In the Dentist's Chair: A Q&A with Annapolis' Top Dentists
Delving into the unknowns of the dental world can be daunting. How do you find a dentist who suits your family’s needs? What is the latest technology and where is it available? What procedure is right for you?
For the answers to these and other important questions, we decided to go straight to the experts. Below are responses to the questions we posed to some of 2008’s Top Dentists.
What qualities, in your opinion, make a great dentist?
A successful dentist needs to wear many hats in today’s environment. He needs to be the consummate professional that remains at the cutting edge of the science and art of dentistry. He needs to have the skills to artistically apply those talents. He needs to be a manager and business entrepreneur to deliver those services in a facility that reflects his commitment to excellence, with a team that shares the same level of passion for quality care. He needs to wrap all this together so that it is accessible for patients with a value that allows them to acquire the smile they dream of. Most importantly, a great dentist needs to be a compassionate educator for his patients so that they can make the decisions that best fits their treatment needs.
—Dr. Scott Finlay
Compassion, sympathy, a gentle “bedside manner,” knowledge, and technical competence.
— Dr. Leo F. Menendez
The qualities that I feel make a great dentist are someone who listens to their patients needs and desires. A patient should always feel comfortable with their dentist. I always strive to develop strong relationships with my patients so that I can get to know them.
—Dr. Martha Sidlowski
Compassionate, caring, empathetic, meticulous, perfectionist.
—Dr. Phil Philbin
A great dentist is someone who has the ability to relate to and really listen to his or her patients’ concerns and desires. They also need to have an artist’s eye and hands.
—Dr. Kathy Farley
From a technical perspective, dentistry is a combination of art and science. From a personal perspective, it is about building trust in your relationship with each patient. People know when you care about them.
—Dr. Jay McCarl
Talented, caring, patient.
—Dr. Clayton McCarl
A great listener. A dentist should listen to what each client has in mind then offer personalized solutions. Patience. A person who cares can give people individual devoted time to understand the person’s needs and wants. Care. Create an environment in which you can provide each client with personal care and attention. Passion for learning. Dental technology is always changing and a great dentist must be committed to keeping up with the change. The doctor should have a properly trained and qualified team to help each quest with their questions and needs.
—Dr. Kian Djawdan
True compassion for the patient’s needs and desires combined with precise skills.
—Dr. Deborah A. Caruso
Someone who listens to their patients, does a thorough evaluation, and can help their patients make the best possible choices to achieve and maintain a healthy and beautiful smile for a lifetime.
—Dr. Bonny Mitchell
Personable, compassionate, and the right mix of scientific and artistic abilities. Both are very important in this field. Creating a beautiful smile requires understanding what beauty is and having the artistic ability and manual dexterity to produce a unique and pleasing smile for each patient.
—Dr. James M. Brinster
A great pediatric dentist should have a passion for their profession and an eager calling to make a difference. A great pediatric dentist should have love for the children, empathy for the parents, long-term goals for the child’s health, and give an overall sense of comfort. A great pediatric dentist needs to be honest, trustworthy, and a good communicator. Top-of-the-line dentistry is a given.
—Dr. Nilda M. Collins
I believe that compassion for a patient’s well being, knowledge of your specialty, and enthusiasm for the profession make a great dentist. Having a great love for patients and respecting their fears and joys help make a happy environment.
—Dr. Maya A. Vernon
What professional dental societies are best in your opinion? (Which qualifications must be met to become a member? What are the benefits of being a member?)
Fellow, American Association of Oral and Maxillofacial Surgery, board certified by the American Board of Oral and Maxillofacial Surgery. To become boarded, one must show clinical competence by passing both a written and oral examination, and be recertified every 10 years. It is the highest standard to meet as an oral and maxillofacial surgeon.
—Dr. Leo F. Menendez
The ADA and Maryland State Dental Association are good and are involved with legislation for dentists. The Academy of General Dentistry is also a good society because it focuses on continued education.
—Dr. Martha Sidlowski
ABO (American Board of Orthodontists). Applicants are required to take a very difficult time consuming three-part examination, which tests the doctor’s knowledge, skills, and abilities through written and oral examinations as well as case presentations to show that the doctor not only has the knowledge and the ability, but takes the time and effort to produce exceptional results. This certification takes years to accomplish and is the highest recognition one can achieve as an orthodontist.
—Dr. Phil Philbin
There are many wonderful dental societies that offer educational experiences for general dentists. The Academy of General Dentistry is a great one because it will keep a record of the number of continuing education hours a dentist takes and only approve reputable courses. Another society is the American Academy of Cosmetic Dentistry. Any dentist can join organizations like these and the benefits of being a member is that if the dentist takes an active role, the dentist can learn the latest techniques and set personal goals such as taking examinations, both written and clinical, that show that he or she has mastered the latest techniques.
—Dr. Kathy Farley
American Dental Association and its state (Maryland) and local (Anne Arundel County) affiliates. Academy of General Dentistry, because it requires ongoing study in all levels of General Dentistry.
—Dr. Clayton McCarl
There are local, national, and international dental associations that offer continuing education for general dentistry and specialized areas of the dental arts. Training never ends. Advanced technical skills and artistic perspective demand hundreds of hours of ongoing training and education. I have earned a Fellowship with the International Congress of Oral Implantologists and the Academy of General Dentistry. I am a Sustaining Member of the American Academy of Cosmetic Dentistry and the American Dental Society of Anesthesiology. These accreditation programs require both rigorous exams and personal case studies to be accepted by peer review.
—Dr. Kian Djawdan
Any continuing education based organizations such as the Academy of General Dentistry. They encourage advancement in the field.
—Dr. Deborah A. Caruso
ADA: helps protect and promote dentistry
AGD: encourages doctors to continue learning through CE courses
Local dental societies (MSDA, AACO Dental Society ): provide CE courses for doctors and staff.
