3 Steps to Undo Years of Dental Problems in a Few Visits

All of us have heard of "paralysis of analysis", when we put off making a decision about something we know we need to address by continually thinking over our options. It's no different in dentistry. People often put off needed dentistry for several years or more. Can you blame them? Some people have had bad experiences in the past for single-tooth issues and are thinking that addressing all of their problems will just be several more bad experiences in a row. Others know they have several dental problems and are overwhelmed by the different options and their associated price tags. It's no secret that having dental work done involves time in the chair (and off work), significant amounts of money and possibly healing time. Good dentistry takes time and money while great dentistry often takes even more time and even more money. We all want to be healthy, and here's how to start:

1) Seek out a trusted source.  It's been said that a journey of 1000 miles begins with a single step. The best way to start to get a handle on your situation is to start a relationship with a dentist that will take into account your goals, finances, and any reservations you have about treatment. If you decide to go through with treatment you're going to spend some time with this individual and his/her team so consider this your chance to make sure you feel like the office is a good fit for you. Many dentists offer complimentary consultations. If your case is simple you might be able to go ahead and complete the exam and records (x-rays, impressions, etc) at this visit. If you have a complex situation you'll probably just have a calm, comfortable discussion and plan on coming back for all the examination "stuff". Ballpark budgets can be discussed to help the dentist concentrate his/her efforts on designing a solution for you that fits within your expectations. For instance, you might find out that what you think you wanted was much more than you intended to invest but that it can completed in sections over time to make it affordable. Most importantly, you should get a "good vibe" from this first visit.

2) Find out where you are so you can find out how to get where you want to be. At some point, someone has to put their hands in your mouth. And that's not all. A detailed exam will certainly involve X-rays but may also include impressions and photos. If there's one thing patients dislike it's surprises in the middle of treatment that add to the cost or timeline. It's always a good idea to ask your dentist questions like "so what will we do if this doesn't work?" or "what could change and put us off course?". This is an important part of making sure that you and your dentist are on the same page about your treatment.

3) Consider Sedation. It's taken several years for your dental problems to develop, but once you've worked up the motivation to take care of them it can be disappointing to learn that it's going to take several hours in the chair to see some results. It's understandable that many people who have avoided the dentist fear discomfort, but for those who aren't phobic even just the time sitting still can be an obstacle. IV sedation is a solution that can address both of those concerns. Not only does it keep you more comfortable, but it can allow your dentist to complete your work more efficiently by chipping away at your treatment plan in larger "chunks". For example, with sedation someone facing the loss of all of their teeth can easily walk out with dentures after just one visit. That's quite a transformation!

Everyone knows that there are many benefits to having a healthy mouth but it's easy to get "analysis paralysis" over some of the obstacles to getting your teeth fixed. Start your journey now and you might find that it's easier than you think. Best of all, when you're enjoying your new smile and the foods you love again, you'll be reminded why you did it in the first place...because it's worth it!

Will Your Medical Insurance Ever Cover Dental Work?

These days, it's important to be educated about all of your options for cutting your health care costs. One option that people aren't often aware of is that in some cases you may be able to get selected dental services covered by your medical insurance. This is one way to help reduce your out-of-pocket costs and leave more of your dental benefits (which often have lower coverage limits) intact for routine services.

The Exception to the Rule

It's important to mention that most routine services like cleanings, fillings, and crowns are almost always excluded from medical insurance coverage. But if dental work is needed as a result of a chronic disease, performed to improve a medical condition or done to restore teeth following an accidental injury, you might have coverage. 

It's wonderful that medical insurance companies see the merit of covering some of these procedures for their subscribers. With training and some willingness to learn by trial-and-error a few dental offices are starting to get familiar with the process. Medical insurance is a whole different ballgame than dental insurance submission but you can help your office by collecting all your medical insurance information like your ID card, benefits paperwork, and contact information for your insurance plan. 

Some scenarios where you might qualify for medical coverage include:

1. You are diagnosed with sleep apnea and you end up hating your CPAP breathing machine so your doctor recommends a special mouthguard instead.

2. You are taking a medication for high blood pressure that sometimes has the side effect of causing extra gum tissue to grow over and even cover some of your teeth. Your dentist uses a LASER to remove some of this to improve the appearance of your teeth and make them easier to keep clean.

3. Your have a small sore on your tongue that won't go away so your dentist performs a biopsy to give you peace of mind and rule out something harmful like cancer.

4. You find out that you need a kidney transplant. Before your doctors will approve you for surgery they ask you to take care of any dental infection, like that broken molar in the back that has been bugging you on and off.

5. You are in a car accident and although thankfully you don't have any major injuries, the accident left you with two broken front teeth that need to be repaired with crowns. 

Worth a try?

Although medical coverage for dental treatment only applies to specific situations and varies widely among carriers, it's one more tool to stretch your healthcare dollars. It never hurts to ask, so the next time your dentist recommends a procedure that seems to be closely related to your general health, you might want to bring it up!

What's in a Brush?

     The first toothbrushes were most likely branches with small, sturdy foliage. Brushes sure have changed over the years but the concept remains the same: when sticky plaque builds up on teeth you need some kind of mechanical scrubbing action to get it off. When you combine a brush with something abrasive (enter toothpaste) then you really have an efficient combination for removing the gunk and junk that is left after meals.

     As a dentist, I get asked about toothbrushes all the time. As any trip to your local pharmacy will prove there are a dizzying array of choices available, from the tried-and-true manual brush to battery-operated spinning brushes as well as the high-end rechargeable power brushes. Many of these (especially the more expensive models) claim to be the best brush out there for keeping dental problems away. Is there a best brush? Despite all the ads, research doesn't give us a clear cut answer. What we do know is this: any brush out there can effectively remove decay-causing plaque from your teeth if it's used correctly. That means that with the right technique, the $2 model can be just as good as the $200 one.

     So what's the right technique? The dental profession has given names to all sorts of techniques over the years, and the current one that stands out right now is called the modified Bass technique: small, circular motions with the brush held at about a 45 degree angle so it's touching both tooth and gum at the same time. Move from tooth to tooth slowly, taking 2-3 minutes to do your whole mouth. Be sure to get the backs of all your molars, where food often collects after a meal.

