the process. What can I expect when I am coming in? As I walk in the door, what's the sense of what's going to happen?

Dr. Sambataro:

Well, there may be some paperwork involved, which can be filled out ahead of time by mailing it or even getting it online. You'll be greeted by a staff member, who will introduce you to other staff members.

You'll initially be seen by Cindy, the hygienist, who will review your medical history and try to get some sense of why you're here, what you're looking for, what you are looking to accomplish, what motivated you to come to this particular office.

And then based on that, start to do a cursory exam, looking in your mouth, looking for any irregularities in the soft tissue...

Dr. Eberts:

By soft tissue, do you mean like my gums?

Dr. Sambataro:

Your gums, your cheek, your tongue, the back of your throat. She'll also see if there are any restorations in your teeth and what are they made out of?

So, that's all done visually and then we'll magnify what we're seeing by using an intra-oral camera to get a better view, which can also be printed as a photo.

Dr. Eberts:

It's a video camera?

Dr. Sambataro:

Yes, a video camera. And you'll be able to see that on the screen as we're doing that, so you'll get a better understanding of what we're looking at. And then we'll follow that up with X-rays to look at those things that aren't visibly evident.

Dr. Eberts:

Okay. X-rays are a little scary because I know there is some issue in terms of cancer and that kind of stuff. So, what do you do about that? Is there something special about what you offer?

Dr. Sambataro:

All of our X-rays are digital, so the amount of radiation is reduced by at least 70% of your typical, standard X-rays.

The other advantage of that is that we can't really take any bad X-rays. If the X-ray comes out too dark, we can lighten it. If it comes out too light, we can darken it.

Dr. Eberts:

So, you don't have to redo the X-ray.

Dr. Sambataro:

Exactly. And we have the immediate results that day. So, if you're really curious and interested, we can give you a copy of that, versus having to run the X-rays in the processing machine and wait for them to come out.

And if they are not acceptable we have to call you back to retake some of the X-rays.

Dr. Eberts:

Okay.

Dr. Sambataro:

And then, the reality is you can look at the digital X-rays and actually see what we're talking about, which is very difficult to do with the standard X-rays.

Dr. Eberts:

Right. How long does this whole process take?

Dr. Sambataro:

This depends on how much we talk and if all the tests are necessary. You're going to be here probably about an hour and a half.

Dr. Eberts:

Now, following the collection of all of this data... all of the X-rays and looking in the mouth and the internal camera, what happens then?

Dr. Sambataro:

First, we will have a consultation to finalize the plan so that you and the doctor are on the same page in terms of what you are really looking to accomplish.

Then, the doctor will evaluate all the records, your comments on what you're looking for, what motivated you to come here, your medical history, and then design a plan for you to evaluate and approve.

Dr. Eberts:

And, who is this consultation done with?

Dr. Sambataro:

Strictly with the dentist.

Dr. Eberts:

With the doctor, okay.

Dr. Sambataro:

And you're welcome to bring any of your family members. In fact, we encourage the spouse to attend the consultation.

Dr. Eberts:

Alright. Moving on to number two, nonsurgical treatment and prevention of gum disease. So, what's the purpose of that?

Dr. Sambataro:

The purpose is to create healthy gum tissue without the use of drugs or surgical procedures.

Dr. Eberts:

Why is that important?

Dr. Sambataro:

One, because it's a more conservative and less traumatic way to treat the problem with even better results because we are addressing the cause more so than the symptoms.

Surgery is dealing only with eradication of the symptoms that have evolved as a consequence of an acute or chronic problem that has not been addressed.

So, nonsurgically, we can look at the causes of this imbalance that has allowed the gums to bleed, what's causing the increase in the number of bacteria that are allowing this disease to continue.

Results would include establishing long-term healthy gums, versus the surgical route, which is going to treat just the current symptoms. If you don't address the causes of it, you're going to be back in here for more surgery.

Dr. Eberts:

Gotcha.

Dr. Sambataro:

And, if we haven't addressed the causes, we're really not creating improved overall health because of the connection between oral health, gum disease, and overall health, typically cardiovascular disease, stroke, and diabetes.

So, even if we correct the gum problem now by surgically cutting your gums, we really haven't done a service to you.