—Dr. Bonny Mitchell
There are many qualified dental organizations that focus on specific aspects of dentistry and offer professional education tracks that allow the dentist to grow as an experienced provider. However, simply becoming a dues paying member of a dental society doesn't guarantee credibility of the dentist. There are a couple of dental organizations that offer credentialing as a way to measure the knowledge and skill level of a dentist. Two such organizations are the Academy of General Dentistry ( HYPERLINK "http://www.agd.org" www.agd.org) and the American Academy of Cosmetic Dentistry (AACD, HYPERLINK "http://www.aacd.com" www.aacd.com). The AACD is the largest cosmetic dental organization in the world with more than 8,000 members.
Cosmetic dentistry today is a field of growing interest for the Baby Boomer Generation. We all want to be healthier and feel better about ourselves, and there is no better place to start, than with your smile. Unfortunately, cosmetic and restorative dentistry is not a recognized specialty by the American Dental Association.
Fortunately, there is an American Board of Cosmetic Dentistry (the ABCD) that can provide the gold standard for cosmetic dentistry in this country, and for that matter, in the world. The ABCD provides a measurement called credentialing, that allows dentists to be evaluated and tested by a jury of their peers that are leaders and educators in the field across the country. Those dentists that hold this accreditation by the American Board of Cosmetic Dentisty have met the requirements that validate them as understanding the current state of the art of cosmetic dentistry and have proven that they can actually provide this level of service on patients. The accreditation process can take years to complete. This is a credential that has been around since the beginning of cosmetic dentistry over two decades ago. To date, there are less than 300 dentists and laboratory technicians in the world that have achieved this recognition. There are currently eight practicing dentists in the state of Maryland with this level of credential.
I am accredited by the American Board of Cosmetic Dentistry and am an Examiner for the AACD in the credentialing process. I’m also a Fellow in the Academy of General Dentistry.
—Dr. Scott Finlay
Academy of General Dentistry, American Academy of Cosmetic Dentistry.
—Dr. James M. Brinster
What is some of the newest technology your office is using? What’s your favorite?
Advanced techniques in both bone grafting procedures, and implant placement.
—Dr. Leo F. Menendez
Our office strives to be on top of the latest technology. We have the “Wand/ Compu Dent” system for administering anesthetic. This technology allows us to control the flow of the anesthetic so that it is much more comfortable for the patient than the regular syringe. We also offer “Cerec” which allows us to complete restoration in just one visit, which would otherwise require two visits and a temporary restoration for a couple of weeks. —Dr. Martha Sidlowski
Digital x-rays, state of the art sterilization systems. Temporary anchorage devices (TADs): mini implants that help to make very difficult cases much more manageable, providing better results with less cooperation. And they are totally painless!
Invisalign, invisible braces that move the teeth with the use of clear plastic aligners (retainers). These are great for adults and teenagers who want straight teeth, but don’t want to deal with conventional braces.
The “Damon System” is the hottest, newest, and the most state-of-the-art brace system currently on the market. It is frictionless bracket (brace) that allows us to move teeth with much less force, more quickly, with less discomfort, while achieving the best possible result.
The combination of the Damon braces and the TADs has revolutionized our practice. Our patients and we love what we are able to accomplish with these new innovations.
—Dr. Phil Philbin
I am enjoying the laser that I use to reshape the gum tissue when I am doing veneers or crowns on front teeth when the gums are uneven or unattractive in contour. The laser is amazing because it is so minimally invasive. I can reshape the gum tissue, make the smile more beautiful, and make the teeth look more attractively shaped and longer. Another technique that has been really useful is a diagnostic wax up and composite overlay. We take models of the patient's teeth and wax them the way we want the teeth to look. We make a matrix and fill it with temporary tooth colored material and place it over the patient's chipped or worn teeth. When the material hardens we remove the matrix and can show the patient, in their own mouth, what their teeth can look like. We take photographs before and after so the patient can take them home. I find this technique is really useful for patients because the patient can see first hand, in their own mouth, what the possibilities are for them.
—Dr. Kathy Farley
Invisalign. Mini-implants.
—Dr. Clayton McCarl
Digital CT scan (I CAT) and 3D imaging software that allow for optimal diagnosis and planning of treatment to provide implant supported fixed teeth that can be delivered to the patient on the day of the implant placement. ICAT and imaging software:
Eliminates guess work and exploratory surgery
Increases confidence for the surgeon and safety for you.
Surgery time is often decreased
Treatment costs are predictable, so no financial surprised afterwards
Careful planning can avoid bone grafts in some cases
Dental Laser: Dental Lasers procedures are more efficient and more comfortable than many conventional methods of treatment. Laser surgery, for example, produces minimal swelling and scarring compared to conventional methods, and frequently reduces the length of surgery and post-operative healing.
Vita easy shade: Digital shade guide technology benefit—no eyeballing the shade of a tooth. Able to select a shade that will naturally blend into the smile line.
Smile Style Guide: This interactive program and book guides us in building a Smile Style through tooth shape and length selection. The program is designed for the doctor and patient to work together to develop the shape of the new smile.
Isolite System: Illuminates the mouth, and keeps everything dry. It gives patients a place to rest their jaw and gently retracts the tongue and cheek. Patients no longer worry about their tongue or feeling the need to swallow. They can just relax.
—Dr. Kian Djawdan
CEREC 3D: Same day restorations such as crowns, veneers, inlays and on lays. Digital radiography.
—Dr. Deborah A. Caruso
Digital x-rays are my favorite. Instant image allows me to expedite diagnosis with less radiation to the patient.
—Dr. Bonny Mitchell
Computers and digital information have transformed how dentistry is provided today. Digital radiographs, 3D computer simulations, and virtual cosmetic imaging have given the patient and the doctor new ways to evaluate and plan dental care. Dental materials create stronger and more natural results. Keeping up with the technology is fun, exciting, and essential in providing quality care. But most importantly, it is the synergy of talents of the dentist that creates predictable smiles. As a consumer or patient we are often "sold technology" as if we were picking products off the shelf. In health care it is more important to put yourself in the hands of an experienced, proven, and credentialed provider to insure the best possible results and not to be distracted by the latest technology buzz—let the dentist focus on what actually enhances your quality of care.
—Dr. Scott Finlay
Digital radiography (x-rays) has been a favorite for our whole office. In addition to being very efficient, it allows for the patient to view their x-rays more effectively and reduces the patient's exposure to radiation.
