Bite Point

The Focus of Dental Education

A test is merely a tool, and a blunt, rusty one at that. We learn so that we can solve interesting problems and make a difference.

The focus of dental education must become solving problems for our fellow human beings, not test scores or clinical requirements. Those are vitally important tools that help us reach our goal. That goal, however-- is something far greater.

Gaining the ability to solve interesting problems in the world around us, and for the people who live in it, is the real reason for all this learning.

So Proud of Age 25 to 34

When I was first in practice--very late 80s and early 90s--I noticed that not many new patients in the age range of 25 to 34 came in healthy. What I mean is, if some physical or esthetic pain occurred, sure, they'd have to come to the dentist. We didn't see too many dentally healthy patients in that age range who were primarily interested in maintaining their health, however. I'd spin theories about how they were in their own sort of "donut hole" when it came to health care costs. Trapped in a decade-long bubble when they were off their parent's medical and dental benefits, but perceived, at least, that they had not the income nor the benefits of their own to support things like dental visits.

Of course, these folks were making two significant miscalculations. First of all, many of them were jetting off to Europe or the Caribbean pretty regularly, or buying luxury automobiles, or sending some significant lettuce off to guys with names like Louis Vuitton, Roy Halston and Mario Prada. Also, they didn't grasp that prevention always costs less than treatment, especially in dentistry.

Ah, salad days.

But now? Oh myyy. Have a look at this bar graph of new patient demographics in our office for the past six months:

Fully 45% of our new patients are age 25 to 34!!!

As I meet and get to know these folks, I realize that these are young people who are making sound decisions in many aspects of their lives. They just "get it." And maintaining their dental health is one part of what they do.

I know, I know--I'm just seeing a tiny slice of American life. All I can say is that in our practice, in an Eastern urban environment with great cultural diversity, this is what we see.

Doesn't matter. I'm proud of my younger patients and of the sound decisions they are making. We're going to strive to prevent them ever suffering physical and esthetic pain from their teeth, and we're going to have a much easier time helping them keep their teeth for a lifetime than we have with any other generation.

Because they started off well.

*****

More on prevention here:

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2010/12/dental-economics-101-from-the-patients-standpoint.html

http://rickwilsondmd.typepad.com/rick_wilson_dmds_blog/2011/12/the-noxnoys.html

Requesting and Transferring Dental X-rays

I'm really proud of this:

http://smilephiladelphian.com/transferring_records.php

And our colleagues at FoundLocals helped considerably.

http://foundlocals.com/

It is important for patients to understand their legal rights when it comes to their medical records, and the Pennsylvania law that I cite is crystal clear.

The Decent People

In the long term, no terrorist, from any culture, will ever win anything of significance through their evil actions. Their ideas are so vile, so filthy, and above all so weak that the only way they can try to spread them is through violence. They cannot win any rational argument. The decent people of the world shall beat them in the end simply because our beliefs, as varied as they may be, are beliefs we can be proud to stand for.

Microscope Dentistry: So Smooth, So Crisp

Two years ago now, I started using this little fella:

This is a Global Surgical Specialties Dental Operating Microscope. It cost as much as my Prius, but every penny was worth it, because Microscope  Dentistry is the biggest game-changer that I've ever experienced in my profession.

In those two years I've naturally been to a number of continuing education courses. The speakers often use PowerPoint to project images of treatments they've done on immense screens. Any and all imperfections show up huge! I know, I've tried it with my own shots. And yet, the artificial restorations that we can create in dentistry often look remarkably like the nearby natural teeth that they're meant to seamlessly blend in with. Dental materials, porcelains in particular, can be made to match not only color but translucency, opacity, saturation and surface texture. The treatments we can provide today are beautiful, even blown up to the size of a tennis court.

Usually, though, their preps look all ratty.

Uneven margins, that critical edge to a dental preparation where the porcelain meets the gums. Nicks on the walls that make it hard for the lab technician to make a well-fitting crown. Tissue tags that lie over parts of the tooth like unwanted crabgrass on a lawn, interfering with the taking of an accurate impression.

These things simply don't happen in the world of Microscope Dentistry.

Here is a combined impression of a dental implant and a natural tooth, both for crowns. That natural tooth is a second molar; typically, there's an awful lot of trauma to the gums at the back (distal) as the highly convex contour is whittled away to gain a proper shape. Here, we hardly even see any blood. And the margin is smooth, crisp and even.

The implant tissue is also visualized extremely well, and it's beautifully healthy. This is always the case when Tom Kohler DDS, our main periodontist referral, has placed the implant.

And here's the impression. Without a spectacularly accurate impression, there will never be a spectacularly accurate dental restoration:

Jucundo et Solvere

Jucundo et Solvere

(1) Delight people.

(2) Solve their (interesting) problems.

All the rest is commentary.

(This is how to achieve success in the realm of the bespoke business, though not in the realm of the commodity.)

 

 

Mouth Guards: Seat Belts for Teeth! -Neha Shah DMD

Please welcome once again my friend and remarkable endodontist Neha Shah, D.M.D., as she informs us about dental trauma and its prevention. (She is my favorite kind of doctor, in any field of medicine or dentistry--the kind of doctor who excels at treatment, and then goes on out and helps people prevent that very treatment that she does so well!)

*****

Seat Belts for Teeth!

As we approach the warmer seasons of spring and summer, there is a generalized increase in outside activity. Though leading an active life is extremely important, safety should be paramount.

