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Dental

Dr Paul F Mitsch

2005-02-01 11:24:00

: I have noticed recently that a friend of mine has bad breath. She brushes her teeth frequently. What causes bad breath?

ANSWER: Bad breath is termed "halitosis."  The social implications of halitosis are easily understood:  alienation, embarrassment and a lasting memory of how a person smells instead of how a person looks or interacts with others.  Our sense of smell is a wonderful sense and it is a protective sense.  Our sense of smell is also closely associated to memory and sense of taste.  As a protective sense, smell will sometimes determine our appetite or may warn us of many pending changes.  And just as we become accustomed to other noxious conditions in our environment, we do not always notice our breath and many times our loved ones do not either.  Even so, our loved ones or close friends might rather endure the foul odors floating from our words than warn us that we are diminishing the insect population!For most of us, we are victims to our habits.  Eating habits, for example, will affect the condition or the smells that produce halitosis.  Garlic is one food that is great for the heart but unmistakable in a wrestling match!  Smoking, alcohol and coffee produce similar results.    Generally, these conditions exist because of sulfides that are produced in the saliva and linger in the mouth.  By neutralizing the sulfides, the breath is neutral and can even be freshened.  In dentistry, many practices have machines that actually measure sulfides and an index or number is produced to tell a patient what his or her particular "halitosis alert" is.  Once the person has a breath level established, the dentist can prescribe a remedy. If a person participates in any habit that results in bad breath, a simple solution in breath care is mouth wash or rinse. There are many available over-the-counter and most will perform very well.  However, breath mints and candies that are used for the same purpose may be more harmful to a person than the halitosis. If the agent (candy) has sugars and especially high fructose corn syrup (HFCS) as an additive, making a habit of the candy may damage the teeth. In this case, the best option is a breath freshener with a sugar substitute such as my favorite, xylitol, because it destroys cavity-forming bacteria. Some believe chewing gum will solve the bad breath dilemma but it has the same effect as candy and also may damage a TMJ (temporomandibular joint) if the joint is stressed.  There are times when halitosis is a condition of health and the person really has no ability to notice or change the condition.  Diabetics have a characteristic smell to their breath when they are entering a crisis.   Patients with Gastric Esophogeal Reflux (GERD) may have a characteristic smell and odor in the morning. Medicines also will be metabolized in the lungs and create or throw off a particular odor.  Of course, periodontal disease and necrosis or dead tissue both produce characteristic odors.  These signs of chronic bad breath should be evaluated and if one cannot control the odor, the person should seek attention and consider where the odor is coming from. We have not yet come to the point that it is comfortable to tell strangers that they have stinky breath.  However, we should take an interest in those who are close to us and consider their breath a courtesy if they have a problem.  If someone approaches me and explains that I could use a little rinse, I will thank them.  And if my family were to notice a smell like airplane glue coming from my mouth, I hope they would tell me so I could get tested for diabetes.  Halitosis and the treatment of all the conditions that cause bad breath are only sensible ways to live a healthier and happier life.

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Dental

Dr Paul F Mitsch

2005-02-01 09:22:00

: How can teeth be damaged simply by what one eats or the habits one has?

ANSWER: This is a great question to look at from three different perspectives: diet, habit and diet-related illnesses.Teeth are damaged in a variety of ways by diet.  The most obvious is caries or the infection of teeth by bacteria and the destruction of tooth structure by acids produced by the bacteria.  Caries - the name of the infection that destroys teeth - is the most prevalent childhood illness in the United States.  However, we are seeing an increase in the prevalence of caries in the adolescent and young adult population.  The problem has been directly linked to High Fructose Corn Syrup (HFCS), a sugar substitute used in foods to lower the cost of preparation.  HFCS is a fuel for the bacteria that is responsible for tooth decay and actually stimulates an increase in the production of the acids that etch and decay teeth.  On the internet in any search engine, type the words "Mountain Dew Mouth" and read about the phenomenon that is increasing the cost of dental care among our young.  HFCS is the culprit in this scenario but it may be affecting all it comes in contact with.  Dentally, I term the problem "pattern decay" and we are able to repair the teeth easily if caught early and the habit is changed.  However, if the habit remains, the repairs will not be effective and the cost may be stunning in the attempt to repair the teeth.  I have seen costs run patients well in excess of a new car in attempting to reverse the process of this damage when it has been extreme!  Diet soft drinks are a substitute but the most appropriate substitute in our diet for these drinks is plain water. Simply stated: exposure of tooth structure and gum tissue to certain foods may damage these structures and demand repairs that will be expensive and difficult to maintain.Habits damage gum tissue and teeth by attrition and changes that take place in the environment.  A smoker increases the risk of periodontal disease by as much as 700% over a non-smoker!  Periodontal disease is responsible for 80% of teeth lost in people over the age of 25!  Chewing gum may stress a Tempromandibular Joint and result in pain and headaches.  Breath mints are loaded with sugars.    Because breath mints are usually held in the mouth in one particular spot the resulting decay and damage is in a pattern which may result in root canal treatment or large repair procedures like crowns.  Chewing ice breaks and cracks a lot of teeth!  Broken teeth need large repairs - usually crowns.  Piercings have damaged teeth due to habits the patient creates as they tap their teeth.  Usually soft tissues are destroyed or changed and teeth are damaged due to these habits.  Ultimately, repairs also mandate a change in the habit.Bulimia, anorexia, chemotherapy and medications are some illnesses and conditions that may affect the teeth and soft tissues in the mouth. Bulimia actually strips teeth in a pattern that leaves the teeth sensitive and turns them yellow.  Restoration of the bulimic is aggressive and includes cosmetic and restorative procedures such as crowns on all or most of the teeth.  The anorexic suffers periodontal disease and bone loss that is dramatic and sometimes must suffer the loss of teeth with denture therapy.  For patients on complicated medications including antidepressants, chemotherapeutics (for cancer and arthritis), blood pressure medications or other systemic medicines, the patient may suffer xerostemia (dry mouth) resulting in decay and periodontal disease.  Patients should attend preventative appointments more frequently and if they have problems, patients address them quickly before they become difficult or complicated.  Illnesses or conditions that affect a patient daily or daily medications should alert the patient or their family to the fact that the patient's teeth and mouth may need attention.  Because of the risk of pain, infection and suffering it is best to include a dentist as soon as possible when any of these situations occur.In conclusion, damage to teeth and soft tissues in the mouth for adults includes many factors that we should all be aware of.  Some of these factors are actually under our control.   The cost of dental care is high and the access to care, although fairly good, is sometimes difficult.  Any person may limit the amount of dental care by becoming responsible for themselves and their loved ones.  Understanding possible consequences of poor choices many times is enough to allow better choices in the areas of diet, habit and illness or conditions as they may affect your teeth.  Prevention is still the most efficient, best priced and most successful dental treatment we have to offer patients in today's society.

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Dental

Dr Paul F Mitsch

2005-01-01 09:20:00

: What kind of dentistry should I expect?

ANSWER: Patients seldom question what kind of dentistry they receive.  The standard of care in dentistry is really defined by what the public expects.  In dental school dental students basically learn how to repair broken teeth and make substitute teeth, so most dentists are repair specialists.  In fact, the field of dentistry has changed so much in terms of research and development that a dentist in this millennium is capable of doing a much better job than simply repairing teeth.  The "new millennium" dentist is capable of seeking education and determining how to predict and prevent damage, pain and even repairs.  Dentistry today has the ability to perform complete dentistry!  If you are simply expecting to fix teeth as they break, you are expecting to have repair dentistry performed.  However, if you are being tested and seeking complete dentistry, you are interested in a host of other things, especially keeping your teeth a lifetime with minimum of pain and a prediction for future repairs or restoration.Damage to teeth occurs in a variety of ways.  During a patient's youth, he or she experiences decay and teeth are damaged and repaired with fillings.  As individuals participate in risky behaviors, teeth may be broken or damaged because of trauma.  However, most damage to teeth occurs naturally as people age and most damage occurs because forces are not balanced.  TMJ problems, orthodontic relapse, chipped teeth and broken teeth may all originate because of forces that are not balanced.  Imagine putting a steel ball between your teeth and clenching hard.  If you were not aware of how hard you were biting; you would probably be able to bite hard enough to break your teeth.  Now imagine if you were sleeping and grinding your teeth or clenching your teeth.  The resulting damage to teeth from grinding will be wear spots, abfractions, tooth movement and broken teeth.  It is suspected that most people who grind or clench their teeth do this when they sleep or when they are stressed.  Complete dentistry will take these behaviors into account; after repairs are made, tests may be performed and the patient should be able to find out how to protect their teeth for a lifetime.    In today's world, health care has made it possible for people to live much longer than we expected even 20 years ago!  As the community responds to the health care industry, the largest concern in the future will be access to good health care. Another concern will be what kind of dental care the patient should seek.  The best investment in dental care is an investment that will minimize cost and damage to teeth and surrounding structures in the mouth.  The best answer to the question asked in this article "What kind of dentistry should I expect?" is complete dentistry - not just repair dentistry.  Seeking complete care means spending time evaluating your unique dental situation, preparing and executing a plan for treatment if it is indicated or desired and then protecting your teeth so they will be comfortable and useful for a lifetime.  Minimizing stress and force may be the most important key in this chain of events that define your dental care.

