Updated July 21, 2006

Choosing Dental Care

by Shirley Gutkowski, R.D.H., B.S.D.H.

Before any instruments are lifted from the tray, you should be offered a preprocedural rinse with an antimicrobial mouthwash. This is a simple precaution that lowers the bacteria count in the mouth and in the spray generated by rotary tools by over 98%, protecting the dental staff as well as the patient. Anyone treating you should wear gloves, a jacket, eye covering, and a face mask at all times.

The comprehensive oral exam includes a periodontal health screening, a full-mouth series of x-rays, dental photographs, an oral cancer screening, and possibly impressions of your bite to build a model of your teeth. (A comprehensive exam should be scheduled every five years or so, whether or not you have a new dentist.)

The full-mouth series of x-rays, or radiographs, taken during the comprehensive exam is important to detect problems such as tumors or abscesses (chronic and potentially harmful infections) at the roots of the teeth. People with diabetes are prone to dental abscesses, which, contrary to popular belief, are not always painful and may not be noticed until the most advanced stages. A full-mouth set of x-rays includes between 14 and 20 separate pictures. A set of bite-wing x-rays, which are taken yearly, consists of four films; these detect decay between the teeth but do not show the root ends where abscesses form.

Many people are concerned about the potential health consequences of getting regular x-rays, but the radiation exposure from dental x-rays is minimal, and the health problems that could arise from not having the x-rays are much more dangerous. A lead apron and collar should always be used during x-rays, of course. Pregnant women may wish to postpone the procedure, but today’s high-speed x-ray film is extremely sensitive, resulting in a much quicker exposure time and a substantial decrease in radiation. If the dentist uses digital x-rays, the amount of radiation to which you are exposed is a fraction of the amount used for regular x-ray film.

Another critical part of the comprehensive oral exam is the intra- and extraoral cancer screening. (A cancer screening should also be performed at each cleaning appointment.) The reason oral cancer has such a dismal five-year survival rate (50%) is that 60% of oral cancers are identified late, when the cancer has already advanced to another area. The potentially life-saving screening procedure involves a visual inspection and gentle physical assessment of the jaw, lips, salivary glands, lymph nodes, tongue, and inside tissues of the mouth for any unusual spots, lumps, or lesions.

There are also some excellent new tools for detecting oral cancer early. One is the ViziLite, a disposable, handheld light whose wavelength is absorbed by healthy tissue but reflected by abnormal tissue. After you rinse with a special solution, the office lights are dimmed, and the dentist examines your mouth with the ViziLite. Bright white spots indicate potential lesions. To confirm suspected lesions, the dentist or dental hygienist can take what’s called a brush biopsy, in which a stiff brush is used to obtain a sample of cells that is placed on a microscope slide and shipped to a lab. Results are faxed to the dental office in about 48 hours.

During the comprehensive exam, your teeth will be checked for stains, cracks, malformations, and cavities. Some dentists use an intraoral video, a camera that allows you to see your teeth and gums from the dentist’s point of view. This device helps you to see your trouble spots and understand the preventive care the dentist recommends.

Another new tool that your dentist may use is a laser-assisted cavity detection device called the DIAGNOdent. Lasers in dentistry are still controversial, and refining the technology is an ongoing task. However, the DIAGNOdent has rapidly gained favor as a tool for detecting decay in the pits and fissures of the back teeth. This laser does not cut or cauterize; it uses a technique called laser fluorescence to measure the density of the enamel. The device translates the degree of decay at each point into a numerical value.

Shirley Gutkowski is a dental hygienist in private practice in southern Wisconsin. She writes a monthly column for the “Patients’ Corner” of www.dentistry.com, and she speaks to diabetes support groups throughout Wisconsin.

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