—Dr. James M. Brinster
Do you have special techniques for dealing with children?
In our pediatric dental office we use a “Tell, Show, Do” technique. We tell the patient what we will do while showing them the instruments that will be used. We also use positive reinforcement by praising each child. It is important to use explanations of each procedure at the child’s level, and to give a comforting explanation to the parents, so that they can become part of our team. In our office, children also get to choose a movie to watch during their visit, and receive prizes at the end of each visit.
—Dr. Nilda M. Collins
I love to sing to them, to talk to them regarding their interests, and give them tender love and care with positive reinforcements and words of encouragement.
—Dr. Maya A. Vernon
The best techniques I find are those that employ gentleness, patience and instill confidence in both the child and the parent. I try to explain as much as possible, and allow the child to ask as many questions as necessary. As a father of two boys, (ages four and six), I know about patience, and answering questions.
We also have nitrous oxide analgesia, and intravenous anesthesia, if necessary.
—Dr. Leo F. Menendez
My technique for treating children is to be sure I am allowed enough time to really spend with the patient. We review everything we are going to do with them in a “tell, show, do” manner. We keep everything simple and to their level.
—Dr. Martha Sidlowski
We love children! First of all, compassion and caring is essential whenever dealing with children. We use many state of the art techniques for early treatment that allows us to catch problems early and prevent more difficult problems from occurring.
—Dr. Phil Philbin
Patience, humor.
—Dr. Clayton McCarl
Don’t underestimate their intelligence. Don’t try to hide things from them. Be up front in a gentle way.
—Dr. Deborah A. Caruso
Be kind and gentle
Use distraction
Be quick
Include the parent during exam and treatment
Allow parent to be in the room with the child.
—Dr. Bonny Mitchell
We encourage parents to bring their children at an early age preferably during a parent’s hygiene visit, to be exposed early on to what dentistry is about and what to expect when it is their turn in the chair.
—Dr. James M. Brinster
What would you recommend patients look for in their search for a dentist?
Aside from the obvious, a clean office, a friendly staff, a pleasant and helpful staff when calling by phone, I would look for a dentist that doesn't appear rushed, allows ample time to explain what he would like to do, and allow you to ask plenty of questions. Also, experience and outcomes about the procedure you are asking about.
—Dr. Leo F. Menendez
I would recommend patients look for someone they can be comfortable with. They need to feel reassured that their needs, wants, and desires will be heard and attended to. They should look for someone who is willing to explain to them what is going on with their dental health. We always schedule a comprehensive exam for all our adult patients for their first appointment so that we can examine their teeth, gums, and TMJ. We treat the overall patient, and not just specific issues. This first visit also allows us to begin developing a relationship with our patients so that they can feel comfortable and a part of our dental family.
—Dr. Martha Sidlowski
For orthodontists, we recommend ABO certification, so that you know that your orthodontist has the ability to perform at the highest level and has taken the time and effort to prove he or she is in the top of their field.
We also recommend that they consult with their friends, family, and dentist to find and atmosphere that they will be comfortable with.
—Dr. Phil Philbin
A patient should look for a dentist who does a thorough new patient evaluation and evaluates and treats their entire jaw, jaw joint, bite, jaw muscle, and teeth system. A dentist should be trained to do more than just fill teeth and make them look pretty. The teeth are just one component of an entire system that is in delicate balance. Placing crowns or veneers, for instance, in the wrong location can cause jaw pain, porcelain fracture, or tooth fracture.
—Dr. Kathy Farley
A good communicator, follow your instincts.
—Dr. Clayton McCarl
Dentistry, like just about everything else, is making huge advances. There is an ever-widening gap between dentists on the leading edge of technology. Do a little research, scan the Web. Make phone calls to offices and ask questions. The staff member answering the phone should be knowledgeable regarding the technology and treatment solutions offered by the dentist.
Changes in dental technology rival leaps in software. Advanced technical skills and artistic perspective demand hundreds of hours of on-going education. Look for a dentist who has earned advanced accreditations with organizations such as the American Academy of Cosmetic Dentistry, the International Association of Implantologists, and the American Academy of General Dentistry.
Today’s dental technology is designed for patient comfort, precision, and accuracy in diagnosis and treatment, and esthetic results. Technology that a cosmetic dentist should have: dental laser, digital x-rays, digital intra oral camera, digital camera and imaging software, an arc light with microscopes (worn by the dentist to improve the field of vision) When considering dental implants, you would also want to work with a dentist who uses a digital CT scan and Virtual 3D software to fully visualize the placement of implants in a real 3D environment.
One size does not fit all in modern dentistry. Designing an individual treatment plan means getting to know you as opposed to your being just another patient. Offering you solutions based on what you would like to achieve. Feeling 100 percent comfortable to ask questions and receive answers in terms that you can understand is a huge yardstick to measure your decision.
Cosmetic and reconstructive dentistry is a serious investment and you should feel that you are getting the personal care and attention you deserve. Ask if the dentist offers exclusively reserved appointment times. Exclusively reserved appointments allow the dentist to focus on you and your comfort. Look for patient comforts offered, such as blankets, headphones, eye mask, neck pillow, and hot scented towels.
—Dr. Kian Djawdan
One who can truly focus on their needs and not have too many “balls in the air.” Look for a dentist who routinely keeps up with continuing education.
—Dr. Deborah A. Caruso
Ask a friend, neighbor, physician, and dental specialist if they are seeing one.
—Dr. Bonny Mitchell
Do your research. Go online, seek information, educate yourself, ask recommendations of family or friends who have had similar care, or even ask for a referral from other specialists in the field of dentistry. Visit the practice you are considering for your treatment. Does the facility reflect the level of commitment to quality that you are seeking? Does the team that supports the doctor you have chosen have confidence enthusiasm and passion for what they do? Ask to look at samples of work that the dentist has actually completed. Is the doctor continuing his education and has he taken steps to be credentialed within specific areas of focus, like cosmetic dentistry? Quality care is a team effort that involves not only the doctor and his team, but also the patient. Communication is essential in creating the vision for what the final results will be.
