Extreme Practice Makeover

Extreme Practice Makeover Let’s play a game and learn the new products and technology we need in our clinics.

Few industries in the world have a day to day experience with such a unique combination of healthcare, technical expertise, and even art the way dentistry does. Just when things seem to become mundane, a new technology emerges to make things easier for a patient, more profitable for the practice, and more exciting for the practitioner. At times it is hard to keep up with all the changes, but it is those changes that keeps our competitive edge and makes better practitioners.Looking around most offices, there is an amalgamation of new and old equipment. Sitting next to the CAD/CAM machine in the lab is a belt driven handpiece. A twenty year old dental chair sits up to view digital x-rays on a high-resolution LCD monitor. Most offices are due for an upgrade, and it’s hard to tell where to start the process. At Dentalcompare, we strive to bring you the latest information on products and technology to keep your office improving rather than decaying with time. We will show how to regain excitement at your office, streamline your day, and help you with your own Extreme Practice Makeover. http://www.dentalcompare.com/epm/

Oral Cancers

The demographics of those who develop this cancer have been consistent for some time. While the majority of people are over the age of 40 at the time of discovery, it does occur in those under this age. Exact causes for those affected at a younger age are now becoming clearer in peer reviewed research. There are links to young men and women who use “smokeless” chewing or spit tobacco. Promoted as a safer alternative to smoking, it has in actuality not proven to be any safer to those who use it when referring to oral cancers. Tobacco companies have started campaigns to promote the safety of smokeless, but it is clear that while it may reduce lung cancers, it has a negative effect on the rates of oral cancers, pancreatic cancer, periodontal disease, and the chronic infections that it produces may even link it to heart disease as well. The gains against lung cancers likely will be offset by losses in other areas.

It is also possible that those in this younger age group have a causal link which is viral based, since the amount of time they have been exposed to other known causative agents such as tobacco is short. The human papilloma virus, particularly versions 16 and 18, has now been shown to be sexually transmitted between partners, and is conclusively implicated in the increasing incidence of young non-smoking oral cancer patients. This is the same virus that is the causative agent in more than 90% of all cervical cancers.

From a gender perspective, for decades this has been a cancer which affected 6 men for every woman. That ratio has now become 2 men to each woman. Again, while published studies do not exist to draw finite conclusions, we will probably find that this increase is due to lifestyle changes, primarily the increased number of women smokers over the last few decades. It is a cancer which occurs twice as often in the black population as in whites, and survival statistics for blacks over five years are also poorer at 33%, versus 55% for whites. As in the above examples, it is unlikely we will find a genetic reason for this. Lifestyle choices still remain the biggest cause. These published statistics do not consider such socio-economic factors as income levels, education, availability of proper health care, and the increased use of both tobacco and alcohol by different ethnic populations, but all these factors likely play a role in who develops the disease.

One of the real dangers of this cancer, is that in its early stages, it can go unnoticed. It can be painless, and little in the way of physical changes may be obvious. The good news is however, that your dentist or doctor can see or feel the precursor tissue changes, or the actual cancer while it is still very small, or in its earliest stages. More about the stages of cancer It may appear as a white or red patch of tissue in the mouth, or a small indurated ulcer which looks like a common canker sore. Because there are so many benign tissue changes that occur normally in your mouth, and some things as simple as a bite on the inside of your cheek may mimic the look of a dangerous tissue change, it is important to have any sore or discolored area of your mouth, which does not heal within 14 days, looked at by a professional. Other symptoms include; a lump or mass which can be felt inside the mouth or neck, pain or difficulty in swallowing, speaking, or chewing, any wart like masses, hoarseness which lasts for a long time, or any numbness in the oral/facial region. Other than the lips, the most common areas for oral cancer to develop are on the tongue and the floor of the mouth. Individuals that use chewing tobacco, are likely to have them develop in the sulcus between the lip or cheek and the soft tissue (gingiva) covering the lower jaw (mandible). In the US, cancers of the hard palate are uncommon, though not unknown. The base of the tongue at the back of the mouth, and on the pillars of the tonsils, are other sites where it is commonly found. If your dentist or doctor decides that an area is suspicious, the only way to know for sure is to do a biopsy of the area. This is not painful, is inexpensive, and takes little time. It is important to have a firm diagnosis as early as possible. It is possible that your general dentist or medical doctor, may refer you to a specialist to have the biopsy performed. This is not cause for alarm, but a normal part of referring that happens between doctors of different specialties.

