Friday, December 28, 2012

Our Most Read Posts of 2012

The year is coming to a close, so we wanted to commemorate our first year in blogging with a post dedicated to the top story content on the HB Dentistry blog. These are the most popular articles we posted and wanted to share them again just in case some of our readers weren't haven't gotten around to reading them yet. Click on the image to read the full article.

1. Symptoms of a Toothpaste Allergy

2. Notes on Dental Hygiene From HB Dentistry

3. Importance of Childhood Oral Hygiene & the Role of Parents

4. HB Dentistry - New Internet Spot

5. How To Floss Your Teeth Properly
If you live in the Niles area and are looking for a dentist, please visit our website for more information:
http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry

Wednesday, December 19, 2012

What Is Orofacial Pain?


Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles or temporomandibular joint. Problems can include temporomandibular joint discomfort; muscle spasms in the head, neck and jaw; migraines, cluster or frequent headaches; or pain with the teeth, face or jaw.

You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. Pain also can be caused by clenching or grinding teeth, trauma to the head and neck or poor ergonomics.


Some people may experience pain in the ears, eyes, sinuses, cheeks or side of the head, while others experience clicking when moving the jaw or even locking if the jaw is opened or closed.


Temporomandibular Disorder (TMD)

The National Institutes of Health estimates that 5 to 10 percent of Americans have TMD, or problems affecting the jaw joint and/or muscles. Your temporomandibular joints are located where the skull connects to your lower jaw. To feel these joints, place your fingers in front of both ears and open your mouth. The muscles on the sides of your head and face control the movements of the joints. Researchers believe women between 20 and 40 may be more likely to suffer from TMD due to hormone levels.


Headaches

Approximately one in eight Americans suffer from headaches. Experts estimate that 75 percent of all headaches are caused by muscle tension, which may be related to the bite. Headaches also can be caused by clenching jaw muscles for long periods of time. Signs that may indicate a headache of dental origin include:

  • Pain behind the eyes
  • Sore jaw muscles or "tired" muscles upon awaking
  • Teeth grinding
  • Clicking or popping jaw joints
  • Head and/or scalp is painful to the touch
  • Earaches or ringing in the ears
  • Neck, shoulder or back pain
  • Dizziness

Sleep Disorders

If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism, or a sleep-related breathing disorder, such as snoring or sleep apnea. Bruxism is the technical term for grinding and clenching. Snoring that goes undiagnosed may lead to an increased tendency for the airway to collapse, leading to sleep apnea. Sleep apnea is a condition when the tissues and muscles in the back of the throat collapse the airway. People with untreated sleep apnea stop breathing repeatedly during their sleep, sometimes hundreds of times during the night and often for a minute or longer.


Treatments to Alleviate Pain

Your dentist has a variety of treatments that can help alleviate your orofacial pain. One device is called an orthotic, or splint, that is worn over the teeth until the bite can be stabilized. Permanent correction may require reshaping teeth, building crowns, orthodontics or a permanent appliance for the mouth. Your dentist might also recommend physical therapy, counseling, relaxation training or massage therapy.

Other ways to alleviate the pain include:

  • Place an ice pack on the painful area for 10 minutes, three or four times per day.
  • Eat softer foods and avoid chewing gum or ice.
  • Cut food into smaller pieces.
  • Keep upper and lower teeth slightly apart, except when chewing or swallowing. Keeping your tongue between your teeth may help with this.
  • Sleep on your back.
  • Don't rest your hand on your chin. When talking on the phone, don't rest the receiver on your shoulder.

How Your Dentist Can Help

Your dentist will take a medical and dental history to determine if any trauma has occurred in the facial area, perform a physical examination to examine your temporomandibular joint and head and neck. Maintaining or correcting your bite ensures optimal health, and proper care will help reduce or eliminate orofacial pain or discomfort.



