18 Questions While You’re in the Dentist’s Chair

It’s National Dental Health Month. Really, you ought to appreciate it.

We’ve all been there. You’re sitting
on the dentist’s chair, with your palms sweating. Maybe you’re wincing, anticipating
a needle full of Novocain or the high-pitched whine of the drill.

Maybe,
like a lot of folks, going to the dentist makes you feel guilty, for not brushing
or flossing or getting dental care as often as you should. Feeling guilty and
anxious is never a pleasure. But before your negative feelings turn to malice,
here are some answers to questions that may occur to you as you sit in the chair.

1.
What if I just get off the chair now and never come back?

Other than
losing all your teeth, there are medical complications that can occur if you do
not get regular dental care. Left untreated, tooth infections can spread to the
jaw and neck. This can not only be very painful, it can also block the airway.
“I’ve seen people die from airway compromise in emergency rooms,” remembers Dr.
Bruce Todoki, an oral and maxillaryfacial surgeon, who takes calls at Kuakini
and Queen’s hospitals. “Sometimes I am called to take out bad teeth in patients
who need chemotherapy, but, because they have not had dental care, the chemotherapy
has to be delayed by a couple of weeks.” Rarely, tooth infections can spread to
the brain and cause bacterial meningitis.

2. Now that you have scared
me, how does someone decide to become a dentist?

There are perhaps
as many reasons as dentists, but most dentists say they knew they could solve
real problems for people.

“I had really bad buck teeth in third grade,
and my classmates used to make fun of me,” remembers Dr. Joyce Hagin. “In fourth
grade, I had braces to correct them, and I remember walking to school with my
new, straight teeth, and I felt so happy. My mother also had bad periodontitis,
and felt ashamed about her dentures. I felt bad for her. I wanted to go to dental
school so that I could make a difference in people’s lives.”

3. What
does it take to be a dentist?

Illustrations:
Michael Austin

Perseverance and study. Dental
school, like medical school, requires four years of graduate study after college.
The first two years of dental school are spent mostly in lectures, reading pharmacology,
physiology, biochemistry and, above all, anatomy of the tooth and surrounding
structures.

During dental school, many hours are spent practicing drilling
and filling on plastic mannequins. At the end of the second year, dental students
practice giving injections to each other. The third and fourth years are spent
in clinics. Unfortunately, in some dental schools, as in some medical schools,
there is a form of official hazing. “We were made to feel stupid. The faculty
did not treat us with respect, unless we had acquired some knowledge,” remembers
one dentist.

After dental school, most newly trained dentists start practicing
as general dentists. Others train further for anywhere from two years to seven
years, to become specialists. There is no dental school in Honolulu, but The Queen’s
Hospital has a dental residency program, where newly graduated dentists can spend
a year further honing their skills in general dentistry.

4.
Is a dentist the same thing as an oral surgeon?

No. In order to become
an oral and maxillofacial surgeon, it used to take four more years of training
after dental school, but now it takes seven years, including going through medical
school. “I saw a lot of interesting cases when I trained in an Atlanta county
hospital,” remembers Dr. Lyle Yanagihara, a Honolulu oral surgeon. “There were
a lot of gunshot wounds and serious infections that we just don’t see here in
Honolulu.”

Compared to Atlanta, Honolulu is very quiet. Here we have mostly
broken jaws and infections. How does one break the jaw? Apparently, there are
quite a few fights here in Honolulu, that end up with broken jaws. Yanagihara
explains, “if you hit another guy on the jaw at the right angle, it can break
very easily.” Sometimes, if there is an impacted wisdom tooth putting additional
pressure, the jaw breaks even more easily. “Once I took care of a 60-year-old
lady, who was playing tennis, fell on her chin and broke her jaw on both sides.”

5.
OK, I understand I need a surgeon if I get hit in the jaw. But what do I need
a dentist for? Why aren’t my teeth tougher? Shouldn’t they be at least as tough
as bone?

Like many people, teeth are only tough on the outside. The
tooth itself has three main layers: (1) a very hard, outer core, usually called
enamel, (2) a layer of bone tissue called dentin and (3) a soft pulp. The enamel
is extremely hard, but also quite brittle. It is 97 percent mineral, made of calcium
hydroxyapatite. It can withstand 100,000 pounds per square inch of pressure. The
dentin is a bit softer, 70 percent mineral. The soft pulp is the sensitive part
of the tooth, with many blood vessels and more than 2,000 nerve fibers per tooth.
When the pulp gets infected, you get a throbbing toothache.

6. Why does
the dentist stick that sharp dental probe all around my teeth? What are dentists
“probing” anyway?

They are probing to make sure you don’t lose your
teeth. Try to think of it this way: Your tooth sits in a socket on the skull,
like a flower in a vase. The upper teeth are attached to the maxillary bone, the
lower teeth to the jaw bone. Each tooth is tethered by ligaments only 0.3 mm wide,
surrounded and held in place by what we call gums and the dentists call gingiva.
If the gum gets infected and goes untreated for too long, the socket melts away
and your tooth can literally fall out.

7 . Even if I brush my teeth?

The
pocket between the tooth and the gum is called the gingival pocket. You cannot
reach it with your toothbrush. Therefore, it’s a prime spot for what are called,
if you’d gone to dental school, subgingival plaques. These plaques are coated
with bacteria, and, if not cleaned by the dentist, will cause the gum to become
inflamed, a condition called gingivitis. If gingivitis gets bad enough, it turns
into periodontitis, which means you are losing gum tissue and even the jaw bone
that supports the tooth.

