Dental treatment has improved dramatically over the last few years. Learn about the latest treatments, and see if your dentist made our list of the region’s 217 most well-regarded practitioners.
Ever since the infamous scene in which Dustin Hoffman had a root canal done without any Novocaine in the 1976 movie Marathon Man, root canals have been portrayed as pure torture — a procedure to be feared and ultimately avoided at all costs. Even President Obama, in his 2010 State of the Union address, tried to underscore how painful the planned bank bailout was going to be by comparing it to a root canal. But, of course, root canals (or endodontic therapy) remain the single most effective way to avoid losing a tooth, and luckily, the procedure has improved dramatically in recent years.
At Assonga Endodontics in Poughkeepsie, Dr. Denise A. Assonga and Dr. Luz E. Mejia are on the cutting edge of what they call “the renaissance of root canal therapy.” Not only do they use the latest materials, technology, and techniques in their pleasant, villa-style office, but they’re committed to educating each and every patient about what a root canal actually entails — and to dispelling some of the enduring myths about this frequent procedure, which is performed more than 14 million times a year in the U.S. Call this dynamic duo root canal cheerleaders, if you will, but their goal is to have every patient say: “ ‘Hey, that wasn’t as bad as I thought it was going to be,’ ” says Dr. Assonga. “Patients often fall asleep in the chair and then say, ‘I can’t believe I fell asleep during a root canal!’ ”
The myths surrounding root canal start at the beginning: defining what it is — and what it isn’t. “A lot of people say, ‘Oh, you’re taking out the root,’ ” says Dr. Assonga. “But that’s not right.” A root canal is the procedure by which the canals in the tooth are cleaned out, the space is disinfected, and the canals are then filled in. A root canal becomes necessary when the living material of the tooth — the pulp, which contains blood vessels, nerves, and other matter — becomes infected. Infection can occur for several reasons, including an untreated cavity, blunt trauma to the tooth (which causes the pulp tissue to slowly die), or because of gum disease around the tooth. “If you had a lot of cavities and a lot of deep fillings when you were young, that may lead to root canal problems because it causes the nerve to be irritated over a long period of time. Then the nerve can die and you need a root canal,” says Dr. Assonga.
The OPMI PROegro microscope
“Patients often ask, ‘If I’ve had a root canal and the tooth is supposedly dead, why do I still feel pain?’ The tissue around it is still alive,” says Dr. Assonga. “Basically, the infection was in the bone surrounding the tooth. If you have a splinter in your hand and you take it out, your hand will still hurt for a little while until it heals. It is kind of similar.”
Dr. Assonga says that the single greatest piece of technology they have is the futuristic-style microscope they use “everyday, all the time.” The $30,000 OPMI PROegro is equipped with a high-resolution, three-chip video camera. “We can look in there and see what is going to work; there are less surprises. In the past, people have had a root canal already on a tooth and they would maybe have to have it extracted. But now we can go in there and fix a lot of the problems that have occurred.”
There is also a 3-D X-ray machine available, although Assonga Endodontics doesn’t currently own one. “But you can see things inside the tooth that you wouldn’t normally be able to see. For instance, you can find an extra root that nobody knew was there.”
The instruments used to clean the canals have been updated too — and are one of the main reasons why a root canal can often now be completed in one visit. “It used to all be done by hand,” says Dr. Assonga. “It would take three appointments, at least. But now we use nickel titanium instruments that can rotate 360 degrees and go around bends and curves and still maintain the same shape of the canal. They really do a much better job. There aren’t many things that are better and faster — but these instruments are one of them.”
One of the hottest topics in the endodontic world is regeneration. In short, it’s the ability to regrow the root of an immature adult tooth. Dr. Assonga explains: “Say a seven-year-old has a tooth come out and when we look at the X-ray, the tooth is not fully formed yet. The nerve grows the tooth, so if the nerve dies, the tooth can’t grow. So we used to put medicine inside the tooth, but the tooth would remain very, very weak. Now we have found that there are some certain cells that are left over in the bone that we can initiate to activate themselves to lay down new tooth structure. We’re in the process of doing several of these now. It’s pretty amazing.”
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Holistic dentistry is an approach that’s growing in popularity — it regards dental well-being in the context of a patient’s overall health, and often relies on both traditional and alternative treatment techniques.
Recent research suggesting a link between oral bacteria and heart disease, as well as concern by some over possible toxic effects of mercury in dental fillings, are just two issues that have helped fuel awareness of the interconnection between the mouth and the rest of the body. There’s even a Holistic Dental Society: Founded in 1977 and based in Florida, it helps provide information for professionals and patients alike to encourage a broad-based approach to dentistry.
One key aspect of holistic dentistry is the use of materials considered biocompatible — those thought to be safest for humans. These can range from metal-free fillings and implants, to bonding agents and other substances that rarely trigger allergic reactions.
Tischler Dental in Woodstock has long been regarded as a pioneer in holistic care in the Hudson Valley. “It’s a cornerstone of our practice,” says Michael Tischler, D.D.S. In addition to the use of biocompatible materials, Tischler Dental provides homeopathic remedies, for instance, for pre- and post-dental care (such as tincture of myrrh to help reduce minor gum pain from inflammation). Another holistic bonus: Acupuncture is also available to help patients relax, reduce dental pain, treat TMJ (jaw) problems, and assist in the overall healing process.
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Thank goodness for dental anesthesia. Those little magic shots that numb the mouth help patients glide through what otherwise might be uncomfortable, even painful, procedures.
But what about post-anesthesia? For a couple of hours after leaving the dental chair, a patient often can’t speak clearly, smile, eat, or drink — you might even catch yourself drooling. Not a pretty picture for folks with a busy day ahead — and an anxiety-provoking scenario for those who may already suffer from dental phobia.
