TED SIMONS: Welcome to Ask an Arizona Dentist. I'm Ted Simons. For many of us, a trip to the dentist is still something we tend to avoid, even more so in these challenging economic times. But, proper dental care is vitally important to our overall health and well-being. Tonight, we'll hear from a panel of dentists about the best way to avoid problems, and keep our teeth healthy and looking their best. We'll also give our viewers the opportunity to call in and ask an Arizona dentist. Dentists will be taking calls throughout the show, answering your questions and concerns at the statewide toll-free number appearing on the screen. Phone lines will remain open until 9:30 p.m., and we encourage you to call.
Joining me tonight is Dr. Mark Hughes; he is president-elect of the Arizona Dental Association Board of Trustees and practices in Glendale. Also joining me is Dr. Brett Dameron and Dr. Allison House, both are board members of the Central Arizona Dental Society and practice in Phoenix. Welcome, all, to Ask an Arizona Dentist. Let's get started with this idea of the fear of going to a dentist. Dr. House, is it still there? And if so, why?
ALLISON HOUSE: It is still there, and I think that for a long time people only came to the dentist when they had a problem, they were in pain. So they had a real negative association with dentistry, but we've had a shift in the profession when we moved to prevention. And procedures are not—they’re not painful; they're—they’re relatively simple if you come in and get checked early.
TED SIMONS: Dr. Dameron, is that how you see it as well? I mean, when I hear a dentist say it’s really not painful, I go, “Oh?”
BRETT DAMERON: Well I think, you know, the new techniques and the new medicines they work, you know, 100 times better than they used to. We use pre-anesthetic before we give the anesthetic, we have sedation techniques that can actually make the patient, you know, groggy and kind of in that little twilight so they don't really remember the whole appointment, nitrous oxide. So we have lot of new things that we’ve used to make the patients very comfortable.
TED SIMONS: What do you think, Dr. Hughes?
MARK HUGHES: Well with the increasing technology, also, the main fear was the shots and the drill noise, and with a lot of the new techniques we have for anesthesia, plus the sedation that we use, that's calmed that fear quite a bit, and with the advent of lasers and quieter instruments, new technology has made it a lot better.
TED SIMONS: It does make a difference there; you have to make the effort to make it less traumatic.
BRETT DAMERON: Yeah, oh that’s a--that’s a big effort on all of our parts. I think we want to make it as good of a visit for each of our patients as we can.
TED SIMONS; And I guess when you do make it as easy and as, you know, beneficial as possible, or at least successful as possible, you get folks coming in for regular cleanings and checkups. Dr. House, why is this idea of regular visits to the dentist for a cleaning and a checkup, why is that so important?
ALLISON HOUSE: Again, because we like to catch things early. We can find so many diseases in the mouth. We can catch a cavity before it becomes a root canal. It's easy to treat things in the beginning stages.
TED SIMONS: Again, how often should someone go see their dentist for a cleaning and checkup?
BRETT DAMERON: I would say every six months we should be seeing you. It shows, you know--all the studies are showing that it takes about six months or less for a cavity to really develop in the mouth, but you have to realize that everybody is maturing every day, so that cavity that was three months old is now six months old, and that one that was six is now 12 and-- so you're always going to be developing new stuff, and if you catch it early, then you’re not going to develop the major problems that really become a lot more costly and a little bit more painful in the long run.
MARK HUGHES: Unlike many diseases in the rest of the body, decay in the mouth and other diseases that we find, many times they're asymptomatic; you don't really feel them until it's very late in the process. So it’s really good to catch it early, before it gets too big, extremely costly and more painful.
TED SIMONS: We want to remind viewers that this is Ask an Arizona Dentist. See the number on your screen? Go ahead and call with your questions, your concerns, anything you want to ask an Arizona dentist. Go right now, toll-free number—call that--that number; and we have dentists standing by, ready to respond, ready with answers. As we continue our conversation here, Dr. House, the idea of catching something early, it's not always something regarding the teeth; there are a whole bunch of things dentists can find, correct?
ALLISON HOUSE: Yes. Oftentimes we can detect diabetes, high blood pressure, lots of heart problems, and they show up in the mouth. We’ve also discovered oral cancer in the early stages, and that’s always--that needs to be treated early.
TED SIMONS: And this is something that, again, a dentist will say -- this is the part where they kind of run their finger around and kind of check for things, correct?
