“Successful” Children’s Dentistry

June 2010

One of the greatest rewards of being a family dentist is the ability to help a child overcome their innate fear of dental care. This remains a pivotal moment in a child’s psychological growth and development and molds their future ability to cope with dental care on a rational level. A child’s first dental visit and all subsequent visits should result in a victory for the child’s dental and psychological needs.

Sophie, a recent new patient, provides a great example of how successful stages of Children’s dentistry results in a positive dental experience. Sophie is eight years old. She had two primary “baby teeth” molars that were normally supposed to be in her mouth for two more years, but had developed advanced decay, and was causing here pain. She understood the teeth had to be extracted. However, there was a large emotional and psychological gap that had to be met before she would allow me to remove her teeth. After numerous questions and answers and developing her trust and confidence, Sophie gave me the green light to proceed. The first hurdle of getting her numb was resolved by using painless computer anesthesia. This challenging step earned Sophie’s trust. The second hurdle of tooth extraction for her was resolved by symbolically using a plastic cup to simulate tooth extraction. Sophie became the pretend dentist and pulled the cup off my fingers (with a little resistance) imagining it was her tooth being extracted. She could imagine the force required to pull on the tooth and how the procedure would occur. Sophie’s actual treatment and her positive experience were now a measurable success and mom was further very pleased, having been more nervous than her child.

Needles, “white coat syndrome”, pain, fear of the unknown, poor communication and lack of proper time with the child are negative factors that enter into the equation of potentially “poor” dental visits. These factors need to be dealt with carefully by the doctor, the dental staff, the parents and the young patient.

For now, take a moment and pretend you are a six year-old sitting at home and preparing to go see the dentist for your first filling. You might be reflecting on past visits at your physician and remember getting shots, creating negative associations with your dental visit. Your parents may have told you openly that you may need a shot in the mouth to numb the tooth and made you very scared. The only real information the child will have to go on is whatever the dentist, the dental staff and parents have provided him or her. Therefore, communication is very important.

Typically, a child will come to the dentist for a dental check up and will receive a diagnosis and treatment plan. During their check-up, the dentist and staff should carefully explain what a cavity is, why it formed, how to prevent future cavities and most importantly how we can easily and simply make their cavity go away. My philosophy is to talk to young patients like an adult until they understand the information and are relaxed about it. Today’s dentistry is wonderful for children because of modern technology that not only makes diagnosis and communication better, but also allows today’s youth to relate much better to their dental needs. Intraoral photographs of the child’s very own tooth allow them to see their cavity and provides a great way for them to visually understand the process, ask questions, and become comfortable with the upcoming filling procedure. An animated educational video at their check up appointment shows the child how a cavity procedure is performed, improves their understanding about the procedure, alleviates their apprehension of the unknown and is done in advance of the upcoming dental appointment. A Diagnodent Laser is a small wand that is placed over the tooth to comfortably diagnose decay, and is another means to discuss the young patient’s dental needs. Other technology is the Computer Anesthesia that makes dental anesthesia completely comfortable and never a worry for young patients. Having cartoons on a monitor in front of the treatment chair affords them a level of distraction during the appointment. Traditional Nitrous Oxide therapy can be helpful but is not always necessary.

All the factors discussed above contribute to a successful formula that worked for Sophie and repeatedly work with most children. The most important factor in the success of pediatric dental care is communication before and during the dental appointment. A child-friendly office environment is also very important to make the child feel comfortable coming to the office.  Experience and a friendly attitude of the dentist and staff are appreciated by the child and result in successful dental care.

The first dental visit for a child should be interpreted as a unique opportunity to provide that child a positive experience and allow them to embrace dental care as a lifelong benefit without anxiety.

Enjoy Your Next Dental Visit

April 2010

Can you actually enjoy your next dental visit? This question offers an interesting challenge for today’s dentistry. Is it possible after centuries of rudimentary dental care that still evokes anxiety and apprehension in adults and children alike, that dentistry has risen to a level that can actually permit you, the patient, to consider dentistry enjoyable? Has the pendulum of education and technology swung far enough the other way to extend an opportunity for patients to openly state “I actually look forward to my dental visit”?

