Dentistry’s Brave New World

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Dentistry used to be a straightforward science&emdash;one that took into account only the health of the teeth and the gums. • But things have changed. • With spa services, anxiety-reducing techniques, cutting-edge cosmetics and more, today’s dentists are going beyond the cavity and catering to the whole person. The days of drill-and-fill dentistry are gone, says Roseville dentist Alfred Osolin, D.D.S. The trend, he says, is away from disease-based dentistry to a broader definition of what dentistry is. Dentistry is moving into the realm of making people look and feel better, says Osolin, whose patients enjoy comfort blankets and 27-inch color TVs while they’re getting smile makeovers&emdash;all with the latest technology, of course. • It’s a brave new world. Here’s what local dentists are doing to make it go ’round.

Aromatherapy, Anyone? Spa Dentistry

Someday, muses Arthur Kwan, D.M.D., there will be an all-in-one building where patients go upstairs to have lipo and come downstairs to have their teeth worked on.

I’ve heard of dentists (outside Sacramento) doing this, says Kwan, who practices with his wife, Sally Hsu, D.D.S., at Nu Smile Dental Group in Rocklin. But I think we’re a little bit more conservative here in Sacramento&emdash;so far.

Although local dentists haven’t added a cosmetic surgery component to their practices yet, an increasing number are offering aromatherapy, warm blankets, herbal eye masks and other soothing services to soften the edge of the dental experience. More and more of today’s modern dental practices are moving toward keeping the patient’s total comfort in mind, says Kwan, who added these and other spa amenities to his dental practice not long after starting his business in 2001. A lot of people we were seeing were very fearful, so we thought, ‘Hey, what if we treated them as if they were friends we were inviting to our home? What can we do to make them feel comfy?’

According to a report released earlier this year by the International Dental Spa Association, there are some 125 to 200 dental spas in the United States. But as the study cautioned, these numbers depend on how dental practices define the term spa.

A lot of them call themselves ‘spa’ because there are candles in the office, scoffs dental hygienist Hilda Sadigh, who persuaded her husband, Jack Harouni, D.D.S., to transform his traditional dental office into Sacramento Spa Dentistry, where services range from paraffin wax treatments to full-body massage.

I’ve been a dentist for almost 20 years and, like a lot of dentists, I’m pretty traditional, so at first I was reluctant, admits Harouni. I kept thinking, ‘How am I going to work in someone’s mouth while someone is rubbing their foot?’

But Sadigh, herself a dentalphobe (imagine the irony), was determined. I know what it is to be afraid of the dentist, she says. I used to demand nitrous oxide [laughing gas], but I don’t need it anymore because I now get a foot massage while I’m having a tooth cleaning.

Although business is good&emdash;and even better since unveiling the dental spa in 2003&emdash;Harouni claims it’s not about the money.

We had a very large and successful practice before the spa, so we didn’t do this to grow the business. We did it to make it a more pleasant experience for me, my staff and our patients.

 

Nighty-Night: Sleep Dentistry

For anxious dental patients, there’s hardly a dreamier solution than being lulled to sleep.

It’s a sweet way to go, says John Hansen, D.D.S., a Roseville dentist and sleep dentistry practitioner. You go to sleep, wake up with no memory of what’s happened, go home and rest.

Sleep dentistry&emdash;also called IV sedation&emdash;is a form of general anesthesia no different from when you go in for a tummy tuck, as Hansen puts it. Although not as widely used as oral conscious sedation, in which patients attain a deeply relaxed state through the use of medication (usually in the form of a pill), its popularity appears to be growing.

Dennis Wong, D.D.S., a Sacramento dentist in private practice, says he’s seeing so much demand from patients that he plans to get IV-certified.

When I explain oral sedation to my patients, they say it’s not enough&emdash;that they want to be completely knocked out, he says. Historically, notes Wong, IV sedation was the domain of specialists, such as oral surgeons. But growing demand has prompted an increasing number of general dentists to add the service.

