Dr Eugene Marais has been involved in implant dentistry since 1994 and is President of the British Academy of Dental Implantology. He gained his knowledge at the Misch Implant Institute in Michigan and Pennsylvania, completing both the surgical and prosthodontic programmes.
In 2008 the International Congress of Oral Implantology awarded him both Fellowship and then its highest status, Diplomate.
To date, he has placed more than 6500 implants, performed several hundred sinus elevations and most other dental implant procedures. He has also spoken at many international implant symposia reflecting his expertise in this field.
In these days of increased awareness to oral health, cosmetic dentistry, oral cancer, teeth whitening, white fillings and missing teeth, the visit to the dentist is fast becoming an essential function!
It is indeed a multifunctional role that the dentist and his team fulfils, definitely not only a “drilling and filling” job. Older adults squirm when they think back to their childhood days visiting the school dentist, and the pain they had to endure with each visit!
As our dental well-being is important and the social media, newspapers and TV are constantly showing toothpaste, denture fixative solutions and low-calorie foods there is a distinct connection with our relationship to our dentist and our health. In general, we are also more concerned about preservation, rather than reparation, which could be a lot more arduous and costly than maintaining what we have. The result is that visits to the oral hygienist have been on the increase and dental procedures like fillings and root canal treatments decreasing!
The dentist’s role in health screening, like in oral health and cancer screening, periodontal disease screening, diet advice and sugar control, as well as smoking cessation, makes it clear that your relationship with your dentist is an important aspect of your life. Aside from the screening and advice there is also the maintenance and preventative aspects relating to our dental care.
Oral health is one unsung aspect of dentistry which never gets a lot of publicity and patients don’t realise it’s all part and parcel of the general dental check-up that the dentist advises. During the “check-up” appointment not only are the teeth are looked at, but the patient as a whole is assessed. The dentist investigates the extra oral parts of the face, feeling for the presence of glands, which may indicate an underlying infection, and also the intra oral parts, which includes the soft tissues of the palate, tongue, throat and floor of the mouth. This may alert the dentist to that fact that there may be oral cancer present, gum disease or decay. A BPE or periodontal evaluation is then done to assess the gums and presence of gum disease. Another important fact to bear in mind is that many systemic, or serious diseases in the body, has tell-tale signs which can be picked up in the soft tissues of the mouth. This information is gathered and stored and used to monitor the patient’s oral health and gum status.
Obesity in the UK is fast becoming a big strain on the NHS, not only from treating diet related sicknesses like diabetes, but also from implementing diet prescriptions
and medicines to help with diet control. Here the dentist plays an important role in assessing sugar intake and diet on each individual patient, makes recommendations on decreasing it and also points out the risks and complications related to excess sugar and obesity. It’s only with regular check-ups that sugar intake can be monitored.
Another aspect to dentistry that we don’t always think about is smoking cessation. Smokers always worry about the nicotine stains on their teeth, not realising their lungs look the same. Your medical history would normally reveal that you smoke, and it’s up to your dentist to guide you to a decision to quit. Once again, it’s only with regular visits that a smoking cessation programme can be put into action and your dentist can help to motivate you quit. So, with all this background knowledge to hand before your dentist even starts any treatment, it’s gives you comfort in the fact that even though your mouth is the focal point of your check up, your dentist is concerned about your whole body and the way in which it relates to your mouth. So, when we take a look at how far the dentist’s knowledge stretches, some more amazing facts about your dentist come to light. The days of surgical face lifts and major cosmetic surgical procedures are numbered, where adult men and women of all age groups are looking at dental treatment options to enhance their facial aesthetics. In a recent UK survey, people when given the choice would rather enhance their smile and facial aesthetics, than spend it on cosmetic surgery on other parts of the body. This stems from the fact that dental procedures are becoming more predictable and less invasive than other procedures.
Everyone knows about teeth whitening procedures and every dental surgery and beauty salon offers teeth whitening as a loss leader to build up their patient base. Little do our potential clients really know about teeth whitening and the effects of whitening agent on the pH of the mouth, which in turn can cause sensitivity and decay. Beauty salons offer quick solutions to their clients, who are only too happy to pay a small fee for a material that could damage their oral cavity and causes decay and sensitivity.
Teeth whitening has become a real treatment option with research and development within the procedure taken to high levels, even for severe cases of tetracycline staining, where resin infiltration can be done to lighten lines on teeth that could not be done before.
