How can a trip to the dentist be such a stressful and challenging situation for so many?

By the nature of our dental name and web site www.TheGentleDentist.com/sedation_dentistry we attract many high fear dental clients who have avoided dental visits for many years.  I would like to address some of the most common situations that we encounter in Shelby Township, Michigan.  It is my hope that if you identify with one of these scenarios that you make a decision to take action and visit your dentist.

  1. “Personal space” is the distance in which one has a certain level of comfort with another individual.  This is defined by the fact that we are more comfortable with strangers at a distance then up close.  The more intimate we are with someone the closer they can encroach on this space.  In the health care profession and dentistry more specifically, we encroach on one’s personal space to treat them usually without permission from the patient.  I tell my dental patients that it takes time to develop rapport and trust so that we can get close enough to them physically to examine and treat them.  We in the medical and dental profession have just assumed that it was OK to jump in the personal space without investing the time necessary to develop trust. This is especially stressful for those who have been in auto accidents, been involved with facial injuries or who have been assaulted.
  2. These traumatic events have made the victim suspicious and skeptical of most anyone and these dental patients usually require a lot of time so that they can trust us.  Eventually permission is granted and we are invited to examine them and enter their personal space.  In our office if they need to stop the visit they have plenty of opportunity to do so without pressure.  Our goal is to have our high fear patients make small positive steps forward no matter how long it takes. Because dentistry deals with one of the most sensitive areas of the body (the mouth) there are many dental patients who have been hurt by the injection, have been treated in a very rough manner or the dentist did not numb them up adequately that they had pain with everything that was done to them. It was during these times that a decision was made and told themselves that they were NEVER going to put themselves in this compromising situation again and so they continue to avoid the dentist at all cost.  We find that these events usually had taken place during a childhood visit and their fear will last their entire life unless something can break the cycle and trust can be restored.   I have heard horrible stories of children getting slapped by their childhood dentist because they complained that they were being hurt.  Many bad events similar to these took place scarring these people for many, many years.
  3. Dental treatment requires a patient to lay flat on their back so we have better access to the mouth to perform dentistry.  This physical body position leaves many feeling venerable and unprotected.   Until they know they are safe, asking a dental patient to lean back may be asking too much out of them.
  4. Gagging is a real issue for those who have a difficult time breathing through their nose.  With a history of gagging there are many patients who are challenged to get back into the dentist for fear that they will be embarrassed from another episode of this.
  5. The sound of the dental drill makes many nervous and am told is like “nails on the chalk board”.
  6. When one avoids the dentist for a long period of time there is a strong tendency of self-condemnation and embarrassment.  The last thing the high fear patient needs is to be “preached at” and being told “you should have …….”.  It is important to show mercy and let them know there is a future and hope.

When we see those who avoided the dentist for many years due to dental fear, a bad experience or other reasons it is vital to not judge them but to let them know that the only thing we can do is learn from the past.  We only have control of the present moment and our reactions to the moment.  With God’s favor they will have a positive future and we at our office want to work towards their goal of this positive future.  I also tell them that it is not my position to judge them because we all have different pasts.  I also provide prayer support for those who desire it.  Many of our patients find comfort in this act of inviting God into their care.

In summary the solutions to the problem:

  • For new dental patients who make dental appointments I like to give them a personal call the day before their first visit to not only welcome them but to start and open the relationship in a non-threatening manner.
  • When one arrives to the dental office we like to give them a tour and treat them like they were visiting our own home.
  • During the interview it is very helpful to discover the source of what makes one so nervous of the dentist and acknowledge it with no judgment.
  • With respect and empathy move forward at the pace the patient feels comfortable doing so.
  • Introduce the use of conscious sedation dentistry which allows us to treat the high fear patient without much memory of the visit.  This also works well when a lot of dentistry in needed at once.
  • Nitrous oxide (laughing gas) is used to take the edge of anxiety off.  The benefit is that they can have treatment without requiring a driver to provide transportation.

Movie Glasses and Headphones attached to our i-Pod are used to block the noises that emanate from the dentistry.  The use of music in this way provides a great distraction.

  • Great techniques used to provide dental anesthesia and numbing is critical to put an end to painful shots and lack of complete numbness.

My hope for you is that your dental provider has an understanding of these principals and uses them to provide compassionate dental care.  Modern dentistry should not hurt and if your fear has kept you from getting your oral health taken care of then take action now.  2011 is here and do yourself a favor and get the New Year off on the right foot by taking the first step by calling your dentist.  If you do not have a happy dental home then call us at now (586)247-3500.  If you prefer to email me directly with questions or concerns about your fear then my email is DrAntolak@TheGentleDentist.com.

Just been diagnosed with cancer? What about your teeth?

According to the Oral Cancer Foundation Close to 36,000 Americans will be diagnosed with oral or pharyngeal cancer this year. It will cause over 8,000 deaths, killing roughly 1 person per hour, 24 hours per day. Of those 36,000 newly diagnosed individuals, only slightly more than half will be alive in 5 years. This is a number which has not significantly improved in decades. The death rate for oral cancer is higher than that of cancers which we hear about routinely such as cervical cancer, Hodgkin’s lymphoma, laryngeal cancer, cancer of the testes, and endocrine system cancers such as thyroid, or skin cancer (malignant melanoma).