     Is it really that simple? It can be. Where people run into problems is by speeding up the process (three minutes is actually a really long time when you're watching the clock) or by using too much force. While taking shortcuts will leave plaque on your teeth that can harden into tartar, using too much force gets your teeth too clean. Clean, smooth teeth are definitely what you want, but brushing too hard will wear away enamel and even gum tissue over time, creating large defects that can tarnish your smile and require fillings, crowns, or gum grafting to correct. The ideal pressure is just enough to remove food and no more. Realize that toothpaste is mostly pumice, so it doesn't take much force at all to scrub your teeth clean.

    So is there a place for electric brushes? While they aren't necessarily better, they can be more convenient. They take the guesswork out of the small circles, so they difference is sort of like a push lawnmower versus a walk-behind model. Also, the spinning action works well enough that little-to-no pressure is needed, so if you're prone to recession these brushes can be better for you. If you're concerned about the price tag, the $8-10 models that run on AA batteries or are disposable can be a great 'test-run' before you decide if you want to commit to one with more bells and whistles.

   A more expensive brush is not a guarantee of less dental problems, but it might be for you. If you're keeping problems at bay with the $2 model though, there might not be any advantage to switching. If you're wondering if what you're hearing is hype or not, your dental team can guide you in the right direction.

What's the Best Toothbrush?

     Just before the holiday season last year I was fortunate to do a segment on our local ABC morning show that focused on this question. It was great to be invited and I had a really good time doing the piece. I've done some TV appearances before but despite my best efforts I usually get a little nervous when the lights come up and we're on live TV. This time though, I found I was a lot more relaxed. You could almost call me calm. At first I gave myself way too much credit and thought I had conquered the jitters that come with being on TV for someone who isn't used to doing it very often. But then it dawned on me: I was calm because this is a conversation I have several times a week in my own office with patients. It's probably the most common question that patients ask, along with 'what's the best toothpaste, floss, denture adhesive, etc...'. It's a question that many people want answered because they are overwhelmed with marketing messages that make all sorts of claims about oral health products. Because most people would like to avoid time in the chair treating decay or other dental problems, many people are interested in using a product if it can give them an edge and further reduce their chance of disease. But how do you sift through all this information? As a dentist, I can tell you the answer isn't one you would expect (but here's a hint: it's more about how you use what you buy than the name on the box; more on that later!).

     There are a lot of great products out there, from multi-setting high-powered brushes to the tried-and-true manual brush (which itself has transformed some over the years). In the next few posts we'll explore some different options and hopefully empower you to find the best combination of preventative products to keep you out of the dental chair for the dental problems you don't want to deal with while keeping your options open for any cosmetic work that you do want. Next up: 'All Your Brushing Options'.

Level 3: Complete Dentistry and Elective/ Cosmetic Care

Where Do You Want to Go?

     Level 3 is where dentistry really shines. You've achieved a solid level of dental health, and you now have the freedom and ability to customize your smile to look exactly as you'd like it to. Modern dentistry can straighten, whiten, and revitalize your teeth to reverse years of aging or just give you an added level of confidence. 

     Entirely optional, this kind of dental work puts you in the driver's seat to allow your dentist to build the smile you've always wanted. Do you want to replace old dental work to make it look like natural teeth? Do you want to fill in gaps or spaces? Have years of wear left you with shorter teeth and less confidence in chewing? Maybe instead you've worn a removable denture for years and you'd like to have dental implants that your denture can clip into. You could even throw away the denture and have several implants placed to reconstruct a full set of choppers that look and feel like natural teeth. 

     Sound expensive? It can be. Depending on your budget, time frame and willingness to undergo multiple procedures your dental team has procedures and materials available to help you achieve almost whatever you like. Although pricing varies widely, you'll have several options at multiple price points to move closer to your ideal vision. At this level of care you'll likely be working with a team of dental specialists that are all on the same page, working in harmony to create your smile. This is perhaps the most important thing to be sure of before making a commitment to an extensive dental transformation: that all of the dentists involved in your care are communicating regularly and are beginning with the end in mind. Many dentists develop close working relationships with trusted specialists and the results they can achieve are truly impressive. It all starts with a commitment to long-term, regular care to maintain anything you decide to have done. Once your dental team comes up with a game plan that matches your vision, they can take you just about anywhere you'd like to go. The first step, as in levels 1 & 2, is to set up an initial consultation to get the process started.

Level 1, 2, or 3... Get Started Today!

Well, those are the three main levels of dentistry. The point I hope comes across is that no matter what level you're at there are options available to you. Whatever your situation, your dentist has either seen it before or has access to information that he or she can use to help you out. Find a dentist who will help you leave any guilt behind, will take you as you are, and will focus on helping you get better. 

Level 2- Routine/ Foundational care

What's So Great About Routine Care?

     If you have a regular dental checkup once or twice a year then you're probably safely in level 2, a state of routine and foundational care. If you're in level one, this is where you want to be. What's so great about level 2? Well, for starters, it proves that the old saying "an ounce of prevention is worth a pound of cure" is as true in dentistry as just about anywhere else. In level 2 you regain control over your dental health, making emergency visits a much rarer occurrence. Together, you and your dentist regularly review your current condition and your future goals. You dentist can alert you to developing problems at their earliest stages so they can be addressed as conservatively as possibly. Since decay and gum problems hardly ever produce any noticeable symptoms in their early stages, these regular visits allow your dentist can find them before they turn into major issues. As older dental work begins to wear out, your dentist will help you prioritize how to replace it before it breaks so your chance of dealing with a broken tooth while on vacation goes down dramatically. 
    This type of routine care builds a strong foundation for keeping your teeth for a lifetime. The economic benefits are twofold: not only does regular care keep your overall dental costs down, but because most of your work will be done preventatively (rather than as a reaction to some emergency), you can schedule it to work best with your finances and insurance limits. 

What Would I Be Signing Up For?

