During the past 25 years, dentistry in America has seen numerous changes in technology, treatment techniques, marketing and traditions of practice. Some of these changes have benefited consumers, but many have been detrimental to both consumers and dentists. Long gone are the days when choosing a dentist and a treatment was simple. Today’s consumer seeking the best dental deal is faced with a bewildering profusion of options.

For example, there are single (individual) practitioners, dental-school clinics, union clinics, HMOs (health maintenance organizations), and referral schemes; “holistic dentistry” and conventional treatments; fixed bridges, removable bridges, and implants; silver fillings and plastic fillings; mouthwash regimens and gum surgery. But which options are reasonable? Which are fraudulent? And what are the tip-offs of dental wrongdoing?

Dishonest Dentists?
The lead article in the February 1997 issue of Reader’s Digest asked: “How Honest Are Dentists?” William Ecenbarger, the article’s author, conducted a multi-state investigation to answer this question.

Dentist John Dodes and two other experts examined Ecenbarger’s mouth separately to establish a diagnostic baseline. Ecenbarger specified that he did not need or want any strictly cosmetic services. The three panelists decided, independently, that he had only two dental problems: a decayed tooth that needed a filling or a crown and a faulty crown, replacement of which was optional.

Ecenbarger then visited 50 dentists he had “randomly selected … from the Yellow Pages in 28 states and the District of Columbia.” He told each dentist that he was relocating, that he had good insurance coverage, and that he was satisfied with the appearance of his teeth. Only 12 of these dentists properly diagnosed the problems the expert panel had discovered. Many wrongly told Ecenbarger he needed extensive treatment. Fifteen dentists did not identify the decayed tooth, and three told Ecenbarger he didn’t have any dental problems. Prices for proposed treatment ranged from about $500 to more than $29,000.

Considering that most of the treatment plans submitted to Ecenbarger were inaccurate, inappropriate or fraudulent, how confident can a dental consumer be? Add to this the burgeoning problems of quackery and hurried, incompetent “care,” and it seems dental consumers have much to be concerned about.

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If that rings familiar to you, so may the rest of it, which goes, “You’re never fully dressed without a SMILE.”

So sang the passel of lovable orphans in the musical “Annie.” And it’s a tune that is being hummed by more and more dentists today.

“When you correct the smile, you see the face differently. It’s about beauty, it’s about self-esteem, it’s about feeling confident about yourself. Who has the right to tell you that you shouldn’t have those things?” said Dr. Ronald Goldstein, DDS, who is just the one to pose that question.

A prolific author — one of his several books, “Change Your Smile” (Quintessence Books) is in its third edition — and pioneer in the field of cosmetic dentistry, Goldstein is a champion for sparkling ivories. “Patients will say to me after we’ve done a procedure, ‘People think I’ve had a facelift.’ That’s the best.”

“It’s true. My friends all thought I had a facelift, but I didn’t,” laughed Sandra Cape in a soft, rolling accent reflective of her home in Atlanta, Ga. The 58-year old made the decision to have a series of procedures done five years ago by Goldstein, including adding porcelain laminates on her upper teeth, braces to help straighten others, replacement of crowns and tooth bleaching. While Cape always loved her smile — “I do have to say, I have always had a nice smile,”– there was one but: a darkened, discolored front tooth that bothered her for years.

“I have to admit I was very self-conscious about this. It just didn’t seem to go with the rest of my mouth,” she said. On a visit to Goldstein’s private practice — Goldstein, Garber, Salama & Gribble L.L.C in downtown Atlanta — the veteran dentist with 40-plus years experience used computer imaging to show Cape what she would look like with the changes.

“I don’t think of myself as a vain person. But when I saw the difference, well, it was like when you see a wonderful antique or piece of art that you absolutely love. You have to have it,” she recalled, adding the entire procedure cost her around $40,000.

Cape is just one of the hundreds of thousands of Americans moving toward extensive cosmetic dentistry to not only improve their looks, but enhance their oral hygiene and lengthen the life of their teeth.

“I don’t differentiate. All dentistry is cosmetic dentistry,” said Dr. Richard Price, consumer adviser for the American Dental Association (ADA) and president of the Newton Dental Associates in Newton, Mass. “Brushing your teeth, flossing, changing a filling, getting rid of a stain — is all cosmetic. Of course, the only one who thought a silver filling was beautiful was a dentist. But to me, it all enhances your teeth.”

While that may be true, Price is quick to point out that the options available now are so varied and sophisticated that virtually no one has to live with bad teeth, or a lousy smile.

“This is almost 100 percent true, because even if all is lost, we have implants. We can virtually replace dentures with gorgeous implants,” said Price, who has been practicing since the mid-1960s. “I am 59 years old and probably the first in my generation since Adam that has my own teeth. It is all too common for us to have parents who had full dentures. That is almost obsolete.”

Coupled with the changes in technology that have led to such things as resins, porcelain laminates and tooth-colored fillings to replace the old silver amalgams, there is evolving aesthetics of the art of dentistry.

