Saturday, June 4, 2011

What is a Prosthodontists?

If you don’t understand the different dental specialties and what they do best, you are not alone. What is more concerning is that many people do not really know their dentist’s credentials before committing to complex treatments like dental implants or cosmetic work. Many proceed with specialty type treatments with their general dentist with assumptions that their dentist is a surgeon or specializes in root canals or is an expert in orthodontics! Remember, just because they do such procedures does not mean they are the experts in it. A friend of mine actually tried to convince me that his dentist is a surgeon because he has a DDS which stands for doctor of dental surgery! Just for clarity, DDS does not imply your dentist is a surgeon. It just means he or she graduated from dental school.

So I’ll start by introducing you to an important specialists: prosthodontists. There are two types of restorative dentists: general dentists and prosthodontists. Why should you know about prosthodontists? Because if you are in need of remarkable cosmetic dentistry, complex dental treatments, and dental implant restorations, then you may want to talk to a prosthodontist (just to help you say it- lets break it down to pros-thodon-tist). About 5% of general dentists have extensive training and experience in such complex treatments and can deliver equally great results.

A prosthodontist has received three additional years of postdoctoral training in dentistry gaining advanced skills in both cosmetic and restorative procedures. In patients with multi-disciplinary needs (e.g. those who need crowns, implants, root canal treatment, and gum surgery), a prosthodontist will act as both the restorative dentist and the coordinator of the overall treatment and other team dentists. They often work with an oral surgeon for teeth extraction, bone grafting, and dental implant placement. They collaborate with endodontists for root canal procedures. They team up with periodontists to manage gum disease and related conditions. And they work with orthodontists for teeth alignment. This team approach is the key to achieving predictable and long term oral health for patients.

Sunday, May 8, 2011

How Old is Too Old For Dental Implants?

  • Are people 85 and over good candidates for dental implants?

  • Should dentists recommend dental implants over conventional dentures in older individuals?

  • How old is too old for dental implants?

People are living longer and healthier lives and it is not uncommon for people to reach 85, 90, or even older ages. Many however, loose their teeth over time due to decay or gum disease and end up with partial or full dentures which cause further bone and tooth loss resulting in total debilitation. The dentures become loose, gum tissue becomes sore, and eating becomes very difficult. The elderly love to stay social, eat good, and share great times with family and friends without the embarrassment and difficulties that come with denture use. The quality of life is especially important at this stage and we need to do everything we can to improve it.

Dental implants dramatically improve life quality for many older individuals by letting them eat better, get better nutrition, stay more social, and lead active and vital lifestyles.

Are elderly good candidates for dental implants?

Yes. Dental implants are equally effective in older people, whether 85, 90, or even 95 years old, and heal with the same predictability as in younger patients. Osteoporosis, common in older people, does not negatively effect the outcome. Even with bone loss, dental implants can be placed successfully without bone grafting.

Dental implants vs. conventional dentures?

Dentists should recommend dental implants instead of conventional dentures in every patient. Dental implants are now the standard of care for replacement of missing teeth. Conventional dentures cause irreversible damage to the jaw bone and significantly compromise patient's chewing function, and therefore should be avoided.

How old is too old for dental implants?

The fact is no age is too old for dental implants. A reasonably healthy person with even a few years of life expectancy can safely and predictably have dental implants and improve their quality of life. There is no reason to let anyone suffer through the last years of their lives by loose dentures and inability to eat, speak, and keeping them from a vital and social lifestyle.

How is the recovery from dental implants?

Dental implant placement, when performed properly by trained surgeons, is a gentle procedure. Recovery from dental implant placement is significantly faster and easier than teeth extraction. Some discomfort may last for 3-5 days which is effectively managed by Tylenol or Ibuprofen. The implants maybe either restored immediately on the same day with a fixed denture or allowed to heal for 2-3 months before supporting the new teeth.

What are the treatment options?

First option is placement of two to four implants for support of a removable overdenture. This options provides great stability for the overdenture and significantly improves function and comfort. The second option is placement of a fixed prosthesis on four to six implants. The fixed prosthesis, also known as a hybrid, offers more comfort and resemblance to natural teeth as it does not have any denture flanges or extensions.

What are the benefits of dental implants?

Dental implants allow patients to eat any food they want comfortably and get the necessary nutrition. Implants effectively support the overlying teeth and prevent them from movement and accidental dislodging. Additionally, dental implants preserve the jaw bone and prevent bone loss that occurs from conventional dentures.

Eat well, Live well, and Stay social

Monday, September 27, 2010

The problem tooth: when should we pull the plug?