     Some people's mouths require more upkeep than others, but in addition to regular cleanings this stage commonly involves occasional fillings, crowns, or gum therapy. If a tooth is ever lost then implants, bridgework, and removable options exist. Those with extensive grinding issues can be fitted for mouthguards to slow down tooth wear and fluoride can be used to strengthen your teeth if you're prone to decay. Are you missing several teeth? Then for you this stage would involve making sure any full or partial dentures that you wear are functioning well. You'll also benefit from having a dentist monitor your situation so you can pursue dental implants before bone loss makes that option harder to obtain. The focus here is on achieving and keeping up a strong foundation so that if you ever want or need to go up to Level 3 (complete dentistry and elective/cosmetic care) you can. This is where the advances made in modern dentistry really shine. We'll discuss some of the exciting options available to you at level 3 in the next post!

Level 1- Urgent/ Emergency Care Only: Damage Control

A Downward Spiral?

    Much of the population falls into this category. The typical picture here involves a number of worsening dental problems throughout a person's mouth. This stage can be depressing, frightening, and emotionally draining. People in this situation can see that things are getting worse but often feel helpless and doomed to stay at this level until they lose all their teeth. Often fear, finances, or both keep a person out of the dental office except for painful emergencies. These happen less often at first but then they start to pick up speed as small problems become big ones in many different areas of a person's mouth at the same time. It's no surprise that when a person at level one makes it into a dental office with a painful problem that the dentist has to do something invasive to relieve the pain. Often this means an extraction or a root canal; while these procedures have become a lot more comfortable over the years, they still aren't entirely pleasant. It's no wonder that folks at level 1 associate going to the dentist with pain and expense, and they start to think "This is why I hate going to the dentist in the first place!". 

What's a person to do?

Frustration and doubt are normal feelings that result from getting pulled deeper and deeper into this vicious cycle. My advice for those stuck at level 1 is to make an appointment for a non-emergency visit and for about the cost of an extraction the dentist can help you by making a complete list of the problems you're facing (from most urgent to less urgent) so you can start to get some control over the situation. Fear of the known is always easier to handle than fear of the unknown. Maybe you can't afford to tackle all of your dental issues right now, but knowing which problems are likely to be the next emergencies can put you in a position to take care of some of them beforehand and break the cycle. Since planned dental work is easier on you than urgent, unplanned work and fillings often cost less than difficult extractions, this path can be less expensive, more comfortable for you, and can allow you to save teeth while they can still be saved. There is no shame in losing teeth or not being able to go through with all your dentist's recommendations right away. What we can do at this stage is keep you comfortable and help you avoid emergencies as your finances will permit while keeping your options open for the future. As your feelings about dentistry and your circumstances change, you'll be in a great position to move up to the next level (which we'll discuss in the next post): routine, foundational care.

Are there different levels of dental care?

There sure are. You can receive quality dental care from just about any licensed dentist, but there are different levels of dental health that our profession can help you can achieve depending on your goals, motivation, and finances. While it would be great if everyone could have a picture-perfect white smile the reality is that many people would be happy if they could just break the cycle of going from one toothache to another or could just chew solid foods again. There are a number of different steps on the ladder from a mouthful of lingering dental problems to a state of confidence-building, worry-free, long-lasting dental health. No matter your current place on the ladder, there is some way that regular dental visits can benefit you. When you're ready and able to move up on that ladder, there's a world of possibilities available to you!

We'll explore the levels of dental care in the next few posts. The main levels of care are:

  1. Urgent/ Emergency care only

  2. Basic, Foundational care

  3. Complete Dentistry and Elective/Cosmetic care

While it's a great goal to get and stay in the highest level of care, depending on what's going on in your life moving around from level to level is sometimes unavoidable; that's reality. Your dentist can serve and help you no matter what level you're starting at, so find a dentist you trust to be on your side today.

Why Put Up With Floppy Dentures?

 If I Would Have Known This is How Dentures Were Going to Be...

   For some people, traditional dentures work really well. As an alternative to no teeth, they can be great. Unfortunately, many people struggle with them. This is especially true of lower dentures. While others may see it as an minor annoyance, for some people a traditional denture (even with a sticky adhesive) can be a nightmare. First you might give up some of the foods that you love, then you stop smiling as often, and later you may even avoid some social situations altogether because of the fear that your dentures may cause some kind of embarrassment. 

Implants Might Be Your Solution

   It doesn't have to be this way. Today's dental implant techniques are highly successful and create options at multiple price points for improving a person's ability to eat and smile with confidence. Of course it's true that dentistry can get pretty expensive depending on just how natural-looking and comfortable you want your new teeth to be (not to mention how fast you need to have them that way). Most times though you and your doctor can come up with a solution to improve just part of your denture experience (like the fear of them falling out) while leaving the door open for upgrading to an even more comfortable situation (like enjoying crunchy foods again) gradually over time as your desire and finances permit.

Finding a Way to Benefit

     While many people may have given up hope that implants are not an option for them due to their age, health, or checkbook, the fact is that most denture wearers can benefit from some kind of implant therapy. Although it can be common for a person in their mid-60s to tell us that he/she doesn't feel there's a point to putting the time or money into implants for their denture, there are plenty of 90 year old people out there thriving with them, even getting them for the first time! The importance of being able to chew and digest nutritious foods doesn't decrease with age--it only becomes more important. A person's ability to eat and smile comfortably is truly a quality-of-life issue. For many dentists, myself included, upgrading a patient's denture experience is one of the most fun and rewarding services we can offer to our patients. Whether you're unhappy with your current set of dentures or you're getting ready to have your first set made and are concerned about how your life will change as a result, an honest talk with a dentist will help you to define what can be done to improve your situation in a way that works for you. There are certainly more important things in life to spend your time dealing with than your teeth--implants can help free you from your denture worries so you can get on to more fulfilling things. It's a decision you won't regret--you just might wish you'd done it sooner. 

     The first step to improving your denture experience is to set up an initial consultation, like the complimentary consultations we offer at Northstone Dental Group. If you're interested in receiving one, you can contact us anytime.

What's the Story on Consultations and Second Opinions?

