Oral Exam for Oral Cancer Screening

Escondido dentistNo single oral exam or oral cancer screening test is proven to reduce the risk of dying of oral cancer. But, did you know that in our office, Dr Mastrovich and our Escondido dental hygiene team screen for oral cancer during all dental and dental hygiene appointments.

During the oral exam, Dr Mastrovich and our hygienists look over the inside of your mouth to check for red or white patches or mouth sores. Using gloved hands, they will also feel the tissues in your mouth to check for lumps or other abnormalities.  In addition to checking inside the mouth, they also palpate the outside of the face and the neck area to check for lumps, bumps, or any abnormalities

Many people have abnormal sores in their mouths, with the great majority being noncancerous and an oral exam can’t determine which sores are cancerous and which are not.

If by chance we do find an unusual sore, further testing may be suggested to determine its cause. The only way to definitively determine whether it is oral cancer is to remove some abnormal cells and test them for cancer in a procedure called a biopsy.

You will be pleased to know that the American Dental Association recommends all adults undergo periodic oral exams when they visit the dentist. The American Cancer Society recommends discussing oral cancer screening, as well, when you visit your dentist. We all have your best interests at heart and strive to keep you as healthy as possible.teeth cleaning

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Are there different approaches to a dental hygiene (cleaning) appointment?

RDH teamIf you are over the age of twelve, chances are you have had a prophylaxis (teeth cleaning) by more than one dental hygienist over the years. Have you ever wondered why one hygienist started by cleaning the ‘inside’ (called lingual, the side closest to your tongue) of all your lower teeth first, while another started by cleaning the inside of one quadrant of your teeth (one quarter) and then the outside (called the facial)?

Dental hygiene schools teach their students to be methodical as they clean the teeth, in order to be thorough and avoid missing any areas. We have found it helps our patients for our hygienists to share their approach at the beginning of the appointment, as there is more than one way to be consistent and thorough. A helpful perspective is “Different strokes for different folks” because each cleaning appointment is customized within the format, to meet the individual needs of the specific patient.

At the beginning of the appointment, after asking if you have any concerns, the oral cancer screening is completed by the hygienist. It is helpful to keep in mind that the hygienist is cleaning both above the gumline and below the gumline.

In one approach used, the dental hygienist then begins your cleaning by assessing the amount of mineralized deposit (tartar) on the lower anteriors (the front teeth from cuspid to cuspid). This is the most common area to have mineralized deposit because there are so many salivary glands underneath the tongue. These salivary glands are continuously releasing mineral rich saliva. If these minerals make contact with a plaque-covered tooth, the plaque acts like a web and traps the minerals. If allowed to remain on the tooth surface for hours, the minerals will crystalize on the tooth surface and the patient will not be able to brush the tartar off. That is where the benefits of dental hygienist appointments become apparent. The dental hygienist can either use hand instruments or an ultrasonic instrument (or both) to remove the tartar.

Stepping forward in this approach, after having cleaned the lower anterior teeth, the hygienist generally has you turn your head to the left. In this way, the hygienist has access to clean the upper and lower cheek (buccal) side of the teeth on your right side, and then the tongue-side (lingual) surfaces of the left side of the mouth. Then you are asked to turn your head to their right, to allow access to the cheek side of the left of your mouth, and then the lingual surfaces of the right side. A large salivary gland, the parotid, is located on the inside of the cheek opposite the first and second molars, which the hygienist checks well for tartar.

The last area to be scaled in this approach is the upper anterior teeth from cuspid to cuspid. As this area is easily accessible and easily seen by you and most patients, it is usually fairly clean. After scaling with hand instruments and, or the ultrasonic instrument, the hygienist will polish your teeth with prophy paste (you get to choose the flavor), usually polishing the lower arch, and then the upper arch. Hygienists have a tendency to be detailed and thorough, so don’t be surprised if they check and double-check for any remaining tartar, stain, or plaque.

By the time the hygienist flosses your teeth, your teeth should feel slippery and clean! Oh, what a nice feeling!

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Finding an Expert Dentist in Escondido and Other Locations (Part 2 of Choosing a Dentist)

Mastrovich dental teamWe love helping our patients and friends whenever we can. As we mentioned in our first blog on this topic, when our patients get job transfers or other reasons leading to their need to relocate, we do all we can to network with well respected, quality dentists we know in other locations to find a great referral.  If that does not produce one or more referrals, then we recommend these six steps for choosing a dentist.

