The Human Connection

As a certified general practitioner and prosthodontist, I've been providing quality dental care for twenty two years. I love what I do and get a lot of satisfaction from helping people with their dental needs and wants. What I do is very detail oriented and quite often the outcome of a case depends on many technicalities. Things like a good preparation, a detailed impression, excellent lab work and many other nuances. When all these steps are done well, you end up with a highly satisfactory result.

However, through all these years I've come to realize that most important is that human connection between myself and the patient. Recently I completed a fairly sophisticated full mouth case. As usual we got a clinically excellent result. What made it so much more special was the rapport that had developed between myself and our patient. We had become more friends than doctor/patient and I found that this personal connection is much more gratifying than a purely clinical happy ending.

In conclusion I would add that the best possible scenario consists of both a clinically superior approach and a more emotional connection!

       

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Your child's first visit to the dentist.

In the United States, approximately 4 million preschoolers are living with tooth decay. You can help your children prevent this serious condition by scheduling regular dental checkups for them every 6 months.

This infographic from a pediatric dentist explains more....

Prevention

Prevention is absolutely key in maintaining a healthy mouth!

The vast majority of dental pathologies are preventable. Most dental problems including dental decay and gum disease start out small and if not addressed will slowly progress into bigger problems. The more advanced these problems become, the more complicated it will be to treat them. It is a cascade of events that will eventually lead to tooth loss and compromised function. Once some irreversible damage has occurred there is no going back. This is exactly why prevention is so very important.

The good news is that a large part of prevention is actually a very simple regimen of home care and hygiene. Things like brushing regularly, flossing regularly and smarter diet considerations when adopted early on are guaranteed to ensure a lifetime of oral health.. The most common pathologies of the mouth are caused by plaque and certain oral bacteria. In other words if plaque and bacteria are not cleaned from surfaces of teeth eventually they will cause tooth and gum breakdown. I've been in private practice for over twenty years and it is completely amazing to me how such simple practices can prevent such debilitating and life changing damage. The general public can have a hard time accepting responsibility for their dental woes. I have heard often how people tend to blame their oral problems on everything but themselves. Where in actuality it was their own negligence that got them in hot water. Unfortunately many people don't realize the importance of prevention until it is partially too late.

For those who have had some issues already, it is not too late to change your ways. No matter how bad things have gotten, one can still take control and create a better future!      

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Benefits of Straight Teeth

Crooked teeth could lead to speech impediments, gum disease, recurrent decay, bruxism and a lack of confidence when talking. Straight teeth encourage clearer speech patterns, a healthier mouth and more confidence in your smile. Learn more in this infographic from an orthodontist in Kansas City.

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Dental Insurance

It’s no secret that going to the dentist can be expensive depending of course on the severity of one's oral condition, which makes many people look into purchasing dental insurance. If you are thinking about buying a dental insurance plan, here are some things you should consider.

Many dental plans operate with a specific network of dentists. This means you have to use a dentist who is part of the network in order to get the full benefit of the plan. Some plans are even more restrictive and will not pay anything unless you use a dentist who is part of their network. Before buying a plan, determine if you are limited to a set network of dentists and check to see that there are reputable participating dentists in your area. If you already have a relationship with a dentist and do not want to change, check to see if he or she is participating with the plan you are considering and if not how to maximize your out-of-network benefits.
Most plans will have a yearly maximum benefit, generally between $1,000 and $2,000. This represents the total amount they will pay for the entire year and is on the low side by today's standards of care. It is important to realize that if your dental costs exceed the plans maximum amount, you will be responsible for the difference. When comparing plans, take into consideration the premium amounts you will be paying compared with the total amount of coverage you will be getting.
Many plans have specified waiting periods for certain procedures. For example, a plan may cover simple work right away, but require you to wait 6 or 12 months before they will cover any major work. Before you decide on a plan, make sure you find out if there is a waiting period and if so, what types of procedures it applies to.
Almost all dental plans break down procedures into preventive, basic, or major classifications. When looking at a dental plan, make sure you understand how they classify certain procedures and how those are covered by the plan. If you need major work, such as an onlay, a crown, a bridge and/or implants, check with the plan description to understand if these are covered and at what percentage. This will help keep you from being surprised later on with an unexpected expense. 

