Austin Dentistry and Wellbeing. Austin Dental Blog.

BOSTON (August 5, 2010) — Brushing, flossing, and twice-yearly dental check-ups are standard for oral health care, but there are more health benefits to taking care of your pearly whites than most of us know. In a review article, a faculty member at Tufts University School of Dental Medicine (TUSDM) debunks common dental myths and outlines how diet and nutrition affects oral health in children, teenagers, expectant mothers, adults and elders.

Myth 1: The consequences of poor oral health are restricted to the mouth

Expectant mothers may not know that what they eat affects the tooth development of the fetus. Poor nutrition during pregnancy may make the unborn child more likely to have tooth decay later in life.

“Between the ages of 14 weeks to four months, deficiencies in calcium, vitamin D, vitamin A, protein and calories could result in oral defects,” said Carole Palmer, EdD, RD, professor at TUSDM and head of the division of nutrition and oral health promotion in the department of public health and community service. Some data also suggest that lack of adequate vitamin B6 or B12 could be a risk factor for cleft lip and cleft palate formation.

In children, tooth decay is the most prevalent disease, about five times more common than childhood asthma.

“If a child’s mouth hurts due to tooth decay, he/she is less likely to be able to concentrate at school and is more likely to be eating foods that are easier to chew but that are less nutritious. Foods such as donuts and pastries are often lower in nutritional quality and higher in sugar content than more nutritious foods that require chewing, like fruits and vegetables,” Palmer said. “Oral complications combined with poor diet can also contribute to cognitive and growth problems and can contribute to obesity.”

Myth 2: More sugar means more tooth decay

It isn’t the amount of sugar you eat; it is the amount of time that the sugar has contact with the teeth.

“Foods such as slowly-dissolving candies and soda are in the mouth for longer periods of time. This increases the amount of time teeth are exposed to the acids formed by oral bacteria from the sugars,” Palmer said.

Some research shows that teens obtain about 40 percent of their carbohydrate intake from soft drinks. This constant beverage use increases the risk of tooth decay. Sugar-free carbonated drinks and acidic beverages, such as lemonade, are often considered safer for teeth than sugared beverages but can also contribute to demineralization of tooth enamel if consumed regularly.

Myth 3: Losing baby teeth to tooth decay is okay

It is a common myth that losing baby teeth due to tooth decay is insignificant because baby teeth fall out anyway. Palmer notes that tooth decay in baby teeth can result in damage to the developing crowns of the permanent teeth developing below them. If baby teeth are lost prematurely, the permanent teeth may erupt malpositioned and require orthodontics later on.

Myth 4: Osteoporosis only affects the spine and hips

Osteoporosis may also lead to tooth loss. Teeth are held in the jaw by the face bone, which can also be affected by osteoporosis.

“So, the jaw can also suffer the consequences of a diet lacking essential nutrients such as calcium and vitamins D and K,” Palmer said. “The jawbone, gums, lips, and soft and hard palates are constantly replenishing themselves throughout life. A good diet is required to keep the mouth and supporting structures in optimal shape.”

Myth 5: Dentures improve a person’s diet

If dentures don’t fit well, older adults are apt to eat foods that are easy to chew and low in nutritional quality, such as cakes or pastries.

“First, denture wearers should make sure that dentures are fitted properly,” Palmer said. “In the meantime, if they are having difficulty chewing or have mouth discomfort, they can still eat nutritious foods by having cooked vegetables instead of raw, canned fruits instead of raw, and ground beef instead of steak. Also, they should drink plenty of fluids or chew sugar-free gum to prevent dry mouth.”

Myth 6: Dental decay is only a young person’s problem

In adults and elders, receding gums can result in root decay (decay along the roots of teeth). Commonly used drugs such as antidepressants, diuretics, antihistamines and sedatives increase the risk of tooth decay by reducing saliva production.

“Lack of saliva means that the mouth is cleansed more slowly. This increases the risk of oral problems,” Palmer said. “In this case, drinking water frequently can help cleanse the mouth.”

Adults and elders are more likely to have chronic health conditions, like diabetes, which are risk factors for periodontal disease (which begins with an inflammation of the gums and can lead to tooth loss).

“Type 2 diabetes patients have twice the risk of developing periodontal disease of people without diabetes,” Palmer said. “Furthermore, periodontal disease exacerbates diabetes mellitus, so meticulous oral hygiene can help improve diabetes control.”