—Dr. Scott Finlay
Reputation. Recommendations from other patients are key. Belonging to this board or that society doesn’t change your doctor's ability to deliver the best most appropriate care for his/her patients.
—Dr. James M. Brinster
How do you deal with patients who have a fear of the dentist?
The most important thing to give a fearful patient is time. Answer their questions, find out what frightens them, and make them feel comfortable by being confident in what you are doing. As an oral surgeon, I also can use nitrous oxide analgesia or intravenous anesthesia if needed.
—Dr. Leo F. Menendez
We deal with patients with fears of the dentist by really taking the time to get to know them and building their trust in us. We explain everything we recommend to them and really educate them on their dental health and needs. The key is to not rush and be sensitive to whatever the stem of their fear may be. We break through many fears by simply treating the patient as a person, and not a tooth or mouth to be worked on. We do use nitrous oxide and sometimes oral sedative to help patients relax, but many times they don’t even end up needing these after they become comfortable with you.
—Dr. Martha Sidlowski
We provide lots of time, caring, explanations, and proven techniques that keep the patient comfortable and relaxed.
—Dr. Phil Philbin
We spend a lot of time discussing, at our very first visit, what the cause of a patient’s fear might be. Once we have identified the possible cause, we can customize a plan for dealing with it. I think people need to believe that their dentist understands their fear, will not hurt them, and will give them the ability to control what happens to them when they are in the chair. In addition to that, we have nitrous oxide (laughing gas) and noise-canceling Bose headphones and flat screen TVs mounted on ceilings of the main treatment rooms so patients can listen to music or watch a movie while they are having their work done. In extreme cases we can prescribe Valium to be taken before the procedure.
—Dr. Kathy Farley
Take time; figure out the source of the fears.
—Dr. Clayton McCarl
During our consultation we ask if they have dental anxiety and listen to what may have caused this anxiety. We listen to what has worked for them as well as what has not. For some it’s the needle, smells, sounds, and even embarrassment. We acknowledge what has or has not worked in the past and then move forward with a personalized solution which can include everything from personal care to advanced sedation techniques.
—Dr. Kian Djawdan
In most cases simply having a conversation about a procedure prior to treatment alleviates most fears.
—Dr. Deborah A. Caruso
Spend quality time getting to know them and understand what they fear. I take my time with them during treatment, allowing them to maintain some control of what is happening to them. Use sedation if needed.
—Dr. Bonny Mitchell
Fear can exist on two levels for an adult. First, most rational concerns can be alleviated through education. Understanding of what the problems are and their consequences, why they have occurred and how they can be managed to hopefully avoid bigger concerns can often disarm most patients.
Unfortunately, there are fears that many carry with us that can’t be reasoned away. Certainly, make the procedure painless and keep the patient as comfortable as possible with large LCD screens at the foot of the chair to watch a favorite movie or TV show, head phones for music, blankets and in some situations, medications to sedate the the patient for longer visits.
The best way to reduce fear is confidence: confidence in the dentist and his team that you are getting the best treatment possible.
—Dr. Scott Finlay
We have the most effective solution to calm an anxious patient—a caring, experienced, and empathetic staff. By far, this key component is the best form of sedation we can offer all of our patients.
—Dr. James M. Brinster
How has dentistry changed for the better in the past five years?
The materials and techniques in both implant placement and bone grafting have improved. This has allowed for a more predictable outcome, fewer complications, and improved success.
—Dr. Leo F. Menendez
Dentistry has changed for the better in the last five years mainly in the division of implants. Extensive procedures like “Teeth in a Day” for implant restorations have eliminated patients having to go without teeth or ill-fitting dentures.
—Dr. Martha Sidlowski
Orthodontics has changed drastically over the past 5 to 10 years. New technology has advanced our profession to new and exciting heights. We can correct problems that in the past were uncorrectable or would require the use of surgery to correct. Aesthetics has also been in the forefront. Patients are enjoying getting that beautiful smile with smaller, more comfortable, and even sometimes invisible braces.
—Dr. Phil Philbin
Digital radiographs, better technology in intraoral cameras allows patients and dentists to see fractures in teeth that can’t be seen by the naked eye. Porcelain systems have improved so crowns and veneers look more life like and porcelain pressed to Zirconium crown technology has revolutionized the way teeth in high stress areas can be restored.
It used to be the only options for crowns on back teeth were gold or porcelain fused to metal crowns. Now we have a new technology called Zirconium, which is a white metal with porcelain over the top. It is both cosmetic and strong. Another wonderful change has been with implant dentistry. There are new grafting procedures and techniques that allow us to make implant crowns look just like natural teeth emerging out of the gum tissue. Gone are the days of the dark line around the gum tissue of a tooth that has had a crown or implant!
—Dr. Kathy Farley
Implant dentistry is the faster growing part of modern dentistry today. People no longer have to live with a denture.
“Teeth in a day” is a wonderful alternative to an ill-fitting denture. Historically, patients faced with losing all of their teeth to periodontal disease and or decay had to endure loosing their teeth and being left to endure an ill-fitting denture. Once you have an ill-fitting denture, and seek alternatives, such as dental implants, patients were often sadly disappointed to learn that the alternative required several dental surgeries over the course of 9-12 months. First graft bone, wait a few months, place dental implants, wait a few months, then fabricate the new crown and bridge or over denture supported by the dental implants.
“Teeth in a day” means eliminating remaining teeth if present, placing dental implants and, at same appointment, providing a temporary (acrylic) hybrid bridge that is attached to an implant (s). The acrylic hybrid bridge is replaced by a higher quality and more durable teeth a few months later after your bone has completely integrated with the dental implants. Most patients find that they are able to eat and speak with a confidence they have not experienced in years the very next day.
I receive several phone calls and emails every week from people who share with me that they cannot chew or eat raw veggies, fruit, or steak. They avoid going out to diner with family and friends. They share with me that they avoid social activities and public speaking. They are perceived as grumpy or anti-social. They share with me that this is not who they are, but rather what they have become as a result of ill-fitting dentures.
