The University of North Carolina at Chapel Hill, NC; AB History. The University of North Carolina at Chapel Hill, School of Dentistry, DDS.
Affiliate Faculty Cincinnati Children’s Hospital Medical Center.
The American Dental Association, The Ohio Dental Association, The Cincinnati Dental Society, The Academy of Operative Dentistry, The Academy of General Dentistry, The International Association for Dental Research. He is a Fellow in the International College of Dentists and a former member of the editorial board of Journal of the American Dental Association. He is a member of the Association for Psychological Type and is credentialed to give and interpret the Meyers Briggs Type Indicator.
Dr. Weinstein serves as a consultant and participates in clinical evaluation and development programs with various manufacturers of dental materials. He has contributed several articles to dental journals on conservative restorative dentistry including the Journal of the American Dental Association. Dr. Weinstein has lectured internationally on enamel bonding, conservative restorative techniques, and integrative dental medicine. He has been a featured speaker at the American Dental Association Annual Session, Chicago Dental Society Mid-Winter Meeting, The Greater New York Dental Society, and many other state and local dental conferences. His practice in Cincinnati emphasizes conservative aesthetic and preventive restorative dentistry, and integrative dental medicine.
With the advances made in dentistry today we are able to give you much better care than in the past. It is now possible for most people to keep their teeth for the rest of their lives. Total comprehensive dental care is an investment that can reduce dental disease and prevent its reoccurrence, thus eliminating unnecessary discomfort and expense caused by neglect.
We Can’t Do It Alone
We do the finest dentistry possible for our patients, but it is necessary that you help too. The use of dental floss, proper tooth-brushing, and periodic checkups are necessary to insure the success of out treatment. Good dentistry can be a long term investment that pays off in a beautiful smile, a healthy mouth, and enjoyment of the things we eat.
Your First Visit
Thoroughness Counts Consideration is always given to eliminating our patients discomfort first. We then want to learn all that we can about you so that we may treat you properly. We will give you a thorough examination which will include a complete medical and dental history, a careful visual exam, x-rays of your entire mouth when necessary; a routine blood pressure reading, upon request, an oral cancer exam, and often diagnostic models of your mouth. We can then determine the best type of treatment indicated for you.
We consider good communication concerning your dental treatment to be one of the most important goals of your care. If you have any questions concerning your treatment or office procedures please do not hesitate to ask us or any of our office staff about them. If you feel that your questions have not been answered adequately, please ask to speak directly with a doctor.
While an extensive list of financial options is available, we request that you pay for services at the time they are rendered. This system greatly reduces billing and collection costs and results in fees which are lower than would otherwise be necessary. We will be glad to complete insurance forms without charge to assist you in securing reimbursement from your insurance company. Please do not hesitate to ask in advance about fees for planned examinations or procedures.
Our appointments are arranged several days to weeks ahead and we schedule an appropriate amount of time for the technical procedures necessary for your care. In addition, time is set aside for emergency problems which often arise. In spite of this, however, due to emergencies, and other urgent dental procedures, we, will on rare occasions be unable to honor specific appointments, or may run a little behind. We firmly believe in the value of your time and will make every effort to see you at the appointed time. If a problem arises we will contact you as far ahead as possible. If you have specific scheduling problems, please inform our receptionist when you make your appointment and we will try to accommodate you.
Long Range Planning-Your Best Investment
Very often more than one type of treatment may be possible for you. We can sit down together, discuss the possibilities, and decide upon the best type of total dentistry for your particular situation. A long term cooperative program of prevention and correction can then be undertaken. Our goal will be a lifetime of attractive appearance, comfortable chewing and lower dental costs. We invite you to discuss frankly with us any questions regarding our services or our fees. The best dental service is based on a friendly mutual understanding between doctor and patient.
Total Health Protection
Protecting Your Total Health
A great deal of time and effort has gone into providing you a safe, healthy, antiseptic environment in which you receive your dental care. Some of the techniques and materials we use daily are listed here. This is by no means a complete list. If you have any questions, do not hesitated to ask. Rest assured that your quality dentistry is carefully conducted with your well-being and safety in mind.
What is being done to ensure your safety and protection in our office?
- Each of us wear fresh gloves and a mask in the treatment rooms. This helps to eliminate cross-contamination.
- “Many items are used only once and then disposed of in strict compliance with OSHA guidelines. Examples include bibs, cotton, gauze, needles & scalpels.