Expected Results

Dr. Eberts:

I see. So, the intended results then are to decrease the likelihood that I'll have these other kinds of issues, like heart disease and diabetes and those kinds of things?

Dr. Sambataro:

And to reduce the potential of losing your teeth. At some point, we can't do surgery anymore because there's nothing left. There's no more gum to cut away.

Now, in some cases, in an acute situation, surgery may be indicated because the symptoms have gotten so bad that we just want to address the immediate problem. And these acute problems could be life threatening.

Dr. Eberts:

Alright.

Dr. Sambataro:

But for long-term health, we've got to look at what the cause is so that we can resolve the chronic issue of the problem.

Process

Dr. Eberts:

And, give me a sense of the process that I can expect. What's going to happen if I come in for this nonsurgical treatment?

Dr. Sambataro:

Well, first it's going to involve an evaluation. Part of that would have occurred during your comprehensive exam; things like evaluating bleeding and even measuring the pocket depths around the teeth, which are generally considered a criteria for measuring inflammation or disease.

What we will want to do is look at what is the current status, because pocket depth doesn't tell you what's currently happening; only what's happened in the past.

We're going to take two different tests. One's called Topas, which measures toxicity levels in the tissue, and two, take a sample of your plaque and look at it under a microscope so that we can see what organisms are in the gum tissue - are these harmful or non-harmful bacteria.

We then start a two-fold approach: 1) eradicating, or at least reducing, the numbers of pathogenic, or bad, bugs and 2) boosting your immune system through nutritional support.

Dr. Eberts:

And, give me a sense of how long this process might take.

Dr. Sambataro:

Well, I guess a part I left out is teaching you and enabling you to carry out daily oral hygiene, with improved brushing techniques, flossing, using an oral irrigator, using some anti-infectant rinses and then doing follow-up on that every two weeks, until we see some improvement and resolution of the problem.

Your treatment may initially include some scaling by the hygienist to remove the hardened, crusted tartar that's formed on the teeth. This tartar allows bacteria to cling to the tooth structure and also prevents you from adequately cleaning, which then acts as an irritation, creating inflammation.

So this would continue until we see some improvement. A lot of that would have to do with your daily commitment and with us really making a good diagnosis as to what those particular bugs are. Also, your constitution and your overall health may determine how you're going to heal.

If you have other health issues, it may be necessary to include some other practitioners to address those particular issues, especially if you have digestive problems or compromised immunity.

Dr. Eberts:

So, I understand that the length of treatments is going to depend upon a number of factors, including how much effort I put into it and the state of my health overall. Just assuming I have average health, I don't have any serious problems, but there is some gum disease there, could you give me a ballpark figure? I mean, are we talking a couple of weeks, a couple of months, a couple of years? What are we looking at in terms of length of treatments?

Dr. Sambataro:

Well, I think it could probably be divided into different classifications, from basic gingivitis, which is just inflammation of the gums, versus someone who has severe periodontitis, which is inflammation and loss of bone and sometimes rapid bone loss, which would be a very intense infection.

You're going to obviously see different resolutions, but a lot of that has to do with your daily commitment. So, in the case of the more severe, if they are committed, I think you would see some resolution in a period of three months. If you're on the other level where you just have gingivitis, maybe a couple of weeks with the right practice.

It's really multifactoral: 1) based on your present status and 2) what your commitment level is to that... and probably a third factor is what your overall heath and constitution are.

Dr. Eberts:

Gotcha. Okay, number three, mercury amalgam removal. So, what is the purpose of mercury amalgam removal?

Dr. Sambataro:

The purpose is to eliminate a known toxic substance that has been implanted into the teeth of many Americans, and of course many people around the world. So, in this highly toxic world, the purpose is to remove one more toxin that is readily and easily taken out of your environment.

The purpose would be to reduce the burden to your body, because you are already exposed to so many other toxins in the air, chemicals in your food, emotional toxins, etc. This provides an opportunity to replace this toxic substance with something that resonates and is more biocompatible with the human body.

Also, it is now clear that this material is mechanically and physically destructive to the tooth because of its physical corrosive nature, causing the filling to leak and allowing bacteria to grown underneath it

This material is also destructive because of the way in which the material was implanted in the tooth, creating large undercuts, allowing unsupported tooth structure there, creating a wedge that will, at some point in time, fracture part of the tooth off.