To appreciate where we are in dentistry today requires a historical view of where we have been. Dentistry has unfortunately seen little advancement for nearly 5000 years because of the complex issues involving hard teeth interacting with soft tissues, and functioning of teeth related to moving jaws. The earliest recorded extractions of “bad teeth” were noted by ancient Egyptians around 3000 B.C. The Etruscans of Central Italy devised clever pioneering techniques to replace missing teeth dating back to 700 B.C. that compared to standards upheld until the 1870s. In 1759, the designation “dentist” was first used. Organized dentistry began in 1840 with the founding of the first dental school in the world, founded by Dr. Harden, a very special name as determined by this author. The American Dental Association was formed in 1859. The first functional and durable dentures were created by the Goodyear Tire Company in 1864. Professor Roentgen of Germany discovered “x-rays” in 1895. Dentistry transitioned in the last half of the 19th century from being a trade to more of a science. The 1950s saw three revolutionary breakthroughs that occurred in dentistry including fluoride added to the water supply, modern local dental anesthesia and the development of the high-speed water-cooled drill. Patients still complain about the high pitch of this drill, but this is a vast improvement over its predecessor, the old belt driven slow-speed “bump & grind” drill.

The last half of the 20th century has exploded with the introduction of new products, equipment and techniques, that further support the notion of a patient finding being able to achieve enjoyment in dentistry. A partial list would include the following: tooth-colored fillings that bond to tooth structure, which makes the tooth stronger and more attractive; bleaching materials applied in the office or at home to provide a whiter smile; air abrasion units that use air blasts of small sand particles to remove decay; decay detection equipment that uses a laser-like beam to detect hidden decay; lasers which currently treat gum disease and will soon remove decay from teeth in the future; intra-oral cameras and digital cameras to provide the patient immediate high quality images of oral conditions for better communication with the clinician; computers to organize diagnostic findings and treatment plans also permit patients a concise form of communication; digital radiography that improves x-ray techniques; and implants used to replace missing roots, which act as a foundation for dentures, crowns and bridges.

The biggest change in dentistry over centuries has been our focus on redirecting care from reactive to preventive. This means that patients have better dental health because of fluoride, sealants, better access to dentists, earlier diagnosis, and more conservative treatment utilizing the latest technology.

The contention of this author is that patients can actually enjoy today’s dentistry. There have been extraordinary advancements in technology that have greatly improved diagnosis, treatment, communication and comfort — all together which permit a patient to look forward to their next dental visit. This can be mathematically proven based upon a recent patient poll conducted in our office. Today’s technology in dentistry means

TREATMENT today on most any level, ranging from cleanings to root canal therapy, received neither a negative or positive rating from the patient. Our poll concluded that patients interpret treatment as necessary, and although they do not find it negative, it is typically not something they look forward to either.

Patient Rating: Neutral.

Technology has also improved CUSTOMER SERVICE, an area important to dentistry. With new trends in spa dentistry, including chair massagers, paraffin wax hand treatments, DVD movies, music, nutritional shakes, etc., patients can literally be pampered in a unique way that they typically do not experience anywhere else. The additional benefit of quality staff to deliver these services to patients remains essential. Patient Rating: Positive.

Technology has improved PATIENT COMMUNICATION in dentistry by utilizing equipment that introduces an entirely new understanding and new level of confidence for patients as never before experienced. Equipment includes early decay detection equipment, intra-oral cameras and digital cameras, and computers (all noted above). Patient Rating: Positive.

COSMETIC DENTISTRY provides patients enthusiasm about achieving a “smile makeover” from beginning to end of treatment.

Patient Rating: Positive.

All of these new technologies now make dental procedures much easier for the patient. The scale is certainly now tipped toward patient comfort and patient satisfaction, which is mathematically proven based upon the above statistics. As dentists, we are delighted with the opportunities we can now offer our patients, and it is truly clear that you, the patient, can actually enjoy your next dental visit. Congratulations!

Cavities & Gum Disease: Silence is NOT Golden!

January 2010

Each of us possesses a fantastic nerve network that creates instant communication between all parts of our body and our brain. This network of nerves is termed our NERVOUS SYSTEM, consisting of over a billion nerve branches in our body, and transmits information to and from our brain at over 250 miles per hour. Information traveling to our brain is about conditions occurring inside our body (such as breathing rate or heart rate) and environmental conditions outside our body (such as sunburn or a mosquito biting us) engaging our brain to react and send out signals to meet our body’s immediate needs.

