Comprehensive Dentistry

Comprehensive dental care is an approach that addresses the immediate and long-term treatment needs and includes prevention and early detection.  The aim of this approach is to establish a healthy oral environment and then maintain health.   When a patient presents to the dentist with multiple problem areas or a history of multiple problems this person requires a comprehensive approach rather than a limited-focus area approach (tooth by tooth dentistry). The comprehensive approach requires evaluation, diagnosis, and a treatment plan.

 First the dentist must determine the source of the problem through a dental exam and review of the patient’s dental and medical histories. Oral health is personal to you, connected to your general health, the medications you take, your nutrition, stress, and overall lifestyle.  Evaluation should include a review of the health of the gums and teeth, jaw joints and muscles, airway, oral cancer screening, medical and dental histories.  The dentist must determine and share with the patient the risks, benefits and alternatives associated with addressing or not addressing the problem(s) and allow the patient to decide how to proceed.  Once the dentist and patient have a clear understanding of what is happening and what can be done a plan for treatment and future prevention can be made.  

 Comprehensive dentistry is not always extensive dentistry.  There may be teeth, gum areas, jaw size and/or joints that are involved.  The key is to consider all these things in the evaluation.  When comprehensive dentistry is needed, a plan for treatment should be organized.  Often, treatment can be done in phases to spread out cost and dental visits.  When comprehensive dentistry is indicated, it is usually less expensive long-term because it minimizes the risk of developing costly and serious issues like periodontal disease and cracked teeth as well as extensive work needed due to oral health neglect.

Situations and conditions that might indicate the need for a comprehensive approach include:

· Through the years many of your teeth have been restored with fillings and crowns and now some need to be replaced. When many teeth have been restored at different times in your life it is possible that your bite can be off.  Before starting new restorations, it is advisable to evaluate if the bite is correct.  It may be time to rebalance the bite through adjustment or by changing old restorations.

· Your bite feels off, or your teeth are shifting. It seems like every time you go to the dental office you need more treatment. These situations suggest there is a need to stop and re-evaluate why this is happening.  What has changed that may be causing frequent problems?  What can be done to address this ongoing issue and take care of the problems?

· You just had a new restoration (filling, crown, veneer) last year and now it needs to be replaced due to new problems.

·  You had a cracked tooth restored and now you have another cracked tooth. Cracked teeth can be a sign of other problems.  If you crack a tooth biting on something hard the diagnosis and treatment is usually straight forward.  If you have a cracked tooth or teeth that do not coordinate with an event like biting on something hard, a more in-depth evaluation is needed.

· Your teeth are crowding even though you had orthodontic treatment.

·  You have a tooth or teeth that need to be removed due to disease.

Changes in your oral health can occur for many reasons:  bodily health changes, sleep apnea, changes in salivary flow due to disease or treatment, like Sjogren’s syndrome, radiation treatment, hormonal changes, prescription drugs, and age.  Sleep apnea is usually accompanied by teeth grinding and acid reflux causing tooth wear, fractures, sensitive teeth and possibly joint pain. Comprehensive dentistry considers your medical history, habits and current physical condition. It addresses the restoration(s) needed to correct the damage present and sets out a plan to maintain your oral health and prevent further damage.

 If you recognize that any of these scenarios sounds like you then you should discuss comprehensive dentistry with your dentist.  Some dentists have pursued extra training through specialty or extensive training to be able to diagnose and treat more involved problems requiring comprehensive care.  If your dentist is not trained, he or she should be able to refer you to someone with training in this area.

 Dr. Robert A. Gallegos is a Fellow in the Academy of General Dentistry, visiting faculty at Spear Education, alumnus of Pankey Institute, a member the American Academy of Cosmetic Dentistry, the American Academy of Dental Sleep Medicine and the American Dental Association.  Dr. Gallegos practices dentistry in Middleburg, VA.

Dr. Gallegos