Hagopian & Boghosian Dentistry

9101 Greenwood Avenue, Suite 302
Niles, IL 60714-1466

Phone: (847) 296-4030

Visit our website: http://www.hb-dentistry.com

Follow us on Twitter: http://www.twitter.com/hbdentistry


A Relationship Based Dental Practice...

Saturday, December 8, 2012

Hagopian & Boghosian Dentistry - New Internet Spot!

video

Thanks for watching our new Internet Spot.  Feel free to ask us any Dental questions or concerns you may have. 

Located in the suburbs of Chicago, Dentists John M. Hagopian, DDS and Alice G. Boghosian, DDS practice a full scope of general and cosmetic dentistry with expertise ranging from porcelain veneers to dental implants, crowns and bridges. Drs. Hagopian and Boghosian can now correct a wide variety of so-called permanent cosmetic dental problems, and can literally redesign your smile.


Hagopian & Boghosian Dentistry

9101 Greenwood Avenue, Suite 302
Niles, IL 60714-1466

Phone: (847) 296-4030

Visit our website: http://www.hb-dentistry.com

Follow us on Twitter: http://www.twitter.com/hbdentistry


A Relationship Based Dental Practice...

Wednesday, December 5, 2012

The Life of a Tooth

Check out this wonderful visual aid that details the life of the human tooth (click on image to access).



If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry


Wednesday, November 28, 2012

To Pierce Or Not To Pierce?


Have you thought about chipped teeth, drooling, gum damage, nerve damage, taste loss, tooth loss or infection? The problems that can arise from an oral piercing might surprise you.

Fractured teeth are a common problem for people with tongue piercings. People chip teeth on tongue piercings while eating, sleeping, talking and chewing on the jewelry. The fracture can be confined to the enamel of your tooth and require a filling, or it may go deep into the tooth; in which case, a root canal or tooth extraction may be necessary.

"Every time you swallow, the barbell hits the teeth, causing constant irritation that can result in mouth ulcers," says Academy of General Dentistry spokesperson Manuel A. Cordero DDS, FAGD.


Infections are also common. Dentists are learning that oral infections can be linked to other infections. "The tongue is covered with bacteria," Dr. Cordero said. "The moment the tongue is punctured, bacteria are introduced into the blood. When that happens, bacteria can travel to the heart and cause a variety of serious problems."

If you decide to pierce your tongue, take care of it. Once the tongue has been pierced, it takes four to six weeks to heal. Barring complications, the jewelry can be removed for short periods of time without the hole closing. Always remove the jewelry every time you eat or sleep.

To avoid serious infections such as HIV or hepatitis, make sure the piercer sterilizes everything in an autoclave, which uses extreme heat to sanitize surgical instruments. Ask the piercer questions about after-care, cleanliness, equipment and other concerns.

Clean your piercing with an antiseptic mouthwash after every meal and brush the jewelry the same as your teeth to remove plaque.

Article Source: http://www.knowyourteeth.com/infobites/abc/article/?abc=O&iid=321&aid=1300


If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry

Tuesday, November 20, 2012

Minimally Invasive Dentistry

The goal of minimally invasive dentistry, or microdentistry, is to conserve healthy tooth structure. It focuses on prevention, remineralization, and minimal dentist intervention. Using scientific advances, minimally invasive dentistry allows dentists to perform the least amount of dentistry needed while never removing more of the tooth structure than is required to restore teeth to their normal condition. In addition, in minimally invasive dentistry, dentists use long-lasting dental materials that conserve the maximum tooth structure so the need for future repairs is reduced.

How does it work?

First your dentist will evaluate your risk for tooth decay. The presence of bacteria, quality and quantity of saliva, and your diet are all contributors to decay. Your dentist will then use strategies to prevent or reduce your risk for tooth decay. For instance, if you have a high level of oral bacteria, you might be advised to use mouthwash daily, limit the intake of certain carbohydrates, and practice good oral hygiene.

Which techniques are used?

