Updated July 21, 2006

Choosing Dental Care

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

Many dentists still use a handheld metal instrument called an explorer to detect decay by probing the enamel for sticky or soft areas. However, there is a great deal of variation in results among clinicians who use this instrument. Depending on the amount of pressure applied and on the sharpness of the explorer, mechanical probing yields different interpretations. A dentist with a sharper explorer might recommend filling a tooth, while another would decide to watch it for a while. The DIAGNOdent laser eliminates discrepancies among clinicians and enables a dentist to make better decisions about how to proceed with a problem tooth.

Treatment options
In its early stages, tooth decay can be reversed. If the dentist decides an area can be watched, a patient can help remineralize the area by using a combination of fluoride, chewing gum containing xylitol or Recaldent, antibacterial mouthwash, and, of course, diligent plaque removal through brushing and flossing. This is called remineralization therapy.

If tooth decay is more advanced and cannot be reversed, dentists have a variety of options for restoring teeth. There has been some controversy over the use of amalgams, or silver fillings, because they contain a small amount of mercury. While the ADA and the U.S. Food and Drug Administration have found no evidence that amalgams are harmful, some people prefer other filling materials, such as composites of plastic and glass. Composite fillings have been proven over time to be as successful and durable as the standard amalgams, but placing them requires a different technique. If your dentist uses only amalgam, it may mean that he does not feel comfortable using composite materials.

Choosing a dental hygienist
In addition to needing a good dentist, you also need a good hygienist. Ideally, your preferred dentist and dental hygienist work together, making it easy for you to have one-stop oral health care. Sometimes, however, a dentist employs a hygienist who doesn’t share the dentist’s level of patient care, or a hygienist delivers outstanding care while the dentist is less attentive. While it’s unusual, some people have their dental needs provided for by two offices.

In most states, dental hygienists work under the supervision of a dentist. Their relationship is similar to that of a pharmacist and medical doctor. The dentist must personally examine new patients, and only he can prescribe dental x-rays and dental hygiene services, but the dental hygienist is also a licensed practitioner. Like the dentist, the hygienist has had extensive education, passed national and regional board exams, and met the requirements for state licensure. (Most states also require a certain amount of continuing education to maintain licensure.)

When looking for a hygienist, the telephone is a good place to start. Ask the receptionist when the hygienist’s last continuing education course was taken, or talk to the hygienist directly. How long has he or she been in practice? Is he or she a member of the American Dental Hygienists’ Association or the state professional association?

A dental hygienist’s focus is the prevention of oral disease and the treatment of periodontal disease. A good hygienist listens carefully to your concerns and does a thorough job. Getting in and out of the office quickly is not always in your best interest; on the other hand, a hygienist who takes forever at each visit isn’t providing ideal service either.

Professional cleaning is the dental hygienist’s job. The hygienist should also perform a follow-up periodontal health screening to check for gum disease at each visit. The cleaning usually involves scraping hard deposits from the teeth, polishing them (although this is an optional, cosmetic service), and applying a fluoride treatment to prevent decay. Probing depths, a measure of the bone structure supporting the teeth that is taken by sliding a probe into the pocket around the tooth, should be recorded yearly. If you’re not sure what the hygienist is doing or why, ask about it.

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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