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A field guide to dentists
It took some searching to find The Real Yellow Pages. The New Orleans volume shrinks annually given the increasing popularity of online searching. Listings for dentists fill 18 pages, including three full-page display advertisements, compared to just 16 pages for physicians – even though we have far more practicing physicians than dentists.
Several larger dental practices advertise full-service dental care, but subspecialty ads abound. In addition to general dentists, subcategories for cosmetic dentistry, endodontists, family dentists, oral and maxillofacial surgery, orthodontists, pediatric dentists, periodontists and prosthodontists are listed.
Along with a diploma from a dental school, prospectives must pass muster with the Louisiana State Board of Dentistry. Dentists have needed professional licenses in Louisiana longer than physicians. In fact, the dental licensing board established in 1880 was the model physicians used 14 years later to establish a board.
General practice dentists
Most practicing dentists are in general practice. There is an optional one to two year residency for general to practice dentistry, but most dentists currently practicing in New Orleans began practice right after dental school.
The typical general dentist treats children and adults for most gum problems and cavities. They fit crowns, bridges and false teeth. Crowns help preserve normal shape and size to a tooth with problems, say a broken or badly shaped tooth or one with a cavity too large to hold a filling without a cover. A bridge on the other hand “bridges the gap” Ronnie Lamarque style, but the gap is one of missing teeth. Bridges made of gold, alloy, porcelain or other materials attach to other teeth and can be removable or fixed meaning removable only by a dentist.
It isn’t uncommon for a general practice dentist to have additional interests and expertise so don’t think you always need some sort of board-certified cosmetic dentist to apply tooth veneers or a board-certified prosthodontist to fit false teeth.
Straightening is the subtitle in the yellow pages under orthodontists. Working from a canvas of crooked and distorted teeth, orthodontists are the art restorers of the dental world. They strive for straight teeth and Hollywood smiles. According to one dental student, orthodontics is the most popular post-graduate training program, in part because it’s only a two-year program compared to six years for oral surgery.
Braces are a system of brackets and wires akin to the devices used to elevate houses. Brackets with small slots are usually attached to the front of the teeth. Wires are then threaded through the holes in the brackets. These wires are progressively tightened over time to shift teeth into more aligned positions. Braces can be metal or tooth-colored, and some even attach to the back of the teeth. Orthodontists also use plastic-like aligners that fit over the teeth like miniature mouth guards worn by football players. These must be removed to eat. Every few weeks the liner is switched out for a new one with a progressive shift gradually changing tooth direction and growth.
At one time orthodontists mostly treated children with crooked teeth. Their classic patient was a child with buckteeth. Today many adults also see orthodontists for various treatments including correction of malocclusions, the dental word for the top teeth not meeting the lower teeth when the jaw closes. Plan on getting to know your orthodontist as their treatment plans usually dictate frequent visits for up to three years.
Endodontists save teeth. Their habitat is the inner core of the tooth along with its roots. Deep areas of tooth decay, replacement of large fillings, gum disease and trauma can damage this inner core or pulp containing blood vessels and nerves that extend into each tooth root. Each tooth is secured into jawbone by one to four or more roots. When pulp becomes inflamed or infected, the tooth is living on borrowed time.
A root canal is the procedure by which an endodontist removes inflamed and infected pulp, cleans inside the tooth, fills the cavity and seals the opening. The tooth is then topped by a filling or a crown. Modern day root canals take one to two appointments, are no more painful than the filling of a cavity and can last years to a lifetime.
Like geese in the wetlands, the habitat of periodontists is the moist gums and tissues that surround and support the teeth. Dental plaque begins as a complex biofilm of harmless bacteria. Over time this soft covering can harden into tarter, which has the consistency of soft grit. Acid producing bacteria move in to feed on the tatar. Besides causing tooth decay, tartar incites inflammation around the gums termed gingivitis.
Periodontists support solid foundations. They stalk gum disease from mild gingivitis to more severe periodontitis in an effort to preserve supporting bone surrounding the teeth. Gingivitis is usually harmless, but continued inflammation in the gums can lead to destruction of the supporting tissues needed to keep teeth in place. Left untreated periodontitis, your grandfather called it pyorrhea, causes teeth to loosen and fall out. Periodontists scale and clean infected tooth and root surfaces below the gum line in an effort to reverse destructive tissue loss.
According to their association website, oral and maxillofacial surgeons are “the experts in face, mouth and jaw surgery.” Their education takes four years of college, four years of dental school and a four to six year residency, including hospital operating room time.
Traditional oral surgery revolves around extraction of wisdom teeth, surgery for fractured jaws and dental implants. Oral surgery practices vary in different communities. Their scope of surgical care can include head and neck cancers, cleft lip and palate repairs, corrective jaw and facial cosmetic procedures and treatment of facial injuries.
Wisdom teeth are probably the bread and butter of oral surgeons as oral surgeons, periodontists and even general dentists provide implant therapy. Tiny titanium posts are implanted into the jaw. Once these implants bond to surrounding bone several months later, small posts are attached to secure new artificial teeth, which are designed and fitted by a restorative dentist.
Think prosthesis, and the territory of this speciality is obvious. A prosthodontist replaces missing teeth. A three-year post-dental school training program at LSU Dental School provides specialized training in fixed, removable and implanted artifical teeth including dentures, partial dentures, fixed bridges and crowns.
Most general dentists are skilled in many aspects of this speciality, but prosthodontists have special expertise that can be invaluable in problem cases. These specialists also design prosthetic parts for missing facial structures, such as ears and noses. Board-certified prosthodontists often become full time teachers at dental schools.
Dentists who identify themselves as family dentists usually welcome children as well as adults. Most general dentists also treat children, but pediatric dentists spend an additional two to three years after dental school training with children. Many also care to those with special needs, a calling that takes particular compassion and understanding.
A view from the LSU School of Dentistry
“We have 64 students in each class. It is the only dental school in the state. Most students are from Louisiana, except five spots are reserved for Arkansas, a state with no dental school, and there are a two to three slots for students from other states,” says Melissa Jackson, a fourth year dental student who grew up in Metairie, graduated from the College of Charleston in South Carolina and returned to New Orleans where she’s a student at the LSU School of Dentistry.
“The first and second year students study basic sciences and preclinical courses such as biochemistry, microbiology and anatomy. But we also learn to cut and prep fillings for fake teeth,” says Jackson. “You must get all the decay but leave a cavity that will retain a filling.”