From the soles of our feet to the top of our head every aspect of our body is loaded with nerves to provide us sensory feedback about our body. The body has an amazing ability to perceive something very miniscule, such as a splinter in our finger or a grain of sand in our eyes, which can become monumentally uncomfortable and greatly disrupt function to that area of our body. Ironically, in complete contrast, other parts of our body can have very severe problems, such as heart disease or cancer, and not interpret this at all.

A philosophical question remains. Why would the body magnify small problems with a major response and yet not interpret major problems at all? The nervous system ironically does not always compute information in a logical fashion. In other words, our nervous system and/or our brain can systematically interpret or misinterpret information about our bodies, whether big or small. A key notion about nerve physiology is that certain areas of the body are consistent about reporting problems while other areas of the body are not consistent.

The major focus of this article is applying this principle of nerve inconsistency to dentistry and understanding why cavities and gum disease don’t typically communicate to our brain with an early warning. Patients do not typically present to my office for dental emergencies until they have very large cavities that have spread into the nerve of a tooth or gum disease so advanced they are in jeopardy of losing many teeth and need a denture. Why do dental nerves do a bad job of reporting cavities and gum disease in our mouth?

Perhaps the answer is because teeth are designed for removal when they become severely infected by bacteria. Further, nerves in our bodies actually adapt to a chronic pain-related problem and this is body’s way of keeping us from long-term suffering from many physical ailments that include toothaches and gum disease. Therefore, one could conclude God designed our teeth to be somewhat easy to remove and since the gums are involved in the extraction process the nerves in both teeth and gums are very tolerant and adaptive to dental problems.

Our dental nerve response means that silence is NOT golden in dentistry. We develop dental decay and gum disease and will statistically not feel this at all. Knowing that dental nerves do not inform us about dental problems clearly means we should all be much more pro-active about going to the dentist twice a year to diagnose and treat dental problems early. Computer technology now allows an extremely accurate scientific break-through in cavity diagnosis. Eight out of ten people or 80% of the U.S. population currently have some level of gum disease. For these reasons, visit your dentist regularly for a thorough dental check-up.

Keeping Your Jaw Joints Healthy

February 2010

A very old acquaintance, Dr. Pete Dawson who is an icon in the world of dentistry, has spent more hours lecturing about TMJ in dentistry than anyone I know. Dr. Dawson states “if you don’t believe in God before you learn about the TMJ, you will after you do”. This implies just how complex and magnificent the TMJ really is.

The temporomandibular joint (TMJ) is a small joint located in front of each of your ears where the lower jaw comes up and joins the skull.  It permits the lower jaw (mandible) to move and function.  The TM joint moves each time we chew, talk or even swallow. Similar to the ball and socket joint of the shoulder or hip, the TM joint routinely rotates (like when we chew gum), but it uniquely has the amazing ability to function as a sliding joint.  This is really an incredible property for any joint.  This feature of the lower jaw sliding down and forward, as when getting ready eat a thick sandwich, is called “translation”.  The jaw further moves laterally in an infinite range of combined movements, making it truly the most complex joint in the human body.

The TMJ has a disk between the two bones (of the jaw and skull) that acts as a cushion to provide protection, so the bones don’t rub on each other and cause destructive wear.

Jaw Joint PainThe round upper end of the lower jaw is called the “condyle”.  The condyle functions against a part of the skull bone called the temporal bone in a specific area called the “articular fossa”.  Between the condyle and fossa is a disk made of cartilage that allows the condyle to move easily and prevent the two bones from rubbing and causing damage.

As with all parts of the body, the TM joints are taken for granted until they begin to cause us problems.  TMJ disorders, termed temporo-mandibular dysfunction (TMD), are not uncommon and have a variety of symptoms. Patients may complain of earaches, headaches and limited ability to open their mouth. They may also complain of clicking or grating sounds in the joint and feel pain when opening and closing their mouth. What must be determined, of course, is the cause.

