Have you ever went to your family physician and they sent you to a specialist or a lab for further evaluation or testing? Probably, because there are so many medical specialties out there and your family MD wants you to be in the best hands out there to get the best treatment. Plus the body is a very complex entity and we’re discovering everyday that it’s even more complicated than we thought before. There are even subspecialties based off of other specialties that get even more specific in diagnosis and treatment.
Dentistry is becoming more and more complex also. We’ve had oral surgeons and periodontists for decades, but now there are 9 specialties in dentistry. The following list is from the ADA and gives you an idea of what each specialty does.

Dental Public Health: Dental public health is the science and art of preventing and controlling dental diseases and promoting dental health through organized community efforts. It is that form of dental practice which serves the community as a patient rather than the individual. It is concerned with the dental health education of the public, with applied dental research, and with the administration of group dental care programs as well as the prevention and control of dental diseases on a community basis. (Adopted May 1976)

Prosthodontics: Prosthodontics is the dental specialty pertaining to the diagnosis, treatment planning, rehabilitation and maintenance of the oral function, comfort, appearance and health of patients with clinical conditions associated with missing or deficient teeth and/or oral and maxillofacial tissues using biocompatible substitutes. (Adopted April 2003)

So dentistry has become almost as complex as medicine. And there are areas of dentistry that are not recognized as specialties, but certainly take further education and knowledge in order to do them well. Areas such as https://www.distinctive-smiles.com/dental-implants.html, TMJ therapy, cosmetic dentistry, sleep apnea therapy, sedation dentistry, etc. may become specialties in the future.

As a general dentist who has had training in all of these specialties and complex areas, I feel confident that we can treat most dental needs. This training also gives me the ability to know when a problem is too complex for us to treat and when a specialist’s expertise is needed. My continued education has allowed me to treat many issues and improve many smiles, but if I know that a problem can be handled more efficiently with a better result due to specialist training or materials, then I certainly fill out a referral and we get the patient to the right person.

Lastly, just like in medicine, patients that have complex problems may need a team approach to handle their care. As a general dentist, we stress that patients can look to us as the “quarterback” of the situation. We will refer them to the best specialists that we know that also communicate well. This constant communication between the specialists, the patient, and our practice keeps everyone moving the same direction to get the patient healthy. But we always stress that patients can come to us to answer questions and give guidance as their treatment moves forward.

I had a patient joke the other day that the dental injection used to remind him of someone taking a javelin and sticking it into his gums because it seems so huge when it’s coming at you. That wouldn’t be terminology that I would use, but it is quite intimidating when you are getting anesthetized to have your teeth worked on.
Anesthesia is the double edge sword of dentistry (just a metaphor). You don’t want to feel pain when I’m cleaning out the rot in your tooth, but getting numb can be uncomfortable and cause anxiety. The number one reason patients do not come to the dentist is the fear of the injection. The mere mention of dental shots and people get this serious, anxious look in their eyes. And who can blame them, when you are taking a big silver instrument that has a 1.5 inch needle attached into a space that is only about 4-6 square inches, I get the sense of claustrophobia and anxiety just writing about it. We used to have to practice on each other in dental school. Who makes better guinea pigs that each other in dental school? Having some student with a shaky hand coming at you with a large syringe will make you contemplate a career change.
Many times the reason that people have this fear is because they had some heavy handed dentist in the 1960s jam the anesthetic in the tissue as fast as he could. That’s a tough memory to shake, but in reality there are three main reasons why injections hurt. One is the initial puncture into the tissue. Second is that anesthetic is an acidic solution and cold. The body wants things brought in that are the same temperature as the body itself and are neutral in pH. The last is that the injection is put in too fast. Eliminate those things and injections are relatively painless.
Given that this is the thing that is feared the most in a dental office, we do everything we can to make these injections as painless as possible. Here’s what we do at our office. I use a topical anesthetic that is compounded at a pharmacy consisting of three types of strong anesthetics instead of using the generic topicals that only have one weaker anesthetic. Better absorption into your gum tissue and less “pinch” when we inject. Our anesthetics are warmed to a temperature that is similar to your body temperature. And last, we use The Wand. You can take a look at a video we posted on our blog a while back (Oct 19, 2011) It puts the anesthetic in a controlled rate so you don’t have that burning sensation from the acidic solution. The needle is attached to a small plastic holder (looks like a wand) so no more big scary silver syringe. Many times patients tell us they didn’t feel anything at all or it was the easiest injections they’ve ever had. The point is that it’s less stressful for the patient and us (contrary to what the media may put out there, dentists do not like to hurt people). So the next time your in our office and want to see what this thing is all about, just ask because I love to show how technology can make your experience a better one. But remember, if you don’t like shots regardless of how they’re given, just avoid them. Good oral hygiene including flossing and brushing and keep up with your checkups including exams, x-rays, and cleanings so you can avoid getting cavities in the first place.