- “Your treatment room is carefully cleaned with a surface disinfectant on all areas likely to come in contact with a patient. These areas include chair, counters, overhead lights, knobs, buttons and pens.
- All instruments are sterilized before being placed in your mouth. Most are sterilized with heat and some are sterilized with chemicals.
- Our heat sterilization equipment is checked weekly for effectiveness by an independent medical laboratory.
- Patient eye protection is available for your use when needed.
- Doctors and all staff members who treat or assist in the treatment of patients are immunized against Hepatitis B.
- We regularly update and modify our infection control systems to ensure the most comprehensive level of care available. We know you expect no less.
Integrative Dental Medicine
Integrative dental medicine may be defined as the art and science of blending the best of conventional restorative and preventive dentistry with a systems approach to the treatment of the whole patient as well as the physical disorder. It is an understanding of how dental diseases and systemic diseases inter-relate. It means asking, “what type of patient has this illness, rather than what type of illness afflicts this patient.” A conservative restorative approach is often best here.
Our oral health is often an indicator of our general health and there is a statistically significant association between oral infection (periodontal disease) and cardiovascular disease, diabetes, spontaneous pre-term births, and stress (Genco). Many medications, illnesses, and treatment modalities can cause a decrease in saliva flow with resultant potential for rampant caries and periodontitis.
There is a growing body of evidence-based science suggesting that chronic stress depresses our immune system, especially in areas of lymphocyte production and natural killer cell activity – white blood cells necessary to fight infection and disease, and that as much as 80% of all illness may be stress-related. This is the realm of psychoneuroimmunology – how our emotions affect our immunity. About half of us seem to naturally cope with stress well, while others do not, and the impact to our overall health can be profound. Often how patients cope with chronic stress is a common underlying factor in the outcome of both the dental and systemic illness.
Integrative medicine, in general, stresses prevention, self-care, and establishing healing partnerships by recognizing all parts of the body – the spiritual and emotional, as well as the physical. It is essentially the “weaving of the best of the scientific and the intuitive, the ancient and the modern, the clinical and the caring to facilitate the emergence of a new medical system, a new paradigm, that provides the most effective healthcare available in a form individually crafted to each person and their particular needs with a minimum of risk of side effects and a maximum of patient understanding and self-empowerment (IBIS).” This is what we try to bring to our dental practice, and our vision of what an ideal fee-for-service dental practice can be in the future.
The following ideas on our approach to mind/body health all have a sound medical and scientific basis, and are all thoroughly researched. Sources are provided for the quoted authors. Among the things that we and the “wellness” community believe are:
- That mind/body health begins with the mind.
- That we must take self-responsibility for the movement and direction of our lives, including our physical and emotional well-being.
- That “emotional intelligence” – the ability to access, label, and express emotions (feelings) as well as the ability to respond to the needs and feelings of others, (Shannon/Simmons & Simmons) is a powerful tool for self-understanding and for maintaining physical and mental health.
- That social support, friendship, and strong, stable relationships protect our health by providing buffers against stress as well as positive emotional outlets.
- That we receive stress in our lives from basically three sources – physical (physiological, injury, exercise), mental (how we feel, attitudes) and psycho-social (interpersonal relationships, conflicts, isolation) (Hafen/Meaney).
- That how we “perceive” stress, and the timing of stressful events has a lot to do with how stress affects us.
- That short-term adaptable “good” stress is necessary in our lives. But when stress becomes chronic, pervasive and uncontrollable, it is implicated in the onset of many serious illnesses including cardiovascular diseases, diabetes, cancer, depression, immunologic disorders and dental diseases, etc.(Laclede)
- That chronic stress, because of stress hormones produced by the adrenal glands, depresses our immune system – especially in areas of t-lymphocyte production and natural killer cell activity – white blood cells necessary to fight infection and disease.
- That our emotions affect our immunity! But we can learn to control our emotions and develop coping strategies rather than allowing our emotions to control us. “Negative” emotions, such as worry, depression, anxiety, hostility and anger, when nurtured, can increase susceptibility to disease. “Positive” emotions, such as optimism, humor, hope, faith, love and determination to live, essentially a positive mental outlook can protect our health and help us to heal when combined with competent medical care. (Hafen, Frandsen and Smith)
- That we can develop our own strategies for promoting physical/mental health by taking self-responsibility, seeking help when necessary, following the directions of our physicians and psychologists, socially interacting with those who support and understand us, becoming more physically active with moderate exercise, developing a positive mental outlook, having emotional outlets (confidants, friends, pets, etc.), understanding the healing power of forgiveness of ourselves and others, nurturing a sense of spirituality – of something else out there, and never losing hope.