After an informed public that is knowledgeable about the risk factors for oral cancer, the dental community is the first line of defense in early detection of the disease. Including both generalists and specialists, there are over 100,000 dentists in the US, each one seeing between 8 and 15 patients per day. If you include those patients who come to a practice and see someone other than the dentist, such as the hygienist, the number of patient visits is significantly higher. The American Dental Association states that 60% of the US population sees a dentist every year. Just doing “opportunistic” cancer screenings of the existing patient population which visits a dental office every day, would yield tens of thousands of opportunities to catch oral cancer in its early stages. One of our goals is to initiate an effort within the dental community to aggressively screen all of the patients who visit their practices. At the same time we are launching a public awareness campaign. This campaign is intended to drive public awareness of oral cancer, and to instill in the publics mind the need for an annual screening for this disease. One only has to look at the impact of the annual PAP smear, mammogram, and prostate exam, to see how effectively an aware and involved public can contribute to early detection, when coupled with a motivated medical community. The dental community needs to assume this same leadership role if oral cancer is to be brought down from its undeserved high ranking as a killer.

Published studies show that currently less than 15% of those who visit a dentist regularly, report having had an oral cancer screening. This is unfortunate, when you consider that historically, the greatest strides in combating most cancers have come from increased awareness and aggressive campaigns directed at early detection. It is now commonplace to annually get a PAP smear for cervical cancer, a mammogram to check for breast cancer, or PSA and digital rectal exams for prostate cancer. These screening efforts have been possible as a result of the increased public awareness of the value of catching cancers in their earliest forms, combined with effective technologies for conducting the examinations. Oral cancer is no different. Actually, it is potentially easier to obtain public compliance for oral cancer screenings, since unlike many other cancer screening procedures, there is no invasive technique necessary to look for it, no discomfort or pain involved, and it is very inexpensive to have your mouth examined for the early signs of disease. Education of the public regarding the risk factors which lead to oral cancer, and the development of public awareness, are primary responsibilities of the dental community.

İmportant that both private individuals, and members of the dental community, realize that a visit to the dentist is no longer about a filling, a crown, or a postponable cleaning, but is actually a matter of life and death. Dental examinations, when properly done and which include a screening for oral cancer, will save lives. If you are a dental professional, we encourage you to become a member of the foundation, and partner with us in this effort to increase the number of annual screenings which are being done. Please check the member’s only area of our site which discusses the issue from a practice management perspective, and where you can find resources to assist you in the incorporation of a comprehensive cancer screening program in your practice.

Discovery and diagnosis

Historically, it has been difficult to determine which abnormal tissues in the mouth are worthy of concern. The fact is, the average person routinely has conditions existing in their mouths that mimic the appearance of pre-cancerous changes, and very early cancers of the soft tissues. One study determined that the average dentist sees 3-5 patients a day who exhibit soft tissue abnormalities, most of which are benign in nature. Even the simplest things, such as a canker sore (herpes simplex), the wound left by accidentally biting the inside of your cheek, or sore spots from a poorly fitting prosthetic appliance or denture, all at first examination, share similarities with dangerous lesions. Some of these conditions cause physical discomfort, others are painless. The question is which ones deserve action, and which ones bear watching and waiting?

There has been a tendency to watch these areas over an extended period to determine if they are dangerous or not. Unfortunately, this philosophy leads to a situation in which a dangerous lesion may continue to prosper and grow into a later stage, hard to cure cancer. Any sore, discoloration, induration, prominent tissue, irritation, hoarseness, which does not resolve within a two week period on its own, with or without treatment, should be considered suspect and worthy of further examination or referral. Besides a routine visit to the dental office for regular examinations, it is the patient’s responsibility to be aware of changes in their oral environment. When these changes occur, they need to be brought to the attention of a qualified dental professional for examination. The dental professional needs to be current in the knowledge base necessary to make a proper diagnosis, and be competent in the proper screening procedures to identify oral cancer.

How to know if you have had a proper oral cancer screening

There are two separate issues, discovery and diagnosis. Discovery is the result of a thorough visual and manual examination. A protocol for a comprehensive oral cancer screening appears elsewhere in this section of the web site. It includes a systematic visual examination of all the soft tissues of the mouth, including manual extension of the tongue to examine its base, a bi-manual palpation of the floor of the mouth, and a digital examination of the borders of the tongue, and the lymph nodes surrounding the oral cavity and in the neck. New diagnostic aids, including lights, dyes, and other techniques are beginning to appear on the marketplace. While making the discovery process more effective, it is still possible to do a comprehensive examination through a proper visual and tactile process.