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Dental

Dr Paul F Mitsch

2004-12-01 09:07:00

: I hear more complaints this time of year about teeth hurting than any other time.  Why is that so?

ANSWER: Probably just coincidence, but it could be all of the different foods we eat.  The holidays are once again upon us and we have many choices to make in terms of entertainment, travel, finances and health care so that we can enjoy the festivities and welcome the coming year.  But don't let the hectic holiday rush prevent you from seeking dental care when your teeth are causing pain. "My teeth only hurt when . . ." is the way many of my patients answer when asked, "Do any of your teeth hurt?" It is extremely important that as we consider our health. We consider that pain is one of the primary indicators of problems or pathology of some kind.  There are reasons a person may encounter pain and there are different levels of pain.  However, if one has no interest in considering the problematic side of pain, some facts may be irrefutable in time; the pain will be worse and the problem may be more difficult and expensive to solve.Dental pain has many presentations and there are countless reasons a person may experience pain with his or her teeth, face, ears or jaw that relate to the person's dental situation. Understanding the major problems will motivate most of us to seek answers and consider if we should "just live with it" when - or if - we experience dental pain.The infection with the highest incident in the United States is dental decay! Dental decay may be primary in nature when the tooth in question has never been filled or restored.  However, secondary decay is more frequent and occurs around existing restorations (crowns or fillings). Dental decay does not discriminate! If the bacteria responsible for dental decay are present and it has an opportunity, it will invade a small space and the decay process will begin. The name of this decay process is Caries. The bacterium responsible is Streptococcus Mutans (virtually everyone harbors these bacteria). The bacteria metabolize substrate (food, usually sugars) and secrets acid which breaks down the tooth. One good rule to follow is that if a person sees the waste product of the bacteria, such as stains, the bacteria may be in the tooth. Pain associated with decay may be simple to fix or it may require extensive restoration or even Endodontic (root canal) treatment. Cracked teeth can also cause pain. Regardless of the level of pain, cracked teeth must be examined and treated! When a tooth cracks, pain will occur when the patient eats or chews. As the crack gets larger, the pain will become more consistent until it is constant. Teeth crack due to the bite, when large restorations fail or break or when trauma to the teeth occur as in an accident. A cracked tooth may be painful and the pain may come and go. The treatment for a cracked tooth varies but will usually be a filling, an inlay or onlay and is usually a crown. Root canal treatment is sometimes important and necessary with a cracked tooth. If the tooth is not treated, it may need to be removed and in some cases the tooth may need to be removed and replaced with an implant or a fixed bridge. Occasionally, a tooth may need to be removed in spite of all efforts in treatment. There is nothing simple about treating a cracked tooth and perhaps the most important thing to consider in treatment is why the tooth cracked and what made the patient notice the pain.Finally, as we have mentioned before, impacted teeth - usually wisdom teeth - sometimes cause pain that is mistaken for sinus pain or neck pain. A good scanning x-ray will determine if there are any unerrupted (impacted) teeth and when, if and how they should be removed. Impacted wisdom teeth are usually painful between the ages of 15 and 25 years of age. The wisdom teeth can be the cause of painful and difficult episodes of infection and should be removed if they are symptomatic.As we enter the holiday season and we are making the annual "to do" list, consider your teeth and any pain caused by your teeth. If dental pain is in your life or the life of a loved one, seek care and diagnosis as soon as possible and consider your opportunities in treatment to prevent more dramatic problems from occurring. Even if you "haven't got time for the pain" because the holiday season is upon us, be sure that if you have dental pain, understand it and fix it as soon as possible!

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Dental

Dr Paul F Mitsch

2004-10-01 15:07:00

: How is dental care different for women who are pregnant?

ANSWER: Women are different than men! This statement may not be politically correct but it cannot be denied when it refers to pregnancy and pregnancy-related problems. In my practice, there are routinely a number of questions and conditions that occur during pregnancy that may be understood and when they are, the patient will not be as anxious and can seek appropriate care. The main focus in dental care for any expecting mother will be two fold:  the mother needs to know how to take care of herself and her teeth; and, the mother needs to know the effects of care or treatment on her unborn child.Understanding the most common or routine problems and treatments is important. The most common situation is pregnancy gingivitis. Pregnancy gingivitis is a swelling of the gum tissue (or the periodontal tissue) that occurs in relation to the hormones and hormone levels during different phases of a pregnancy. This is usually reversible with simple rinses and the patient should seek dental attention to assure there is no other treatment necessary.  Pregnancy gingivitis is generally accompanied by bad breath, bleeding gums and minor to moderate pain. This may occur in any trimester, but is usually most uncomfortable in the months five through nine.  Home remedies should not be employed and aspirin should never be used.  A good idea is to make a dental check-up as soon as you find out you are pregnant and ask for a cleaning and thorough examination. X-rays can be taken and your unborn child will be protected by a lead shield that you should request. Another common problem is decay and abscess formation.  Often patients may neglect pain or minor symptoms in their mouths.  During pregnancy as the body adapts to  the growth of the child, the mother many times will become "run down" or exhausted and nutrition is difficult to tend to properly.  As this condition prevails, infections that were minor begin to become stronger and may threaten the health and comfort of the mother.  Abscessed teeth are infections.  These are usually periodontal (associated with the gum tissue) or periapical (associated with decayed teeth and the roots of the teeth).  These infections once acute - painful and noticeable - must be dealt with.  Elective treatment like root canals may save the teeth or the teeth must be removed.  Generally, the dentist will visit with the patient's OB/GYN and consider the best medicines to use and any treatment for the mother that may affect the baby.  Again, ignoring treatment is not an option because the infection can affect the pregnancy and the baby.  Finally, wisdom teeth are a common problem in pregnancies.  Pericoronitis of a wisdom tooth describes the condition when the wisdom tooth is not completely in the mouth or is impacted (under the tissue) and the area around the tooth begins to swell with infection.  Pain is traditionally the first symptom.  Treatment of pericoronitis usually involves medicating the patient, using home rinses and removing the tooth as soon as possible.  However, with a pregnancy, we will often attempt to palliate the patient - or make the patient more comfortable until treatment is safe - and control or eliminate the infection and remove the tooth after delivery.  This one problem can and should be avoided by early removal of third molars (wisdom teeth).Pregnancy should be a healthy and productive time in most women's lives.  Dental problems are minimal.  If the expectant mother begins to experience problems or is anxious about the risk of problems, immediate evaluation and consultation with a dentist is advised.  Because there are two patients to consider, it is never fair to allow the mother to be anxious in this time and most dentists will agree that all questions the mother-to-be has about dental health should be addressed.  There are no bad questions regarding good dental health before - and during - this special time for women.

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Dental

Dr Paul F Mitsch

2004-10-01 15:07:00

: What is meant by a "long term treatment plan" in dentistry?

ANSWER: In dentistry, the cost of maintaining teeth is directly proportional to the preventative plans you make.  The dental work you have by the time you are an adult must be maintained and will usually not last a lifetime.  Elective or opportunistic work is typically scheduled after maintenance work in an adult's treatment plan.  There is an appropriate order of events which would suggest that opportunities be taken after required treatment is completed.  For individuals with families, elective care is generally put off so that the children's treatments are the first priority.  So how do we gain enough information to make the proper judgment in terms of planning for dental work in the future?  How should we find out about what to really expect after watching shows like Extreme Makeover?For our children we must try to minimize future dental costs as much as possible.  Check-up appointments are really only a start.  Nutritional counseling with the dentist or dietician may be the most important part of preventative planning.  High fructose corn syrup (HFCS) is a nutrient in drinks and foods that has no real nutritional value and is harmful to us in terms of our future and existing dental work.  Counseling patients about nutritional or harmful habits is one of the true forms of preventative care.  By changing behaviors such as the intake of HFCS, our families are more likely to avoid dental expenses caused by such behaviors.  Instead, we are able to treat family members who need or want care.  Therefore, it is important to evaluate both the immediate and long-term needs of our children in order to focus our resources on valuable elective care or needed maintenance care.The next step in determining the level of treatment we need is a careful analysis of what we have, what we may need in the future and what we may qualify for in terms of elective or opportunistic treatment (such as cosmetic dentistry).  With diagnostic tools today, the dentist is able to provide the patient with information including x-rays, photographs, short informative movies and even mock-up models to better explain present and future treatments needed or wanted.  The patient then is in a position to make choices in terms of his or her treatment plan. Patients would never consider plastic surgery without having an expected outcome.  In dentistry, it is important that the patient tries to obtain as much information as possible regarding the "outcome" of the patient's future treatment to assure satisfaction.  In addition, with dentists and patients leaving or transferring areas so often, it is important that the information be transportable for the patient so that the next dentist can edit or amend the existing plan rather than start over.The treatment plan, then, is the basis for needed care to be prioritized and the foundation for future treatment be based upon.  It is an important tool for families and individuals to consider when choosing treatment and doctors.  Treatment plans in families should be integrated and transportable so patients understand their obligations to assure their satisfaction with their dental treatment in the future.  Thus, a\ well-organized dental treatment plan for an individual, family member or child turns dreaded dental visits into visits that are productive and enjoyable!  Next time you visit a dentist, ask that you receive a full report of your existing dental condition and request a full treatment plan.  For more information, the ADA at http://www.ada.org/ is a good reference.

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Dental

Dr Paul F Mitsch

2004-09-01 12:08:00

: I have read that orthodontic treatment for young children should be avoided.  Is this true?

