When has the cosmetic makeover gone too far?

Dr. Little’s Thoughts On Why Deep Sedation Is More Effective Than Just A Pill

There is a lot of confusion about “sedation” dentistry. I will explain it as well as I can and provide you with some links so you can further inform yourself on this confusing topic.

Technically sedation can vary, from taking a mild sleeping pill all the way to deep sedation (intravenous). Many of the ads you see on TV or hear on the radio discuss conscious sedation, as if they are all the same…well they are not. The Oregon Dental Association requires that doctors have different “permits” for these different levels of sedation. (www.adsahome.org) There are 3 levels. Generally level one allows the doctor to administer “laughing gas”. Level two allows the administration of pills and possible laughing gas. Level three allows for the direct administration of drugs intravenously and or pills and or laughing gas. Very few dentists are licensed to do all three. There are just a handful in the Portland Metro area. There is quite a bit of extra education and licensure required.

“Deep Sedation” (level three) is the deepest sedation. It is about three times more effective than with pills alone. At West Hills Family Dental we have all levels available for you if needed, including general anesthesia. I am partial to the level three. This type is the most predictable and our patients like the fact that it is safer. Just think about it. If you are prescribed pulls there are many factors to be considered. Pills are absorbed in the intestine. Variables such as food, stress, time, weight, etc. all have an effect so it is very hard to predict the proper dose needed at your appointment. The ability to give you just the right amount is very difficult and doctors error on the light side to prevent and overdose which can be serious….so what if you are still anxious? Take more pills? How many? How long will it take? Hard to adjust when you are in the office? I think you can see some of the problems. By administering drugs directly to your system by IV we can give you the perfect dose for your needs. It is safer because by titration of the dose we can immediately monitor your level so the dose is tailor-made for you right when you need it, no more, no less. Not like pills. Further we have reversal drugs that can be used immediately, if necessary. With pills it is just not possible to reverse a dose quickly, therefore the reason for a lighter dose in the first case.

Additional information available at these web sites:
www.oregon.gov/Dentistry/anesthesia.shtml, www.ada.org/prof/resources/positions/statements/useof.asp, www.dentalfearcentral.org/ivsedation.html

What is First and Second Phase Orthodontic Treatment

The goal of First Phase Treatment is to develop the child’s jaw size to make room for the future eruption of permanent teeth and to improve the relationship of the upper and lower jaws. Children sometimes exhibit early signs of jaw problems as they grow and develop. An upper or lower jaw that is growing too much or not enough can benefit from early orthodontic treatment. The early correction can prevent later removal of permanent teeth due to excessive overbite or overcrowding. Leaving such a condition untreated until all permanent teeth erupt could result in a jaw imbalance too severe to achieve an ideal result with braces.

• To maintain the First Phase Treatment results and to allow the remaining permanent teeth to erupt, retainers are worn at night between phases. Starting at age ten, children lose twelve primary baby) teeth and by age twelve or thirteen they gain sixteen permanent teeth. During this period occasional appointments for observation and retainer adjustments will be necessary, usually on a three to six month basis.

• Influence jaw growth in a positive manner
• Improve the width of the dental arches
• Reduce the need to extract permanent teeth
• Reduce or eliminate the need for jaw surgery
• Lower the risk of trauma to protruded front teeth
• Correct harmful oral habits
• Simplify and shorten treatment time for definitive orthodontic treatment (phase)
• Increase stability of final treatment results
• Improve speech development
• Improve position of first molars
• Guide permanent teeth into more favorable positions
• Improve lip competence
• Preserve or gain space for erupting teeth
• Improve compliance before the busy teenage years

The goal of Second Phase Treatment is to position all the permanent teeth to maximize their appearance and function. This is best accomplished by placing braces on all the upper and lower teeth. Due to the improvements made in First Phase Treatment, Second Phase Treatment requires less patient involvement (less frequent use of headgear and rubber bands), often eliminates removing permanent teeth and greatly reduces the time spent in full braces.

Orthodontist of Orthodentist – What Is The Difference????

