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Dental Consumer Information from Dr. Covert

Dear Friends,

The following is a summary of my best dental advice after thirty years of practice. Topics that I think will be most beneficial to you are prevention, selecting the proper dentist, dental insurance, dental consumer awareness, corporate dentistry, and other miscellaneous information. PREVENTION * Brush twice a day with a Sonicare or Braun Oral B toothbrush. Use Colgate or Crest toothpaste. * Floss every day. * See your dentist twice a year. * Cleaning appointments for adults should be one hour. * Adults should have bite wing x-rays at least once a year, twice if you are at high risk for tooth decay. Children should have bite wing x-rays twice per year * Take your children to the dentist by two and one half years old. * As soon as children's teeth erupt, brush them morning and night. SELECTING THE PROPER DENTIST * Due to the recent influx of corporate dental practices and the changing nature of the dental profession, I encourage you to educate yourself and become a better dental consumer. Remember that all dentists do not have the same education, specialty training, experience, or value system. It is crucial to select the right specialist for a specific procedure. * Actual orthodontists are identified by MS or MSD following their DDS. They can also be identified by the terms "orthodontics exclusively" or "practice limited to orthodontics." These doctors have completed a two or three year residency training program and either have a Master’s degree in orthodontics or a certificate in orthodontics. They are Board certified or Board eligible. If they are a "Diplomat of the American Board of Orthodontics," they have taken an oral and written examination as well as presented cases for approval by their specialty board.

*There is no formally recognized "Cosmetic Dentistry" specialty, there are no "Cosmetic Dentists". All dentistry if done correctly is "Cosmetic". Some dentists become more proficient however through continuing dental education and experience. * Orthodontists, periodontists, oral and maxillofacial surgeons, endodontists, and pediatric dentists are not required to be Board certified. However, Board certification reveals the practitioner's extra effort to be at the pinnacle of their profession. * In my opinion, Orthodontics should be done by a residency trained orthodontist, not a general dentist who does orthodontics. I advise against orthodontic programs at large corporate practices or high profile advertising offices. * If an office offers other procedures besides orthodontics such as cleanings or fillings, they are not orthodontists. * Many general dentists do a very good job with anterior root canals, and some do molar root canal procedures well. However, I recommend that trained endodontists do most molar root canals. They have two or three years of additional training, most do their treatment under microscope, and they are able to perform endodontic surgery if you require it. * Many general dentists are very competent surgeons. However, I recommend that boney impactions (third molars) are extracted by oral surgeons with IV sedation, not general anesthesia which I believe is an unnecessary risk. * My advice is if you are uneasy or something doesn't feel right, get a second opinion. * Select your dentist carefully; evaluate the facility, the staff, their education, and their philosophical and ethical values. * Invisalign and implant companies are marketing themselves directly to consumers and giving lists of participating dentists. They are both encouraging general dentists to become involved with these procedures. My opinion is that you would be much better served by having properly trained orthodontists, oral surgeons, and periodontists take care of you and be prepared to handle any complications. SPECIALISTS The following is a list of specialists in the area that we recommend.This is by no means a complete list; there are other outstanding specialists. * Orthodontists (teeth straightening): Dr. Blalock, Dr. Lueke, Dr. Ferris, Dr. Pierson, Dr. Hulme * Oral and Maxillofacial surgeons (complicated wisdom teeth extractions, implants, biopsies, other surgeries, medically compromised patients):Dr. Leonhart, Dr. Tiner, Dr.Kaercher

