Passionate Artistry

The Dental Program

toothbrushes

The Add Life to Your Smile Program is for patients who want their teeth, including any new dental restorations, to last. The program assesses current conditions that compromise the longevity of your smile. It provides corrective treatments and strives to provide results that have the potential to last for 40 years or more. It implements the latest advances in dental science, materials technology and proper aftercare. The program identifies situations where a decision must be made for services with a short-term life expectancy.

Five primary factors are addressed: (1) control of tooth decay, (2) control of periodontal disease, (3) control of wear, (4) quality control, and (5) the experience of pleasure during and after treatment. The dental team (dentist, dental hygienist and dental assistants) identifies the presence of disease related to the first three factors, and then recommends treatment to eliminate and/or control any disease. Within the program, the dental team provides quality control, an absolute essential for long-term results. Success is judged not just by the longevity created by completing the first four steps, but also by the patient receiving a payoff in terms of comfort during treatment phases and satisfaction with results.

Historically, dentists and patients have concentrated on removing tooth decay. The assumption was that the mouth would be healthy if the decay was removed. In addition to recognizing and removing decay, the program emphasizes preservation of existing teeth and dentistry through the prevention of new decay caused by habits, medications and systemic disease.

Unfortunately, many people continue to lose teeth and have disfigured smiles from gum (periodontal) disease. For the past 35 years, there has been an increased focus by most dentists on maintaining both tooth and soft tissue health. The program focuses on restoring periodontal tissues to health and maintaining this health through an active control protocol.

The influence of tooth wear is often overlooked. Wear can occur on individual teeth (fractures or cracks), on groups of teeth (such as just the front teeth) or throughout the mouth. Wear can also affect the temporomandibular joint (the joint that supports the lower jaw). Failure to recognize the future consequences of wear can result in the need for replacement of restorations, even those with a perfect fit and appearance. Smart dentists and patients who implement the Add Life to Your Smile Program are adding the assurance that wear factors are taken into account.

The most difficult factor for patients to evaluate is quality. A lifetime smile is unlikely without the dentist striving for perfection with every dental service. Patients can be guided by the dentist’s apparent attention to detail, the use of magnification while working, referrals from local dental specialists, and lack of participation with low benefit dental plans. Higher quality dentistry may cost slightly more as costs for better laboratory work, materials and education are factored into fees.

Finally, dentistry should provide pleasure for the patient. For some of you, pleasure dentistry is an oxymoron. Most patients with attractive and healthy smiles derive considerable pleasure out of their smiles and they look forward to dental visits. The problem then, is how to get the rest of you to that point. To do this, the dentist must provide a comfortable experience with attention to painless shots and the use of the newer, quieter drills and the latest anxiety reducing techniques. You should expect dentistry to be provided at a pace that is comfortable for you and your pocketbook. The esthetic results should not just satisfy the dentist’s critical eye, but they should allow you to say, today and for decades to come, “I really love my smile!”

Factor 1 – The Control of Tooth Decay

For patients who are decay free, control of tooth decay involves preventive measures that everyone knows – brushing with fluoride toothpaste, daily flossing and regular visits to the dentist to catch any new cavities before they become large.

For all other patients, the initial effort is to treat any painful area and to remove all decay. Patients are conditioned to the word “decay.” When they hear this word, they know that there is a hole in their rotting tooth. Dentists may use other phrases that describe existing decay or identify the fact that decay is getting starting. These include “fractured filling”, “leaking restoration”, “sticky spot”, “incipient lesion”, “open margin” and many combinations of these and other words. In all of these cases, bacteria have established a location to do their dirty job of converting sugars into an acid that continues the decay process.

Whether you hear the word “decay” or one of the other phrases, your tooth should be restored. Left untreated, decay-causing bacteria will continue to thrive in your mouth and the disease will be ongoing. New techniques and materials permit very conservative fillings to be placed in even the smallest of decayed areas (dentists refer to this asmicrodentistry), thus reducing future costs and possible pain.

Some dentists may say they want to “observe” or “watch” a tooth with early decay. Although it doesn’t make sense to watch cavities get bigger, there are a few reasons why this may be acceptable to you and your dentist.

