Which dentist you choose to provide dental care for you and your family is a very important decision. Dentists vary immensely in there clinical experience, commitment to continuing education, technical skills and knowledge, dedication and commitment to their patient’s. This article addresses information consumers should understand when making that decision.
Which dentist you choose to provide dental care for you and your family is a very important decision.
Tooth by tooth dentistry refers to dentistry that focuses on addressing concerns of particular condition of a patient, such as; restoring a tooth versus looking at all conditions the patient has and addressing them in a comprehensive manner. Examples might be: fixing a front tooth without considering that the patient has severe wear on all front teeth or placing an implant or bridge when the patient has a bite problem or crowding. The patient may choose to treat this with, orthodontics resulting in retreatment of the bridge or implant in an improper position or not considering the patient’s bite when the patient is being treated for periodontal disease with tooth mobility or having a tooth or restoration fracture because of a bad bite.
Standard of care in most dental practices involves checking for cavities, assessing and treating the health of the supporting structures of the teeth, examining x-rays and an oral cancer screening. However your dental exam should include much more than this. It should include an exam of all parts of the system and an assessment of how it is working comprehensively. Are there any signs or symptoms of breakdown in the masticatory system.
The masticatory or biting system is composed of 3 parts. It includes your temporomandibular joints, muscles of mastication, and the teeth. During your clinical exam all parts of the masticatory system should be examined and assessed. How the teeth occlude or come together is critical for the long-term health of the masticatory system. Any part of the system can breakdown with poor occlusion or function.
Temporomandibular joints are the hinges of the masticatory system located in front of your ears. Examples of joint breakdown might include joint noise such as pops, clicks, crepitus or coarseness, limited opening or closing, locking, or joint tenderness or pain. During your dental visit these things should be assessed through clinical examination and dental history. The joints should be load tested to assess joint health during your dental exam. This means the dentist putting pressure on the joints with joints fully seated into correct position. Healthy joints do not hurt when load tested. Centric relation versus centric occlusion should also be checked. Centric relation is how you bite with your temporomandibular joints fully seated in the correct position. Centric occlusion is how you bite together. These 2 positions are ideally the same. In other words the teeth should come together with the joints fully seated in the correct position. Improper biting or occlusion may affect the health of the TMJs. (The poorly misused term TMJ refers to this.) Comprehensive dental care would include examining, diagnosing, educating you as a patient and suggesting appropriate treatment options for any particular diagnosis.
The muscles of mastication are the muscles of your head and neck that move your teeth and joint during mastication or chewing. Your exam should include assessment of these muscles through clinical exam and dental history. Temporal headaches for example are most often related to problems with the biting system because the temporal muscle is a muscle of mastication. This becomes the dentists responsibility to diagnose and treat the temporal headache problem. If problems are present your dentist should diagnose, educate and treat appropriately. The underlying problem is most often related to how the teeth come together.
The third part of the biting system is the teeth. Tooth or dental breakdown may include a fractured tooth or multiple teeth, worn or short teeth, loose teeth, bone loss around teeth, recession or stripping of the gingival tissues around teeth, dental pain, or sore teeth or toothaches. These problems are often or most often caused by the teeth coming together or biting improperly. The dental exam should include much more than simply diagnosing where a cavity is. If any of these problems are present you should be educated about dental occlusion or how teeth should come together relevant to your occlusion. How to correct the issue should be discussed.
So in summary the dental exam should include all parts of the biting system being assessed, proper diagnosis, education of the patient and appropriate treatment suggestions or options.
Without proper dental assessment and dental treatment pretty smiles may disappear over time . Appropriate care should include educating the patient and informing them of any potential problems present and future. The benefits of treatment versus the consequences of no treatment should be discussed.
There are rules for dental aesthetics and function that are guidelines or goals for all patient’s when delivering care.
