Can Assistants Place Fillings In A Dentist’s Office?
The answer to this question depends on which state you are in. Each state has different regulations as to what dental assistants can do. Most states allow every dental assistant to do some basic things. These include…
- Assisting the dentist with suction and instruments
- Taking impressions of your teeth
- Making temporary crowns
- Taking x-rays (if they have the appropriate education)
Now in some other states they have dental assistants known as Expanded Function Dental Assistants (EFDA). Some states call them different names including Registered Restorative Assistant in Expanded Functions or Registered Dental Assistant Qualified In Or To Perform Expanded / Extended Duties / Functions. Talk about a mouthful! These assistants have usually had significantly more training and are able to do some additional things. These include…
- Polishing teeth
- Filling cavities after the dentist has drilled them
Now here is the real question. Is it a good idea for assistants to place fillings?
Personally, if I was having fillings done I wouldn’t let an assistant place them on me unless they had someone else assisting them. It isn’t because I think assistants are bad at placing fillings. Most experienced EFDAs are actually quite good at it. I worked with a couple early in my career that did a great job. The biggest challenge they faced wasn’t putting the filling material in well though. It was keeping the teeth isolated! The success and life of a dental filling is strongly related to how well your tooth was kept entirely isolated from any saliva or blood during the process. This is less important with silver fillings and extremely important for any type of white filling. I’ve found that one person alone will almost always struggle to keep a tooth isolated well. If they use a rubber dam or Isolite system they may be able to do better but otherwise another assistant is almost a necessity.
That Dental Office Smell
One of the earliest memories I have of dental offices isn’t of getting my teeth cleaned or the noises but rather that pungent smell! You know what I’m talking about. You open the door to the dental office and it hits you. It smells like some terrible combination of heavy duty cleaners, mint, and a nail salon. When you leave you feel like your clothes still smell like it. People who work at dental offices go home smelling like it every day!
What causes this smell?
Eugenol based dental products: This is the most common source of that dental office smell. Dentists use several products containing eugenol (clove oil) everyday. These include temporary filling materials, temporary cements, bases under fillings, and dry socket pastes. Eugenol works very well to calm down sensitive teeth which is why dentists continue to use it despite it’s pungent smell.
Formocresol: This one is a little more unusual. It makes everything smell like formaldehyde. That’s the same stuff they use to preserve anatomical samples or dead bodies for dissection. You’ll find this smell far more often in a pediatric dentist’s office or a root canal specialist’s office as they typically do more procedures that use it. I find this smell to be the most pungent of all the smells and seems to stick around the longest and soak into everything. My wife always comments that I smell terrible if I’ve used it that day!
Cleaning Products: Dentists use a variety of cleaning products to spray down the chairs, cabinets, and disinfect everything they use. They contribute that hospital type smell.
Acrylic: Dentists use acrylic materials for dentures as well as some temporary crowns. This has that really chemical smell very similar to a nail salon. In fact, the type of acrylic used for many dental products is the same as what is used for fake nails. This smell gives some people headaches if exposed to it for too long.
Burning teeth – Dentists drilling on teeth with not enough water can generate enough heat to cause a burning smell. This is really unpleasant but not usually too noticeable unless you’re right there.
Does every dental office have to smell like this?
Good news! No they don’t. When I first opened my own office, I had a couple of goals in mind. Make patients comfortable, treat them right, and not have have that terrible smell!
The first way we do is by only opening those materials when we absolutely have to. We close them immediately and if possible do it away from where the patients are.
The second is to cover the smell with other smells. We have scent generators throughout the office that provide a much healthier citrus type smell. Much better than the dentist office smell! I’ve also heard stories of other dentists baking cookies in their office. Personally that just sounds cruel to me!
Should I Take My Child To A Pediatric Dentist?
Once you decide to take your child to the dentist the first decision you’ve got to make is whether you should go to a general dentist or a pediatric dentist. I’m here to give you some more information so you can make a good decision.
So first of all, what is a pediatric dentist?