Valentine’s day is coming up and even though it is more of a “hallmark holiday”, it’s still fun for the kids. And hopefully you have someone special you can celebrate with. The fact that this holiday is coming up gives me an opportunity to discuss something that relates to the general public. As dentists, we have this curse of speaking in terms that make no sense to the general public. Here’s a quiz for you.

1. An amalgam is
A) a mouth retractor
B) a type of filling material
C) a new kind of nail polish

2. The mesial of a tooth is
A) the front surface of a tooth
B) the second layer past the enamel
C) a growth sticking out the gums

3) You have acute necrotizing ulcerative periodontitis. What do you have?
A) a simple cavity
B) a disease which is leading to tooth loss due to loss of bone
C) the lack of kissablity

The answers are B, A, and both B/C in case you’re wondering. My point is that dentists talk this alien language and expect the general public to understand. What happens is the patient has a lack of understanding the diagnosis and the recommended treatment. This lack of communication then leads to the patient not scheduling and not getting the treatment that they really need. When a patient doesn’t understand why they need it, there is no value in the recommended treatment. The patient then only looks at how much it’s going to cost and weighs that against the fact that it may not be hurting right now, so they just put it off. And usually by the time it starts hurting, it’s going to cost more and take more time to fix.
This leads me to kissability. That’s a word that everyone understands. Does your partner want to kiss you? If you haven’t had your teeth cleaned in over 6 months, you’re chances of getting kissed are going down. You’re building up odor-causing bacteria under your gums, your gums are getting inflammed, your gums start bleeding, and you get bad breath. I don’t know how you feel about it, but I feel that’s pretty gross. And I bet your partner feels the same way! Good brushing helps and flossing takes that a step further. Brushing your tongue and using mouth rinse will improve the situation also. But even the best brushers and flossers are going to build up tartar. Tartar is like a big apartment building where all the odor causing bacteria like to live. They sit back, eat the sugars and carbohydrates we put in our mouths then spill out acids and odor causing toxins. Why would you let that stuff sit in there for months and years? Get into the dental office and have us clean that stuff off. You want to know what is the most attractive to your partner or a possible partner? It’s a nice smile and good breath! Don’t mess that up and the potential for a good Valentine’s Day increases dramatically.

As we get closer to the holiday season, I like to look at my options as to where I buy my gifts. Given that I own a small business, I try to support other small businesses and companies that make things here at home. So even if it costs a couple dollars more, I feel good to support those businesses plus I usually get better customer service and attention when I go to a mom and pop store. But what happened to the mom and pop stores? There are far fewer than just a few years ago.
Well, a while back, Sam Walton figured out that the more that you buy of something, the cheaper it would be and the big box store was born. For example, I can buy a 12 pack of Coke at a lower price from Wal-Mart than I can at a small convenient store. It’s all the same Coke, but the price is less at Wal-Mart so people go there to save money. It’s what is called a commodity. It means you get the same thing no matter what the cost is. A Coke is a Coke.
Dentistry is looking at a similar situation in the future. Employers are paying less for dental benefits which means their employees are getting usually stuck with a PPO (participating provider option) plan. As I’ve discussed before, practices have to discount their fees around 30-40% in order to be on the PPO list. This basically means the practice needs to see about 30-40% more patients in order to pay the bills and run a business. This leads to less time being spent with each patient and can lead to cutting corners with materials and staff. Those practices that have elected to not be on those plans are able to provide a better, more attentive experience for their patients. Regardless of the economy, people typically buy what they want and not necessarily what they need. So it boils down to value versus price. If price is the most important aspect then you’ll go to the lowest bidder. But if an individual places value in their health, then they may go to a place that provides a better experience and it may be worth the extra cost. Dentistry is not a commodity, it’s a service that varies with every practice and every provider. Veneers and other cosmetic services, for example, can be done several ways. Is there an offer to increase patient comfort with pillows, blankets, headphone, and sedation? There is value in taking the extra steps to get the best result. The insurance companies want to pay less so practices then have to see more patients and possible lower the value. This can turn a practice into an assembly line atmosphere and decreases customer service. So buy your Coke at your local big box store if you want to save a few bucks, but don’t let the insurance companies tell you where to go for better dental health. I always say you get what you pay for and there is no better investment in you or your family’s health.

