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Questions Across the Net from a Young Inquisitor!

We thank Melisa Herta for her questions.

Dear Melisa,

First of all, I want to commend you and your teacher for such a far reaching project. I can only assume that you came across my name on the Internet. I just finished talking with one of the administrators from my local school system and some think the Internet is a total waste of time. I suppose people thought that the industrial revolution would not amount to much, either!

Secondly, I think your questions are terrific. They are so terrific that I will actually have to do some thinking to answer them. Leave it to our youth to keep me on my toes.

1. What inspired you to become a dentist?

My father actually gave me the idea as a high school student. I was very good in science and I liked to do intricate models etc. with my hands.

2. How does a laser make teeth whiter?

Sorry, I have to plead stupidity on this one. I haven't really seen too much in the dental literature about laser whitening and if I did I didn't pay much attention to the articles because the lasers are so expensive. It will be a while before most dentists are buying lasers because of their cost (somtimes greater than $100,000) and the fact they have been approved for such limited use.

3. Does Whitening toothpaste actually work?

I haven't seen a lot of scientific research in this area so my opinion is just that, my opinion. I would think the limited time that the material (toothpaste) is in contact with the teeth would limit it's effectiveness severely. In other words, I doubt it is very effective.

4. Why do some medicines discolor people's teeth?

Some medicines (a good example is tetracycline) are incorporated into the structure of teeth as they are forming. In tetracycline's case the teeth look gray and dark because the actual drug is deposited in the crystalline matrix of the teeth. Other drugs cause discoloration by altering the structure of the crystals and allowing other stains to be incorporated into the teeth. A good example of this would be excess flouride causing what dentists refer to as flourosis. Flourosis results in white spots, brown spots, and (in severe cases) even malformed teeth. The above stains can not be easily removed from your teeth. They usually require some form of covering to mask the faulty color. Lastly, some drugs cause stains to form on the surface of teeth. Good examples of this are iron pills and a mouth rinse we use in dentistry called Clorhexidine. These types of stains can be removed by a dentist or hygienist when you have your teeth cleaned.

5. What precautions do dentists take because of AIDS?

Boy I could write a book about this one! Actually, we take many precautions to prevent many communicable diseases from spreading between patients and ourselves. These precautions include but are not limited too: gloves, masks, clothing, safety glasses, sterilization of instruments, disinfecting of surfaces in our operating rooms, disposable products for items that come in contact with patients that are not able to be sterilized, and covering with plastic coatings things like computer keyboards, light handles etc.

6. Can brushing too hard expose a nerve?

Brushing too hard doesn't actually expose a nerve but it can wear away the enamel of a tooth, usually around the gumline where the enamel is thin. After the enamel is worn away the dentine is exposed. The dentine is filled with small tubes that have tissue connected to the pulp or more fleshy part of the tooth at its center. The pulp contains nerves and blood vessels and other tissue just like other areas of your body. The dentine transmits insults (hot, cold, touch) to the tissue in the pulp so it may feel like the actual nerve is exposed.

7. How has your job changed since you got out of school?

Another great question that would take me a term paper to answer fully! I will attempt to summarize the changes. I would say my job constantly changes. Payment methods have been changing as the insurance industry makes more types of plans available. Staffing has changed (good staff are very hard to come by). Procedures are always changing. We have new and better esthetic restorative materials now that we didn't have when I graduated. Regulations from various state and federal agencies have mushroomed to the point that we really can't totally comply, it's just impossible to even be aware of all the regulations much less have time to implement them all in our daily routines. We would never get any dentistry done! Legal difficulties have changed the way we practice and keep our records. We must devote a great deal of time to legal treatments of our patients rather than totally being concerned with dental treatment objectives.

Lastly, technology is changing rapidly. In my office we have all patient records, chart, ledger, insurance information, health history and even X-rays on computers in each operating room. We have just converted to taking X-rays without film using a CCD chip which transfers an image directly to our computer. There are many advantages to this method including: no chemicals involved in developing, no waste of film, instant X-rays, time saving for staff because they don't have to develop them, 80% reduction of radiation to the patient, and we don't have to file the X-rays they are on our computers. Other technology advances include: imaging, patient education videos, and CD ROM and electronic insurance claims.

8. Do you think robots will take over any part of the dental field?

I don't feel this is likely in the dental office in the near future except for the fabrication of restorations. New equipment is being developed that will allow us to make indirect (not in the patient's mouth but usually at a dental lab) restorations via scanning and computer controlled milling machines. The reason I don't see robots being used for other purposes is that dentistry is not a repetitive type of work. Each patient and each restoration has many different variables that would be hard for a robot to handle.

9. Do you think there will be more women in the dental field in the future?

Sure! I think dentistry is a terrific field for women! My dental class had 2 women out of 110 students. Classes today have much higher percentages.

10. What do you think the future of dentistry will be like.

I think dentistry in the future will continue to be a challenging profession that is rewarding both in personal satisfaction and income. Common treatments for patients will gradually move away from as much restorative dentistry and be more focused on cosmetic dentistry and in controlling periodontal (gum) disease. Implants will be common place and lasers will be used to actually fuse our future filling materials to the tooth creating restorations of the future that will be stronger and last longer than before the tooth required restoration.

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