A pediatric dentist is someone who went all the way through dental school and then completed an additional 2-3 year residency in pediatrics. They learn everything there is to know about treating children from sedation to behavior management to special types of procedures specific to children. Their offices are usually set up to treat children in a more non-threatening manner than your typical general dental office.
Are general dentists qualified to treat children?
Most general dentists receive minimal training in treating children during dental school. That isn’t to say some general dentists aren’t very good at treating children. I’m a general dentist but I’ve personally treated thousands of children over my career and feel very comfortable doing so. Other general dentists don’t feel comfortable at all and refer children out to a pediatric dentist immediately. Most general dentist are happy to tell you about their philosophy of treating children if you ask.
Who should definitely see a pediatric dentist?
Even though I’m very comfortable treating children, there are still some circumstances where I refer children out to my local pediatric dentist.
- Under age 7 with a lot of large cavities. Significant dental treatment can be challenging enough for adults and even more so for young children. A pediatric dentist is better equipped to get treatment done quickly, effectively, and handle any complications that may occur.
- Very anxious children.
- Any child who needs sedation. Sedation on children is much more challenging than sedation on adults. You want someone who does this all the time, which is what a pediatric dentst does.
- Children with special needs. Most pediatric dentists have received additional training in help those with special needs.
Other Common Questions About Pediatric Dentists
When should I take my child to the dentist?
Current recommendations are that you take your child to the dentist within 6 months of them getting their first tooth in. The reason for this recommendation really isn’t so that the child can have check-up but more so that the dentist can have a discussion with the parents. The major things discussed are…
- Diet is the single biggest factor in kids developing cavities.
- Never give your child a sippy cup of juice or milk at night. Water only.
- Limit sugary beverages and snacks as much as possible.
- Best ways to clean their teeth
- When to start using fluoride toothpaste
If you’ve got all this down already and your kids are at low risk, I’m OK with waiting until kids are 2 before starting to be seen regularly. I think starting to be seen at 2 is good for the children at that point so they can get used to going to the dentist without it being a scary thing. The older generation is full of dental-phobics and the new generation of dentists are trying to avoid that as much as possible.
Best practices for parents when taking their children to the dentist
I know that as a parent you want to protect and watch your children. Some parents take this a bit further than others. I get it! I’ve got four kids of my own.
In general at the dentist, children under age 4 usually do better with their parents around. Around age 4 children start to do far better with parents out of the room. Ever left your children with your parents or a babysitter and when you come back they tell that they were absolute angels? You can’t believe it right? They are always little tornado’s of energy when you’re around. It’s the same at the dentist’s office. Kids who are otherwise cooperative and helpful can act out simply because their parents are around. If you feel like your child is being uncooperative, consider leaving the room to see if their behavior improves. It’s also important to avoid speaking with the dentist or hygienist as much as possible while they are actively treating your child. Keeping children engaged and comfortable takes focused attention on them, not on their parents. By all means ask questions before and after treatment, just not during. Following these couple of tips can make all the difference in the world in your child’s dental visit.
Why won’t my pediatric dentist let me be there during sedation?
The reasons are very similar to why you aren’t allowed in while a loved one is having surgery in the hospital. As I discussed previously, sedation of children can be tricky. A pediatric dentist, while very skilled, still needs to focus all of their attention on that child especially if sedation is involved. A parent in the room makes this difficult. Also, if complications arise, they need to be able to treat it quickly and effectively without a worried parent standing over. This is rare, but the #1 concern for a pediatric dentist is keeping your child safe.
Places Not To Go:
Now there are some places that bill themselves as a kid’s dentist, but aren’t actually. Usually these are corporate run places staffed by general dentists. I would stay away from these types of places at all costs. The major offices in this market are Kool Smiles and Small Smiles. I’ve seen how they are run and it isn’t good. They usually double and triple book their dentists and hygienists. Even if you get a good dentist or hygienist there, they won’t usually have enough time to do things as well as they can. Waiting long periods of time isn’t unusual. Production goals are all that management cares about. These places market heavily to people on Medicaid because few dentists participate. It is far more common for pediatric dentists to participate with Medicaid than general dentists. The last estimate I saw was that about 30% of pediatric dentists nationwide participate with their state medicaid program. If you can avoid these corporate places, please do. If your child is on medicaid and it is your only option, try to find an individual pediatric dentist who accepts it instead. You and your kids will be happier.
