There are four basic kinds of practices, with many variations of these four themes.

Level I – Elemental Dentistry
The level I dental practice is characterized by seeing many patients, and the focus is crisis management. Patients come in with an apparent need, and only want to have the problem fixed. There is little or no time for relationships. This type of practice is structured like an emergency room, and is concerned with affordability, takes all kinds of insurance, and joins as many PPO’s and HMO’s as necessary to provide sources to maintain a high volume of patients.

Level II – Mechanical Dentistry
In this type of practice, there is always inadequate time for relationship building with the patients. This practice does “smile makeover” or whatever is hot in the marketplace. The level II dentist is similar to the level I dentist with the exception that the level II dentist looks to do more crown and bridge, implants, and veneers. The focus is still disease treatment. I started as a level II dentist. I have dedicated myself to advanced training in TMJ, occlusal bite therapy and advanced crowns, implants, and dentures. I developed a vision for my practice to provide comprehensive optimal care.

Level III — Biologic Dentistry
The biologic dentist is as concerned about the cause of disease as the repair of the defects. This dentist focuses on the creation of health, rather than simply treating effects. A vision or picture of health is seen by the dentist, which becomes the foundation of the entire practice. Also, a big part of this practice is an all-encompassing preventive program. The following characterizes a level III practice.

1.) Individualized patient interaction and value clarification prior to treatment
2.) Master plan for each and every patient
3.) Quality is the constant and time a variable

The level III practice does value clarification, not manipulation. It is outcome oriented, not event driven. Focus is on the creation of health, rather than the treatment of disease. Level III is about health, and is: Co-discovery, Co-planning, Co-development of health and treatment, and Co-operation – essence of a win-win relationship.

Level IV – Whole Person Dentistry
The dentist plans dental treatment to fit the patient’s values, lifestyle and quality of life. Level IV dentistry is a logical extension or development process of a level III practice. Level IV dentistry is biologically sound, technically excellent – esthetic and functional complete mouth rehabilitation. It includes: complex periodontal treatment, complex orthodontics, complex endodontics, mucostatic partial dentures, osseointegrated implants, sophisticated occlusal therapy, complex maxillofacial surgery, and complex prosthodontics.

The dentist, team and patient work together to “create something different” and that difference is biological health. I am committed to improving our practice to provide Level IV, whole person dentistry.

Frequently dentists are asked about the causes and treatment for halitosis (bad breath). If you tell your dentist about your concerns and then experience a comprehensive evaluation, it is very likely that some discussion will follow that addresses your concerns.

Most commonly, oral odors are created by food you have eaten or periodontal (gum) disease. Other causes can be sinus infections, chronic gastroesophogeal reflex, anorexia, bulimia, and diabetes. Smoking and alcohol can cause odors as well.

Foods such as garlic and onion contain large molecules that are responsible for their odor. These large molecules must be excreted fully before the odor is gone. Unfortunately, they are removed from your body by way of your lungs. It can take as long as 24 hours before the odor is gone. Regardless of how carefully and thoroughly you brush, floss, and use mouthwash, the odor does not go away; it is only masked. It will return until all of the molecules are expended through your lungs.

Sinus infections are characterized by pain, fullness in the sinus area, and a thick mucous like discharge. A bacterial infection can cause a foul odor. Once the infection is treated, the odor will go away.

Diabetics often have a breath odor that is caused by ketoacidosis, a condition that occurs when their sugar/insulin balance is out of control. This odor has been characterized as smelling like acetone.

Chronic gastric (stomach) conditions and bulimia can lead to changes in the body chemistry that create a sour breath odor which also can be chronic.

Physicians treat all of the above systemic conditions. Dentists can help you determine what might be contributing to breath odors and even help you find the appropriate physician to treat the underlying causes.

Odors caused by poor oral hygiene and periodontal diseases are the easiest to treat. Frequently, they can be treated simply by hanging the way you care for your teeth and mouth. If periodontal disease is the cause, the disease must be treated but when the disease is under control, the odor goes away.

Mouthwashes only mask odors for a short time. If you have persistent odor, consult with Dr. Frank to explore the possible causes.