Minimally invasive dentistry techniques include:

Remineralization: Remineralization is the process of restoring minerals. Remineralization can repair the damage created by the demineralization process. Fluoride plays a very important role in remineralization. 

Air abrasion: When a tooth cannot be remineralized and decay is present, your dentist may use air abrasion to remove the decay. Air abrasion is used instead of a traditional drill and may not require anesthesia. It resembles microscopic sand blasting and uses a stream of air combined with a super-fine abrasive powder.

Sealants: Usually made of plastic resin, dental sealants protect teeth from bacteria that cause decay. Sealants fit into the grooves and depressions of the tooth and act as a barrier, protecting against acid and plaque. Sealants do not require any cutting of the tooth and can be placed on teeth that might be susceptible for decay at any time.

Inlays and onlays: Usually dentists use crowns to restore a tooth, but inlays and onlays do not require them to remove as much of the tooth structure. Inlays are similar to fillings except that they are custom-made to fit the cavity in your tooth and are typically the same color as the tooth or gold colored. Onlays are used for more substantial reconstruction and also do not require your dentist to remove as much of the tooth as would a crown.

Bite splints: Many people grind their teeth at night. Grinding, or bruxism, may cause serious damage to the teeth, and may require you to need crowns. Grinding, which often begins in your teenage years or early 20s, can be detected and corrected before much damage has been done. Dentists can create bite splints for you to wear at night or during stressful times when most teeth-grinding occurs.

Where can I find a dentist who practices minimally invasive dentistry?

Most dentists use minimally invasive dentistry techniques in their everyday practice. Ask your dentist if he or she uses these techniques.



If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry


Tuesday, November 13, 2012

Temporary Dentures Improve Patients' Smiles and Overall Health

As people  begin to realize how their appearance may influence their social life, many are turning to alternative methods to perfect their smile. Temporary dentures are not only economically feasible to wear while waiting for a permanent denture, but they can also aid in a person's overall health and restore a fading smile, according to a study from the January/February 2008 issue of General Dentistry, the Academy of General Dentistry's (AGD) clinical, peer reviewed journal.
"A smile serves as an individual's most powerful tool," says AGD spokesperson Laura Murcko, DMD. "A great smile can make great, lasting impression, boost a person's self-esteem and confidence as well as improve their overall health."
However, each year in the United States, over 20 million teeth are extracted, leaving scores of people with imperfect and sometimes devastating smiles. A recent online survey of more than 1,100 AGD members revealed that more than 86 percent of dentists reported that their patients deemed social embarrassment as a problem associated with tooth loss. 
"Unsightly gaps in the mouth do not have to be part of a person's permanent appearance," says Dr. Murcko. While many dentures help to restore a damaged smile, interim removable partial dentures, also known as temporary dentures provide an immediate and short-term pleasing result.
"They also allow the patient to eat regular food and serve as a space maintainer in younger patients who've lost teeth as a result of trauma," according to the lead study author, Canan Bural, DDS.
When people suffer from tooth decay or periodontal disease, losing just one tooth can be a sign that more teeth will be lost. This means that placing a permanent denture in the mouth is difficult. "When continued tooth loss is expected in a patient, dentists are limited in terms of the type of dentures they can offer to the patient," explains Dr. Bural. In instances such as these, temporary dentures can greatly benefit the patient.
Survey Says…Common problems associated with natural tooth loss:
•   Reduction in ability to chew—91.91%
•   Social embarrassment—86.35%
•   Avoid eating certain foods—73.83%
•   Feel nervous or self-conscious—68.7%
•   Emotional pain—66.26%

