A book that will improve your smile

An expert explains modern dental care in terms everyone can understand.

Whoever brushes his teeth after every meal and snack for three minutes each time, flosses at least once a day and visits his dentist and dental hygienist every six months, raise your hand... I don't see many hands up out there. Nevertheless, prevention of dental disease by regular care of teeth and gums is the recipe for minimizing expensive and painful dental treatment. Unfortunately, most Israelis get into a dentist's chair only when they have a toothache or other acute problem. Dr. Eitan Mijiritsky, an expert in oral rehabilitation who graduated from Tel Aviv University's School of Dentistry and is a faculty member at the Hebrew University-Hadassah dental school in Jerusalem, is trying to change that. He wrote an excellent book in Hebrew explaining everything you wanted to know about dental care but preferred not to ask. Published by Matar, the 208-page, NIS 78 softcover volume is called Lehayech Befeh Maleh: Hamadrich Lerefuat Shinayim B'yisrael (With a Big Smile: The Guide to Dental Medicine in Israel) and is available in bookstores and from the Hebrew Web site at www.teeth.co.il. He wrote much of the well-illustrated volume, which also includes chapters on dental specialties such as root canal, maxillofacial surgery, orthodontics and periodontics by six experts in these fields. Although dental health has major implications for the wellbeing of the rest of the body, dental care is unfortunately excluded from the basket of health services. Patients must pay out of pocket, either for the care itself or for private, non-inclusive dental insurance. Diseased teeth and gums not only reflect and result from chronic diseases in other organs in the body, but can also cause systemic complications involving the heart, insulin resistance, digestion, premature childbirth and others. Information empowers patients, and Mijiritsky's well-conceived and -written book helps patients of all ages know what to ask, whom to turn to and how to protect the natural resource that healthy teeth and gums represent. Since so many private interests in the dental field are competing for shekels, the more educated the consumer is, the better. The book also reports on new dental technologies that in recent years have significantly expanded the options of both dentists and patients. "The most difficult cases developed over years until they became severe," writes Mijiritsky in his preface. "The increase in awareness of dental care in Israel has induced more people to understand that treating a cavity and gum infection is very simple in its beginning stages, and that if they just get to their dentist for a routine checkup every six months, they will save themselves a lot of pain, time and money." THERE ARE more than 7,000 licensed dentists in Israel, and one-tenth of them are trained specialists. Many were trained at the dental schools of the Hebrew University-Hadassah and Tel Aviv University, while others graduated from foreign institutions. Here they complete six academic years, the first four studying theoretical medical and other subjects, with practical training on physical and computerized dental models and then on humans starting in the fourth year. How do you choose your dentist? It's best to hear recommendations from satisfied customers. The first call is important: If you have difficulty getting an appointment or one you set is postponed time after time, this may not be the dentist for you. One should also visit the clinic to see if it is clean and esthetic; if the dentist and his assistant use disposable gloves and have suitable sterilization equipment; if the patient is required to fill out a (very important) health questionnaire; if the dentist is patient and generous of his time to answer questions and listen to you. X-rays should generally be performed during the initial visit, Mijiritsky advises. After explaining the basic anatomy of the teeth, gums, jaws and salivary glands, the author goes on to explain preventive dentistry. Toothbrushes, he says, should be replaced every three or four months, or before if they have already shown signs of wear. Overused brushes, he explains, are not efficient at removing the transparent plaque layer bacteria and food that can coat teeth and cause cavities and gum infections. While battery-operated and (more expensive) electric toothbrushes have become very popular, they have not been proven to be more effective than manual brushing, but if they encourage people to use them or help those with functional disability to brush, they are beneficial. Holding the brush at a 45-degree angle in relation to the gums, several teeth at a time, is recommended. It is also best to follow the same order each time so you don't leave any out. Three minutes is the proper amount of time for each brushing session. Brushing after each snack is ideal, but few people do it; morning and night (before going to bed) are the minimum. You are also advised to brush the surface of your tongue, where