Wednesday, July 23, 2014

Types of Dental Careers

Dentistry is an interesting field; it is both a science and an art. It deals with the esthetics, physiology and pathology of the oral cavity. In other words, it is the professional care and knowledge of the teeth, gums, tongue, and cheek. To become a Dentist, one should ideally have an eye for esthetics through symmetry, tooth shade, and harmony of the teeth and smile. One should ideally have knowledge on what is both normal and healthy as opposed to abnormalities and diseases. In short, the dental profession involves the proper diagnosis, treatment and prevention of oral disease [1].

In order to become a dentist, one must undergo intensive training and studying. On average, in the U.S, it takes eight years to complete the courses required to become a dentist. After completing a dental bachelors degree, one can opt to take continual studies in either dental specializations or post-doctoral trainings [2].


Getting Started on the road to becoming a Dentist


Bachelor’s Degree


Before becoming eligible to become a Dentist, a student must first earn a bachelors degree in college. This usually takes two to four years, depending on what course the student takes. It is advised to take a health related course such as  biology or a pre-dental program. Choosing a course of study is important because some dental schools require specific courses before admission [2].


Dental Degree


In order to get into dental school, a student must first pass the dental admissions test. This test can be taken before or after completing the bachelors degree. It can take up to four years to earn a dental degree. During the first two years the student is taught the basics of anatomy, histology, physiology and pathology; their dexterity is then honed in a controlled setting. The last two years are hands on clinical practice under close supervision of a licensed dentist [2].


Licensure Examination


Before a dental graduate can practice their profession, they will have to pass a dental licensure examination administered by their state. The exam is composed of two parts: written and practical. The applicant must pass both parts before obtaining their license [2].


Post-Doctoral Specializations


After completing a dental degree, the student is now a general dentist. They are capable of performing a variety of dental treatments such as crowns, bridges, dentures, restorations, and teeth cleaning [1]. They could even take a specialization for any one of these particular fields. If a dentist decides to follow through with specialization, they will have to gain an in-depth and thorough knowledge on that particular field. A certificate of completion and recognition is thus given to dentists who have successfully completed their post-doctoral trainings. 


Most common post-doctoral specializations

Orthodontists


An orthodontist specializes in diagnosis and treatment of misaligned and crowded teeth. A dentist must study tooth movement and facial development for an additional three to five years before they can call themselves orthodontists [1].


Periodontists


A periodontist specializes in the diagnosis, prevention and treatment of gum disease. This field of dentistry specializes in understanding the supporting structure around the tooth, gums and bone. In order to become a periodontist, one will have to study an additional three years following their dental degree [1].


Dental Surgeon


A dental surgeon performs complicated tooth extractions, placements of dental implants, and surgical operations of the oral maxillofacial area. This often includes surgical removal of benign and malignant tumors along the head and neck and surgical treatment of temporo-mandibular joint problems. In order to be a dental surgeon an additional four to seven years of study at a hospital is needed. During these years the perspective dental surgeon will receive hands on training in anesthesiology, emergency medicine and plastic surgery [1].


Endodontist


An endodontist specializes in the diagnosis and treatment of disease involving the pulp – the tooth’s nerve and blood vessels. It is their duty to clean, shape and fill canals of their dental patients. To become an endodontist, a qualified dentist must study and train another two to three years specializing as an endodontist [1].


Prosthodontist


A prosthodontist restores extracted and missing teeth through alteration of dentures or artificial teeth. The dentures can be fixed, removable, complete or partial. Prosthodontists deal largely with esthetics and harmony of dentures with other oral structures. They are also required to study stability and retention of dentures to prevent dislodgment during function. To become a prosthodontist, a qualified dentist will have to study an additional two to three years in this specialization [1].


Pedodontist


A pedodontist is also known as a pediatric dentist. They perform preventive and comprehensive dental treatment on children, from infancy to teenage years. Teeth of the young patient are a lot different compared to adult teeth. The attitude of the child patient is also different. For these reasons a specialized dentist is needed when treating children [1].


References
[1] Unknown Author. (2005, April 4). Fields of Dentistry. Retrieved from  http://www.hsc.stonybrook.edu/dental/thereach/fields.htm
[2] Unknown Author. How Long Does it Take to be a Dentist? Retrieved from http://education-portal.com/how_long_does_it_take_to_be_a_dentist.html

Thursday, July 17, 2014

G. V. Black's Classification of Tooth Decay


Caries are the most prevalent infectious disease of the oral cavity. Throughout the years, people from all over the world suffer from tooth decay and seek dental treatment to arrest its progression. To standardize the classification of caries between dentists, GV Black devised a system to name them in 1869. The nomenclature is mainly based on the location of caries. GV Black also published a series of papers that discuss how dental caries should be treated given the knowledge and materials available at that time.[2]

Six Caries Classification[1]



1.      Class I Caries - These type of caries are found on the occlusal (biting) surfaces of the posterior (back) teeth. Occlusal surfaces have pits and fissures thus this type of caries is also known as pit-and-fissure caries. Pit-and-fissures as the name implies, are irregular surfaces of the teeth that resulted from imperfect coalescence of enamel during the development of the tooth crown. The bristles of toothbrushes often cannot effectively reach the bottom part of pits-and-fissures that's why the bacteria stays there and will demineralize the tooth to create class I cavities. 