This article appears in the July/August issue of Nutrition Today.

This is a very complicated topic. The intricacies of the insurance system and variables in dental practices make it very complicated to explain, but we will try to share some insights into the world of insurance confusion.
It is a fact that dental insurance is nothing like medical, and you should keep that in mind. The coverage is very different, and there is nothing that dental insurance realistically covers at 100%. Most PPO plans state that they pay 100% of preventive services ( cleanings and exams), 80% of basic services ( fillings) and 50% of major ( everything else). There are some variations in which services fall into which group based on the plan. It is important to know that they pay percentages of their “usual and customary fees” which they define based on some national averages. Also keep in mind that these fees have not been updated for 15 years or so, so do your own math and figure what realistically the payment can amount to, especially if you live in a prominent area, say, such as Westlake Hills in Austin. Another important thing – the yearly maximum that insurance pays on most plans is $1500. While it is better than nothing – it will not help you tremendously if you need a lot of dental work and you need it done in one year. Insurance does not cover TMJ disorder treatment, cosmetic services, implants. Most insurance agents offering better policies do not sell dental insurance at all. So it is up to you to make a choice if dental insurance is worth the premiums for you for these benefits.

It is also a fact that there is a difference between in-network providers and out-of-network providers. While most people don’t realize it, no two dental practices are the same, even without any affiliations with insurance networks. Every dentist is different when it comes to education and experience, has a different approach to dentistry, chooses different equipment and materials, techniques and methods, and also how to run their business. When it comes to determining fees -  all of those factors plus the going rates in the area where the practice is located are crucial. Knowing that, even if you do shop around, you will probably not find a big difference comparing fees of dental practices of similar philosophy. If you find a big difference -  odds are – you are comparing apples and oranges and you may want to ask yourself what that difference gives you and what you might be sacrificing by choosing one practice over the other.

With in- network providers, the insurance company and your employer negotiate the rates and what is covered. So the insurance companies set their level of reimbursements to the doctors for various procedures and the rest of it is your out-of-pocket. Unfortunately, because of being very outdated ( ask any insurance agent) – the reimbursement rates are very low, and the doctors who strive to produce cutting-edge dentistry using the latest equipment simply cannot make it work, otherwise there would be no out-of -network providers. There is a reason why many dental practices choose to be independent -  so they could be the ones setting the bar for themselves. And even then, there are apples and oranges.

Hopefully this helps you a little bit to understand the big picture ( or at least see that it is even bigger). We believe, that one factor in determining your choice of a dentist trumps all others -it  is not insurance, not if the dentist is in- or  out-of-network, but the dentist himself.  The level of continued education, experience, desire to stay current with technology, and if you can trust him or her is what will help you get your money’s worth and get many more benefits in the long run. You want to develop a relationship with your doctor that will help you achieve and maintain your oral health for a lifetime, not just for the time of your appointment. And that is what we do every day and love it!

By Consumer Reports

Spring misery
Most people who saw a doctor for their allergy symptoms said the visit helped a lot, our survey found.

Allergies are hard to treat—60 percent of the springtime allergy sufferers we surveyed had limited success managing their itchy eyes, sinus pain, sneezing, and other symptoms. But if you are miserable every time the trees bloom, don’t give up. Our nationally representative online survey, conducted by the Consumer Reports National Research Center, polled 1,814 adults in April 2009 during the spring allergy season. Here’s what allergy sufferers said might help:

Avoidance

It’s not easy to steer clear of pollen and other allergens. Only one in five respondents said they were “highly satisfied” with the avoidance measures they tried, such as staying indoors with the windows shut and the air-conditioner on, having someone else mow the lawn, or doing outdoor activities on low-pollen days. But when these tactics worked, they were even more effective than taking over-the-counter medicine for allergies.

Staying indoors and taking other avoidance measures may be most important between 5 a.m. and 10 a.m., when allergen levels are typically highest. If you try this approach, set your air conditioner to recirculate the air so you reduce the amount of pollen and other outdoor allergens from flowing into your home.

Check the pollen count in your area before going out. When you return home, take a shower to wash the pollen off your skin, and wash your clothes.