BRETT DAMERON: Absolutely, and we’ve got even have new techniques where we’re using special lights and special solutions that we’ll have the patient rinse with. And it actually will--we'll be able to look down about 20 cell layers. So we’re catching these oral cancers in their infancy instead of catching them when they’re in stage 4 and they’re spreading throughout the entire body. It's very beneficial to everyone, the entire population, to have this done every year.
TED SIMONS: Dr. House, you have a personal experience regarding catching things early with a dental checkup?
ALLISON HOUSE: My father went to the dentist every six months, and our family dentist found a oral cancer lesion. And he's here today because it was found early and it was treated.
TED SIMONS: That's fascinating. Good news. Do you get that often, though? Does a dentist see those kinds of things very often?
MARK HUGHES: Oh yeah. I’ve--just in the past year, I've diagnosed four oral cancer patients and sent them for biopsies so it's–you--we hope we don't see it very often, but we do still.
TED SIMONS: I want to ask about dental x-rays and how important dental x-rays are to a--just a checkup and these sorts of things. I know some folks worry even about the safety of dental x-rays. Talk to us about that.
BRETT DAMERON: Well x-rays are very safe; we’re not doing a CAT scan every time you come in. So the amount of radiation that you're getting is very, very minimal, almost--I guess you can compare it with maybe sitting in front of the TV for a few hours; you're getting about the same amount of radiation. The x-rays are so important because when you're looking in the mouth, you're only seeing just like the tip of the iceberg, so to speak. There's—there’s such an enormous amount of information that we don't get: the bone, the sinuses. There could be tumors, there could be cancer, there could be stuff underlying that we'll never—we’ll never even see.
TED SIMONS: How often do you see that, Dr. House, where the checkup shows maybe something and you look at the x-ray and go, “There's something else.”
ALLISON HOUSE: I would say several times a day that you catch something on x-ray you cannot see in the mouth.
TED SIMONS: Yeah, and just straight x-ray? Nothing special? Nothing fancy? Just the x-ray that we've all had numerous times can make that big a difference?
ALLISON HOUSE: Absolutely.
TED SIMONS: As far as kids, Dr. House, when's a good age to start with a kid in dental care?
ALLISON HOUSE: We would like to see a child when they get their first tooth, which is about six months old, and definitely by the time they are 12 months we’d like them to have seen a dentist. A lot of that is just education for the parents, but we like to make sure that everything is coming in normally, that the teeth are being brushed. That first tooth needs to be brushed, even if they're six months old.
MARK HUGHES: A lot of times with the families today with both parents working, a lot of the parents don’t want to get up at night with the kids, so they'll put a bottle in the crib with the baby with juice, or milk or whatever. And any kind of liquid, especially if it has sugar in it, is going to promote decay. And we see a lot of kids a year, a year and a half year old with all of their teeth rotted. It's called Nursing Bottle Syndrome. And it's really tough because if it starts at that point, it'll just continue on to the point where all their baby teeth will be rotten and then when their permanent teeth start to come in, they'll have a lot of decay on it too.
TED SIMONS: Talk more about that, because I think some folks would say, “Well, if a kid is just about ready to lose his teeth, why do I take them to the dentist? They'll fall out anyway.” How do you respond?
MARK HUGHES: Well, there's a lot of good to be had by the temporary or primary teeth. They're there for spacing. We want to keep the space for the permanent teeth to come in, and an example of that: I have four daughters. Three of them had teeth knocked out early playing sports when they were very young, and two of them actually lost the space, and so when their permanent teeth came in, they came in a little behind schedule because of the bone, the bone had healed over, and so it made it harder for the permanent teeth to come in, and they were also really crowded, and we ended up having to have braces put on them to spread--spread the teeth apart. So it made it a lot more difficult to get the space that was needed for the permanent teeth.
TED SIMONS: Do kids generally get the kind of dental care they should be receiving?
BRETT DAMERON: Oh, I think they do, but, you know, I think a lot of it depends on the parents, and it depends on the system as well. You know, there's a lot of kids out there who--who aren't getting treatment, and it's whether it's a money issue, or whether it's both parents are working. If they're not getting in on an annual basis, there could be a lot of problems, and that's what is neat about the association, actually; we do a lot of screenings at schools and stuff to really find out the problems before they become major problems.
TED SIMONS: Expectant mothers as well. Talk to us about that. How important for an expectant mother to get a dental checkup?
ALLISON HOUSE: It's very important, and there's two reasons. The first reason is we've linked gum disease to early-term birth. So you can go into labor early with gum disease. The second reason is that cavities are contagious. And so, moms will give that bacteria that causes cavities to their children. And so, we'd like to stop that; we'd like to prevent that from happening.
