The Future of Dentistry
By Dr. Paul J. O'Malley

Minimally Invasive Bio-Cosmetic Dentistry (M.I.B.C.D.)
This is my philosophy. What does it mean?

Minimally Invasive Dentistry

Repairing teeth, gums and dental function with the least invasive (least destructive) process is 'Minimally Invasive Bio-Cosmetic Dentistry'. Additionally, it means using the most durable, long-lasting, materials and procedures for the patient, to help them keep their teeth for a lifetime.

For example, I use a microscope to evaluate gum disease. I treat gum disease based on handling the specific bacteria found - not just redness, bleeding, plaque, etc. Once the harmful bacteria are under control, healing occurs naturally. (See section under hygiene care.)

Another example is using inlays or onlays to conservatively restore your teeth versus placing large, weak fillings. Worse, if a crown is used, the entire tooth must be reduced, hence potentially more trauma. An inlay is a tooth-colored, lab-hardened material that is bonded to the inside of a tooth, so it 'lays in' -- hence, inlay. Similarly, an onlay wraps over a part of a tooth to hold it together, laying on the tooth, thus onlay. Both an inlay and onlay preserve huge amounts of natural tooth. More care and skill are required to prepare and place an inlay or onlay versus a crown. But it is better all-around, with only minimal destruction taking place to get such a lasting, beautiful and excellent result!

Traditional Dental Treatment vs. MIBCD Program

Patient Joe comes to a dental office to fix a large cavity. The decay is on both the chewing service and between the teeth. The dentist puts in a large white filling (hopefully not a silver-mercury filling).

Problem: The filling is too weak to last very long, and support the tooth (unless it is a very small filling). In fact, a direct filling is only about 20% as strong as the opposing enamel. So, two years later Joe has a small crack in his tooth and a worn out filling that is affecting his bite.

Traditional solution: Dentist decides to place a crown to hold the tooth together. He must now grind down the tooth in order to put a crown over it.

Problem: 5 years later Joe has pain in the since crowned tooth.

Traditional solution: Doctor takes X-rays and can see an abscess, so he suggests a root canal to handle the pain. He opens the tooth through the crown, does the root canal and patches it closed.

* Note. An X-ray cannot see through conventional crowns. Therefore, any hidden decay under the crown would not be visible, and would remain hidden and destructive.

Problem: Three years later Joe's crown feels loose. Doctor suggests re-cementing. He takes off the crown, but unfortunately finds the underlying tooth decayed and cracked to the gum line. Joe needs an extraction.

Traditional solution: Doctor suggests the removal of the tooth and an implant plus crown.

Has this or a similar situation happened to you or someone you know? That's dental history. Now let's look at the future of dentistry.

M.I.B.C.D. Approach - Minimally Invasive Bio-Cosmetic Dentistry

Joe comes into the office to fix a large cavity (same as above).

Dr. O'Malley suggests an inlay (see photo), which is a lab hardened porcelain / composite material.

Additional advantages are:

An inlay is about as hard as the original tooth enamel
It will not wear down the opposing tooth
X-ray can see through inlay material for future evaluation
It looks and feels natural
It's made of a biocompatible material
It's long-lasting and wear-resistant

Ten years later this tooth is healthy and intact (if patient has good hygiene).

It is important to use materials that have as close to the original strength of a tooth while at the same time causing minimal trauma during the procedure.

In the above example, Joe ended up losing a tooth after many procedures and many thousands of dollars.

With M.I.B.C.D., Joe's tooth would have been saved the first time. The M.I.B.C.D. procedure could have saved him all that time away from work as well as the costs to do all those additional procedures.

The cost of the inlay, while initially some 4-5 times more than the direct filling, would have been a bargain in the long run.

What is Biocompatible Dentistry?

Biocompatible (holistic) dentistry is a philosophy that recognizes that the teeth and associated structures are a part of the whole body. Because of this important relationship I offer a wide range of healthy treatment options. A Whole Body philosophy stresses the use of safe biocompatible dental materials whenever possible. I also work closely with highly qualified health professionals to assist them in their efforts to return the patient to optimal oral and overall health. My Health-Based approach to holistic dentistry means that I treat the teeth, jaw and related oral structures, in a scientifically exact way, keeping in mind the connection between the mouth and body - they are intimately connected!

	Onlay	Inlay	Filling	Crown
Strongest, with minimal tooth reduction	✔	✔
Longest-lasting potential	✔	✔		✔
Strong, most natural looking	✔	✔
Less trauma potential, both short and long term *	✔	✔	✔
Statistically less chance for future root canal	✔	✔	✔**
Metal-free	✔	✔	✔	Conditional
X-Ray able to see through this restoration at future check ups	✔	✔	✔

* Less possibility of nerve sensitivity or future root canal.

** A filling is 70 - 80 weaker than the original enamel; therefore it will wear down and potentially break its seal if it's a large filling.

Oral hygiene care - Traditional program vs. M.I.B.C.D. program

Patient Tom comes to see Doctor Y. Tom has deep pockets in his gums and lots of tartar/calculus with heavy plaque on his teeth. His gums are red and bleeding and he has areas of gum recession. Doctor Y diagnoses the level of gum disease and has Tom get all four sections (quadrants) deep-cleaned. Next, Tom goes to see the gum specialist Doctor P. Doctor P says Tom needs full mouth gum surgery. His gums and bone are "corrected" - for now!!

