What's In A Smile? Part 2

Smile!
by Jonathan B. Levine, DMD, Jane Larkworthy

(Page 2 of 2)

Step Two: Narrowing Your Search

Once you get some dentists' names, call their offices and conduct a phone interview with each one. The first checkpoint for clearance depends on the answers they give you. Without exception, ask the following:

• "Does she work with different specialists?" If the receptionist replies, "Oh, she's extremely talented. She does the root canals, oral surgery, perio, even orthodontics," say, "No thank you," and move on to the next name on your list. No dental professional is good at every specialty. You want someone who works with a team of specialists to handle the different divisions of dentistry.

• "And can you tell me some of the names of the specialists she usually works with?" You should absolutely ask this question, then check on the specialists' names as well. Professional football players wouldn't train with-or be in the same league with-a high school team. You get the analogy.

• "Does she have hygienists? Who's doing the cleaning? A hygienist or the dentist?" If the receptionist says that the dentist is doing the cleaning, say, "Thank you" again and hang up again. Cleaning is a hygienist's specialty.

• "How much time will a routine cleaning take?" It should last at least forty-five minutes.

• "Has Dr. So-and-So been published?" And by that, I don't mean before-and-after ads on the subway or a Web site with dancing molars. Ask if this dentist has been quoted in reputable magazines or whether any of his works have been published in a professional dental journal.

• "Does she give lectures? Where? How often?" The lectures should be at either a reputable dental school or the local university and should be as recent as within the past year.

Step Three: Evaluating A Visit

Upon your first visit to a new dentist, schedule a consultation only, with no dental work. Remember, you should be interviewing the dentist as much as the dentist is interviewing you. After all, this is a potential employee you'll be paying. Don't just ask questions, but observe the surroundings.

• His best work: Ask to see photographs of patients he's treated who've had similar conditions.

• What's her specialty? Ask if she's a dental specialist, such as a prosthodontist. (Does she do a lot of restorative dentistry?) If her answer is, "Oh, I do all kinds of dental specialties," head for the hills! A dentist cannot (and should not) do all things. If you're in a metropolitan area, especially, there should be a different specialist to go to for each area of dentistry.

• Sterilized for your safety: Is there a dedicated sterilization area? Ask the dentist: "Do you have an autoclave?"( An autoclave is a heat sterilizer. Every instrument that goes in the mouth should be autoclaved.) Check to see (or ask) whether all the examining rooms are barrier-controlled for full sterilization. You can tell by asking (or checking to see) whether everything used is covered with plastic.

• In-house tech support: Ask which technicians he works with (ceramist, metal technician), and for how long. The best answer is: "We have an in-house lab." And the longer he's been working with this technician, the better.

Further, you know you're really in a top-notch practice if there are on-site laboratories with ceramists (a ceramist is the person who makes the porcelain veneers), plaster technicians (they prepare the mouth model for the ceramist), and metal technicians (they create the substructures for the bridges and implant crowns). Any lab with lab technicians will have the latest ceramic equipment.

While having every piece of state-of-the-art equipment does not necessarily guarantee expert care, the following technologies can help your dentist provide the high-quality care you are seeing. Ask if the practice uses any of the following:

• Digital X-rays.
• Digital cameras.
• The latest autoclave equipment.
• Fiber-optic hand pieces.
• Magnification eyeglasses for the dentist.

You should also inquire about patient communication technology, which can aid your dentist in explaining whatever concerns she may have or procedures she may propose. Ask if she uses:

• Computer imaging.
• Patient education software.
• Intra-oral camera.

Finally, don't underestimate the value of office aesthetics. Make sure to ask yourself: Do the office, examining rooms, staff, and environment seem dedicated to making patients comfortable?

Special Medical Concerns: What to Know Before You Go

Before you get in the dentist's chair, reviewing this list will help prevent potential bumps later on.

Bleeding

• If you bleed easily, check with your physician as to whether this could influence your dental appointment.

• Heart conditions may require medication, such as Coumadin, which thins the blood and can therefore cause an increase in bleeding.

Heart-Related Issues

• If you have any heart-related issues (mitral valve prolapse, heart murmurs, congenital heart defects), find out from your cardiologist whether you have regurgitation or not. If you do, you need to be premedicated one hour before getting dental work.

