Dr. Brian Saby's Dental Blog

Throughout this series, I hope to help you get a better understanding of what modern dentistry has to offer.  This should help you make more informed decisions when choosing a dentist and determining the dental treatment you would like.

I have been practicing dentistry for over 29 years.  I learned early on that people don’t really like coming to the dentist.  They do however love the benefits that available through today’s dentistry.

When a person visits the dentist, they are not looking for fillings, gum treatment or any of the other treatments we provide….They are looking for  comfort, function, stability and beauty.   How we get there may involve fillings, gum treatment, crowns, and what not. 

To achieve your dental goals, your dentist must first do an examination.  The thorough dental exam will include an inspection of your face, head and neck. We will be looking for anything that may indicate a problem or potential problem.

Following the outside examination, your dentist will do an examination inside your mouth.  This will include an oral cancer screening, looking at your soft tissue, tongue, throat, floor of your mouth, palate etc.  He will be looking for anything that is not considered normal or may indicate pathology.

The examination continues with an assessment of your chewing muscles.  Palpation, or pressing, on the muscles of mastication (as we like to call them) should produce no pain or discomfort.  He will also ask about frequency of headaches as this may often be associated with painful bite muscles.

Your dentist will examine your jaw joint, listening for sounds such as clicking or popping.  He will want to know the frequency of the noises and if you have any pain in your jaw or ears.

An examination of your bite will occur.  This is often called an occlusal exam.  Here, the dentist will assess how your teeth come together.  He will look at how the upper teeth relate to the lower teeth, both in function and when the jaw is seated in the socket. He will also see how the teeth bite together and work when chewing side to side.

After these assessments, the dentist will examine your gums and supporting tissues around the teeth.  This will involve measurents called probing, where we see how deep beneath the gums the teeth are attached.  He will look for areas of gum infection and check for mobility of your teeth.

Next the dentist will look at the teeth and see if there are any areas that exhibit decay, cracks, or potential for fractures.

You and your dentist will also look at your smile to see if it is the way you desire.

Your dentist will also review any x-rays that were taken.

Armed with all this information your dentist will be able to make a treatment plan that will help you achieve your long term dental goals.

Once a dentist has finished a comprehensive dental examination, he must come up with a treatment plan to help meet the patient’s dental goals.  These usually are:  Comfort, function, stability and esthetics.  More plainly: Look good, feel good, chew well and last a long time. 

To reach these goals, we often divide dental treatment in to two phases.  Phase one treatment involves the treatment of active disease.  Phase two treatment involves repair of damage caused by the previous disease.  In some cases, phase one treatment will be all that is required, in other situations, phase one and phase two treatment can be accomplished at the same time.  Sometimes, phase one treatment must be completed prior to phase two treatment.

Phase one treatment…stopping disease.

Creating healthy gums.  This usually involves gum treatment.  The goal is to have healthy gums that do not bleed.  This usually means a trip to the dental hygienist for a deep cleaning.  If the gums are still inflamed after initial gum therapy, laser gum therapy, chemical gum therapy or surgical gum therapy may be needed.

Creating healthy teeth.  This involves fixing any cavities that have formed.  These can be new cavities, or cavities under and around old fillings.  Worn teeth must be examined and the cause of the wear determined.  If it looks like the wear is due to grinding the bite must be stabilized.  If the damage is caused by acids, the source of the acids that dissolve the teeth must be found and eliminated or reduced if possible. 

 Creating a healthy bite.  This part of dental treatment is not as familiar to the general public.  In order to function properly and to reduce wear, the bite must be checked to ensure that the lower teeth move into the upper teeth in a way that maximizes the biting forces and reduces the strain on the muscles and jaw joint.  Many times the phase one treatment for this problem may be an appliance that is worn at night to help relax the muscles and prevent wear.  Phase one bite therapy may involve balancing the bite by selective tooth adjustment.

 After the disease is halted phase one treatment is either completed, or the final part of the phase one treatment may be to move the teeth.  This is done to allow the bite to be as good as it can be.  Teeth are moved with braces. 

Following phase one dentistry, the teeth and gums should be in a state where they are not infected or inflamed and the teeth are where they need to be. At this point, all treatment is either completed and only regular check ups and maintenance is required or it is time to start restoring the teeth to their ideal form and function…phase two treatment. 

I will discuss more about phase two dentistry in our next segment.