So, mercury amalgam is unacceptable, not just because of the toxic aspect of it, but also because of its structural, mechanical weakness, resulting in the fracture of teeth, which then could lead to root canal therapy or extraction.

Expected Results

Dr. Eberts:

And what are the intended results? What can I expect from this?

Dr. Sambataro:

Well, certainly a major benefit is that you're going to eliminate a structural weakness that this material created in the teeth. So, if nothing else, the teeth will not be as brittle, not as susceptible to fracture.

On a more systemic scale, we're eliminating a potential toxin that's being released into your body. Many patients will experience a relief of symptoms, such as facial pain, sometimes a metallic taste in their mouth, a burning of their tongue, even the reduction of fatigue and anxiety. That varies from one patient to the next and a lot of this is just anecdotal, but there's certainly enough literature to support the benefits of why you'd want to take this out of the mouth.

Dr. Eberts:

So, you're suggesting that this is another example of, through this comprehensive examination and treatment protocol, that I can have some expectation that my general health may improve?

Dr. Sambataro:

Correct. Many patients report improvements.

Dr. Eberts:

Not that it's guaranteed, but there is a possibility the my health will improve generally?

Dr. Sambataro:

Obviously, there is no guarantee because there are many factors involved in reestablishing one's health.

Mrs. Eberts:

So, why don't the white fillings... why doesn't stuff get underneath them like the amalgam fillings?

Dr. Sambataro:

Because of the process in which they are placed. The amalgam is mixed to create a soft, condensable material which is basically stuffed into the center of the tooth. There is no chemical linkage between the amalgam material and the tooth structure.

The white material is bonded to the tooth through the use of a bonding adhesive, which will link the internal tooth structure to the white filling material. There truly is a cross-linking mechanical and chemical retention that will not allow leakage to occur.

Dr. Eberts:

Good.

Dr. Sambataro:

And since it's non-metallic, there's no corrosion either. The material does wear with time but can be restored without removing the entire filling.

Process

Dr. Eberts:

And what's the process of this? What can I expect?

Dr. Sambataro:

The process involves protecting you first of all, as well as myself and my staff during the removal. Because it's toxic, we do not want to breathe it while we're drilling it out. We also don't think it's a good idea for patients to breathe it due to the proximity of the nasal passage.

We also don't want you swallowing any little pieces, so the process will involve placing a small, rubber "raincoat" over the teeth that will prevent you from swallowing any of the toxic material.

You will be administered oxygen during the process so you're not only oxygenating the system, but you're also preventing breathing of the material as it's coming out.

The remaining part of it is going to be somewhat similar to what you have done any time you replace a filling. But as an extra precaution we're not going to go in there and just pulverize the material. We're going to section it carefully and pry the pieces out so there's less vapor produced, because it's the vapor that's dangerous. When you heat the material up through the high speed drill, the mercury vapor that is released is even more toxic.

So, the most important thing in this removal is to protect you during the process and to protect the teeth so that they're not over-traumatized.

One thing we want to prevent, since you're making an effort to get the mercury out, is for you to end up with more problems with your teeth, requiring root canals or extractions.

Understand that the removal process is traumatic. The tooth is living tissue and we want to do this a-traumatically. This way, when we remove the mercury amalgam and place the new material, the body will allow the teeth to heal in a normal fashion.

Dr. Eberts:

Is there some preparation for this, in terms of what gets done before the teeth are removed or after the amalgams are removed, what is that about?

Dr. Sambataro:

Well, based on your current health status, we might recommend that you be seen first by a health practitioner, such as a naturopath or alternative physician, to make sure your system is prepared for this process, once again to protect you. So we may not even start the process till they feel like you're ready for removal.

If you're fairly healthy and you're doing this proactively, we have a list of recommended supplements that will give you some protection, such as Vitamin C, Methionine and Glutathione.

And obviously a healthy diet, including fruits and vegetables and adequate sources of protein, are going to also make the whole process easier for you. If you've ever experienced any detoxification, you'll know that it's not a very fun experience, so we want to reduce that.