• Heart conditions and structural defects also increase the risk of developing a heart valve infection called endocarditis after dental procedures. Bacterial endocarditis can occur when bacteria travel through the bloodstream to the heart and colonize there. Bacteria circulate in the bloodstream and should flow through smoothly when they reach the heart. But any heart abnormalities can potentially cause bacteria to cling on and ignite infection. This is why antibiotics are given to patients with heart conditions before dental procedures with high bleeding potential (extractions, root canals, scaling and root planing, implant placements, even standard cleaning on certain bleeding-prone patients)-it's done to stave off infection.

Sensitivities or Allergies to Medications

• If you're allergic to penicillin, novocaine, or any other medications, always be sure to tell your dentist or hygienist.

• If you're allergic to an oral antibiotic, your dentist will most likely instruct you to take an alternative that you are not allergic to.

• If you're taking any type of medication, always be sure to tell your dentist or hygienist.

Pregnancy

• If there is any chance that you are pregnant, or you know you are, it's advisable to avoid major dental procedures whenever possible. However, in the event that dental work can't wait, the only anesthetic used should be Carbocaine. Unlike local anesthetics, such as Xylocaine or Septocaine (updated brand names for the now antiquated novocaine), Carbocaine contains no epinephrine (a synthetic adrenaline), which can put the fetus at potential risk.

• As most are aware, pregnant and potentially pregnant women should not be x-rayed. But once again, on the rare occasion when an X-ray can't wait, make sure that it's a digital X-ray and that two aprons are placed over you.

• One thing that many people don't know, however, is that hormonal changes brought on by pregnancy render gums more susceptible to plaque. Thus, if you are pregnant, you should get dental cleanings more often.

Family Valuess

When should your child's first dental appointment be? Once teeth begin to appear, you should start thinking about scheduling your child's first dental appointment. Most dentists recommend the first visit around age three, or earlier if you notice any staining or have other concerns.

• Prep yourself: Call your dentist and ask him to explain to you what goes on during a child's first visit, so you can then prepare your child for what to expect. Also, be sure to bring your child's medical history with you to the appointment.

• Prep your child: Instead of instilling fear in your child about the dentist, get her excited about doing something as grown-up as going for a checkup. Explain how important it is for people to take care of their teeth. Explain the procedures she will encounter, such as the big reclining chair and the bib, the big light that looks like a smile, and the cool probing mouth mirror. Reading together a child's book about going to the dentist will help get your child excited and also waylay any fears of this unfamiliar visit. A couple of good books are My Dentist Makes Me Smile by Leslie Craig (1stBooks Library) and Open Wide! A Visit to the Dentist by Cecile Schoberle (Simon Spotlight/ Nickelodeon).

The first visit is more of an introductory one, where the child is shown around, so to speak, checking out the sights (the big illuminating light, the swinging X-ray machine) and sounds (the suction tube, the electric toothbrush-the drill can be saved for later) to help familiarize him with the dentist's office. Instead of a fear zone, the dentist's office can be one of wonder- it's up to you as the parent to set the example. If your dentist wants to spend some time alone with your child, that's fine (if your child seems comfortable). It's important for the dentist to establish a relationship and trust with your child. Once a child is comfortable in the dentist's office, the visit should last about twenty to thirty minutes. The visit may include the following, depending on the child's age:

• An examination of the teeth, bite, gums, and oral tissues to monitor growth and development.

• A discussion among the three of you on proper athome oral care.

• A possible discussion about fluoride needs.

• Nutritional advice for healthy teeth.

• A gentle tooth polishing, which can be an exciting and positive way to end a first visit (the whirring of the brush, the grape flavor of the toothpaste, the smooth feeling of teeth afterward).

Copyright © 2006 Jonothan B. Levine, DMD

About the Author

Jonathan Levine, DMD, is a man with a mission: To give the world a reason to smile. A "smile beauty" practitioner for more than two decades, Dr. Levine is an accomplished aesthetic dentist, professor, product innovator, entrepreneur, author and philanthropist. His dental practice, located on Fifth Avenue in New York City, attracts high-profile members of the fashion community, social circuit and Hollywood elite. In 2002, he and his wife, Stacey, co-founded the revolutionary smile beauty company GoSMILE™.

Jane Larkworthy is the author of Smile! The Ultimate Guide to Achieving Smile Beauty with Jonathan B. Levine, DMD.