Archive for the Dentist Advice Category

What is Minimally Invasive Dentistry?

What is Minimally Invasive Dentistry?

This term is used rather loosely, but generally it refers to using less invasive procedures to treat dental problems and focusing instead on prevention or reversal of decay.

For decades, dental schools taught “Extension for Prevention” regarding filling teeth. This was a term from a dentist who is considered one of the fathers of modern dentistry, G.V. Black. When drilling a tooth to place a silver filling, a dentist would drill beyond the decay and take out all of the grooves on the top of the tooth, decreasing the risk of future decay. While this may sound too aggressive, it was a predictable technique and many of our older patients still have these fillings which can be 40 to 50 years old and going strong.

Since Dr. Black’s time, dental materials have advanced tremendously and we no longer think that all cavities are the same. The study of dental decay is called “cariology” and it recognizes many types and stages of cavities. One type is “arrested decay” which implies that a tooth had early decay starting in the outer enamel surface but that decay was stopped before it got into the tooth and is now just a scar.   The decay is stopped by minerals in saliva or dental products, usually calcium or fluoride. In our practice, we give a patient the option of filling or just observing early or “incipient” decay in hopes that the decay will not progress.

Another trend that some dentists feel is too aggressive is the placing of crowns or “caps” on a large number of teeth when not all of the teeth need them. Reversible procedures, such as resin bonding or veneers, is less invasive and can be a better option.

Minimally invasive procedures used by Hakala Family Dentistry include:

-sealants on permanent teeth to prevent decay in the grooves

-fluoride products and other remineralization products such as MI Paste, which has calcium and phosphate

-laser cavity detection

-low-exposure digital radiographs

-observing incipient decay by checking every 6-12 months, when a patient prefers this to placing a filling

-attempting to save a tooth rather than extract if that is the patient’s preference and if it is a reasonable choice

-partial crowns (onlays) instead of full crowns when indicated

-bonding teeth with filling material instead of cutting them for crowns

There are many options for almost every dental problem and we do our best to inform our patients of all available options so that the treatment fits each person’s individual needs.






Corporate-run Dental Offices

“Corporate Dentistry” – or dental practices under the control of dental management companies, are increasing in number. How do they differ from traditional dental practices?

People in Colorado are aware of some of these dental chains – that begin with a “C” or a “P”, for instance. Others are not so obvious – they may have an unique name, but still are part of a large organization. These offices usually have the following:

– dentist owns only part or none of the business

– dentist is under pressure to make a profit

– new, younger dentists go through the practice with a high turnover, so you don’t always know who you will be seeing

– high cost dentistry in high volumes are usually expected of the dentists

– some of the practices do not employ dental hygienists to cut costs, and use unlicensed assistants more to compensate

– practice managers often have no dental background, but have a say in what treatment is done

– some practices are for children, because a general dentist can see a high volume of kids covered by Medicaid and it is lucrative

We have provided a link to a presentation from Columbia University Dental School specifically about this type of practice. Below the link we have printed negative comments from the dentists who participated for this project.

Link for the negative comments below:

Negative comments from dentists who worked for dental management companies:

•”Very few have any ethical standards; profits are main goals, a “good” doctor is only one who makes lots of production, regardless of patient satisfaction.” ~ 2yrs DPMC

•”Most of my concerns stem from no autonomy in managing the office. I would like it run a certain way, corporate runs it another. We need to share our office space with general. Budgets restrict what I am able to do.” ~ 3yrs DPMC

•”These institutions should be banned by the ADA. They are unethical in what they do and their services are below standard of care.” ~ 2yr DPMC

•”On the whole, dental corporations are very money oriented. I have witnessed many scenarios where the office managers without a dental degree dictated what treatments (usually the more expensive ones) were need by the patients.” ~ 1yr DPMC

•”I think they are entities more focused on making money rather than patient care. The practitioners I know including myself have only been able to work for these large companies for under a year due to the high stress and burn out rate.” ~ 2yr DPMC

•”’Practice Manager’ dictating treatments and not the treating dentist. / They never know when to refer and the quality of work, when I see it, is horrendous. These recent graduates are pressured into performing too many procedures and unnecessary work is often being performed and the patient care is substandard, in my opinion.” ~ 0yrs DPMC

•”They are destroying dental field.” ~ 0yrs DPMC


•”Chains are ruining the quality of care patients deserve. They are mills to make a quick buck. Chains are ruining private solo practitioner practices.” ~ 0yrs DPMC

•”Though I have no real personal experience to draw from, I automatically assume a negative bias about dental management companies. I assume that quality of care will be compromised, I assume that production and profit will drive patient care and that I won’t have control over my treatment planning.” ~ 0yrs DPMC

    Our advice – if you are a patient of a “corporate ” practice and are given a surprising treatment plan, go get a second opinion! Try to find a dentist who is a full owner of his or her practice and seek their advice before you proceed with the plan.