Alan R. Weinstein, DDS
- Meyers, IB: Introduction to Type. Palo Alto, AC, Consulting Psychologists Press, INC Sixth
- Keirsey, D.: Please Understand Me II – Temperament – Character – Intelligence. Del Mar, CA.,
Prometheus Nemesis Book Company, 1998.
- Shannon, Joseph: “Emotional Intelligence”. Cortext – Spring 1998.
- Simmons, S; Simmons, JC: Measuring Emotional Intelligence. Arlington, TX, The Summit
Publishing Group, 1997.
- Hafen, B; Karren, K; Frandsen, K; Smith N: Mind/Body Health – The Effects of Attitudes,
Emotions and Relationships. Boston, MA, Allyn and Bacon, 2010.
- Meany, M: “Stress and Disease” – Who Gets Sick and Who Stays Well. Cortext 1996.
- Integrative Medical Arts Group, Inc. IBIS Medical.com
- Genco, RJ; Ho, AW; Grossi, RG; Dunford, RG; Tedesco, LA. Relationship of Stress, Distress, and
Inadequate Coping Behaviors to Periodontal Disease. J Periodontol 1999; 70:711-723.
- Laclede, Inc. Biotene dry mouth products.
Periodontal Disease and Systemic Disease
Periodontal disease (periodontitis – leading to bone loss, and gingivitis – limited to gingiva) is extremely common, often chronic, frequently insidious, inflammatory and infectious in nature. These diseases result from exposure of the periodontium to dental plaques – complex bacterial “biofilm” masses that accumulate on the teeth from which over 400 species of bacteria have been isolated. Although specific bacterial types cause periodontitis, these biofilms shed virulent components and metabolites especially lipopolysaccharide resulting in a chronic inflammatory response. Periodontitis progresses in episodes of attachment loss with much diversity regarding susceptibility. As many as 30% of the adult population has some degree of periodontal disease.1-3
Systemic disease and conditions as risk factors for causing periodontal disease include diabetes mellitus, neutrophil disorders, osteopenia, Down syndrome, the host’s immunoinflammatory response, and stress. Other acquired and environmental factors include smoking, nutritional deficiencies, and poor oral hygiene. 1,2,6
Untreated periodontal infections can potentially spread bacteria and inflammation by-products through openings in the gum tissue throughout the bloodstream and trigger or influence other chronic diseases, including stroke, heart disease, diabetes, respiratory infections, infections in and around prosthetic devices/artificial heart valves and cause premature spontaneous births by pregnant women. Proper pre-operative antibiotic coverage is indicated for any patient at risk prior to treatment. 1-4
A common factor of both periodontal disease and these illnesses is stress. Stress depresses our immune system’s ability to produce and maintain lymphocytes (white blood cells necessary for stopping infection) and natural killer cells (specialized cells that seek out and destroy foreign invaders). Both are necessary to fight infection and disease. Research shows an increase in circulating WBC’s but a decrease in circulating B-cells, T-cells, helper T-cells and large granular lymphocytes. 5
Recent studies have shown 3 times the rate of stroke in people with periodontal disease. Fatty deposits in carotid arteries of stroke sufferers show 70% contain bacteria 40% of those bacteria are oral in nature.
Atherosclerosis and resulting coronary thrombosis, ischemic heart disease and stroke are together the major causes of death in the United States. Hypertension, high cholesterol, and cigarette smoking account for only 1/2 to 2/3 of the incidences of cardiovascular disease. Patients with periodontal disease have demonstrated almost 2 times the rate of heart disease. Bacteria mix with blood clotting cell platelets to form clumps that travel through blood vessels irritating vessel walls and promoting the formation of heart-stopping blood clots. Inflammation produces proteins (prostaglandins, interleukins) that can irritate the interior of blood vessels, causing sites where fatty deposits can form.
Diabetes Mellitus (Pancreas):
The most common endocrine disease. Diabetes is characterized by metabolic abnormalities and long-term complications involving the kidneys, eyes, nerves, vasculature, and periodontium. The National Institute of Diabetes, Digestive and Kidney Diseases (NIDDK) study of Pima Indians in Arizona showed that diabetics with periodontal disease were 3 times more likely to have heart attacks than those without periodontal disease. They were non-smokers. NIDDK research conducted on the Pima Indians for the past 30 years has helped scientists prove that obesity is a major risk factor in the development of diabetes. One-half of adult Pima Indians have diabetes and 95% of those with diabetes are overweight.