ANSWER: Orthodontic treatment for children is no longer a controversial therapy in dentistry. In the past there have been strong feelings within the profession of dentistry regarding the treatment of younger children in orthodontics. The controversy was based upon feelings and thoughts of differing groups with differing philosophies, such as the American vs. European philosophies. These arguments may still exist, but the science is complete and the treatment of a child well before adolescence is not only advised but recommended.  The exception to this would be a child who has behavioral issues that may hinder treatment.So why treat children and what are the advantages of such treatment? Before we answer these questions it is important to think in broader terms than we once did.  Repositioning of teeth in orthodontics is more than building a smile in the front of the mouth from "ear to ear." Repositioning of teeth will determine the comfort and function of the tempromadibular joint and the surrounding and supporting structures, including the cervical vertebrae! That's correct! Orthodontic treatment includes more structure than just the front teeth. In fact, orthodontic treatment takes into account muscles, nerves and bones in other parts of the head and neck. Correcting the teeth may have an effect on these structures greatly benefiting the child.  Some doctors in the past have preferred to focus on adults or fully developed youngsters instead of treating a developing child. This lack of treatment, however, is rare and usually due to a behavioral problem on the child's part.   When steps are not taken to treat a child's orthodontic problem, allowing the condition to mature, we may see a worsening of the condition. This has been compared to allowing a child to "hobble" on crutches until he or she is fully developed, then evaluating a fractured leg for repair or an underdeveloped leg for prosthesis!  In dentistry, with our outstanding diagnostic capacities and the interceptive treatments most trained orthodontists are using, we can now treat problems when we identify them. The outcome of treating a child is usually a healthier bite and a healthier patient.However, the expectation that if a doctor treats a young child, the child should not need future treatment is prevalent. Patients and their parents still suggest that if they are going to need treatment they should wait and be treated only once. This is incorrect. Treatment at a young age assures proper growth and development so treatment at a later stage may optimize the cosmetic outcome. It would be easier to think of child orthodontic treatment as a developmental stimulus to keep or get space problems under control. Adult orthodontic treatment is easier to manage if space problems have been previously managed. Many of the orthodontists in our area even refer to this as "phase 1" and " phase 2" treatment based upon these ideas.  Expecting our children to be treated at the state of the art rather than with our imaginations, will determine the best outcomes in the long run.In conclusion, children may benefit from interceptive orthodontic treatment. To intercept problems and allow proper development makes good sense and has been proven in the past 50 years of dentistry. Orthodontics is a specialty in dentistry. The registered orthodontist stands ready as a member of the American Association of Orthodontists to answer your questions regarding treatment of younger children. Your general dentist and the pediatric dentist are good sources of information for you regarding the favorite child in your life. You may also want to venture into websites (including ada.org) to find out more.

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Dental

Dr Paul F Mitsch

2004-07-01 10:05:00

:    What should one know and consider before making the decision to have a cosmetic dentistry procedure?

ANSWER:  Cosmetic dentistry has certainly changed our perception of teeth within the past few years!  Most of us may recall a family member or someone who lost their teeth and generally all of us fear the removal of all of our teeth and being forced to wear a denture or false teeth.  In today's world we see "makeovers" on television and vicariously participate as people transform themselves, changing their bodies, and especially their teeth.  The changes that take place in the mouth usually include whiter, brighter teeth that are even with healthy gum tissue.  These changes are made in virtually every case viewed.  Thus, our expectations and especially the expectations of our youth is that their teeth may be changed.  Our perceptions are not what they were ten or twenty years ago; we no longer fear the loss of teeth as much as we value the maintenance and the enhancement of teeth. Things have definitely changed!  Cosmetic dentistry is one of the leading edges in changing the way we consider our dental future.Cosmetic dentistry is a revolution within the dental profession resulting from technologies and training which allows average individuals to benefit from procedures that were at one time complex and difficult.  The expense of cosmetic dental procedures has also been developed to meet the demands of most individuals.  So it would appear things have changed!  Cosmetic dentistry is now available to most healthy people.  The questions most people ask: How much?  How much money?  How many teeth?  How much time will it take?  Once the fear of dentistry is overcome and the patient can comfortably have dental work done, these questions turn into "when can we start?"  This is where things may not have changed so much.  Prior to beginning any significant change (cosmetic dentistry is a significant change for some patients), the patient needs to understand cosmetic dentistry is only effective when he or she is healthy.  Therefore, all conditions of their dental health need to be addressed prior to beginning cosmetic procedures.  Once the patient is infection-free, with no discomfort, and is functioning properly, the predictability of the cosmetic procedure will include a minimal risk.  The gum tissue (known as the periodontal tissues) must be in tip-top shape; the bite (sometimes associated with TMJ) should be even and not broken down in the back of the mouth; and they should not have worn out or decayed teeth.  These are the three big areas, which should be looked at before crowns, or laminates are contemplated.  The patient's general health is also considered prior to the restoration.  If the patient is in great shape, a photographic determination will then help the dentist and the patient decide on how many teeth will need to be treated to obtain a better smile.  Usually, eight or ten teeth in the upper are treated and other teeth are planned or treated in the future.  Postoperative care is important for the patient to understand as well.  The teeth are now a significant investment and must be taken care of and examined more frequently.  Cosmetic dentistry is a continuing field of study and even has an academy that you may log onto in order to learn more: http://www.aacd.com/.  Membership and certification in cosmetic dentistry is an ongoing and important qualifier for dentists to participate in this important field; therefore, patients should ask their dentist about the training and organizations they belong to which qualify them to treat patients desiring cosmetic dentistry.  As a dentist, my own treatment was interesting, very rewarding, and I would do this again in a heartbeat.  My treatment not only helped keep my teeth more comfortable but also provided the best chance of having my teeth for at least as long as I have my tongue!

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Dental

Dr Paul F Mitsch

2004-06-01 11:37:00

: Is it always going to be nessary... children and Orthodontics?

ANSWER:       The controversy is  basically over insofar as orthodontic treatment for children.  In the past there have been strong feelings within the profession of dentistry regarding the treatment of younger children in orthodontics.  The controversy was based upon feelings and thoughts of differing groups with differing philosophies, such as the American vs. European philosophies.   These arguments may still exist, but the science is complete and the treatment of a child well before adolescence is not only advised but recommended.  The exception to this would be a child who has behavioral issues that may hinder treatment.So why treat children and what are the advantages of such treatment?  Before we answer these questions it is important to think in broader terms than we once did.  Repositioning of teeth in orthodontics is more than building a smile in the front of the mouth from "ear to ear."  Repositioning of teeth will determine the comfort and function of the tempromadibular joint and the surrounding and supporting structures, including the cervical vertebrae!  That's correct!  Orthodontic treatment includes more structure than just the front teeth. In fact, orthodontic treatment takes into account muscles, nerves and bones in other parts of the head and neck.  Correcting the teeth may have an effect on these structures greatly benefiting the child.  Some doctors in the past have preferred to focus on adults or fully developed youngsters instead of treating a developing child.  This lack of treatment, however, is rare and usually due to a behavioral problem on the child's part.   When steps are not taken to treat a child's orthodontic problem, allowing the condition to mature, we may see a worsening of the condition.   This has been compared to allowing a child to "hobble" on crutches until he or she is fully developed, then evaluating a fractured leg for repair or an underdeveloped leg for prosthesis!  In dentistry, with our outstanding diagnostic capacities and the interceptive treatments most trained orthodontists are using, we can now treat problems when we identify them.  The outcome of treating a child is usually a healthier bite and a healthier patient.However, the expectation that if a doctor treats a young child, the child should not need future treatment is prevalent.   Patients and their parents still suggest that if they are going to need treatment they should wait and be treated only once.  This is incorrect.  Treatment at a young age assures proper growth and development so treatment at a later stage may optimize the cosmetic outcome.  It would be easier to think of child orthodontic treatment as a developmental stimulus to keep or get space problems under control.  Adult orthodontic treatment is easier to manage if space problems have been previously managed.  Many of the orthodontists in our area even refer to this as "phase 1" and " phase 2" treatment based upon these ideas.  Expecting our children to be treated at the state of the art rather than with our imaginations, will determine the best outcomes in the long run.In conclusion, children may benefit from interceptive orthodontic treatment.  To intercept problems and allow proper development makes good sense and has been proven in the past 50 years of dentistry.  Orthodontics is a specialty in dentistry. The registered orthodontist stands ready as a member of the American Association of Orthodontists to answer your questions regarding treatment of younger children.    Your general dentist and the pediatric dentist are good sources of information for you regarding the favorite child in your life.   You may also want to venture into websites (including ada.org) to find out more.

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Dental

Dr Paul F Mitsch

2004-05-01 08:19:00

Question:  I was told I need to have my wisdom teeth removed. I have never understood why I have them if they serve no real purpose?