“You are sculpting teeth, matching colors, designing bite. It takes skill and precision,” said Goldstein. And the public appreciates it. According to a recent survey conducted by the American Academy of Cosmetic Dentistry, 9 out of 10 people think that an attractive smile is a huge asset, two-thirds believe that an unattractive one hurts your chances at success, and almost 90 percent always remember someone with a great smile.

According to Rob Johnston, he is one of the unforgettable.

“I am not kidding when I tell you that for six months after I had all my work done, I did not encounter one person who didn’t comment on my teeth. That includes strangers,” said the gregarious 52-year old president of the Pinnacle Company, an Atlanta-based apartment management firm. “Now, nine years later, it’s what I’m known for.”

To get those pearly whites, Johnston had to endure two years of wearing braces — “I was the only one in the orthodontist’s office over 15″ — and had to give up something else. “This was instead of the Porsche I really wanted. He took my darn car.”

Goldstein also straightened his top teeth, and “basically enhanced every tooth in my mouth.” After years of feeling self conscious of his smile because of poor dental work, Johnston was eager to pay the cost, which turned out to be $45,000.

But the moral of the story is that Johnston still ended up with his Porsche, albeit several years later, and has a renewed sense of self-confidence.

“People want to be around happy people. A smile is the best way to manifest that. A smile eases people’s defenses, and just makes really good business sense,” he said.

While oral hygiene and tooth-longevity are some of the sensible reasons, proponents point to self-esteem as one of the most important.

“Absolutely. This is no joke. When someone leaves the chair in my office with tears in their eyes, it’s not because of pain,” added. Dr. Price.

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About the time your child turns five, he will start the process of losing his baby teeth, and permanent teeth will emerge. The timing for this varies for each child. Generally, if your child had teeth early as a baby, you can look for the permanent teeth to appear early as well. A common situation I have seen with kids this age is when permanent teeth erupt prior to the loss of the baby teeth. If this is the situation with the bottom teeth, encourage your child to wiggle and loosen the baby teeth on his own. If this occurs with the upper teeth, you should consult your dentist, as the placement of the permanent tooth could be affected.

Once all the permanent teeth are in place, you should speak to your dentist about having a dental sealant applied. This has been shown to be effective in protecting the permanent teeth from decay.

Dental Emergencies

As with most things in life — prevention is always the goal. Encourage your children to use mouth protection if your child is involved in sports. You can talk to your dentist about the proper appliance for your child. However, accidents still will happen.

*If your child breaks a tooth or loses a tooth — CONTACT YOUR DENTIST IMMEDIATELY. Keep the mouth clean. Apply ice if there are signs of swelling.

*Should your child complain of a toothache, have your child rinse with warm water. Try flossing in the event the pain is caused by something lodged between the teeth. If the pain persists, call your dentist.

*If your child cuts his tongue, gums, lips, etc … understand it usually appears worse than it is. The mouth is a wet environment; it may appear to be bleeding profusely. Rinse the mouth with water. Apply ice (ice pops work great with little ones), if the bleeding does not slow down, call your dentist or go to the emergency room.

Orthodontics

The ADA states: “It is recommended that every child receive an orthodontic evaluation by age seven” to identify any orthodontic problems. The ADA defines orthodontic problems as malocclusion. “Some examples or causes of malocclusion are crowded teeth, extra teeth, missing teeth or jaws that are out of alignment. Most malocclusions are inherited, although some can be acquired. Acquired malocclusions can be caused by accidents, early or late loss of baby teeth, or sucking of the thumb or fingers for a prolonged period of time.” Today there are many options available in terms of types of orthodontics or braces. Generally, the duration of treatments is about 24 months — but this varies depending on extent of correction needed and compliance of patient.

An excellent source of information is the American Dental Association. If you need help locating a dentist in your area or would like additional information on this topic, you can visit their Web site at www.ada.org.

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The American Dental Association (ADA) recommends scheduling a visit to the dentist within six months of the eruption of the first tooth, and no later than the child’s first birthday. Unfortunately, many parents are under the mistaken idea that no dental care is needed until after the eruption of permanent teeth.

Early dental care is important for several reasons. First, the parents will learn how to care for the child’s new teeth. Cleaning even the tiniest new tooth is essential. The dentist can also assess any potential problems perhaps relating to nursing, bottle-feeding, thumb-sucking, etc. The dentist will also assess your child’s need for fluoride. You should check your water supply for fluoride, if your water is not fluorinated, a vitamin supplement may be necessary. And possibly the most important reason for early dental visits is to ensure your child’s comfort at a dentist’s office.

I made a point of finding a local dentist that specialized in pediatric dentistry. The dentist and staff are very compassionate. They are specially trained to deal with the pediatric patient and their special needs. They are also expert at being silly and reassuring at the same time and guaranteeing your child’s comfort. As a matter of fact, my dentist office is so fun that my kids whine to me, “Mom, PLEEEEAASE! Can we go to the dentist?” His office has an arcade room, video games, toys, etc. We actually go early to insure the kids get enough time to play. I will admit; this extra fun comes with a price. This dentist is more expensive than a family dentist, but no more expensive than a day at an amusement park. That is the way I look at it. I am happy to pay the extra money. My kids are happy and have a great time. And when there have been problems, my children are comfortable with the dentist. My daughter didn’t even flinch when she had to have a cavity filled in a “baby” tooth.

