What’s new in dentistry? New Jersey Monthly wanted to know, so we selected six of this year’s Top Dentists and—pardon the pun—drilled them about the state of their profession. The dentists on our panel were chosen from among the top vote-getters in this year’s Top Dentists survey. They represent six of the nine dental specialties identified in the survey.
Our panelists are Dr. Edward Feins, a general dentist in River Vale; Dr. Scott Gersch, an orthodontist whose main office is in Westfield; Dr. Howard Kotkin, a pediatric dentist in Chatham; Dr. Bradford Porter, an oral and maxillofacial surgeon whose main office is in Haddonfield; Dr. Maya Prabhu, an endodontist whose main office is in New Brunswick; and Dr. Cheryl Goren Robins, a periodontist in Millburn.
What are the most exciting new technologies for patient treatment now in use in your specialty?
Edward Feins: Most of the new technologies marry computers to devices that we use to help us diagnose or treat disease. For instance, digital radiography [or x-ray] has been a great help in our office. It enables us to take radiographs with about 10 percent of the radiation that was needed to expose traditional film.
The Diagnodent is a laser probe device that finds early signs of decay in teeth. The VELscope is a new oral cancer-screening device that helps detect early changes to the oral mucosa before any visual lesion develops.
Scott Gersch: Some of the newest advances in orthodontics are Temporary Anchorage Devices, also called miniscrews or pins. Some people feel that TADs will replace the need for external anchorage devices (such as headgears and facial masks), and may one day revolutionize orthodontic treatment. In addition, we’re using digital radiography, digital imaging, and self-ligating mini-brackets—which allow a wire to move freely and thus decrease friction and in turn decrease treatment times.
Today’s technology also allows for more aesthetic options. For example, we are using tooth-colored ceramic brackets, lingual appliances on the back of teeth, and clear removable aligners such as Invisalign and Invisalign Teen.
Maya Prabhu: Today, endodontists are trained in the use of the surgical operating microscope for routine care. The introduction of nickel-titanium instruments have afforded greater flexibility in curved canals. Our microsurgical skills have been enhanced with ultrasonic devices that help us manage our surgical sites with extreme precision.
Cheryl Goren Robins: Probably the most significant technology is the use of digital imaging. This ranges from individual tooth x-rays to CT scans for 3-D imaging of patients’ jaws.
Biomedical engineering and biologic materials have also had a tremendous impact on how we save and replace teeth. Teeth that could previously not have been saved can have the bone and gum tissue support restored with procedures called guided-tissue regeneration that involve growth factors and bone materials that did not exist even a few years back. Dental implants are now designed not only to replace the roots of teeth, but also to allow for faster integration into the bone and enhanced gum-tissue response to make them even more like the natural teeth they replace.
What does the future hold?
Feins: Both computer and biotechnology will continue to improve so that we are relying more and more on computers to fabricate, on a very accurate level, many of our restorations for teeth. Digital impressions of teeth and CAD-CAM [computer-aided design and computer-aided manufacturing] fabrication are already in place. This technology will become more prevalent. Improving biomaterials is important as we continue to strive to restore and augment teeth rather than amputate them with procedures such as crowns. As materials improve we will be able to better mimic and restore teeth with materials that closely match the physical properties of natural teeth and thus help prevent premature tooth loss. Stem cell research may hold promise in regenerating teeth and supporting structures.
Gersch: The orthodontic community will see greater use of lasers, further development of intra-oral scanners, and the greater implementation of 3-D volumetric x-rays. These volumetric x-rays will allow us to see three-dimensional images of the entire head and neck, giving us a better picture of where teeth are in the jaw.
Howard Kotkin: The future of dental technology in pediatric dentistry is the Cari-Free bacterial analysis. A sample of the child’s saliva is obtained with a Q-tip and analyzed in an incubator…Children with high bacterial counts can be identified before they get cavities, and their bacterial levels can be lowered.
Bradford Porter: It is conceivable that in the near future we will be able to grow bone in a predictable fashion. Many of the challenges that face the oral and maxillofacial surgeon are the result of the loss of bone and soft tissue. There are limits to solutions for these problems, which require additional surgical procedures. Consequently, advances that simplify and make these procedures more predictable are quite exciting.
Prabhu: The latest excitement is in the field of regeneration. Our researchers are exploring the prospect of regenerating pulp-like tissue in the root canals by employing stem cells. Tissue engineering is not easy and we are far from achieving our goals, but what could be more biologically compatible than one’s own pulp tissue as a root canal filling material?
Robins: The materials of dental implants and the teeth that are placed upon them have already evolved to the point where it is difficult to tell them apart from the natural teeth. They will continue to evolve so that they become even more compatible with the patient’s own tissues. This means faster healing and even greater cosmetic possibilities.
What are the most beneficial cosmetic procedures you perform?
Feins: Porcelain veneers and porcelain onlays are helping patients achieve beautiful smiles with a high degree of success. Porcelain veneers are a conservative treatment. They can change the color and shape of teeth and create a whole new smile in a very short period of time. Placing porcelain onlays on back teeth that have been damaged from large silver amalgam fillings helps prevent the need for crowns.
Gersch: Straightening teeth and improving one’s bite are the most significant things an orthodontist does for patients of all ages. We’re able to align teeth in more aesthetic ways than ever before—with Invisalign, for example—and play a key role in the interdisciplinary treatment of other cosmetic procedures. It’s important for teeth to be in the proper positions before general dentists and prosthodontists can do their work.
