The world of dentistry is ever advancing, but not everyone has taken advantage of recent improvements. In fact, one local dentist says cavity rates seem to be on the rise.
When Dr. Kevin Boulard of New England Dental Visions in Nashua began practicing dentistry, tooth care was at its prime. That was back in 1994. In recent years Boulard has seen a rise in cavities, especially in 20-somethings. Shockingly, he said he has patients who come in with 10 to 15 cavities at one time.
“Our practice, and dentistry in general, tries to be preventative in nature,” Boulard said. “I don’t really know where the ball was dropped and why there is this huge increase of cavities. Somewhere along the way it stopped being a priority.”
Changes in diet and culture are having an impact on teeth. Boulard said young people are drinking more soda, energy drinks and sports drinks, which are all loaded with sugar. Adults stop at Dunkin’ Donuts for that large coffee with, you guessed it, sugar. And even when we try to do well, we can end up hurting ourselves — Boulard said more and more people are drinking bottled water, which lacks the fluoride that’s added to tap water. Fluoride helps “prevent and even reverse the early stages of tooth decay,” according to kidshealth.org.
Boulard did say that when people do have a problem they are getting their work done sooner, which keeps it from being worse. He attributes this to greater access to dental insurance. Then again, Boulard said something like 40 percent of people who pay for dental insurance don’t actually use it. Often patients come in only when they experience pain. Others aren’t as lucky and don’t come in at all because they can’t afford it.
When they do come in, they will notice some great changes in the field of dentistry as a result of modern technology.
“Dentistry is always evolving,” Boulard said. “The biggest thing has been the use of digital radiography.” This is a digital form of X-ray imagery in which sensors are used instead of traditional photographic film. Boulard said this is a huge advancement in two ways: it cuts down on the radiation (Boulard said it creates only a quarter of the radiation of traditional X-rays), and it produces images that are easier to read. Boulard said it is much more convenient to read the X-rays on a computer screen than to squint at film. And the better the dentist can see, the better he can do his job.
Technology has made other common dental practices easier as well. Boulard uses the CEREC 3 System to fix a crown in one visit instead of two. He takes an optical impression of the tooth, coverts it to a 3-D image on a computer, designs a new crown using CAD/CAM technology and then sends it to the milling machine for fabrication, according to his website, nedentalvisions.com. The crown is then put in place.
Night guards, which people wear to prevent grinding of teeth at night, can now be made without the patient having to bite into an impression gel — Boulard can simply take pictures of the teeth and send them to a certified lab where technicians will produce the night guard.
“Dentistry is getting easier,” Boulard said. “So now we try to make the patient experience better so people are more likely to go.”
Boulard said many baby boomers have a negative impression of dentistry from experiences 40 or 50 years ago, so he pulls out all the stops to encourage people to come in — Boulard is perhaps the only dentist in the state who offers VIP limousine service. Boulard himself drives the limo for elderly patients and sedation patients.
“It works out pretty well,” Boulard said. “These patients are appreciative of the service.”
Catering to sedation patients is good business for Boulard. He said 80 percent of his new clients come for this service, for which he obtained special certification.
“A lot of people are afraid to go to the dentist and if they can not remember the experience it works for them,” Boulard said. The fear can be driven by a simple dislike of people working on their mouths, a previous bad experience (Boulard said it takes 10 good visits to overcome one bad visit), a natural fear of doctors or just a fear of pain, even if the patient has never experienced pain.
While some people neglect their teeth, some are going in the opposite direction and getting cosmetic work done, embracing more of the latest techniques. According to his website, Boulard offers 12 different cosmetic and restorative procedures. He said baby boomers are the most likely to get the work done. With a down economy and less disposable income, people are not having as much elective work done now as a few years ago, Boulard said, but he is confident that that will change with the economy.
He said improvements to tooth-whitening systems have been great but if done improperly the treatment can lead to heightened tooth sensitivity. He said the whitening products available at grocery stores may have the same chemical components that a dentist uses but they are much weaker and must be used for a long time to get results, whereas at the dentist office you can see dramatic changes quickly.
Adults are also more likely these days to get their teeth fixed because of Invisalign, which allows them to have straighter teeth without braces.
Boulard said he likes using these new technologies. Some of the bigger machines, however, are very expensive. As he is the only dentist in his practice, he must weigh how much benefit an expensive machine will have before he increases his overhead. He said offices with more than one dentist might be more likely to buy these machines because they can get more use out of them.
In general Boulard said a lot of older dentists are retiring and there may be a shortage of new ones to replace them because of the high cost of education. There is also the question of what the future of national healthcare will look like and what impact that will have on dentistry.