Dentistry for Non-Dentists

Perfect Smile

Dentists take care of your oral needs and problems. We concentrate on your teeth, your gums and your jaw  joint. Many dentists are also getting into something they call sleep medicine or OSA (Obstructive Sleep Apnea). A dental appliance  (something like a retainer) is used to reposition your jaw into a position that helps keep your airway open when you sleep so as to make it easier for you to breath and decrease snoring. TMJ (temporomandibular joint) problems can cause pain when eating or if bad enough, constant pain in your temples or around your ear canal. Sometimes an appliance is all you need and in the worse cases, surgery is needed.

 

The most common dental visit is the check up and cleaning. This involves the dentist reviewing your medical history to make sure we don’t do anything that might harm you or your conditions and that you don’t have anything that can harm us. It’s important to know what medications you are taking and any illnesses, surgeries or other therapies that you have had. For very involved dental procedures, we may talk directly with your primary care doctor so that we can treat you safely.

 

Xrays are used to visualize what we can’t see with our eyes alone. The modern dental xray system uses very low radiation and stores the images on a computer much like a photo with your phone. The images reveal much about the health of your teeth and jaw bones and sometimes reveal some potentially bad situations that you may not have known about. Sometimes this allows us to intervene when problems are manageable and sometimes we need to refer someone to an oral surgeon or a ENT doctor(ear, nose and throat).

During the cleaning and check up appointment, we look at your teeth, gums and other parts of your mouth ( tongue, palate [roof of your mouth]), the back of your throat and under your tongue. We will feel your neck to make sure your lymph nodes are normal and we are always keeping a keen eye out for unusual bumps, pigments or growths just in case. Over my career I have discovered cancer in a couple of patients.

We take a very good look at your gums and make measurements (pocket readings or probing) and we make a note of the appearance and color of the gums and other parts of the mouth. These measurements are a way to quantify any progression of gum disease and in many instances will cause us to recommend further treatment. On that note, diabetes, smoking and drinking alcohol are disease modifiers that increase the likelihood of gum disease and tooth loss not to mention your overall health.

A regular dental cleaning is called a dental prophylaxis and is where we remove build up from the teeth and give them a good polish. This is all that is needed in a very healthy mouth, in fact, dental insurance companies  know that this procedure done regularly on patients (usually every 6 months)  prevents gum disease and more expensive deep cleanings or tooth loss replacement as well as preventing cavities from going from small filling to large fillings, crowns, root canals and extractions. Insurance companies are ALL ABOUT PROFITS so they want you to have regular cleanings and usually cover these services at 100%. They save in the long run and they are correct because we all benefit from having less dental work. Unfortunately, people are lazy, scared, forgetful or just uneducated about such things. The truth is, even the poorest populations are provided dental services for free and many still neglect their teeth. All I can do is try to educated all that I can.

What is a deep cleaning? I have been a dentist for a long time and I know for a fact that many dentists are over prescribing deep cleanings. Don’t get me wrong, when needed, it’s a life saver or should I say a tooth saver? If those gum measurements I mentioned earlier are above a certain level (normal is set at about 3 mm. or less, three millimeters is about 0.12 inch or a bit more than one tenth of an inch) we take this into consideration with your gums tendency to bleed when probed, the amount of hard build up(calculus) on the teeth, the amount of bone loss around the teeth as seen on xrays and the amount of hard build up actually seen on the xrays below the gum line. These findings reveal a dangerous situation beginning in your mouth. We call it periodontitis or periodontosis and it is an aggressive disease that has a local affect on your immune system that actually instructs your immune cells to remove the build up but the process they use also destroys the connection between your teeth, gums  and jaw bone. It can be related to many other inflammations in your body and in some it’s been shown to be related to heart and circulatory diseases. My office can handle regular cleanings and deep cleanings when needed. Most deep cleanings require anesthesia or numbing of the area to allow us to clean below the gum line without hurting you. This is the same anesthesia we use when we do fillings and other procedures. Yes, shots.

We try to make injections as painless as possible by applying a gel before hand but some just hurt. It often depends on the area of your mouth and the amount of nerve endings in that area. The good news is that they are done quickly so the uncomfortable feeling is over quickly.

Back to the deep cleaning. To remove the calculus (the hard build up) we have special scrapers and for especially hard build up we use an ultrasonic scaler that uses high frequency vibrations to break it up. This also squirts out a lot of water so it doesn’t overheat. We often do this in quadrants (one quarter of your mouth)  spread out over a few visits. If patients follow up with vigorous twice daily cleanings and flossing and regular check ups we can improve your health and save a lot of teeth. We won’t even mention lessen bad breath.

The next most common appointments I have are for fillings. When we find a cavity that is beyond self repair ( yes, there is a point at below which we just keep a close watch on a very small cavity) we need to remove the carious or infected tooth structure and replace it with a filling. In the old days, these were mainly those silver fillings. I haven’t done any of those in over 20 years. Now I do tooth colored fillings only.

First we numb the tooth then we use our trusty drill to remove the cavity ( we actually create a cavity or hole in the tooth so the proper term for tooth decay is caries) and leave only clean non-diseased tooth structure behind. We then condition the tooth and place the filling. When the filling goes between two teeth, we place bands around the tooth sort of like a wooden form for a concrete porch or sidewalk. The band keeps the filling material where it needs to be and provides the appropriate shape to restore the tooth for proper chewing. For white fillings, we use a curing light which makes the material harden. We then trim off the excess material, sculpt it to the proper shape, check the bite and polish it.

