A comprehensive approach

The oral cavity or mouth consists of many parts and can roughly be categorized into hard tissues(teeth and bone) and soft tissues(gums, cheeks, palate, etc.). Optimal function and appearance requires that all the parts are healthy. So when it comes to treating the mouth, it is absolutely imperative to apply a comprehensive approach. I've come across many situations in my career where certain aspects of a condition were ignored during previous treatment and as a result the outcome is poor or failing.
Recently, I did an examination on a patient who just had some restorative work and needed a second opinion because he was not pleased with the results. I found that the patient had moderate to severe bone loss(Periodontitis) and had to tell the patient that all the recent work should be removed in order to treat the supporting bone and gums. Needless to say Mr. X was not happy. The moral of this story is to make sure that a thorough evaluation(clinical and radiographic) is performed before a treatment plan is derived and carried out. As we all know, its always better to do it right the first time!

Onlay

As I have mentioned previously, existing restorations in our teeth do not last forever. Due to a constant wear and tear, older fillings tend to break down over the years. It can be somewhat confusing to the average person as to what is an appropriate replacement for an old and defective filling. There are many choices but as a general rule the proper choice for a replacement is directly proportional to how much tooth structure is remaining after the excavation. So the size of the original restoration is definitely a factor. Another factor is the nature and severity of the defect, meaning how much recurrent decay is present at the time of diagnosis. It is also very important to be conservative and not remove any more healthy tooth structure than is necessary.
In my experience most existing defective fillings are best restored with an Onlay. An Onlay is a type of dental restoration that is the best of both worlds not only in the sense that it provides proper coverage but also it is not overkill in preparation. What happens in most situations is that after a defective filling is cleaned out, the walls that contained the old filling will be too thinned out to support another direct filling especially at the very top of the tooth. Those thin walls are then reduced by a couple of millimeters and the Onlay is fabricated in the Laboratory from an impression of the teeth. The analogy that I like to use is a mushroon shape in cross section where the "cap" covers most of the biting surface and the "stalk" sits in the tooth where the filling was. This design is ideal because we are essentially only removing what is defective. It is also relatively more conservative in preparation than some other choices such as a crown for example. The idea is that the more of your own tooth we can hold on to now, the better off you are in the long run and more options are available in the future.
Onlays are made of a type of porcelain and are bonded in with a resin cement. This is a very strong combination and teeth that are restored in this way will typically not require further treatment for many years.

Interesting facts

In this post, I've decided to keep it light and just list some interesting facts that are dentally related;
The average woman smiles about 62 times a day! A man? Only 8!
Kids laugh around 400 times a day. Grown-ups just 15.
Smilers in school yearbooks are more likely to have successful careers and marriages than poker faced peers.
More people use blue toothbrushes than red ones.
The average toothbrush contains about 2,5000 bristles grouped into about 40 tufts per toothbrush. The tufts are folded over a metal staple and forced onto pre-cored holes in the head and fused into the head with heat. The handle is made of at least two materials, usually plastic and rubber.
Top of the American teeth stakes in the poll for greatest looking teeth were Hollywood actors Brad Pitt and Julia Roberts.
50 % of the general population consider the smile the first facial feature they notice and 80% are not happy with their smile.
38.5 = the total days an average American spends brushing teeth over a lifetime.
Americans spent nearly $2.025 billion on Halloween candy this year. That would fund the National Institute of Dental and Craniofacial Research for almost six years.
33% of Americans have untreated tooth decay.
90% of systemic disease have oral manifestations.
83% of people believe their teeth are more important to their appearance than hair and eyes.
How people take care of their mouths is often a reflection of how they feel about themselves. At birth the only fully developed organ is the tongue which is needed for sucking. For the first two months of life our mouth is our primary organ. We use it for survival, expressing ourselves and to explore our new world. consequently it is very significant in our unconscious. Because of this it can be assumed that how we take care of our mouths is a reflection of how we feel about ourselves. People who feel good about themselves take good care of their mouth and people who have a poor self image generally do not take good care of their mouth.

Discomfort

In deciding the topic of my next entry, I always try to put myself in the patients' shoes and think from a patient's perspective. What came to mind recently is the discomfort that most people automatically associate with dental treatment. In my mind the vast majority of the "usual" discomforts of dental treatment can be avoided. In other words an assumption that dental treatment is inherently uncomfortable is false. My staff and I always try to pay attention to the smallest detail in dealing with patients and our priority is to keep our patients mentally and physically comfortable at all times. This attention to detail goes a very long way and the positive reaction of our patients even surprises me at times. Not a day goes by where I don't get a "Wow, that wasn't bad at all" and I take pride in the fact that I am exceeding my patients' expectations on every level. So the next time you find yourself apprehensive at the thought of dentistry, just remember it doesn't have to be that way!

Benign neglect

Benign neglect is a policy or attitude of ignoring a situation instead of assuming responsibility for managing or improving it. I take this topic very seriously as I've had some experience with it and it's consequences. Years ago when I took over an existing practice, I came to realize that some of the patients did not want any treatment unless they were in pain or half of their tooth fell out! I found myself explaining and educating my patients as to the importance of early diagnosis and treatment of conditions that they were not aware of. Later after some investigating I realized that the previous dentist rarely did a thorough examination and basically if the patients did not have a complaint they were given a clean bill of health and sent on their way. This practice may seem like a conservative approach on the surface but of course it is not only detrimental to the health of patients, but also unethical. It is a proven fact that by the time a patient experiences some symptoms, some irreversible damage has already occurred. For example some recurrent decay under an existing restoration is usually diagnosed at a periodic exam and subsequently the filling and decay are excavated and a new restoration placed. Now, if the same tooth is neglected, the nerve could easily become invaded by the advancing decay and become infected, thus requiring more invasive treatment such as root canal therapy. I feel that it is my professional and ethical duty to use all technological advances at my disposal to make thorough diagnosis on a regular basis and protect the health of my patients in the long run.

Sticking with your treatment

Some of us are lucky and have very few dental issues in the way of gum disease or recurrent decay.
On the other hand the majority of the population, at one point or another, will develop more than one form of pathology at the same time. In these situations it is imperative to have a comprehensive approach in treatment. Now it's human nature to deal with your problems one at a time and it is totally understandable that to many people problems in multiple areas of their mouth seem overwhelming. I have been told by some of my patients, "why don't we deal with this first and then we'll see....." and over and over again the result is a vicious cycle that never ends! One needs to always keep the big picture in mind. The pathologies that are put on the back burner not only don't go away, but by the next check-up are worse and would require even more invasive treatment. The much wiser approach is to hunker down and try to eliminate all problems as soon as possible. There is always a light at the end of the tunnel and by addressing all issues, one can quickly get back on track.

Dental Implants

Although you have a number of restorative options for the treatment of missing teeth, none have proven to be as functionally effective and durable as implants. In many cases, dental implants may be the only logical choice for the restoration of all necessary functionality of the teeth and supporting structures. An important advantage of dental implants over more traditional forms of treatment such as a fixed bridge, is that your other teeth are not prepared to hold the prosthesis. Thus they are much more conservative in terms of your own teeth.
Today's dental implants are virtually indistinguishable from other teeth. This appearance is aided in part by the structural and functional connection between the dental implant and the living bone. Implants are typically placed in a single sitting but require a period of osseointegration. Osseointegration is the process by which direct fusion of a dental implant root and the bone of the jaw occurs. An osseointegrated implant takes anywhere from three to six months to anchor and heal, at which point we would complete the procedure with the placement of a crown. Dental implants can also be utilized to replace multiple teeth.