       Detecting class I caries is sometimes a bit tricky. A "catch" after the dental explorer is passed on the occlusal surfaces, is an indication of a class I caries. However, deep fissures that do not have caries can also give the dentist the feel that there is a "catch" in the explorer. That's why it takes good tactile sense and ocular inspection to make a very accurate diagnosis. 


2.      Class II Caries - These are cavities that involve the occlusal surfaces and the proximal area (the area that is in contact with another tooth) of an affected tooth. With this type of caries, more than one surface of the tooth is affected. 

       Class II caries are also detected the same way as Class I caries although it is a bit challenging to pass the explorer on proximal areas. Bitewing radiographs are very helpful diagnostic aids. They tell the dentist if the proximal area has caries by way of presence of radiolucent areas. 


3.      Class III Caries - Caries that involve only the proximal area of anterior (front) teeth is classified as Class III Caries. This type affects the smooth-surface of a tooth, or the surface that is facing the lips, the palate (for upper teeth) or the tongue (for lower teeth). Class III caries happens on areas that are not habitually cleaned and constantly covered with plaque. 

       Class III caries are usually very easy to detect. They show areas of cavitation and brown-black discoloration that can be seen immediately. The explorer is ran on the facial and lingual proximal surfaces to check for cavities. 


4.      Class IV Caries - If caries affects the proximal area and the incisal (cutting) surface of anterior teeth, then it is classified as Class IV. 

       The process of detecting class IV caries is also the same as class III. 


5.      Class V Caries - Class V caries are those that are found near the gingival (gums) area of the tooth. It also affects a smooth surface. 

       To detect class V caries, the explorer is run through the facial or lingual aspects of teeth from the cervical (near the gum) to the coronal (near the crown) surface. An indication that there is class V caries is a "catch". 


6.      Class VI Caries - The tip of the cusps of posterior teeth can also have caries. If that is the case, they are classified as Class VI caries. Note that unlike Class I caries that originate from pits-and-fissures, Class VI caries affects a smooth-surface. 

       To check for Class VI caries, the explorer is passed through the cuspal inclines and tips.


Root Surface Caries
Root surface caries are not classified under any of the six classes. As the name implies, they occur on the cementum of the tooth that's always covered in plaque. Cementum being less mineralized than enamel, is more prone to demineralization caused by caries. Root surface caries progresses rapidly also because of the same reason, that's why it should be treated immediately. It is prevalent in the older population that have experienced gingival recession.

Preventing caries
Plaque is the main etiologic agent of dental caries.[3] It consists of bacteria like Streptococcus mutans and Lactobacillus that ferment sugars. As a result of this fermentation, these bacteria produce acids that lower the pH inside the mouth. The drop in pH is what causes tooth demineralization or caries to occur. That is why, eliminating plaque will prevent the progression of dental caries.

1.      Maintain excellent oral hygiene - It has been shown that tooth brushing effectively gets rid of plaque inside the mouth. The bristles of the brush removes plaque inside pits and fissures of teeth and can even go in-between contact areas.[5]

       Flossing should always follow tooth brushing. The thread of the floss that is inserted in between contact areas removes plaque that were not removed by toothbrush bristles. This prevents caries originating on the proximal areas of the teeth, along the gingival margins, as well as gum diseases.

       Regular professional scaling and polishing is also proven to disrupt plaque or calcular deposits (hard tartar build-up) with the use of dental instruments.

2.      Modify diet - avoid eating foods that are sugary and starchy since they are ferment-able carbohydrates. Caries-causing bacteria inside the mouth use these carbohydrates for their metabolism and as a result, they release acids that cause the pH inside your mouth to drop to 5.5. This drop in pH is critical because it causes demineralization. One great way to check the pH of your mouth is by using pH strips, these can be easily found at pet stores for monitoring aquarium pH.

3.      Remineralize teeth - Teeth are more resistant to caries when they are remineralized because of deposited fluorohydroxyapatite crystals on the surface. To remineralize teeth, they are exposed to low amounts of fluoride frequently. Rinsing with green tea daily[3] and increasing dairy consumption are the best ways to remineralize teeth.[4]

References:
[1] Roberson, T., Heymann, H., & Swift Jr., E. (2006). Sturdevant's art and science of operative dentistry. Missouri: Mosby Inc.
[2] Wolff, M., Allen, K., & Kaim, J. (2007). A 100-year journey from GV Black to minimal surgical intervention. Compendium of Continuing Education in Dentistry, 28(3), 130-134.
[3] Awadalla, H., Ragab, M.,  Bassuoni, M. Fayed, M., & Abbas, M. (2011). A pilot study of the role of green tea use on oral health. International Journal of Dental Hygiene, 9(2), 110-116.
[4] Ferrazzano, G., Cantile, T., Quarto, M., Ingenito, A., Chianese, L., & Addeo, F. (2008). Protective effect of yogurt extract on dental enamel demineralization in vitro. Australian Dental Journal, 53(4), 314-319.
[5] Gutkowski, S. (2008). Minimal intervention. RDH, 28(6), 88-117.