By Mary Osborne

In the 1960′s Dentistry believed periodontal disease was caused by calculus. Inflamed gum tissue was described as being like the skin on our finger if it had a splinter in it. Dentists believed their only recourse was to remove the calculus deposits every six months, and they assumed most people would experience some level of periodontal disease as they aged. This belief was a mechanical model for treating periodontal disease.

During the seventies and eighties we understood that periodontal disease was caused by bacterial plaque. We told our patients that if they could break up the plaque before it began to destroy the supporting structures of their teeth they would have healthy gums. Once the disease began, we saw it as a gradual degenerative process. Patients were told to have their teeth cleaned more often than six months, because it was needed to break up the bacterial colonies. This was primarily a chemical model for treating periodontal disease.

Our understanding of periodontal health and disease continues to grow and change. We understand the importance of mechanical removal of hard and soft deposits. We see patients with no plaque that have acute disease, and yet we see patients with heavy plaque and little or no disease. The disease is seen as site specific and episodic. We now have a better understanding of the patient’s bite and its effect on periodontal health. Finally, some people are genetically more susceptible to gum disease.

Additional risk factors contributing to periodontal disease are stress, malnutrition, smoking, diabetes and even pregnancy. In this integrative model we are partners in caring for your teeth and gums as part of your total health. We focus our appointment on the way the oral conditions are presently and how they may change over time. After our assessment we recommend a plan to return to health because we are now finding oral health is directly related to our general health. We are here to help you understand the many changing factors of oral health and to shift from thinking of oral health as an absolute, to one of total well being.

“Gatorade and Drinks that are supposed to be healthy”

Decay is making a come back in children and adults. One major problem is the misrepresentation of acidic and sugary drinks as healthy drinks.

Gatorade is the major drink of choice for today’s athletes. Unlike water, Gatorade has sugars and acids that are leading to decay. Flavored water drinks also contain sugars and acids. Diet Soda doesn’t contain sugar but is high in phosphoric acids that break down tooth enamel. Citrus drinks like orange juice and grape juice are strong acidic drinks that can abrade enamel.

Today, sweets, sodas and sport drinks are not a treat, but a part of children’s everyday diet. Bottled water also does not contain fluoride unless it is specifically labeled.

Children and adults should limit these unhealthy drinks. When drinking these acidic drinks like orange juice and Gatorade, rinse your mouth with water. After drinking avoid brushing your teeth for 20 minutes. Surprisingly, it is better not to brush your teeth right away because the acid etches the enamel and a toothbrush will damage the enamel.

Drink fluorinated water as much as possible, it is healthy and the dosage of fluoride is proven safe.

Amalgam

Made of: Mercury mixed with silver, tin, zinc and copper. Mercury is nearly 50 Percent of the mixture.
Types: Traditional (non-bonded), bonded
Used for: Fillings in back teeth
Lasts: At least seven years, usually longer
Costs: The least expensive type of restorative material

Advantages:
- Amalgam fillings are strong and can withstand the forces of chewing.
- They are inexpensive and convenient.
- The filling can be completed during one dental visit.

Disadvantages:
- Amalgam doesn’t match the color of your teeth. Healthy parts of your tooth must often be removed to make a space large enough to hold an amalgam filling.
- Amalgam fillings can corrode over time, causing discoloration where the filling meets the tooth. A traditional (non-bonded) amalgam filling does not bond to the tooth. It just sits in a pocket created by your dentist.
- Some people may be allergic to mercury or be concerned about its effects, although research shows the amount of mercury exposure from fillings is comparable to what people get from other sources in the environment.

Composite Resin:

Made of: A mixture of plastic and fine glass particles
Types: Direct or indirect
Used for: Small and large fillings, especially in front teeth or the visible parts of teeth; inlays
Lasts: At least five years
Costs: One-third to twice as much as amalgam, but less than gold

Advantages:
- Your fillings or inlay will be invisible. Your dentist chooses a resin that matches the color of your teeth.
- A filling can be completed during one dental visit. An inlay may require two visits.
- Composite fillings can bond directly to the tooth, making the tooth stronger than it would be with an amalgam filling.
- Less drilling is involved than with amalgam fillings because your dentist does not have to shape the space as much to hold the filling securely. The bonding process holds the composite resin in the tooth. Indirect composite fillings and inlays are heat-cured, increasing their strength.
- Composite resin can be combined with glass ionomer to provide the benefits of both materials.