ANSWER:  Wisdom teeth are third molar teeth. They begin to erupt into the mouth between the ages of 12 and 18. Thus the term "wisdom teeth", this is the time when one considers themselves most wise.However, the incidence of third molar difficulty is no casual joke. If these teeth do not erupt (and in most cases there will not be sufficient space for them to come into the mouth) the problems they produce and the difficulties patients experience are certainly a risk. When asked about third molar teeth it is often a common answer that seldom are third molar teeth seen in people over 40! They have been lost or they are impacted and in many cases causing problems. Over the age of 60 it is extremely rare for one to still have their third molar teeth. So, why is there a range of opinions from dentists regarding wisdom teeth? To consider this it is important to understand the location of the teeth, the development of the teeth and the problems a patient may encounter with these teeth.The location of wisdom teeth is at the very back part of the mouth or the dental arch. These teeth are located in a part of the lower jaw that usually inhibits their eruption (ability to erupt completely into the mouth). The lower wisdom tooth is also in the angle where the nerve to the jaw and tongue run. This makes the lower wisdom tooth painful up to the ear and sometimes under the eye when it becomes infected. The upper wisdom tooth is in the back part of the jaw and when it erupts sometimes it will cut into the cheek. The upper wisdom tooth is also close to the sinus and may cause sinusitis or conditions that make all the upper teeth hurt. Because it is so far back in the mouth the upper wisdom tooth is difficult to clean and many times will decay and break or abscess. The development of wisdom teeth begins at about 12-14 years of age and continues through late teen years to the mid-twenties, generally. The first part of the tooth to develop is the crown or the top part of the tooth followed by the roots. The tooth develops encased in bone or impacted. As the roots develop, if the tooth does not erupt the roots become involved in the lower jaw with the nerve that innervates the lip and tongue and in the upper jaw with the sinus. This usually occurs between 16 and 25 years of age. The impacted tooth may also rest against the roots of the second molar teeth and if so may cause periodontal or gum tissue problems with these teeth and sometimes the loss of second molar teeth due to complications.The complications or problems occurring with third molar teeth include the things we have mentioned above. However there are more subtle problems that we should include as risk factors when evaluating a patient. Young patients heal much more quickly and better than older patients with this type of surgery, especially when it is elective. Women present with an increased risk during pregnancy due to the drugs that must be used and the potential trauma they would have to experience with infection and pain. Other health risks, like diabetes, heart problems or cancer usually are not present until the third or forth decades in life. Finally the social atmosphere or the ability for a young person to take time off and heal as well as the preparation for payment by their family is important to consider. Often it is a college student coming home with emergencies and needing their wisdom teeth out at difficult times for them, during finals or in the middle of important semesters. When we determine that someone has wisdom teeth (using x-rays) the advice for the patient is explained by both the benefits of removal compared to the risks associated with keeping the teeth. The American Board of Oral and Maxillofacial Surgeons have strict criteria for the recommendation of the removal of third molar teeth. If there is any hesitation with the determination of this issue one should consult their dentist or make an appointment with an oral surgeon and ask if their wisdom teeth exist and if or when they should be removed. Once again, the web site at the American Dental Association is a great place to get more information. The address is http://www.ada.org/

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Dental

Dr Paul F Mitsch

2004-04-01 14:46:00

Question:  Should I replace my silver fillings? 

ANSWER:  Black fillings, silver fillings or amalgam fillings are all usually the same thing. The question we are continuously answering in dentistry is when these fillings should be replaced and what should they be replaced with. In the past years there has been confusion within the profession of dentistry over the safety of silver filling materials. In the public the confusion has fueled lawsuits and destroyed relationships dentists have built with patients over the years.  So what is the correct answer? When or why should a person replace existing dental care and how should they replace it?There are many opinions to this set of questions but I believe there are only two reasons to replace existing dental work. The first is simple; failure. When restorations or fillings fail and they all will at some point, the tooth may be restored again or the tooth will have to be removed. So the first reason is simple; replacement is due to wear or breakage. It is also true that wear or breakage is sometimes not noticeable so the patient should attend check up appointments, especially if they have dental restorations. When pain occurs usually the remedy is time consuming and will be a great deal more expensive than when a dentist finds a failing restoration that can be replaced or repaired. The second reason for replacement is a little more abstract but it is also simple; the function of the restoration in terms of mechanics or cosmetics is not up to par and the patient would benefit from restoration. In this case the patient may demand or ask for a dark filling to be replaced or the dentist may point out that the restoration is wearing and will cause problems unless the worn area is corrected. In the latter case patients may sometimes complain of food packing around their fillings and this is simply a sign of worn restorations that should be replaced. It will also place the patient into the first category we just discussed if the restoration is not replaced.Finally, what should we replace fillings with? Cosmetic tooth colored materials are available for every application that we may restore teeth in today! Silver filling materials and even gold is also available. So what is best and what should I use? The answer to this question depends upon the size of the filling and the amount of tooth left for restoration. It may be simple to fill a tooth with a plastic, tooth colored composite but if the restoration is only going to last a year or so then other options may be easier and in the long run much more economic to use. Other options range from traditional metal or silver fillings, inlays made of metal composite or porcelain and crowns. The choice should depend upon the amount of tooth left or the health of the tooth and the desire to restore a tooth for a long period of time. A 10-year-old child may need a tooth filled for less than a year while an adult would love to restore a tooth for 10 or 20 years at a time. My advice is to request your dentist to visit with you about the condition of existing restorations and ask them for advice on replacement and materials they may use. Then it is always a great idea to look at the information from the American Dental Association at http://www.ada.org/ and learn about what the future may hold for you. Deciding what your dental future is may be much easier than discovering the future through failure!

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Dr Paul F Mitsch

2004-02-01 09:04:00

: How often should I go to the dentist?

ANSWER: There are routines that we all have on a daily basis. In our adult lives we have routines as well that we perform on schedules. Most of us agree that changing oil in our cars every 3,000 miles is a good routine to follow if we want our cars to run properly. In fact at one time we changed oil every 6 months or 6,000 miles. So routines change! Visiting the dentist is one routine that is not only a great suggestion but is also important for a number of reasons. The fact that infection is subtle means that a person with a dental infection may have no indicators such as pain or swelling and may compromise their health without being aware of it. Dental infection is linked to other systemic infections. At a routine dental visit these things may be discovered and taken care of before they become a nuisance or a threat. How often one goes to the dentist for an evaluation or a cleaning really depends upon the condition of their health and the condition of their mouth. In response to our general health we are beginning to understand that our day-to-day lives are so busy that we often compromise our health. It is estimated that in 10 years 40% of Americans will be obese if we do not change our daily habits.  So in light of our daily health it is important to understand that some people may need to see a dentist every month while others may need to simply check and evaluate their dental condition once a year. The 15 year old in braces who is having trouble keeping their teeth and gum tissue clean would be an example of monthly maintenance and evaluation, a diabetic would be a more frequent visitor while a 22 year old who does not smoke or drink pop with a healthy diet may need only yearly visits. In relation to their mouth, a person with 20 fillings or 10 crowns and otherwise good health may need to see the dentist or hygienist 3 or 4 times a year. Our "maintenance schedules" need to be designed for our needs, depending on our general health and our existing dental needs and conditions.

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Dental

Michael Jones

2004-01-01 11:40:00

: What are some tips for daily oral care?  What is the proper procedure for brushing and flossing?

ANSWER: The best way to remove decay-causing plaque is by brushing and cleaning between your teeth every day. Brushing removes plaque from the tooth surfaces.  Brush your teeth twice a day, with a soft-bristled brush. The size and shape of your brush should fit your mouth, allowing you to reach all areas easily. Use toothpaste that contains fluoride, which helps protect your teeth from decay. When choosing any dental product, look for the American Dental Association Seal of Acceptance, an important symbol of a dental product's safety and effectiveness.Cleaning between the teeth once a day with floss removes plaque from between the teeth, areas where the toothbrush can't reach. It is essential in preventing gum disease.By taking care of your teeth, eating a balanced diet and visiting your dentist regularly, you can have healthy teeth and an attractive smile your entire life. Follow these tips to keep your teeth and mouth clean and prevent gum disease.When brushing… Place your toothbrush at a 45-degree angle against the gums. Move the brush back and forth gently in short (tooth-wide) strokes. Brush the outer tooth surfaces, the inner tooth surfaces, and the chewing surfaces of the teeth. Use the "toe" of the brush to clean the inside surfaces of the front teeth, using a gentle up-and-down stroke. Brush your tongue to remove bacteria and freshen your breath. When flossing… Guide the floss between your teeth using a gentle rubbing motion. Never snap the floss into the gums.  When the floss reaches the gum line, curve it into a C shape against one tooth. Gently slide it into the space between the gum and the tooth.  Hold the floss tightly against the tooth. Gently rub the side of the tooth, moving the floss away from the gum with up and down motions.   Repeat this method on the rest of your teeth.  Don't forget the backside of your last tooth.

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Dr Ray Lansdowne

2003-12-01 09:52:00

: I read recently that some dentists in the area provide caps in a one-appointment process using a milling machine as opposed to the usual multiple visit variety.  Why wouldn’t all dentists provide the convenience of the one appointment for their patients?