In addition to checking with dentists in your current/last location, and specialists in your new location, additional sources to contact for recommendations for respected general dentists in a new location can be:

          1. Talk to other non-dental health professionals you are acquainted with, such as physicians, podiatrists, optometrists, veterinarians, psychologists, pharmacists, chiropractors, hospital administrators, public health officials.
          2. Contact the local dental society. They may vary in their willingness to help with names, but it is another place to start.
          3. Call the dental schools in your city or the cities nearby. Dental educators know the abilities of previous students and colleagues.
          4. Contact the local dental hygiene schools can be a similar source for recommendations.
          5. Call local dental laboratories from online or the telephone book. The dental labs see examples of many dentists work as they fabricate the fixed prosthetic bridges, partial and complete dentures, orthodontic devices and other lab work.
          6. Commercial firms recommending health practitioners often have in depth files on practitioners, AND consumers must recommend the potential conflicts of interest as these firms must make an income as they do this.
          7. Less successful solo reasons for selecting a dentist (your single selection criteria may produce a dental referral that may not take into account the quality of dentistry you seek) :
            • Geographic location, personality and considering a friend’s dentist.
            • Fees (usually low for a reason: often low quality or less complete service)
            • Participation in your employer’s dental plan (some can be competent, but also a strong possibility that the dentists participate in the plan for various other reasons)
            • Advertising (professionals who advertise are usually no worse or better than their lower-visibility colleagues; and be especially cautious of dentists who advertise with unrealistic claims)

One or more of these questions offered by MouthHealthy.org (website by the ADA, for consumers) may help you start your personal list of questions to ask as you gather information about dental offices via internet, phone and in person:

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          • Is the appointment schedule convenient for you?
          • Is the office easy to get to from your home or job?
          • Does the office appear to be clean, neat and orderly?
          • Is your medical and dental history recorded and placed in a permanent file?
          • Does the dentist explain techniques that will help you prevent dental health problems? Is dental health instruction provided?
          • Are special arrangements made for handling emergencies outside of office hours? (Most dentists make arrangements with a colleague or emergency referral service if they are unable to tend to emergencies.)
          • Is information provided about fees and payment plans before treatment is scheduled?
          • Is the dentist a member of the ADA? All ADA member dentists voluntarily agree to abide by the high ethical standards reflected in the member code of conduct.

You and your dentist are partners in maintaining your oral health. Take time to ask questions and take notes if that will help you with your selection process.

It is important to find the dental professional that best matches your needs and desires. If you are new to the Escondido area and are seeking an expert dentist and team, give us a call to schedule an initial exam.

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What do the numbers mean when my hygienist measures my gums?

Syd 4“What do the numbers mean when my hygienist measures my gums?” Have you ever sat in your dental hygienist’s chair and wanted to ask this question?  We love to answer questions and help our patients grow to be experts in their own personal dental conditions and care.  This process seems to be measurement of your gums but it is actually more than that.  One of the most common reasons for tooth loss is the loss of supporting bone around a tooth due to periodontal  or gum disease.  Actually, periodontal means “around the tooth” so disease activity around a tooth, periodontal disease, is important to evaluate and assess so the tooth can be maintained in a state of health.   The special millimeter ‘ruler’, called a periodontal probe, is a tool to measure the vertical tissue attachment levels around each tooth.  From these measurements, which are taken at six points spaced around the tooth, the level of supporting bone can be calculated.

Periodontal measurement 3.jpgYou might then wonder why it would be important to know where the bone levels are around each tooth.  As the surrounding bone supports  a tooth, more bone generally means the tooth will be more stable with better long term functionality.  Numbers from 1-3 millimeters are considered a “normal’ depth.  Measurements greater than 3mm (4 and larger) are considered a pocket and the deeper the pocket the more problematic it is to maintain the area in a state of health. Along with the probing number another factor is also recorded at the same time, called “bleeding on probing” or BOP for short.  This represents the current disease activity in that particular area and is mostly a sign of inflammation from bacterial infection.  Once the combination of pocket depth and BOP is charted, a specific treatment plan can be prescribed to control the problem so further bone and tissue loss can be minimized.

It is important to have your bone levels checked at your annual dental exam and hygiene appointments in between.  If you are unsure whether your dentist or hygienist performs this check, don’t hesitate to ask them. At our office, this is one of many areas our hygiene team and Dr Mastrovich check at least annually, so that we can find any problem areas as soon as possible. If you are wondering about your periodontal dental health, give us a call to schedule an initial exam.