Why are My Teeth Sensitive?

sensitive teeth help

Teeth can be sensitive to cold, hot, sugar, touch, and biting hard foods.

Cold sensitivity -is a sign that a tooth is “alive”, meaning the nerve hasn’t died. There may be a cavity, a crack in the tooth, or it may just be sensitive around the gumline due to gum recession. This is a common occurrence, because most people are keeping their teeth as they age, and as they get “long in the tooth”. This phrase actually refers to teeth looking longer on older people due to recession of the gums from gum disease or heavy toothbrushing. As a result of the gum recession the root of the tooth, which has microscopic nerve endings, is uncovered. Grinding and clenching can also cause tooth sensitivity. If you have cold sensitivity, a dental examination should be done to determine the cause and the treatment options.

Sweet sensitivity – usually means that there is decay in the tooth, but can also be from exposed roots. Again, a dental exam is in order.

Heat sensitivity – is not a problem if it is momentary, especially if you switch from cold food or liquid to hot. Prolonged, throbbing pain with hot food or drink can indicate that a tooth is dying. The dead pulp tissue inside the tooth will form gases that expand with heat, causing significant pain. Don’t delay getting to the dentist if you have this symptom.

Biting pain – can be from a cracked tooth, especially if it occurs when you are chewing hard foods and is momentary. Another cause of pain with biting can be tooth grinding. Tooth grinding or clenching causes the nerve or “ pulp” of the tooth to be irritated, so bite pressure and also cold can cause pain. If your teeth are more sensitive when you wake up in the morning, especially if they are sore on both sides of your mouth, you may be grinding/clenching during the night and should consider a bite guard.

10 Resources for Free and Reduced Fee Dentistry in Metro Denver

denver dentists

Photo credit: Larry Johnson








Not everyone has dental insurance or money to pay for dental care, especially with jobs disappearing.

If you have a dental problem and no insurance, what can you do? Well, you can cancel the cable TV, skip the acrylic nails and cut your own hair (hair and nails grow out, teeth don’t!).

If you still can’t afford traditional dental care, there are other alternatives. There are so many options for dental care for children, I will save those for my next column.

Here are some resources for adults:

1) Barter.
Place a Craigslist add offering to provide your skills in exchange for dental care.

2) Attend the Colorado Mission of Mercy (COMOM) event, which occurs during one weekend each fall. The Colorado Dental Association has sponsored the COMOM, which provides free dentistry to hundreds of people on a first-come, first-serve basis. The location changes each year, in 2014 it will be in Henderson, CO. Get there early and bring a book, you will have to wait in a queue. You won’t get a new set of veneers, just the basics are provided – but the price is right.

3) The University of Colorado School of Dental Medicine provides discounted dental care. There are even residencies to train dentists to become orthodontists and periodontists (gum specialists). Be patient, getting into the system can take awhile. (This is a state institution run by state employees). Dental students tend to work at a slower pace, but everything is done by the book.

4) Denver Health has a dental clinic at their main campus, and an oral surgery residency there provides services such as removal of wisdom teeth. They have 2 other affiliated clinics referred to as “Eastside” and “Westside”. Treatment is provided on a sliding fee basis, for residents of Denver County.

5) Tri-County Health provides discounted dental care to people over age 55 who reside in Arapahoe County.

6) Colorado Coalition for the Homeless has a dental clinic at 21st and Champa, for qualifying homeless people.

7) Inner City Health Center has 2 clinics, one at 3800 York Street, and another called New Hope Dental at St. Anthony’s Central Hospital . Dental treatment is provided on a sliding fee basis.

8) Community College of Denver has a dental hygiene program that provides cleanings and x-rays at reduced cost at the Lowry Campus.

9) Medicaid. While Medicaid provides comprehensive dental care for children, adults are not so fortunate. If you qualify for both Medicare and Medicaid and have certain health conditions, dentistry is provided through the Colorado Access Plan.

10) Your Dentist. If you have a cavity or broken tooth and can’t afford major treatment, ask your dentist if there is a temporary or “provisional” option to stop decay and stabilize the tooth for several months. Sometimes a temporary crown can keep you chewing and smiling while preventing abscesses.