Click here for additional information on screening

Once suspect tissues have been detected, the only way a definitive diagnosis of oral cancer may be made is through biopsy. Given the large number of tissue abnormalities a dentist sees every day, it is not logical, nor practical, that each one of these be biopsied. The first question which may help in the determination of which abnormality bears closer examination, is how long has the suspect condition been present? Any condition that has existed for 14 days or more without resolution should be considered suspect and worthy of further diagnostic procedures or referral. Certainly, it is common knowledge that two of the most prevalent lesions that mimic oral cancer, are the herpes simplex ulceration, and aphthous ulcerations, each resolving of their own accord in approximately 10-14 days. Perhaps that sentence should be underlined, since one of the most common diagnoses received with referred patients to a major university cancer pathology department is “an atypical herpetic/aphthous lesion” These all too frequently turn out to be squamous cell carcinomas, which have been under observation…. for several months.

Still, it would seem impractical at these early timelines to engage in biopsy. A oral biopsy brush is available that makes this decision to get an early diagnosis through biopsy easier to make. Simple, painless, and accurate diagnosis of soft tissue abnormalities can be obtained through its use.

Detailed description of brush cytology, and the oral brush biopsy.

Note that this system is not designed to provide the kind of information, specifically cellular architecture, that would be obtained through a punch or incisional biopsy. But it will provide an answer to the question of whether malignancy exists or not, through a quick, minimally invasive, and inexpensive procedure. Should positive results be returned through this system, the brush biopsy must be followed by a conventional biopsy procedure for confirmation. The strong argument for the brush biopsy is that it eliminates the waiting and watching of a suspicious lesion, while it develops from a highly treatable and curable, early stage localized cancer, into a life threatening late stage malignancy. Positive identification of oral cancers at the earliest stages, result in the best prognosis for cure and long-term survivability.

Creating awareness, discovery, diagnosis, and referral. When it comes to oral cancer and saving lives, these are the primary responsibilities of the dental community. The most important step in reducing the death rate from oral cancer is early discovery. No group has a better opportunity to have an impact than members of the dental community.

Start a dialog with your patients today. Even if talking about cancer with them is difficult, there are mechanisms around this.

After an informed public that is knowledgeable about the risk factors for oral cancer, the dental community is the first line of defense in early detection of the disease. Including both generalists and specialists, there are over 100,000 dentists in the US, each one seeing between 8 and 15 patients per day. If you include those patients who come to a practice and see someone other than the dentist, such as the hygienist, the number of patient visits is significantly higher. The American Dental Association states that 60% of the US population sees a dentist every year. Just doing “opportunistic” cancer screenings of the existing patient population which visits a dental office every day, would yield tens of thousands of opportunities to catch oral cancer in its early stages. One of our goals is to initiate an effort within the dental community to aggressively screen all of the patients who visit their practices. At the same time we are launching a public awareness campaign. This campaign is intended to drive public awareness of oral cancer, and to instill in the publics mind the need for an annual screening for this disease. One only has to look at the impact of the annual PAP smear, mammogram, and prostate exam, to see how effectively an aware and involved public can contribute to early detection, when coupled with a motivated medical community. The dental community needs to assume this same leadership role if oral cancer is to be brought down from its undeserved high ranking as a killer.

Published studies show that currently less than 15% of those who visit a dentist regularly, report having had an oral cancer screening. This is unfortunate, when you consider that historically, the greatest strides in combating most cancers have come from increased awareness and aggressive campaigns directed at early detection. It is now commonplace to annually get a PAP smear for cervical cancer, a mammogram to check for breast cancer, or PSA and digital rectal exams for prostate cancer. These screening efforts have been possible as a result of the increased public awareness of the value of catching cancers in their earliest forms, combined with effective technologies for conducting the examinations. Oral cancer is no different. Actually, it is potentially easier to obtain public compliance for oral cancer screenings, since unlike many other cancer screening procedures, there is no invasive technique necessary to look for it, no discomfort or pain involved, and it is very inexpensive to have your mouth examined for the early signs of disease. Education of the public regarding the risk factors which lead to oral cancer, and the development of public awareness, are primary responsibilities of the dental community.