Since graduating in 1981 I have seen some incredible changes in the delivery of dental services.  I thought it would be a good idea to share some of the changes with you, as a lot of the changes in dentistry are not readily apparent to the general public.

When we were in dental school, esthetic dentistry was not even discussed except when we were setting up a denture.  When we were restoring teeth, the goal was to make the front teeth acceptable in appearance, and little or no consideration was given to the appearance of the back teeth.

At that time, it wasn’t that dentists were unconcerned about the appearance of our patients; it was that the materials and techniques available to us were limited.  Back fillings were either silver amalgam or gold.  Front fillings were available in tooth coloured material, however, the material was not that great and a limited number of tooth shades were manufactured. 

The goal when placing a restoration in a tooth is to have a seal that will prevent leakage of the oral fluids.  Gold restorations could be constructed to have a mechanical seal; gold is malleable and can be burnished to obtain the excellent fit required.  Silver amalgam restorations seal the filling by corroding.  The corrosion layer between the filling and the tooth has enough thickness to seal the cavity.  Both of these restorations have a great track record and still function as acceptable restorative materials, however they are not always acceptable in appearance especially in front teeth.

White fillings were made of composite resins filled with finely ground glass particles.  The problem with these fillings was that they did not stick to the tooth, therefore there was limited usage and the fillings did not last very long.

Things were changing quickly.

To create a long lasting restoration that did not leak and create sensitivity, there needed to be a way to glue the filling to the tooth.  It is very difficult to glue to a tooth.  This is good for you as this keeps things from sticking to your teeth (except spinach), but creates a problem for a dentist who wants to stick a dental restoration on your tooth.  While it was discovered as early as 1955, that application of a mild acid solution to a tooth created a surface that could be bonded etching and bonding of teeth did not become routine until the late 70’s.  In the 80’s great advances were made in the science of bonding to tooth structure.   With these advances came new tooth coloured resins with greater colour matching and strength.  Light cured resins were developed to allow for greater control of placement by allowing the dentist to cure the resin on demand.  (That is what the blue light does, for those of you who have had bonded restorations.)  The advances in dental bonding are ongoing.  We are currently in the seventh generation of dental bonding resins.

Today, we can predictably bond to tooth material.  This allows for placement of restorations that are not only acceptable, but also invisible.  The modern dentist can make front and back tooth restorations out of composite resin or bonded porcelain, that not only look great but also function like a normal tooth.

Dental bonding has dramatically changed the way dentists practice dentistry.  It has opened a whole new field of esthetic or cosmetic dentistry.  Today, if you would like to change your smile to make it look better you have that option.  A dentist trained in smile design and current in the state of the art esthetic procedures can easily create for you a smile that you love.

For more information about esthetic dental restorations ask Dr. Saby 

The following article was published in the Boise Beauty Examiner:

A smile is the universal form of communication. With a smile we can portray happiness, excitement, approval, energy, and love. Smiling is sexy- and if we smile with confidence, it’s one of the most beautiful things we can do!

The color, shape, and alignment of the teeth all contribute to a beautiful smile. Tooth whitening or bleaching has become one of the most popular beauty treatments, and thanks to our Idaho cosmetic dentists, we can have straight teeth without even needing braces! The first step to getting the smile of your dreams is to consult a cosmetic dentist specializing in aesthetics.

Choosing the right cosmetic dentist, one with extensive training, substantial experience and a gentle approach that understands clients’ needs, is the key to achieving a successful outcome through whitening or bleaching your teeth, or for achieving straight teeth and a beautiful smile! Below are some guidelines for successfully choosing a cosmetic dentist.
Does the dentist have credentials in cosmetic dentistry?
Many dentists perform some sort of cosmetic work as part of their services, but how do you know if you are paying someone who is qualified to perform tooth whitening, bleaching, or give you straight teeth and a beautiful smile? In cosmetic dentistry, as in medicine, specialties exist that are indications of a high level of education and training. Presently, however, no specialty in cosmetic dentistry recognized by the American Dental Association exists. In 1984, however, the American Academy of Cosmetic Dentistry (AACD) was formed and has the filled the need for credentials in the area of cosmetic dentistry. The organization currently has 7,000 members in the U.S. and in 40 countries around the world. It is the largest international dental organization dedicated specifically to the art and science of cosmetic dentistry, and it administers the leading accreditation program for cosmetic dentists. This accreditation process requires dentists to attend many continuing education courses in cosmetic dentistry, to be tested and to submit a number of cosmetic cases to be judged by a panel of cosmetic dentistry experts.

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