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Get major restorative under control, then dental maintenance can be easy

Dental exam and treatment options

Restorative dentistry is our specialty and people often wonder what their experience might be with dental implants and reconstruction.  Every case is different, and we strive to give every client an experience in our office that is personally tailored to their specific dental needs.

During the examination process, we go through a very detailed dental history with our patients, explain all their options and provide our recommendations regarding the most effective restorative solution. We want our patients to be involved in their treatment process and we give a variety of solutions within the range of excellent treatment options.

We use the dental acronym of BARC to help patients evaluate each option based on their individual values and needs.  For each treatment option, each of the following are discussed:

  • B – Benefits to the patient of the treatment being considered
  • A – Alternatives to the treatment, which always includes the option of not progressing with treatment
  • R – Risks involved with the treatment being considered
  • C – Complications that could be possible for the treatment being considered

After helping patients regain dental health by treating their restorative needs, patients are typically able to maintain their dental health more easily with their regular dental hygiene and dental check up appointments.

Our patients say they are very happy with their experiences and highly recommend Dr. Mastrovich for others considering this type of dental treatment because of his expertise in both the Escondido area and the dental community in San Diego.  Patients repeatedly thank Dr Mastrovich and his entire team for taking the time to help them understand their options and the pros and cons of each, while recognizing each patient’s uniqueness and specific needs.  Again and again, patients talk of how they feel like they’ve found their dental home and can feel comfortable and confident coming to Dr Mastrovich’s dental office.

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Regular dental exams help prevent bigger problems

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In our ongoing “Ask the Dentist” topics, a question that is often brought up is “What are the benefits to regular dental exams and cleanings?”

The main reason to have regular dental exams is to catch potential problems early and keep them small. For instance, removing decay early while it is comparatively small can prevent the growth of the decay reaching the tooth pulp and resulting in the need for endodontic root canal treatment (removal of diseased tissue in the root canal and replacement with a material) and possible crown, depending on the extent of the decay.

Often people ask how frequently they should have their dental exams and cleanings, and have a particular time interval in mind based on what they have heard or experienced growing up. This is best diagnosed by your dentist, as it depends on many factors ranging from how many and what type of existing restorations a patient has (fillings, crowns, bridges) that need to be checked; whether there is gum disease that needs to be treated and managed; and medical conditions and changes that may affect dental health.

What happens during a dental cleaning visit? We measure your gums and check for any recession as well as remove any plaque build-up that has occurred. Remember to keep your regular cleaning appointments to remove the plaque that daily brushing and flossing doesn’t completely remove.

Frank has been coming for over ten years, is very happy with his checkups and the results of regular dental exams and care that helps prevent bigger problems.

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How often do I need dental x-rays?

A frequent question we hear is, “Doctor, how often do I need dental x-rays?” The guiding principle in radiation is ALARA (As Low As Reasonably Achievable). What ALARA means in lay terms: as infrequent as possible to still achieve excellent diagnosis and care.

Many patients comment that their insurance policy allows (or doesn’t allow) for a specific interval for x-rays. Their policy has to do with what the insurance company designates as ‘reasonable’ (often termed ‘usual and customary’), based on premiums and costs, NOT on a clinical examination and evaluation of a patient’s individual circumstances and needs. Dentists must apply clinical judgment in deciding when and what type of radiologic (x-ray) examination to prescribe to optimize each patient’s oral health.

There is no recommended frequency for panoramic radiograph (x-ray) or full-mouth surveys (FMX). The decision to repeat a panoramic radiograph or FMX should be based solely on the individual patient’s needs (not on the frequency allowed in the dental insurance contract). The only imaging examination with a frequency recommendation is the bitewing, and its frequency based on an assessment of the patient’s caries (decay) risk. In summary, the clinical decision is:

  • Based on findings from the patient history and the clinical examination
  • Tailored to the needs of the individual patient
  • Influenced by the patient’s risk of dental disease
  • Supported by the dentist’s knowledge of disease progression and utility of various imaging techniques

Additionally, some factors the dentist considers in deciding when to prescribe radiographs are:

  • Health status of a new or established patient
  • Date and availability of the most recent prior radiographs
  • Patient age and stage of dental development
  • Risk of dental caries (decay)
  • Clinical evidence of periodontitis (gum disease)
  • Number of teeth and desire for prosthodontics care
  • Pain, swelling or other signs or symptoms of dental disease

If you have more detailed questions about your particular circumstances, please contact Dr. Mastrovich and our helpful office team at 760-741-6650 and www.MastrovichDental.com

We welcome your comments and general questions below, and we will try to answer as many as possible here in our Ask the Dentist blog.

Photo credit reuters.com

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