For more information see these websites:

You have older fillings, and your dentist recommends that one or more be replaced. How do you decide?

tooth filling denver

Reasons to Replace a Filling:

tooth filling denver

Photo credit: Matt Lemmon

– New decay around the old filling
– Broken filling
– Food packing between teeth because the gap is not filled.
– A filling on a front tooth is badly stained
The tooth has sensitivity to sweets, which can indicate decay

Occassionally , a patient will go to a new dentist because their insurance coverage ends or they move. At a recent dental class I heard an interesting statistic: patients are 7 times more likely to have fillings replaced after an examination with a new dentist than if they were examined by their previous dentist. 7 times! There are many reasons for this, some legitimate and some questionable.

Questionable reasons to replace a filling:

  • The previous dentist was aware of suspicious areas and was just observing those teeth because they had been stable for a long time. This is a conservative approach, as teeth can have scarred areas of “arrested” decay that don’t progress. A new dentist won’t necessarily be aware of this.
  • The new dentist may be very aggressive and “creative” with treatment recommendations.
  • The new dentist may prefer one type of material (i.e. composite resin or porcelain inlays) and will recommend that the existing fillings be replaced, even if the teeth are comfortable and there is no decay.

If you receive a dental treatment plan that calls for replacing several fillings and you are not comfortable with it, ask for a copy of your x-rays and seek a 2nd opinion from another dentist. Even if it turns out that you do need a lot of new fillings, you will find it reassuring to get another opinion.

The American Dental Association has an informational article about this subject. Click here to read it.

Investment Advice from a Dentist

At a meeting a few years ago, Warren Buffet discussed what he tells young people when they ask him about the best investment that an individual can make. His answer? Yourself!

Mr. Buffet tells them “Just imagine that you are 16 and I am going to give you a car of your choice, any car you want to pick. But there is one catch. This is the the only car you are able to have for the rest of your life.” He goes on to describe how well that hypothetical car would be cared for – the owner’s manual would be read several times, the car would be garaged, the oil would be changed twice as frequently as necessary, and any little rust spot would be taken care of immediately.

Then he reminds his young audience that they only get one body with one mind, and it has to last a lifetime so it needs to be cared for in the same manner. He reminds them, “It doesn’t do any good if you start working on it when you are 50 or 60 and the little speck of rust has turned into something big.”

What a great analogy! In dentistry, the rust is tooth decay and gum disease. We would love to have each and every one of our patients come in at least twice a year to catch those rust spots before they spread.

Did you know that more money is spent in the U.S. on hair coloring products than on dental care? What is bothersome about this fact is that hair grows out, but you only get one set of teeth. We often hear “I don’t have insurance” as a reason for not having dental treatment. But we also see people spending substantial amounts of money on hair, fingernails, and even tattoos that aren’t covered by insurance either.

Dentistry is one area of health care where prevention has proven to be very effective. Routine cleanings, sealants, filling cavities while they are small, fluoride treatments – these all prevent the progression of dental disease. And you cannot be truly healthy if your mouth is not healthy. So my advice is: invest in yourself!

How Bite Guards Help

bite guard

bite guardWe have all seen athletes wearing colorful bite guards to protect their teeth. It makes a lot of sense to protect teeth from damage during contact sports such as football, or to avoid breakage from a flying hockey puck. But why should you wear a bite guard at home, while you sleep? Most people grind or clench their teeth during sleep, even if they are not aware of it. During REM sleep (rapid eye movement stage), most muscles in the body are relaxed, except the jaw muscles and eye muscles. Many people also clench their teeth while awake, in stressful circumstances. This clenching and grinding (also called “bruxing”) can cause damage to the teeth and the bone around them. The amount of grinding and clenching a person does depends on many factors, such as personality type, how their teeth fit together, life stressors, and even what medications they take.

Who would benefit from a bite guard? Just about everyone, in our experience, but some people with excessively worn teeth can especially benefit. Bite guards help prevent cracking, wear, and breakage of teeth. They also prevent gradual bone loss from extra forces on individual teeth, by distributing pressure evenly. Tight jaw muscles can also benefit from bite guards, and many people sleep better when they wear one. This is why they are used by people with “TMJ” syndrome, with damage in or around the joints that allow opening and closing of the jaw.

What is the cost of a bite guard? Over the counter or “boil and bite” guards can be purchased inexpensively at drug stores. Most dentists do not recommend these, however, because the softness of the material can make you clench even more. But they do keep your teeth apart and can be helpful for some individuals. Custom-made bite guards can cost several hundred dollars, but they fit much more accurately and are more effective. The price is due to the materials and time involved in taking impressions of the teeth, having a laboratory fabricate the guard, and having the dentist or staff adjust the guard for a proper, even fit. If you consider the cost of a crown on a tooth, or a dental implant, a bite guard is a wise investment.