More people are becoming aware that there is an alternative to ill-fitting dentures. Today’s modern dental technology with CD scans and 3D imaging software is making it possible to offer people an alternative that can be accomplished in weeks instead of years.
Imagine a life without dentures, being able to eat and speak with confidence. We take great pleasure in helping people change their lives to be the person they once were again. It is amazing to watch how much different someone can look and feel in just a few weeks when they can regain the confidence to enjoy life again.
With the advances in computers and technology dentistry has been affected significantly. Examples:
Digital x-rays, which allow for better diagnostic ability as x-rays can be digitally enhanced. Software is available to provide diagnostic detection of dental decay. Ultra sensitive sensors that require minimum radiation to produce an image, reducing the patient’s exposure to radiation significantly. Once the image is taken it comes up on the computer screen immediately, eliminating the need for processing a film or to have a developer or use developing solution which are not environmentally friendly, and no need to wait 3 to 5 minutes for the film to be developed.
Digital patient charts which eliminate cross contamination allows for the patient information to be accessed at any location in the office and the information to be e-mailed to other doctor’s laboratories.
The advancements in dental materials such as porcelains and porcelain substructure resulting in the ability to optimize the aesthetic results by not using metal restorations of metal substructures.
I-CAT cone beam CT scan for the dental office eliminating the need for a traditional CT with decreased cost to the patient and decreased exposure.
3D imaging software to virtually plan surgical placement of dental implants.
Vita easy shade—shade guide technology. Eliminates eye-balling shade selection for dental restorations. Provides the lab with an accurate shade and composition so that the dental restoration can naturally blend into the smile line.
—Dr. Kian Djawdan
Materials get stronger, easier to use and more cosmetic as time goes on. Technology keeps improving with equipment as well.
—Dr. Deborah A. Caruso
Beautiful teeth like materials used for fillings
Teeth replacement with implants-more available and accepted by patients
Digital x-rays
Cosmetic procedures more available
Whitening, bonding, veneers
—Dr. Bonny Mitchell
Technology and materials make dentistry today more predictable, durable, and more natural than ever before.
—Dr. Scott Finlay
The materials available to dentists and dental labs for restorations are getting stronger and are more naturally esthetic.
—Dr. James Brinster
What certifications are required of your staff members?
They must know CPR.
—Dr. Leo F. Menendez
All our staff must have current CPR training, and OSHA training. All staff members are encouraged to attend continuing education classes. All assistants are required to be x-ray
certified and expanded functions so that they can do more to help patients within our office.
—Dr. Martha Sidlowski
X-ray and orthodontic certifications.
—Dr. Phil Philbin
CPR certification and OSHA certification. Other certifications depend on the position. Assistants that make temporaries are “Expanded Functions Dental Assistants.” Hygienists must be Certified Dental Hygienists.
—Dr. Kathy Farley
X-ray certification, CDA (certified dental assistant), Basic Life Support Certified.
—Dr. Kian Djawdan
There are different levels of certification for dental assistants. All our assistants have the highest qualifications, that is, “Certified Dental Assistant” which requires months of training outside the office. All staff members including administrative are CPR certified. All staff participate in numerous hours of continuing education annually.
—Dr. Deborah A. Caruso
OSHA trained assistants are x-ray certified, and hygienists also need a hygiene license by the state.
—Dr. Bonny Mitchell
“Dental Hygienists” and “Certified Chairside Assistants” licensure is dictated by the Maryland State Dental Board and renewal of the license requires biannual continuing education requirements.
All team members in the office are trained in CPR and in our office, all members are cross trained to understand all facets of dentistry that are provided within the office, so that they can better communicate with and educate our patients.
—Dr. Scott Finlay
Maintain active licenses’ with state along with radiology, CPR and OSHA certificates.
—Dr. James M. Brinster
Dentistry has changed for the better in many ways, and in many areas. In pediatric dentistry, there is better public awareness of the specialty, better preventative measures, and better dental materials. The use of digital radiography has given us images that can be analyzed with different computer enhancements, while also diminishing radiation to the child.
—Dr. Nilda M. Collins
Do you personally see each patient for a final, quick review after routine cleanings (if performed by another member of your staff)?
Doctors usually see patients during their initial visit for a comprehensive exam, during their 6-month exams, and whenever a problem or question may arise. I also tell my patients that they can call and ask for me personally with any questions, especially clinical.
—Dr. Martha Sidlowski
In our office the orthodontist sees all the patients at every visit. They are seen prior to any work being done and after.
—Dr. Phil Philbin
Dr. Katy Ehman or I do examinations on patients after their cleanings.
—Dr. Kathy Farley
Yes, if they’re due for an exam or having any concerns.
—Dr. Clayton McCarl
Exams are required every six months, however, there’s always time for a quick “hello.”
—Dr. Deborah A.Caruso
Absolutely!
—Dr. Bonny Mitchell
Yes, it’s important to examine the oral cavity after each cleaning, because it gives us an opportunity to answer any questions the parents may have and to detect any [problem] areas of the mouth that the parents should be aware of.
—Dr. Maya Vernon, Pediatric Dentist
Yes. A great benefit of being a dentist are the relationships that you develop with patients. Certainly you have the responsibility to monitor their dental health, but it is also important to know them more than just teeth and gums. You have to remember that patients often see their dentist more frequently than their physician. Dentistry can often be a screening source for other health ailments as well as something such as high blood pressure. It’s fun to see young patients grow up, start driving, go to college, get married, and even start their families. It’s great to be a part of the community in that sense.
—Dr. Scott Finlay
Yes, of course. However, it may not always be quick. Many patients wait until their routine hygiene appointment to speak with their dentist about pain they may be experiencing or problems they may be sensing. Likewise, it is during the routine visit that any problems in the mouth are identified. It is important that a dentist reserves time in his/her schedule to focus on each patient each visit to diagnose and educate them on what they may be experiencing.
—Dr. James M. Brinster
After each cleaning is performed, myself or one of my associate pediatric dentists do a comprehensive oral exam on each patient. If the child needs any type of preventative or restorative treatment, a treatment plan will be discussed that day or the patient will be brought back for a consultation at a later date.
—Dr. Nilda M. Collins
How do you keep current with new technology?