When the cavity or broken tooth reaches a certain size, a filling will not work. This situation may lead to us recommending a crown or a cap. Two names of the same thing. To make a crown, first we numb you (oh boy, not that again), we remove the diseased tooth structure and reshape what’s left of the tooth to allow it to support a crown. Sometimes we may decide that so much tooth is affected by decay or damage that it is not really salvageable and we would recommend that it be extracted (removed).

After the tooth is the proper shape, we will take an impression of the new shape. As a side note, digital scans with expensive scanners can be used to do a digital impression that can be saved to a file on a computer and sent to a milling machine in the office or in the lab. This allows the crown to be made on the same day. The limiting factor here is the cost. If a dentist does invest in this expensive equipment, it stands to reason that a certain price and certain quantity needs to be done to allow for a good return on investment (ROI). I do it the old fashion way that uses a rubbery impression material that gets hard in a few minutes and I send it to a dental lab and they return a finished crown that has an amazing fit and a handcrafted realism to it ( as much as is possible) and the turn around time is about 2 weeks so that I need to make you a temporary crown for you to wear while the new one is made. Been doing it for forty years and have had great results.

Another problem we deal with is missing teeth. Some teeth are missing genetically but most are removed after accidents, too much decay, too big of tooth fractures or too much bone loss around the tooth from advanced gum disease (periodontitis). Sometime there is so much bone loss, the tooth is so loose, it falls out on its own. Remember that deep cleaning that some people need?

To replace a single tooth, nowadays, the ideal replacement is a dental implant. I don’t do implant surgery but I work with great oral surgeons and gum surgeons who place the implants and I provide the new replacement tooth that screws or glues to the actually implant. Titanium is what the implants are made out of because it has been shown to be very compatible with bone and in fact it stimulates the bone to grow around it. Due to many factors, implants aren’t always ideal.

If there are strong teeth either side of the missing tooth, we can do a bridge or permanent partial denture. It’s basically 3 crowns in one piece that 2 are actually caps that glue onto teeth and the other is the missing tooth replacement. They can look very realistic. Sometimes several missing teeth in the correct position can be used to make a large bridge. Each case is individual and has to be thought out ahead of time.

Implants are generally the most expensive tooth replacements followed by bridges and partial dentures with the cheapest replacement being a removable snap in tooth that is mainly for looks.

When someone is missing all or several teeth, removable dentures are made. These have in the past been the final possibility. Implants have added another dimension by either giving anchors to dentures that normally just sat on the remaining jaw bone (we call them the ridges) or actually bridges that replace all the missing teeth. These are very expensive.

Dentures are made by taken impressions of the remaining dental arch ridges and using different techniques to determine where the teeth should be, their size and bite orientation and their color. This takes a few appointments. There are also digital impressions and computer designed dentures which is nice technology….if you can afford it.

When a cavity or a tooth fracture is too deep, the nerve of the tooth (pulp) is damaged. Sometimes a tooth that had had many procedures done to it like several fillings or fillings needed to be redone because of more decay because we didn’t floss enough or ate too many refined carbohydrates, reaches a point that is just too much for it and the nerve deteriorates. These teeth if left long enough become infected and very painful. The solution is either to extract the tooth or ideally if there is enough tooth structure remaining do a root canal. A root canal is a simple idea but is very difficult to perform correctly. All dentists learned how to do root canals in dental school but there is also a specialty in dentistry called Endodontics that is a two year program in addition to the four years of dental school. A root canal is the procedure by which we remove the infected nerve material in the tooth, sterilize the canal and replace it with a rubberized biocompatible sealer that prevents bacteria from re-entering the tooth canal system.

My philosophy is that if the tooth needing the root canal has normal shape (anatomy) and I can reach it easily like a front tooth, I will do the root canal myself. If I see something that bothers me, I will refer you to an endodontist.

After the root canal is completed, usually we need to place a crown on it to fully restore the tooth for good chewing. If I refer someone to the specialist, the specialist has the patient return to me to place the final restoration.

Unfortunately some teeth just can’t be saved. These teeth have to be removed. All dentists have learned various techniques to remove bad teeth. After all, the DDS after my name stands for Doctor of Dental Surgery. Tooth extraction or dental surgery is an art in itself. There are rules to follow and some dentist are better at it than others and yes, there are specialists called oral surgeons who have special training after dental school. I’ve taken out a lot of teeth in my career and I know by looking at the xray if I can save you some money and take it out myself but It’s good to know that the oral surgeon is available if needed.

Orthodontics is the process of straightening crooked teeth to give an ideal smile. Mostly it’s cosmetic, right? Not always. If your teeth don’t bite in a balanced fashion, your jaw joint can be damaged. You can have pain in that joint and eventually some severe damage. As far as sleep apnea is concerned, I meet an orthodontist who could reshaped your upper jaw with braces so that you can breath more easily. Sometimes if you have that missing tooth, orthodontics can move teeth to close the space.

 

Anyway, I hope you have learned some useful information and know that I am here to help. If you have questions, feel free to send me a text or an email.

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Robb Walters