  • If the decay is not yet through the enamel it is possible that the enamel will remineralize as fluoride is taken up into the weakened surface of the enamel. This is most likely to happen in very clean mouths, without decay activity on other teeth.
  • You may have adjacent teeth with treatment options that could change the treatment recommendation for the tooth in question.
  • For budget reasons, you may need to space out treatment, so the dentist will plan on observing some situations until you can afford to treat areas with more advanced disease.
  • You may not be healthy enough to undergo dental treatment.
  • Your dentist may think you aren’t going to live long enough for any decay on your teeth to be a real concern.

After decay is removed, the dentist should recommend one or more of these additional steps for patients predisposed to dental decay:

  • Anti-microbial rinses for two weeks following dental visits to reduce harmful bacteria
  • Replacement of dietary sugars that ferment into acids with non acid-producing foods and snacks – especially with gums or mints that contain the sugar Xylitol
  • The use of a prescription toothpaste
  • The use of a prescription fluoride rinse or fluoride-carrying trays that fit over the teeth

More information about the diagnosis and treatment of “at risk” mouths is found in the article, “Your Crown May Last Forever, But Your Tooth Might Not!”

Factor 2 – Control of Periodontal Disease

Periodontal disease is disease of the gums and bone that surround the teeth. Like tooth decay, periodontal disease is a bacterial disease. Signs of periodontal disease may include bleeding, red or purple gum tissues, swelling of the gum tissues, deep spaces between the gum and tooth (pockets), pus expressing from the space between the gum and the tooth, and halitosis. Gums may recede exposing sensitive root surfaces, but it is possible to have no gum recession and still have the disease. Although gums may be painful, it is more common that the patient does not experience pain symptoms from periodontal disease. Like diabetes, its early progression can easily go unnoticed.

Periodontal disease is a bacterial infection that causes the breakdown of the connective tissues that attach the gum to the tooth. It may also involve the breakdown or loss of bone around individual teeth or all teeth in the mouth. The goal of treatment is to remove the bacteria that cause the disease and to minimize the ill effects of the disease by improving the environment for future cleansing of the areas around the teeth. This involves removing calculus (tartar) deposits, repairing or replacing ill-fitting fillings, and removing decay. Bacteria are further reduced with meticulous oral hygiene and anti-microbial rinses.

Some deeper pocket areas may be treated non-surgically with antibiotics placed directly in the infected pocket or with a dental laser to sterilize infected pockets. Oftentimes, pockets must be reduced surgically and bone defects may be corrected with grafting procedures. The simpler problems are often treated within the general dentist’s office, while a dental specialist, the periodontist, usually cares for these more complicated issues.

More complete information about the causes and treatment of periodontal disease is found in the article, “What Gives? It Could Be Your Gums.”

Factor 3 – Tooth Wear

Although a small amount of wear may be considered normal, over half the population suffers from wear on their teeth that is more properly called a disease of use and abuse. Many people first recognize that their teeth are wearing when they see slight chipping on their front teeth. A number of other effects of wear are less likely to be recognized. These include notches at the gumline (sometimes called erosions or abrasions), vertical crack lines in the enamel, flattening of the back teeth, cracking off of parts of the teeth, the appearance of bone protrusions (called exostoses) on the roof of the mouth or sides of the upper and lower jaw) and reduction of facial height with accompanying reduction in facial attractiveness.

Treatment of isolated teeth in the presence of general wear throughout the mouth may result in a shortened lifespan for the restorations. If we wear through the sole of one shoe, but the other shoe still has half its leather, we don’t just replace the worst sole. Likewise, problems can occur in a mouth when broken or decayed teeth are repaired in the presence of ongoing wear elsewhere in the mouth.

Your dentist should address the wear factor. You should know what to expect in the future so together you can make good decisions today. Wear is treated by correct selection of materials and designs for dental restorations, wearing of bite splints, orthodontics or bite reconstruction. If treatment is delayed until great destruction is evident, the solutions become challenging and more costly.

Read the Article, “Grinding Your Teeth to Smithereens” for more information on the wear factor.

Factor 4 – Quality Control

The patient is not in charge of quality control, but should be educated regarding the dentist’s efforts at quality control. For dentistry to last, quality control must exist throughout the treatment process, whether gum disease, dental decay or wear is being treated. The quality-minded dentist will perform thorough exams, employ an outstanding team, maintain sharp and well-tuned instruments, use accurate impression materials, insist on precision dental laboratory work, purchase strong and esthetic restorative materials and have exceptional technique.