TED SIMONS: Interesting. Were you going to say something as well regarding child care and the service? How parents need to get those things in?
ALLISON HOUSE: Well, we talked a little bit about the trauma and the fear of dentists. If your first experience at five years old is having your tooth pulled, that makes coming to the dentist very frightening. If your first experience is having your teeth cleaned, that's a happy experience. We’d like them to have that.
TED SIMONS: Remind our viewers. This is Ask an Arizona Dentist. We have dentists standing by to respond to your questions and your concerns. Telephone number on your screen will be there, the dentists will be there until 9:30 tonight. But we'll keep that phone number up there for the entire program, a chance for you to go ahead and get a call in, and I know a lot of folks have questions and concerns regarding all aspects of dentistry, including teeth-whitening. We’ve talked about disease, and we’ve talked about preventive care and a lot of things here, but teeth whitening. Very big factor in dentistry right now. Positives and negatives.
BRETT DAMERON: Well there’s--yeah there’s a lot of both. I think the positives to teeth whitening is that you’re increasing your appearance, you know, your popularity has been linked directly to your teeth; you have straight, white teeth you’re going to do better in life, as opposed to somebody who doesn’t. I think it makes you feel better about yourself. Are there really any negatives to teeth-whitening? Other than sensitivity that maybe will happen within the first 24 hours or so if you have a professional whitening, there really isn’t a lot of negatives to it; there aren’t any studies out there that are showing that there are any problems, long-lasting problems, with the teeth.
TED SIMONS: So when people feel that sensitivity, that’s nothing to be too concerned about, unless it lasts, for what, a couple of days.
BRETT DAMERON: About 24 to 48 hours, and this is a professional whitening done in the office. Now if you’re doing it at home, it’s kind of a whole ‘nother deal because there is no supervision. So we don’t even know that the product you’re using even works for you. And sometimes people will overuse that product, or not use it enough, and then that’s when they come into our office and say, “Well why is this not working?”
TED SIMONS: Is there a difference in the products? You walk into some of these drugstores and along with 47 different types of toothpaste you’ve got 47 different types of tooth-whitener. Are there differences?
BRETT DAMERON: Yes, I think they all kind of fall into a couple different categories. One is going to be an abrasive. And basically, most of the systems are stain-removers. So they’re saying that it’s whitening the tooth due to you removing the stain. So hence it’s whiter tooth. There’s a couple products out there, over-the-counter, that will actually be like a crest strip, or little trays that you put in there with a little bit of solution, and that will whiten them. The problem is that it’s not made for each person; it’s made for a gross amount of people, and one size fits all, so to speak. And—
MARK HUGHES: --and strips are a weak concentration, and that concentration only lasts for an hour or so. And when they come into a dental office for a professional whitening, we have the ability to use a lot stronger materials that have absorption abilities, and so they can get deeper into the tooth and clean the pores out, and you get a lot better result with whitening.
TED SIMONS: And when the doctor—Doctor House, when a patient comes in and says, “I want teeth-whitening. I want to get ahead and do this.” What exactly do you tell them about the process, what to expect, what to look out for?
ALLISON HOUSE: Well I think, before we start, I would want to examine to see if it’s appropriate to even whiten their teeth. If there’s a lot of tartar buildup, or if they have a lot of cavities, it’s not appropriate to whiten their teeth at that point. We need to get them to a state of health before we jump in and start doing cosmetic.
TED SIMONS: Do you see a lot of that? Folks coming in saying, “My teeth aren't white enough.” And you look at them, “I know why your teeth aren’t white enough: they’re not clean.”
ALLISON HOUSE: Yes, because they’re covered in tartar. It doesn’t help to bleach the tartar. You know, we want to bleach your teeth.
MARK HUGHES: And there's also some systemic things that people that have taken a lot of fluoride from a real young age, sometimes their teeth are a little bit brown. That's not going to come out with whitening. Also, we see some people who had tetracycline at a real young age, and that makes your teeth purplish or brownish. That’s not going to come out; that’s inside the tooth, so that’s not going to come out. And a lot of times, those people come in with the expectation of using a whitener to whiten their teeth, and it’s just not going to happen.
ALLISON HOUSE: The over-the-counter drugs do work, but you just have to know what’s appropriate for each person. And that’s by dental professionals.
TED SIMONS: I was going to say, you don’t know that until a dental professional tells you, correct?
MARK HUGHES: That’s correct.
Dr. Dameron, the idea of Invisalign, these invisible braces—what are these things, and how new are they, and how effective are they?