* *Obesity and Diabetes. www.niddk.nih.gov/health/diabetes/pima/obesity/obesity.htm
Spontaneous Pre-Term Births:
Women with periodontal disease were 7-8 times more likely to have premature, low birth-weight babies. Possible low-grade infection causes damaged cells to release inflammation-causing substances that could affect the term of the pregnancies.
Behavioral Psychosocial Status: Oral diseases can lead to pain and malaise, which can lead to a decrease in immune function and can impact a patient’s sense of well-being. Poor oral function, esthetics and hygiene can lead to loss of pleasure from eating and drinking and loss of life satisfaction through concerns of “self-presentation” – a fear of embarrassment. These concerns can affect socialization and self-esteem – vital factors in “Emotional Intelligence” and “Wellness”. 5 The Biopsychosocial Model of Illness of noted University of Rochester psychiatrist Dr. George Engel states that: 1. A person’s immune system affects their disease. 2. Thoughts, emotions, and life experiences may affect the outcome of the illness. 3. Treatment acts on the pathogen but is influenced by the person’s environment and psychosocial functioning. Mental health issues may contribute to the cause of the illness, and illnesses may worsen our mental health, which may affect the outcome. 6,7 Positive problem-focused coping strategies rather than emotion based coping is most effective for stress management. 2,6
Xerostomia (Dry Mouth): The causes of dry mouth include side effects of many medications, diseases (Sjogren’s Syndrome, HIV/AIDS, diabetes, Parkinson’s disease), radiation therapy, chemotherapy, nerve damage, and aging. Sequelae of chronic xerostomia are related to progressive caries, acceleration of periodontal disease, candidiasis and generalized dental breakdown at a time when patients can least afford it physically, financially, or emotionally. Treatment can include scrupulous oral hygiene, dietary factors, hydration, therapeutic topical fluoride gels/toothpastes, and saliva enhancing/tissue protective products. 8
- Research, Science and Therapy Committee of the American Academy of Periodontology. J Periodontal, May 1998; 69:841-850.
- Williams R, Cohen DW, Newman M, Offenbacher S, Beck J, Genco R, Cianco S: Periodontal Aspects of Systemic Health. Compendium Special Issue, Fall 1999; 19:4-53.
- Slavkin H: Does the Mouth Put the Heart at Risk. JADA, 1999; 130:109-113.
- Sue MacDonald: Cincinnati Enquirer; 10/1998.
- Hafen B, Karren K, Frandsen K, Smith N: Mind/Body Health – The Effects of Attitudes, Emotions and Relationships. Boston, MA, Allyn and Bacon, 2010.
- Engel G: The Need for a New Medical Model: A Challenge for Biomedicine. Science, 1977; 196:129-136.
- ”Mark Schneider, MD “Cortext” Spring 2000 “Psychobiology of Mental Control.
- Laclede, Inc. Biotene and Oralbalance saliva enhancing products. www.Laclede.com. OBESITY
Ninety-seven million American adults, or 55% of people over 20 are overweight or obese. Over 300,000 people die each year due to obesity related causes.1 Of children ages 6 to 11, 13% are overweight, up from 11% in1990 and 4% in the 1960’s.2 Obesity and overweight substantially increase the risk of morbidity from hypertension; dyslipidemia; type 2 diabetes; coronary heart disease; stroke; gallbladder disease; osteoarthritis; sleep apnea and respiratory problems; and endometrial, breast, prostate, and colon cancers. The Body Mass Index is useful to provide a healthy weight to height ratio. The BMI categories of underweight, healthy weight, overweight, obese, and extremely obese are based on the government’s 1998 Clinical Guidelines on the Identification, Evaluation, and Treatment of Overweight and Obesity in Adults. Research suggests excess fat in the abdomen is a greater health risk than excess fat in the hips and thighs.3
Your Body Mass Index = weight/height and is calculated with this formula:
U.S.: Multiply your weight (in pounds) by 704.5. Multiply your height (in inches) by your height (in inches). Divide the first result by the second.