In conclusion, one needs to realize that regardless of any insurance, a certain level of commitment and financial responsibility on your own part is necessary for maintaining a healthy mouth. However, every little bit of assistance is obviously helpful and the name of the game is to maximize your benefits by weighing your specific options. At my practice, Elite Dental Studios, after a comprehensive examination we come up with an ideal treatment plan and then we make sure that all finances are discussed and understood before any treatment is performed. This is to avoid any surprises in the future. We also offer interest free 12 month financing to those who are eligible. Bottom line is that lack of insurance should not be a deal breaker because your teeth are just too important not to take care of!

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Primary and Permanent Teeth Eruption Sequence

As a family practitioner, I am often asked when baby teeth and permanent teeth are supposed to erupt? There is of course no standard answer to this question as there is much variation from one patient to the next. Some kids are early and some are later and that is OK. The main concern during this transition is to keep the existing dentition healthy and to make sure that all teeth are at least accounted for.  When necessary a request for orthodontic consultation is recommended. I've also included the following eruption charts only as basic guidelines.

 

 

Primary Teeth Eruption Chart

Permanent Teeth Eruption Chart

Crown Lengthening

Crown lengthening is a minor surgical procedure. It is generally performed in order to improve the health of the gum tissue, or to prepare the mouth for restorative or cosmetic procedures.  In addition, crown lengthening procedures can be used to correct a “gummy” smile, where teeth are covered with excess gum tissue.  The portion of a tooth that is not covered by gums is generally called the crown of the tooth. Crown lengthening exposes more of the natural tooth to the oral cavity, by reshaping or re-contouring bone and gum tissue.  This treatment can be performed on a single tooth, many teeth or the entire gum line, to expose a pleasant, aesthetically pleasing smile.

Crown lengthening is a versatile and common procedure that has many effective uses and benefits. The main reason for performing this procedure is to expose more healthy tooth structure in cases where damage due to a cavity or fracture extends below the gum line. Once more of the tooth is exposed, then the restorative dentist can effectively treat the area by removing any pathology and placing a restoration such as a bonded resin filling, inlay, onlay or crown.

Also in some situations extra gum tissue can make teeth look unnaturally short, and also increase susceptibility to periodontal infections.  Removing excess gum tissue, through crown lengthening, can restore a balanced, healthy look and thus create a more cosmetically pleasing appearance. This can be done in conjunction with porcelain veneers to improve the aesthetics of the case even further.

The ideal way to handle a case in need of crown lengthening is through a multidisciplinary approach where a surgeon or periodontist preform the surgical aspect and a restorative dentist or prosthodontist does the restorative work.

Dental Implants or Bridgework – Making The Best Choice

When you need to replace a missing tooth, there are two general alternatives to consider: You can choose traditional bridgework, or select the relatively newer option of dental implants. Both offer a solution that's reliable, functional, and esthetically pleasing. However, there are a few important differences between the two systems and both should be carefully considered before making a decision.

A fixed bridge is a more traditional dental restoration that's held in place by attachment to the adjacent natural teeth. A bridge therefor requires a minimum of two healthy adjacent teeth. The tooth-replacement section or fake tooth is called a “pontic”. The "abutments" are basically crowns that sit over and are cemented to your own prepared teeth. These abutments are in turn connected to the pontic(s) which bridge the gap in between. The system works well, but there's a catch: Even a single-tooth replacement requires a three-unit bridge — and healthy adjacent teeth must be reduced or “prepared” by removing their enamel, which increases the risk of future damage.

By contrast, a dental implant can be a single-tooth replacement system, with no effect on healthy adjacent teeth. It involves placing a titanium metal implant directly into the living bone of the jaw, in a minor surgical procedure. After a short time, the bone and the implant fuse, and a custom abutment and crown restoration are placed on top to complete the prosthetic tooth system. Dental implants don't decay, and they're less likely to lead to gum disease than a natural tooth bridge. They also last longer, potentially offering far greater value.