Recreational activity may increase for the general public, however children play competitively for their school throughout the year. When they play sports for their school, the school takes on the responsibility of ensuring the student athletes’ safety. They supply them with or provide them with list of gears that are necessary for their protection. However, one of the most neglected safety gears is the mouth guard. Even though it is recommended, athletes rarely wear it especially in sports like baseball, basketball or soccer. Just as a helmet, chest vest, kneepads, and shin guards serve to protect different parts of the body; mouth guards serve to protect the teeth against impact injuries.

Dental trauma is nondiscriminatory; nonetheless, the most active kids and adults are the most susceptible. Up until we are 6- 7 years old, any injuries to teeth that occur would be to primary or “baby” teeth. And though this can be traumatizing, it is less likely to have permanent or long-term consequences. However, as the adult, permanent teeth start to form, erupt and replace our “baby” teeth, protection from trauma becomes imperative. Damage to these permanent teeth can be devastating, irreversible or permanent. The most common teeth that are prone to sport or fall injuries are our front teeth. Teeth can fracture, shift from its original position in the jaw or can completely be knocked out of the mouth. The severity, lengths of time from injury to treatment and the type of treatment rendered all have a significant impact on the outcome and long-term consequences.

Mouth guards are like seat belts. Just as seat belts help to restrain and protect the driver during an accident, mouth guards help to protect the teeth from impact and to keep the teeth in position in case of an injury. Athletic directors and coaches across schools should encourage and insist on use of mouth guards for all their student athletes.

When impact injuries to teeth do occur, it is important to see your dentist right away. Time is of the essence. The longer the tooth remains in the altered, injured state, the more likely it will have irreversible damage. This is analogous to a fractured finger, for instance. When one suspects a fractured finger, the best time for treatment is immediately. We know that the sooner the finger is splinted, the better the outcome and the faster the recovery. The concept is the same for teeth. Teeth that have sustained traumatic injury, like a dislodged tooth, will need to be splinted and require root canal therapy. The dentist may refer one to an endodontist. Endodontists are dentists who are specialist and have the knowledge and the special skills to diagnose and treat teeth with acute traumatic injuries or teeth that have had past history of traumatic injury. Endodontists, who are root canal specialists, can properly diagnose, monitor and conservatively treat teeth with traumatic injuries.

So next time, wear your mouth guard and when you are up at bat, knock one out of the park, not your mouth!  But if you do, go to the dentist immediately!

*****

Dr. Shah's office information is:

Neha Shah, D.M.D.
Atlantic Endodontics
235 E. Jimmie Leeds Rd
Galloway, NJ 08205

(609) 568-6415

 

Be Bold and Create

But success in these matters comes down to a triangulation of natural ability, practice and focus. And of the three, natural ability (in all walks of life) is by far the least significant.

Do not be confused by the fact that modern American culture (especially sports and entertainment culture) glorifies natural ability. That's just because the industrialists who run things don't want us to create too much; they want us mostly to consume what they make. Do not be taken in by their myths.

Be bold and create.

Not With Who

An industrialist or a Wall Street type or a politician (of any stripe, even a communist one) is primarily concerned with More. Not with why. Not with delight. Not with change, or the reasons why change might be good.

And certainly not with who.

Articulating Paper- Isn't there an App for this yet?

Anyone who has ever had any sort of dental restoration has heard those charming words: "Bite and grind, please!" as we check whether our crown or filling is properly hitting the opposing teeth. Occlusion, we call this. How our teeth meet each other across the arch. Which in all except the most catastrophic cases of crowding and misalignment, is far better than how the Rs and Ds meet across that fabled aisle in the Capitol Building...

When we exhort our patients to close their jaws and check a restoration, we slip marking paper between their teeth and get marks that show the pressure points between opposing teeth. It's like a language to me at this point; second nature. I can tell when my restoration is too high and adjust it down till it's just right, yet not overshooting until it's out of contact entirely. Do that, and teeth will shift unpredictably until they hit once again as we bite. It's a classic case of more is not necessarily better.

Now, before going on, I must say that this phrase "bite and grind" is problematic. It's a Freudian slip waiting to happen, is what it is.

Once, years ago, a patient came to our practice who plied the trade of exotic dancer. And yes, it happened, dang it! All morning I had steeled myself against the inevitable, but then, the inevitable happened anyway.

"Bump and grind, please."

Arrrgh! I was so embarassed. I'm a rather Victorian sort of chap at heart, in some ways. And how is one to recover from such a gaffe?

Anyway- to the marks. Big, heavy marks indicate high pressure points between the teeth. Marks that look like rings- marking material in a circle, with no material in the middle- "doughnuts"- indicate even higher pressure points!

We dentists pay great attention to the absence of marks, as well. No mark where there should be a mark is often a rather bad thing, and corrections must be made to bring all the proper marks back.

Always reminds me somehow of Sherlock Holmes and that dog:
"Is there any point to which you would wish to draw my attention?"
"To the curious incident of the dog in the night-time."
"The dog did nothing in the night-time."
"That was the curious incident," remarked Sherlock Holmes.

Here's the curious thing about articulating paper marks- sometimes, very small marks indicate the highest pressure of all!

Have a look at this photo:

Those two marks on the last tooth in back are fairly small. Yet there was pain, including muscular pain. What was happening is that the patient's teeth had gotten out of alignment. Whenever she closed to chew, she could get her teeth together, but first they had to rock over this last pressure point. Muscles and teeth got sore!

I adjusted her bite and here's what we got:

All the marks are better, but the ones at the white arrows weren't even there before! And there are doughnuts. Comfort ensues. And the black arrow points to the reduction in pressure that made all the difference.

Maybe someday there will be an app for digitally reading bite pressure between teeth. Until then, the next time your dentist has you bite and grind on that funny paper on a stick, remember that she is reading a very specialized language indeed.