Article Source: KnowYourTeeth.com

If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry



Tuesday, November 6, 2012

Periodontal Maintenance

Periodontal diseases are infections of the gums, which gradually destroy the support of your natural teeth. There are numerous disease entities requiring different treatment approaches. Dental plaque is the primary cause of gum disease in genetically susceptible individuals. Daily brushing and flossing will prevent most periodontal conditions.
Adults over 35 lose more teeth to gum diseases, (periodontal disease) than from cavities. Three out of four adults are affected at some time in their life. The best way to prevent cavities and periodontal disease is by good tooth brushing and flossing techniques, performed daily.
Periodontal disease and decay are both caused by bacterial plaque. Plaque is a colorless film, which sticks to your teeth at the gum line. Plaque constantly forms on your teeth. By thorough daily brushing and flossing you can remove these germs and help prevent periodontal disease.
Periodontal diseases can be accelerated by a number of different factors. However, it is mainly caused by the bacteria found in dental plaque, a sticky colorless film that constantly forms on your teeth. If not carefully removed by daily brushing and flossing, plaque hardens into a rough, porous substance known as calculus (or tartar).
Bacteria found in plaque produces toxins or poisons that irritate the gums, which may cause them to turn red, swell and bleed easily. If this irritation is prolonged, the gums separate from the teeth, causing pockets (spaces) to form. As periodontal diseases progress, the supporting gum tissue and bone that holds teeth in place deteriorate. If left untreated, this leads to tooth loss.
The best way to prevent gum disease is effective daily brushing and flossing as well as regular professional examinations and cleanings. Unfortunately, even with the most diligent home dental care, people still can develop some form of periodontal disease. Once this disease starts, professional intervention is necessary to prevent its progress.
Other important factors affecting your gum disease:

  • Smoking
  • Diabetes
  • Stress
  • Clenching and grinding teeth
  • Medication
  • Poor nutrition

Source: www.hb-dentistry.com Video Source: The ADA via YouTube

If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry

Tuesday, October 30, 2012

What Is Pericoronitis?

Wisdom teeth do not always emerge (erupt) into the mouth properly because there may not be enough room in the mouth for them to fit. Sometimes, a part of the tooth may remain covered by a flap of gum. Food particles and bacteria can get trapped under this flap and cause a mild irritation, a low-grade infection called pericoronitis and swelling. This usually happens with the lower wisdom teeth.

What You Can Do

You cannot treat pericoronitis at home. Do not use warm compresses on your face. If you recognize the symptoms, get treatment right away. The symptoms may include:
  • A bad taste in the mouth — This often happens when there's an infection.
  • Bad breath (halitosis)
  • Pain in the area around your back teeth — Pericoronitis usually occurs around the wisdom teeth.
  • Swelling behind the very back teeth — If you have pericoronitis, you'll notice that the gum tissue in the back of your mouth is swollen. This swelling may not allow you to bite comfortably without pinching the swollen tissues between your teeth.
  • Not being able to open your mouth fully

What Your Dentist Will Do

Source
Pericoronitis can be tricky to treat because the overlying flap in the tissue won't go away until the wisdom tooth fully emerges naturally — which is unlikely to happen — or is removed by an oral surgeon. 
Your dentist, however, may try to treat the problem without extensive procedures. He or she will clean the area thoroughly to remove damaged tissue or pus. If the area is infected, you'll be given oral antibiotics as well.
Your dentist will tell you how to keep the area clean, which is the best way to prevent the problem from coming back. You will have to brush and floss every day and also rinse your mouth with water several times a day. This will help to prevent food particles from building up in the area.
If the condition returns, your dentist probably will send you to an oral surgeon, who will remove the tooth. Once the tooth is out, you should not have the problem again. If the problem is caused by an upper wisdom tooth biting the gum covering a lower wisdom tooth, the upper one may be removed first.
Article Source: Colgate
If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry

Tuesday, October 23, 2012

Soda or Pop? It's Teeth Trouble By Any Name



It's called "pop" in the Midwest and most of Canada. It's "soda" in the Northeast. And it goes by a well-known brand name in much of the South.
People across North America use different words to identify a sugary, carbonated soft drink. But however they say it, they're talking about something that can cause serious oral health problems.
Soft drinks have emerged as one of the most significant dietary sources of tooth decay, affecting people of all ages. Acids and acidic sugar byproducts in soft drinks soften tooth enamel, contributing to the formation of cavities. In extreme cases, softer enamel combined with improper brushing, grinding of the teeth or other conditions can lead to tooth loss.
Sugar-free drinks, which account for only 14 percent of all soft drink consumption, are less harmful.1 However, they are acidic and potentially can still cause problems.