Prescription medicine

Only about one in four said they were highly satisfied with prescription allergy drugs. But most who were felt they had successfully managed their symptoms. Common medications included fexofenadine (Allegra and generic), a “second-generation” antihistamine that’s less likely to cause drowsiness than older antihistamines; fluticasone (Flonase and generic) and mometasone (Nasonex), corticosteroid nasal sprays; and montelukast (Singulair), which blocks molecules that can cause inflammation and allergies.

Overall, 8 percent of respondents received allergy shots, which can provide relief by gradually increasing the tolerance to specific allergens.

Over-the-counter medicine

More than two-thirds of our respondents relied on nonprescription drugs, including: diphenhydramine (Benadryl Allergy and generic), an older antihistamine that can cause drowsiness; loratadine (Claritin and generic) or cetirizine (Zyrtec and generic), second-generation antihistamines; and pseudoephedrine (Sudafed and generic), a nasal decongestant. Overall, nonprescription drugs were less likely to help manage symptoms than either avoidance or prescription medications, but they were better than doing nothing at all.

What you can do

Consider discussing your symptoms with a doctor. Most people who saw a doctor said the visit helped a lot, and 59 percent of those people said they had managed to rein in their symptoms.

Part of that benefit may be that the people who saw a doctor were more likely to take prescription drugs. And those medications, notably the steroid nasal sprays, often do work well, research suggests. Seeing a doctor also helped respondents pinpoint the OTC drugs and allergy-avoidance strategies that worked best for them. That may be because choosing from all the options can be confusing, and some are clearly better than others.

Finally, explore our allergy trouble tracker, which allows you to compare your symptoms to those of our survey respondents to help you find a remedy that may work for you.

By Debra Fulghum Bruce, PhD
WebMD Feature
Reviewed by Brunilda Nazario, MD

The kiss. The smile. The breath. What’s most important to you (and to your significant other)? Chances are it’s good breath. Let’s get personal. Bad breath (halitosis) may be common in dogs — but for people, bad breath affects how you feel about yourself, not to mention how others perceive you. In fact, you may not know you have halitosis until a brave friend tells you. How can you tell if you have bad breath? A simple way is to stick a clean finger in your mouth and scrape saliva from the back of your tongue. Put it on the back of your hand, wait a minute, then smell your hand. Is it something you’d want to kiss? If not, check out these 15 tips about causes and cures for bad breath. Start freshening your breath today!

5 Common Causes of Bad Breath:

1. Blame bacteria for bad breath. Bacteria breed inside your mouth. These micro organisms lurk between your teeth and cover your tongue. When bacteria stagnate, they multiply and give off toxins and stinky odors.

2. Say “Ahhh.” The deep holes in your tonsils, called crypts, are a common cause of halitosis. If your tonsils are too wide and pitted, a cheese-like smelly substance collects in these holes. These nuggets sometimes smell, and may cause bad breath.

3. Pungent foods and bad breath. Foods such as onion, garlic, and fish can cause bad breath — even hours after you brush your teeth.

4. Bad habits = bad breath. Any type of smoking (cigarettes, cigars, pipe) or chewing tobacco can leave you with a really nasty taste — and smell — in your mouth.

5. Tummy troubles. Sometimes GI problems such as GERD or an ulcer can cause bad breath when you burp and gas is released. Also blame low-carb diets, which cause ketosis, a fat-burning state in the body that produces dragon breath.

10 Tips to Banish Bad Breath.

Now for the fix, here are some simple tips from oral health experts on how to have breath that’s “kissing fresh”:

1. Brush your teeth — and tongue — twice a day to banish bad breath. While you’re brushing your teeth with a fluoride toothpaste, brush your tongue – especially the back of the tongue. Brushing your tongue will remove smelly bacteria that cause bad breath. One study found that by brushing the tongue, volunteers reduced their perception of bad breath by 70%. You can also buy inexpensive tongue scrapers at most pharmacies.

2. Floss once a day for fresh breath. Flossing is must-do. Flossing gets out hidden food particles and removes plaque, a coating of bacteria that forms around the tooth. Flossing also helps prevent periodontal disease — another common cause of bad breath.

3. Gargle with peroxide to fight halitosis. An antimicrobial mouthwash is important if you have a problem with excess plaque. “You can also gargle with peroxide for fresher breath,” says Mike McIlwain, DMD, a dentist at McIlwain Dentistry and an assistant clinical professor in Pediatric Dentistry at the University of Florida. McIlwain recommends gargling with peroxide to his patients. “Treat it like your favorite mouthwash. Just swig, swish, and spit. The oxygen in the hydrogen peroxide kills mouth bacteria that cause bad breath,” McIlwain says.