10 different dentists, 10 different approaches

     Whether you’ve been away from the dentist for a while and have several issues or a new problem has sprung up with one or two teeth, often the best place to start is with a consultation to get a grip on what is going on and what can be done to address it. This is one place that patients can get frustrated because they might find that their new dentist does things completely different from their old one, or that their visit sounds completely different from the experience that their neighbor described going through when he or she (fill in the blank--broke a tooth, needed a root canal, etc) last year. One dentist may have given a short, free consultation, while another may have charged hundreds of dollars for a longer visit that included several x-rays, pictures, and impressions.

     The truth is that like in medicine the vast majority of dentists out there genuinely care about your best interests and use them to guide their decisions. Dentists love helping people to improve their health, comfort, and confidence. But dentistry is much different than medicine in that it is not controlled nearly as much by insurance companies so individual offices are freer to practice as they wish. As a result we all tend to do things a little differently from each other, more so than family physicians that may be required by your insurance to run certain tests based on your symptoms.

      When going to a new dentist communication is key so that you aren’t left feeling like you were forced into something you didn’t sign up for. Often patients can feel confused after leaving an appointment. Even though they’d like to get a second opinion they may have already invested time and money getting the first one and they fear that a second might take even more time and money so they’re not sure what to do! There are a couple schools of thought on how dentists approach new patient visits, and as a patient it can be good to know what you might encounter when you walk into a new office for the first time so you can select dental care that meets your expectations.

Consultation or Comprehensive Exam?

     Most approaches boil down to either a short consultation or a longer, more thorough comprehensive exam. Some offices offer both while others require you to do one or the other. In our office for example we always offer free consultations. At a visit like this you can expect about 30 minutes of a doctor’s time to discuss what is going on and some possible options to address it. Occasionally a single x-ray may be needed to make sure certain options are possible. It’s no secret that the question on everyone’s mind is “how much is this all going to cost?” That’s a very fair question because in dentistry there are usually several ways to create a beautiful smile. As the comfort, chewing ability and natural looking quality of the options goes up so does the price and often your budget is going to determine what option you choose. At this visit you can expect to talk about some very ballpark figures that can help you focus on one or two options. You’ll also want to discuss how long you can expect to be in treatment and whether or not any specialist visits would be involved. At this point you can go home, think things over, and decide if you would like to get more opinions or start with treatment. The next step would then be a fee-based comprehensive exam. The fee covers all the detailed record gathering, x-rays, photos, and impressions that are needed to plan out the specifics of your treatment. It’s only after a doctor has had a chance to plan your exact treatment that an exact estimate can be given but you can expect it to be close to the ballpark figure you’ve already discussed. Some offices choose to start with the comprehensive exam. It’s a matter of choice, but if you feel this is what is going on you’ll want to make sure the fees for this have been discussed with you prior to going through with it. On a positive note, if you came into an office looking for an opinion but left with a full exam, you should have most of the records that any dentist would need to give you a second opinion. There may be a fee to have them copied and transferred to another office but any dentist will make them available to you.

Where Do I Start?

     Knowing you need to see a dentist to address several problems or just one can cause a lot of anxiety about what’s going to be recommended, how long it will take and how much it will cost, just to name a few common concerns. In general with dentistry if you’re having a problem or have just been away for a while the sooner we can see you the more options you’ll have.  A short, relaxed consultation with a dentist can be a great first step towards developing a relationship with a dentist that will result in giving you back a healthy, comfortable, beautiful smile. If you need to see a dentist, set up a consultation with an office today!

2010 ODA Humanitarian Award Winner: Dr. James E. Nicholls!

It's Official!

    Northstone Dental Group is celebrating the recent news that co-owner and founder Dr. James Nicholls has been announced as the 2010 recipient of the Ohio Dental Association's Marvin Fisk Humanitarian Award. This award is given to dentists who have provided oral health care to those in need by donating their time, skill and personal resources. The Columbus Dental Society nominated "Dr. Jim" for his accomplishments over his thirty years in practice, particularly for his participation in Doctors With A Heart Day at his office starting in the late 1980s. 


A Career of Caring

     Dr. Nicholls graduated from The Ohio State University with a degree in pharmacy, then worked as a pharmacist in the Northland community while attending dental school at OSU. He began his practice on Schrock Rd in 1979 and a few short years later moved across the street to the larger building where the practice(now Northstone Dental Group) is located today. He first participated in Doctors With a Heart Day, a day of donating free  health care to the community, in 1988. The concept, started by Iowa dentist Duane Schmidt, is simple: any health professional can pick one day a year to open up the office doors and donate free care to those in his or her community that can't afford basic services. The idea is that anyone can do this at their own office. If every health care provider would pick a day to give back then access to care for at-risk individuals in a community could be improved and the burden on the usual safety net clinics might be reduced. The offering has grown over the years to include several other area general dentists and specialists volunteering with Dr. Nicholls and Dr. Halderman. Recently other dentists in Central Ohio have even formed similar events at their own offices.


    "It's great to be picked for this award," says Dr. Jim, "back when I started this I never imagined I'd be recognized for it some day". He will be presented with the award at the 144th Ohio Dental Association Annual Session in September in Columbus.

What's the Story on Tooth Grinding/TMJ?

Do You Grind Your Teeth?     

You may notice some gradual shortening or flattening of your teeth over time. It's possible that your dentist noticed some wear on your teeth at your last cleaning but you weren't aware of it. Maybe you had an idea that you were grinding at night because you wake up with a stiff jaw in the morning. Or, it might be that you've had some broken teeth or broken fillings lately even though this hasn't ever been an issue for you before. Whether your jaw clicks, pops, hurts or doesn't seem to do anything at all, it's possible that you grind your teeth. Tooth grinding(also known as bruxism) is incredibly common in the United States. While it's commonly linked to stress there can be a number of different causes, most of which are out of a patient's control since it commonly occurs while sleeping. The causes, however, are vastly outnumbered by the different ways in which grinding can affect a person's teeth and jaw joints/muscles. The effects can be as mild as some minimal wear or flattening of a person's teeth (which may not even be noticed by the person doing the grinding) to a debilitating and painful complex condition that severely affects a person's quality of life.Fortunately most people's experience with grinding, if any, falls short of this type of situation. Once a person's grinding habit is identified problems can often be avoided or managed with dentist supervision and treatment, if needed.

