Fast-forward to the 1700s. Parisian surgeon Pierre Fauchard, rightly called the father of modern dentistry, published the book The Surgeon Dentist, in which he covered all facets of diagnosis and treatment of dental diseases, including orthodontics, prosthetics, periodontal diseases, and oral surgery. The mid 1800s would see the discovery of anesthesia, followed by numerous technical improvements in dental apparatus, including the foot-treadle drill.
The notion of oral hygiene was energized in 1890 with Willoughby Dayton Miller's The Micro-organisms of the Human Mouth, which suggested that tooth decay (dental caries) was caused by bacteria. In 1956, a paper was presented entitled "Grand Rapids Fluoridation Study--Results Pertaining to the Eleventh Year of Fluoridation," with the remarkable findings showing "[A] reduction of 60-65 per cent in the prevalence of caries in the permanent teeth of children born subsequent to the change in water supply." In other words, tooth decay would be preventable for most people, and dentistry should evolve into a prevention-oriented profession.
For some practices, this evolution was immediate, but for many, prevention was not exactly compatible with the "drill, fill, and bill" model that had existed for generations. As always, there is more money in disease than health, but when insurance companies entered the fray big time in the 1970s, patients discovered that co-pays on major restorations were often sky-high. Thus, preventive dentistry--with an emphasis on periodontology--quickly emerged. The grim jest: "Your teeth are fine, but the gums will have to be removed" inspired millions to visit their dentist regularly.
The most basic perio-linked preventive tool is dental floss, which dates back to the early 1800s, but became more practical to consumers in the 1940s, as nylon replaced surgical silk. Still, even though virtually all Americans brush their teeth, according to a 2008 survey, only 49% of Americans floss daily, and 10% never floss. But failure to floss encourages the build-up of plaque, causing tooth decay, inflamed gums (gingivitis), periodontal disease, and eventually tooth loss.
A frequent non-surgical plaque removal technique is scaling and root planing--a careful cleaning of the root surfaces to remove plaque and calculus (tartar) from deep periodontal pockets and to smooth the tooth root to remove bacterial toxins. Sometimes, though, greater intervention is indicated, such as gum graft surgery--employed as a therapy for gum recession (exposed tooth roots). In this procedure, gum tissue is taken from the palate or another donor source to cover the exposed root. This is referred to as Free Connective Tissue Graft (FCTG), and is widely used.
However, as is noted in the literature, FCTG techniques can be associated with postoperative pain, bleeding, and swelling. A few years ago, a novel method called the Pinhole Surgical TechniqueTM (PST) was developed by Dr. John Chao, of Alhambra, CA. A specialized dental instrument is inserted into the entry point and moved to free the gum tissue, then the gums are gently guided down to their proper position. Next, via a small angled device, several collagen strips are passed through the entry point and placed under the gums.
"The collagen helps to keep the gum tissue in place and stimulates the body to generate more collagen. PST takes about a half hour to an hour and as many as ten teeth can be treated at the same time. The small entry point quickly heals and is virtually undetectable the next day," says Dr. Chao.
A select number of dentists around the US have been trained in this technique, including Dr. Howard Hoffman, of Aventura, FL. Dr. Hoffman is dedicated to doing right by the patient, and provides all manner of compassionate care--or as he calls it "Exceptional Dentistry."
In addition to PST, Dr. Hoffman offers cosmetic dentistry, sedation dentistry, and sleep apnea and TMJ solutions. "It is an honor for me to have the ability and opportunity to offer PST to people dealing with receding gums, or those who need other important forms of oral care."
To close in a historical vein, George Washington certainly started losing teeth in his 20s and wore dentures, but they were not made of wood.
Michael D. Shaw
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