Disadvantages:
- Although composite resins have become stronger and more resistant to wear, it’s not clear whether they are strong enough to last as long as amalgam fillings under the pressure of chewing.
- These fillings take 10 to 20 minutes longer, or sometimes more, to place than amalgam fillings because each thin layer of the filling must be cured, or hardened , using a visible blue light.
- Indirect fillings and inlays take a least two visits to complete. Your dentist takes impressions at the first visit and places the filling or inlay at the second visit.
- In large cavities, composites may not last as long as amalgam fillings.

Cast Gold:

Made of: Gold alloy (gold mixed with other metals)
Used for: Inlay and onlay, crowns
Lasts: At least seven years, usually longer
Costs: More than most other materials; six to 10 times more expensive than Amalgam
Advantages:
- Gold doesn’t corrode.
- The gold color is more pleasing to some people than the silver color of amalgam.
- Gold fillings are durable enough to withstand chewing forces.

Disadvantages:
- You must visit the dentist at least twice to receive a gold filling. At the first visit, the dentist makes an impression of your tooth and a temporary filling is placed.
- The gold filling is made from the impression and is placed at the second visit.
- The cost is high because of the gold and the work involved.
- If gold and amalgam fillings are right next to each other in your mouth, an electric current can result from interactions between the metals and your saliva, resulting in sharp pain.

Ceramic- Cerec

Made of: Porcelain
Used for: Inlays and onlays, crowns
Lasts: At least five years usually longer
Costs: More than most other materials; five times more expensive than amalgam

Advantages:
- Less tooth reduction than gold or a standard designed crown
- Ceramics are tooth-colored
- Ceramics are more resistant to staining and abrasion than composite resin
- Complete in one visit

Disadvantages:
- Initial high investment

Fluoridation in water has been the greatest achievement in dentistry. Fluoride in water replaces the calcium minerals in teeth, which makes children’s growing teeth (up to age 14) stronger.

However, as more people move into towns with well water children are not receiving fluoride. Also, many people are no longer drinking tap water with fluoride. Instead people are drinking bottled water, which does not have fluoride. For children to age 14, we prescribe oral fluoride in the form of drops for babies and chewable tablets for children.

Today, people are living longer and eating more sugars than ever before. Aside from radiation treatments, teeth will only decay in the presence of sugars from food. “Weak teeth” are a very rare occurrence. Some people are more prone to decay because their bacteria or plaque produces stronger acids that attack the teeth.

Decay will progress until it finally reaches the nerve. This will most likely cause pain or discomfort. Prior to decay reaching this point, it is removed, and a material is used to replace the lost tooth structure. Decay also occurs under “old fillings”. As the metal corrodes, a gap between the tooth and the filling develops in which bacteria will easily penetrate and cause more rapid destruction of the tooth structure.

Fluoride in prescription dose rinses and gels are an added insurance to preventing decay and extending the life of fillings and crowns. The ultimate and best insurance policy in preventing decay is brushing and flossing two to three times per day. Decay is preventable, however once it starts, it will most often result in restoring the tooth.

Fluoride can also be beneficial to those who have been diagnosed with periodontal, or gum disease. In periodontal disease the bone level supporting the tooth decreases which often leaves root surfaces exposed in the mouth which are normally covered by gum tissue. These areas are very susceptible to decay and the use of fluoride can re-mineralize the root surfaces, thus making it more difficult for decay to occur. Fluorides can also aid in “tightening” the gum tissue, which will decrease the amount of bleeding and also help to minimize the pocketing around the tooth.

Children often get cavities due to poor homecare habits. They forget to brush after breakfast or before bed and when they do brush, they rarely will clear plaque from all tooth surfaces. Rarely will children floss effectively. Children wearing orthodontic appliances like braces face an additional burden to keeping their tooth surfaces cavity-free. Fortunately, the extra protection offered by fluoride treatments can counter these threats and reduce the risk a child will develop cavities.