     Why does grinding cause problems? For one, although our tooth enamel is the hardest substance in our body it was not designed to come into contact with other teeth covered with enamel for more than a split second each time you chew. Add it all up and your teeth should only come together for about 9 seconds over the average day. Someone who grinds, however, often does so for three hours or more every night. Add to this the fact that some people also grind some more during the day (maybe while driving or at work) and you can see why it's a recipe for wearing away that protective enamel. Once you get through to the dentin layer underneath it, the tooth wears away about seven times faster.

So What Do I Need to Do?

     For some people, only the teeth are affected. When that's the situation the goal for most dentists and their patients is to restore those teeth that have been chipped or broken back to health with fillings and/or crowns while setting up a game plan for protecting and reducing any further damage to the teeth. In other people, problems arise in the muscles (often sort of like a Charley horse). This can occur either just occasionally for some people or more regularly for others. Often a soft diet and over-the counter pain medication can get a person through the occasional episode. For others who have pain more often some type of mouthguard is usually used. Most dentists make one or several styles of occlusal (bite) guards; fortunately, most of them work well when they are designed and fitted by a licensed dentist. Although mouthguards can be obtained for less outside of a dentist's office, there can be a big advantage to having your dentist supervise your care and provide the ongoing repairs and maintenance that are usually needed. 

 

     In rarer cases the problem is within the jaw joint (TMJ) itself. Sometimes this is clear right from the start, but other times it is only discovered by the process of elimination when other attempts to treat the pain are unsuccessful. In these cases, a referral to a doctor with extensive training in TMJ disorders and treatment is usually a person's best bet. While there is no specialty limited specifically to bite problems, there are many qualified oral surgeons, prosthodontists, orthodontists, periodontists and general dentists that have a strong interest in helping those with more severe problems and who have received additional training in this area. Surgery is reserved as a last resort, and there are several options available for those suffering in these situations.

     While both the problems related to tooth grinding and the options available to treat them range from simple to complex, fortunately most people can benefit from a discussion with their doctor. I often recommend keeping a journal about when and how the problems or discomfort you're having affect you. It's always tough to sum up an ongoing ailment while you're in your doctor's office--we all forget some detail until later that might be the key to selecting the right treatment. The more details you doctor has available the better he or she can serve you.

What are My Options to Replace a Single Missing Tooth?

A Common Situation

     One of the most common treatments in dentistry is the replacement of a single missing tooth. It's something we do so often because recent studies estimate that more than 70% of Americans are missing at least one tooth (not including wisdom teeth) whether that tooth was lost to disease, a traumatic accident, or even because it never formed in the first place. 

While there are several treatment options to solve this common problem, they can vary widely in terms of durability, initial and long-term maintenance costs, number of appointments needed and total length of treatment time. Ultimately the choice is yours but your dentist can help you to understand the pros and cons of each option in your specific case. It's also important to keep in mind that in some cases if your situation seems stable and not likely to worsen with time, simply doing nothing and leaving the space can be an appropriate option. In most cases, though, some kind of treatment would improve the situation.

Removable

     Removable appliances are usually the most economical way to replace a single tooth, but they often have more disadvantages. The most obvious is that the device comes in and out of the mouth and often moves around while chewing and speaking. To prevent it from being a choking hazard it must often be bulky. Where a removable device usually becomes a more attractive option is for the replacement of several missing teeth. In this kind of situation the price difference between a removable partial denture and teeth that stay in all the time and look and function naturally can be much larger, so the disadvantages become less of an issue. There's definitely something to be said though for the psychological advantage of teeth that look and feel like a part of your own body. A removable device can speed up bone loss in the missing space though, making the upgrade to a fixed or cemented-in solution more costly or time-consuming to achieve in the future.

Fixed Option #1: Bridging the Gap

     Once the decision is made to go with a 'fixed' or cemented-in option, the most common choice is between a bridge or an implant. A bridge is essentially a chain of crowns made of metal and porcelain (or just porcelain) that uses the teeth on either side of the space for support while placing a natural looking tooth in the space itself. This option almost always requires removing some of the top and sides of the support teeth to produce a bridge that will stay cemented in place predictably. Some advantages include the time of treatment (usually just 2-4 weeks), the number of appointments needed (2-3) and the fact that most dental insurances provide coverage for the procedure. Disadvantages include that they are harder to keep clean (they require special brushing and flossing methods), higher replacement costs if something breaks or fails down the road, and the fact that you have to involve the teeth on either side (which increases the small chance that  they may need additional treatment, like a root canal, in the long-term). That final consideration (the teeth on either side) can often make the choice between a bridge or an implant easier. If the teeth on either side of the space have large fillings or some other condition that would have require putting a crown on them sometime in the future anyways, then a bridge may ''kill two birds with one stone'' by filling the space and improving the teeth next door at the same time. If those teeth wouldn't have needed crowns or have never had any work done to them, then the option that really shines is the dental implant.

Fixed Option #2: Implants Can Mimic Nature

 

     With over forty years of solid research behind them, dental implants have really changed the way dentists treat missing teeth. They represent a way to replace what has been lost  

by adding back rather than taking away from the surrounding teeth. A titanium implant is placed in the bone in the area of the missing tooth. After a healing period a post called an abutment can be added and a crown is made over this piece. The advantages include little to no drilling on the teeth next door and the fact that implants do not decay and never need root canals. If they fail to heal in the bone in the short term, the procedure can often be repeated. If the replacement tooth breaks in the long term, replacing the crown and/or abutment could be all that is needed (at a cost of about a third of replacing a failed bridge). The disadvantages are mostly related to the additional time that is involved to allow the implant to heal in the jawbone. These times vary depending on the area of the mouth involved and the quality of the bone there. Current guidelines suggest waiting no less than 3 months but possibly up to 6 months for the most predictable results (although in some cases a temporary crown can be inserted on the same day as the placement of the implant). Additionally, to achieve the best results it is often necessary to improve the site of the missing tooth by grafting bone or soft (gum) tissue before a properly-sized implant can be placed there. These additional procedures, while adding time and expense to an overall treatment plan, can make the difference between a ''just O.K.'' result and a solid, long-term result that really mimics nature. The pictures shown here represent an almost ideal situation where we planned from the start to place the implant just a few months after the loss of the tooth. We were able to put a bone graft into the area at the same time the tooth was removed. Afterward, healing went well (a little bit of gum recession resulted in the exposure of a some of the metal collar under the crown but this wasn't a concern for this patient). Many times, however, the tooth has been missing for awhile and more gum and bone has been lost; in this case a choice has to be made between undergoing additional procedures or settling for a less than optimal result.

