Dr. Brian Saby's Dental Blog

If you have dental fear, you are not alone.  While it is easy to say that going to the dentist is no big deal, if you are afraid, it is a big deal.  I don’t like heights and no one can convince me that there is no reason to be afraid of gravity’s effects.  My fear, like yours is real.  I also realize that there are things I can do to make it okay to be up high.  I ski and can ride a chairlift because they have safety bars.  Proper ladder selection and placement make it easy to climb and should push come to shove, my wife can clean the eaves trough. Unfortunately, you cannot get someone to have your dental work done for you, so you may have to come up with a way around this problem. 

So many people are afraid to go to the dentist that it is almost enough to consider it normal.  The apprehension levels vary from slight to extreme.  Many people will put up with considerable pain, discomfort and loss of function because of “dental phobia”.

There are a number of reasons for dental phobia.  The most common being a past experience that was unpleasant.  I would like to meet the “old horse doctor who put his knee on my chest to pull a tooth”.  I think he traveled around, inflicted pain and then took off.  The old knee on the chest method of yanking a tooth has not been used for a number of years.  The perception of a previous bad experience is very real, even though the actual experience may have been quite different.  Our memories are not the most accurate instruments.

Today, almost all dental procedures can be accomplished with little or no pain to the patient during the procedure.  Modern local anesthetics and local anesthetic techniques are very reliable and produce profound anesthesia.   There may be some discomfort after some procedures, but most of this pain is usually short lived and can be handled using pain medications.

Many people will avoid the dentist because they are afraid of the needle.  Again, the new techniques involved in delivering the anesthetic are quite amazing and can be accomplished with little or no pain.  Strong topical anesthetics prior to injection and new equipment like the computer-controlled injection have made dramatic improvements to anesthetic comfort.

One of the main reasons for fear of dental procedures is the loss of control.  When one is having dental work, they must become totally reliant on the dentist.  They must sit still and quiet while he or she works on one of the body’s most sensitive areas.   With not much else to do, they get to concentrate and postulate on what is going on.  Of course, there are some pretty wild sounds to help the imagination during the procedure. Watching television during the procedure helps to take your mind off what is going on.

There are a number of things you can do to overcome your dental phobia.  The first and most important is to find a dentist with whom you are comfortable.  You should interview any prospective dentists and make sure that this is a person who you can trust and feel comfortable with.  Set up an appointment just to meet the dentist, just to talk.  Let him or her know about your fears and what your expectations are regarding your dental care.  You can then evaluate if this is the dentist for you.

Once you have determined that this a dentist you would like to try, set up another appointment to have a full evaluation of your mouth.  This would include a dental examination and any x-rays that would be required.  If you and your dentist establish that you have some dental work to be done, you can come up with a plan to do it in such a way that it is most comfortable for you.  You may want to start with something simple like a cleaning appointment, or maybe even a small filling.  This would be an excellent way to establish a trusting relationship, which would help you overcome your fear.

Sometimes, it is necessary to use some form of sedation to help you.  Nitrous oxide or oral medications are available to help lower anxiety levels and have been used effectively for many patients. 

It is possible to overcome dental phobia sufficiently to allow you to have any required dental work completed.  Our experience has been that some patients even forget that they used to be scared to come to the dentist.  They may not enjoy it, but it is no longer a big deal.

Despite the publics increasing attention to improving their oral health, the thought of going to the dentist still evokes overwhelming fear in many patients.  In some people, the fear of going to the dentist is so great that they will put up with discomfort and even severe pain, rather than seek dental care.  Some will only seek dental help when the pain becomes intolerable.  They then choose to have their teeth amputated rather than fixed.

Why is it that dental fear is so prevalent?  Nearly everyone knows a person who has an exaggerated negative dental experience.  Of course the entertainment industry has not helped quell the fears of dental patients and even Blue Cross the dental insurance company uses a subtle reference to dental fear to help keep you from using your dental benefits.

Almost every dentist has heard the story of the “old horse doctor who put his knee on my chest to get the tooth out!”  Yet no dentist I know of has ever had to put a knee on a chest to extract a tooth, nor would this ever help get a tooth out. 

To some dental fear may arise from the belief that the procedure will be uncomfortable, while others fear the feeling that they have no control over the situation.  Some people associate the sterile smell of a dental office with medical facilities that may trigger associative fears. 

In the early years of dentistry, good pain management was unavailable and there was pain associated with dental procedures.  As science progressed, the effectiveness of dental procedures and local anesthetics became better and better resulting in more comfortable dental appointments.  Today, it is possible to perform dental procedures in a totally comfortable manner.  Excellent topical anesthetics and computer controlled local anesthetic systems allow for comfortable delivery of local anesthetics with profound effects.