4. Use a fluoride mouth rinse for sweeter breath. Not only do decayed teeth hurt, they have an awful odor. Tooth decay can be prevented with fluoride toothpaste and proper dental care.

5. Drink lots of water to avert bad breath. “Lack of fluids can lead to dry mouth (xerostomia) and cause bad breath,” says Murray Grossan, MD, a board certified otolaryngologist at Cedars Sinai Medical Center in Los Angeles and coauthor of The Sinus Cure. Dry mouth or reduced saliva can be the result of not drinking enough liquids, mouth breathing, or medications like antihistamines.

6. Reduce upset stomachs to ease bad breath. Over-the-counter antacids may ease a sour or acidic stomach, which can cause halitosis when you burp. If you are milk intolerant and have GI problems, try lactase tablets.

7. Check your sinuses; infections cause bad breath. Bad breath is often a clue to an underlying sinus infection. “The purulent post-nasal drip is the culprit,” says William Sears, MD, also known as “America’s Pediatrician,” an associate clinical professor of Pediatrics at the University of California, Irvine, School of Medicine. Post-nasal drip is most noticeable after sleeping at night, which is why many people rush to brush their teeth first thing in the morning.

8. Eat yogurt for sweeter breath. Yogurt replenishes the good bacteria in the gut and “promotes a healthier mouth,” McIlwain says. Sears recommends celery “to remove stinky bacteria.” You may also try eating parsley between meals to fresh breath. Parsley reportedly has antibacterial and antifungal properties.

9. Chew gum with xylitol to banish bad breath. Chewing gum makes you salivate if your mouth is dry and causing bad breath. Saliva is what washes away the bacteria in your mouth.

10. See your dentist. At least every six months, see your dentist for teeth cleaning and an oral exam. Your dentist can check your mouth and teeth for open cavities and gum disease that cause bad breath. If self-care tips don’t work to stop your bad breath, see your doctor. Occasionally bad breath is a sign of a more serious problem, such as an infection, chronic bronchitis, diabetes, or kidney or liver disease.

An integral part of maintaining overall health is good oral health. It is important to understand the connection and be able to make educated decisions regarding dental care.

Recent studies have proven that oral infections can have great impact on your body’s total wellbeing. As a matter of fact, after many years of disconnect and treating people for only a specific health problem, medical doctors are now advised to send their patients to have a periodontal assessment to be able to see the whole picture.

Cardiovascular disease, the leading killer of men and women in the United States, is a major public health issue contributing to 2,400 deaths each day. Periodontal disease, a chronic inflammatory disease that destroys bone and gum tissues that support the teeth affects nearly 75 percent of Americans and is the major cause of adult tooth loss. And while the prevalence rates of these disease states seems grim, research suggests that managing one disease may reduce the risk for the other.

For patients, this may mean receiving some unconventional advice from their periodontist or cardiologist. Periodontists now may not only inform their patients of the increased risk of cardiovascular disease associated with periodontal disease, but also assess their risk for future cardiovascular disease and guide them to be evaluated for the major risk factors. The physicians managing patients with cardiovascular disease may also evaluate the mouth for the basic signs of periodontal disease such as significant tooth loss, visual signs of oral inflammation, and receding gums. Read more…

Important Simple Facts About Gum Disease.

FALLACY: Tooth loss is a natural part of aging.
FACT: With good oral hygiene and regular professional care, your teeth are meant to last a lifetime. However, if left untreated, periodontal (gum) disease can lead to tooth loss. It is the primary cause of tooth loss in adults 35 and over.

FALLACY: Gum disease doesn’t affect overall health.
FACT: Emerging research links periodontal disease to other health problems including heart and respiratory diseases; preterm, low birthweight babies; stroke; osteoporosis; and diabetes.

FALLACY: Gum disease is a minor infection.
FACT: The mass of tissue in the oral cavity is equivalent to the skin on your arm that extends from the wrist to the elbow. If this area was red, swollen, and infected, you would visit the doctor. Gum disease is not a small infection. Its result, tooth loss, leads to a very different lifestyle—dentures. The changes in your appearance, breath, and ability to chew food are dramatic and have many other undesired consequences.