The most rewarding and beneficial cosmetic procedure we perform is on children with extreme malocclusions or a cleft lip or palate. They usually walk into my office introverted and not wanting to smile because they are embarrassed by their teeth. While it doesn’t happen overnight, those same patients walk out smiling and with a newfound confidence.
Porter: Our practice does not perform any isolated cosmetic procedures per se. However, we do orthognathic surgery. This involves moving one or both jaws in conjunction with orthodontic treatment. The result of orthognathic surgery is to improve the function of the jaws and teeth. Often, an associated result of the surgery is improved facial esthetics.
Robins: My favorite cosmetic procedures fall under the heading of periodontal plastic surgery. This involves creating a gum tissue framework that enhances and complements the beautiful restorative work that my colleagues perform. Some patients have very short teeth because they have too much gum tissue in the way or because they have worn the teeth down. I can remove the excess gum tissue and restore the teeth to the correct sizes. Other patients have too little gum tissue and the teeth appear very long due to recession. In these cases, I can create new gum tissue to cover the recession, and again restore the area to a more harmonious state.
What is the biggest misconception about your dental specialty?
Gersch: One of the biggest misconceptions about orthodontics is that it’s for children and teenagers only. Although most patients begin orthodontic treatment between the ages of 9 and 14, healthy teeth can be moved at almost any age.
Kotkin: People believe that pediatric dentists only deal with children with behavioral problems. We are actually prevention-based, and help all children enjoy their visit to the dentist.
Porter: Two misconceptions that we often deal with are pain and infection. Some surgeries do result in a great deal of discomfort. However, patients are often surprised how little pain is generated by many procedures—such as dental implants. Patients with dental infections are often surprised that we do not recommend antibiotics for several days prior to the extraction of the offending tooth. Antibiotics are important, but usually secondary.
Prabhu: “Root canals are extremely painful.” This is truly a myth. Enhanced vision, sophisticated technique, better microbial control, and new, improved anesthetics have made endodontic treatment a peaceful and relaxing procedure.
Robins: There are two big misconceptions, and they both involve pain. The first is that patients believe nothing is wrong if they do not feel pain. For periodontal disease, that is a very dangerous assumption because by the time a patient feels pain, it is often too late to treat the area. The second misconception is that periodontal and implant procedures inflict a lot of pain. Patients continually remark that the fear was far worse than the actual procedure.
How do current insurance practices affect your decisions about patient care?
Feins: Insurance many times does not cover some of the more contemporary treatment modalities that would spare patients from expensive treatment in the future to repair a neglected problem. [For example], dental implants can replace teeth—lost from having old crowns or failing root canals—without introducing dentistry to adjacent teeth as is done to perform a bridge. Sometimes performing a bridge requires reducing or grinding down perfectly good teeth. This sets the stage for future treatment and expense on those teeth.
Gersch: Orthodontic insurance is different than traditional dental or medical insurance in that each insured individual usually has a lifetime maximum benefit for orthodontic services, and this benefit can be used regardless of what type of orthodontic treatment is performed. Our goal is to work with every patient’s insurance, helping them receive their maximum benefit.
Kotkin: Some patients need their dentistry performed in a hospital under general anesthesia. Insurance companies are not paying for hospital bills as readily as in the past.
Porter: During consultation with the patient, I attempt to outline treatment options, costs, and anticipated results. I do not change this approach based on the patient’s insurance situation. On the other hand, the patient may select a treatment that is more fully covered by his or her insurance plan to help minimize their expense.
Robins: My decisions about patient care are independent of insurance reimbursement. Furthermore…the particular therapies I recommend may vary from person to person. For example, a patient may be medically compromised, and surgical therapy may not be the ideal treatment for that patient. Instead I might recommend an alternative non-surgical approach that the insurance company does not cover. Or perhaps I might recommend more frequent preventive care and hygiene appointments even though the insurance may only cover half of the optimal number of visits.
What’s the best part of being a dentist?
Feins: Being available to help people on a daily basis. Our office has a policy that someone who is in pain will be seen the same day. It is very rewarding to help relieve the pain of a toothache. Sometimes it is restoring a smile with veneers or replacing missing teeth and seeing the difference treatment makes in a patient’s life.
Gersch: Developing relationships with patients. As an orthodontist, I get to see my patients over a long period of time. I hear who won the soccer game, see prom pictures, learn about engagements and weddings, see families grow, and know what’s new in their lives.
Kotkin: When I complete treatment on a child who was apprehensive, a smile and a hug is the best reward.
Porter: I enjoy the camaraderie and feel very fortunate to work with many excellent referring dentists.
Prabhu: To have the ability to take away someone’s pain is like taking a potent elixir every day. Who could ask for more?
Robins: Dentistry allows me to make patients healthier, but also to develop long-standing personal relationships with them. When a patient thanks me for helping them keep their teeth, or when they tell me about their first steak dinner in twenty years after [we] have replaced their dentures with implants, I know I have done something meaningful.
Click here to view a pdf of the full Top Dentists list.
Click on the links below to view the separate category listings for this year’s Top Dentists:
Top Dentists 2009: Endodontics
Top Dentists 2009: General Dentistry
Top Dentists 2009: O/M Pathology, Radiology & Surgery
Top Dentists 2009: Orthodontics
Top Dentists 2009: Pediatric Dentistry
Top Dentists 2009: Periodontics
Top Dentists 2009: Prosthodontics
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