2006 Top Dentists

By Brenda Melvin / Illustration by Matt Mignanelli

Extreme Makeover
Trends In Cosmetic Dentistry

"The American ideal of what is white and what is not has completely changed within the last five years," says Dr. Kevin Ryan of the Springfield Esthetic Dental Center. "Lighter isn't good enough." Ryan is referring to the increased desire for extreme tooth whitening, due in part to the plethora of consumer ads and beauty makeover shows that flaunt porcelain perfection. A recent study of the American Academy of Cosmetic Dentistry found that demand for tooth whitening procedures has increased by more than 300 percent since 1996.

There are a few options for achieving a brighter smile. Folks who are in a hurry for whiter teeth may opt for in-office bleaching. During this process, also called chairside bleaching, the dentist applies a bleaching agent to the teeth and uses a special light or a laser to enhance the results.

Most patients choose the dentist-supervised at-home bleaching route. As Ryan explains, this process involves making an impression of the patient's teeth in order to create "trays" for the upper and lower rows which are then filled with a whitening solution and worn for an hour a day for a prescribed number of weeks. The results of this treatment typically last about two to three years at a cost of $299 to $500. The process is not for everyone, however. "Patients should have all natural teeth in the area that they are whitening," Ryan advises. For example, those who have crowns will likely achieve an uneven result in terms of coloration. Also, patients with sensitive teeth, periodontal disease or worn enamel may not be suitable candidates.

For those with greater financial resources, veneers have become the makeover of choice. A veneer is a thin shell of porcelain that is adhered to the tooth to change the size, shape and/or color. Patients who opt for veneers usually want to change all of the teeth that are visible in their smile. Over the course of a couple of office visits, the teeth are prepared, a mold is created and sent to a lab for fabrication of the veneers, and the bonding process is completed. The results? "Patients see a spectacular change in the way their teeth look right away," says Ryan. He does, however, caution patients to have realistic expectations since veneers are considered reasonable facsimiles of natural teeth, not perfect replacements. "People with unusually high expectations who will examine their teeth for every little imperfection are unlikely to be satisfied," he notes. Veneers can last anywhere from ten to twenty years depending on the way they are treated. "The worst enemies for veneers are poor dental hygiene and heavy teeth grinding, which can lead to a bad bite," Ryan adds. At a cost of $600 to $2500 per tooth, it pays to take care.

Cosmetic options are also available for restoring missing teeth. Bridges involve bonding a thin tooth-colored material to the back of the adjacent teeth to hold the replacement tooth in place. In some cases, a crown may also be used to support the missing tooth for a longer-lasting result. Today, dental implants are considered the gold standard—functionally and aesthetically—for tooth replacement. A small titanium screw is placed directly into the jaw bone to replace the root portion of the missing tooth. After placement, the implant must then fuse with the bone, a process that can take weeks, or even months, to complete. Also, implants can be quite costly, averaging $1200 to $3000 across the country. However, the upside is that almost anyone who can tolerate a tooth extraction can receive an implant, and the opportunity to sustain the look, feel and function of their natural teeth for several years.

Fear Factor
The Advent of Pain Free Dental Care

The dreaded needle, the cringe-inducing sound of the drill, the blinding light that magnifies your tension, daring you to squirm. It's no wonder millions of people avoid much-needed care based on the fear and anxiety they associate with a visit to the dentist. Dental phobes take note: there is a potential solution—in fact, quite a few.

Lie back and relax...
Sedation dentistry, a method that allows patients to receive treatment while in a relaxed, monitored state, is a large part of Alexandria Dr. Andrew Sklar's dental practice. Patients take a sedative pill an hour prior to treatment and arrive with a companion. Once the sedative takes effect the dental procedures are completed, often leaving the patient with little or no memory of the experience. Five to six hours of rest post-treatment is recommended. "Most patients feel no discomfort whatsoever during their treatment and feel surprisingly good afterwards," says Sklar. The patient is never unconscious but rather in a deeply relaxed state, able to be responsive. Vital signs are constantly monitored throughout the visit. In Sklar s experience, complex dental treatments that typically require six to eight appointments can often be done in as little as one visit.

Also emerging in popularity is the concept of a "dental spa"—a facility that features Zen-inspired surroundings and spa-like twists on traditional dental equipment, such as massage-capable dental chairs. Paraffin hand treatments and soothing foot rubs are also on the service menu, as are portable CD/DVD players with a varied selection of movies and music to alleviate anxiety.

The Drill: there has to be another way...
A technique called air abrasion may one day eliminate reliance on dental drills. During this procedure, tiny particles of aluminum oxide are blasted onto the teeth in a stream of water to remove the decay and ruined enamel caused by cavities. In addition to reducing patient discomfort, this system has shown to be more precise than conventional drills, allowing the dentist to save the healthy enamel that surrounds a cavity.