Unfortunately Tom now has a lot of tooth sensitivity, hot and cold bothers his teeth. Now it is also difficult for him to eat comfortably and painful for him to brush and clean his teeth. Over the next two years Tom does have his teeth cleaned but they hurt! He cancels some appointments and tells his wife it hurts too much, and had he known this he would never have had surgery!

Three years go by and Tom has red gums, lots of plaque, still some pockets and new recession; and, of course, sensitive teeth which is why it is difficult to keep his teeth clean.

What went wrong?

Tom followed a normal mainstream 'traditional' program. The problem was one of missed gradient treatments and not really handling the real cause right away:

By following a program that discovered the real cause and then treating it.
Through effective treatment, maximum healing could occur.
By further empowering the patient to be in control with exact customized home techniques for infection control.

After all those steps (gradients) are done, and there is still a remaining gum or bone defect (not inflammation), those issues can be handled with minimally invasive low trauma gum surgery. Remember, ideally, infection is handled with bacteria control not surgery.

Surgery handles the remaining defects. Once the patient's mouth is clean and maximally healthy - only then would surgery be advised.

M.I.B.C.D. Hygiene Protocol

M.I.B.C.D. provides the following unique services and gradient approach to complete oral health.

Microscopically evaluated oral hygiene treatment

A) Using a microscope our hygienist can evaluate the types of bacteria in a patient's plaque. From this evaluation, an exact program can be followed to get back to ideal health, or to maintain ideal health.
B) I have observed that patients with gum disease and deep pockets have high levels of certain identifiable bacteria. (A patient can actually see the bacteria for themselves, visible on a private monitor in the hygiene room.) Once these bacteria are identified, and treated with cleaning and herbal antibacterial remedies and products, healing and health return! I simultaneously teach you what you can do at home to decrease your dependence on us and handle your gum health to prevent any recurrence!!
C) Laser treatment. When gum disease forms deep pockets I can use the laser to sterilize, and thus decrease the pockets. This procedure is fast and virtually pain-free. It is also conservative and therefore fits my philosophy for being minimally invasive. Once the pockets are reduced it is much easier for you to keep the area clean and much harder for harmful bacteria to hide and re-populate.
D) Gum surgery (only if needed) this option would be reserved for patients who have extensive destruction of gums and bone - as a result of destruction caused by long term gum disease.

When a patient has extensive bone loss my M.I.B.C.D. approach is to first handle the cause and bacteria via the above gradient A,B,C steps. Next I can correct the bone loss and severely recessed gum areas with surgery, but only after A,B,C steps are fully performed.

The simplicity is that I treat the cause first. Once that is handled I correct any defect that may make home-care too difficult to keep these affected areas clean and healthy.

M.I.B.C.D. COSMETIC DENTAL APPROACH

I combine the art and beauty of natural life-like dental restorations employing the most biocompatible (body neutral) materials.

My goal is to create customized beautiful smiles using minimally invasive techniques, whilst utilizing biocompatible materials.

I do this by first discovering what my patients' needs and wants are, and then designing their perfect smile to their liking and specifications.

I am a perfectionist when it comes to speed of service and quality of materials. I therefore expect and get the best from my labs and materials.

The results are beautiful, natural, healthy smiles created fast, comfortably, and made to last.

Procedures

Ultra-thin veneers
Inlays/onlays
All-porcelain crowns
Tooth colored fillings (when small - but only 40% as strong as enamel)
Teeth re-shaping
Teeth whitening
Laser reshaping gum tissue for symmetry
Full smile reconstruction
Full mouth reconstruction
Nylon night guards
Natural custom biocompatible dentures and partial dentures
Alternative biocompatible root canals (Biocalyx Endo-Cal 10)
Mini bonded cosmetic bridges

My Final Thoughts

I have placed thousands of veneers and cosmetic restorations. I have a passion for and love to create beautiful, natural looking teeth and smiles. But even more, I love the positive effect this work has on my patients. Some have cried tears of joy knowing that the embarrassment or introversion they suffered as a result of their teeth was finally over. Not only that, many have said they did not know it could be so fast, easy and comfortable and wished they had done it years before!

I really understand what patients can go through with dental procedures. When I was thirty-nine I had to undergo extraction of my front tooth at the oral surgeon's office.

I have to confess that the shots were so uncomfortable that I decided to learn how to give painless injections. I got so good that I gave myself my own shots when I did future work on my front tooth. My dental assistant thought it was strange but she knew I gave painless injections, so why not on myself! Well, anyway it didn't hurt and that's all I cared about!

I can definitely tell you from this experience that I really did understand how my patients felt. That is why I learned and later taught how to give painless shots!

I also made and designed my own cosmetic bridge, which was, of course, minimally invasive. I definitely understand the importance of receiving comfortable dentistry. I pass all this understanding on to my patients, as I want your experience to be great, just like I know it can be.

About Dr. O'Malley

Dr. Paul O'Malley Dr. O'Malley's philosophy is to determine and understand his patients' needs and wants, thereby discovering the underlying causes, and then applying the principles of biological, health-based dentistry. In this way he can effectively and comfortably help his patients improve their oral and overall health and smile with confidence.