BRETT DAMERON: Well Invisalign is like you’ve said; it’s just basically clear braces. It's a series of trays that they’ll make that each tray will move a tooth a certain distance over a period of about two weeks, and then you go into the new tray. It's a nontraditional sense of moving teeth. It's been around for probably about eight years, I would say. The traditional way is where you're putting the bands or the brackets on the teeth, you’re using wires, you’re seeing the orthodontist ever month, and he’s bending the wires to get the teeth to where they're supposed to go. I think the--the clear braces are a great alternative for working adults who don’t want to have the metal, they don’t want to see the braces. You know, professionals as far as in broadcasting, professionals in politics. People who are out in the public a lot, they don't want to be able to—they don’t want people to know that they’re doing all this. So, it's a fantastic product. It absolutely works, but you can't do it for everybody. I would say it's more so for adults than for kids; it's really hard to make a bunch of trays and have it fit a kid that his teeth are always moving. So it's more for adults, and I think the traditional braces will still stay with the kids.
TED SIMONS: Is that how you see it as well?
MARK HUGHES: Yeah. The trays have to be worn 22 hours a day, so a lot of the kids aren’t going to keep them in, or they’re going to lose trays. And the way the clear braces, the Invisalign products are set-up, they’re--all the trays are fabricated at once through a computer program. And if you lose trays, or you’re not wearing them all the time, it really can mess up the sequence of movement of the teeth. So, most orthodontists or specialists that do braces will tell you about 20% of their practice is eligible to do the invisible braces or clear braces.
TED SIMONS: Interesting.
MARK HUGHES: They're becoming a lot more prevalent now, and they’re--it's really becoming popular, and you can see why; it’s making a big difference.
TED SIMONS: A reminder: the telephone number on your screen is for to you to call and Ask an Arizona Dentist about your dental concerns, your questions. Of course we have three experts on the panel here, but we have plenty of dentists standing by as well to take your telephone calls. The phone number at the bottom of the screen. Specialists. In general, why is it important to get a specialist referred by your dentist?
ALLISON HOUSE: Well we have specialists in dentistry just like we have specialists in medicine. You wouldn’t have your family physician perform your heart bypass; you have someone with special training who only does that procedure. It’s the same thing in dentistry. We have specialists, such as an endodontist; an endodontist only does root canals. If you're going to have something very complex, it’s important that you have someone with extra training.
TED SIMONS: Is that how you see it as well? Because I think some folks think,”I got a root canal; I got a this and that." I'm just going to go to my dentist. Get it over with.”
MARK HUGHES: Well, and a lot of them prefer to come—you’re comfortable with your family dentist, and—but it's like she said: you wouldn't have your family physician do heart surgery on you, and it's the same thing. Most of the specialists have anywhere from 2-5 years of additional training after dental school. They're very proficient in what they're doing, a lot more so than your general dentist. We kind of do a little bit of everything. That's all they do all day is that specialty, and it makes it a lot easier for us, especially for difficult cases.
TED SIMONS: List some of the—some of the things and the conditions that would prompt you to go ahead and send someone to a specialist.
ALLISON HOUSE: Well the most common is wisdom teeth; we’d send you to an oral surgeon. And, again, it depends on the level of complexity. If something is going to be very straight forward, and I’m comfortable, then I’m going to do it. But once you get to a certain difficulty level, you’d like that extra training. So wisdom teeth are a good example. Perhaps a very difficult root canal would go to an endodontist, or a root canal specialist.
MARK HUGHES: I don’t enjoy doing root canals, so generally I send most root canals to a specialist. I do some braces in my practice, some clear braces and conventional braces, but there are a lot of times where there are difficult cases where I would like to consult with a specialist who’s had more training. And there are three or four guys in my area who are--you know, I’m very comfortable calling up and asking them what they would do in this situation, and in a lot of cases, if I don't feel comfortable, I’ll just send that patient over to those guys because I know they can handle that situation better than I could. And it’s all about, you know, what’s best for the people, what’s best for our patients. We want them to have the best care possible.
TED SIMONS: We were talking just a while back about teeth-whitening and straightening and these sorts of things, and I neglected to ask you—those are common, those are things we’re familiar with. What are other options as far as making better an imperfect smile?
