Phases of Dentistry
As with any branch of health care, dental treatment is based on a needs assessment of your current condition. In medicine, there is a “triage” of care; dentistry is very similar. Our treatment process is guided by priority and urgency of care and a goal of creating a plan to anticipate and prevent problems in the future.
Our immediate goal in treating any new patient is to control, intercept and prevent pain, and treat infection. Dental infection is a serious matter, especially for children, for whom it can be life-threatening. In most cases, emergency care begins with an examination and any, necessary xrays to properly diagnose the situation at hand and plan an appropriate course of action.
- Some emergencies don't hurt - left untreated, periodontal (gum) disease can develop into an oral infection that can lead to tooth loss. As part of the first phase of dentistry, we look for signs of infection or abscesses and dangerous conditions such as oral cancer and jaw tumors.
- “Why can't you just pull my tooth?” It is common for patients that have a toothache to ask our doctors to remove the tooth to solve the problem. While it may seem that this is a quick fix, it is not always the best option. Saving your teeth, whenever possible, is the smartest move. Tooth loss can have a “domino effect” on your smile - one goes, and other problems follow. Given room to move in the absence of a vital permanent tooth, biting forces will cause other teeth to shift into the open space and create a dysfunctional bite. This imbalance can also force teeth to come together in the wrong places and cause trauma to existing teeth, or, additional tooth loss over time.
In this phase of your oral health care, we record a comprehensive medical and dental history to understand your overall health condition. Researchers continue to uncover additional information about the connection between mouth and body health. Some of the predominant concerns include:
Diabetes is a group of diseases marked by high levels of blood glucose resulting from defects in insulin production and insulin action. Diabetes can lead to serious complications, such as blindness, kidney damage, cardiovascular disease and circulatory problems in lower extremities. Most people with diabetes can control their glucose levels to help minimize the risk of complications through a prescribed medication regimen combined with a healthy lifestyle and proper nutrition.
Diabetes & Oral Health
When diabetes is not controlled properly, high glucose levels in saliva can help bacteria thrive. Preventive dental care becomes critical in avoiding dental disease and early response to symptoms is important to avoid progression of disease. Other oral complications of diabetes:
- Diabetes reduces the body's resistance to infection, increasing the risk of periodontal infections in the gums and bone.
- Increased bacterial presence in the body weakens the immune system and slows wound healing.
- Patients with diabetes have a reduced salivary flow; combined with increased glucose levels, oral fungal infections such as thrush are common.
- Diabetic patients commonly experience taste impairment.
References: Centers for Disease Control (CDC) Diabetes Fact Sheet http://www.cdc.gov/diabetes/pubs/pdf/ndfs_2007.pdf, Journal of the American Dental Association, JADA, Diabetes and the Oral Health http://www.ada.org/prof/resources/pubs/jada/patient/patient_18.pdf
To continue pumping efficiently, your heart needs a continuous, plentiful supply of blood and oxygen, which is delivered to the lungs by the arteries. Chronic inflammation of the gums may release bacteria into the bloodstream causing inflammation of the lining of these arteries. Narrowed or clogged arteries cause damage to the heart muscles. The incidence of heart disease is about 2 times greater in people with periodontal disease.
GERD Gastroesophogeal Reflux Disease (Heartburn)
People with Gastroesophogeal disease (GERD) may report a foul taste in the mouth, a burning sensation in the mouth and may have tooth erosion caused by digestive acids entering the mouth. Use of antacids and some peptic ulcer drugs can cause Xerostomia (dry mouth), impair taste, or lead to bacterial accumulation on the surface of the tongue and result in oral infections.
Certain oral rinses can be prescribed for patients with GERD to decrease acidity and minimize the bad taste in the mouth. Fluoride treatments can also help strengthen the teeth and make them more resistant to damage from exposure to digestive acids.
Chemotherapy & Radiation Therapy
Cancer treatments, including chemotherapy and radiation therapy, can cause a number of oral complications. High on the list of problems is Xerostomia, also known as Dry Mouth Syndrome. Many medications cause this condition, in which the salivary flow is reduced, allowing bacterial plaque to build up on teeth surfaces and making them more susceptible to decay.
Oral infection is a serious concern for patients undergoing cancer treatment. The body's immune systems are considerably weakened during chemotherapy and radiation therapy, and what otherwise might be a minor dental infection can become a life-threatening condition for a cancer patient. Often physicians will recommend a complete dental examination to rule out any oral infections before proceeding with cancer treatment.
Reference: National Institute for Health, “Oral Complications of Dental Treatments for the Dental Team” http://www.nidcr.nih.gov/OralHealth/
Sjögren's syndrome is a chronic Autoimmune disease in which the white blood cells attack moisture-producing glands. The most common symptoms are dry eyes and dry mouth, and Sjögren's may also cause dysfunction of other organs such as the kidneys, gastrointestinal system, blood vessels, lungs, liver, pancreas, and the central nervous system.
