Patients too fearful to go to the dentist. Educate patients that dentistry has changed

The American Dental Association studies indicate that 50% of the population in the United States don’t see a dentist on a regular basis. Fear is one of the most common reasons we hear for this lack of care. Patients often tell us of bad experiences going to the dentist as a child. Many patients don’t realize how much dentistry has changed. First of all, the anesthetics are much improved, they act more quickly, last longer, and do a much better job of eliminating all feeling in the tooth. We use a topical anesthetic to numb the area before the shot, and with smaller and thinner needles, the shots are virtually painless. Drill techniques have also improved greatly. While it is still necessary to sometimes use the "drill", they are so much improved that the drilling time is greatly reduced. Many patients use tape or CD players with headphones to further relax during a dental procedure. If a patient says " I hate dentists ", let him or her know how much dentistry has changed, and is no longer a need for fear. 
 

Accidental tooth loss by injury Act Quickly

If the tooth is loose, even extremely so, but is still attached in any way, leave it in place; do not remove it. If it is out of the socket completely and unattached, but is still in the victim’s mouth, it is best to have the person hold it there, if possible, until a dentist can attempt re-implantation. If it is out of the mouth, do not let it dry out. Handle it as little as possible. Do not attempt to disinfect the tooth or scrub it, or remove any tissue attached to it. If it is recovered from the ground or other soiled area, rinse it off in lukewarm water. Preserve it in milk until a dentist is available. If milk is not available, lukewarm water will suffice. Time out of the socket is critical in the long term success of re-implantation. After 30 minutes, the success potential begins to decline. However, re-implantation is still possible after several hours, so the attempt can still be made even if the tooth has been out for a long period. 
 

Dental decay - "cavities"  Prevention through the use of sealants

Fluoride has been a great benefit to patients of all ages in helping prevent dental decay. Regular brushing and flossing lowers the chance of developing "cavities". However, the most decay-prone areas of the teeth are the grooves and depressions on the chewing surfaces of the back teeth 
which require further preventive care. To prevent decay, a plastic-like coating called a sealant should be painted on the chewing surfaces of all the back teeth. Studies have shown that sealants can reduce tooth decay by as much as 90% to 100%. The American Dental Association recommends sealants be placed as soon as the first adult teeth come in at age 6 or 7. Sealants should continue to be used as each adult back tooth comes into the mouth. All back teeth that need to be sealed are present by age 13. Sealant application is simple, fast and painless. 
 

Gum disease - THE SILENT KILLER OF TEETH Detecting early symptoms

The American Dental Association says that over 75% of all adults have or will have some form of gum disease. With statistics like this, it is important that all health providers are aware of the signs and can make the proper recommendations to the patient. Gum disease, or more commonly called "periodontal disease", is a bacterial infection in the gums and supporting structures of the teeth. It can be divided into several categories. 
The first stage is called "gingivitis" and is characterized by gum tissue that is red, puffy, and bleeds easily when touched with a toothbrush, 
floss or dental instrument. The second, third, and fourth stages are initial, moderate, and advanced "periodontal disease", respectively. These stages are different from gingivitis because the infection has destroyed the bone supporting the teeth, causing eventual tooth loss. Additional signs of advanced gum disease are swelling of the gums, pus oozing around the teeth, bad breath, receding gums and looseness of the teeth. The treatment is more involved at these stages, usually consisting of a special cleaning with anesthetic and sometimes gum surgery. 
 

Patient concern about AIDS Modern infection control

A recent survey of dental patients showed that infection control was #1 on their list of concerns about dental care. Some patients have even stopped 
going to the dentist because of their fears. Fortunately, trips to the dentist have never been safer. The case in Florida where the patient was apparently infected with the AIDS virus by her dentist is the only such case out of tens of millions of dental treatments performed since the introduction of the virus. The Center for Disease Control still does not know the method of infection. Even one case is too many. The dental profession has responded by adopting "universal precautions". These involve sterilizing all instruments in dry-heat ovens or steam autoclaves to kill any bacteria or viruses. Disposable items are used whenever possible. The chance of contracting an infection in the dental chair is extremely remote, but the chance of losing one’s teeth because of lack of proper dental care is extremely likely. We should not let our patients’ unfounded fears lead them into real problems. 

Discolored teeth Adhesive Dentistry

For over 100 years, dentistry has restored teeth primarily with a material made of mercury and silver. It has done it’s job well, although we have had to live with it’s weaknesses. Those weaknesses consist of cracking teeth due to the expansion of the material, and restorations turning black as the silver material corrodes. Now in 1997, we have many ways to provide tooth-colored restorations. We can use adhesives to bond tooth parts that look and act like teeth. We can provide a bright, healthy and strong smile with these exciting new techniques in adhesive dentistry. 
 

Medications causing dry mouth create an increase in cavities in the senior population  Topical fluoride rinses

Many seniors today have retained their own teeth, avoiding the trauma of removable dentures. Many are on medications creating dryness of the mouth as a side effect. Without the natural benefit of saliva to decrease bacterial action, we see an increase of cavities on the root surfaces of 
these patients. Anyone on a medication causing a dry mouth effect should be encouraged to see their dentist for regular dental cleanings and topical fluoride rinses. 
 

Dental disease associated with pregnancy A dental evaluation and preventive dental care

Many mothers have experienced gum disease, dental pain and/or tooth extraction during or shortly after pregnancy. This is often seen as being a "normal" side effect of being pregnant. Dental disease, which is an infection of the teeth and/or gums, is not "normal" for any patient. There are three basic things that happen during pregnancy which make the patient more susceptible to dental disease. First, hormonal changes may make the gums more susceptible to gum disease. Second, pregnant women to eat smaller, more frequent meals, exposing their teeth and gums to tend sugar and acids more often. Third, the cravings for "junk foods" and inadequate oral hygiene pose an increased threat to the teeth and gums. Pregnant women should be advised to schedule a dental evaluation and receive preventive dental care. Personalized oral hygiene instruction should also be given to fight disease and promote overall good health for the mother and her baby. 
 

Missing teeth  Implants

"Well, you know Doc, it’s only a back tooth. No one will see it so I’ll just get rid of it. It’s not going to make a difference". The plain truth is that it will make a difference. The loss of just a single tooth can set a course that can destroy the entire mouth. "Well, if that’s true, tell me more. I sure don’t want to lose the front ones that I smile with". Teeth will drift and tip into a space that is created by missing teeth. Just like two gears of a car that are not properly aligned, pretty soon you’ve got a whole lot of problems. "Well I don’t like that. What can I do?" If it sounds like I’ve heard this conversation a few times, you’re right. If I’m going to keep a patient happy, I need to provide options at this point. One of the options would be an implant. This is the replacement of a tooth with a false root that is surgically placed. It is often followed by the careful construction of a crown which replaces the missing tooth, to prevent teeth from shifting and thereby avoiding further tooth loss. 
 

Bad breath (halitosis) Dental evaluation and treatment of probable tooth decay and gum disease

While bad breath might be a symptom of some other disorder, it most likely stems from dental decay and periodontitis (gum disease). Periodontitis is a disease affecting gums and bone that support the teeth, and it results from inadequate tooth brushing and flossing. In this disease, the irritated gums pull away from the teeth and form pockets between the teeth and the gums. These pockets fill with bacteria and pus and give off a foul odor. 
Patients with bad breath should be referred for a complete dental evaluation. If gum disease and/or dental decay is diagnosed, it can be treated readily. The patient will no longer have an infection in his or her mouth, and he or she will no longer have the embarrassment of bad breath.