IV sedation is a boon for the severely anxious patient who wouldn’t climb into the dental chair without it. It also means fewer appointments, since the idea is to let you sleep for however long it takes to get the work done (within reason, of course). And there’s another benefit: You’ll hurt less afterward, thanks to an anti-inflammatory medication added to the IV cocktail. People who use the IV tend to have much less pain after the procedure than people who don’t [have the IV], says Hansen, who reserves the IV option for longer, more involved cases, such as full mouth reconstruction.

Although patients may worry about feeling headachy and hung over following sedation, the main aftereffect, according to Hansen, is fatigue.

But before you get sedated&emdash;whether orally or IV-style&emdash;make sure your doctor has proof of proper training from a reputable institute, such as DOCS, the dental organization for oral conscious sedation. Although the American Dental Association states that anesthesia is safely administered to tens of millions of dental patients every year, the organization has established guidelines for training dentists in the proper and safe use of the medications, which includes monitoring the patient’s condition during treatment. Airway management, Hansen notes, is particularly critical during IV sedation, which may render the procedure unsuitable for overweight or obese patients. Medically compromised patients also are at increased risk.

For most patients, however, the big worry isn’t medical risk, but cost. Whereas oral sedation runs in the ballpark of $200­ to $400 per treatment, the price of IV sedation is much steeper&emdash;anywhere from $800 to $1,200, by Hansen’s estimates.

 

I have more demand for oral sedation because it’s less money and because it’s easier to just take a pill [than an IV], says Hansen, who retains the services of an anesthesiologist only one day a month.

Still, oral sedation just isn’t enough for some people&emdash;and there’s a very good reason for that.

With oral sedation, you’ll be very relaxed, Hansen explains, but you still know the doc’s ‘in there.’

Implants: Changing Dentistry in a Big Way

Are implants the wave of the future? According to several local dentists, the answer is a resounding yes.

Implants have totally changed the way we do dentistry, says Brock Hinton, D.D.S., of the Prosthodontic Dental Group, which places some 700 to 800 implants a year.

Wong takes it a step further, asserting that the current technology is so successful that it’s almost like a physician finding a cure for cancer.

A modern alternative to dentures, implants are a stronger, more attractive option for replacing missing or lost teeth, according to the American Academy of Cosmetic Dentistry. They also are more expensive, notes Wong, who says local dentists typically charge approximately $1,500 for each implant and $900–$1,600 for the crown/restoration.

But, he says, it’s worth it. It’s a great new choice. It’s what I want for myself and my family. An increasing number of patients are asking for implants, too, Wong says, which is why he added the procedure to his list of services two years ago.

What’s so much better about today’s implants? According to Wong, the early ones were experimental and, inevitably, doomed to failure. But the use of titanium changed all that. Titanium integrates with the body, so the [jaw] bone actually fuses to the metal, he explains. It’s like having a real tooth.

Precision and predictability in implant placement is better than ever, notes Hinton, thanks to advancements in computer dentistry. Computers are being used to fabricate surgical stents for precise implant placement, leading to a more predictable result for the doctor&emdash;and less trauma for the patient.

Nonetheless, not all dentists agree that implants are the wave of the future. Keeping our teeth, not replacing our teeth&emdash;that’s the wave of the future, predicts Osolin.

Removing the Fear Factor

Identifying herself as a dentalphobe with a dental emergency, 52-year-old Sue Draper made a phone call this summer that changed her life. After years of dodging the dentist, Draper fell into the gentle hands of Scott Snyder, D.D.S.&emdash;and hasn’t missed an appointment since. (She’s had many.)

He eased my fears when he told me, ‘We don’t believe in pain here,’ says Draper, whose crippling fear of dentists began around age 6, when an abscessed baby tooth was yanked without anesthesia. It hurt and it hurt and hurt, and it was very frightening.

 

Such traumatic early experiences are often the precursor to lifelong dental anxiety, says Snyder, who believes old-fashioned communication is as important as modern-day medications in fighting dental fears.

I find that communication is really the best way, says Snyder, a Sacramento dentist in private practice. Snyder practices what he preaches, reserving a full hour for first appointments&emdash;time that is spent, largely, getting to know his new patient. If we can get X-rays or some other work done during that visit, great. But if the patient isn’t ready, we just spend time talking.