My son, Logan, just turned 6 years old a few days ago. You can see below that he was having a lot of fun at the zoo.

Lots of fun at that age and lots of questions about school, sports, life, etc. This is one reason why I love Wikipedia. If he asks a question that I may not know the answer or wants a little more info then we can go there and then we can discuss. Well I’m sure all of you out there have heard the term “cosmetic dentist” because that term gets thrown around a lot in our world. So I thought I’d looked that up that term on Wikipedia and here is the first paragraph.

“Cosmetic dentistry is generally used to refer to any dental work that improves the appearance (though not necessarily the function) of a person’s teeth, gums and/or bite. Many dentists refer to themselves as “cosmetic dentists” regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.”

While the term “cosmetic dentistry” is not in our logo or tagline, we strive everyday to improve a person’s appearance by providing dentistry that not only increases the strength and health of a person’s teeth, but also looks good. You can see some of the before and after pictures in our smile gallery which demonstrates how healthy teeth can also look better. At our preventative appointments, we look at the shade of the teeth and discuss if the patient is happy with their smile and we offer whitening, porcelain veneers, cosmetic bonding, Invisalign, Six Month Smiles, or even Botox and Juvederm.

The term “cosmetic dentistry” should really be considered a philosophy. I strive everyday to make a patient’s teeth healthier, but also make them look better at the same time with everything we do. Our philosophy also includes letting a patient know what is possible with their smile and their teeth then let them decide. For example, a lot of patients don’t know that we perform Botox and Juvederm procedures. Many times we use those procedures to frame a new, beautiful smile and sometimes we use them because a patient wants to feel younger or gain more self esteem. Or they want a solution that doesn’t require the expense of porcelain veneers so we discuss the pluses and minuses of cosmetic bonding.

Regardless, the staff and I decided to be trained to do these procedures because it gives the patient more options. So the next time you see us or any other dental professional and you are looking to improve your smile, make sure they give you some cosmetic options. A dental professional that only offers one or two solutions is not giving the full story. They’re your teeth and you should have all the information to make an informed decision.