Dental lasers have also been used in place of drills to cut teeth and bone and remove decay. Some dentists have even used lasers in root canal treatment, one of the most feared dental procedures.

No more needles?
The DentiPatch is a recent alternative to needle injections. Like a band-aid, the patch is applied to the gums where it diffuses anesthetic to the gum tissue. The patch can be used by itself for most routine dental procedures or as a prep treatment to alleviate the pain if a needle is required.

While needles may not be completely avoidable, there are ways to make injections less painful. Most discomfort associated with injections is actually caused not by the needle but by the rate at which the anesthesia is injected: the slower and steadier the dentist, the less painful the injection. A device called the Magic Wand monitors and controls the rate at which anesthesia enters the gum tissue, making the injection virtually pain free for most patients.

Pet Therapy
Dogs have long been known for their comforting, often therapeutic, effect on people who are coping with health ailments or physical challenges. Now, man's best friend is blazing new trails in dentistry. Meet Disco, the resident dental aide at DC Smiles in Alexandria. Obedience school-trained and certified by Fairfax Pets on Wheels as fit for duty, the perky five year old Jack Russell terrier has been with DC Smiles for about three years and holds office hours about three days a week, greeting patients in the reception area and sitting with several as they undergo non-surgical procedures. "Patients with severe dentist anxiety are incredibly soothed and calmed when Disco sits on their laps," explains Tonya Singer, who manages the office. "They stroke Disco or just hold onto him and Disco seems to love it too, so it's actually a reciprocal kind of therapy!" For more on Disco and the benefits of pet therapy, visit the DC Smiles website at www.dcsmiles.com under the "Dental Phobia" tab.

The Truth about Cavities
Prevention, Detection and Treatment

Feel pain when you indulge in an icy popsicle or a piping hot cup of coffee? Could be that you just have sensitive teeth. Might be that you have a cavity.

Cavities most often occur due to tooth decay that arises from heavy consumption of sugary, sticky foods that collide with bacteria in the mouth to form plaque. Excessive plaque build-up can lead to erosion of the tooth's enamel and eventually create holes in the surface of the tooth. If left untreated, cavities can result in tooth loss.

Historically, cavities were filled using metals like gold and silver. Today, that approach is less common, particularly in light of ongoing health debates regarding the safety of mercury levels found in many metals. There is also the aesthetic appeal of more uniform tooth coloration. "I exclusively use tooth colored composite resin filling to treat cavities," says McLean Dr. Lois Wilson, whose practice emphasizes restorative dental care. "Newer non-metal materials are bonded and more likely to strengthen and hold the tooth together," she explains. "With metal fillings, there is a tendency for cracks and stress fractures to occur, caused by temperature-based expansion and contraction of the metal over time." A composite resin is a plastic mixture filled with glass (silicon dioxide). The dentist prepares the mixture, places it in layers and uses a special light to harden each layer. The composite is then shaped to fit the tooth and polished to prevent staining and early deterioration.

Thanks to technology, cavities can be detected even before surface holes become apparent. Through DIAGNOdent Laser Cavity Detection, a laser is used to scan the surface of the tooth and read the level of fluorescence in the dentin, or inner layer, of the tooth. "I can use the laser to see through the enamel shell and pick up decay underneath even before a hole shows up in the enamel," Wilson explains. This early detection process can result in a less extreme treatment solution, as the dentist can confine the incision to the affected area without cutting away as much enamel.

The prevalence of cavities has declined over the years, due in part to higher levels of fluoride in rinses and drinking water, healthier diets and broader access to regular dental care. Still, the best ways to keep cavities at bay are regular brushing and flossing, twice-yearly checkups, avoidance of sugary foods, and...eat cranberries? According to a recent study conducted by the International Association for Dental Research, there may be an unusual benefit to eating cranberries. In this lab-based study, researchers tested two cranberry antioxidants—quercetin and myricetin—against a bacterium called streptococcus mutans, a leading cause of tooth decay. The antioxidants made it harder for the bacterium to do its work, leading the researchers to believe that it may not be able to make dental plaque the way it normally does. A cavity-fighting solution right in your neighborhood grocer's fresh fruit aisle? Stay tuned.

Brace Yourself!
The Straight Scoop on Orthodontics

While braces are often considered a youthful rite of passage, there is an increasing trend among adults to get their teeth fixed. "More and more Baby Boomers can now afford to have plastic surgery, and they are coming in for cosmetic orthodontic treatments as part of their transformation," says Vienna Dr. Allen Garai, who specializes in correcting tooth alignment and bite problems. He explains that most patients initially come in for aesthetic reasons and may not realize that their appearance concerns are caused by a 'bad bite.'