Why You Should Buy A Waterpik
When you go to the dentist do you always dread the question, “So have you been flossing?”? You can lie and tell them you have been (but they’ll know you haven’t) or you can tell the truth and you’ll get “the speech” for the 100th time. Or do you floss but but still feel like you’re leaving food between your teeth? What if I told you that there was a product out there that would cut out your need to floss and you could get better results? That product is a Waterpik. In simple terms, it uses a small wand that directs a stream of pressurized water or mouthwash wherever you need to clean.
Why do I like them so much? It’s really simple. Study after study has shown that it is far more effective and easier to use to than string floss. Here are just a couple of the many studies and papers written about it…
2015 Study From The Journal of Clinical Dentistry: An 81.6% reduction in plaque between teeth compared to 63.4% for string floss
2008 Review Paper: Better outcomes for gum health, bleeding, and pocketing around teeth (an indicator of gum disease)
2005 Study From Nebraska: 93% more effective at reducing bleeding and 52% more effective at reducing gingivitis than string floss
Some other benefits include…
- It cleans deeper than string floss is able to. String floss can reach about 3 mm below the gumline whereas the Waterpik can reach effectively at least 6 mm and more in some cases.
- Its quick! You can clean your entire mouth in approximately 1 minute.
- It’s easier to use if you aren’t coordinated enough for floss.
- It’s safe to use around implants.
I think almost everyone would benefit from a Waterpik but these people benefit the most…
- Braces. I think everyone with braces should invest in a Waterpik. Using floss threaders or superfloss to get under the wire and clean around every teeth takes too much time and is too difficult for most people.
- If you have crowns, bridges, or implants. Crowns and especially bridges on your teeth make it more difficult to keep them clean. The most common area to get decay around a crown is in between your teeth. Cleaning these areas out can go a long way towards extending their lifespan.
- A large number of fillings. Fillings tend to build up plaque at a higher rate than teeth that haven’t had work done on them. Similarly to crowns, they often fail when they develop a cavity under the filling that starts in between the teeth.
- A history of gum disease.
Lastly, why is keeping your gums healthy so important?
Keeping your gums healthy isn’t important just for your teeth! Gum disease has been linked with a staggering number of other health conditions. These include diabetes, heart disease, pre-term birth, and pancreatic cancer! We’ve got quite a few articles on the mouth-body connection here. An investment in a Waterpik (and using it regularly) will benefit you in so many ways.
Ready to buy a Waterpik?
I’ve found you can get the best price on Amazon. They also have a lot of helpful information and customer reviews about the different models of Waterpik. Pictured below is their standard model, The Waterpik Aquarius. It has all the tips you need for any situation, easy pressure adjustment, and a self contained water system. I think it is your best option if you’re going to invest in a Waterpik.
When Should Children Start Using Fluoride Toothpaste?
Ever wondered when exactly you should start using fluoride toothpaste while brushing your kids teeth? Don’t worry, you’re not alone! Many parents have no idea when they should start. The answer to this question will be different for each child and family. I’ll help you figure out what works best for you.
Before we get into all that, you might want to read up on my thoughts on fluoride usage. **Cliff notes version: I’m strongly in favor of using fluoride toothpastes, mouthrinses, and professional applications but I’m not in favor of water fluoridation or any other systemic fluoride in most cases.**
Low Risk Children
The general rule of thumb for using fluoride toothpaste in kids is that you shouldn’t use it until they can start spitting it out. Most kids are able to start doing this around age 3 and even earlier in some cases. My 2 1/2 year old daughter is quite good at spitting already! Even when they can spit, you want to use as small an amount of toothpaste as you possibly can. A small smear of toothpaste is more than enough.