Often, says Snyder, the conversations revolve around the patient’s fears&emdash;what has caused them and what can be done about them. Sometimes it’s as simple as letting the patient listen to music to block out the sounds of the dental office, he says. Many times, he says, patients are embarrassed about their teeth, in which case the best thing to do is to go very slowly and let the patient set the pace.

Snyder doesn’t believe in bouncing around between chairs, either, which, according to Draper, adds to her comfort level. You don’t have people rushing around you, or rushing from room to room. The whole staff is that way.

Giving patients some measure of control also is key to reducing fear, notes Guy Acheson, D.D.S., a Rancho Cordova dentist whose early training in anesthesia resulted in a long history of treating severely anxious patients.

A lot of fear, I think, stems from not having control, says Acheson, whose patients have typically seen up to five other dentists before landing in his chair. By actively involving patients every step of the way, Acheson says, they become part of the decision-making process, which gives them a sense of control. It’s not for me to tell them what needs to be done and expect them to submit their bodies to science, he says. They have to recognize and articulate to me what their problems are, and then we come up with a game plan together.

As a rule, says Acheson, dentists have traditionally been not very sympathetic to patients and their needs&emdash;but they need to be.

You can get distracted with a lot of technology, he says, but dentistry is a people thing.

 

Cutting-Edge Cosmetics

Will a megawatt smile give you va-va voom power? You know, sex appeal?

Most American adults&emdash;96 percent, to be exact&emdash;believe it will, according to the American Academy of Cosmetic Dentistry. That, plus the proliferation of television makeover shows, are just two factors behind the industry’s explosive growth, with some doctors reporting close to a 40 percent increase in cosmetic services in 2005.

Business continues to boom, says Hansen, who specializes in cosmetics. The biggest change I’ve noticed in the past five years is that there are so many options. It’s not just veneers anymore.

The latest craze, according to several local dentists, is Lumineers. Every single day I have patients who call and ask if we do Lumineers, says Hansen, who credits the frenzy to a fantastic advertising campaign. Similar to conventional veneers, Lumineers are ultrathin porcelain laminates that are affixed to the teeth, remedying such cosmetic issues as gaps, small teeth and discoloration. But there’s a difference: While veneers require tooth removal, Lumineers are simply placed on top of the teeth&emdash;which, according to Hansen, makes them a viable option for only a small percentage of people. If you think about it, the only time you’d be able to do that and not look like Mr. Ed is if you have really small, narrow teeth that need to be made bigger, he says. That’s not really a very high number of patients.

 

Lumineers can’t solve every problem, agrees William Swearingen, D.D.S., a cosmetic and general dentist in Citrus Heights. But for people with minor space, crowding or color issues, he says, they’re a great product and really have a place. One advantage of Lumineers, says Swearingen, is that the bonding is done directly to enamel, which is the strongest bond. And because there is no tooth removal, he says, a patient who is unhappy with the results can always elect to have them taken off. Lumineers are usually less expensive than conventional veneers, too&emdash;an important consideration since veneers start around $1,200. For best results, Swearingen adds, look for a dentist with substantial experience with Lumineers.

Tooth-whitening continues as the most popularly performed cosmetic procedure, reports the AACD, and the materials just keep getting better, notes Kwan. One of the most popular, Zoom!, was preparing to release its third generation, Zoom! Advanced Power, at the time of this writing. The big difference with the new Advanced Power is [you’re] reaching an even whiter shade in slightly less time, reports Kwan. Zoom!&emdash;which involves applying a hydrogen-peroxide whitening gel to the teeth, then activating it with a specially designed light&emdash;originally took only about an hour and a half in the dentist’s chair, resulting in teeth that were six to 10 shades lighter.

 

Orthodontia also continues to offer exciting new alternatives. When I suggest orthodontics, people immediately think ‘braces,’ which a lot of them don’t want, says Swearingen. Those who would rather not spend the next several years with a mouthful of metal can now consider Invisalign. The clear plastic aligners get brownie points for invisibility and speed, often taking a year or less from start to finish. Swearingen also practices what he calls instant orthodontics, modifying the shape of the teeth and the gums (with lasers) and applying porcelain veneers for a brand-new look, making it appear that the teeth have been moved orthodontically.