BRETT DAMERON: Well there’s lots of things that you can do. I mean, we always will start off with some type of a whitening product, or really consoled on the many options that you have. If your teeth aren't perfectly straight, if they aren’t the right color, or right shape, or they’re too short or they’re too long, we can even go in and just change the anatomy of them. We can actually do some bonding, which will change the anatomy or the color. Quite often we do porcelain facings, or partial crowns, or full crowns that will actually change the entire smile, so to speak. You can do –we do full mouth rehabs where people’s teeth don’t come together at all and you have all of them cracked.
TED SIMONS: The bondings and the facings do those things—I know in the past I heard they actually, some would fall off or something along these. Do they do that anymore, or are they pretty much on there for good?
BRETT DAMERON: They’re pretty much on there for good. I mean there's always going to be an instance where something’s going to get hit: a fork, a bar fight, I could go on and on and on, but traditionally, these—the adhesives that we use to bond the porcelain to the teeth are almost the same exact strength as tooth to tooth. So if you’re going to break off an area of these crowns, a lot of the time you're going to break the tooth regardless.
TED SIMONS: Speaking of things in the mouth, piercings have become popular here in the past—well, maybe not so recent years, but they’re popular. What do you think of that? What do you think of piercings?
MARK HUGHES: Well, there’s—they’ve become very popular. There is a possibility that when they’re done that nerve damage can occur. They’ve also found that, especially like with the lip piercings, the flat side of that piercing sets against the gums, and they've seen now that, after four or five years, where that—where that flat part was up against the gum tissue and the bone, that that bone actually is deteriorating. So these young kids that are--have these lip piercings, you know, when they're 15 to 20 years old, and by the time they're 25, they have big holes in bone, when they're 25, and they're actually losing a lot of--some of their teeth because of that.
TED SIMONS: I'm a teenager. I go to you, Dr. House, and I say I want to get a piercing in my lip, and I want a piercing in the tongue. Tell me about the dental risks. What do you say?
ALLISON HOUSE: Well the piercing in the tongue I see a lot of kids that break their teeth, and they end up having to crown their teeth. They’ll bite on it, the metal portion.
BRETT DAMERON: They constantly play with it.
TED SIMONS: Yeah, so—
ALLISON HOUSE: They’ll run it across their teeth, and they’ll chip their teeth. So you’re just setting yourself up for dental work.
TED SIMONS: Yeah, there is—I’ll start with you on this. There--talk about recent trends. Going to Mexico, whether it’s a coordinated effort or just on your own to get dental work done because of a perceived benefit in terms of pricing and these sorts of things--talk to us about this, and again, the risks involved.
MARK HUGHES: Well, a lot of it is the standard of education and training that the dentists here, as opposed to the dentists there, receive. It’s generally a much higher quality of education and training that you receive here. Also because of the board, and the continuing education and stuff that's available, there's a very high level. We try to keep all of our dentists on the cutting edge of what’s going on. Also the standards: sterilization and the water standards in Mexico are not anywhere near -- there's no oversight on that, so you’re not sure what you’re getting into when you go down there for treatment. Also if—a lot of people are going down there for large cases to be done. If something happens and goes wrong, you would have to go back down there to be treated. I’ve had several patients who have had cases done down there, they’ve had a tooth blow up, they call me, you know, for pain medication. And it’s like, “Do I do insert myself in that chain, you know, because they chose to go down there for treatment?”
TED SIMONS: Very quickly, again, same idea before as far as advising someone who says, you know, I don't know, “My last visit was south of the border.”
BRETT DAMERON: Well as far as do they want their last visit down there?
TED SIMONS: No, no, if someone comes to you and says, “I went there before.” How do you keep them from going there again?
BRETT DAMERON: Well you can't keep them from going down there. You know, I think the only thing that you can is you can educate the public, you can educate your patients and you can just, you know, lay it out straight. You know, “These are the qualifications that we have here. These are the qualifications they have down here.” There's, “You can't go down there and sue somebody because you can't do that in Mexico.” Here, because of the standards and because of all the supervision, you do have recourse if you're not happy with a certain product, a certain person, a certain--whatever. Down there, you have no recourse whatsoever.
ALLISON HOUSE: A big concern is that we have a very vulnerable population that goes down there. A lot of older patients, and they’re on a lot of medications, and we have eight years of education; we have a lot of pharmacy training, so we understand what those medications do and how to treat those patients best. And you don’t know what you’re getting into when you go down there.
TED SIMONS: We will stop it right there. Thank you so much for joining us tonight. Thanks to all of our panel of experts. And remember, dentists will be available to take your toll-free call at the number on your screen until 9:30 p.m. You can also visit our website, azpbs.org/dentist, for more information and links to additional resources. Thanks for joining us. I’m Ted Simons