It is important that both private individuals, and members of the dental community, realize that a visit to the dentist is no longer about a filling, a crown, or a postponable cleaning, but is actually a matter of life and death. Dental examinations, when properly done and which include a screening for oral cancer, will save lives. If you are a dental professional, we encourage you to become a member of the foundation, and partner with us in this effort to increase the number of annual screenings which are being done. Please check the member’s only area of our site which discusses the issue from a practice management perspective, and where you can find resources to assist you in the incorporation of a comprehensive cancer screening program in your practice.

Discovery and diagnosis

Historically, it has been difficult to determine which abnormal tissues in the mouth are worthy of concern. The fact is, the average person routinely has conditions existing in their mouths that mimic the appearance of pre-cancerous changes, and very early cancers of the soft tissues. One study determined that the average dentist sees 3-5 patients a day who exhibit soft tissue abnormalities, most of which are benign in nature. Even the simplest things, such as a canker sore (herpes simplex), the wound left by accidentally biting the inside of your cheek, or sore spots from a poorly fitting prosthetic appliance or denture, all at first examination, share similarities with dangerous lesions. Some of these conditions cause physical discomfort, others are painless. The question is which ones deserve action, and which ones bear watching and waiting?

There has been a tendency to watch these areas over an extended period to determine if they are dangerous or not. Unfortunately, this philosophy leads to a situation in which a dangerous lesion may continue to prosper and grow into a later stage, hard to cure cancer. Any sore, discoloration, induration, prominent tissue, irritation, hoarseness, which does not resolve within a two week period on its own, with or without treatment, should be considered suspect and worthy of further examination or referral. Besides a routine visit to the dental office for regular examinations, it is the patient’s responsibility to be aware of changes in their oral environment. When these changes occur, they need to be brought to the attention of a qualified dental professional for examination. The dental professional needs to be current in the knowledge base necessary to make a proper diagnosis, and be competent in the proper screening procedures to identify oral cancer.

http://www.oralcancerfoundation.org/news/index.asp

This is Gruen von Behrens.

• Started using spit tobacco at age 13
• Was diagnosed with oral cancer at age 17
• Has been through 35 painful surgeries
• Parts of his neck and tongue were removed

A dentist can often identify early signs of oral cancer or precancerous lesions. The American Dental Association provides the following information about oral cancer:

Oral cancer often starts as a tiny, unnoticed white or red spot or sore anywhere in the mouth.

VELscope® is a revolutionary hand-held device that provides dentists and hygienists with an easy-to-use adjunctive mucosal examination system for the early detection of abnormal tissue, including cancerous and pre-cancerous tissue. It is based on the direct visualization of tissue fluorescence and the changes in fluorescence that occur when abnormalities are present.

http://www.velscope.com/

Piezosurgery

Piezosurgery® technology opens up a new age for osteotomy and osteoplasty in Implantology, Periodontology, Endodontics and surgical Orthodontics.
 

Ø       Micrometric cutting action

Ø       Selective cutting action: minimum soft tissue damage

Ø       Maximum intra-operative visibility (cavitation effect)

Ø       Minimum surgical stress

Ø       Excellent tissue healing

    Maximum safety

Piezo Surgery Video

13/08/2007

http://www.piezosurgery.com/homeDent.asp  İlk kez 1998 yilinda bir periodontolog olan İtalyan Dr.Thomas Vercelotti tarafindan bu cihazin kesfedilmesi ile calismalar baslamis. Bugun o kadar cok kullanim alani var ki : 1-Osteotomi ve osteoplasti tekniginde kullanimi (J oral maxillofac surg 62, 759-761, 2004) 2-Dar kretlerde  alveoler kret genisletmesi isleminde (Int J Periodontics Restorative Dent.,20,358-365,2004) 3-Otojen kemik grefti alim islemlerinde ( J clin periodontol., 32, 994-999, 2006) 4-Nervus alveolaris inferiorun transpozisyonunda (J oral maxillofac surg., 34, 590-593, 2005) 5-Sinus tabani yukseltilmesi isleminde (Int J periodontics Restorative Dent., 21, 345-367, 2001) 6-Ortagnatik cerrahide kullanimi (Journal of Cranio-Maxillofacial surgery., 32, 381, 2001) Piezosurgery® technology opens up a new age for osteotomy and osteoplasty in Implantology, Periodontology, Endodontics and surgical Orthodontics.   Ø       Micrometric cutting action Ø       Selective cutting action: minimum soft tissue damage Ø       Maximum intra-operative visibility (cavitation effect) Ø       Minimum surgical stress Ø       Excellent tissue healing     Maximum safety   1-Mectron (piezosurgery) (www.piezosurgery.com) 2-Esacrome (Surgysonic) (www.cellinelaser.com/TR/surgysonic.asp) 3-BioSaf (Easysurgery) (www.bio-saf.com/prodotti/easysurgery04.html ) 4-Satelec (Piezotome) (www.acteongroup.com/SitePiezotome/LANG_u/Acc.asp)   Thank you for informations about piezosurgery to: Muammer GÖZLÜ,DDS,PhD Periodontist Dentestetik Dental Center 0090 533 472 12 12 Konya/TURKIYE www.dentestetik.com  DENTSECTORTV BLOG