Lase-O-Rama

Just as lunchtime lasers became all the rage for aging baby boomers wanting younger-looking skin, lasers are fast becoming a staple in dentistry, used for everything from diagnosing cavities to fixing gummy smiles.

I can’t work a single day without a laser, says Osolin. It’s a wonderful tool.

Osolin, who routinely uses lasers for gum contouring when doing cosmetic work, is especially excited about the diode (soft tissue) laser’s use in fighting gum disease. The laser has extended by at least 100 percent our capacity to control conventional gum disease, he says. Lasers work by disinfecting the periodontal pocket, explains Osolin, resulting in bacteria-free gums that stay healthy longer between treatments.

Another laser gaining ground among local dentists is the Diagnodent, an ultrasensitive laser that can detect cavities in the formative stage, long before an X-ray would. And there’s even a laser that may make it easier to drag your kids to the dentist: the Waterlase, which makes it possible to remove tooth decay without a drill.

Lasers in dentistry have unlimited potential, says Kwan, who notes that other current uses include draining of abscesses, biopsies of suspicious tissues, fibroma removals and treatment of cold sores. I believe lasers should be the standard of care in a dental office, he says.

 

D.D.S., I Love You
By Andrea Todd

This month, I will celebrate my one-year anniversary with Paul. And my husband, Gary, is thrilled. Take the kids, he suggests. I came to Paul in pain&emdash;physical and emotional: the right side of my face swollen from a dying upper bicuspid, my lower left jaw throbbing from a fractured molar, a root canal never completed.

How did it get to this point, you ask?

That’s where the emotional pain, the result of years of dental-related abuse, factors in&emdash;the psychological scarring due to hours of humiliation spent reclined, in that chair, with that glaring interrogation light blasting hot on my face, a bespectacled man accusing, You don’t floss! I can tell, you know, when a patient is lying to me. . .. Do you brush your teeth? You eat a lot of sweets, don’t you? Don’t you? Don’t tell me you don’t! I can see candy corn trapped in your gumline from last Halloween!

Then, drill in hand, You really should take better care of your teeth . . .

By the time I saw the scene in the movie Marathon Man (the dentist drills teeth sans Novocain to extract information), it didn’t frighten me a bit ’cause I’d lived it, baby. Boy, did I live it. If I were to analyze it Freudlike on some proverbial couch, I could recall exactly when my dental trauma began. At age 7 or 8, I was still a thumb sucker, and my mother had the brilliant idea&emdash;since she couldn’t get me to stop herself&emdash;to have Dr. Crookham, a perfectly nice dentist up until that point, lecture me on how I’d have ugly buck teeth if I continued. I remember that day in the office the way a child would remember getting lost in the supermarket or having to go get the belt: sweet Dr. Crookham reaching for my thumb when I denied my habit, describing in a stern voice he’d never used with me before how my teeth would stick out of my mouth like a rabbit’s if I kept it up.

Humiliated, I started to cry.

Thankfully, our insurance forced us to switch dentists. And that’s when the fun really began: Entering a cavity-prone age, I was a constant presence at the dental office, where they drilled my mouth like it was the Gulf Coast. The drilling was bad enough&emdash;that burning smell of excavated decay, the noise&emdash;without the dentist peering into, stretching the sides of, pinching and prodding my mouth&emdash;and of course, there was The Shot.

Back then, as I will tell my children someday, The Shot hurt. The Shot, I was to discover, really hurt when you were having your two front teeth drilled and the dentist jammed the needle up into the area just below your nose.

 

I was 9 years old. I cried. I screamed while I cried.

Look at those elephant tears, the dental assistant mocked. Aren’t you a little big to be crying so much?

Because I was so cavity-prone, the dentist recommended fluoride treatments&emdash;thick, orange goo I somehow swallowed during the course of one procedure and threw up into my lap.

It was all my fault, everyone seemed convinced. Everyone&emdash;my mom, the dentist, his assistant&emdash;Nurse Ratched of the dental world&emdash;insisted I needed to eat less candy, brush more, floss. Not drink sugary sodas. It’s why my teeth were yellow, I was told when I complained about their color. That, or They’re naturally that way; there’s nothing we can do.