8.
How does the dentist’s probe help?

The periodontal probe is used to
measure the degree of gingivitis caused by bacteria. The deeper the probe can
be pushed into the space between the gum and the tooth (it’s called the gingival
pocket, remember), the worse the inflammation. If the probe goes in quite deep,
then the bacteria probably have done so much damage that part of the gum or even
the bone has been lost.

9. How do I keep that from happening?

You
start by brushing and flossing, of course. Your dentist can smooth out ill-fitting
tooth fillings, and fill cavities. But a crucial part is to remove the plaque-well,
really the calculi.

10. Calculus? Like math?

Calculi is Latin
for stones (and the Romans counted with stones, which is where we get the words
calculate and calculus.) But dentists call hardened plaques calculi. They are
little stones on your teeth, and, since they are coated with millions of bacteria,
unless they are removed, no matter how much you brush your teeth, the gums and
teeth will continue to erode.

A dentist or a dental hygienist has to remove
them.

11. Is that why the hygienist scrapes my teeth with what
seems like an ice pick? She seems to be working awfully hard.

Some of
the calculi are hidden between the tooth and the gum, so that you cannot see them
or reach them with the toothbrush. The only way to get rid of them is to work
very hard with that ice pick-like instrument, which, by the way, is technically
called a curette.

When the hygienist uses the curette, she is trying to
pull hard, so that the plaque tears out from the tooth. The plaque cannot be just
scraped off. It must be yanked out. Your gums will thank her, even if you won’t.

12.
Most people don’t get gum disease, right?

Wrong. According to Dr. Gregg
Uyeda, a Honolulu periodontist (specialist in gum diseases), “More than 97 percent
of people have gum inflammation or gingivitis.” You need to know about it. “Education
is most important,” Uyeda adds. “It takes only five minutes, but every dentist
should educate the patient about how important it is to control gingivitis.” Through
brushing and flossing and proper dental care, you can keep your gums in good shape.

13.
Gums, gums, gums. Whatever happened to old-fashioned cavities?

People
still get cavities. And you can loose your teeth two ways: from below through
gingivitis and from above by acid generated by bacteria in the plaque. There are
always bacteria in our mouths, but two cause most of the damage: streptococcus
mutans and lactobacilli. These bacteria produce lactic acid, which not only causes
inflammation of the gum, but can also melt away the enamel of your teeth to form
cavities. Cavities can be prevented with tooth brushing, fluorides, diet, and
fissure sealants.

14. What’s the best way to brush my teeth?

“Just
massage your gums gently with the toothbrush,” advised Dr. Jun De Los Reyes of
the Kalihi Palama Dental Clinic, “and always use a soft toothbrush. Don’t try
to dig into the gums, or the gap between the tooth and the gum.

15.
What’s a dental sealant?

Fissure sealants are like a clear plastic cover
that the dentist can put over the teeth to prevent cavities. Since 90 percent
of all cavities occur on the molars, where rough chewing surfaces sometimes cannot
be reached by toothbrushes, and since fluorides do not protect well against molar
cavities, dentists have been using sealants to prevent cavities in children. “Some
Micronesian children, and many Asians, have very deep molar fissures,” adds De
Los Reyes, “and I use sealants quite often on them.”

16.
What about fluoride? Is it in the water?

No, our water is not fluoridated,
except on the military bases. Fluoride occurs naturally in water, but at different
concentrations in different parts of the country. In the 1940s, the U.S. Public
Health Service found that there was a direct correlation between fluoride concentration
in water and cavity rates. Fluoride was first added to tap water in 1945 in Grand
Rapids, Mich. Now, 5 percent of all Americans drink fluoridated water. Fluoride
in tap water has been shown to cut cavity rates in children by 50 percent and
by 20 percent in adults.

“It is unfortunate that we do not have fluoridated
water in Honolulu, because it helps teeth to become strong when the infants are
still young,” according to Dr. Nadine Salle, a pediatrician at The Queen’s Medical
Center. “Almost all pediatricians prescribe fluoride drops for babies starting
at age 6 months.”

The good news is that most toothpastes have fluoride now.
Over-the-counter fluoride rinses are also available. In a study done in Norway,
where 90 percent of children use fluoride toothpastes, using fluoride rinses decreased
the rate of cavities by another 50 percent.

17. But fluoride won’t
keep me from seeing the dentist?

No, you need regular dental care to
preserve your teeth. You don’t want to have dentures, but you will if you don’t
control both cavities and gum disease. The best way to keep your teeth healthy
is to have hidden plaques removed by a dental hygienist, to have cavities repaired
by a dentist, by eating a healthy low sugar diet, using fluoride in either toothpaste
or mouthwash and brushing your teeth and gums well at least once a day.

18.
So I am happy to be in the dentist’s chair?

Whether you know it or not,
yes.

Glossary

Calculi:
hard stones that form between the gum and the tooth, from plaques that are
not cleaned properly.
Caries: tooth cavities
Enamel: the
very hard, outer layer of the tooth
Gingiva: gum
Gingivitis:
bacteria infection and inflammation of the gum
Periodontitis: bacterial
infection of the gum leading to destruction of the gum and the jaw bone supporting
the tooth
Plaque: invisible film of bacteria that coats the teeth and
gums
Pulp: the soft, inner part of the tooth that’s very sensitive,
because it is rich in nerves and blood vessels