In the modern caring dental office, the dentist must make every effort to make the patient feel relaxed.  It is important to establish a relationship with your dentist prior to having your work done.  You should feel comfortable with your treatment plan and be confident that this is the right treatment for you.  You should also have a signal worked out with your dentist to ensure that he or she will stop the procedure should you feel any discomfort or simply need a break.

Should you need a little more than TLC to help you with your dental appointment, there are other avenues that could be explored.  Today, many dental practices are marketing “Sleep Dentistry” to aid nervous patients.  Sleep dentistry is simply the utilization of medications to help a patient through the appointment.  A medication such as Atavan, or Halcion produce a sleeplike state but still allows enough alertness for response to verbal or physical commands.  In some patients, there is also an amnesic effect that results in little or no memory of the appointment.  The utilization of these medications has allowed for even very nervous dental patients to have great dental appointments.

If you have a fear of dentists and would like to find more information about techniques to help you get the dental care you desire, ask your dentist.

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.

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.

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.

What do dentists mean when they talk about comprehensive treatment?

Once you have had your thorough complete dental exam, which includes examination of the teeth, the gums and other soft tissue, occlusion—how the teeth fit together in function, the jaw joint and the muscles used for chewing and support of your jaw, your dentist will review all pertinent findings and make an evaluation of the overall health of you chewing system.

A comprehensive treatment plan should address not only current issues such as active decay, and gum problems but also potential problems.

The comprehensive treatment plan will be devised to obtain the optimum functional and esthetic result. 

It is the dentist’s responsibility to present an optimal treatment plan.  This discussion should include benefits of ideal treatment, potential risks of treatment and potential risks if the treatment is not done.  This allows you, the patient to make an informed decision regarding their dental treatment.

This summer I had to replace some outdoor stairs at my home.  When these stairs were built about 12 years ago, we did not use treated lumber, as a result, there were signs of rot.  The stairs were still functional, but I had some concern that they could break.  Not wanting to have a stair failure as Aunt Tilley was climbing down, I decided to tear out the old stairs and build new ones.

Many readers are now saying: “Brian, did you whack your head while windsurfing on Friday?  This is a dental column.  While we find your stair story fascinating, what has it got to do with teeth?”  Let me explain.

Many times after examining someone’s teeth and going over treatment options, I hear the line “If it ain’t broke, why fix it?”  While it may be true that there are no clinical symptoms at the present time, there may be advantages to treating some teeth before they cause problems.  Much the way we replaced the stairs before an accident occurred.

We can often predict which teeth will eventually fail.  By taking action before failure we are able to prevent dental emergencies and restorative complications and treatment of the affected teeth can be scheduled at a convenient time. (more…)

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.

(more…)

Have you ever wondered what dentists do to keep up and get ahead in the wonderful world of dental science?

When most dentists get out of dental school, they are ready to start practice and save the world’s teeth.  It seems almost universal that a new graduate feels that they are up to date on all there is to know about teeth and that everyone else is behind the times.  “You are better off seeing a new graduate, who knows everything, rather than one of those old timers who must be behind.” is a common thought often expressed by the new dentist.

Of course it only takes about a week or two in practice to realize that maybe you don’t know everything.  In a few more weeks, you quickly discover that your dental school education prepared you for private practice in only the very basic sense.  Actually, your dental school training gave you a very good foundation on which to grow, learn and eventually become a very good dentist.  What it cannot give a young dentist is experience.

To learn more and to keep current, dentists take continuing education courses.  Local dental societies and universities traditionally gave these courses. Over time there has evolved a large business of supplying dental courses to dentists and dental staff. These are either through private businesses or non-profit organizations.

Another way for a dentist to learn and improve is to pursue a fellowship or accreditation by a recognized organization.

An example is the American Academy of General Dentistry.  This organization is dedicated to dental continuing education and has set a standard for quality in this area.  The AGD has set up a system to track and record the courses taken by a dentist member.  When the dentist has taken 500 hours of course study, they are then eligible to write the fellowship exam.  After successfully writing and passing the 400-question examination the dentist would be awarded a Fellowship in the Academy of General Dentistry.

Another organization is the American Academy of Cosmetic Dentistry.  The AACD is an organization dedicated to appearance related dentistry.  This organization has a credentialing procedure that recognizes achievement in the art and science of esthetic dental care.  A written examination, clinical case presentation and an oral examination are required to achieve accreditation.  

While it is kind of cool to be awarded a fellowship or an accreditation status, the real benefit of pursuing these is the education and professional development that occurs in the process.  The true benefactor is the patient of dentists who go through these processes.

If you are in the process of choosing a dentist, be sure to ask your dentist about the continuing education he or she pursues.