To make matters worse, my sister, who drank sugary sodas, ate what I ate and didn’t brush as often because Mom was too busy monitoring my brushing, had my mom’s perfect teeth. They were white and rarely had cavities, just one root canal when my sister got hit with a softball. The only person who didn’t scold, didn’t lecture, didn’t get mad at me every time I saw the dentist was my dad, whose teeth were naturally yellow and who, as a result of bone loss, had lost a few by the time he was 40. (Gee, think there’s something genetic going on here?)

I resisted every visit to the dentist with tears, panic attacks, Dad dragging me to the car. I once gave myself a headache over an approaching dental visit. Another time, I ran away, hid in the bathroom for an hour after school, purposely missing an appointment. (Is it any wonder I still sucked my thumb?)

Eventually, I went back to Dr. Crookham. That checkup was my first cavity-free one ever. Dr. Crookham ended up fixing my rabbit teeth (admitting my two front teeth were naturally oversized&emdash;not in any way a result of my thumb sucking); he even removed two of my wisdom teeth.

 

In 1988 I moved to New York, where I worked as a freelance writer much of the time and had no dental insurance. Only in cases of extreme pain&emdash;and I’m talking excruciating nerve damage here&emdash;would I go to some friend’s fancy dentist. (One worked on Michelle Pfeiffer’s pearly whites!) These dentists would peer inside my mouth and try to contain expressions of shock and disbelief. They’d do just enough to get me out of pain, and then start suggesting procedures I could never afford out-of-pocket.

I thought I’d found my Dr. McDreamy in Stanley Tushman, D.D.S. I returned to see him six times. When he told me I needed a root canal in a front tooth that so long ago had fallen prey to decay, I started to sob openly because of The Shot I’d have to get. I give the best shots in the city, he assured me, and he did, with a soothing tone and an understanding smile. He did the emergency procedure the night before Thanksgiving, and called me Thanksgiving morning to see how I was feeling. I developed a bit of a crush on him. I even started wearing mascara to my appointments! I saw him until I ran out of room on my credit card; he became upset when I couldn’t have surgery on a gum issue that would have cost $2,000. That’s when things started to sour. After I had moved from one sublet to a cheaper sublet in Harlem, and then back to California to get some money saved, he had trouble locating me to pay the balance on my account. Finally, he tracked me down here, where he sent me a nasty note threatening to sue me if I didn’t pay the $300 immediately.

Stanley . . . where did our love go?

In 2005, I came to Paul Phillips, D.D.S., of East Sacramento Dental Care, with a mouth that looked like Beirut. He has been my dentist ever since. It’s the first time I’ve seen the same dentist for a whole year since 1988. He jokes about the shape of my mouth almost as much as I do (a different approach, say, than the dentist who kept saying things like, Oh, boy, Wow, this is something, and I’ve never seen this problem before!). He pulled the cracked tooth, root-canaled a few, crowned a couple. The procedures have not been pain-free, but I don’t dread them. He explains every procedure and insists that I tell him if I’m feeling discomfort. Not pain&emdash;discomfort. (It doesn’t really matter if I don’t: Dr. Phillips says he can see it in a patient’s eyes when something hurts.) Where another dentist had suggested root canals and partials&emdash;even dentures, Dr. Phillips suggested restorative work on each tooth first&emdash;painstaking procedures more prolonged, but ones that would nonetheless salvage teeth. And he doesn’t shrug off my (comparatively trivial) concerns about the way my teeth look&emdash;in fact, he considers that an important part of his job. When he asked me, Do you want perfect teeth? I laughed out loud. You can’t do that, I replied, then, Can you?

We’re just about done with one side of my mouth, and those teeth look great. We’re working our way around, trying to undo years of damage and neglect. I can’t say I enjoy dental visits, but they don’t make me throw up anymore. Most importantly, I go. And next month I’ll be taking my kids.

You know you’ve got a good dentist&emdash;a great dentist&emdash;when he keeps you coming back for more. When you’re a mom and you trust your kids’ mouths&emdash;and their fragile, impressionable young psyches&emdash;with him and his whole staff (which consists of no Nurse Ratcheds; only warm, cheerful employees who offer up near-perfect smiles as incentive).

Happy anniversary, Dr. Phillips. Thanks for giving me back my smile.