Dental care in a down economy.

Before I start, I would like to recognize that some of the materials that are mentioned may seem repetitive. This is due to the fact that various tips and recommendations are relevant to different topics and circumstances. One such recommendation is a minimally invasive approach to oral health in conjunction with a preventative and comprehensive philosophy.
In a down economy the last thing you should be doing is avoiding the dentist completely. It is very important to maximize your care by continuing all routine visits such as bi-annual cleanings and examinations. This will ensure that firstly, the status quo is maintained and any potential problem is avoided(preventative approach). Second, if a pathology is diagnosed, it can be treated in a timely manner before it progresses and require more aggressive treatment in the future(minimally invasive approach). Finally, in those instances where multiple pathologies need to be treated, seeing the whole picture will allow you and your dentist to devise an appropriate treatment plan with beneficial sequences(comprehensive approach).
Remember that just as in life in general, ignoring potential and/or existing problems will usually lead to bigger ones.

Tooth Whitening

Many people are not pleased with the appearance of their own teeth and one of the easiest methods of improving this appearance is by tooth whitening.
Enamel, the first layer of tooth surface, is actually semi-translucent, or clear. The layer underneath the enamel, known as dentin, is typically yellow, but may be gray, brown or black. This hue is what is seen penetrating through the enamel. In order to whiten the dentin, a peroxide solution is placed on the enamel. This process opens the pores of the enamel, allowing the solution to reach the layer of dentin. The solution will then begin to lighten the dentin, resulting in the appearance of whiter teeth.
As far as specific techniques and systems go, there are three basic categories. The first and least effective are over-the-counter products such as whitening strips. The second used to be the only professional option and consists of trays that are made by dentists and worn at home by the patient. The newest and most effective are chairside methods in which the entire procedure is preformed in the office over the course of approximately two hours. In this system a special light is used in conjunction with the whitening agent in multiple applications.
The good news for the patient is that many options are available nowadays and many are proven safe and effective.

A question of priority

In my 18 years of private practice as a family practitioner and Prosthodontist, I've heard all kinds of excuses for avoiding and/or delaying dental treatment. Regardless of what the excuse is, I think in most cases it is simply a question of priority. Most people can understand, on an intellectual level, that an existing pathology needs to be removed and corrected. However unless the person is in pain or discomfort, they may feel that the recommended treatment can wait or in some extreme cases totally avoided. Of course the problem with this line of thinking is that clinical pathologies never go away and as a matter of fact usually lead to irreversible damage which will require even more treatment down the line. I have seen patients regret not following through with recommended treatment too many times and those who remain consistently healthy are the ones that do not procrastinate!

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!