Moderate to High Risk Children
The exception to this rule is in kids who are at a higher risk of cavities. Kids who are at higher risk of cavities include any of the following:
- Parents with a significant history of tooth decay
- Parents (especially mothers) with untreated tooth decay
- Consistent exposure to juice, soda, or sports drinks (more than 1 such drink a day)
- Children who have to use a nebulizer for asthma often
- Any other consistent exposure to sugary foods or medications
In kids with these higher risks, I’d recommend using a fluoride toothpaste starting as early as eighteen months to two years. Now here is the really critical part of this whole thing… You want to put the tiniest smear of toothpaste on their toothbrush as possible. Most toothpastes will say to put a pea sized amount of toothpaste on your toothbrush. This pea sized amount is great for older kids and adults but definitely not great for younger kids who can’t spit well. This smear should be no more than about 1/6 – 1/4 the size of a pea.
People may say “But, you’re against systemic fluoride exposure! How can you recommend using toothpaste when you know your child will swallow it?”. Here is my reasoning…
- Cavities in young children are a big deal! The loss of baby teeth due to cavities at a young age leads to significant issues with adult teeth.
- Cavities in young children usually have to be treated with some level of sedation. Sedation is not only expensive, but also carries of a level of risk.
- A tiny smear of toothpaste contains at most, about 0.1 mg of fluoride… Less in most cases. In comparison, a pea sized amount of toothpaste contains about 0.3 mg and people who drink fluoridated water receive between 1-3 mg of fluoride a day (rough estimate). Estimates of how much fluoride exposure people get today is nearly impossible because of all the different avenues of exposure. That said, a very small smear carries a relatively low risk.
I’m not downplaying the risk of systemic fluoride. I just believe that the benefit of preventing cavities in these young children outweighs the risk of the relatively minimal fluoride exposure.
If you aren’t comfortable even with this small amount, then you need to work really hard to control the risk factors for cavities for your child. They can’t do this themselves.
- Limit sugary drinks to 1 a day, with it being drunk all at the same time, ideally during a meal.
- Limit snacking on carbs and sugary items.
- Get any of your untreated cavities taken care (you can pass these bacteria on to your child).
- Brush and floss their teeth consistently.
A proper diet and regular brushing and flossing reduces a child’s risk of cavities to almost nothing!
Dark Spaces In Between Your Teeth
One common question I get, especially from some of my older patients, is why they have dark spaces in between their teeth. Dentists usually call these “black triangles” and they tend to appear as you get older but can appear at any age. Black triangles can appear for several reasons.
- Bone loss around your teeth. Your gums follow the shape of the bone around your teeth. When you lose bone, the gum tissue slowly follows. One of the first places people lose bone with gum disease is in between the teeth. As this bone recedes, the gums are no longer able to fill in the space between your teeth all the way.
- Gum recession from brushing too hard. If you brush too hard you can actually damage the gum tissue which will recede. If it recedes enough these dark areas can show up.
- The specific shape of your teeth. Teeth that only touch each other lightly at the tip have a much larger space that needs to be filled in by the gum tissue than teeth that have a more broad contact area that is closer toward the gum tissue.
- After scaling and root planing. This is an extension of the gum disease and bone loss part of the equation. Many people with gum disease don’t know they have it. The bone loss has already occurred but the gum tissue hasn’t followed yet. In fact, the gum tissue when it is unhealthy tends to be larger than normal. Once the gum tissue is healthy again it starts to follow the bone. This tends to open up those spaces.
This diagram explains a little better what measurement is important for minimizing black triangles. As the bone recedes or the point where the teeth touches goes more towards the tip of the tooth that measurement gets longer. Beyond a certain length your body can no longer close it all in with gum tissue.
So what can be done about black triangles?
Bonding or veneers to widen your teeth and cover the areas. This works well when the black triangles are relatively small. When the black triangles are larger, you can’t always close them all the way as it would make the teeth look disproportional.
Flattening and lowering where the teeth make contact (by removing some enamel on the sides) and then using braces to pull everything back together. This is a pretty aggressive type of treatment just to help get rid of the black triangles. Most people aren’t willing to go through this unless they are already having braces done for another reason.