ANSWER:  To continue our discussion on the CAD/CAM (Computer Assisted Design/ Computer Assisted Manufacturing) technology from last month’s issue:     The CAD/CAM has advantages that were all listed in the article you are referring to.  The precaution to which many dentists subscribe is not to be the first neither to be the last to become involved in the technological advances.  That way one does not buy into something that will not be sufficiently tested and proven to be better than that which is currently utilized or that something that will be obsolete before it produces income.  This particular device is somewhere in its third generation of development and shows great promise.  Most technology will increase in capabilities and come down in costs after the initial offering (note the history of the computer).  This particular system has virtually no competition, yet.  Several competitors are on the verge of introducing their products.  When that happens, dentists will have a better feel for the efficacy of the device in relation to its cost.   At some point, most dentists will undoubtedly have a similar system.  It will in my estimation have to be better for both the patient and the dentist than what is now utilized (but we are getting closer, just as we are with lasers, air abrasion, and caries detection without the explorer).  The restorations must have had a track record of durability in short term studies at least as good as the short term studies of successful traditional restorations.  It is best if long-term studies have been accomplished, however, if one waits for the time required for long-term studies to be complete better procedures and materials will be available.  For me, I must utilize the traditional methods for now weighing all the factors such as optimal fit, esthetics, costs and obsolescence.  For me, until technology advances to the point of replacing the traditional method, not just enhancing or augmenting the old, I will stick to the tried and true and not be swayed by the sales pitches that appeal to the emotions or ego.  I am not advocating that anyone leave their dentist because he/she utilizes these high tech items, but by the same reasoning, it may be that the care and services utilizing the more traditional methods are just as valid.  Technology is most effective when it enables one to deliver services or products at a savings in time and/or costs as compared to the existing procedures without sacrificing quality.  When that happens, then it is time to get on board.  Until then, one either enjoys the toys at the expense of personal economy, or passes on the costs of health care services.

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Dental

Michael Jones

2003-12-01 08:41:00

: I rarely floss my teeth. I read recently that flossing and cardiovascular health are linked.  How?

Michael Jones Question: I rarely floss my teeth. I read recently that flossing and cardiovascular health are linked.  How?Answer:  After reading from the sources: National Women's Health Resource Center, and The American Dental Association, you might want to re-examine your priorities. A growing body of research suggests that good oral health, including brushing and flossing daily, not only cuts down on tooth decay but may prevent serious health problems, including heart disease, osteoporosis, stroke, diabetes, respiratory problems and pre-term, low birth weight babies.   Because oral health is so critical, the NWHRC and an oral health product company, have launched "Brush Up on Wellness", a national campaign to increase public awareness on the signs, symptoms and dangers of periodontal (gum) disease. Women in particular are being targeted not only because they tend to be the ones who buy the toothpaste and make the dental appointments in the family but because of their risks for gum disease and other diseases which have been linked to gum disease.   Women are at greater risk for developing a number of health conditions associated with advanced periodontal disease, such as heart disease (the #1 killer of American women), diabetes and osteoporosis.   A study by researchers at the University of North Carolina, Chapel Hill, has even suggested a link between low birth weight babies and gum disease. Eighteen percent of all low birth weight deliveries can be linked to advanced periodontal disease and that a periodontal infection is potentially as important as smoking or alcohol use during pregnancy.   Nearly one in four women ages 30 to 54 has periodontitis, an advanced state of gum disease in which the bone and gum tissue that support the teeth break down. Also, nearly half of women ages 55 to 90 who still have their teeth have periodontitis.

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Dr Ray Lansdowne

2003-11-01 14:34:00

: I read recently that some dentists in the area provide caps in a one-appointment process using a milling machine as opposed to the usual multiple visit variety.  Why wouldn't all dentists provide the convenience of the one appointment for their patients?

ANSWER: If I follow you correctly, you are referring to the Wichita Eagle article regarding the CAD/CAM  (Computer Assisted Design/Computer Assisted Manufacturing) technology, which mills a crown from a block of ceramic/porcelain material to be placed in the mouth for a restoration.  This technology has been around for several years and like all technology, it has advantages and disadvantages.  Dentistry is both an art and a science.  All dentists as small business owners must weigh the pros and cons of everything done in regards to their practices.  Most stereotyping of dentists is not from the best side as is true of most stereotyping, but if there is one thing that is nearly universal; it is a dentist's attraction to gadgets.  There could be multiple reasons for such an attraction.  Often it is a fatal attraction, in that the latest gizmo doesn't live up to its hype.  As a result of the accumulation of multiple devices in their storerooms, there is a tendency for many dentists to be conservative in the purchase of items to enhance their practice, especially high dollar items.   The article was informative even if in the opinion of some it was biased.  There seemed to be no disadvantages of having products from this machine.  The company has a product to sell and as is happening all throughout the health industry, the manufacturers are increasingly going to the consuming public to pitch their produce, in hopes that public pressure will enhance their sales, rather than rely on the providers to select a product or material to utilize.  The item of which you speak seems to me to be such a ploy.  The aspects that would instill caution for many, indeed perhaps most dentists (out of the 400+ dentists in the area, only some 15 or so have the device), are at least three in number.  I am obliged to speak only for myself and not for any others.     First and to me the most significant is the accuracy of the marginal fit for the final crown to the tooth.  The less accurate the fit, the more cementing or bonding material is exposed to the fluids in the mouth.  Cementing and bonding materials are not as durable as the restorative material and any roughness attracts more bacterial buildup than highly glazed porcelain or highly polished metal.  Today, although most cementing materials are actually bonding in nature regardless of the type of restoration, this is still the weak link in the restoration that will allow leakage and recurrent decay.   Second and perhaps the most important to the patient, is the esthetics or looks of the restoration.  I will agree that nearly anything close to the color of a natural tooth is better than the black fillings that show when laughing, talking or smiling will be more appealing to the eye.  The blocks, from which the restorations are milled, are of a uniform shade (that is the color from the top of the tooth to the bottom is the same).  It was not until quite recently that multiple shade options were available (still the same color top to bottom, but now one is able to have one tooth one color and another color for a different tooth).  Another consideration in the art of shading is characterization: the ability to make one part of the tooth different from another portion.  If one looks at a natural tooth, the biting surface or incising edge of a tooth is of a different color or hue than the body, which is still different from the gingival (close to the gums) area.  Although these differences can be added to the milled restoration, it is added to the surface and glazed, which adds more waiting time and the stain is over time lost to the acidic fluids of the mouth especially any phosphoric acid which is found in soft drinks.  In the laboratory processed restorations, the shades and characteristics are built into the restoration at all depths and as such are not changed by the fluids of the mouth.  An additional factor is if the milled restoration is not acceptable to the dentist the complete process must be repeated causing even longer single visits.  As with any procedure, there is a learning curve.   The third important precaution for me is the realization that I am responsible for the material if there is something that is defective in its application or function.  I really do not wish to have several thousand restorations in my patient's mouths only to have to replace them at no additional expense to the patient should they fail due to material shortcomings.  Even though it is at no additional expense to the patient, chances are they would not choose to have the procedures redone if there were more proven techniques.

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Michael Jones

2003-11-01 08:49:00

:  How does gum disease affect the body?

ANSWER:  In researching the answer, I find that there are many factors, but few solutions. The mouth cleanses itself through the production of saliva, the higher the flow of saliva; the better the mouth is cleansed of bacteria. However, if your diet is high in sugary foods, the natural bacterial growth is enhanced and if you do not brush or floss your teeth after every meal or sugary snack, the bacteria are given time to attack your teeth and gums.   The keys to good dental health are easy to list but difficult for most people to implement. Brushing after every meal is a key to dental health, flossing after a meal is another key, annual or semi-annual visits to your dental professional for the cleaning of plaque from teeth and prompt care of developing gum disease is a valuable tool. However, each of these key factors to dental health may be easy to mention but in today's busy world hard to implement. Everyone does not carry a toothbrush with them nor do many people have the time to brush their teeth due to the requirements of work or study. The development of dental floss devices that are small and may be carried in a purse or pocket makes this key to good oral hygiene and plaque prevention one that is easy to implement even during the day and immediately after meals.   The latest research on oral hygiene demonstrates that having bad teeth and gums can contribute to high cholesterol and bacterial infections. The research supports the theory that people with gum disease are at significantly increased risk of arteriosclerosis, the thickening of the arterial walls that leads to heart attacks and strokes. Chronic gum disease may also contribute to diabetes; respiratory infections and bacterial infection may trigger the development of rheumatoid arthritis. Daily brushing with a manual toothbrush has limited effectiveness in the areas between the teeth and periodontal diseases begin in these areas. It is imperative that food be removed from between the teeth before the bacteria in your mouth attack it and begins the decay process. Without seeing a dental care professional every day, the use of floss or a flossing device is the best method to avoid the buildup of plaque and to remove the food particles from between the teeth. Suppressing the formation of plaque is critical in lowering the risk of periodontal disease and related illnesses.   Regular care from your dental professional, regular brushing with fluoride toothpaste and the use of dental floss or a flossing device are essential in the prevention and treatment of periodontal disease.

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Dental

Dr Ray Lansdowne

2003-10-01 11:23:00

:  Some dentists have the letters DDS after their name, others have DMD and some have an alphabet soup of letter after their names.  Does the DMD stand for Dental Medical Doctor and what do other letters stand for?