Functional guidelines include all the teeth hitting together with the temporomandibular joints in the correct position to share the occlusal load. Ideally when the lower jaw moves to the left and right the canines should be properly positioned to protect or disclude all of the other teeth. The idea is that the mouth is like a nutcracker with the hinge in the back. The canines are considered the most important teeth in the mouth. The canines have a large strong roots and are physically suited to protect the other teeth. They’re positioned mechanically like the handles of the nutcracker where it is hard to break the nut. Therefore on left and right movement they’re beautifully suited to provide the role of protecting all other teeth. This is called canine protection. Any of the problems previously discussed about joint, muscle or teeth may occur without canine protection. This is very important. On forward movement lower front teeth should be straight and aligned to provide even occlusion on the upper front teeth. Without this most often severe wear may occur. However any of the other problems mentioned with muscle, joint or teeth may also occur.
Aesthetic guidelines include teeth being shaped and positioned correctly. More information on this can be found on the treatment planning page of the website. What you should understand is that you need more than just a cosmetic dentist. Completed cosmetic dentistry treatment or nice-looking natural smiles at a younger age may fail without attention or treatment regarding function. Success or good dental health is completely about correct function or dental occlusion.
Patient’s who have these problems are treated many different ways in different offices. Has your dentist completed an appropriate exam, dental history, medical history, and explained and educated you relative to these problems? Patient’s who have these problems need a treatment plan developed.
Has your dentist completed an appropriate exam, dental history, medical history, and explained and educated you relative to these problems?
Best peer practices include using photography to educate you. Many problems you are not aware of will become apparent in the consultation room with photography of your teeth on a monitor. This should be part of your clinical exam. This is an excellent way to become educated about your dental health. This is an essential part of a new patient exam. Photos are useful to the dentist both diagnostically and for patient education. For example, what teeth show when you smile, are the teeth positioned correctly in the face, and what do the teeth that your dentist would like to restore really look like.
Best peer practices for involved cases in developing a treatment plan include 3 things after a competent clinical exam and patient education. This is a complete set of dental radiographs, photography of the patient, and mounted casts of your teeth. Mounted casts are copies of your teeth in an articulator. This is a device that is anatomically correct to your mouth so that the dentist has a copy of your teeth and exactly how they move. This information is considered the dentists homework. The dentist should study this and develop a treatment plan.
Problems occur when there is no attention given to proper function. Cosmetic cases can fail. Implants can fail. Restorative dentistry can fail. Root canals may be necessary. Orthodontics can fail. Bone loss may occur around the teeth. Teeth may become loose or mobile. Teeth may require extraction or crowns because of fractures. Dental pain may occur. Temporal headaches and other facial muscle pain may occur. Temporomandibular joint problems may occur, and smiles may go away from excessive wear or loss of tooth structure.
Comprehensive dental care is relevant in all areas of dentistry from children’s dentistry, family dentistry or general dentistry, cosmetic dentistry, pediatric dentistry, orthodontics, periodontal dentistry, oral surgery and implant dentistry or removable prosthesis dentistry . The message is that proper dental function is key to a healthy dentition and these principles discussed intersect all areas of dentistry.
Dr. Peter Dawson with the Dawson Academy in Florida and Dr Frank Spear with the Spear Institute in Arizona are two of the most highly respected teaching professionals in the United States and internationally. Both of these doctors teach these principles discussed above. Dr. Dawson teaches the concepts of complete dentistry. His goal is to make dentists the Masters of the Masticatory system. He has stated that understanding and practicing these principles puts the dentist in the top 10% of the dental profession. Dr. Spear has likewise commented that to make a commitment to continuing education at the Spear Institute separates these dentists from the rest of the profession. This is not done by the average dentist. Continuing to learn after a dental school education is critical. It requires time, expense and dedication directed at ongoing continuing dental education and commitment to excellence by the dentist.
It matters who you allow to provide dental care for you and your family.
Key principles of good esthetics:
3 of these teeth are crowns matched perfectly to the other teeth using the rules described below.
- The front teeth should be mirror images of each other with the midline of the front two teeth perfectly vertical or perpendicular to the ground.
- The tissue height over the canines and centrals should be on the same line with the laterals slightly shorter. On the incisal edge or biting edge the canines and centrals should be slightly longer then the laterals and follow the lower lip line. The anterior teeth have a length to width ratio on each tooth and have a corresponding size relationship to each other, as shown in the photo.
- Colors should be appropriate and have proper texture and characterizations to be pleasing in a smile photo.
- Pink tissues or gingival tissues should be healthy, in the appropriate locations and resemble this photo.