Now, dentists have a new trick to speed up the return of sensation to the lips and tongue area after routine treatments. OraVerse is a sort of reverse anesthesia — the product is injected in the same way the original shot is given, while the mouth is still numb. According to the manufacturer, clinical trials show that patients usually regain sensation twice as fast with OraVerse.
“Generally, if it takes, say, two hours normally for numbness to wear off, the time is cut to about one hour,” says John T. Lynch, D.M.D., of Hudson Highlands Dentistry in Middletown, who has been using OraVerse for about two years.
Another group that can benefit are children who might be upset by the sensation of lingering numbness in the mouth (the manufacturer doesn’t recommend it for children under six or kids weighing under 33 pounds). “Numbness can scare some children,” says Lynch. “They may not understand what it is.”
An OraVerse shot can run about $10-$12. But many patients don’t mind the extra cost. “They say it’s a big help when they have a dental appointment on a busy day and need to be fully functioning again as soon possible,” he adds.
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Getting a crown normally requires at least two trips to the dentist. Not to mention having to wear a temporary one — which may be unstable or unsightly — while waiting days or weeks for an outside laboratory to make the permanent crown.
But now, a new high-tech procedure allows dentists to create crowns right in their office — in one visit. The makers of CEREC technology — it’s short for Ceramic Reconstruction — offer a dental restoration system now used by more than 12,000 dentists nationwide.
Here’s how it works: After a tooth has been prepped for treatment, the dentist takes a series of special computerized photos of it. The image is then digitally transformed into a 3-D model of the tooth, which is viewed on the computer screen, in a process sometimes known as computer-assisted-design/computer-assisted-manufacture or CAD-CAM technology (it was first used in electronics and car manufacturing).
Next, the dentist (who receives special training to use the equipment) designs the crown to exact specifications, fine-tuning its shape with the digital imaging system. The final design is then uploaded to a special milling machine, right in the dental office, which molds and trims a tooth-colored ceramic block to the precise tooth shape required. When that’s complete (usually in less than half an hour), the dentist fits and anchors the crown, and voilà; the patient is good to go — all in one visit.
While not inexpensive — a CEREC unit can cost upwards of $100,000 — the system’s makers tout other advantages of its “one-stop shopping” dental procedures. In addition to saving time for busy patients, the process requires less drilling and anesthesia, no messy impressions, can sometimes preserve more of a damaged tooth, and is a boon to dental-phobic patients who fear spending long amounts of time in the chair.
The CEREC system can create fillings, inlays, and partial crowns, too. A few dentists also use the technique to create porcelain veneers, but achieving the perfect color match desired for front teeth can be trickier; the so-called “instant crowns” are most often used on less-visible back teeth.
Edwin O. Wiley, D.M.D., of Galloway Dental in Warwick, has been using CEREC technology to make crowns, inlays, and onlays for about a year. “Many patients prefer them, especially the fact that there’s no need for a follow-up visit to complete the crown,” he says. The procedure usually involves taking about nine computerized photos, from which the crown is designed — and the cost is usually comparable to a traditional crown, Wiley adds. “There’s no real downside to the procedure. The only question would be whether the tooth itself is suitable for a crown.”
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Gone are the days of enduring the ugliness — and, some say, possible health risks — of a mouthful of metal fillings. Nowadays, tooth-colored composite fillings can take the place of the clunky-looking silver that has been used for more than a century to fill cavities in teeth.
Many dentists now offer both types of fillings. So patients often have a choice — metal or “invisible” — when heading to the dental chair. Some folks opt for one or the other, or a combination; others prefer to have metal fillings replaced by the newer technology. Here’s a primer on the two alternatives.
Also known as metal or silver fillings, traditional silver amalgams are usually a combination of mercury, silver, tin, copper, and sometimes other metallic elements. The upside: silver amalgams are quite durable (especially when used on back teeth, which we rely on for chomping and chewing), and they have a long history of “tried-and-tested” use. Also, dentists who practice general dentistry don’t require additional training to work with this technique, and patients appreciate that silver fillings generally cost less than tooth-colored options; they’re also often covered by dental insurance plans.
Metal fillings do have drawbacks. For some patients, it’s mostly a matter of aesthetics. And while the metal material itself is quite durable, some dentists say these types of fillings — especially if they’re large — weaken a tooth’s structure, leaving it more susceptible to breakage.
The biggest objection in recent years has been the controversy over possible health risks from mercury in the mouth. Many who argue against using metal fillings (which are generally comprised of about 50 percent mercury) warn of a host of potential health risks, ranging from psychological and neurological problems to birth defects, if mercury should leak into the body over time. The American Dental Association’s current official stance is that “the major U.S. and international scientific and health bodies… have been satisfied that dental amalgam is a safe, reliable and effective restorative material.” Meanwhile, the debate continues.
On the other hand, mercury-free, “invisible” fillings have several pluses, in addition to what some see as the potential health benefits. Made of composite resins (such as glass particles and a setting ingredient), they’re the same color as teeth and hence, more attractive. They usually require less removal of tooth structure, so a smaller hole is required for fillings. They’re less sensitive than metal, reducing that “ouch” sensation when sipping hot or cold liquids, for instance. They also bond right to the tooth, enhancing its strength.
Disadvantages include a higher cost: more-extensive training is needed by a dentist to work with white composite fillings, and the materials used are pricier, too. Cost can vary considerably, but you can expect to pay anywhere from $75 to $150 per silver filling; composites may range from roughly $150 to $250 per tooth, depending on the dentist. Also, some dental insurance won’t cover “invisible” fillings. And while it’s impossible to predict how long a filling will last, some experts say the lifespan of a white composite usually runs about seven years; metal fillings tend to last about 12 years.