There are also whitening materials around now which control the oral pH, maintaining a neutral balance which reduces sensitivity and stabilises exposed roots, protecting them from decay. This allows the dentist to prescribe a long-term course in teeth whitening knowing that the patient will have a predictable outcome, without any fear of sensitivity or risk of decay. Your dentist should provide you with the name of materials they use for your whitening procedure and be able to assure you that it is safe to use!
Adult orthodontics also feature high on the cosmetic dental list. As kids, we all remember the ghastly bits about braces, like the blocky uncomfortable removable appliances we were forced to wear (and the extraction of one or several teeth to make way for others!) When we look back and see the failure of all those attempts, it does conjure up fear and unpleasant ideas in our minds, which often keep fallacies alive. However, treatment modes and times have changed radically over the last decade or two, making adult orthodontics, and for that matter orthodontics for everyone, a lot easier, less uncomfortable and visible, and predictable!
Companies like Invisalign, Clearstep, 6 month Smiles, etc, have revolutionised orthodontics for dentists and patients alike, and have cleared up the fears we’ve always had about orthodontic treatment. The main worries are treatment times and the aesthetic look of the braces. Once the dentist has made the correct diagnosis and the patient has decided upon the method, excluding retention – treatment can be done within 6 months, and often in cases where prior orthodontic treatment was carried out, even shorter periods. It is important to know that long term retention is important after initial orthodontics to ensure relapse doesn’t occur.
As far as the looks of braces is concerned, another myth can be debunked, because braces like Invisalign are clear, and cannot be seen. Even fixed brackets, wires and elastics are clear which makes them fairly inconspicuous and a lot more socially acceptable. Over the last three years adult orthodontics cases have doubled each year as patients are keen to rectify problems created by lack of, or incomplete children’s orthodontics.
Next on the list of cosmetic dentistry options is the replacement of amalgam fillings with natural tooth coloured restorations. We’ve all had the nasty amalgam fillings which have unfortunately been done over decades! Thankfully they’ve been banned in certain countries, but unfortunately their legacy lives on in our mouths! There are several options available to the dentist to change these fillings to a more natural looking one. The option of using a composite restoration, which is made of a micro filled resin which is light cured, has been the choice of many a dentist. These have truly been lifesavers, but only in the right situations.
The size, depth and proximity of the cavity really does dictate if a composite restoration can be done. If it is too deep it can cause sensitivity on the tooth, which may or may not disappear, in which case a root canal therapy may be required. If the cavity is between two teeth, it may be difficult to achieve, with the effect that food will always get trapped between the teeth when eating. A tooth coloured composite filling really should only be done in single surface or small, shallow multi-surface cavities. Once the size of the cavity gets large and contact between teeth is broken, then your dentist needs to look at other options, like porcelain inlays. These are solid porcelain restorations, which are shaded to the natural colour of the tooth, and moulded to follow the contour and contacts between the teeth. This allows eating without food impaction and ease of cleaning, and of course they are very aesthetic! Dental laboratories who make these inlays for dentists are normally certified to be able to do so, giving the patient piece of mind that their inlay would survive the tests that the mouth would put to it. Dental Implantology also features high on the list of cosmetic treatments and affects adults of all ages. Starting with the older generation and specifically here where we are on the Costa Del Sol, the social aspect of living here and interacting is an important factor. Combined with the fact that statistically it’s shown that we are all living longer it has become a necessity, and not a luxury, to have a good dentition. From a dietary point of view, it is known that as we age and lose teeth we have to modify our diet to a softer more refined one, which in turns has a detrimental effect on our alimentary canal and digestive system. Also from a social point of view, single people may place more emphasis on a good healthy smile to find friends. Whilst dentures have been lifesavers for edentulous patients, implant retained fixed bridges have given these individuals a far healthier and more socially acceptable lifestyle.
In the younger person, the loss of a tooth can be traumatic, creating an often-costly cosmetic nightmare. There are numerous treatment options when replacing a missing tooth and your dentist should discuss all the options with you before you decide on a solution.
In older patients where the loss of all the teeth in an arch is becoming more common, systems have been designed to replace these failing teeth, sometimes within a day!
Immediately the Arton dental implant comes to mind where the whole procedure is done within 24 hours. This includes the extraction of all the failing teeth in the jaw, placing a number of implants and providing a fixed bridge. This concept has changed the face of adult dentistry, improving the quality of life for many people affected by chewing and eating problems. Once again, the value of oral health connected to health of the rest of the body is underpinned. I hope you enjoyed this month’s column – look forward to talking to you again soon.