There is an advertisement that is being placed by an organization that represents Orthodontic specialists. The ad implies that orthodontics can be preformed by orthodontist only. The Invisilign technology has cut into the Orthodontist financial “pie” because general dentists are doing the majority now. However that is no excuse for making some of the public equate that “only orthodontists” do orthodontics. As a generalists/Orthodentist, we are qualified and held to the same standards that the specialist/Orthodontist are. I, along with some of my orthodontic and pediatric and pediatric collogues are on the cutting edge of orthopedics. This is the treatment of the whole jaw early in our lives to create enough space before braces. Sometimes called First and Second Phase Orthodontics. By correcting these issues early saves both time, money and even more, prevents the need for extractions. Who is better to do this than the Pedodontist or Generalist/Orthodentist? Both of these modalities of dentistry see the patient sooner than the Orthodontist. I think this is more of the reason for the short – sighted ads placed by the Organization.

Some people say orthodontists are the only ones that should do orthodontics. Following that same line of logic then…kids under twelve should be seen by a pedodontist, crowns, veneers and bridges by a prosthodontist, root canals by an endodontist, cleanings and perio by a periodontist, extractions by an oral surgeon. The fact is that these are all specialties that dentists have limited their practice to. A general or “family” dentist is held to the same levels of care that all of the specialist. However, there is one difference…the general dentist has specialist that he/she refers patients to if the treatment is in ‘need’ of a specialist. The fact is that the generalist should be able to do most procedures. The extra cost incurred by going to a specialist is because of this fact. A fair analogy would be going to an Ear Nose Throat Specialist instead of your family Doctor. If your physician saw that you needed to be treated by a specialist then he would refer you to one that he trusted which is exactly what you would want. The fact that most of your basic needs are met by your general physician/dentist makes sense. On the other side I would not want my family physician “specializing” in hip replacements when it is my cold that I wanted to have looked at. The same is true of dentists. I wouldn’t go to my dentist for a tooth that hurts if he is only trained in “cosmetics”. Choosing a good generalist is important. Interview the doctor and ask questions. If he does “orthodontics” then ask what his qualifications are. It took me many years and hundreds of post-doctoral courses to be proficient in orthodontics. It is true that you just don’t start doing orthodontics or any other “specialty” until you are qualified to do so. This is a rule that our profession holds us to at the perils of loosing our license if we do not! Go for second opinions if you feel uncomfortable with the treatment or costs proposed but be sure your doctor is well rounded in all areas of dentistry. One shoe does not fit all and the same is true in dentistry. So make sure you get the dentist that “fits” and yes that means a good knowledge of orthodontics too.

Advances In Dentistry…Some Good…Some Not So Good

There have been many advances in dentistry over the last few years. Some are a good value to you, the patient, others, well I would classify them as gimmicks that have not value at all.

A couple of examples of the good ones are implants. In 1968, this office was built by Dr. Nelson. He was one of the implant pioneers in the Portland area. Today the success rate is around 98% and accepted world wide. They have become simplified and their cost, relative to other treatments, have come down. In many cases, a tooth can be extracted and an implant placed the same day! In endodontics (root canals), electronics have taken out much of the guesswork. Nickel-titanium (the same metal that allows the Twistoflex glasses frames to bend so much and bounce back), files, and rotary instruments have made the process much quicker. Most are done in one appointment and in less than one hour!

There have been many other great advances in dentistry. Some technologies, however, in my opinion, aren’t in the best interest of the patients. For example, there is a milling machine that allows the dentist to “make” a crown in a single appointment. What the patient may not know is that the machine is approximately $100,000 and owned by the doctor who now has to make payments. Let me share with you an excerpt from the president of the ODA (Oregon Dental Association) in one of our journals, ” Do not overtreat!! Often that old amalgam restoration will outlast by many times the porcelain crown you just sold the last patient because you need to make a payment on your new Cerac machine. The patient’s pocket is not a bottomless pit. Be reasonable with treatment plans and fees”. (the complete article can be found in the February 2004 Oregon Board of Dentistry News, President’s Message) Need I say more? Besides, I used to be a dental lab technician and I can say, without a doubt, that they are substandard to a quality “hand made” inlay or crown.