    
      Another factor to be aware of is that not all dental insurances cover dental implants, but this is improving. While it's understandable to want to choose the option that takes less time or has a lower cost up front, it's important to remember that treatment doesn't end the day the space is filled--we hope to provide you a solution that will serve you for a long time. However, nothing we do in dentistry lasts forever- a dental implant can result in lower costs and less time in the chair in the long run. 

     As always, your dentist can help to guide you through the pros and cons in your particular situation. Fortunately, there is rarely a 'wrong' option--your dentist's goal is to empower you to choose the option that makes you feel the most comfortable while improving your chewing and self confidence by replacing your missing tooth.

 

So What's the Story on Tooth Whitening?

Too Many Choices?

When you decide that you're interested in whitening your teeth, you soon find out that there are a ton of different options to choose from, many of which make the same promises but carry widely different fees or treatment times. By the time you're done digesting all the options, you probably aren't sure whether to bleach at home, at a kiosk, in a doctor's office, overnight, or during the day. Do you use a pen, strip, tray, or maybe a liquid? Do you need to be supervised by a dentist? Do you need a laser or a light? It can be confusing even for your dentist, as some companies may market one product to doctors while recommending another directly to consumers for use at home. There are many ways to bleach your teeth. The truth is that the before and after pictures you see may not tell the whole story. Think about when you see an ad for a product claiming to give you six pack abs or that promises quick weight loss. The examples they show are almost always the very best results. You can be sure that many other people  improved somewhat but fell short of what the pictures show. In fact, attaining a six pack or losing weight can be a great analogy for tooth whitening: everyone responds a little differently, so attaining the goal (in our case, white teeth) involves tailoring a regimen that works for your individual situation. In this post we'll sift though some of the more common options available to you and your doctor. Keep in mind that just like that friend who seems to be able to lose weight by barely exercising, there are people that can get great results with a minimum of bleaching. Then there are others that may need to bleach for 4-6 months or more to achieve the results they're looking for. When you go in prepared for a long treatment time, you won't be disappointed if bleaching takes awhile. Getting quicker results will be a welcome surprise.

Over the Counter

Over the counter options include strips, gels, pens, and liquids, and represent the lowest concentration of peroxide (the two main types used for whitening are hydrogen peroxide and carbamide peroxide, both of which are safe but whose active ingredients are used up over different periods of time). The benefit is that these are easy-to-use and you generally don't need to be supervised while using the product because the concentrations are low enough that side effects like sensitivity are less common. That same benefit can be a drawback, however, because unless you fall into that group that bleaches very easily, you may be disappointed by the results of one package of whatever product you're using. I'll often tell my patients to try no more than one or two packages and if they're disappointed with the results we'll discount our bleaching fee by that amount so they're not losing out by trying an OTC product first. If you've never bleached before, trying an OTC product may be worth a short trial run. The number of people I've met that can get the results they're looking for with this option is small but it is possible. For the majority of us, the best results are usually obtained by the next step up: dentist-supervised tray bleaching.


Custom Tray Bleaching

There are many advantages of custom-fitted take-home trays made by your dentist. First, a higher concentration of peroxide can be used because the active material is held in place by your tray. Also, since you can expect a professional strength product to have a higher chance of side effects the dentist supervision you receive will help minimize you chance of problems. Your dentist's exam before bleaching will allow him/her to identify conditions that make bleaching more difficult (like particular types of internal stains) and areas like recession that might cause sensitivity issues. Your dentist can adjust your treatment accordingly to make your experience more comfortable and help you achieve your goals. While you'll usually start to see results in two to four weeks, most people will get the best results with eight to twelve weeks of daily tray use. In extreme cases it can take up to six months to whiten. Just like dieting and exercise, you get out of it what you put into it. I recommend bleaching just one arch (either the top or the bottom) first so you can really see it working. After that it is easier to 'catch up' with the rest of the teeth. You can expect to invest more than with a single package of OTC whitener (probably about the same as five to six packages) but in many cases this is the best way to get the maximum results. It is also less of an investment than the final option: in office whitening.


Same Day In-Office Whitening

This is what you began to see a few years ago on makeover shows, and with claims of fast, easy whitening it generated a lot of interest as an alternative to wearing trays. You might compare this option to liposuction: it can be the easeist way to get results fast but you'll pay more, you'll still need to do some work on your own afterward, and not everyone is a candidate. The idea is that in a supervised way your teeth are exposed to a very high concentration of peroxide for about an hour. Some brands use a light to activate the bleach and others are designed to work just fine without it.  Your dentist has to place some protective coverings over your gums and lips to prevent injury to them. The good news: when it works it can be a great way to have instantly whiter teeth. The reason this hasn't fully replaced everything else: we know that only about 25% of people get an outstanding result with in-office treatment alone. Some of the whiteness that you see after the in-office treatment is due to the teeth dehydrating over the hour of being deprived of saliva and exposed to the air. Within a couple of hours they rehydrate and lose some of this initial brightness. Most people get a nice 'jump-start' but need to continue bleaching with trays at home for several weeks to reach their brightest levels.  Some dentists will include trays and take-home bleach in their fee for the in-office treatment, and starting with the in-office session may be a great way to shorten your overall treatment time. While sensitivity tends to be more of an issue, it will usually last only a day or two and can often be controlled with over-the-counter pain medication. 

Whether you plan to try OTC products or are interested in a treatment offered by your dentist, it can be very helpful to bring this up to your dentist so he/she can steer you in the right direction. Bleaching your teeth can improve your confidence and give you a radiant smile, and your dentist should be happy to help you achieve your goals in a safe and effective way. Feel free to ask any of your bleaching questions here and I'll be happy to answer them for you.  