Causes of TMD (TMJ symptoms) include arthritis (i.e. rheumatoid arthritis), which can result from an injury or from grinding the teeth at night.  This may cause parts of the TMJ to fuse, preventing jaw movement altogether.   Another common cause involves displacement or dislocation of the disk that is located between the jawbone and the socket. A displaced disk may produce clicking or popping sounds, limit jaw movement and cause pain when opening and closing the mouth.

Problems with Jaw Pain

The disk can also develop a hole or perforation, which can produce a grating sound with joint movement. There are also conditions such as trauma or rheumatoid arthritis that can cause the parts of the TMJ to fuse, preventing jaw movement altogether.

Stress may trigger pain in the jaw muscles and simulate TMJ problems. Affected patients frequently clench or grind their teeth at night causing painful spasms in the muscles and difficulty in moving the jaw. Patients may also experience a combination of muscle and joint problems. That is why diagnosing TMJ disorders can be complex and may require different diagnostic procedures.

Why do people grind their teeth any way?  That is really unknown.  However, people with uneven teeth that grind create very unusual forces on the TM joints and may create TMJ symptoms.  Having teeth pulled that cause teeth to shift and drift into bad positions, wearing teeth down over time, crooked teeth — all create an imbalance the TMJ must endure and that can inevitably flare up and hurt similar to a bad back.

TMJ corrections are most often diagnosed by your dentist and treated by wearing a hard plastic mouthpiece custom designed to provide relief.  If this non-surgical treatment is unsuccessful or if there is clear joint damage, surgery may be indicated (arthroscopic or direct surgery).

Prevention is always the best medicine.  Keep your teeth healthy.  Replace missing teeth.  Get a “nightguard” (grinding appliance) if you suspect you grind or wake up with sore TM joints in the morning.  Get regular check-ups at your dentist and ask about TMJ problems if you suspect you may be experiencing them.

What is Special About Front Teeth?

December 2009

By: Dr. Scott R. Harden

Front teeth are very important to all of us. In fact, many people are quick to decide on having their back teeth extracted, but go to great lengths to keep their front teeth. Is a smile that important? Apparently it is, as I have observed over two decades.

“The best thing I ever did was to get receive my cosmetic smile makeover”. As she entered the Historical Society function at the Old Mill in Canton last week, Joanne’s glow and warmth clearly reflected her newfound confidence and eager desire to flash her beautiful smile. In her fifties, she stated her confidence soared and was far more liberating than any new outfit or hairstyle. And besides, she went on, “those things are only temporary anyway. My new smile was an investment in myself and my self worth”.

Esthetics. So front teeth clearly reflect a social standard that is important to everyone. There are many great old sayings about smiles. Because of your smile, you make life more beautiful. If you see a friend without a smile; give him one of yours. A smile improves the value of your face. I appreciate these sayings because they represent the happy times in life. And dentistry can certainly help assure a persons smile by keeping their front teeth healthy, whiter, and straighter. Nice front teeth don’t cause you to smile but they certainly give you every excuse to. Front teeth, therefore, are special because they provide all of us the smile we need to interact socially with others.
Relationship of Front Teeth. Most everyone has heard the term “Overbite”. An overbite refers specifically to how far your top front teeth overlap the lower front teeth, from 0% to 100% or even more. A 100% overbite, also called a “deep bite”, means your lower teeth are not visible when biting together. “Overjet” is the term used to describe how much space exists between your lower teeth and upper teeth when you bite together, as measured horizontally. This is typical in people with small lower jaws compared to their upper jaw. Overbite and Overjet affects how you eat, how you speak and how your teeth function together. These are very important to measure in children for potential orthodontic care and for adults as well.

Chewing. Front teeth are important for biting into things like apples or sandwiches. Our front teeth are called incisors because they “incise” food and perform a unique function different from our back teeth.

Phonetics. Sounding out words. This is a fundamental aspect of speech and many sounds are performed by the interaction between your front teeth providing a stopping place for your tongue and lips. To form an F-sound or V-sound means your lower lip must contact your upper front teeth. Th-sound requires your tongue to heavily contact your upper front teeth. L-sounds and N-sounds also require your tongue to contact the back of your upper front teeth.