What is sport dentistry?

Sports Dentistry is the treatment and prevention of oral/facialathletic injuries and related oral diseases and manifestations. The 1990 report of the “Better Health Program” entitled, “Sports injuries in Australia, Causes, Costs and Prevention” estimated that sports injuries cost Australia (population 18 Million) about $1.4 billion per year and that between 30-50% of these injuries are preventable. Multiply these numbers for the United States (population 260 million). Participation in exercise and sport whether positive or negative, will always remain a major consideration in the health of a national population. In sports, the challenge is to maximize the benefits of participation and to limit injuries. Sports dentistry has a major role to play in this area. Prevention and adequate preparation are the key elements in minimizing injuries that occur in sport. For sports dentistry the prevention of oral/ facial trauma during sporting activities can be helped by many facets. Included are teaching proper skills such as tackling technique, purchase and maintenance of appropriate equipment, safe playing areas and certainly the wearing and utilization of properly fitted protective equipment.In some sports, injury prevention, through properly fitted mouthguards are considered essential. These are the contact sports of football, boxing, martial arts and hockey. Other sports, traditionally classified as non contact sports, basketball, baseball, bicycle riding, roller blading, soccer, wrestling, racquetball, surfing and skateboarding also require properly fitted mouthguards, as dental injuries unfortunately, are a negative aspect of participation in these sports. The National Youth Sports Foundation for the Prevention of Athletic Injuries, reports several interesting statistics. Dental injuries are the most common type of oral facial injuries sustained during participation in sports. Victims of tooth avulsions who do not have the teeth properly preserved or replanted will face lifetime dental costs estimated from $10-15,000 per tooth, the inconvenience of hours spent in the dental chair and possibly other dental problems. (See “What to do when a tooth is knocked out” Section) Treatment of oral/facial injuries, simple or complex, is to include not only treatment of injuries at the dental office, but also treatment at the site of injury, such as a basketball court or football or rugby field, where the dentist may not have the convenience of all the diagnostic tools available at their office. Knowledge and ability to do “on site” differential diagnosis is essential, withoutthe use of radiographs and dental operatories, to determine the future treatment and prognosis of the injury. Preseason screenings and examinations are essential in preventing injuries. Examinations are to include health histories, at risk dentitions, diagnosis of caries, maxilla/mandibular relationships, orthodontics, loose teeth, dental habits, crown and bridge work, missing teeth, artificial teeth, and the possible need for extractions for orthodontic concerns or wisdom teeth. These extractions should be done months prior to playing competitive sports as to not interfere with their competition or weaken their jaws during competition. Determination of the need for a specific type and design of mouthguard is made at this time. Mouthguard design and fabrication is extremely important. There are four types of mouthguards according to the dental literature. Stock, Boil and Bite, Vacuum Custom made, and Pressure Laminated Custom made. (See Mouthguard Section). First of all, it is essential to educate the public that stock and boil and bite mouthguards bought at sporting good stores do not provide the optimum treatment expected by the athlete. These ill fitting mouthguards cannot deal with idiosyncrasies athletes and children may have. If everyone had the same dentition; were of the same gender; played the same sport under the same conditions; had the same experience and played the same position at the same level of competition, and were the same age and same size mouth, with the same number and shape of teeth, prescribing a standard mouthguard would be simple. This is the precise reason why mouthguards bought at sporting good stores, without the recommendation of a qualified dentist, should not be worn. Idiosyncrasies are to be noted during mouthguard design and fabrication. These may include jaw relationships where mouthguards may have to be designed on the mandibular arch such as a Class III prognathic bite. Otherwise, where possible, mouthguards should be built on the maxillary (upper) arch. Erupting teeth (ages 6-12) should be noted so the mouthguard can be designed to allow for eruption during the season. Boil and bite mouthguards do not allow for this eruption space. For patients with braces, special designs for the mouthguards are essential to allow for orthodontic movement without compromising on injury prevention and fit. This can only be achieved through consultations with your dentist. (See mouthguard section for further information on types and designs for mouthguards.) Sports Dentistry also includes the need for recognition and referral guidelines to the proper medical personnel for non dental related injuries which may occur during a dental/facial injury. These injuries may include cerebral concussion, head and neck injuries, and drug use. We are NOT suggesting that dentists treat these injuries, but as health professionals dentists should be able to recognize these entities and refer these patients to the proper medical personnel. For example, if a patient comes into the office for a broken or knocked out tooth, dentists must rule out the possibility of a head injury or concussion before treating the patient for the dental injury. If certain symptoms are present, such as persistent head aches or nausea, immediate referral to medical personnel is essential. (See concussion section). Smokeless tobacco should also be included and addressed under Sports Dentistry. Smokeless tobacco is often associated with certain sports, and the public should be educated on the dangerous properties and consequences of using smokeless tobacco. (See Smokeless tobacco section.) Is not uncommon for dentists to recognize the symptoms of anorexia and bulimia through dental examination. Eating disorders are not as infrequent as one may think in female athletics. Woman’s gymnastics, volleyball, and basketball are just a few sports where eating disorders have been documented in the medical/dental literature. Erosion patterns in the teeth, caused by gastric acids, often help dentists in the differential diagnosis of eating disorders. These patients need to be referred to the proper medical and psychological health professional. As you can see sports dentistry deals with much more than just mouthguards. Visit the other sites on Sports Dentistry

