Six Month Smiles
November 11, 2012
Typically, fall and winter tend to be my heaviest time for continuing education. What is continuing education for a dentist? It is a must. As in any profession, learning never stops. If you stop learning, you halt growth both professionally and personally.
Dentistry offers continuing education in every aspect of the profession. Dentists can learn everything from new techniques in “filling” teeth to using Botox. In the next month I am travelling to Detroit to learn some new surgical techniques, New Jersey to learn a different way to do root canals, and Arizona for a refresher course on treatment planning and communication with patients. Travelling and being away from home is not my favorite part of this learning process, but you have to go where the information is.
In the 18 years of continuing my education, I have taken courses that have been career changing and others that were of no interest to me. Recently I was in Indianapolis for an orthodontic course entitled ‘Six Month Smiles’.
Many adult patients are unhappy with crooked teeth. Some of them may have had braces when they were younger and didn’t wear their retainers and others may have never had braces but always wanted straighter teeth. I have numerous adult patients who are currently in braces with an orthodontist. I also have many patients that are not willing to make the commitment to wear metal brackets in their mouth for 2 or more years.
A few years ago I took a course for Invisalign. This is a system that uses scanned impressions of the mouth and provides a series of digitally produced removable clear trays called aligners. The patient wears the trays 24 hours a day and is only supposed to remove them to eat and brush their teeth. The trays are changed every 2 weeks and with each change the teeth are moved. The intended end result is straight teeth. Treatment time depends on the complexity of the movement desired. In my experience, treatment usually takes a year or more.
I have had my frustrations with Invisalign. Certain movements of teeth can be unpredictable. In addition, because the patient can remove the trays, there is a compliance issue. I limited the cases I did to patients who I knew would be compliant and had relatively easy tooth movements.
Six Month Smiles is a system that I am using to replace Invisalign. It uses clear braces and a white wire so they are barely noticeable from speaking distance. And, the patient can’t take them off so it makes the movements more predictable in that regard. Why is it called Six Month Smiles? Treatment is usually completed in 6 months with a range from 4-8 months.
These are considered cosmetic braces. That means that their purpose is to treat the patient’s chief complaint, which is usually crooked front teeth. It does not change the bite relationship and is not intended for people with bite issues. The system is absolutely NOT a replacement for traditional orthodontics in most cases. Traditional orthodontics should always be discussed and considered.
However, this is the perfect solution for many adults. If you wish your front teeth were straight, don’t have gum disease, and don’t have any significant bite issues, this system may be for you. Email me some questions so I can write the answers to them in a future column.
Interdisciplinary Dentistry
December 21, 2011
Last week I was invited to attend the annual North Eastern Society of Orthodontists (NESO) meeting in Boston. You may ask why I attended an orthodontic meeting when I am not an orthodontist? The reason I was invited was because of the strong interdisciplinary component of the meeting. What is interdisciplinary dentistry?
I’ll use the example of a 38 year old woman I saw just yesterday as a new patient. She had not been to a dentist in a couple of years and wanted to have her teeth cleaned. She saw one of my hygienists, had her teeth cleaned, and then saw me for an examination. My examination of new patients usually includes a set of photographs of the teeth. Over the years, this has proven to be invaluable for me to be able to discuss a patient’s dental status. It is much easier to show and explain than just explain.
I evaluate 4 areas in every patient. Those areas are the biology, esthetics, function and structure of the teeth. The biology is the health of the gums and bone that support the teeth. This is important because this is the foundation of good health. I always evaluate the esthetics of the teeth because the smile is the most prominent feature of the face. The function of the teeth is an evaluation of how the muscles, joints and teeth are working together – does the patient have any muscles or joint (TMJ) issues and do the teeth show any signs of wear? Lastly, the structure of the teeth is the condition of the teeth themselves – what is the patient’s dental history and what is the condition of the existing restorative dentistry in the patient’s mouth?
As I was taking this new patient on a “tour” of her mouth, I simply described what I saw. As often happens, my patient started asking a lot of questions. The bottom line is that she always wondered why she had repeated dental problems and had a list of things she did not like about her teeth. Her dentists in the past had never looked this deep into her dental issues, so she was never given the opportunity to do anything about it. In the past, if there was a problem, the problem would get the quick fix, a crown or a filling, and life would go on until failure occurred again.
This patient, who came in just to have her teeth cleaned, announced that she was ready to fix her teeth correctly. As her dentist, I need to be able to deliver the level of care she expects. This is only possible with effective collaboration between a group of dentists. Her treatment will probably be phased over the course of a few years. It will require collaboration between me, an orthodontist, a periodontist and an oral surgeon. This is interdisciplinary dentistry.
Much of the NESO meeting was about treatment like this. The dentist must have the educational background of the many different disciplines of dentistry and be able to communicate their findings in simple terms that patients can understand. Doing a complete exam and reporting findings is the obligation of the dentist to the patient. This at least gives the patient the opportunity to choose the level of health that is right for them as an individual.
When it comes to actually doing the dentistry, it is essential that the general dentist, the quarterback of the team, has the right players assembled to make the entire treatment a homerun.