Functional Support. Front teeth function in vertical and horizontal directions. Front teeth lean forward normally at a slight angle and this causes a very complex interaction when biting and chewing. Front teeth are important because they act as the steering wheel when you chew separating your back teeth apart ideally both in forward and lateral motions. They also provide a vertical stop when biting together that really helps take pressure off your back teeth and avoids back tooth wear.

Front teeth are very special in many ways to our every day life. Speaking, smiling, eating, and our overall confidence all stem from our front teeth. Dentistry helps ensure healthy, white front teeth for many people and lets all of us have the opportunity to flash our beautiful smile and improve the quality of our face and our lives.

A Dental Christmas Time Story?

December 2009

As the Christmas season approaches there is an amazing transition that occurs in the lives of hundreds of millions of people each year. It is a time of great joy, a time when people respect each other and a time when our hearts and minds are filled with the blessing of the Holy Spirit. It is a time to savor present joys and past memories of home, family and friends, good days and hard times, and a time to reach out and give thanks to God for the richness in our lives.

This article is dedicated to human compassion and the altruism displayed by a married couple whose unselfish actions forever changed a young boy’s life, in the true spirit of Christmas.

The birth of their child was a precious gift they had long awaited and dreamed of. He was a wonderful baby and possessed all the greatness as witnessed in any child, except that his face displayed a genetic defect that greatly transformed his appearance. This sweet and precious baby, needing love and attention, innocent to his condition, was whisked away from his mother’s arms and immediately taken for immediate medical evaluation. His start into the world was abrupt and challenging. This theme would so mark the balance of his young life.

The baby was afflicted by an unsightly disorder known as bilateral cleft lip and palate.   It resulted from incomplete development and fusion of his upper jaw, lip and nose. Oral-facial clefts are among the most common congenital anomalies, and occur in approximately one out of every five-hundred births.

This child’s parents faced the most difficult decision in their young lives. Could they financially and psychologically provide for their child in this dental related need? As the child looked up at them and displayed his loving spirit through his compassionate and needing eyes, they knew then that they were not ready in their young lives to embrace the needs and demands required to care for their child’s special needs. Christopher was soon after placed in a foster home, with pending hopes and prayers of a better life.

The year was 1985, and after spending the first year of his life in a foster home in South Korea, Christopher was adopted by an American couple and brought to his new home in the United States. The unselfish decision to adopt this child was only superseded by their loving compassion to select a child possessing a cleft lip and palate, because they knew many couples might overlook him for adoption.   Looking beyond his defect this couple could identify with Christopher’s wonderful spirit even as a baby. Dedication, nurturing and support were the traits Christopher’s adoption parents knew they must possess to raise their new child to his greatest potential.

Christopher had two splits that extended from his palate onto his upper lip and extended to each nostril. It further resulted in loss of eleven of his permanent teeth. Surgery after surgery was strategically performed in order to help him develop physically. However, even after numerous operations in the United States, his condition had been altered, but not successfully corrected.

During the crucial developmental stages of his life, Christopher was constantly being stared at and ridiculed for something that he absolutely had no control over. Imagine how Christopher felt as a child in grade school, being from Korea, having a cleft lip and palate defect, and in braces. He simply wanted his physical defect to go away. The stress ultimately caused him to develop a generalized anxiety disorder characterized by not eating well, being a loner and not having a happy, normal outlook on life. Christopher became emotionally drained with virtually no self-esteem. Following a total of twenty different surgeries, his family’s financial resources were completely drained, leaving them with little hope to ever correctly repair their son’s condition. Christopher’s confidence and hope had plummeted and he resigned to accepting that his current appearance was as good as it would ever be.

Dentistry now offered the final hope for Christopher, in the form of complimentary care never needed more than for this fine young man.   A thorough diagnosis, review of his medical-surgical history, a comprehensive restorative treatment plan with six months of seamlessly staged treatment, now allowed Christopher at age twenty, to emerge as a confident young man with the appearance he had always dreamed. The wall that Christopher had built up to shield himself from the world, and the cruel stares and hurtful comments, slowly came down. The new Christopher, harboring many years of anguish, thankful for his adoption parents and the gift dentistry had to offer him, has now formally began to introduce himself to the world and he looks into his future with confidence and optimism for the very first time in his life.