Save A Tooth™ Emergency Tooth Preserving System   Only FDA approved emergency tooth preserving system Safeguards knocked-out tooth and delicate root cells up to 4 days following injury, maximizing opportunity for long-term implantation success First and only scientifically designed system to store and preserve knocked-out teeth for 24 hours! Requires no training to use Helps prevent loss of natural tooth when priority must be given to more serious injuries Includes: Hank’s Balanced Salt Solution for optimum cell metabolism; removable, patented basket and suspension net for root protection Shatter-proof container with tightly fitting top prevents spilling; top fitted with sponge on underside enables atraumatic removal of tooth from container Invented by Paul Krasner, DDS, Clinical Professor of Endodontology, Temple University School of Dentistry American Dental Association Seal of Acceptance1 Save A Tooth 1 Recommended by Leading Dental Trauma Specialists 5 million teeth are knocked out every year 800,000 teeth are knocked out during sports activities in the United States each year A knocked-out tooth will die in 15 minutes if not taken care of properly 25% of school-aged children experience some kind of dental trauma 50% of athletes experience dental trauma during their lifetime One-time use only; not for internal use. S aveSave-A-Tooth is Better than Other Storage Media Water and Ice: Do not have the same pressure as the cells in the tooth, so the cells actually burst when the knocked-out tooth is placed in these media   Saliva: Causes the root cells to burst Does not replace nutrients Bacteria in saliva can cause infection of the root cells   Physiologic saline and Milk: Do prevent the cells from bursting Do not replace nutrients, so the cells still begin to die within 15 minutes None of these media provide a safe way to transport the tooth without causing damage to the cells . www.save-a-tooth.com Water and Ice: Do not have the same pressure as the cells in the  tooth, so the cells actually burst when the knocked-out tooth is placed in these media Saliva: Causes the root cells to burst Does not replace nutrients Bacteria in saliva can cause infection of the root cells Physiologic saline and Milk: Do prevent the cells from bursting Do not replace nutrients, so the cells still begin to die within 15 minutes None of these media provide a safe way to transport the tooth without causing damage to the cells Water and Ice: Do not have the same pressure as the cells in the tooth, so the cells actually burst when the knocked-out tooth  is placed in these media Saliva: Causes the root cells to burst Does not replace nutrients Bacteria in saliva can cause infection of the  root cells Physiologic saline and Milk: Do prevent the cells from bursting Do not replace nutrients, so the cells still begin to die within 15 minutes None of these media provide a safe way  to transport the tooth without causing damage to the cells            www.save-a-tooth.com           www.sportsdentistry.com www