These days, a visit to the dentist does not have to be accompanied by fear. New technologies have made many dental procedures simpler and less likely to cause discomfort. In our annual roundtable of Top Dentists, we asked six practitioners about these advances and other aspects of the state of the dental arts in New Jersey.
Our panel is comprised of six of the top vote-getters on our Top Dentists list from six different specialties: Dr. Noah Chivian, an endodontist in West Orange; Dr. Debra Duryea, a general dentist in Mendham; Dr. Daniel Bills, an orthodontist in Sicklerville; Dr. Sangita Madan, a pediatric dentist in Hackettstown; Dr. Richard H. Shin, a periodontist in Oradell; and Dr. Anthony Sallustio, a prosthodontist in Ocean Township.
What are some of the biggest changes you’ve witnessed in dental treatment since you started your practice?
Daniel Bills: In my office, every step of the treatment process—from patient check-in to diagnosis to patient education to treatment planning to treatment delivery—is now aided by the use of computers. In addition, technological breakthroughs such as self-ligating—or tieless—braces and clear aligners have completely transformed the way that I practice. We now have great aesthetic options for our patients that move teeth quickly and comfortably.
Debra Duryea: Shifts toward prevention and staying healthy have eliminated many of the problems our parents and grandparents had to face. Better materials, better laboratories and continuing education allow the dentist to produce restorations that are long lasting.
Sangita Madan: I’ve grown to love digital radiography….it is so much better for the patient—there’s less radiation—and we have instantaneous results. No more developing chemicals that are harmful to the environment.
Anthony Sallustio: Dental implants and technology have played a significant role. Dental-implant treatment is highly predictable and a good investment for long-term dental health. Patients can benefit from the digital world we live in. From x-rays that are safer to computer-made crowns, it’s changing how we can deliver precision dentistry.
Richard H. Shin: The general population is more aware of their periodontal health due to media and public responsiveness. They are more knowledgeable and concerned with the connection between oral health and overall general health.
Noah Chivian: For endodontists, the use of a microscope during treatment provides enhanced magnification and illumination, enabling the practitioner to locate the opening of the canals and examine beyond them. The captured image, projected onto a monitor, is then accessible to the patient when the procedure is explained. As well, the advent of three-dimensional cone beam scans and nickel titanium rotary instrumentation provides superior reproducible results with greater ease for both patient and dentist.
Many people suffer from dental phobia. How can a dentist ease patients’ fears?
Madan: It all begins from that first dental experience. Those with fears have usually been traumatized as youngsters. As a pediatric dentist, I see it all the time. The parents are usually traumatized as well. I do a special meet-and-greet with all my new patients. We discuss the visit away from the clinical setting, and everyone knows what to expect. Also knowing what the bad experience was helps me to approach the visit differently. This builds confidence in the child and trust in the doctor.
Bills: We spend a lot of time educating our patients about the new technologies we use in our office that allow us to treat cases faster and more comfortably than they ever imagined. Once patients understand this, some, if not all, of their fears tend to be alleviated.
Chivian: Most patients see a dentist because they’re in pain; many more avoid the dentist due to fear of pain. Often, that fear is a throwback to the depiction of medieval dental practices. I ease my patients with compassion and information: Research shows that 80 percent of root-canal patients do not experience pain. An overwhelming majority of the remaining 20 percent had confused the pain that caused the need for root-canal therapy with the actual treatment itself. So in reality, a very small number of patients require post-treatment.
Duryea: I think the most important thing with treating “phobic patients” is the demeanor of the dentist and his or her staff. The office environment is also important and should be calming and comfortable. Communicating so that the patient understands their treatment, listening to the patient’s concerns and giving them control puts them at ease.
Sallustio: Anxiety can create significant dental problems for those resisting treatment. When I spend time listening and understanding patients’ fears, I can help them overcome their concerns and complete treatment.
Shin: Many patients’ fears stem from an earlier bad experience at a dentist visit, usually from childhood, which keeps them away for years. In our office we try to ease a patient’s anxiety by accommodating each individual through spending the necessary time to assess the individual’s immediate needs and create a treatment plan that will not only restore that person’s oral health, but keep them on track in the future. We make ourselves available to adequately answer all patients’ questions in a relaxed and friendly atmosphere ensuring their experience with us is as comfortable as possible.
What advice can you give parents to get their children on track to optimum oral health?
Madan: My advice to all parents is to get in their child’s mouths from day one. Wipe the gums with a damp washcloth after feedings. If you’re going to put your child to bed with a bottle, then water only. Childhood caries is the most chronic disease in children and four times more common than asthma among adolescents, according to the CDC. Parents need to get their child to a pediatric dentist by age one. In addition to the examination, an assessment of their diet and home care is key to a healthy child.
Duryea: The most important thing parents can do is implement healthy dental habits at a very young age…. Teaching children how to brush and floss, plus teaching them which foods are healthy for their teeth and which are not, will stick with them throughout their lives.
Bills: The American Association for Orthodontists recommends that every child see an orthodontist for a screening by age seven, or even earlier if a parent or a dentist discovers a problem. The vast majority of 7-year-olds do not require orthodontic intervention. However, for the small percentage who do, if we do not catch the problem at age seven, it may be difficult, if not impossible, to treat later in life.
Chivian: Today’s emphasis on fitness is a solid approach. Teach a child that oral care is an integral part of being in good shape. Like athleticism, knowing you have a clean, healthy smile leads to self-confidence and makes you strong and happy.
Shin: My best advice would be educating their children in the benefits of good nutrition and limiting their consumption of sugary soft drinks and snacks early on.
What’s the best part of being a dentist?
Shin: I enjoy the challenge of a difficult case and seeing it through, from the patient’s initial consultation to the follow appointments after treatment. Of course, being able to help people achieve their optimum oral health can be very rewarding as well.
Madan: The best part is having a child who is scared or had a bad experience, taking them through the steps of the appointment, so that ultimately by the time they leave, they can’t wait to come back.
Bills: There is nothing that I could imagine being more rewarding than giving someone the confidence that can only come from a perfect smile.
Chivian: The best part is the ability to relieve pain in an expeditious manner, and to help patients save their teeth. In this throw-away society, where no one fixes a toaster, for instance, I find it satisfying to repair and retain rather than replace.
Duryea: The best part of being a dentist is being able to be a small part of the lives of my patients, especially when I can enhance the quality of their lives by keeping them healthy and feeling good about themselves.
Sallustio: The joy of a patient satisfied with their treatment is what motivates me. As a maxillofacial prosthodontist, I help patients with a variety of unique dental issues resulting from trauma, cleft palate, and head and neck cancer. I couldn’t see myself doing anything else.
And the toughest part?
Sallustio: There are plenty of challenges and it’s why I like the profession. Our world is measured in millimeters, which requires dentists to be critical of their work.
Bills: The toughest part about being an orthodontist these days is helping patients understand that orthodontics is about so much more than just straight front teeth. With the increase in companies and non-orthodontists promoting “quick fixes” to only the upper front teeth, the role of proper occlusion in the long-term health and stability of the dentition is, unfortunately, sometimes lost.
Shin: The profession can be extremely physically demanding. It can be difficult at times to balance family obligations and my increasing work schedule as the practice grows. A dental practice is like running a small business, and you need to be able to rely on your staff so that you can be free to attend to patients.
Duryea: The hardest part is dealing with insurance companies.
Madan: The toughest part is changing the misconceptions that parents have regarding baby teeth and a child’s oral health in general. Tooth decay can lead to severe pain and infection and tooth loss. The mouth is the gateway to the rest of the body. If it’s not healthy, neither is the child.