We're Drinking More and More

Soft drink consumption in the United States has increased dramatically across all demographic groups, especially among children and teenagers. The problem is so severe that health authorities such as the American Academy of Pediatrics have begun sounding the alarm about the dangers.
How many school age children drink soft drinks? Estimates range from one in two to more than four in five consuming at least one soft drink a day. At least one in five kids consumes a minimum of four servings a day.2
Some teenagers drink as many as 12 soft drinks a day3.
Larger serving sizes make the problem worse. From 6.5 ounces in the 1950s, the typical soft drink had grown to up to 20 ounces by the 1990s.
Children and adolescents aren't the only people at risk. Long-term consumption of soft drinks has a cumulative effect on tooth enamel. As people live longer, more will be likely to experience problems.

What to Do

Children, adolescents and adults can all benefit from reducing the number of soft drinks they consume, as well as from available oral care therapies. Here are some steps you can take:
  • Substitute different drinks: Stock the refrigerator with beverages containing less sugar and acid such as water, milk and 100 percent fruit juice. Drink them yourself and encourage your kids to do the same.
  • Rinse with water: After consuming a soft drink, flush your mouth with water to remove vestiges of the drink that can prolong exposure of tooth enamel to acids.
  • Use fluoride toothpaste and mouth rinse: Fluoride reduces cavities and strengthens tooth enamel, so brush with a fluoride-containing toothpaste such as Colgate® Total®. Rinsing with a fluoride mouthwash also can help. Your dentist can recommend an over-the-counter mouthwash or prescribe a stronger one depending on the severity of the condition. He or she also can prescribe a higher fluoride toothpaste.
  • Get professionally applied fluoride treatment: Your dental hygienist can apply fluoride in the form of a foam, gel or rinse.
Soft drinks are hard on your teeth. By reducing the amount you drink, practicing good oral hygiene, and seeking help from your dentist and hygienist, you can counteract their effect and enjoy better oral health.


Article Source: Colgate

If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry

Tuesday, October 16, 2012

Importance of Childhood Oral Hygiene & the Role of Parents



The foundation for healthy permanent teeth in children and teenagers is laid during the first years of life. Poor diet, poor habits of food intake and inadequate toothbrushing habits during the first 2 years of life have been shown in several studies to be related to tooth decay in children. The development of caries in primary teeth further increases the risk of developing caries in new permanent teeth.
Therefore it is essential to establish a proper oral hygiene routine early in life to help ensure the development of strong and healthy teeth. Parents, as consistent role models, are key for setting a daily routine and to making their children understand the importance of oral hygiene. Toothbrushing should be presented as a habit and an integral part of the daily hygiene routine. Children are very sensitive to social stimuli such as praise and affection, and learn best by imitating their parents. Physiological and mental development affects the oral care of children.

Importance of the primary dentition

Primary teeth start to erupt in children from the age of six months. The primary dentition is complete by approximately two and a half years of age. The enamel of primary teeth is less densely mineralized than the enamel of permanent teeth, making them particularly susceptible to caries. Primary teeth are essential tools, both for chewing and learning to talk. They help to break up food into small pieces, thereby ensuring efficient digestion. A full set of teeth is an essential prerequisite in learning correct pronunciation. Primary teeth also play a vital role in the proper alignment and spacing of permanent teeth; it is therefore imperative that they are well cared for and preserved until normal ex-foliation takes place. Establishing a proper oral care routine early on in life sets the foundation for the development of healthy and strong permanent teeth. In addition to good oral hygiene, diet also plays a key role in keeping teeth healthy. In this respect it is not only the quantity of sugar that is important, but also the frequency of consumption. As much as possible, children should be limited in the amount of sweets between meals, especially in the evening or at night.