Saliva performs an important function in the body. Saliva flow helps wash the teeth, tongue and oral tissues, keeping bacterial levels down by maintaining oral pH levels. It also contains enzymes which assist the digestive processes, and facilitates taste processes.
A regimen of artificial saliva fluids and fluoride treatments are commonly prescribed for patients with Sjögren's syndrome. Xylitol, a sweetener used in sugar-free products such as chewing gum and mints has been proven to reduce the incidence of tooth decay, and is often an effective supplement in managing oral health in Sjögren's syndrome patients.
References: Sjögren's Syndrome Foundation http://www.sjogrens.org/home/about-sjogrens-syndrome, Carifree® Bio-tech products for prevention of dental decay http://www.carifree.com/index.html
Studies show that cavity-causing bacteria can be transferred from the mother to the fetus in the developmental stages. It is especially important that women who are pregnant or planning to become pregnant have a complete dental examination and cavity risk assessment. Armed with information and preventive care, the risk of transfer of harmful oral bacteria can be greatly reduced during pregnancy. Even after delivery, moms should maintain an aggressive campaign against tooth decay to prevent incidental transfer of destructive oral bacteria from mother to child.
Periodontal disease is a greater risk factor for premature/low birth weight babies than either smoking or alcohol consumption; increased bacterial presence inhibits fetal development. Mothers with periodontal disease increase their risk for premature/low birth weight babies by 7.5 times, and 18.2% of premature/low birth weight babies are due to periodontal disease.
Reference: Journal of the California Dental Association, March 2003, Caries Management by Risk Assessment: Consensus Statement, April 2002. http://www.cdafoundation.org/journal/jour0303/consensus.htm
Your body's overall health affects the balance of your physiological systems. If you or a loved one has a compromised immune system due to a systemic health issue, please contact us to help you with managing your oral health.
The Diagnostic phase of dentistry is a pivotal point in creating a plan to keep your smile healthy. As with the collection of historical medical and dental information, your current situation is part of the body of data that is used to create an efficient strategy to protect, preserve and maintain your oral health.
During this phase, we “listen, look and feel” using informational tools, such as oral examination, gum measurements, xrays, photographs, study models, and your feedback to “plot” your smile. We then create a complete road map of the health of your teeth, gums, jaw joints and supportive bone structures upon which to base our recommendations and diagnosis.
Another important tool used in our practice is saliva testing. Often influenced by systemic issues, the quality, quantity, pH level and bacterial levels of saliva have a tremendous impact on oral health. Diet and nutrition are also analyzed during this phase of dentistry; of particular interest to the dental care professional is the frequency of meals, snacks and beverages. Studies show that how often we introduce food substances into our mouth is linked to the duration of increased bacterial activity, which directly affects the incidence of tooth decay.
It's hard to quit smoking - we know! It's well worth it, though and we want to fully support our patients in quitting. In addition to the effects smoking has on body health, it creates problems for oral health as well. Smokers have slower healing times, which rules them out as a candidate for dental implant procedures, and can increase post-operative discomfort after tooth extractions due to dry socket, in which the blood clot over the extraction site is lost. Smoking is also a significant contributing factor in gum disease.
It's true, no one knows more about your own body than you do! We use risk assessments to survey your lifestyle, eating habits and determine the risk factors that may influence your oral health. Be sure to take our Risk Assessments prior to your first appointment with us.
During this phase, it is of equal importance to us that we both treat active conditions and address the potential for disease. To accomplish this, we apply all of our learning from our data collection during previous phases to perform necessary procedures and prescribe appropriate therapies to reduce the risk of disease.
During the Disease Control phase, some of the problems we commonly address include:
Periodontal Disease, or gum disease, is always under suspicion in adult dental care. An estimated 80% of Americans have some form of gum disease.
Formerly known as Pyorrhea, periodontal disease begins with, you guessed it - oral bacteria. These destructive bodies penetrate under the gum line and cause inflammation as the body tries to fight them off. If left undisturbed, the bacterial process continues its work and destroys connective tissue, and eventually bone. When bone is destroyed, teeth start to become loose and eventually fall out. Repairing the damage from gum disease can be costly, so we monitor our patients very carefully to prevent and control this invasive disease.
Reference: National Institute of Dental and Craniofacial Research, "Periodontal (Gum) Disease: Causes, Symptoms, and Treatments", 2010. http://www.nidcr.nih.gov/OralHealth/Topics/GumDiseases/PeriodontalGumDisease.htm
Bite and Joint Trauma
If our diagnostic assessment reveals that the teeth or jaw joints are being damaged due to teeth grinding or an imbalance in the bite, we may recommend a bite appliance or bite adjustment procedure as a first measure of treatment. This is important to protect your investment before moving forward with fillings, crowns or other types of restorative treatment to repair tooth damage.
We are all familiar with cavities, or dental caries. This too, is a bacterial process in which the pesky fiends penetrate the tooth surface, and, left undisturbed with a nutritional supply of food particles and sugars, destroy tooth enamel and eventually work their way towards the nerve of the tooth, causing pain.
