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In January 2006, Dr. Malkemus began writing dental health articles for The Community
Voice newspaper. He wanted to give back to the community and share his passion for
health, as well as his observations of the remarkable planet around us. Current
and past articles are provided here. To view his articles as they appear, see the
Health, Beauty, and Fitness Section at www.thecommunityvoice.com.
Other Resources
If It's Not Broken, Don't fix It
If It’s Not Broken, Don’t Fix It!
By George A Malkemus DDS
Minimal Intervention
“If it’s not broken, don't fix it” is a good rule of thumb to live by; however, what should we do if something is broken? In the past, many dentists would simply fix the problem and go forward. In dentistry today, there is another movement that is gathering momentum around the world: Minimal Intervention.
Minimal intervention is a treatment philosophy that promotes an, "If it’s not broken, don't fix it, and if it is broken, find out why it is broken." Then, form a treatment plan that involves the least amount of trauma to the patient and the patient's healthy oral tissues. Minimal intervention's basic goal is to conserve healthy tooth structure.
Catching treatment early is the best way to conserve teeth and gums. Not being able to treat dental issues when they are in the early stages of disease has always bothered me. In the early stage, less treatment is typically necessary, which is better for the patient physically and emotionally, as well as financially. With the rapid advancements in technology, I and many dentists, now have many more methods to identify dental disease and fix it before it gets to the critical surgical stage.
Minimal intervention promotes the patient's well being through early identification, early intervention, minimal treatment, and prevention.
At one time, dentistry was a "drill and fill" kind of treatment. Those days are gone. Now regular dental maintenance therapy is the goal. Depending on your condition, you could have one to four or more check-ups and cleaning each year and take an active role in your own oral health care. Yes, that means those brushing and flossing routines for healthy people. It also means a good balanced diet. The minimal intervention philosophy believes that little changes in your behavior will have a big impact on your total health!
New Technologies
Dentists have many new techniques and equipment in their offices today that were only imagined as few as 10 years ago. These techniques are used to detect dental disease early, before it becomes critical. Today, we have the marvel of digital x-rays, intraoral cameras, lasers and fiber optics, to name a few. Computers have moved from the receptionist's desk to the exam room (in dentist terms called the "operatory" or "treatment room"). Computer technology is now a premier detection tool when used to show digital x-rays and digital photographs. Computer software can manipulate the digital image to increase cavity detection. The image can be enlarged and then zoomed on a specific area of concern. The contrast can be change to improve cavity detection, and the brightness and darkness of an image can be adjusted for better viewing.
Cavity Detection
For decades the primary instrument available to the dentist for detecting decay was the "dental explorer". The dental explorer was poked into the grooves and pits in teeth, feeling for soft spots. Soft spots, which stick with an explorer, indicated that there was a deep cavity that had broken through the enamel of a tooth. Enamel is the outer hard protective coating around teeth; it is the second hardest substance in nature after diamonds. However, acid dissolves enamel and bacteria produce acid to break down enamel. Once through the enamel, the decaying bacteria penetrate to the live tissue inside the tooth, the dentinal pulp. Eventually if left untreated, the nerve becomes infected, causing pain and need for root canal therapy or an extraction.
In the past, decay was not removed until it penetrated through the enamel. That is because amalgam fillings [made of half silver and half mercury] have to have a large hole prepared in the tooth to allow them to lock into place and a substantial thickness to keep them from breaking. A little cavity would need a large amount of drilling to make a hole big enough for an amalgam-filling placement. Now with the advent of tooth colored bonded fillings, less tooth structure is removed and the treatment is less invasive. Bonding is a way of gluing the filling to the tooth so the only drilling necessary is the decay removal. Therefore, it is better to catch the decay early while still just in the enamel. Unlike the internal dentin of the tooth, enamel has no nerve ending so usually numbing is not necessary for the bonded filling preparation and placement.
Studies have shown that the sticking of the explorer from one tooth to the next is actually transferring decay and inoculating teeth that did not have decay before the explorer checking process began. Along with digital x-rays, decay in my practice is now detected using visual magnification with a video camera. With the video camera, I am able to inspect all the surfaces of the teeth, looking for darkness in the grooves and pits of the enamel. Thus, I am able to catch decay early and prevent its spread through preventive tooth colored fillings with minimal drilling. The video camera has the added benefit of allowing patients to see the decay for themselves.
Preventive Dentistry
The minimal invasive movement evaluates the whole person. If an individual has a cavity, it is important to determine why they have a cavity. When the reason for their cavity is identified, preventative measures can be recommended that will extend the life of their teeth. Minimally invasive procedures help patients feel good about receiving dental treatment and create a new attitude about dental and oral health care.
So take advantage of preventive dentistry and the new non-invasive technologies. Even if you have waited too long, there is still hope! It is never too late to get into great dental health and begin a healthy maintenance program. With the use of modern dental methods, including conscious sedation, it can all be done in complete comfort.
ENJOY LIFE AND KEEP SMILING!
George Malkemus has had a Family and Cosmetic Dental Practice in Rohnert Park for over 22 years at 2 Padre Parkway, Suite 200. Call 585-8595, or email info@ malkemusdds.com. Visit Dr. Malkemus’ Web site at http://www.malkemusdds.com
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