Archive for the Preventative Care 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.






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.

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.