It is obvious that it is a serious problem and one that can be treated more successfully if it is treated at an early enough stage.  Early diagnosis is critical in the success but these cancers aren’t painful in the early stages.  When they get symptomatic when the patient can notice them they have usually metastasised to the neck or lymph nodes.  Your semiannual trip to the dentist is therefore critical since we do an oral cancer exam each time you are examined by Dr. Antolak. 

Oral cancers are mostly found at the side and under the tongue.  They usually appear as a red or white patch which is usually asymptomatic.  If there is any sign of this a brush biopsy or biopsy can be taken which will determine if there is pathology.

Rapid and aggressive treatment is important including surgery to remove the involved area, radiation and chemo therapies.  Radiation and chemotherapy kills off fast replicating cells.  Cancer cells, saliva producing cells, hair follicles, and any other fast growing cells are killed off by the chemotherapy.  Radiation therapy has an even more focused kill so if the saliva glands are in the path of radiation there is a significant reduction in the saliva.  Since saliva provides moisture and natural protection against gum disease and cavities the mouth is prone to more decay.  In addition the bone is prone to infection because the bone cells have a reduced capacity of healing. 

It is critical to seek dental care immediately to remove and fill any teeth that could have problems after the cancer treatment is started.  Dentures will have to be remade or relined to improve the fit.  A poorly fitting denture can create ulcers in the mouth which will be difficult to heal after radiation therapy is completed.

 One of my recent cancer-surviving patients told me that there was not been enough emphasis on the long term effects of radiation treatment on the teeth after the cancer treatment is done.  She wanted it to be known to others how fast dental decay can occur once the saliva glands are irradiated.

If you have questions or need to know what your next step should be please email Dr. Antolak at DrAntolak@TheGentleDentist.com or call (586)247-3500.

Please remember our Candy Buy Back which takes place on November 2.  We will be paying children $1.00 per pound of candy they turn in.  The candy will be distributed to children in Haiti, Detroit and to the Men and Women in uniform  serving our country overseas.

Shelby Dentist: Differences between mini-implants and regular implants

 

I have patients come into our Shelby Township Dental Office asking advice on whether to have mini implants or standard sized implants placed.  This is a fairly common question I get and want to give some information which describes their commonalities and their differences.   Generally, I would have to answer  that the basic differences in them is the flexibility and what they are going to be used for.

Dental implants are made of titanium, a metal that is completely compatible with the body.  The human  body does not have a reaction to this metal.  Very few metals are bio-compatible which means that they do not create an immune response in the body.  This is what has made implants successful over the past 40 years or so.

  • The standard dental implant is usually made of 2 pieces and is greater than 3 mm in diameter   The standard dental implant has an external screw that allows it to be screwed into the bone and an internal thread which allows different components to be torqued down into the dental implant.    The inside threads of the standard sized implant allows different  components to be attached to them.

The components or abutments are used to:

  • replace missing teeth or a single tooth.
  • Hold  removable dentures in place so they can be snapped on and off. These abutments are like “snaps” and because they are screwed into the dental implant they can have a stronger hold than the mini dental implants

There are many different manufactures of these standard  dental implants that have their own shape and design.  The good news is that they all work very well with a over a 95% chance of success.

  • Mini dental implants are a solid one piece screw that is less than 3 mm in diameter with a specialized ball shaped end that sticks out of the jaw bone.  Inside of the denture is a rubber O ring that fits around this ball.  When the denture is placed over the ball the rubber O ring keeps the denture retained.

Comparisons:

  • Because the mini dental implant is only 3 mm in diameter it needs to be 1 piece for strength. The 2 piece standard dental implants have enough diameter so that an internal thread can be placed inside of the top of the dental implant and keep it strong enough.  When comparing the two systems it is necessary to use four mini dental implants to hold a lower denture in place whereas two standard implants would be comparable.
  • The cost of a standard implant is about 50% more because of the fact that there are more components and because the surgery is a little more advanced.
  • Mini dental implants are good for those who are in poor health because no flap of gum tissue needs to be made for these.  Because no flap is needed it also becomes more challenging because the bone in these patients is usually very thin and it is hard to determine where the ridge of bone is.
  • Because the standard sized  dental implant has individual components screwed into them the become more universal and can be used for different purposes.

I can do and have done both mini dental implants and standard dental implants in my Macomb County Dental office but I prefer the placement of standard dental implants if there is enough bone because it is more predictable to use in my hands.

About The Author

Dr. Robert Antolak, DDS graduated from the University of Michigan in 1987 with his Doctor of Dental Surgery degree. He is dedicated to providing the highest quality and appropriate cosmetic, sedation and general dentistry in the most comfortable and gentle way possible. Because being a dentist has been a lifelong dream, Dr. Antolak has a passion for the profession. He enjoys helping people feel better about their smiles and therefore their self-image with dental implant and cosmetic dentistry. His Dental Practice is located in Shelby Township, Michigan.  For more information visit The Gentle Dentist.