The Right Dental Checkup Can Save Your Life

Alan A. Winter, DDS

Seven ways to tell whether your dentist is doing his job.

You may think that you see your dentist just to have your teeth cleaned, a cavity filled or to get a crown. But your dental visits should include much more than that.

During your regular dental checkups, your dentist should be performing not only the standard services that most people know about, but he/she also should be examining your mouth carefully for signs of disease that could affect other parts of your body, such as cardiovascular disease and lung disease.

To get the most from your dental checkup, your dentist should…*

Check for periodontal disease.
People with gum (periodontal) disease are nearly twice as likely to have heart disease. Untreated gum disease also has been linked to increased risk for such conditions as stroke and pneumonia. Bleeding gums are not normal and are a telltale sign of gum disease. Surprisingly, however, some dentists (and hygienists) don't use a tool called a periodontal probe, which is a millimeter ruler that measures the separation between gums and teeth to routinely check for periodontal disease. The deeper the pocket, the worse the problem. If gum disease is diagnosed, your dentist should devise a treatment plan to reduce inflammation and restore gum health—and perhaps refer you to a periodontist, a dentist who specializes in the treatment of gum disease.

Screen for oral cancers.
A dentist should screen for oral cancers at every checkup. This involves looking for suspicious lesions on or underneath the tongue, on the palate and inside the cheeks. Oral lesions sometimes go unnoticed by the patient because they don't ordinarily cause pain. Your dentist also should palpate the floor of the mouth and under the neck for lumps that may indicate cancer.

Important:
Your dentist should check for ill-fitting crowns and/ or fillings—sharp edges can cause chronic tissue irritation that can become precancerous. Caution: If you have a sore in your mouth that does not heal within two weeks, see your dentist to have it evaluated.

Use digital X-rays.
Conventional dental X-rays expose you to 10 times more radiation than digital dental X-rays. High-speed film is better than conventional X-ray film but still uses more radiation than digital. Because the effects of radiation are cumulative, it makes sense to limit your exposure whenever possible. When you call to schedule an appointment, ask if the dentist uses digital X-rays. Important: While every dentist should use a protective apron to cover the patient's torso, a thyroid collar should also be used to protect this sensitive gland, which is located at the base of the neck and can be unnecessarily exposed to radiation from dental X-rays.

Follow infection-control procedures.
To prevent the spread of germs, any equipment touched by the dentist and/or dental assistants, such as the overhead light, telephone and intercom buttons, should be covered with clear plastic that is replaced after each patient. Disposable products, from suction tips to drinking cups, should be used at all times. Nondisposable instruments must be sterilized between patients to kill bacteria and viruses. For your safety, dentists use an autoclave, which resembles a small safe and sterilizes under high heat and pressure.

Keep pace with technology.
Progressive dentists stay up to date on new technologies in order to offer the most current therapies, which may provide better results than outdated ones. For example, computer-aided design and computer-aided manufacturing (CAD-CAM) technology, which does not emit radiation, can be used to make digital impressions (for crowns, for example) that are extremely precise. Cone beam scanners take 3-D images of the jaws to better plan for the insertion of dental implants, remove wisdom teeth, etc. Important: 3-D images reduce risk and improve outcomes. However, new technologies do not necessarily translate to high-quality dentistry, and dentists who don't use all forms of new technology may offer outstanding service.

Present you with options.
Your dentist has a legal and ethical obligation to present you with all viable treatment options, even if he doesn't perform them all himself.

Let's say you cracked a tooth on an olive pit and the tooth can't be saved. Many dentists will suggest a replacement bridge but won't mention a dental implant (even though it might be a better option) because they don't do implants. You don't want a dentist who says, "This is what we're doing" and proceeds without discussing options.

Refer you to specialists for diagnoses and advanced treatments.
Up to 80% of dentists are general practitioners, but when you need advanced care, you may want to be treated by a professional with advanced skills, such as a periodontist… oral surgeon (to remove impacted wisdom teeth, for example)... endodontist (for root canals) or orthodontist (for braces). A responsible dentist will not be offended if you inquire about specialists and should be willing to offer an appropriate referral.

If your dentist does not follow the steps described in this article, contact the American Dental Association (312-440-2500, www.ada. org) or a specialty organization such as the American Academy of Periodontology (312-787-5518, www. Perio.org) for a referral.

*Twice-yearly dental visits are recommended for most people. For people with gum disease, four visits per year are typically recommended.

Bottom Line/Health interviewed Alan A. Winter, DDS, founder and president of Central Park Periodontics, PC, www.CentralPark Perio.com, in New York City. Dr. Winter is a diplomate of the American Board of Periodontology and an adviser to the Journal of Implant and Advanced Clinical Dentistry.





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