And following all removal, we will then refer you to someone who can help you through a detoxification program, if you're interested. Understand getting it out of the mouth is only the first step. Then, you'll want to make some commitment to getting it out of the rest of the body.

Dr. Eberts:

Especially the brain, the kidneys and the liver.

Dr. Sambataro:

Yes, liver, kidneys, brain. Yeah. And any other organ that it might have found its way to.

Dr. Eberts:

Okay, cavitation testing and treatment. What is the purpose of this? Why would you do this?

Dr. Sambataro:

Cavitations are literally a hole in the bone, so it's a hole in the bone that was left from chronic infection or improper debridement of a socket. When that tooth was removed, if there was any infection in there that was not thoroughly cleaned out, or the ligament that attaches the tooth to the bone is not completely removed, then what you have is incomplete healing of the socket, resulting in this hole in the bone. These holes are generally small and cannot be picked up on an X-ray, even a digital X-ray.

That's why we use this very specific machine called a Cavitat... it was named because it helps diagnose cavitations. For an X-ray to pick up holes in the bone there has to be approximately 60% or more bone loss. A Cavitat, using ultrasound, will show bone discrepancies and changes at 10%, so it's a much more accurate way of detecting these things.

And the reason you want to address these chronic bone infections is that they release toxins into the body, which create havoc with your immune system and potentially other systems like your circulatory system.

Expected Results

Dr. Eberts:

So, what are the benefits of this cavitation testing? What are the Expected results behind this?

Dr. Sambataro:

First to determine if cavitations are present, where they are located and the extent or severity of them. A treatment plan will then be developed to eliminate these jaw infections that you may or may not be aware of... .more than likely you're not aware of. Think of any infection that may be occurring in your body. You'd want to eliminate that.

Sometimes these asymptomatic, chronic infections are debilitating to your overall health. And we don't know what the potential problems could be on each individual. But patients have experienced improvement upon removing these cavitations, such as the elimination of chronic fatigue, fibromyalgia, facial neuralgias and TMJ problems.

So there has been clear evidence that any chronic infection has a direct effect on the clotting mechanism of the circulatory system such that it could create increased thickness of the blood, which they call hypercoagulation.

That obviously could lead to cardiovascular problems and could be the reason for your chronic fatigue. You're trying to move thicker blood in the same size vessel and it's going to reduce oxygen and nutrients to the body.

It's important to treat these cavitations.

Process

Dr. Eberts:

Yeah. Let's do that. And what is the process? What can I expect to go through?

Dr. Sambataro:

The diagnostic part of it is the ultrasound, which is a very easy process. We have a machine that basically is made of two parts; a transducer and a receiver. The transducer sends a signal through the skin and across the jawbone. And on the other side we'll have aloe as a medium to allow the receiver to pick up the signal.

The signal is sending sound through the bone and if the bone is hollow, it's going to create a different interpretation than if it's solid. Based on that, we're going to get some readout that we'll be able to pinpoint not only if there is infection, but where is it localized? Is it in the upper jaw, the lower jar, is it around a root canal, is it where you had an extraction?

Based on that, and what the severity of the infection is, there are several approaches to its elimination. Either a nonsurgical approach, which is trying to detoxify the jaw, or a surgical approach where we're actually opening up the cavitation in order to clean out the infection by scraping and removing the debris which will allow new blood to circulate into that hole. This would then allow normal healing to occur.

However, before either approach, we will want to make sure that you can heal properly, that you have the proper nutrients and that your immune system is strong enough and your circulatory system is strong enough.

If we treated surgically, you could expect some tenderness for a few days. This procedure does involve the use of a local anesthetic. In comparison to an extraction, it's a lot less traumatic.

Dr. Eberts:

Now, the Cavitat measures differences in bone density, indicating that there may be these holes that you're talking about, but it doesn't directly measure infection. So, what is the correlation between these variances in bone density or the presence of these holes and infection? Is it like 100 percent or 50 percent? Is there some data that suggests there's a good correlation there?

Dr. Sambataro:

The studies show there's about a 90 to 95 percent correlation between what's found on the Cavitat and what's found once the areas are surgically opened.

Dr. Eberts:

You mean in terms of infection?

Dr. Sambataro:

Yes. Infected bone and soft tissue.