harmful bacteria accumulate. Modern toothpaste was not available until the 1940s; before that, salt and bicarbonate of soda were used. Fluoridated toothpaste is regarded as best for protecting enamel, and fluoridated drinking water will help even more, especially with children. Unwaxed dental floss, special toothpicks and mouthwashes are also recommended. Mijiritsky discloses that indulging in chocolate, which melts quickly, is less harmful than repeatedly eating sticky foods such as potato chips, Bamba-like snacks, toffee or marshmallows. Frequent drinking of sugary soft drinks, especially acidic colas, also causes teeth a lot of damage. On the other hand, chewing sugarless gum for a limited time after meals collects and removes food particles and stimulates production of saliva, which contains anti-bacterial agents. It's hard to find anybody who has been spared a single filling, as cavities (the rotting of enamel) affect more than 99% of the population. The author also explains the types of X-rays, anesthetics and fillings ("white," amalgam or porcelain) and their uses. A chapter focuses on rehabilitation of the mouth (prosthetics) a specialty that requires four years of study beyond the dental degree. It involves special esthetic dentistry challenges, changes in the relationship between the jaws, integration of prosthetics and orthodontics, implants, partial or complete lack of teeth that requires bridges and dentures, bone loss in the jaws, bruxism (chronic erosion of teeth caused by teeth grinding) and jaw joint disorders. THE VARIOUS options for replacing missing teeth are as complicated as those facing an architect in rehabilitating buildings. The author provides comprehensible explanations and illustrations of them all, including the most recent dental implants. The success rate of these artificial teeth, which are screwed into the jawbone, is very high, even in people with osteoporosis and controlled diabetes, he says. Although they generally are performed in stages over a period of months, in some cases an implant can be carried out in one session. Dr. Olga Cherniak-Aji contributed a chapter on root-canal treatments, a phrase that sets the teeth of many patients on edge. But this endodontics procedure (involving removal of the pulp inside the tooth) should not be feared, she says, as local anesthesia can make it painless. Success rates in treating diseased roots the first time range from 80% to 95%; renewed treatment success rates due to reinfections are lower, between 62% and 78%, but if they have to be renewed for technical reasons, rates range between 89% and 94%. Dr. Yuval Tsuberi discusses periodontal (gum) diseases in his chapter. Plaque, he explains, erodes the bonds that connect the tooth to the jawbone, and symptoms include bleeding, swollen gums, sensitivity to cold, heat and sweet tastes, bad breath and a change in the gumline. This condition, greatly exacerbated by smoking, is most responsible for tooth loss and usually begins locally even in teenagers and in a widespread manner after the age of 30. Studies in the US found that 70% of adults aged 35 to 44 have a loss of two millimeters in jawbone affecting at least one tooth. The rate is 90% in those aged 46 to 55. It is treated by intensive scaling of plaque, keeping gaps between teeth clean, mouthwashes, drugs and surgery. PEDODONTICS is the term for pediatric dentistry, to which Dr. Lior Herzianu devotes a chapter. He urges parents to take infants to the dentist for a checkup when their first teeth erupt, and to clean them gently with gauze on a daily basis. "Baby bottle caries" tooth rot resulting from a baby holding the teat of a bottle of juice or even formula in his mouth for a while is a major cause of devastating tooth damage in children. Dr. Ofer Mardinger writes his chapter about maxillofacial surgery, which is required for congenital deformities, implants, serious infections in the mouth cavity, wisdom-teeth problems, jaw joint diseases, tumors and other conditions. About half of all children require braces, says Dr. Meir Redlich in his chapter on orthodontics. But it is relevant not only to teenagers, but also to adults who have crooked, crowded or unstable teeth. Dr. Talia Gazit-Rappaport discusses orthodontics for adults in a separate chapter. Orthodontics for both age groups have been enriched by new techniques and materials in recent years, and success rates are very high. Infectious diseases affecting the teeth, damage from smoking, dental care during pregnancy, halitosis (bad breath), bruxism, esthetic dentistry (including teeth whitening) and anxiety about dental treatment each get their own chapters, as does a discussion of technologies on the horizon, including computer-aided design and lasers. Mijiritsky ends this welcome and informative volume with a lexicon of dental terms, information about the Patients' Rights Law of 1996, and a list of relevant addresses, phone numbers and Web sites. If you are uninformed or nervous about dental care, you will probably break into a big smile while reading it.