American Association of Orthodontists Recommendation for Early Orthodontic Screening

The American Association of Orthodontists recommends that all children have an orthodontic screening no later than age 7.

Why screen by age 7?

- The posterior occlusion is established when the first molars. At this time, one can evaluate the antero-posterior and transverse relationships of the occlusion, as well as discover any functional shifts.
- Incisors have begun to erupt and problems can be detected. Such as crowding, habits, deep bites, open bites and some Facial asymmetries.
- For some, a timely screening will lead to significant treatment. Benefits; for most, the principal immediate benefit is a parent’s peace of mind.

The dentist who makes timely referrals is rightly regarded as informed, caring and concerned for the total well being of the patient.

The benefits of early treatment:

For those patients who have clear indications for early intervention, Early treatment presents the opportunity to:

- Influence jaw growth in a positive manner
- Harmonize width of the dental arches
- Improve eruption patterns
- Lower risk of trauma to protruded upper incisors
- Correct harmful oral habits
- Improve aesthetics and self-esteem
- Simplify and/or shorten treatment time for later corrective orthodontics
- Reduce likelihood of impacted permanent teeth
- Improve some speech problems
- Preserve or gain space for erupting permanent teeth
- Early orthodontic screening can lead to simpler, more effective treatment for dental patients or, at lease, greater peace of mind.

Additional Information >

Today people are more likely to see their dentist on an annual basis than their physician. The role of the dentist is to help people achieve oral health. The mouth is not a separate entity from a person’s body or their entire health. The following are some examples of medical problems that can be diagnosed by the dentist:

- Early diabetes can show its signs by bleeding gums.
- Reflux can cause erosion of the teeth.
- Bad breath could be a stomach problem.
- Chapped corners of the mouth can be sign of a lack of vitamin B12.
- Enlarged tonsils can lead to crowded top teeth and a tongue thrust.
- Allergies and breathing problems can lead to dry mouth and bleeding gums.

In our doctor exams we are looking at all of these factors of your health as well as an oral cancer exam. We refer you to your physician if we believe you should pursue any potential problems.

Physicians we recommend:

Dr. Mark Allara
Family Medical Associates
One Central Street
Middleton, MA 01949
978-774-2555
www.familymedicineassociates.com

Dr. Lisa Connolly
Willowdale Medical Center
16 S. Main Street
Topsfield, MA 01983
978-887-3675

A health-centered model for dentistry is offered to dentists in a number of continuing education courses at the Pankey Institute. The philosophy of comprehensive dentistry is to have a complete new patient exam, where information about the patient’s jaws, muscles, teeth and gums is not only taken, but also co-discovered with the patient. Having the patient understand their problems allows the dentist to become a partner in helping the patient achieve health.

Spending time with the patient allows the dentist to know the patient. “Never work on a stranger” was a credo of Dr. Pankey. Becoming familiar with a patient does not mean knowing his cousins uncle, but rather understanding the patient’s goal and desires for his dental health and being able to challenge them to achieve it.

Unfortunately, the drill, fill bill disease pattern is still very popular today. Filling the tooth with the newer ‘white’ fillings or crowns solves only half of the patient’s problems. The tooth is fixed, but why did it break? Which tooth with break next? Often, patients end up having a mouth full of crowns that do not fit together, similar to a puzzle with the improper pieces. This type of dentistry can be frustrating and unrewarding to the dentist as well as the patient. Solving the technical riddle of restoring a patient’s mouth involves a thorough analysis of the jaw, muscles, teeth and bite, along with a team of specialists to review all of the patient’s options for treatment.

Comprehensive dentistry does take time and the dentist will see fewer patients. Comprehensive dentistry may also appear to be more expensive, however an investment to restore health and maintain stability is less expensive in the long term than patch and fill dentistry, which in most cases will result in pain and emergency care. One advantage of comprehensive dentistry is that it can be staged over time so it can be affordable. Instead of working on patients in ‘my’ best interest, comprehensive dentistry allows me to work with patients in ‘their’ best interest.