Doctors With a Heart Day 2009 Video

Just wanted to share a recent video from Doctors With a Heart Day 2009 at our office. Keep an eye out for announcements for next year's event, which will likely include volunteer physical therapists as well!

What are implant dentures?

'Dentures aren't a replacement for teeth. They're a replacement for no teeth'. This is a common phrase in the dental world to describe the limitations of traditional dentures. At their best traditional dentures can be a beautiful replica of a full set of pearly whites, fooling even close friends and loved ones with their natural look. Even a great looking set of dentures, however, usually leaves something to be desired when eating a meal with foods like steak, salad, and crunchy vegetables. Most denture wearers experience the shifting, sliding, and falling out that can be a very frustrating part of the denture experience. Besides making eating difficult, it can give a person a lot of anxiety about their denture coming out during social or romantic situations. Many people can get by with an upper denture because there is usually a lot more bone for the denture to rest on and more suction provided by the roof of the mouth. Unless advanced bone loss is present, a little adhesive can generally make an upper denture tolerable. But a lower denture is a completely different story. Making a traditional lower denture that satisfies all of a person's expectations for fit, comfort, and chewing ability is without a doubt one of the hardest things to do consistently as a dentist. Try as we might, the lack of bone combined with the strong action of the chin muscles and the floor of the mouth pulling upwards and outwards often makes trying to keep a lower denture in place during chewing like trying to keep a tight squeeze on a bar of soap with wet hands. This is where dental implants can make a huge difference in a person's quality of life, by giving support to a lower denture to keep it in place while eating and speaking. Just two titanium implants can reduce a lower denture's movement and improve all of its features. Depending on how much movement a denture wearer is willing to put up with, more implants can be added (often with a bar connecting them) to reduce the movement even further. If enough implants are used(often 5-6 in the lower jaw) a prosthesis with no movement at all can be made, with the additional benefit that the teeth can stay in all the time. This can be done gradually, adding a couple implants every few years until enough are in place to go with this option. Because bone loss starts the moment teeth are removed, it's best to make implants a part of the plan with lower dentures right from the start. As bone loss takes place, the window of opportunity for having implants slowly closes, so that by the time a person is really having problems with denture movement, extensive bone grafting may be needed, adding time and expense to one's treatment. With dental implants, dentures CAN be a great substitute for teeth, and can be very rewarding for both patients and their dentists, who get to hear about their improved chewing, self-esteem, and confidence compared to what they experienced with traditional dentures. Feel free to ask any questions you have about implant dentures, and I'll be happy to try to answer them for you.

Sedation Options in Dentistry

Sedation dentistry most often involves the use of anti-anxiety medication to do just that--reduce your anxiety surrounding dental treatment. Depending on your level of fear and the procedure that you need to have done (taking into account things like how long it will take), your dentist can discuss different options to improve your dental experience. It's important to remember that something like having a dental implant placed or undergoing root canal treatment causes different levels of anxiety in different people, and the goal is to match the level of sedation with your particular needs. In order of the lightest to the heaviest levels of sedation, here are the options you'll usually have:

In a general dental setting (and often in the movies) the most common option (due to its high level of safety) is nitrous oxide, known affectionately as 'laughing gas'. When mixed with oxygen and inhaled through a small rubber mask that fits over your nose, nitrous oxide produces a feeling that most people find very pleasant. The phrase I like to use (because it seems to be accurate) is that once the gas kicks in, being at the dentist sounds like a much better idea than it did on the way to the office. By reducing your anxiety, the gas also elevates your pain threshold (which is great because even though you'll still receive numbing medication, for some people things like opening wide and having your lips and tongue tugged on can be bothersome too). It also can make the appointment seem shorter. If for any reason you don't like how the gas makes you feel, it can be turned off and its effects wear off very quickly. Perhaps the best benefit of this option is that after a few minutes of breathing regular oxygen as the procedure is finishing up, you're back to feeling like your old self and can drive yourself home with no after-effects (though to be completely honest, you sometimes feel a little drained--this is thought to come more from the adrenaline surge you get building up anxiety before the procedure than from the gas itself). If I haven't convinced you yet, it's also wonderful for all procedures performed on children, allowing us to build positive experiences for them from the start. In many offices there is no charge for the gas so you may want to consider it even for minor work like fillings and other small procedures.

The next step up would be oral sedation, usually given as a single dose in pill-form before your appointment. For a small fee (the cost of the pill at the pharmacy) you'll reach a slightly more sedated level than with nitrous oxide, but will still be awake and breathing on your own. If you appear to be strongly affected your doctor will likely attach a monitor to you to keep a constant watch on your blood pressure and breathing habits to keep you safe. You'll probably talk during the procedure but will have little recollection of it. This type of sedation means that you need to arrive at the office with an escort who will stay there until your appointment is over, can go over post-operative instructions with us, and will drive you home afterward. This is a common option if you'd prefer not to remember too much about the visit, but requires a little more planning because you'll probably be drowsy for several hours after your appointment so you'll have to make arrangements for work, etc. Another great use for this type of sedation is take a small dose to help you get a restful night's sleep before the appointment. Because medications affect everyone differently, you might be a little more or less sedated than you planned on but over a couple of visits your dentist can figure out a dosage that works best for you.

The safe way to reach a deeper level of sedation (though still called 'conscious sedation' because you're still breathing on your own) involves the use of intravenous (IV) medication. When you take a pill your level of sedation cannot be adjusted because taking more pills while in the chair is not a safe option. With IV sedation, however, your doctor can predictably raise your level of sedation if you are uncomfortable or lower it if you appear to be approaching levels deeper than conscious sedation. You'll be in a state where you can be woken up if needed, but you'll probably spend much of the appointment with your eyes closed and will have less memory of the procedure than you would with oral sedation. Like oral sedation you're required to bring an escort. There's an additional requirement of not having anything to eat after midnight the night before your appointment. Due to the additional training, equipment, and medications needed to offer this option, IV sedation almost always carries a moderate fee.