You will have a hard time judging the dentist the way a dental professionals judge themselves (under a microscope). Instead, use the hints that you can see. Above average fees may be a clue, but are not always reliable. You should attempt to judge the dentist’s passion for perfection. Dental school admission committees choose their students based upon many talents, not the least of which is a passion for perfection. “Perfect” is seldom possible and oftentimes not even desirable when restoring teeth. Even when a patient is very pleased with the results, the dentist still sees what is not perfect.

Over time, dentists either tend to decrease their efforts to seek perfection (resigned) or increase their efforts toward the elusive goal (passionate). Resigned dentists may or may not be highly skilled, but their efforts at attaining great results become diminished over time. Passionate dentists are almost always skilled, some very highly skilled.

An unskilled dentist is unlikely to be “passionate”. It is hard to be passionate when you want to create perfection but cannot get close. Seeing one’s own work on a daily basis would be too upsetting. Some skilled dentists also are unable to handle even minor imperfections in their work. Dentistry may become a secondary interest for these dentists. They often seek other business opportunities or sports activities where they can more closely approach perfection.

Passionate dentists are able to handle the limitations inherent in dentistry, but do not accept these limitations as permanent. Each new patient is another opportunity to approach perfection.

Quality control is the most consistently recognizable trait of a passionate dentist. The passionate dentist is always working on quality control. This is your key to finding a great dentist and ending up with great results. Although patients have a difficult time telling quality (until years later), you can recognize quality control immediately throughout the dental office.

Here are some of the quality controls that make for exceptional dentistry:

  • Examinations are thorough and you receive detailed explanations regarding your oral health.
  • The dentist and hygienist use magnification (loupes, microscopes, close-up cameras) during exams and for any detail work.
  • If any work isn’t right, by your standards or the dentist’s standards, it is made right.
  • The office is clean throughout, especially the restroom, treatment rooms and reception area.
  • The office runs close to schedule most of the time
  • The staff is well-groomed and well-trained.
  • The dentist clearly enjoys work and attends many continuing education courses and/or study groups to improve her/his dentistry.
  • The dentist has photos of her/his own work available for you to view.
  • There is at least one piece of high technology dental equipment in use in the office (laser, digital x-rays, computerized patient education, high power microscope).
  • The office does not provide managed care dental services.
  • The dental team makes considerable effort to keep you comfortable during your treatments.

There are many quality controls in the dental office that are perceptible only to the dentist and staff, but what you can see is an excellent indicator of what you can expect.

Factor 5 – Pleasure

A long-term smile is not a success unless it brings pleasure to the wearer. For some individuals, this means the security of not needing much future dental work. Some individuals are thrilled just to have their teeth if their parents wore dentures. Others are so delighted to own a smile that it lights up their face. Still others derive pleasure from knowing (and maybe bragging) about how they have invested in and received the best dentistry available. All of the good feelings that come with a lifetime smile can be described as “pleasure”.

In an effort to provide exceptional dentistry, dentists may overlook keys to the patient’s happiness. It is easy for dentists to focus on the product, rather than the service. Patients who share their motivations are more likely to receive exceptional product and service.

Patients who never achieve dental health will not realize the benefits from a healthy mouth. Instead the focus will be on pain prevention. This comes in the form of total avoidance or limiting treatment to emergency situations. The downward spiral of an unhealthy mouth further confirms to the patient that teeth are simply an unpleasant experience.

Painless dental experiences at the hands of caring dentists have helped many fearful patients make the leap from completely scared to fully repaired. The great news today is that this leap is no longer a surprise. It is not an exception, but the expected.

Many dentists have the training, talent and tools to provide an excellent and painless experience for the patient. Quieter drills, dental lasers, improved training, relaxation techniques and even competition among dentists are resulting in dental visits that are easier than ever. Tens of thousands of patients are now discovering the benefits of a healthy and attractive smile. Yes, this may require sedation for the very fearful. It is wonderful that some dentists are now trained to provide safe sedation with newly available sedative drug regimens.

Pleasure is a prize you receive along with your lifetime smile. Once experienced, most patients continue to enjoy their dental visits and healthy smiles for a lifetime.

If you would like to learn more about the dental procedures and treatments performed by cosmetic dentists Dr. Rob Strain, DDS  and Dr. Laura Wittenauer, DDS please call us at 760.568.9494 or click here. Serving new patients in Rancho Mirage, Palm Springs, Palm Desert and surrounding areas.


It was great. Each staff member greeted me and they walked me through the whole office. I highly recommend Studio Dentistry. They are great!!

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