By attending continuing education meetings, local study clubs, attending our association annual meeting, and reading, reading, reading.
—Dr. Leo F. Menendez
We are always kept up to date with the new technology by our sales reps from our supply companies. We also attend the local conventions where many new things are put on display in the exhibit hall.
—Dr. Martha Sidlowski
In our practice we spend an inordinate amount of time and money keeping up to date. We travel nationally and internationally to learn the most current techniques and technologies on the market. We far exceed the state and national requirements for continuing education.
—Dr. Phil Philbin
Hours and hours of continuing education classes, seminars, intensive study programs, study clubs, journals, and books. I take classes in all phases of dentistry including occlusion (bite problems), TMJ, implants, and cosmetics. I am a sustaining member of the Academy of Cosmetic Dentistry and attend its scientific sessions and seminars. While this exposes you to a variety of techniques, I think the very best way to keep current is to attend long training sessions that require you to bring your patient and actually learn the latest techniques and then use these techniques and new materials immediately. This is the way I learned many of my cosmetic techniques. I took my staff and my patient to the Las Vegas Institute for Cosmetics multiple times and went through the training process. It is stressful but it is the best way to stay current and to do a great job for your patients.
—Dr. Kathy Farley
Education and dental supplies.
—Dr. Clayton McCarl
As a Fellow of the ICOI, AGD and a sustaining member of the AACD, I attend at least six weeks of continuing education every year. These dental associations offer annual meetings with lectures, hands on clinics and demonstrations of new technology and equipment. These meetings provide me with the opportunity to learn about cutting edge technology and how I can continue to offer my clients the best that modern dentistry has to offer.
There are local, national, and international dental associations that offer continuing education for general dentistry and specialized areas of the dental arts. Training never ends. Advanced technical skills and artistic perspective demand hundreds of hours of ongoing training and education. I have earned a Fellowship with the International Congress of Oral Implantologists and the Academy of General Dentistry. I am a sustaining member of the American Academy of Cosmetic Dentistry and the American Dental Society of Anesthesiology. These accreditation programs require both rigorous exams and personal case studies to be accepted by peer review.
—Dr. Kian Djawdan
By reading countless journals and trade magazines, by viewing demos at trade shows, and by meeting with manufacturer’s reps.
—Dr. Deborah A. Caruso
Take many hours of CE courses
Discussions/reviews cases with specialists
—Dr. Bonny Mitchell
I attend continuing education from coast to coast to keep up on the latest advances and trends in dentistry. Technology is continually evolving and the investment in continuing education is essential to providing quality care.
—Dr. Scott Finlay
Within our team we maintain R&D specialists who seek out new technologies and reserve time in our schedule to learn about the products or procedures that can have the biggest impact on our practice. Our investment in advanced technology means a long-term investment in our patient’s future. State-of-the art technology invites informed decision-making and enables patients to make wise choices concerning their oral health. Lunch and Learns with manufacturer’s representatives are a very common occurrence at our office.
—Dr. James M. Brinster
What is the biggest challenge dentists face today? Medical malpractice? Cost of insurance? Payment from clients?
Very low, unreasonable reimbursement from insurance companies for highly technical, complicated, stressful, time-consuming surgery.
—Dr. Leo F. Menendez
The biggest challenge dentists face today is insurance trying to dictate treatment. Allowed amounts for insurance are very low and really limits what patients can have covered by their insurance. Many dentists are dropping their participation with insurance because fee schedules are not increasing with the rate of inflation. Many dentists just can’t afford to do “quality” dentistry at the insurance’s scheduled fees. This is a real disadvantage for the patients.
—Dr. Martha Sidlowski
The biggest challenge we find is getting the insurance companies to pay. In our office we take care of all the hassles. We manage the insurance from start to finish for our patients. Finances, which are a problem in many offices, are rarely a roadblock in our office. We provide many alternative payment plans, financing, and no-interest loans to make it possible for anyone to get that fabulous smile.
—Dr. Phil Philbin
We do not have any challenges with malpractice, insurance, or payment due in large part that we are fortunate to have a niche practice limited to Implant, Cosmetic, and Reconstructive dentistry. The solutions we offer are considered elective. Our clients have chosen to make a serious investment in restoring their smile and confidence. We do not push or sell dentistry…we help people explore the range of possible solutions and if and when they are ready we are here to help. I am among less than 4 percent of dentists in the world who can personally offer a complete solution to hopeless teeth in the comfort of one office with one dentist and offer IV sedation.
—Dr. Kian Djawdan
Abiding by the stringent regulations set by the Board of Dentistry and also getting reimbursed in a timely manner by insurance companies.
—Dr. Deborah A. Caruso
The cost of new technology.
—Dr. Bonny Mitchell
Patient education and getting the right information out to the public. Helping patients understand the difference between hype and health. Helping patients realize that quality care cannot be compromised. Aesthetics is no more than a reflection of the relative health of a system. There are no short cuts. You can’t fool Mother Nature.
—Dr. Scott Finlay
Payment by third parties can be very labor intensive and frustrating for patients and for us. As a courtesy to our patients we strive to make it as effortless as possible to maximize their dental benefits.
—Dr. James M. Brinster
Has fluoride in the public water system eliminated most childhood tooth decay as promised? Why do people oppose it?
Why do people oppose it? Fluoride is not totally widely available. In Anne Arundel County, many homes are supplied by well water; therefore, I still extract many teeth due to severe tooth decay.
—Dr. Leo F. Menendez
Although public water fluoridation has decreased decay, the increase of sodas and sugary power drinks has increased the decay.
—Dr. Martha Sidlowski
Not really, so many people including children and young adult s are drinking bottled water only a few of which contain fluoride.
—Dr. Deborah A. Caruso
Unfortunately, no. I still see a number of children with decay; however, there are numerous children I see that have zero cavities or fillings.
—Dr. Bonny Mitchell
For those on public water, fluoride has markedly reduced the incidence of decay. At the same time, access to dental care has increased and must be considered as a contributing factor to this decline. It should be remembered that fluoride is highly toxic and could present a myriad of health concerns if taken in excess.