Dr. Eberts:

Okay.

Dr. Sambataro:

So, when he site is opened up, there is visible evidence of infection. The material that's removed from there is sent off for a biopsy and there is about a 90 to 95 percent correct correlation between what was initially found on the Cavitat and what is returned from the lab.

Dr. Eberts:

Excellent.

Dr. Eberts:

Good. Jumping ahead now to restorative treatment. What is the purpose of restorative treatment?

Dr. Sambataro:

Well, part of that is what we discussed in the amalgam removal, why you want to remove the mercury amalgam. To properly restore the teeth, you want to make sure that you are providing an adequate restorative material that's going to support the strength and integrity of the tooth for a number of reasons:

One, not only to provide longevity, but also to insure less treatment and less lost time and less frequent visits to the dentist.

There's a fine line between finding a biocompatible material that also has the strength and durability. And there are materials available. So, to explain that further, we would not want to use something that may be the most biocompatible but it only lasted for a couple months.

The downside of that is having more frequent visits, more trauma to the tooth, higher probability that the tooth's going to die, and you end up with a root canal or extracting the tooth.

On the other hand, you don't want to use some material that may be very durable but highly toxic. So, in the process of restoring the tooth, you have to make a judgment based on the amount of tooth structure that's remaining, the condition of the overall health of the patient and whether they have any detrimental habits that may be causing excessive occlusal trauma, such as clenching or grinding.

In determining the proper restorative material, you have to take all those things into consideration, and in most cases nowadays, is it aesthetic? You know, gold is a very durable product, but it is metallic and the body doesn't necessarily resonate well with it, but even if it did, would you want to put it on a front tooth?

So, there's a lot that's involved in deciding one, what is the proper restorative material for that patient based on their current condition, two, understanding all the options of restorative material, and, three, what is going to create the durability and longevity.

From my perspective, it is better that they don't have to replace that material too often. Even if it looks nice, if it's going to break down, to me it's more important that you don't have to drill the tooth again.

Expected Results

Dr. Eberts:

So, at least some of the intended results from your restorative treatment is that I can expect to have less frequent visits?

Dr. Sambataro:

Right, which is less costly, less traumatic to you emotionally, but I think even more important, less traumatic to the tooth.

Because, for me what's most important is that you don't end up with the need for a root canal. To me, I'd rather have some non-biocompatible material than have a root canal, to be honest with you.

And I think that unfortunate result is quite common. What happens is that a small filling ends up being a moderately-sized filling, which then becomes a large filling, which then fractures, requiring a crown, which then caused further trauma, killing the tooth and requiring a root canal done through the crown or replacement of the crown, and ultimately a potential infection that requires the removal of the tooth and replacement of it with a bridge or implant. So, that's the scenario.

Process

Dr. Eberts:

So, what is the process? What can I expect in terms of how this will unfold; this restorative treatment?

Dr. Sambataro:

First, during the comprehensive exam, where we're looking at the teeth clinically, visually, I should say, then with an intraoral camera and then X-rays. All of this will help us determine the current status of the tooth and what's going to be in the best interest to allow this tooth to last a long period of time.

That may involve removing the old filling, cleaning out the decay, and then what's very important and new that we're doing now, we're using a stain to apply inside the tooth to see if there's any remaining decay.

The standard criteria for decay is we look at it and see if it looks decayed and does the instrument stick in it? And if it doesn't do either one of those, we assume there is no decay. But, could there be sub clinical or histological (microscopic) decay?

Applying the stain and then rinsing it off will show up as remaining stain if it's still decayed. It allows you to then further remove that decay.

Then, the next part of that is to sterilize, or I should say disinfect, the tooth before you place the new filling, and we do that with a laser.

So, the difference in typical restorative is not only finding the right material that's going to be best for the tooth. It also includes

•  safely removing the decay and then

•  checking that you've removed all the decay,

•  disinfecting the tooth, and then

•  properly restoring the tooth,

•  etching, bonding;

•  if it's small a composite may be adequate, but if more tooth is missing, an inlay or onlay is used, which is made out of a ceramic material which has a higher density and is much harder, or

•  if there's an extensive amount of tooth structure loss, then placing a cap, or a crown, over the top of the remaining tooth structure.