Example: If you’re 5’5″ and weigh 140:
140 x 704.5 = 98,630
65 x 65 = 4,225
98,630 divided by 4,225 = 23 BMI
The higher your BMI, the greater your risk. A BMI over 25 = overweight (5’4 and over145lbs) and a BMI over 30 is considered obese (5’6 and over 186lbs). Weight loss of 10% of body weight/ 6months is considered safe.
Elevated blood cholesterol can clog arteries and potentiate heart attacks. High-density lipoproteins (HDL good cholesterol) + low-density lipoproteins (LDL) + very low-density lipoproteins (VLDL triglycerides) = total serum cholesterol. The higher the LDL levels in the blood, the greater the risk of heart disease.
Polyunsaturated Fats: Vegetable oil, flaxseed, sesame, fish oil (omega-3 fatty acids). Mono-unsaturated Fats: Olive, canola, peanut oil, some margarines raise HDL “good” cholesterol levels. HDL is protective and draws cholesterol away from the arteries.
Saturated Fats: Raise blood LDL (bad) cholesterol levels. Increased arterial plaque. – Animal fat: Beef, pork, lamb, butter, and milk. – Coconut and palm kernel oil. – Trans (hydrogenated) oils: Fast-food fries, margarine, may lower HDL and raise LDL.
The Probably Not So Bad:
Cholesterol (shrimp, eggs, organs) may not as bad as we thought. Low in saturated fat. Limit to 300mg/day. 4
“Good” total serum cholesterol:
Under 200mg/dl (180-190mg/dl or lower best). Total- cholesterol-to-HDL ratio should be below 4.6 for men, and below 4.0 for women. Limit saturated fat to 10% and total fat intake to 30% of total daily calories (50g).
COMMON DENOMINATORS of FAD DIETS
* Low calorie diets tend to be deficient in nutrients. * Out of balance. * High water loss.
* Fasting state ketosis… possibly dangerous! * “Quick fix” vs. lifestyle change.5
2. http://www.cdc.gov/nccdphp/dnpa/dnpalink.htm (Centers for Disease Control)
4. http://www.aicr.org (American Institute for Cancer Research)
5. AICR, American Heart Association, American Dietetic Association, Surgeon General
Nutrition and Vitamins
Factors That Can Affect Our Immune System
DRUGS OF ABUSE:
- Alcohol: As long as your liver is ok, your immune system seems to be ok.
- Tobacco: Alters immune ability – both mechanical (emphysema/chronic bronchitis) and PMN systems, causing 30% of all cancer deaths. Smoking increases risk of cancer 50 fold.
- Optimal Fat Burning Diet- 40% complex carbohydrates (cereals, rice, pasta, bread potatoes) 30% protein, 30% fat (no more than 50 gm). Limit sugar. 2
- Fiber: Protective against cancer of the large bowel – increases transit of toxins through the gut. Keeps things moving along.
- Cut down on Nitrates – Nitrosomines: Bacon, sausage, and salami.
- Drink up to _ your body weight in oz. of water daily! (i.e. _ x 128lbs. = 64oz. max)
- Vitamins and Minerals to boost immunity:
|VITAMINS & MINERALS||SOURCE||DAILY AMOUNT|
|* A||Whole Milk, Eggs, Liver, Dark Green 5000 IU & Orange Vegetables & Citrus Fruits||5000 IU (International Units)|
|B6||Bananas, Avocados, Chicken & Potatoes||3 mg|
|B12||Beef & Liver||9 mcg|
|FOLIC ACID||Enriched bread, Pasta, Rice||400 mcg|
|C||Citrus Fruits||75-200 mg|
|* D||Milk, Sardines, Liver, Butter & Egg Yolks||400 IU|
|CALCIUM||Skim Milk||1000 mg max|
|* E||Soy, Cottonseed Oil & Corn Oil, Nuts, Seeds||15-30 IU|
|ZINC||Seafood, Oysters, Whole Grain, Poultry, Liver||15 mg|
|SELENIUM||Seafood, Grains, Meat, Milk and Vegetables||25 mcg|
|IRON||Liver, Oysters, Beef & Molasses||27 mg|
MORE MAY NOT BE BETTER – TAKING MORE THAN THE RECOMMENDED DAILY REQUIREMENT MAY BE HARMFUL. * Vitamins A, D, E, and K are fat-soluble – stored in body. You do not need a supply every day.
1. Keller, Dr. Steven E.: “The Immune System.” Cortext, Fall 1998.
2. Meinz, David: www.eatingbythebook.com
3. Burns, Dr. Steven: www.teachhealth.com