—Dr. James M. Brinster
In Annapolis and its surrounding areas, there are a lot of communities without fluoride in their water. Even though most receive supplemental fluoride, we can see more decay on the teeth of these children than in those who drink fluorinated water. Most scientific studies show that fluoride in the water, in the proper amount, greatly reduces tooth decay. Most parents understand the benefits of fluoride, though few oppose its use due to misinformation or the fear of anything “unnatural.”
—Dr. Nilda M. Collins
Cosmetic Dentistry Questions
Once you whiten your teeth, are the specific foods you should try to ignore?
Any “colored” foods. Coffee, red wine, and even juice can stain teeth (that have or have not been whitened). However, when teeth are whitened, the “pores” of the tooth enamel are “open,” which will allow color to absorb more easily than usual.
—Dr. Deborah A. Caruso
While foods like coffee, tea, red wine, and dark berries will stain your teeth, it is unrealistic to think a person should forgo something they love forever. This, of course, assumes the patient uses moderation. If you drink five cups of coffee a day, your teeth will stain faster than someone who drinks just one. After bleaching, a fluoride treatment can help to close the open tubules in the teeth and help to deter stain. Patients should keep the touch up trays and do one application every six months to keep the color bright.
—Dr. Kathy Farley
Any foods or liquids that could stain a coffee cup or white shirt could potentially stain teeth. For a short period after the whitening procedure, teeth can be more susceptible to staining; however, this returns to a normal level after a few days. Teeth will always seem to darken over time, whether or not they have been whitened. The purpose of whitening is to oxidize out, or deep clean, the porosities in the teeth that have become impregnated with organic debris. You can expect the results of whitening to last a few years and at that point, a touch up application should return the teeth to the lightened shade.
—Dr. Scott Finlay
The usual culprits, and everyone’s favorites—coffee, tea, and red wine. Using whitening trays on an occasional basis in the future will keep your whites white.
—Dr. James Brinster
Coffee, tea, and red wine will discolor your teeth again, but with home whitening trays, you can repeat the whitening treatment annually if desired.
—Dr. Bonny Mitchell
Tooth whitening is not a permanent solution to whiter teeth. It requires maintenance. Avoid smoking, coffee, tea, red wine, and other foods and beverages that may cause staining. Your dentist may also provide you with a touch up kit and recommend an at-home touch up three or four times annually.
—Dr. Kian Djawdan
After an in-office whitening procedure, we usually advise patients to stay away from anything with color, such as coffee, tea, red wine, smoking, and red sauces for the first 48 hours. After that you can resume your normal diet, but coffee, tea, red wine, and smoking are items that do promote staining.
—Dr. Martha Sidlowski
Is there an age limit on having your teeth straightened?
No. Adults make more than 40 percent of orthodontic patients today.
—Dr. Kathy Farley
No. If you find that you avoid smiling due to crowding or misaligned teeth, you are never too old to explore the possibility of straight teeth. Solutions typically include orthodontics, smile design, or reconstructive dentistry. We have had the pleasure of helping many clients who are in their 70s to find renewed smile and confidence.
—Dr. Kian Djawdan
I have personally treated a gentleman in his 60s. While there are unique challenges with mature cases, we all get to decide at which age we stop improving the quality of our lives.
—Dr. Jay McCarl
Absolutely not! Now more than ever, adults are asking for orthodontic treatment—especially Invisalign.
—Dr. Bonny Mitchell
There isn’t any age limit to having your teeth straightened. Everyone deserves a healthy, functional, and aesthetic smile.
—Dr. Martha Sidlowski
None at all, although it is more challenging for adults as the bone supporting the teeth is denser as we get older.
—Dr. Deborah A. Caruso
What is the advantage of having your teeth whitened in the dentist's office vs. buying self-whitening kits?
Having your teeth whitened in office allows the patient to enjoy instant results.
—Dr. Kathy Farley
An advantage of having you teeth whitened in the dentist’s office is that you are having someone examine you first. A dentist can advise you on specific issues that relate to whitening (for example, crowns and fillings that won’t whiten may have to be redone after whitening). Custom fit trays allow for better comfort and less sensitivity. Higher strength gels allow for better results.
—Dr. Bonny Mitchell
Self-whitening kits may work, but only the dentist’s office can provide you with the highest level of whitening concentration that will provide the best results. While over-the-counter products can offer improvement up to three shades, professionally administered whitening, using custom-made trays with a prescription strength whitener, can improve patient smiles by up to seven shades and is found to be the most effective for all smiles.
—Dr. James Brinster
The over-the-counter whitening products are a great way for the patient to test-drive the whitening experience and to begin to get a handle on what improvements they may desire for their smile.
As you may guess, professional whitening systems are more effective and it is always important to be evaluated by a dentist to see if you are an appropriate candidate. Even in the mall today, you can get your teeth whitened, but buyer beware. It is my opinion that for those types of whitening procedures, you should be thoroughly evaluated by your dentist before you make the investment. In most situations, the fee for the service at the dental office is no more expensive than it is in the mall, but you have the additional confidence that a trained dentist is monitoring your results.
—Dr. Scott Finlay
Whitening gels dispensed by or completed at a dentist’s office have a higher concentration of whitening agents. In-office procedures provide a quicker result.
—Dr. Martha Sidlowski
Professional whitening is done in a controlled environment with much stronger chemicals. These whitening agents should not come in contact with any tissue except teeth structure. Home whitening doesn’t allow this.
—Dr. Deborah Caruso
What kind of new technologies are available in the field of cosmetic dentistry?
From Invisalign orthodontics to cosmetic imaging, computers have given us a vision into the future. Modern materials and bonding agents can create functional, healthy, and beautiful results. Keep in mind that it’s not products that patients should be seeking out, but the abilities of an experienced, tenured, and credentialed cosmetic dentist.
—Dr. Scott Finlay
One of the newest technologies in cosmetic dentistry are restorations with zirconia cores, which are white as opposed to metal, which sometimes gives a dark line around the gum of the crown. The zirconia does not allow for any dark (unaesthetic) lines.
—Dr. Martha Sidlowski
Zoom II, bonding, chair side veneers, gingival recontouring, enamel recontouring, and splinting.