ANSWER: To continue last month’s discussion, there are nine disciplines within dentistry that are recognized by the American Dental Association (ADA) as designated specialties, granted with formal education beyond the degree granted for general practice studies (DDS/DMD).  They are as follows:Oral & Maxillofacial Surgery (American Assoc. of Oral & Maxillofacial Surgeons - AAOMS)Endodontics (American Assoc. of Endodontists - AAE)Orthodontics and dentofacial orthopedics (American Assoc. of Orthodontists - AAO)                                                                              Pediatric dentistry (American Academy of Pediatric Dentistry - AAPD)Periodontics (American Academy of Periodontology - AAP)Prosthodontics (American Academy of Maxillofacial Prosthetics - AAMP)Oral and Maxillofacial Pathology (American Academy of Oral and Maxillofacial                                                                       Pathology  - AAOMP)Dental Public Health (American Association of Public Health Dentistry - AAPHD)                                             Oral & Maxillofacial Radiology (American Academy of Oral & Maxillofacial                                                                       Radiology - AAOMR)   Those qualified to practice in these specialty areas may have an MS (Master of Science) if the institution conferred such a designation and indicate their area of specialization by the listing under the name of their specialty organization in the dentist listings of the Yellow Pages.  Often the specialist will utilize the term Fellow,  or the initial F, then the initials of the specialty organization indicating the completion or passage of qualifying exams within the specialty recognized by the ADA.  The specialty organization is in parentheses following the above listing of the recognized specialty fields.   Although not recognized as a specialty by the ADA, the general dentist is organizationally represented by the Academy of General Dentistry (AGD). The AGD offers designations as a Fellow or Master (FAGD and MAGD) for the attainment of additional continuing education levels for the general dentist while maintaining membership.  In order to maintain one's membership within the AGD, the general dentist must annually maintain a basic level of continuing education credit hours.     There are a multitude of dental organizations that relate to the practice of dentistry.  Some are honorary and others represent areas of dentistry that are not recognized by the ADA as official specialty areas, yet dentists find these fields mesh with their interests.  They are too numerous to mention and dentists often utilize the initials of those organizations and indicate that they are Fellows in the organization.  It should be mentioned that the National Dental Association, organized when dentists of color were not honored as equals, is also a national organization representing their members.   There are nine specialty areas of dentistry along with the general dentist providing services to the public.  General Dentists and Pediatric Dentists are designated Primary Care Dentists as they are the entry point or a 'dental home' for the public.  Although the other specialty areas may see patients without direct referral from primary care dentists, the specialty areas of dentistry are used by primary care dentists in the overall treatment plan for the patient by referring patients with more complex problems or with needs the referring dentist elects not to provide.  If a primary care dentist does not provide a service, he/she will refer the patient to an appropriate specialist who can provide the service.  After the specialty care is provided, the patient will return to their 'dental home' for continuing care.  Establishing a dental home is something one should do before an emergency.  Allow your dentist to get to know you and you should know him/her before a crisis erupts.  As a dentist we are admonished to never treat a stranger.  That should apply to the patient as well, never let a stranger treat you.

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Dental

Dr Ray Lansdowne

2003-09-01 15:42:00

QUESTION:  Some dentists have the letters DDS after their name, others have DMD and some have an alphabet soup of letters after their names.  Does the DMD stand for Dental Medical Doctor and what do other letters stand for?  

ANSWER:  It should be stated at the outset that neither DDS nor DMD is superior to the other and the training for each is virtually identical.  They both must pass the same National and State Dental Boards.  The literature on the topic may be somewhat biased depending on the degree of the author, so I'll be as unbiased as possible with my DDS degree.  Some of my best dental friends are DMDs.  The DDS designation stands for Doctor of Dental Surgery and the DMD designation stands for Doctor of Dental Medicine.  Your next question would probably be "Why then is the latter not DDM?"  The DMD degree in Latin is translated "Dentariae Medicinae Doctoris", hence the DMD and not DDM.  Lets look at the history of the degrees conferred, which may help remove the confusion.  In the early history of the healing arts, the field was separated into medicine and surgery, physicians (who focused on healing diseases by the administration of internal and external medicines) and surgeons (who focused on treating diseases, injuries and deformities by manual and instrumental operations).  Space does not allow for the interesting details of the relationship between the physician and the surgeon, but when you see me sometime ask me about King Louis XIV of France and his experience with a not so aristocratic ailment.   For dentistry, the schooling began in the United States with the formation of the first dental school, University of Maryland-Baltimore College of Dental Surgery, in 1840.  The surgical reference based on the observation that ointments and medicines would not heal the broken down tooth prevailed as other institutions opened dental schools.  Harvard University founded its dental school in 1869 and since their degrees were issued in Latin, they chose not to utilize the standard DDS degree (Latin: "Chirurgiae Dentium Doctoris"), as the English CDD was not acceptable.  The English DDS translation into Latin would be Doctor of Dental Science and according to History of the Harvard Dental School, this was not acceptable as "…dentistry was not properly a science".  Whoa!  That calls for an ointment over the wound to heal it.  Speaking of science, the medical science of the day called for persons with elevated temperatures to have body fluids expelled, letting off heat, and if they had a chill, warmed them up with cauterization or heat plasters.  Both medicine and dentistry have come a long way since those days.}  Finally, Harvard looked to a Latin scholar for recommendations.  The scholar suggested the word 'Dentariae' be added to the degree 'Medicinae Doctoris' and so it became Dentariae Medicinae Doctoris or DMD.  One dental school conferring the DMD degree has the entire diploma in Latin and states the degree as Doctorus Medicinae Dentariae, still translated as DMD.   The practice of dentistry is an art as well as a science.  The science is well defined (and as with other health fields, constantly refined) for dentistry and is virtually the same in all of the dental schools, regardless of the degree conferred, as is the art of dentistry.  The art part is up to the individual student.  There are both Picassos and Rembrandts in the area of artistic skills.  It was not until after World War II that, as new dental schools were opened, the three schools conferring the DMD degree had more company.  Today there are 55 dental schools.  The number of DDS degree institutions is 35 and the DMD number is 20.  The 10 Canadian dental schools are evenly split. The conferring of the degree designation is left up to the individual school.  The moral: don't select your dentist on the basis of DDS vs. DMD degrees; the education is the same and are all legally qualified to provide dental care to the public, provided a state license is granted and the renewal process is followed as dictated by state law.  The other letters stand for a variety of degrees and designations.  There are nine disciplines within dentistry that are recognized by the American Dental Association (ADA) as designated specialties, granted with formal education beyond the degree granted for general practice studies (DDS/DMD)   Next month, we will look at those disciplines, designations, and degrees within dentistry that are recognized by the American Dental Association (ADA).

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Dental

Dr Ray Lansdowne

2003-08-01 11:28:00

QUESTION: I’m in my early 50s, evidently have pyorrhea and probably will lose my teeth.  I don't understand how it could happen.  I brush my teeth two times a day and have my teeth cleaned fairly often.  Now, all of a sudden, I have pyorrhea.  My parents and grandparents all had dentures.  Is there any hope that I can keep my natural teeth and (the second half answered below) what can be done to keep my kids and grandkids from this same fate? 

ANSWER: This month’s answer will conclude our discussion on Pyorrhea. You can read my first two responses from the June and July issues, or online at http://www.theqandatimes.com/.    The following information is taken from presentations at the Pediatric Restorative Dentistry Consensus Conference, April 15-16, San Antonio, Texas and published in Pediatric Dentistry, Vol. 24 - No. 5 - September/October 2002.  There is a model of disease that is used in understanding dental disease.  That model is termed "nonexclusive contributory disease model".  This model has three elements: "environmental", "genetic" and "infectious agent", and states that any specific element may contribute to, but does not necessarily "cause", the specific outcome of a cavity.  (With children, decay is the primary cause of concern regarding dental disease and as such, I will limit the discussion to kids’ cavities)  This fits the current understanding of this infectious disease process and can assist the dentist in determining the risk assessment for the child.Infectious Agents:    Streptococcus Mutans (S mutans) is the organism that causes plaque to form on the teeth.  They help form an intraoral biofilm (dental plaque) through their ability to adhere to tooth structure by laying down materials creating a highly sticky bacterial environment.  Once that film is laid down, Lactobacilli, associated with carbohydrate consumption, are associated with the progression of the disease process.  Studies show that levels of S mutans above 500,000 colony-forming units per milliliter of saliva are associated with higher levels of smooth surface cavities, while the presence of lower numbers of S mutans in saliva or their presence in fissure systems are predictive of fissure or chewing surface cavities.  Generally, mothers transmit the S mutans to their children.Genetics:   Children manifest the mother's immune system for the first months of life.  This immunity is transferred both by the placenta and via colostrums found in lactation products.  Since the child's temporarily acquired immune system is not particularly effective against the strain of S mutans resident in the mother, acquisition is more likely to occur from the mother than others.  Inherited disorders that affect tooth development or salivary flow and immune system competency increase the incidence of dental decay.  Dental enamel that is not well mineralized, such as in cases of ectodermal displasia, may also be more susceptible to dental caries.Environment:   Some environmental issues include the teeth present, the family cavity history, plaque control, carbohydrate (sugar), socioeconomic status (SES) and fluoride exposure.  It has been said that, 'bad teeth run in families'.  Bad teeth run in families with adopted kids as well, hence environmental factors play a prominent part in dental disease.  First of all, teeth must be present.  Persons with smooth surface cavities (in between the teeth and along the gum line) are at a higher risk of future decay.  Persons with fissure sealants (a plastic coating on the chewing surface of back teeth and grooves of some front teeth) have a reduced risk of both pit and fissure and smooth surface cavities.  Because the child's mother provides the most probable source of transmission of the cavity causing organisms, the level of the mother's infection directly correlates with the subsequent development of dental caries in the child.  In general, the greater and more frequent the exposure to carbohydrates, the greater the risk of developing cavities although this risk appears to be at least partially offset by twice-per-day brushing with a fluoridated dentifrice.  (Wait until about age 2 before using fluoridated toothpaste so the child will be able to keep from swallowing the toothpaste.)  The socioeconomic status (SES) is moderately well associated and inversely related to risk (the poorer the children, the greater the risk) for dental caries (decay) in children.  When studies capture the fluoridation status of the water supply, fluoride significantly reduces the SES risk.   What does this all mean to you and yours?  The same that it meant to me as my kids were growing up caries free.  My generation went to the dentist generally when there were problems.  I had plenty of problems.  When I received my dental education, I first applied my knowledge gained to myself, then to my family and once in practice, to my patients.  For my grandparents, it was too late for me to help them to keep their natural teeth.  My parents enjoy good dental health as does my wife and her side of the family.  Our kids grew up cavity free, and I expect they will remain so all their lives.  Their children are also on target for a cavity free life.  Water in the military was fluoridated, but back in Wichita, we supplemented the small amount of fluoride naturally in Wichita's water with fluoride tablets.  Their mother cleaned their teeth before bedtime until they were able to adequately provide for themselves.  With their grandparents' help, we limited the amount and especially the frequency of their intake of sweets.  They had regular dental checkups with topical fluoride (their fissure sealants are still effective and have been replaced over their adult years as needed) and although they didn't use toothpaste to clean their teeth, they did apply fluoride toothpaste or gel to freshen the mouth and protect the teeth by brushing with it for a minute or two before going to bed.  So, short of becoming a dentist, find one that will recommend specifics for your situation and if you are off tract, assist you in getting back on tract to good dental health.