New permanent teeth

Although permanent teeth are already partly formed in children aged 0 to 3 years, eruption only occurs later in life (from about 6 years on) when the 32 permanent teeth (16 in the upper and 16 in the lower jaw) replace the 20 primary teeth. During this time root resorption and crown shedding of primary teeth take place. With the eruption of the first permanent teeth (from about 6 years on), the mouth contains a mixture of both primary and permanent teeth, which puts children at increased risk of caries. Often the eruption of this permanent tooth is not realized neither by the child nor by the parents, because it is positioned behind the last primary molar and is not replacing any primary tooth. Although enamel is fully formed at eruption the surface remains porous and is inadequately mineralized. Subsequently, a secondary mineralization occurs (second maturation), in which ions from the oral cavity penetrate hydroxyapatite and increase the resistance of the enamel against caries. Furthermore, any primary teeth with caries form reservoirs of bacteria, which can easily attack the immature enamel of the new permanent teeth. During the eruption, the occlusal surfaces of the new permanent teeth are on a lower level than the primary teeth. Toothbrushing becomes more difficult than before, given the coexistence of loose primary teeth, gaps and newly erupting permanent teeth. The jaw is also growing significantly, making space for more teeth. The cleaning of the narrower interdental spaces becomes more important with increasing numbers of permanent teeth.

Role of Parents

Parents have a key role in helping their children to develop a proper oral hygiene routine in the first years of their life. Parents should lead and supervise their children’s toothbrushing approximately for the first 12 years, until motor and mental functions allow the child to routinely perform a proper toothbrushing technique alone. After brushing the teeth for their children for the first 2 years of life, parents will have to use playful motivation to encourage their children to brush their own teeth from about 3 years onwards – the time when children want to brush their teeth alone. Each time the child has finished brushing, parents should re-brush the hard-to-clean areas. At the age of around 6 years, children are able to brush their teeth using a proper brushing technique. In this phase, parents have to continue supervising the regular brushing efforts of their children. The special anatomical situation of changing dentition makes it indispensable that parents still need to help their children in the daily toothbrushing task until eruption of the second molar (around the age of 12).
Development stages of children from the age 0-12
As soon as the first primary teeth erupt into the oral cavity, parents should begin brushing their children’s teeth. From the age of two years, teeth should be brushed twice daily with smaller than a pea-size amount of children’s toothpaste. Small children tend to swallow a large amount of toothpaste, so that there is a risk of developing dental fluorosis. Supervised application of the amount of toothpaste to the toothbrush is important. Due to the risk of fluorosis, the fluoride content of toothpaste for children up to the age of 5–7 years was reduced in most European countries (250 ppm to 750 ppm). Beginning with the eruption of the new permanent teeth, children should be switched from a low fluoride containing children’s toothpaste to a higher fluoride containing toothpaste (1000 ppm to 1500 ppm). This ensures the best caries protection
as possible for their new permanent teeth.

Toothpaste Use

Toothpaste with an age adapted content of fluoride is recommended

Primary teeth should be brushed by parents twice a day from the first tooth onwards. Parents should re-brush thoroughly after the child has brushed first. From the age of 6 years children have the ability to brush their teeth alone twice daily. However, parents must supervise the toothbrushing (until the age of 12) and check on the condition of the toothbrush. A worn toothbrush is also less effective at cleaning teeth.


Article Source: Colgate

If you live in the Niles area and are looking for a dentist, please visit our website for more information: http://www.hb-dentistry.com

Our office is located at 9101 Greenwood Avenue, Suite 302, Niles, IL.  60714
Call us at  847-296-4030.

Follow us on twitter:  @hbdentistry