*Periodontists (gum surgery, implants):Dr. Amir Hosseini, Dr. Edwardo Lorenzana, Dr. Clint Faulk * Endodontists (root canals): Dr. Aaron Vaughn, Dr. Christopher Bates, Dr. Timothy Ingram * Prosthodontists (complicated dentures, full-mouth rehabilitation): Dr. Mickey Calverly, Dr. Robert Laughlin, Dr. Paul McLornan, Dr. Jason Gillespie *Pediatric dentists(for children with complicated dental problems or behavioral issues): Dr. Ben Taylor, Dr. Steve Martin DENTAL INSURANCE * If you lose your insurance, by all means do not stop your dental care. * Go at least once a year for a cleaning and exam. Even without insurance, it is much better than trying to catch up and repair later. * $200 a year can keep your teeth healthy and save you so much more in the long run. * When selecting insurance, indemnity insurance is probably best, but if it is unavailable, then PPO's are much better than DMO's or HMO's.DMO's and HMO's can cause a lot of unwarranted situations pertaining to your care. DENTAL CONSUMER AWARENESS * Inform yourself! The Academy of General Dentistry and the American Dental Association have informative websites. * Our website drjohncovert.com has a link to the Academy of General Dentistry as well as other helpful information. CORPORATE DENTISTRY I would be remiss if I did not mention the new influx of corporate dentistry. * Corporate dental practices often employ inexperienced dentists. * Their practices have a high turnover rate. * Employees are often underpaid and poorly trained. * These offices often use poorer quality labs as well as supplies and materials. * These dental practices are owned by "for profit" corporations. * Basically, after you pay the management, the marketing people, rent for the building, corporate overhead, the dentist, employee's supplies, and labs, there is no room left for a genuine patient-doctor relationship that you deserve. * You may find yourself receiving unnecessary or expensive treatments. * Many of these corporate dentists have production quotas per day or even per patient. * Sometimes corporate dentists and heavy marketing identifies a doctor as Dr. John Smith, D.D.S. They do this to enhance credibility. It should be Dr. John Smith or John Smith, D.D.S. Not both. MISCELLANEOUS INFORMATION * Unless there is severe malocclusion, most orthodontic cases should not begin until all primary teeth are lost which generally is around fifth grade and older. Most often there is no need for a phase one and phase two. It costs more, wears out patients and parents, and is not always necessary. Remember: *If you or your child are having orthodontic treatment, you must continue with regular examinations and cleanings. * You only need scaling and root planing if you have pocket depths of 4-5 mm or more. This should be done with anesthesia and take at least ninety minutes per arch. Most often this should be done in two appointments. * If your periodontal condition does not get better after improving your home care, scaling, and root planing, then you should consult a periodontist. If laser treatment is offered, ask plenty of questions about ADA recommendations or the National Periodontal Organization's endorsements.

*If you are going to a periodontal office for periodontal recall cleanings, the periodontist should do an examination at each visit, not just a cleaning by their hygienist. If they do not, you might as well stay at your general dentists office where a cleaning is less expensive and where the dentist can do the exam. Inform your referring dentist if they are not checking you at each visit. * People only need a night guard or occlusal splint if they are clenching at night or during the day. * I prefer a minimum of eight weeks of healing before restoring implants. I do not like immediate, next-day implants. It may be prudent to avoid these. * About twenty percent of crowned teeth eventually need root canals. * Almost all premolars and molars with root canals need crowns. * Contrary to popular culture, silver amalgam fillings are not less healthy for you than white fillings. * Wisdom teeth eruption does not make your teeth crooked. * Dental radiographs, especially digital, are not harmful, even to pregnant women. * Dental examinations and treatment done under magnification and with extra light is the standard of care. * Citrus candies including "Limon," "Lucas," and "Chinese" Mexican candy are devastating to your dentition. * After you drink a soda or sports drink such as Gatorade or Powerade (which are very acidic and have a high sugar content), rinse with water. * Root Beer has the lowest acidity of all soft drinks. * Do not put aspirin or whiskey on a toothache; they will burn your tissue. * Do not give children a bottle of juice or milk to take to bed. Only give them water after brushing their teeth. * Do not smoke or dip snuff. If you do, try to stop because both of these practices are devastating to your oral and general health. * Avoid biting into lemons and limes.

* Occlusal splints (night guards) - if you are bruxing (clenching) and need a night guard they must be made correctly or they can be more harm than good. They need to be custom made for you out of hard (not soft ) acrylic. They also need to cover your full arch, and contact all of your opposing teeth. Never just the anterior (front) teeth only. Avoid using athletic mouth guards from the store and over the counter remedies. These must be properly made at a dental lab and precisely adjusted.

I hope this information is helpful to you and helps you manage your dental care. Best Wishes, John Covert, D.D.S.