Sedation Dentist serving High Point, Greensboro, Winston-Salem and the Triad area.


This is the period when proper early care makes the biggest impact. Those who have not learned how to brush or floss properly will become concerned about their bleeding gums, bad breath, removal of unnecessary wisdom teeth, and their first bout with a real toothache. This is also the’stage during which exploring or new activities lead to accidents requiring swift and expensive action to ensure proper preservation of the dentition. This period is also when those who had braces and who did not practice proper oral hygiene will require cosmetic work. The growth spurt is nearing its end or is complete, and placement of implants to replace missing teeth can start.

For many, this is the time when they find themselves in a place other than home for purposes of college, job, or relationships. At this point, many are trying to save money by not spending, and one of the things that are’sometimes neglected is dental care. Some have skipped out on the extraction of wisdom teeth earlier and now find that they will have to take time off from their job or’school to pursue extractions and recovery.

Those who had never had a bad dental experience and’did not practice the habit of brushing after all meals and flossing twice per day will start to struggle with bad breath, gum disease, and cavities. Long hours on’the job or at school make the bad habits worse. Treatment by the’dentist for repeated bouts of teeth and mouth infections is commonplace. Those with good habits may’try to improve’their teeth by doing bleaching or cosmetic bonding.

Braces make performing proper hygiene more difficult, and I always recommend that during active orthodontic’treatment, instead of cleanings twice per year, the patient receive cleanings four times per year. The savings of proper oral hygiene and need for less gum surgery afterward will more than pay for the two additional treatments per year. Breakdown of enamel around the brackets when proper and additional hygiene measures are not pursued will result in breakdown of the enamel, similar’to the breakdown that occurs during pregnancy or from extreme soda use without proper and immediate brushing and flossing afterward.

Motorcycling, partying, skiing, contact sports of all types,’seizures, and altercations can lead to the immediate destruction or loss of teeth. This will need immediate treatment’to minimize the damage, and many young people may not have saved up an emergency fund for a situation like this. Many end up in later years spending tens of’thousands of dollars to take care of defects that they were unable to take care of at the time of the emergency. Others will end up in dentures or temporary appliances of various’types. These temporary measures can affect the social life of a young adult and decrease their self-confidence.

One of the rites of passage from being a dental student’to being a dentist is practicing a procedure for the first’time on your lab partner. We practiced impressions on each other. We practiced cavity detection on each other.”We practiced injections on each other. One day, my lab partner was doing a periodontal (gum disease) evaluation on me.

Bert! You have gum disease!

What I said.

Gum disease. You have bleeding, lots of bleeding points.”Have you ever been treated for gum disease

No. How bad is it

You have some pocketing, and bleeding from the pockets.”Here, let me go over it with you.”

I spent numerous visits in the clinic getting my gum’disease treated and perfecting my brushing and flossing’techniques. It was disheartening, and I felt lousy for neglecting my dental health for so long. I was happy that I’did not have to go through the trauma of extractions again because of my neglect.

A bloody toothbrush without pain is often ignored, but’that is a mistake. Gum disease starts slowly and painlessly.”In smokers, it can be undetected because of the effect of nicotine in constricting blood flow; therefore, they may not see bleeding as readily as nonsmokers. Smokers also need more regular check-ups to detect oral cancers.

A traditional cleaning will not be sufficient to decrease gum disease. Additional treatment of scaling and root planing with local anesthesia and/or conscious sedation may be needed. Treatment may have to be repeated, or more advanced surgery will have to be done. More than’two visits to the dentist per year may be needed to keep gum disease at bay. Sulcular (space between the tooth and the gum) and oral antibiotics as well as rinses may be needed, and in cases that do not respond properly, a visit with a periodontist (dental specialist in treating gum disease) is in order. Gum disease is the most common cause of bad breath.

Toothaches can occur for the first time during this transitional’time. A “real toothache, as I refer to it, is one in which decay breaks down the teeth, to the point where bacteria get into the nerve and cause an irreversible pulpitis(inflammation of the tooth pulp). The options at this time’do not include a filling; the nerve of the tooth has to be’taken out or the tooth has to be extracted. The removal of’the nerve and subsequent post buildup and then a crown usually takes care of the problem, but in the event that it does not, the dentist will usually do an extraction. If’the extraction site is filled with bone-grafting material, it preserves the bone, and in several months a replacement’tooth implant can be placed.

Altercations or on-the-job accidents can cause broken’teeth, and the treatment usually requires some type of cosmetic restoration of the teeth. Some teeth may need’to be extracted if the fracture line extends below the gum into the supporting bone. Other’teeth may need root canal’treatment if the fracture is just into the nerve of the tooth.”An un-salvageable tooth can sometimes be treated with an immediate implant that can have a temporary done immediately after placement. Grafting helps to maintain or create new bone for placement of the implant or provide’the shape of bone, so if a dental bridge is made, it does not have a large space to trap food.

Delivering a denture or removable prosthesis to a patient for the first time can be very stressful for both doctor and patient. Sometimes a denture is all they can afford.

I feel very sad when I have to remove a tooth that has no cavities because trauma has made it non-restorable. The last choice for a patient is to leave the dentist with the’space for the missing tooth unoccupied.

I feel a sense of loss and a bit of remorse when I assist a patient in losing a part of their body albeit a tooth. After all someone who loses a part of their body is starting a journey’this is the beginning of a long road that is going in the wrong direction.

 

Chapter 6: Three Periods of Dental Health