Given the choice, my preference is usually an implant restoration. However, it is critical to preform a comprehensive examination, as many other factors can influence the treatment plan. Certainly cases should be evaluated on an individual basis. 

Effect of Various Medications on Oral Health

Many medications including some vitamins, minerals and herbal supplements can negatively effect your oral health. It is extremely important to ensure that your dentist has a recent copy of ALL medications you take so they can avoid certain side effects during your visits and treatment. I will review some drug groups and their oral side effects in this post;

Anticoagulants which are usually prescribed for preventing stroke and heart disease can prolong bleeding during and after certain treatments. Examples include aspirin, warfarin and/or heparin. The dosage of this class of drugs is usually adjusted before certain treatments and should be discussed with your dentist and physician. 

Certain medications can alter your taste and cause a metallic or bitter aftertaste. Among them are cardiovascular agents, central nervous system stimulants, non-steroidal anti-inflammatory agents, respiratory inhalants and smoking-cessation products.

Some medications have been known to cause mouth sores and/or inflammation of oral soft tissues. This list includes blood pressure control medications, immunossuppresive agents, oral contraceptives and some chemotherapy agents. Again all such prescribed meds should be discussed and included in your patient file and a special oral hygiene regimen may need to be recommended to alleviate their effects.

Anti-seizure medications such as Phenytoin, some meds prescribed after organ transplants and calcium channel blockers have been known to cause gingival hyperplasia or overgrowth of the gum tissue. Meticulous oral hygiene will keep these symptoms in check.

Some medications can cause dry mouth which in turn will damage the gum tissue and/or cause tooth decay. Also many prescribed or over-the-counter medications have a significant amount of sugar which if not properly cleaned off dental surfaces can lead to cavities or recurrent decay under existing restorations. Be especially careful with children's formulations and seek out sugar-free alternatives when possible. 

Bottom line is that unless your dentist knows about the medications that you are taking, he may not be able to control potential side effects.   

 

Dental Infections

Dental infections are not all the same and there are three basic types:

The first type is an infection inside your tooth, in the living pulp tissue. This comes from tooth decay or severe irritation such as trauma. Ordinarily, when bacteria grow in your body, your body responds by sending antibodies and white blood cells to fight the bacteria. Because of this body response, the tissue will swell as it heals. For minor infections, the antibodies and white blood cells may completely eliminate them, without the outside help of antibiotics. However, inside your tooth, this natural defense mechanism breaks down because there is no room for antibodies and white blood cells. And antibiotics are of no help here either. Therefore, when your tooth becomes infected, it will not recover, and the pulp tissue will die. The treatment for this condition is a root canal treatment, where the necrotic soft tissue inside your tooth is removed and replaced with a sealer material that keeps infection from seeping back into the tooth.

There is a second type of tooth infection which occurs in the bone around the end of the root tips. This usually occurs after the first type. You will get what is called a tooth abscess. An abscess may or may not be painful. When bacteria are in the bone, your body can fight them with antibodies and white blood cells. The problem is that there is a constant supply of new bacteria to the region from the dead pulp tissue inside your tooth. Your body may or may not be successful in containing the infected area, so an abscess can go on for years without hurting. But the risk of damage is great. The abscess can grow and spread, and it can even cause the root of your tooth to be gradually dissolved. Treatment, again, would be a root canal procedure. In some rare cases an existing root canal can fail or become reinfected. Treatment in this case would be either a re-treatment or root canal surgery(apicoectomy).

The third type is a gum infection also known as gingivitis or periodontitis. This occurs in the gum tissue and/or the bone directly below the gums. Again, your body can fight this. It can also result in an abscess. The treatment for this is very different and does not require root canal treatment. This type of dental infection requires thoroughly cleaning the root surface, removing tartar and other irritants. There are many grades and types of gum infections and specific treatment regimens depend upon the specifics of the case. A subdivision of this type would be a wisdom tooth infection, which occurs in the surrounding gum and is treated with the extraction of the wisdom tooth. 

The vast majority of these infections are avoidable and the best way to steer clear of these conditions is to visit the dentist regularly and follow recommended advice and/or treatments.