Advanced Computer-Aided Diagnostics

young manHippocrates is credited with the statement that "there can be no treatment without diagnosis." What was true then is still true today. What is different today is that dentists need not simply depend on their five senses to examine and understand their patients’ problems. Sophisticated computerized equipment now enhances our ability to evaluate health and disease in ways that weren't even imagined but a few decades ago. In our office, we are leaders in bringing the practice of dentistry into line with the medical model of interview, examination and objective testing. I refer to the use of things that may be counted or measured as part of the process of arriving at a diagnosis – "Dentalmetrics." The advantage of using the Dentalmetric approach of the practice of dentistry is that dentist and patient may share the data and the understanding that it brings. By way of analogy, the average person is probably not an expert on heart disease, but most people readily understand that a blood pressure reading of 120/80 is far healthier than one of 135/90… The patient may feel okay, but it's hard to argue with or deny this objective measurement, and statistics typically don't lie. The same type of data has become available to the world of dentistry.

Digital Imaging

Our office has been computerized since 1987. In 1998, we added computerized digital radiography (X-rays). Digital X-rays have both great direct and indirect benefits for the dentist and patient alike. The most noteworthy patient benefit is the greatly reduced radiation exposure. Digital films require approximately 50% less radiation than conventional X-rays. But the patient also benefits from our ability to manipulate and enhance the images on the computer for better clarity and interpretation versus traditional film media. In addition, when referrals are called for, a specialist can receive the necessary images – virtually immediately and with the same quality as the original. This speeds up and simplifies consultations. Finally, the security of your dental records is enhanced in that, like your dental chartings, clinical notes, and histories, all images are backed up both locally and on remote locations in a safe environment that preserves your records and maintains their confidentially.

Digital Photography

Digital photography has also been a great addition to our clinical practice. Unlike traditional film, digital images are available to us instantly. This is a great way to objectively view a clinical result, document a treatment history, create a visual record for later comparison and communicate with specialists or laboratories. At Pleasantville Dental Associates, we employ two types of digital photography. We use a normal single reflex camera with a close-up macro lens and ring light for standard oral photography and portrait shots. But we are also fortunate to have an intraoral camera capable of extreme close-up imaging. This is helpful for seeing and documenting conditions like fractured teeth where dental X-rays are unable to detect or document such problems. Intraoral photography can often take the place of a dental X-ray, negating the need for unnecessary radiation, and provide supporting evidence to increase the chance of a successful insurance claim outcome. And lastly, having the ability to post an image of the problem area, bigger than life for all to see, is very helpful in building patient confidence that we are treating the correct problem. Wherever possible, our practice works to level the playing field of communication. Seeing and understanding your problems builds trust and confidence. Your dental care should be a true partnership of meeting our needs and goals.

Seeing "Color" in a Whole New Way

We also use a unique form of photography with a device called "Shade Scan." the Shade Scan system uses a specialized camera with a self-contained computer system that is programmed to recognize and interpret various elements of a tooth's color, color value and its degree of translucency. We find this information to be of great value in our cosmetic dentistry practice when we need to match natural to artificial teeth. Combined with clinical digital photography, Shade Scan allows the dental laboratory's ceramist to rival mother nature, thus achieving the most natural result possible. This device has also been a useful tool in objectively measuring the success of our results in cosmetic tooth whitening procedures. This analysis is consistent with our practice philosophy where "measurement separates fact from opinion."

Laser-Aided Decay Detection

How does your dentist know when you have a cavity? Traditionally, this is accomplished in two ways:

First, there is visual inspection. Here we look and poke at three of the five tooth surfaces – the biting surface, the cheek side and the tongue side. We look for discolorization and breaches in the integrity of the normally hard enamel and root surfaces. Next there is an examination of the interproximal, or in-between surfaces, via X-ray imaging. These two methods are probably 95% effective. Yet despite the combination of clinical and radiographic examinations enhancing our ability to discover most decay, believe it or not, the number one (dental) public health advancement of the twentieth century – fluoride – on occasion inhibits our ability to detect decay in the pits and fissures of the biting surfaces. With so much fluoride in toothpastes, mouth rinses, vitamin supplements and public drinking water, we have produced generations with very hard enamel surfaces that are more resistant to breakdown than those of previous generations. This is generally very good, but it occasionally presents a diagnostic challenge. Although seemingly hard and resistant to physical probing, bacterial invasion of the biting surface pits and fissures can penetrate below the enamel layer well into the dentin layer, before becoming obvious on clinical or radiographic examination. In the past, the discovery of such problems would occur only after the underlying support of the enamel failed and this surface collapsed, there was enough decay to become obvious on an X-ray or the tooth became sensitive or painful. Faced with this problem, dentist had to make a choice: either engage in wholesale cavity preparations on the biting surfaces to detect this problem before it got worse or try to guess which teeth were at risk. One choice could lead to over-treatment; the other to under-treatment.

To deal with this issue, our practice uses a third method of decay diagnosis: laser-assisted decay detection. The tool that we use is called DIAGNOdent. DIAGNOdent is a small desktop device with a pencil-sized wand that emits a laser beam. This laser does not cut or alter tissue, but rather the beam is directed into the tooth, penetrating through enamel and, to some degree, decay/dentin. The sophisticated computer technology contained within the unit is programmed to analyze the degree of light penetration and dispersion, thus differentiating healthy from diseased tooth structure. This brilliant technology is not only highly accurate in disease detection, but is also helpful in quantifying the degree of breakdown. This is helpful in knowing prior to the start of treatment in order to know how much intervention will be needed.

To learn more about this technology, we invite you to visit the DIAGNOdent website.

Joint Vibration Analysis

You may have heard of Temporomandibular Joint Dysfunction. One of the most famous cases of what we refer to as "TMD" was highly reported in the late 1980's when actor Burt Reynolds was out of work for over three year with TMD – the result of a traumatic injury.

TMD typical stems from one of two root causes: either macro trauma, as from a direct blow to the jaw or a motor vehicle accident, or micro trauma, often less obvious – usually the result of nocturnal parafunction like tooth grinding.

With macro trauma, typically both dentist and patient have no problem with connecting the dots between cause and outcome. Micro trauma, however, often results in a more frustrating diagnostic picture. Imagine one day realizing that you are experiencing headaches that just don't go away, limitation and perhaps pain on opening or closing your mouth, clicking, popping or ringing around your ears, sore muscles or other atypical facial pain. These are just some of the signs and symptoms of Temporomandibular Joint Dysfunction. Then imagine having no idea how you arrived in this situation or who to see for help.

We can offer the diagnostic and treatment help that you need – as one of only 1 percent of dental practices in the United States to employ and master the use of computerized joint vibration analysis, or JVA, in the diagnosis and staging of temporomandibular joint dysfunction.

JVA is a relatively simple, in-office procedure which involves no pain, no radiation and costs far less than the comparable information that would be derived from an MRI.