If you were to take a survey of the “over 40” crowd.  You would find that the majority of people over 40 have had numerous fillings in their teeth, especially the back teeth.  You would also find that most of the old fillings are silver amalgam and likely quite large. (Feel free to try this at your next summer barbeque; it will make you the topic of conversation for months.)

The prevalence of dental restoration in that demographic group is largely due to the fact that this group missed some important dental developments during their formative years.  Fluoridation, dental sealants and the importance of flossing and brushing in the pre-teen years being the main advances in protection against tooth decay that were advanced shortly after this age group got their first cavities.

Fortunately, dentists have been very successful in the treatment of dental decay.  For many years now we have been proficient in placing fillings teeth that have been affected by decay.   Unfortunately, fillings have a limited life span and fail over time.  Each time a filling fails the next filling needs to be bigger.  At a certain point, there may be too much filling and not enough tooth to produce a good result.

Dental fillings were designed to fill a hole in the tooth using the remaining tooth to support the filling.  When the filling exceeds a certain size the remaining tooth structure is too brittle to hold the filling without fracturing under the strain of chewing.  This results in fracture of the remaining tooth.  To prevent tooth fracture or to repair a tooth that has fractured the dentist will recommend that the tooth have a crown.

A crown (also called a cap) is a restoration that covers the outside of the tooth.  The crown acts to hold the tooth together and replace the missing tooth material.  Think of it as a casing for the tooth.

To produce a crown, a thin veneer of tooth material is milled from the outside and the top of the tooth.  This produces enough space for the restorative material and allows for the crown to be shaped so it can function like a tooth.  Usually, 1 to 1.5 mm of tooth is removed around the tooth and 1 to 2mm removed from the biting surface.  A very accurate rubber-like impression is taken of the tooth and a plaster model is produced that is exactly like the prepared tooth.  A dental lab technician will then construct the crown that fits the model, and therefore the tooth precisely.  The crown is then cemented over the tooth preparation, any you are on your way to years of happy chewing.

Crowns can be made of a number of materials.  The most conservative, longest lasting material is still gold.  The malleable nature of gold allows for final finishing in the mouth that makes for best seal.  The main drawback of the gold crown is the colour. 

If esthetics is a concern, a veneer of porcelain can be made over the gold of a crown.  With modern, porcelain technology, these teeth can be made to be indistinguishable from natural teeth.  New technology even allows for all porcelain crowns that fit well, are strong and have the maximum esthetic potential.  This is especially helpful when the tooth to be crowned is near the front of the mouth.

Dr. Saby can help you decide if it is best for you to have crowns on some of your teeth and if so, what type you should have.

It appears that there are still many people out there who are slightly misguided when it comes to complete loss of teeth.  I would like to spend this week’s column discussing dentures and the common misconceptions surrounding these artificial body part replacements.

First and foremost, you do not naturally lose your teeth when you get older.  In the past, when dental care was not generally available, it became very common for people to eventually have all their teeth out.  As it takes a while for dental disease to eventually claim all the teeth, tooth loss became associated with aging. 

In reality, there is no reason to lose your teeth, as you get older, today it is generally accepted that most people will have their teeth for their entire life and the necessity to have complete dentures is most often the result of conscious decisions.

Dentures are not a substitute for natural teeth; they are a substitute for NO teeth.  It is widely believed that removable complete dentures will give the same function as natural teeth, but even the best-made dentures cannot come close to providing the function of natural teeth.  It has been shown that the biting forces generated by dentures approach only 10 – 20% of that of fixed teeth.  Dentures are by their very nature, are loose.  Even a properly fitting upper denture is not fixed in place, but held in by suction.  Lower dentures, with 1/6 the surface area for suction and a tongue moving around are even worse.

Dentures are not factory original parts but after-market add-ons.  The gums remaining after teeth have been removed were never intended to support acrylic bases and denture teeth.  As a matter of fact, immediately following tooth extraction, the bone that was there to support the teeth, starts to disappear.  The additional load from the denture hastens this shrinkage.   As this bone loss progresses, the fit of the denture will change.  The denture wearer may adapt to this change as it happens slowly so they may not notice the subtle degradation of the fit and function.

So, yes, even though you have dentures, you should see your dentist at least once a year.  At this appointment your dentist will do an oral cancer exam and soft tissue check.  He will also evaluate and clean your denture.  If the fit is not adequate, he may suggest a reline.  If the teeth are worn out he may suggest a new denture.  We recommend that a denture be relined every two years and that they be replaced every five years.

At your regular denture and gum check, your dentist will also be able to discuss with you some of the possibilities available today where you can have a fixed solution to your problem using dental implants.