I just got back from a few days in Scottsdale, AZ where I took a great three day seminar at the Scottsdale Center for Dentistry. We were in class from about 8a until 530p each day. Which were long days, but don’t feel too bad, it was great weather, had some great mexican food, and had a good time (although I didn’t get to hit the little white ball around). This isn’t my first time to the Scottsdale Center. I’ve actually been out there about 10 times in the past six years and am re-energized everytime I come back. Dr. Frank Spear, who is a mentor of mine, leads the Spear Education curriculum in which dentists learn a high level of education including dealing with how teeth come together the correct way (or lack thereof), patients with joint disorders, larger cosmetic and functional cases, case presentation, and practice management. If that sounds like a lot, it is and probably more. I’m part of the Spear faculty club and a member of a local Spear study club. I also take courses once or twice a year in St. Pete’s, FL at the Dawson Center (another big name in dentistry). I am part of the Academy of General Dentistry and one of the services this group provides is keeping track of the hours of continuing education over the years. Once you have over 500 hours, you are eligible to take the fellowship exam to become a fellow of the AGD. I just passed that mark a couple months ago. This means that I have taken over 500 hours of my life to sit and learn about what I what I love to do…dentistry. So I will start studying the rest of this year and take that test early next year although I am not excited to start studying again.
I am boasting a little about my history of continuing education because I’m proud of the fact that I’ve furthered my knowledge of my field and that’s a benefit to our patients. But the fact remains that unless your dentist is seeking to improve his ability to provide you with the best care possible, then I firmly believe that you should seek a new dentist. There are so many opportunities out there beyond taking just the minimum requirements to further your education that there is no excuse not to.
The Ohio State Dental Board requires that in order for a dentist to keep his license, he/she must take 40 hours of continuing education at minimum every 2 years. You can take it online, go to a lecture, take a hand on course, or take a dental continuum (almost like a residency). I chose the latter because I feel my patients, staff, and I can benefit most from that. Another interesting note is the amount of investment in continuing education by the dental community. And I don’t put these numbers out there because of the amount, but because of the discrepency of the numbers. The average American dentist spends $900 every 2 years in CE. A dentist taking a continuum, such as Dawson or Spear, spends about $10,000 in that 2 years. The people who benefit most from that are the patients. These doctors have an much higher level of understanding of not just the teeth, but of the whole chewing system. “A physician of the mastigatory system”, not just “a tooth doctor” as Dr. Dawson says.

I’m sure some of you were watching the Today Show several weeks ago and heard the story about how dental x-rays are causing brain tumors and that cancer is in the waiting after your next dental check up. We’ve had several inquiries about this issue in the past (even more since that story ran) so I thought I would give you some numbers and my take as a dentist. First off, one thing that I agree with the story that was aired is the fact that x-rays should only be taken when necessary. Contrary to some belief, we don’t just snap these things because “dental insurance” says it’s covered or because we want to add to the bill. As a dentist, I can only diagnose what I can see. I cannot see in between your teeth during your exam. The only thing that shows me a view of in between two teeth that are in contact with one another is an x-ray. In essence, I cannot perform a complete exam without x-rays. In my opinion, bitewing x-rays should be taken once a year at a minimum. If you have fillings that are in between your teeth, it might be a good idea to get them every 6 months whether your “insurance” covers it or not. Patients always want us to be conservative and get upset when we tell them they need a crown or root canal. Well in order for us to be conservative, we need to catch things early. Many times when a cavity that is in between the teeth becomes apparent in the mouth, we are usually talking about crowns. Remember that I can only diagnose what I can see.
The other type of x-ray that we utilize is the panoramic x-ray. This is the one that goes around your head and gives us a view from the right joint to the left joint including sinuses, carotid arteries, jawbones, and teeth. We recommend that x-ray every 3 years (although many “insurances” cover it only every 5 now). This x-ray does not have the fine resolution it takes to diagnose cavities, but it is great for diagnosing abnormalities including infection and cancerous lesions plus if a blot clot or plaque is big enough in the carotid then it’ll show up as well (BTW, we’ll drive you to the ER if we find one of those). So the next time we recommend a panorex x-ray, think about it’s ability to catch things early. It could help save your life.
Lastly, let’s talk some numbers. Everyone is scared that they are getting too much radiation. And if they’ve had a bunch of tests and x-rays in the hospital, they are worried that the dental x-rays may be the tipping point in causing cancer. These numbers come from the Department of Radiation so I’m not making them up. The maximum amount of occupational exposure for US radiation workers is 5000 millirems each year. High dose x-rays include mammograms (1000mr), spinals (around 450mr), and pelvimetry (875mr). The low dose group includes cervical spine (52mr) and femur (21mr). A film based panorex is 2mr (these are the ones we like to take once every 3 years). A digital bitewing (the kind we take) are less than 0.05mr meaning the series of 4 that we usually take each year is about 0.2mr. One last analogy, if you fly from coast to coast on an airplane, you get 4mr of background radiation. That’s equivilent to 80 digital bitewing x-rays. Don’t let the media hype scare you. The benefits of detecting cavities, gum disease, abscesses, and oral cancer far ourweigh the risks involving dental x-rays. They are safe and effective.

*BTW, if you were wondering why I put the quotation marks around the word insurance above, take a look at my previous blogs about “dental insurance”