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Dental

Dr Ray Lansdowne

2003-07-01 10:56:00

:  I'm in my early 50s, evidently have pyorrhea and probably will lose my teeth.  I don't understand how it could happen.  I brush my teeth two times a day and have my teeth cleaned fairly often.  Now, all of a sudden, I have pyorrhea.  My parents and grandparents all had dentures.  Is there any hope that I can keep my natural teeth and what can be done to keep my kids and grandkids from this same fate?  

ANSWER: To continue our discussion on Pyorrhea from last month’s question, this is what life is all about, making life better for those that follow us especially our own family.  Kids today can expect to keep their teeth free of dental disease for all of their life.  The knowledge is available; it just has to be utilized.  Will Rogers said, "We are all ignorant, only on different subjects".  Seek out a dentist that earns the title of doctor, (teacher) by teaching you the fine points of maintaining or regaining your and your family's oral health.  The focus of every dentist should be to assist all of their patients to be less ignorant of their dental health needs and more knowledgeable regarding preventive dentistry and treatment options.   Although a lot of people don't think of seeking the advice of a dentist until there is a problem, let alone before the kid has any teeth, prevention begins before the first tooth erupts, not after.  The recommended time for a child's first visit is between the time the first tooth erupts and the child's first birthday.     My personal preference is to see the mother while she is pregnant, then the child around his or her first birthday.  This gives me, a general dentist, who is already seeing the parents, an opportunity to impart information regarding prevention early enough to be effective.  Prevention starts even before birth as the habits of the parents are passed on to the kids.  If parents have good oral hygiene habits, good dietary practices and no harmful habits like tobacco use, the kids will be more apt to emulate the parents and develop good habits as well, and visa versa.    Lets start with a newborn.  Generally there are no teeth present in the mouth at birth.  However, good habit patterns need to be established.  Start with a daily cleansing with a moist soft cloth or gauze to wipe out the oral cavity on the ridges and under the tongue.  This establishes the habit of daily oral cleansing and as soon as the first tooth erupts, begin brushing it with a soft bristle brush, while continuing to cleanse the rest of the oral cavity.      As the back baby teeth erupt between the ages of one and two, the cloth can be substituted with a soft-bristled brush for everything.  Keep in mind however, that the brush cannot adequately cleanse between the teeth and as soon as the space between any two teeth closes, floss is needed for adequate oral hygiene.     As soon as teeth erupt, there is potential for dental disease to develop.  Knowledge of the contributory factors in dental caries such as allowing milk to pool and remain in the mouth at night resulting in Baby Bottle or Nursing Caries needs to be recognized and avoided. The motor skills necessary to keep the mouth free of the colonization of disease-causing bacteria are the same motor skills it takes to write cursively.  Those motor skills are developed around the age of 8 to 10 years.  Therefore it is necessary for the parents to maintain the oral health of their children until those skills develop during which time the kids are taught and learn the necessary techniques to adequately remove plaque.  The developmentally challenged child may need assistance for a longer period of time and some need assistance through out life.     Certainly, the health model of practice (utilizing preventive measures) is the preferred model.  However, once disease is present, using a disease model for assessing causative or contributive factors is essential to plan future preventive measures and it helps in the understanding of the nature of dental disease. 

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Dental

Dr Ray Lansdowne

2003-06-01 10:13:00

QUESTION:  I'm in my early 50s, evidently have pyorrhea and probably will lose my teeth.  I don't understand how it could happen.  I brush my teeth two times a day and have my teeth cleaned fairly often.  Now, all of a sudden, I have pyorrhea.  My parents and grandparents all had dentures.  Is there any hope that I can keep my natural teeth and what can be done to keep my kids and grandkids from this same fate?

ANSWER: There are two parts to your question.  I will address the first part in this issue and the second part concerning your offspring in another issue of the Q & A Times.   For those that may not know, Pyorrhea means "a flow of pus".  The general disease you speak of is 'Pyorrhea Alveolaris' or Periodontal disease.  It is characterized by a loss of support of the teeth.  Bacterium (germs) build up around the teeth, the gums become inflamed and pull away from the teeth forming pockets.  The pockets as they deepen harbor more types and numbers of bacteria.  As the process continues, the alveolar bone (this is the bone that surrounds the teeth) is lost, and the end result is loosening of the teeth, which ultimately fall out if left untreated.  There are many factors that contribute to periodontal disease, but primarily it is the body's response to certain types of bacterium that are toxic to one's system.  I will attempt to explain it in more easily understood terms: the body's immune system interprets the tooth, around which the bacteria organize and attach, as the foreign body.  As the body tries to isolate the tooth (now considered a foreign body) from one's body, periodontal pockets form.  As the population of bacterium increases, their waste products also increase and pus is one of those waste products, which flows from the pockets.  Ultimately, the defense mechanism succeeds or perhaps fails, and the tooth is isolated and sloughs from the body, allowing a layer of skin to protect the body from further invasion albeit without the tooth or in most cases teeth.  If adequate measures are instituted early enough, it is possible to arrest the process and maintain one's teeth for many years to come and perhaps for a lifetime.  The earlier the process of arresting the disease begins, the better the outcome.  Prevention of the disease is the best measure.  The old adage "An ounce of prevention is worth a pound of cure" is certainly applicable here.   I would encourage you to seek the services of a dentist that will, as a part of the cleaning/exam process, measure the depth of pocket formation around your teeth, evaluate the extent of any disease present and assist you in arresting the disease.  The dentist will not be able to stop the disease process alone.  It takes a very active role by the patient to control the disease.  Without a personal evaluation and examination, including necessary X-rays, it is not possible to determine the extent or prognosis of your particular situation.  Periodontal disease at present is not curable, at least not in the way of returning to the health prior to the onset of the disease, but the earlier one treats the disease the more likely one is to retain one's teeth.  It may not be too late even for you.   Other factors that contribute to the breakdown process include tobacco product usage, hereditary factors (immune response, saliva quality and quantity), environmental factors (diet, beneficial and harmful habits, ability and willingness to effectively clean the teeth on a daily basis, how the teeth are positioned), and certain systemic complications that predispose (not actually cause) one to 'get' periodontal disease.  Bad teeth run in families, but they run in families with adopted kids as well.  That gets us into the second part of your question, which I will address in a future article.  This is what parenting is all about, making life more abundantly successful and healthy for our children and their children's children.

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Dental

Dr Ray Lansdowne

2003-03-01 13:26:00

:  My dental insurance says it will pay for dental work at 100%, 80% and 50% depending on the procedure, yet that doesn't always happen.  What gives?  Is it because my dentist is not a participating provider?