The First Visit

You can help reduce anxiety by telling the child what to expect before the first visit. Naturally with very young children this may take some creativity. Role-playing is often very effective. Reading books specifically written for children on the subject might also help minimize fears. On the initial visit you might expect an exam, X-rays, cleaning and perhaps a fluoride treatment depending on your child’s age.

Brushing

Beyond regular every-six-months visits to the dentist, daily sound oral hygiene should be encouraged at home. Believe it or not, this should begin before your baby even has teeth. According to ADA “Wiping baby’s gums with a clean gauze pad after feeding will remove the plaque and bacteria that can harm erupting teeth.” A particular concern at this stage is protecting newly erupting baby teeth from decay due to continued exposure to sugary liquids (i.e., milk, juice, etc.). Never put your child to sleep with a bottle! Before sleep, wipe your child’s new teeth or gums with a damp piece of gauze.

By the age of two you can begin to introduce toothpaste. Initially, parents should see to the brushing to be certain the teeth are adequately clean. Use no more than a pea sized amount of toothpaste and teach your child not to swallow the toothpaste. The ADA warns of the risk mild fluorosis, “which is a cosmetic defect noticeable as very light spots on permanent teeth and develops only while the teeth are still forming. Fluorosis only occurs when more than the optimal daily amount of fluoride is ingested.” Parents are urged to continue regular supervision and educate their child on proper technique until about the age of six or seven. Be sure to include instruction on flossing as well. Children should be flossing and brushing daily.

According to the ADA, the following should be considered when choosing toothbrushes and floss:

“The most important thing to look for when choosing a toothbrush is the ADA’s Seal of Acceptance. The Seal is the symbol that the product meets ADA standards for safety and effectiveness. The ADA recommends consumers change their toothbrushes at least every three months or sooner if the bristles become frayed. Children’s brushes may need to be replaced more often because they can wear them out sooner.

Powered toothbrushes are another excellent idea. Powered toothbrushes may be easier to use for people with dexterity problems or a physical disability. Children may also be more inclined to brush regularly because of the novelty of using a powered toothbrush.

Floss or other inter-dental cleaners don’t come in such fancy packages, but are equally important for oral health-care and should be used by everyone once a day. Again, look for the products with the ADA Seal.”

Early oral hygiene, practiced daily, will instill good habits to last a lifetime.

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The first thing you should do is throw out your non-electric, bristle-worn toothbrush and replace it with a fresh, new, electric toothbrush (you should get a new toothbrush at least every three months). If a deluxe model is not in your budget, a standard, battery-operated toothbrush will do the trick. These usually run for around five or six dollars or so and can be purchased at most any department or drug store.

Most people brush their teeth once in the morning and once before they go to bed, but care should be taken to brush your teeth after lunch and dinner as well. If you don’t have access to a sink and other necessary materials during these times, at least carry with you a package of nonstick, sugarless gum, preferably a brand containing xylitol. Not only will this help prevent plaque and tooth decay, it will help freshen your mouth in general (you don’t want your boss or that important client to avoid talking to you because of your bad breath).

When you do brush your teeth, you should brush vigorously for at least three minutes (six is preferable), which may seem like an eternity to some, but is well worth the time. After brushing, you should use a good mouth rinse, such as Listerine Total Care, which helps strengthen teeth, fight plaque, reduce cavities, restore minerals to enamel, and kill germs that cause bad breath (once again, you don’t want to scare off associates by simply talking to them face to face).

One of the most important ways to take care of your teeth is to floss each and every night. Simply take a strand of floss (10 to 18 inches is preferred), slip it between each of your teeth (all the way down to your gums), and floss with 10 or so vertical strokes to dislodge food particles and plaque. Not only will this help preserve your teeth (“floss only those teeth you want to keep,” a dentist once said), it will give you good, strong gums that are largely free of bacteria. If your gums don’t bleed a bit during teeth cleanings at the dentist, there’s a good chance that you are flossing regularly.

Naturally, sweet, sticky foods should be avoided to maintain a bright, healthy smile. If you must indulge in sweets (and who doesn’t from time to time?), only do so when you are in a position to brush and floss immediately afterward. Also, instead of eating nutrition-absent sweets for an extended period (such as nibbling on jelly beans while sitting at your desk), eat a cookie or a piece of pie (at least they have some food value), finishing it within a couple of minutes so you can go take care of your teeth and get back to what you were doing. Even better, substitute sweet snacks with cashews, carrot sticks, or pretzels.

Taking care of your teeth is an important aspect of maintaining a healthy lifestyle. Regular brushing, flossing, and other such preventative measures can help ensure that you have a pretty smile and relatively inexpensive, hassle-free trips to the dentist. Speaking of the dentist, you should visit him or her every six months.