There are several options for orthodontic care, including traditional braces with stainless steel, titanium alloy or ceramic wires; lingual, or hidden, braces that are worn on the inside of the teeth; and Invisalign, which uses a series of clear, removable aligners to straighten the teeth. Garai uses all three, although the vast majority of his patients still go with the traditional model, partially due to cost. Because of their specialized nature, lingual braces and Invisalign are generally more expensive than traditional braces. They are also only appropriate for adults or adolescents who have all of their permanent teeth in place.

Are you a candidate for lingual braces? "A good lingual patient would be someone who has a deep bite," Garai explains, referring to a condition in which the top teeth cover most of the bottom teeth. While linguals provide a huge aesthetic boost and a comparable or shorter treatment time than that of conventional braces, there are drawbacks including tongue discomfort and potential speech impairment.

"With traditional braces, what moves the teeth are the wires," explains Garai. "Advances in wires can cut treatment time and reduce the number of patient visits needed." Enter self-ligating brackets, also called "speed braces," that eliminate the need for rubber bands (ligatures) and metal tie wires to hold the arch wire in place. The brackets allow the wire to slide back and forth with fewer adjustments. Brackets can be metal, ceramic, or a combination of the two. Metal brackets tend to be least expensive and usually involve a shorter time horizon and less pain. They are also smaller than traditional metal braces. However, as orthodontists need special training to use self-ligating systems, they may not be as widely available as other treatment options.

Invisalign, a popular addition to the orthodontia toolbox, involves the formation of teeth impressions that are processed using computer imaging technology to create a customized series of aligners made of clear, strong medical grade plastic that is virtually invisible when worn. Patients change the aligners approximately every two weeks, a process that gradually moves the teeth into straighter position. Unlike braces, removable aligners allow patients to eat and brush their teeth as usual. On average, patients complete treatment in about a year. A modified version, called Invisalign Express, is available to correct less severe problems like minor crowding or gaps. Treatment time is generally less than six months.

Whichever route you take, experts agree that maintaining proper oral hygiene and following the prescribed maintenance and care of your braces or aligners is essential. In the end, that gorgeous smile will be worth it!

'Cause We Love 'Em
Pets Need Dental Care Too!

Have you brushed your dog's teeth today? What about the cat have you checked her gums for inflammation? If not, you're not alone. Dental care is one of the most commonly overlooked areas of pet health care. As a result, according to the American Veterinary Dental Society, eighty percent of dogs and seventy percent of cats show signs of oral disease by age three. If untreated, more severe problems, including heart, lung and kidney disease, can emerge. So its time to get serious about those canine molars and feline gums. Here's what you need to know about dental care for the animal set.

A Home Care Practice
"Your pet's teeth should be brushed every day, if possible," recommends Dr. Charles Williams of The Animal Dental Clinic in Vienna. To ease Fido's or Tabby's anxiety, the American Animal Hospital Association (AAHA) suggests a three step approach. Start by using your fingertip to gently rub the gums with either beef bouillon for dogs or tuna water for cats, primarily along the gum line which is ripe territory for plaque build-up. Gradually introduce gauze over your finger to rub the teeth and gums. Finally, once the pet can handle gauze, try brushing with a pet toothbrush or a very soft people toothbrush in a circular fashion over the teeth and gums. Use dog or cat toothpaste only, as the human variety will upset your pet's stomach.

For an added boost, try feeding your pet dry food or hard biscuits after each meal. Both produce abrasion to keep plaque at at minimum build-up rate.

Time for the Dentist?
Starting a routine dental practice at the puppy or kitten stage can help your pet adjust to the idea. It also allows the dentist to evaluate the pet's "baby teeth," missing teeth or extra teeth. As the pet ages, the dentist will begin to look for signs of disease or other abnormalities. The AAHA recommends annual visits starting at age one for cats and small-breed dogs and age two for larger dogs.

Williams advises that professional cleaning may be needed every 3 to 6 months or every 1 to 2 years depending on the pet's condition. During the process, the dentist will go below the gum line, clean the inside of the teeth, remove plaque, apply an anti-plaque fluoride treatment and polish the teeth while the animal is under anesthesia. And what would the visit be without a photo op? "Dental x-rays are necessary to gain a full picture of your pet's dental health. Many problems occur below the gum line, where the naked eye cannot see," Williams explains. X-rays can also confirm the need for extraction of teeth that are loose or badly infected.

Persistent bad breath, brownish colored teeth and swollen, red or bleeding gums may indicate the onset of periodontal disease, an infection of the tissue surrounding the teeth. The condition initially appears in the form of plaque. If left to spread, plaque can lead to gum inflammation (gingivitis) and an infection around the root of the tooth. In severe cases, the tissue surrounding the tooth is destroyed, the socket holding the tooth erodes, and the tooth becomes loose—a very painful process that can be avoided with routine home care and regular dental checkups.

It is estimated that proper dental care may add as many as five years to your pet's life. Consult with your veterinarian for advice, and make every year count.

(Winter 2006)