Cavities are Contagious!
Studies show that cavity-causing bacteria are transmittable to other people. This aspect of dentistry is drawing more attention, every day. The new “kissing disease”; the transfer of bacteria that cause tooth decay has been traced to oral contact through kissing and sharing of toothbrushes and food utensils. So, if you or a loved one has tooth decay, a strong plan of defense is required to reduce the risk of “giving” cavities to others!
We use Cari-free® Cavity Prevention Products to help you and your family prevent dental disease.
Read more at carifree.com»
Addressing the Causes of Oral Disease is as Important as the Treatment
Because we know what causes tooth decay and gum disease, part of our dental care strategy is to prevent disease altogether. Before we ask you to invest time and money in dental procedures, we feel it is our responsibility to identify and deal with the causative factors of oral disease. “Causes” can be traced back to our diagnostic findings, such as bacterial and pH levels in the saliva, eating habits, medications and systemic conditions.
Knowledge is Power
Beginning with your first visit to our office, we work closely with you to help you reduce your risk of developing cavities or gum disease by creating a customized home care and nutrition routine designed to address your specific risk categories.
During the re-evaluation phase, we assess our progress to determine if we have 1) controlled the bacteria that cause oral diseases and 2) created a stable oral environment that will support a plan to restore and correct the damage done by dental disease.
We re-apply our diagnostic tools, including saliva and bacterial testing, and again review the flow, quantity and consistency of the saliva, along with current pH and bacterial levels. We also discuss our diet recommendations with you to find out what is working for you and what we may need to adjust. Measuring our progress at this stage will let us know if we need to modify our approach at all, or if we are ready to proceed with further treatment.
With a stable oral environment, we can then proceed with plans to rebuild areas that have been damaged by dental disease and to correct problems. Common procedures that we perform include:
Tooth Restoration - Dental Fillings, Crowns, Onlays and Inlays
These procedures are used to restore a tooth to healthy function. Our doctors treat areas that have been damaged due to tooth decay or trauma and place a restoration to re-build the tooth to proper biting strength.
The type of restoration used depends on the size of the area being treated and the location in the mouth. Teeth that have sustained a lot of damage may require full crown coverage, in which our doctors fabricate a custom crown from gold, other precious or semi-precious metals or porcelain. More conservative restorations such as fillings, inlays or onlays may be used for smaller areas.
Cosmetic Care - “Form follows Function”
In the course of restoring your smile, it is often possible to incorporate cosmetic changes at the same time. Natural-looking tooth colored fillings and esthetic porcelain shades offer a number of options to enhance your smile appearance as well as rebuild the strength in your teeth and bite.
In addition to supporting a proper bite balance, teeth serve a vital role in the body's digestive and nutritional systems. Your body's “engine” is built to rely on the chewing process to break down food and aid the digestive system in obtaining necessary nutrients for the body. Often patients with missing or broken-down teeth lack proper nutrition because of an inability to chew correctly. This is especially a problem in small children and seniors, who have specific dietary needs, and can lead to gastric ailments due to poorly chewed food.
Procedures that are performed to replace missing teeth include:
Dental Implants have been used for years to replace missing teeth. A tiny surgical cylinder replaces the root of a missing tooth, and is then restored with a crown or bridge for a natural-looking result. In cases of multiple missing teeth, dental implants can be used to anchor a denture and keep it comfortably snug while talking, chewing or laughing.
Our doctors work closely with Implant Specialists, including Periodontists and Oral Surgeons, to place dental implants, which are later restored in our office.
Complete and Partial Dentures
A removable partial denture is used to replace several missing teeth, and is custom-fitted to be retained by existing natural teeth. When all of the teeth in an arch are missing, a complete denture is carefully designed to replace the original teeth.
While dentures are sometimes the only practical solution, we try to prevent our patients from reaching this point. Removable dental appliances, over time, can contribute to loss of healthy bone structure due to lack of stimulation from chewing with natural teeth and absence of circulatory blood flow between tooth and bone.
We want to help! If you are missing teeth, please contact us to discuss your options.
During the maintenance phase of dentistry, we monitor your oral health with regular checkups and preventive dental cleanings to keep your smile in good condition. It is important to protect your investment with good follow up and re-evaluation to catch any problems at the earliest possible stage.
With proper bite balance and a healthy oral environment, we can continue pursue your cosmetic interests. Are there changes you would like to make to your smile? Often, dramatic results can be achieved with minor treatments, such as teeth whitening or cosmetic bonding. Porcelain veneers and crowns are available in a variety of shades and are a beautiful solution for a number of common cosmetic dental concerns, including:
- Minor chips or cracks in teeth
- Stained or discolored teeth
- Teeth that are misshaped or look “too long” or “too short”
- Teeth that are slightly misaligned, and non-symmetrical in appearance
Everyone deserves a beautiful smile! If you are interested in cosmetic dentistry, please contact us today for a personal consultation with our Team to explore the possibilities!
Please do not hesitate to Contact Us if you have questions about caring for your smile.