FALLACY: Bleeding gums are normal.
FACT: Bleeding gums are one of nine warning signs of gum disease. Think of gum tissue as the skin on your hand. If your hands bled every time you washed them, you would know something is wrong. Other signs of gum disease include: red, swollen or tender gums; sores in your mouth; gums that have pulled away from the teeth; persistent bad breath; pus between the teeth and gums (leaving bad breath); loose or separating teeth; a change in the way the teeth fit together; and a change in the fit of partial dentures.

FALLACY: Cavities are the number-one cause of tooth loss.
FACT: Periodontal disease is the number-one cause of tooth loss. According to the 1996 American Dental Association/Colgate survey, U.S. dentists say gum disease is a more pressing oral health concern than tooth decay by a 2-to-1 margin.

FALLACY: Treatment for gum disease is painful.
FACT: New periodontal procedures including local anesthesia and over-the-counter medications, have made patients’ treatment experiences pleasant and comfortable. Many patients find they are back to normal routines on the same day or by the next day.

Assess Your Risk of Gum Disease Here.

Greetings, everyone.

Austin is warming up and the spring is just around the corner. The fruit trees are starting to bloom and it is time to enjoy the great outdoors. The weather could not be any better. As Doc Tor often says: “This is why we live in Texas!”

Since Dr. Gotun’s return from his amazing trip to Brazil, we have been very busy. Referring your family and friends to our practice is the biggest compliment we can get and we are very grateful for your support and trust.We promise that we will take care of them as if they are our own.

Over the years to come Dr. Gotun will be sharing his Brazilian experiences with you, but we thought we will give you a little preview:

This is a photo of a lush landscape in a small town Santa Rita de Jacutinga. From countless banana trees to beautiful exotic blooming shrubs, Brazilian nature is absolutely breathtaking.

There are no words that can describe the overwhelming splendor of the Samba Parade in Rio de Janeiro. Just in one night 6 samba schools ( each of them with 3000 to 5000 participants and 5-6 gigantic floats) pass in front of the jury.The show starts at 9 pm and ends around 6-7 am. The amazing costumes, music and dancing are sure to leave the spectators speechless, as there is nothing that can compare to the grandeur of the Carnival in Rio.

And then, of course a beautiful Ipanema beach.

There are pros and cons to everything. White sports drinks and energy drinks may boost your performance and keep you awake throughout the day, they too have their drawbacks when it comes to oral health.

We all are aware of the effects of sugar on your teeth. But what most of us don’t really pay attention to is the acid. Cavities form when bacteria in the mouth mixes with sugar, leading to decay. Erosion occurs when chemicals strip the mineral off the teeth. The consequences of the erosion are far worse than decay, because erosion affects all teeth at once. This causes hypersensitivity, discoloration and cracks on the teeth. Serious cases require crowns or even dentures if entire teeth have disintegrated.

Sports drinks contain high levels of acid that can cause tooth erosion as well as high levels of sugar. Sipping these drinks throughout the day increases the chances for trouble, as they could dissolve the entire tooth over time.

A variety of juices, teas, sodas ( including diet) are also high in acids. The Journal of Dentistry published a study which showed that orange juice decreased enamel hardness by 84 percent. Lemon, orange and grapefruit juice can strip away the enamel with their acidity too. Lemon juice tends to be the most erosive of them all.

In 2008 researchers at the University of Iowa’s College of Dentistry found that energy drinks and sports drinks, such as Gatorade and Red Bull, eroded the enamel more than soda and fruit juices.

So what is the solution to this problem? Should we avoid all those drinks alltogether? We believe that the key is moderation and some helpful practices to keep your teeth as safe as possible:

• Drink the acidic beverage at once, instead of sipping it all day.
• Use a straw to avoid the teeth from being immersed in liquid.
• Substitute acidic beverages with water.
• Rinse mouth with water after drinking acidic beverage instead of brushing. The bristles of the toothbrush may damage the enamel softened by the acid.
  
• Consult your dentist on the best oral health solution that work for you lifestyle.

Read more about it here…

Sometimes it seems that we will faithfully change the oil in our cars on a regular basis while putting off routine dental care for ourselves. . . unless we run into a speed bump such as a toothache. Pain is a powerful motivator, and a lot of us depend on emergencies or roadblocks like that to persuade us to change the road we’re on. But maintenance of your dental health can be one of the most important routines you can establish! Whether you are old or young, good dental care can even become the deciding factor in maintaining quality of life – or life itself. It’s not just a matter of filling cavities!