Less common, the deepest levels of sedation are often reserved for treatment in an oral surgeon's office or in the most serious cases of dental anxiety. As you'd expect for a surgery like having your appendix removed, you are unconscious and breathing is controlled for you via machine until the procedure is over. Though this option has a long track record of safety, it can sometimes result in more drowsiness and nausea. Since it requires the most equipment and training it often carries the highest cost but in some instances it is the only option.

Hopefully this gives you some idea of what options are out there. Your dentist can discuss whether you are a candidate for one of these types of sedation. For some people these techniques can mean the difference between being able to receive dental care or not, while others may choose to use them only from time-to-time for a particularly involved or anxiety-producing procedure. As always, the choice is up to you, but know that you can probably benefit from at least one of the many types of sedation in dentistry. If you have any questions, please feel free to contact us here or at www.northstonedental.com!

Discussing Fear and Anxiety with Your Dentist

It's no secret that going to the dentist is consistently ranked as one of the things most feared by people, sometimes listed higher than public speaking or even death. I've heard many different stories from our patients over the years about dental experiences that caused them a great deal of pain or left them feeling traumatized for life. Often these were procedures they had done as children, and the memories still conjure up anxiety, in many cases so much so that certain parts of the dental experience trigger an overwhelming sense of terror or a 'fight or flight' type of response. This could include arriving at the office, getting in the chair, or seeing the instruments on the table. It often results in a vicious cycle of avoiding the dentist until something is seriously wrong and extensive work is needed, leading to even more anxiety and causing the person to think 'This is why I hate going to the dentist in the first place!'

Regardless of your level of anxiety about receiving dental care, you can be sure that a caring dentist will be happy to discuss the things that are unpleasant for you, and would prefer to know about them so they can do their best to minimize their impact on you. Many people feel embarrassed or guilty and feel the need to apologize for what are often uncontrollable responses that come from their fear and anxiety. The first thing to realize is that your fears, whatever they may be, are completely normal and are probably shared by many others just like you. Your dentist has almost certainly heard a story similar to yours at least once and is there to help you have better experiences moving forward. We really do want to make you as comfortable as possible, and our profession as a whole has more tools than ever before at our disposal to do this. We know that these triggers are different for everyone, and something that really frightens one person may just annoy someone else but isn't even noticed by another. Some people are more comfortable being able to ask many questions about a procedure (this is always allowed and highly recommended if you are interested) while others would prefer to know as little as possible about the details. Knowing as much about your past experiences allows us as dentists to try to tailor your dental experience to your individual triggers and emotions. This type of open discussion can do wonders for improving how you feel about the dentist! But beyond discussion dentistry has many other tools we can offer to make your experience a better one; these are often grouped together into what is called 'sedation dentistry'... (more on this in the next post)

Doctors With a Heart Day 10.22.2009

This Thursday our office will participate in its 4th annual Doctors With a Heart Day. This special event was first conceived by an Iowa dentist named Duane Schmidt in the early 1980s. Dr Schmidt's intention was to inspire physicians, dentists, podiatrists, optometrists, physical therapists, and psychologists to pick one day a year to open their doors and provide free care to their community. Although originally the event centered on Valentine's Day, offices can pick whatever time of year works for them. We've found that as the holidays draw near and the prospect of all the other demands on people's spending increases (making dental care that much harder to obtain), we've enjoyed offering this service in late October each year. As a thank you not only to the North Columbus community that has nurtured and sustained our practice for over 30 years, but also to all those in need in Central Ohio, we're proud to open our doors from 8AM-5PM this Thursday to offer free dental care to anyone who thinks they would benefit. We'll have seven volunteer dentists from around Columbus to extract and fill teeth, adjust dentures, provide cleanings and more on a first-come, first-served basis. We saw 180 patients last year and hope to be able to help even more in 2009. For directions, further information, and to download and print registration forms, please visit us here . Please pass this along to anyone you think may benefit, and we'll look forward to seeing you on the 22nd! Northstone Dental Group 1730 Schrock Rd Columbus, OH 43214

What's the deal with all the X-rays? (Part 1)

As you come in for your new visit or twice-yearly checkups, it becomes obvious that in the modern practice of dentistry you can expect to have X-rays (or radiographs, as we like to call them) recommended to you pretty often. What's the deal with all these films? They carry a monetary cost (often, but not always covered by insurance plans) in addition to raising concerns about radiation exposure. As with many things in life, you have to weigh the pros and cons. The truth is that a regularly-taken series of radiographs is one of the most important parts of a successful preventive dental plan. Whether your dentist takes a full series, routine bitewings, or an orthopantomograph (the one where you stand up and the tubehead rotates around you), these films allow a dentist to keep your overall time in the chair and costs down in a number of different ways. First off, although we like to think that we're pretty good at catching dental caries (decay) and periodontal (gum) disease in its early stages, we are limited when all we use is the naked eye (even with the nerdy-looking microscope glasses that we wear). In certain areas, like in between teeth and under existing fillings, decay is often detectable several months earlier on well-taken radiographs than under direct vision. It's amazing how silently decay can grow and when it finally becomes visible in these spots, you can be sure it's going to be deep, opening the door for more involved dental work (like a root canal and/or a crown) . If we can find a spot of decay while it's still small, now we're only talking about a small filling or even better, a chance to stop the decay in its tracks with a high-fluoride toothpaste or rinse. The cost savings for a filling vs. a root canal and crown can be over a thousand dollars, making the films (at less than fifty bucks a year) a pretty attractive option. Lately, a lot of people are analyzing their spending and trying to eliminate unneccessary purchases. This can be a great thing in many aspects but it can work against you in dentistry where, like the old saying, an ounce of prevention is worth a pound of cure. In our office we recommend keeping up with a regular schedule of X-rays, but if yearly films aren't an option for you right now then getting them every two years can still make a tremendous difference in your ability to avoid future unplanned dental work. As far as radation exposure is concerned, over the long term the exposure from the number of films that must be taken for a procedure such as a root canal can outnumber the exposure for routine preventive X-rays. Also, digital films (which are becoming increasingly more common) reduce your exposure even further. As always, it's important to be as informed as possible about the dental treatments that are recommended for you, and your dentist should be happy to discuss any concerns you may have about the pros and cons of dental X-rays.