Updated July 21, 2006

Choosing Dental Care

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

If x-rays are taken, asking to see them can help you judge the quality of your care. Unless your teeth are malaligned in your jaw, the radiographs should show perfectly proportional teeth. An x-ray in which the appearance of the teeth is distorted cannot give the clinician good diagnostic information; retakes are sometimes necessary.

Make note of the technology the hygienist employs. Hygienists who rely only on hand instruments may not be doing all they can for their patients. Ultrasonic scalers, for instance, are an improvement over mechanical scalers because they not only remove hard deposits and stains but also kill bacteria and create a soothing sensation on the gums.

Dental anxiety
It doesn’t matter how talented a dental team is if you are afraid to visit their office. Over the years, dental practices have taken strides to reverse their unfortunate reputation as places of torture. Slogans like “We Cater to Cowards” or “Gentle Dental Care” fill the Yellow Pages, and some dental practices seem more like spas than medical offices. Low lighting, soothing aromas, and hot towels can be a boon to those who have learned to fear the dentist office. If you tend to avoid the dentist out of fear, ask how dental anxiety is handled during your initial phone call.

Some practices offer step-by-step desensitizing sessions, in which the first few visits don’t involve going into the treatment room, and the anxiety is gradually overcome. If a dentist will only provide barbiturates or nitrous oxide sedation for anxiety, however, keep calling around. While drugs are extremely effective at decreasing anxiety, and for some people, prescription drugs should be used at every visit, a good dentist and dental hygienist team should have a plan to try relaxing a nervous patient before offering pharmaceuticals. For people who have an overwhelming fear of the dentist, oral care can be accomplished in a hospital under general anesthesia. (Some dentists do general anesthesia in their offices, but it is not yet a recognized dental specialty.)

If a fear of needles makes you dread tooth repair, ask if the dentist uses an advanced anesthetic delivery system called the Wand. This tool electronically delivers the anesthetic so that it reaches and numbs the tissue ahead of the needle and delivers the dose at a slow, steady rate. This makes the procedure longer but virtually pain-free, even on sensitive places such as the roof of the mouth.

For most people, low-level anxiety can be overcome before they leave home or in the dentist’s chair by learning some simple relaxation techniques such as deep-breathing exercises. Some people may prefer a practice that provides virtual reality glasses or ceiling TV screens for distraction; others find it relaxing to bring their own music in a cassette or CD player and headphones.

Diabetes and dental care
Finding excellent oral health care and a comfortable office environment is especially important for people with diabetes, who are at increased risk for gum disease, dental abscesses, and oral thrush (a fungal infection that forms white, sore patches inside the mouth). Diabetes can make any infection slower to heal; at the same time, the presence of an infection such as gum disease can raise one’s blood glucose level, making diabetes harder to control. Oral surgery and dental anxiety can also upset blood glucose control.

Because of the interaction of diabetes and periodontal disease, people with diabetes may require dental visits as often as four times a year. When searching for an oral-health-care provider, ask about a dentist’s or hygienist’s experience in treating people with diabetes. Are steps taken to keep invasive procedures as short and stress-free as possible? Is the dentist willing to wait until a person’s diabetes is under control to begin nonemergency treatment?

In general, the morning is thought to be the best time for people with diabetes to have routine dental appointments, because their blood sugar level should be closest to normal after the morning meal and medicine. Inform your dentist and hygienist at each visit how well your diabetes is being controlled and if there have been any changes in your condition or medicines since your last visit. Check your blood glucose level before the appointment and, if your stress level is high or the procedure is prolonged, during it as well. If periodontal surgery is necessary, have your physician and dentist discuss the procedure together.

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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