Common Problems When You First Start Wearing A Dental Appliance
Whether you’ve just started wearing a nightguard, snoring appliance, or TMJ appliance, you’ll likely run into a couple of problems that may make it difficult to get used to wearing the appliance. The main reason why most of these appliances aren’t effective is that people don’t take the time to get used to wearing them. If you can wear it consistently for four weeks, you’ll have made the habit and gotten over most of the problems and it’ll be simple. Here are the most common problems and what you can do about them.
- Excess saliva. Anything new in your mouth causes your saliva glands to work overtime. As you slowly get used to wearing it, your brain won’t feel the need to make excess saliva anymore. This process usually takes a couple of weeks.
- Tooth soreness. With any of these appliances, mild tooth soreness isn’t unusual. Appliances can put some different forces on teeth that they’re not quite used to. Again, with time this soreness should go away on it’s own. If the soreness is severe or doesn’t go away in a couple of weeks you should see your dentist to see if they need to adjust the appliance.
- Taking it out in the middle of the night. Some people wake up halfway through the night, take it out, and then go right back to sleep. Most of the time they don’t even realize they did it. This is OK and perfectly normal! Continue to wear it and don’t worry if you take it out. As you get more used to it, you’ll take it out less and less.
- Slight bite changes in the morning. This happens most often with snoring appliances. Your dentist should provide you with a morning repositioning appliance that you’ll bite on for a couple of minutes which should reset your muscles into the correct position. If the bite changes are more significant or don’t go away within about an hour of waking up you should see your dentist. Some appliances will occasionally cause permanent bite changes (although this is rare).
- TMJ or muscle pain. This is another one of those problems that usually goes away on it’s own as long as the pain is mild. If it’s more severe or not lessening after a couple of days see your dentist and they may need to adjust your appliance.
Tips To Reduce Gagging
Gagging can cause people to have a lot of anxiety about dental treatment, especially impressions of your teeth. It is still an unfortunate part of dentistry that we have to take trays filled with goop and put them in your mouth for several minutes. This can be challenging even for people without a bad gag reflex. One of these days this will all be replaced by digital impressions (sooner rather than later) but until that day comes, there will be a need for techniques to help you reduce gagging during dental procedures.
Take these tips from someone who has a severe gag reflex (and yet I still became a dentist somehow). I was the kid you’d hear down the hall at the dentist’s office, gagging and choking with the smallest thing in my mouth. My least favorite were the fluoride trays they’d do at each visit.
One day I was in dental school and they told us that we’d need to take impressions on each other until we got them just right. I thought it would be the worst day of my life! That was the day I learned that there are a lot of things you can do to help your gagging. In fact, I learned that a lot of what you need to do to help your gagging is mental! One entire evening, and twenty impressions later, and my gag reflex was much improved. Here’s what I learned from that day as well as many years of dental practice helping guide gaggers through some difficult procedures!
- Try putting some salt on the tip of your tongue.
- Anesthetic spray in the back of your mouth can desensitize the areas that stimulate your gag reflex.
- Laughing gas (nitrous oxide) is commonly used to help people with a strong gag reflex. It helps you relax and not be quite as sensitive to the sensations.
- Mentally prepare yourself before the impression. A lot of your gag reflex is a result of thinking you’re going to have a bad gag reflex. Once you can get over this, it is much easier.
- Lean forward (definitely not backwards). This will make sure the material doesn’t flow backward out of the tray and into your throat.
- Breathe deeply in and out through your nose.
- Distract yourself during the impression. You can do this mentally by thinking about somewhere else, or physically by making a fist with your hands or a pushing a fingernail into your skin to cause some slight discomfort.
- If all else fails, remember that it will be over within a couple of minutes!
Reasons To Get Your Wisdom Teeth Out
It’s very common today that wisdom teeth are taken out before they have come in or caused any problems. Ever wondered why this is?
- Most people don’t have room in their mouth for them. Contrary to popular belief they don’t cause any crowding of your other teeth but they do have a tendency to come in half-way or in the wrong direction. Wisdom teeth that come in correctly are far more rare than wisdom teeth that have problems.