—Dr. James Brinster
Tooth whitening is very popular. There are improved materials and techniques for veneers, crowns, and bonding. Invisalign orthodontics.
—Dr. Bonny Mitchell
Digital photography. The ability to email photos to the lab for better communication with the ceramist. Digital determination of shade. Different composites that allow for better strength and finishing.
—Dr. Kian Djawdan
What can someone have done that will give them instant improvement to their smile after one appointment?
The two procedures that give instant improvement in one appointment are in office whitening and cosmetic recontouring. Cosmetic recontouring is when the dentist simply reshapes the worn, chipped edges of the front teeth. As teeth wear, they wear unevenly and the corners often become sharp. Rounding the sharp corners and straightening the worn edges can make a dramatic improvement in a tired, worn smile. It makes a big difference in a smile where the teeth are not straight. By changing a few edges you can sometimes make crooked teeth appear straight. There is no anesthesia needed for this and it is done in one visit.
—Dr. Kathy Farley
Two procedures can provide instantaneous results: professional dental whitening and direct dental bonding. Bonding is a great way to “nip and tuck” those minor blemishes or chips in teeth that can disfigure your smile.
—Dr. Scott Finlay
During a dental cleaning stains and buildup are removed and the patient is educated with a thorough discussion and demonstration of how to brush, floss, etc. to keep the teeth clean and gums pink and healthy. Also, bonding, veneers, and crowns can fix chipped, worn, or discolored teeth.
—Dr. Bonny Mitchell
Bleaching, veneers (composite), or, in the right hands, CEREC or Lumineers.
—Dr. Kian Djawdan
What are veneers and how do they work?
In most situations, veneers are new porcelain surfaces that are bonded on the teeth to change the color, contour, and function of the teeth. The amount of change that is desired would determine the type of veneer that the dentist chooses. In many cases, the preparations to the teeth can be very conservative. Planning is essential and the dentist should be able to explain the reasons for his design and provide a visual model in the form of photographs and 3-dimensional imaging that demonstrates what the intended results will be.
—Dr. Scott Finlay
There are two kinds of veneers. Veneers are restorations that cover the front surface and sometimes the sides and biting surface of a tooth. They are bonded on the tooth. The bonding is like the glue that holds them in place.
Direct veneers are handmade by the dentist with composite materials in the office. They are bonded to the teeth in one visit and require no lab time. The dentist has to have a high level of skill and artistry to do these well and they only last three to five years before they begin to stain. We use these in young patients who break teeth or to close spaces between teeth.
Indirect veneers are porcelain veneers. They require two visits. During the first visit the tooth is reduced in height and width to accommodate the porcelain and an impression is taken and a temporary is made. A lab fabricates the porcelain veneer so the quality of the lab and the skill of the technician is critical. At the second visit the porcelain veneer (that looks like a thin shell of porcelain) is “bonded” onto the tooth.
Veneers can be used to close open spaces, lighten the color of teeth, lengthen and straighten teeth, and create an overall more youthful, beautiful smile. The key is to choose a dentist who understands how to design a cosmetic smile that is appropriate for your face, shape the teeth correctly so the lab tech can have the room necessary to create the look you and the dentist decided on, and send the case to an excellent lab tech.
—Dr. Kathy Farley
Veneers can correct discolored, misshapen, chipped, worn, or slightly misaligned teeth.
The tooth is prepared and receives a very thin layer of ceramic, which is cemented over it, covering the outside surface and the biting edge of the teeth.
With the correct diagnosis and treatment technique, and a good dental ceramic laboratory, the dentist can create very beautiful and natural looking teeth.
—Dr. Bonny Mitchell
For the most dramatic and permanent cosmetic enhancement, veneers will accomplish a healthy, natural looking, beautiful smile with little or no discomfort. Veneers are thin laminates of porcelain that fit precisely over the front of each tooth.
Lumineers, which require very little, if any, tooth reduction and minimal or no anesthesia, have amazing results that are more natural looking than earlier generations of cosmetic dental procedures. Lumineers can provide an end result that is whiter, brighter, optimally contoured, and aligned smile whose outcome is often more predictable than whitening and/or orthodontics.
—Dr. James Brinster
What is cosmetic dentistry and how do you find a qualified cosmetic dentist?
Cosmetic dentistry is the art and science of creating healthy, beautiful smiles. Although it is the focus of any dentist to restore the health and function of a patient’s smile, cosmetic dentistry takes that effort a step further to enhance the beauty and aesthetics to make teeth look naturally beautiful.
Obviously there are dentists that have focused specific training and interest in cosmetic dentistry. How does a person find the dentist that is right for them? How does the consumer know who has received the training and who has the talent to actually create beautiful smiles?
The American Academy of Cosmetic Dentistry (AACD) is the largest, worldwide academy that focuses specifically on cosmetic dentistry. There are over 8,000 members in 70 countries. The mission of the AACD is dedicated to the advancement in the art and science of cosmetic dentistry and encouraging the highest standards of ethical conduct and responsible patient care. The AACD can serve as a resource for the consumer to educate and to assistant in a search of qualified credentialed cosmetic dentists. ( HYPERLINK "http://www.AACD.com" www.AACD.com)
Cosmetic Dentistry is not a specialty recognized by the ADA but, fortunately, there is The American Board of Cosmetic Dentistry (ABCD) that provides a credentialing measure to access the skills of dentists in their aptitude and ability to perform cosmetic dentistry. Accreditation has become the gold standard in cosmetic dentistry. Accreditation is a process in which a dentist or dental laboratory technician is evaluated by a jury of his peers, examiners within the ABCD, that are leaders and educators worldwide in the field of cosmetic dentistry. Those dentists that have succeeded in achieving the designation in being accredited have validated they that possess the skill and knowledge to create excellence in cosmetic dentistry. They have proven that they can create beautiful results in real world situations. This credential has been in place since the birth of cosmetic dentistry over two decades ago. Accreditation is a process that can take years to accomplish. Currently there are less than 300 accredited dentists worldwide. There are eight practicing in the state of Maryland.
—Dr. Scott Finlay