Probably the most widespread and insidious cause of dental health-related problems is gum disease. Studies indicate that 3 out of 4 adults will develop it in their lifetimes, and if you’re a man with gum disease, you’ll run twice the risk of a heart attack and three times the risk of a stroke. There is a strong connection between gum disease and diabetes; if gum disease is under control, most diabetics see an improvement in their overall health. Ladies, hormonal changes affect gum disease, especially if you are pregnant, and it can complicate pregnancy in a variety of ways. The development of rheumatoid arthritis may be aggravated by gum disease. And for those of us over 40, studies link gum disease with dementia. Who needs all that?

Don’t forget, each time a patient comes in for a procedure, Dr. Gotun always checks for any suspicious signs of oral cancer. Oral cancer is one of the deadliest forms because it so often goes undetected until it is advanced. It is becoming more common than some of the more well-publicized forms of cancer. Early signs are often subtle: most patients don’t even know they have it. It is not hard to diagnose, yet the survival rate is low just because it is often found so late. Smokers or those who chew tobacco run a special risk, but everyone diagnosed with human papilloma virus (HPV) should be checked on a regular basis, too. Any sore spot in your mouth that does not heal within 14 days should be seen, and we are here to help you if you need an appointment. Learn more about oral cancer…

Are you putting off getting those recommended fillings because you half-humorously tell yourself “I can always get dentures”? Do you like food you have to chew? Dentures are a good solution for severe problems, but they only provide about 10% of the chewing capacity of your own teeth. So if you like a good, chewy slice of ciabatta or you are a steak lover, plan to keep your own teeth!

In other words, the next time you look at that little sticker on the windshield and think it’s about time to schedule another oil change, let that be a reminder to take care of yourself as well. After all, you are more important than the car. Call for an appointment: we’ll be glad to “take a look under the hood” and keep you on the best route to good health!

Dr. Gotun and Staff.

Photos help us diagnose your oral health at a higher magnification than with the naked eye or using magnification loops. They give us an opportunity to show you what we see, and you will be able to see the problems for yourself, which in turn will help you make informed decisions about your treatment options. Photos are a great tool for us and they help us in monitoring your status or changes. They also enable us to answer questions in a way that is easier to understand, as they are a great visual aid.

Our goal is to find and treat the underlying causes of problems, not just the symptoms.

Although all of the dental community follows the same medical standards, all dentists are unique in their own ways. There is a difference in experience, education and overall expertise. But most importantly, some medical professionals choose a philosophy that differs from others. That is the beauty of the art of dentistry. Often in medicine, there are no simple answers, because no two bodies are the same. It is the same in dentistry. Our mouth does not function separately from our body, and therefore it should be treated as such. We all have physical and personal characteristics that have to be taken into consideration for the diagnostics to be accurate and for the treatment to be effective. Because of this, the approach has to be altered for each individual case. We do not take the easy route. We make sure we do it right the first time. This is how Dr. Gotun practices dentistry.

Dr.Gotun’s philosophy is uncompromised quality of care for the best possible outcome in the long run for even the most hopeless of dental conditions.

Over 30 years of experience and well-known excellence in dental care in Austin and Texas have polished Dr. Gotun’s techniques and methods. He chooses only the best and most efficient up-to-date technologies, materials and techniques that have proven to work long-term, have fewer side-effects, are the least invasive and that ensure the most effective dental care for his patients. Dr. Gotun has extensive experience and advanced training that enables him to create unique individual solutions for his patients. Some of these solutions are so outside of the textbook that Dr. Gotun has spent years sharing his knowledge with new generations of dental professionals.

“ I cannot wait to wake up in the morning and get to work! I love what I do and I will practice dentistry as long as I physically can!” This statement by Dr. Gotun says it all. Think about this for a minute:  What is there in your own life that makes you feel as passionate? You will feel and appreciate the difference this attitude can make in getting the care you need!

Some can consider our practice non-mainstream and that is exactly what a lot of people are seeking, when their condition cannot be successfully resolved or managed by the standard of care. Dr. Gotun’s integrative approach has been very successful for many years and many cases have been solved against all mainstream dental beliefs. Our patients appreciate his philosophy and we are proud that many of them have stayed with him his entire career. We have patients who have moved out of state who still come back annually to have their care here!