Some other examples are “lasers” and those one-hour bleaching systems. Independent (Clinical Research Association) has shown how those bleaching systems don’t work as well as the “home” bleaching systems. An article from the JADA February 2004 issue states, “With respect to esthetics, our literature review showed that power bleaching has questionable whitening efficacy. Jones and colleagues demonstrated that a typical in-office laser bleaching session produced significantly fewer desirable color changes than did two at home bleaching protocols. No perceivable difference between energized versus nonenergized bleaching when performed under standardized conditions.” What happens is that the teeth become dehydrated making them “look” whiter, but it is short lived. There are some other issues, but you might ask yourself, “why are so many dentists pushing these systems?”. Well, mostly it has to do with advertising. Have you seen those “make over” type shows? They are actually paid add spots. These doctors can create a “want” for the dentists campaigns. It has nothing to do with the efficacy of the product!

I have been following these trends and will always do my best to keep my patients well informed of the pros and cons of all treatments. Before using any product in this office, it is thoroughly researched. I love what I do, I love the patients I work with and I will always strive to earn their trust by “watching out for them”.

Mercury Free, Metal Free Office

This seems to be a hot topic to some people so I will stick to what is KNOWN. There is a known dentist in the area that is scaring families into thinking that fetuses get mercury poisoning from their mothers through the mercury fillings in their mouths and other bizarre statements. When we take a look at the objective (as opposed to anecdotal) research that has been conducted, a much different story arises. For example: John W. Albers, M.D., PhD., of the University of Michigan Medical School says there is no association between abnormal neurological signs and amalgam exposure. The Life Science Research Office (non-profit, independent) report can be viewed by clicking here. There are thousands of research projects that have been done by non-profit and independent programs.

Let’s face it, All dentists would love to replace all of the silver/mercury fillings out there. There is a lot of money to be made but not by being dishonest about why they should be replaced. Amalgams have been a good restoration for many years and outlast many of the newer materials today but you have to admit they aren’t the best looking. So cosmetically you want those silver/gray looking fillings replaced with something that looks great? Sure!! But let’s be honest about the reason why. Make sure it is your reason and not the dentists. More information available at www.agd.org.

Cosmetic Dentistry – What Does It Mean?

You can find cosmetic dentists everywhere: in the yellow pages, the Internet, radio etc. However, there is no such thing as a specialty of cosmetic dentistry.

ADA Specialties -
Endodontics, Oral-Maxillofacial Surgery, Radiology, Oral-Maxillofacial Pathology, Orthodontics, Pediatrics, Periodontology, Prosthodontics (Maxillofacial Prosthodontics), Public Health

Why are there so many dentists advertising as cosmetic dentists? The word “cosmetic” is a powerful word used in the advertising industry and it is no different in dentistry. I feel it is overly abused. As an informed consumer in dentistry you need to have your dentist inform you of all of the possible options that you might have. What is the problem with cosmetic dentistry? If your dentists are limited to a type of dentistry like cosmetics then you have limited options. With this in mind you should seek a dentist that is well rounded in their post-doctoral (continuing education courses) studies. The saying, “if all you have is a hammer then everything looks like a nail”, comes to mind. When looking at treatment options you need to have a variety of plans that can be tailor made to your needs, not the doctors. An article I wrote was published in the Academy of General Dentistry titled, “When has the cosmetic makeover gone too far“.  This publication is distributed to dentists all over the country and can give you some insight to this issue we dentists are struggling with. There are many dentists out there and you need to find one that is right for you. An interview with a prospective dentist might be a good idea – it is your money and your dental health…, be wise.

My Problem with Cosmetic Dentistry

I feel there is a severe problem with the shift towards cosmetic dentistry. Without a comprehensive understanding of dentistry you cannot be expected to identify potential options that the patient has the right to know. For example, there is a prominent cosmetic dentist in California that teaches at one of the big cosmetic schools. On his website he lists his services – Veneers, All porcelain crowns, Metal-free filings, Specialized hygiene services,Teeth whitening. That is it!!! Where did the rest of his dental background go? What about orthodontics, endodontics, perio surgery etc??? Since all he sees is a couple of solutions then you will not get what you need. If all you have is a hammer then everything looks like a nail. Click on this link for an article (.pdf format) that I have written on this subject and it has been published in a dental journal.