If you haven’t visited the dentist over the past year (or longer), you’re not alone: According to 2014 data from the Centers for Disease Control and Prevention, 38 percent of adults hadn’t visited a dentist in the previous year. And if you’re not keeping up with your dental hygiene, it’s easy to keep avoiding the problem and procrastinating your time in the chair. Whether it’s fear or shame that keeps you from scheduling a visit, it’s time to face the issue head-on. But don’t worry. We spoke to some of this year’s Top Dentist winners to get the experts’ perspective on the technological advancements that have exploded in the field over the past few years, and what they told us will surely ease your worries. Early detection and treatment of major dental issues is easier than ever—you just have to get in the chair.
Cleanings and Checkups
The basics of a dental cleaning have largely remained the same over the years: According to Dr. John Kling II, buildup of tartar and plaque has to be physically removed, and hygienists still use instruments like dental scalers. However, the advent of ultrasonic technology offers a way to access hard-to-reach areas for a more complete cleaning. These systems also can include antimicrobial rinses to help stave off bacteria, keeping your teeth clean and healthy.
In its most recent iteration, the National Health and Nutrition Examination Survey found that an astounding 92 percent of adults aged 20-64 had tooth decay in their permanent teeth, so the treatment of cavities is something that almost everyone will have to deal with in their lifetime. Kling says that overall the trend is moving away from aggressive removal of the tooth structure toward more conservative approaches. Today, there are more options available than just silver amalgam fillings. Newer composite bonding materials are easier to manipulate, can be layered and are much more aesthetically pleasing than other options because the colors are nearly indistinguishable from the shades of natural teeth.
An aspect of regular dental checkups that becomes increasingly important as you age is the oral cancer screening. Fluorescence staining is one method of detection, and Kling says that devices such as the VELscope system help find precancerous or cancerous lesions at an early stage. The VELscope system is handheld and helps the practitioner immediately identify abnormal tissues based on how the tissue responds to the light emitted by the device. As with any kind of cancer, early detection is key when it comes to achieving a good prognosis.
Gum disease affects almost half of American adults aged 30 or older, which probably isn’t that surprising when you consider your own flossing habits. Luckily, milder forms of gingivitis can be reversed with regular brushing, flossing and dentist visits. If it progresses to periodontitis, it can ultimately cause gums to recede and, worst case, can lead to tooth and bone loss.
Dr. Karl Smith’s goal as a periodontist is primarily to help patients keep their natural teeth by making them healthy, and laser technology is now used in about 80 percent of his cases to kill bacteria and remove disease. When compared to the combination of antibiotics and gum-flap surgery of the past, laser technology is less invasive, requires less healing time and offers more aesthetically pleasing results. Plus it’s less painful and doesn’t lead to increased sensitivity, which will be welcome news to those with lingering fears of the dentist.
According to Smith, these developments mean that there has been a major shift in what they can do for patients. Even just 20 years ago, treatment for gum disease was mostly limited to removing the diseased tissue, which led to poor aesthetic outcomes. Today, however, periodontists are able to actually stimulate the development of new gum tissue using growth factor technology. We know—it’s like science fiction. Doctors are able to now restore and regenerate the tissue once disease has been removed, though Smith is quick to note that it won’t work miracles and that, like so many other elements of medicine, outcomes do depend on a patient’s overall health.
Plenty of Americans know the horror of dealing with braces during their formative years. But with the emerging field of myofunctional orthodontics, potential issues with a patient’s bite can be identified years earlier and addressed in a way that eliminates the need for extensive orthodontic intervention later in life.
Dr. Liliana Calkins of Sunrise Orthodontics is one practitioner pioneering the discipline in Northern Virginia. Starting at a younger age (she sees patients as young as 3 whereas most orthodontists wait until the tween years), she is looking at patients’ oral needs through a more holistic lens. In other words, she’s looking at the whole structure of the mouth when addressing a patient’s needs and looking to treat the underlying disruptive muscle patterns that lead to crooked teeth, so the overall benefit is that results are more stable and there is less need for future work.
With this treatment philosophy, there is a bigger focus placed on patient education. Rather than relying on braces to physically correct the problems, Calkins combines the use of a device like Myobrace that is only worn a few hours at a time with a therapy called orofacial myology, which involves exercises to adjust habits that make up the disruptive muscle patterns. Not only does this pave the way for better development of the face and surrounding muscle structure, but it also avoids a common pitfall of treatment with traditional braces: Teeth won’t shift back later in life because the underlying causes have been addressed.
And as in all things, the trend in orthodontics is toward more customization. Digital scans of the mouth combined with 3-D imaging software allow the doctor to use brackets and archwires that are specifically created to address the individual patient’s treatment needs. “When you go to get your eyes checked, the prescription that is given is unique to you. I cannot wear your glasses, right? So why would I give you brackets that are generic?” Calkins says.
Chipped and Cracked Teeth
Grinding your teeth, chewing on ice or indulging your sweet tooth by snacking on hard candy can all lead to chipping, cracking or otherwise damaging your teeth. If you just can’t break those habits, though, don’t stress too much: Chips and cracks can be fixed with bonding or crowns, depending on the severity of the damage.
For smaller chips or even discoloration, the cosmetic results of composite resin bonding have improved in recent years, according to Kling, due to better, more natural-looking materials. “I can add tiny layers of material and sort of build the tooth from the inside out almost so it looks very much like a natural tooth,” Kling says. “In the past you had these different materials that didn’t handle really well, and the colors weren’t very stable—it’s just a completely different world now than it was.”
These improved materials can impact a patient’s overall oral health as well. Smith says that because he as a periodontist deals with the skin and bone surrounding teeth, his work is often impacted by what other specialists might do for a patient. Because fillings and crowns have moved away from metal and toward materials that are closer to natural tissues, like ceramic, he says he sees a better result in the health of the surrounding gum.
Most Popular Cosmetic Requests
Remember Ross Geller from Friends and that episode where he winds up with glow-in-the-dark-white teeth? Well, those days are in the past. Cosmetic dentistry has vastly improved from the days of obviously fake, Chiclet-esque outcomes; overall, the trend is toward beautiful teeth that look natural, and improvement in materials has made this possible.
Veneers, according to Dr. John Kling II, are really the ultimate in cosmetic dentistry. Today’s porcelain version can be “thinner than a potato chip,” he says, which means that less natural tooth has to be removed in preparation. Compared to veneers that are up to 1 millimeter thick, which means that much natural tooth had to be removed to accommodate them, these minimal-preparation veneers preserve more of the natural tooth underneath while perfecting the smile.
Another popular approach to addressing cosmetic concerns like dark or white spots on teeth is the more conservative use of direct resin bonding rather than bleaching or using veneers. Today’s resin materials are easily manipulated to achieve the desired results. “That’s a big aha moment for some patients,” Kling says. “I can pull up tons of photographs and show people that sometimes the most conservative procedure is also the most cosmetic procedure.”
The appearance of gums, whether there be too much or too little, is another common cosmetic concern for patients. Dr. Karl Smith, a periodontist (or plastic surgeon of the mouth, as he calls it), deals with these cosmetic requests. And it’s not just an issue of vanity: If there is too little gum tissue, the roots of teeth can be exposed, and too much gum tissue can lead to complications like infections and bleeding. Lasers are used to trim excess tissue, and growth factors are used to encourage the growth of new gum tissue, respectively.
Click here to see the full list of 2016 Top Dentists