- If they push against the teeth in front of them in the wrong way, you can develop a cavity on both teeth and need to have them both removed. You usually don’t know this is going to happen until it is already too far progressed to do anything about. This is a very common problem when wisdom teeth are tipped forward about 45 degrees.
- One of the more common problems that happens with wisdom teeth is known as pericoronitis. Food gets trapped in the gum tissue around the tooth and causes an infection. This is an extremely common occurrence with wisdom teeth that aren’t in quite all the way. It can cause quite a bit of pain and continue happening over and over again until the wisdom teeth are removed.
- I see a lot of cavities form on wisdom teeth. Cavities form because it is nearly impossible to keep these teeth clean. These cavities usually are very difficult for your dentist to fix effectively due to their location.
- Wisdom teeth that are in all the way and causing no problems still don’t provide any extra chewing function. Even second molars (the teeth in front of the wisdom teeth) don’t provide a whole lot of extra function (only about 5%).
- Gum disease leading to bone loss around the back side of your second molars is also pretty common. This is another consequence of not being able to keep the area clean.
- Recovery from wisdom tooth removal is much easier at age 17-18 than at 30. The bone around your wisdom teeth becomes denser with age and makes it more challenging and traumatic to remove the teeth later in life (in general). You also have the time to recover from wisdom tooth removal at a young age rather than when you are older and have more responsibilities with a job, family, kids, etc.
- Impacted wisdom teeth sometimes form a cyst around them. If this cyst gets large enough it can jaw problems. This is a rare complication but can cause significant problems if it occurs.
Don’t Do These Things For Dental Pain!
You’ve got terrible tooth, TMJ, or gum pain! You’ll do anything to make it go away right? I’ve seen people try some really crazy, dangerous, and wildly ineffective things to deal with it. In no particular order, here are some things that you really shouldn’t try for dealing with your dental pain.
- Put aspirin next to your tooth. Not only is this totally ineffective, you also run a really high risk of developing something called an aspirin burn. The technical name for aspirin is “salicylic acid”. Yep, thats right… acid. Leave it on your gums long enough and it will literally break down the skin in the area causing something similar to a burn. This is really painful and will likely hurt worse than your original problem.
- Take more Ibuprofen or Tylenol than the maximum dosage. For Ibuprofen the maximum dosage is 800 mg every 6 hours. Any more than that and you can cause significant kidney damage. People with existing kidney disease or certain GI issues should usually take less. For Tylenol the maximum dosage is 1000 mg every 6 hours. Excess Tylenol can cause severe liver damage.
- Place Orajel next to a tooth with a toothache. Orajel will numb the gum tissue if you have a canker sore but won’t do anything for a real toothache.
- Try to pull your tooth yourself. I know most people would never do this, but pain can make you do some crazy things! I have had several patients who have tried to do this. It’s usually a guy who uses a pair of pliers out of their tool box. Unless they had severe gum disease with no bone left around the tooth, all anyone has ever managed to do is break the top of the tooth off. It almost never takes care of the problem or the pain.
- Mix alcohol and prescription painkillers. Some people think that the combination of prescription painkillers and alcohol will dull the pain better than either alone. Of all the things on this list, this is by far one of the most dangerous. The combination of alcohol and narcotic medication has a strong tendency to suppress your breathing. This can kill you. Just don’t do it!
- Mix anxiety medications (benzodiazepines) and prescription painkillers. This has the same effect as mixing alcohol and prescription painkillers. It can suppress your breathing with complications up to and including death.
- Oil pulling. It just doesn’t work.
- Take someone else’s antibiotic. If you’re going to take antibiotics you need to take a full course of medication. Only taking a couple of pills leads to the development of antibiotic resistant bacteria. This can be dangerous to you as well as other people.
- Place magnets around an infected area to “heal” it. This is another one of those ideas that won’t cause any damage but won’t help you either.
Want to know what you actually can do for severe dental pain? We’ve got information on that too. Or use our search bar to search for your specific question.