ANSWER:  To say the least, it is frustrating for one to be led to believe 100% of a bill will be taken care of by a third party only to find out that such is not the case.  The answer is quite complex.  The information required to answer your questions is generally found in the fine print of the contracts and employee benefits booklet.  First it is necessary to clarify terms and concepts.  In your question, you used "dental insurance" to represent a company as opposed to a "third party administrator", which would be a more accurate term.  The term "dental insurance" used as a benefit is more accurately termed "prepayment of benefits".  True insurance is coverage for the unexpected or events that are unanticipated.  Other than trauma or cancer, oral disease is very predictable, and even in those situations, there are some steps that one can take to lessen the chances of injury or disease, like wearing a mouth-guard for sporting activities and not using tobacco products.The Plan is what an employer wishes to provide employees as a benefit of employment rather than having all compensation in the form of salary.  Salary compensation is subject to taxes withheld for Social Security and Medicaid, with an equal amount paid by the employer.  Therefore, pretax benefits are a win-win situation for both the employer and the employee.  For the Plan to succeed, it is necessary for it to be on sound financial ground.  Actuaries know within narrow margins of error just how many people in a group, based on data obtained over many years, will need what dental services. They then advise (based on the funds available for providing dental benefits) third party administrators the limitations and amounts that can be allowed for each of the services to be built into the plans.  This assures the plan will be financially viable.  At this point the employer chooses either a Direct Reimbursement Plan or selects an insurance company to serve as the Plan Administrator.  The major factor in the development of any Benefit Plan is how much funding the employer can spend annually over a three to five year Plan Contract.  After the Plan Administrator subtracts its fees, the total must then be allocated between the services expected to be claimed as benefits.  Obviously, the Plan cannot pay 100% of all claims unless the employer has unlimited funds.  Because of limited funding it is necessary to limit the expenditures to considerably less than the cost of providing the benefits.  The major restriction or limit placed within the Plan is its yearly maximum.  There are few policies that exceed $1000.00 in annual benefits, which by the way was the annual maximum well over 30 years ago when dental plans emerged as an employee benefit.  Other limits that are listed in the contract language include deductibles, co-payments, non-covered services and the phrase "the least expensive procedure that provides professionally acceptable results".  Deductibles and co-payments, if not collected, produce over-utilization which in turn causes a rapid depletion of available funds set aside to pay benefits, thereby potentially allowing the plan to become insolvent.  That is the reason it is generally considered a fraudulent practice for dentists to "forgive" the deductible and/or co-payments that are stipulated in the contract as the patient's financial obligation.  The phrase "the least expensive procedure that provides professionally acceptable results" is used to save money by paying for an alternative treatment rather than the procedure you and your dentist decided to have accomplished.  The alternative treatment is not determined by you and your dentist, but by a dental consultant.  This person, possibly not even licensed to practice dentistry in your state, is hired and paid by the Plan Administrator.  This may not seem fair but it is in the contract language.  Contract language is extremely important in controlling costs and promoting the plan to potential purchasers.  This is where your question's focus lies.  It sounds more enticing to consider a Plan paying 50% of crowns rather than say $260.00 for a crown.  An employer may have the knowledge of fees charged for a crown restoration, but not really understand the fine print that explains the 'percentile' allocation as it relates to 'usual, customary and reasonable' terminology in the contract language.  We now have new words to define: "Usual, Customary and Reasonable" (UCR) and "Percentile".  Using the 50th Percentile fee means that half of the dentists providing that service will have a fee at or below that level and half will have a fee for more than that amount.  For dentists with a fee at or below the percentile stipulated in the contract the patient will be reimbursed by the plan administrator, a full 50% of the fee.  For dentists with a fee above the stipulated contract percentile, the patient will be reimbursed 50% of the maximum allowed by the contract language.  The portion of the fee above that level will be owed by the patient as a co-payment, unless the Plan discriminates on the basis of being a PPO, DMO or a Point of Service Contract.  That gets to the point of your second part of your two part questions. (I warned you it was complex).  Not all plans require the patient to have the services provided by a preferred provider to be reimbursed or be reimbursed at the highest level.  Those that require preferred providers also require a participating dentist to sign a contract.  From the dentist's side, signing a contract and thus becoming a preferred provider presents a legal document necessitating him/her to abide by the contract in all aspects of the obligations written in the contract and generally include any changes the plan administrator might institute in the future.  The dentist has a way out of the contract if he/she doesn't like any new language, but risks loosing patients that expect the doctor to write off all fees above the contract limits.  That poses a financial dilemma if not an ethical dilemma, for the dentist, which is not easily addressed.  If your policy allows you to select the dentist of your choice and doesn't require a contract with participating dentists, the policy will still impose limits on their liability in the policy and require you to pay the difference rather than requiring the dentist to write off the balance.I hope that your questions were answered, or at least some light shed on the subject.  Above all, select your dentist based on what you feel is important and not on whom a Plan Administrator prefers.  They may prefer someone for reasons that don't mesh with your reasons or values.  Select a dentist you know and trust.  Wichita is blessed with having a high percentage of excellent dentists.Bottom line is that Dental "Insurance" Companies are in business for a profit.  Even those that are officially non-profit in structure desire more income as it can be used to increase benefits for the officers and employees.  Limits on payouts increase the bottom line profits.  The good news is that pre-tax benefits allow people to take advantage of dental benefits, increase their dental knowledge and obtain access to improved dental health.  We can all be grateful that government in spite of all its shortcomings, on the issue of pre-tax benefits, "promotes the general welfare" of its citizens.

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Dental

Dr Ray Lansdowne

2003-02-01 14:31:00

:  What causes tooth discoloration?

ANSWER:  There are many classifications of tooth discoloration and each has at least one cause.  For space limitations, I will discuss a general darkening of a tooth.  There are two basic classifications of tooth discoloration: intrinsic (an internal darkening) and extrinsic (a surface discoloration).  Intrinsic:  The main cause of the darkening of a tooth is trauma, making the assumption that the teeth did not come in dark, as with tetracycline stained teeth.  Tetracycline is an antibiotic that is given for infections.  Before it was known to cause tooth discoloration, it was given frequently to children especially when the child was allergic to other antibiotics.  A blow to tooth can happen suddenly and severely or over a long period of time when teeth don't fit together properly.  When a tooth is traumatized sufficiently, the blood vessels within the pulp of a tooth can rupture, the blood cells enter the dentinal tubules and over time, as blood degenerates and turns black, the dark color is then seen through the translucent tooth structure.  In other cases the trauma is not severe enough to cause nerve damage but the tooth will turn dark as the pulp shrinks and secondary dentin that forms is dense and usually darker.  The remedy will involve endodontic (root canal) treatment to remove diseased pulp tissue and seal the canals in the tooth or to allow internal bleaching of the crown, that portion of the tooth above the gum line. The choices then are covering the visible tooth structure with an artificial crown (cap) or to bleach the dentin tubules using heat and bleaching chemicals.  If the tooth is sufficiently lightened by the bleaching, and not needing an artificial crown to strengthen the tooth, then filling the access opening to the nerve with a tooth colored filling material may be enough to satisfy the esthetic and functional concerns.Extrinsic:  These are generally stains that are surface oriented.  Such stains can often be reduced or eliminated by a thorough professional dental cleaning.  Time, translate that as age, will have a darkening effect on tooth structure.  It may be because of long standing extrinsic staining or from a shrinking of the pulp as mentioned above without the pulp needing treatment.  Our teeth naturally become darker as we age.  The advent of tooth bleaching has become extremely popular to reduce the appearance of ageing in our teeth.  There are over the counter (OTC) products, in-office procedures and at-home bleaching materials dispensed by the dentist.  There have been very few negative results of professional bleaching.  Some of the early OTC products were not as safe, as some had a low pH, that is a high acid content, which would make the teeth white at the expense of the soundness of the tooth structure.  Any of the OTC materials that have the American Dental Association's seal of approval will have been sufficiently tested and can be considered safe for use.  OTC products generally are not as high in strength as those dispensed at the dental office.  This is because OTC materials are not custom fitted to the tooth borders with the gum tissue.  If the bleaching agent is strong enough to allow for a rapid shade improvement, then it can irritate the gums, not a good thing for additional purchases or referrals.  If your dentist indicates that you could benefit from tooth bleaching, then you could probably benefit from an ADA approved OTC bleaching product.  The only negative is the lower concentration and limited coverage area of the OTC products.  The OTC bleaching products are approved for healthy teeth so have a complete dental evaluation before trying such products.  As always, if you experience sensitivity with any OTC dental products contact your dentist for an assessment of the problem.

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Dental

Dr Ray Lansdowne

2003-01-01 11:40:00

:  My wife grinds her teeth much of the time when she is asleep. Is this a common condition?  It seems like it would destroy her teeth.  What causes her to do this?  What is the treatment?

ANSWER:  The condition you describe regarding your wife grinding her teeth while asleep is termed "Nocturnal Bruxism".  It has been estimated that Bruxism may be present in 5% to 20% of the total population with a higher incidence in patients with certain sleep disorders, such as sleep apnea.  Dentists have found visible evidence of bruxism in at least 10% to 20% of the population and it is found approximately equally between the sexes.In some cases, local anatomic factors, such as malocclusion (a bad bite) or skeletal malformations (improper upper and lower jaw relationship), play a role.  In some persons the central nervous system is a causative factor.  There are psychological factors with some cases and on a short-term basis, stress of various kinds may induce or aggravate bruxism.  Bruxism is three times more predominate in allergic children than in non-allergenic children.  The resultant malocclusion (from mouth breathing) may create a continuation of bruxism into adulthood unless proper occlusion has been established.You are absolutely correct in your evaluation that it could destroy her teeth. Besides the obvious wear on the biting surfaces of the teeth, teeth are often crowned when the bruxism results in the fracture of a cusp from a posterior tooth.  There is also a theory of tooth structure loss at the gum line caused by bruxism and/or clenching of the teeth termed Abfraction.  Previous theories regarding this loss of tooth structure implicated toothpaste and/or toothbrush abrasion.As far as the treatment is concerned, the diagnosis of the cause is of first priority.  Treatment may consist of correction of the position of the teeth and jaws to bring the teeth, jaw joint and the muscles of chewing into harmony.  If the teeth are more severely worn, it may be necessary to crown those so worn.  Any missing teeth should be replaced to keep teeth from shifting and creating more interference with the bite.  A multidisciplinary approach may be necessary to evaluate neurological implications, psychological factors, sleep apnea, or allergy involvement.   The first evaluation should be with one's general dentist as the majority of the causes are dental in nature.  Your dentist will be able to coordinate any therapy involving other professionals should that be a necessity.