“Herodontics” is a term used by some to describe measures far beyond reasonable to salvage a failing tooth. After all, the oath traditionally taken by dentists is to save the tooth, no matter what it takes.

For example, let’s say you have a tooth with deep decay and your dentist tells you that, sure, it can be saved — but only with a root canal, some bone and gum tissue removal to create space for the crown, and a large post and build-up to support it.

Or perhaps your tooth was twice treated with root canal…and you are still in pain. Of course, you would hate to lose a tooth that you’ve already spent so much money and time on. So your dentist suggests a root surgery and maybe a root amputation and then a new build up and another crown. And he gives it a 50/50 chance of long-term success.

Heroics like this are costly, time-consuming, difficult to perform, and, sadly, ineffective in the long run.

Thankfully, current industry knowledge and technology have created a paradigm shift in treatment recommendations. Today, if a tooth is significantly compromised, we can take a longer and broader view of the available options and outcomes. Even when we can perform procedures A, B and C to save the tooth, as dental professionals dedicated to the health of our patients, we have to ask ourselves, “Should we?”

Sometimes, saving the tooth for the short term may cause more complications in the long run, as with herodontic procedures such as root hemisection, aggressive crown lengthening, apicoectomy of a tooth previously treated with root canal, and even crown supports on teeth with massive missing structure. Of course we can perform these procedures, but the onus is on us to determine if there are better, more successful, evidenced-based treatments that may not include actually saving the tooth. Sad as it seems, chances are that we’re only saving the tooth until the next necessary procedure.

I say it’s time to pull the plug on that problem tooth and spare patients the pain, frustration, and disappointment of fix after fix that only prolong the inevitable. In fact, I propose that dental professionals start practicing “simpractidontics,” simple and predictable dentistry that’s current, successful, cost-effective and longer lasting. I want to educate my patients about all of the possibilities — short- and long-term — and engage them in making better decisions for their overall oral health. Now, don’t you think that’s an entirely different kind of hero?

Thursday, December 10, 2009

Dental Implants: Marketing vs. Reality

Dental implants are now, the standard of care for tooth replacement, improving dental health of million of people with missing teeth. Implants have also greatly impacted dental economics with increasing number of dental practices and companies offering their services and products. To gain market share, many dental practices advertise dental implants in the newspaper, with mailers, or on the Internet, offering incentives to attract potential patients to their offices. Here are common advertisements:

"Implant for $1,095; Abutment & Crown for $950; We Guarantee Successful Placement!"
"Implants Starting at $995"
"One-Hour Dental Implants"
"No Pain, No Bleeding, No Sutures”
“Free implant with purchase of crown”

If these offers sound too good to be true, they usually are. Here is what you need to know before getting burned by misleading advertising.

"Implant for $1,095; Abutment & Crown for $950; We Guarantee Successful Placement!"

This is a very common advertising ploy. It does not tell you the whole story. An implant refers to the post placed in the bone. The abutment is the extension attached to the implant, supporting the crown. Such “special” fees do not correlate with cost of labor and materials for a level of precision and quality that implant supported crowns require. Here is the typical range costs to surgeon and restorative dentists to replace a single missing tooth:

Implant placement related costs to the dentist:
  • Dental Implant (reputable companies with well researched implants): $400 to $450
  • Healing abutment (a temporary extension that sits on the implant): $40 to $50
  • Surgical guide (a stent guiding accurate implant placement): $50 to $150
  • Drills (series of drills in various diameters necessary to prepare the bone for implant placement): $50-$100
Prosthetic (actual tooth) related costs to the dentist:

  • Impression post (to take impression of implant): $40 to $50
  • Implant analog (An implant duplicate used for models): $25-$35
  • Permanent abutment (supports the crown): Customized by lab: $225 to $450; Stock type: $100 to $150
  • Permanent abutment screw (holds abutment on implant): $50 to $65
  • Permanent Crown (made by a quality lab): $250 to $600

And for teeth replacement in the upper front area (smile zone) add:

  • Temporary Abutment (Necessary for support of temporary crown): $125-$175
  • Temporary Crown (Necessary for implants in the smile zone): $125-$175
As you can see, these costs to the dentist automatically add to $1,360 to $1,1950 just for the cost of materials. This does not include the impression materials, accessory materials, and personnel and administrative costs.

It is nearly impossible to offer such fees as $1,095 for an implant and $950 for a quality abutment and crown, and cover expenses for materials, labs, office, staff, marketing, and a leave marginal profit for the dentist. Here is the catch: Dentists employ common “cutting corner” strategies to offer a low fee and still make profit on this procedure.

Cutting Corner Strategies:
  • Placing “no-frill” implants: Implants are titanium posts that are placed into the bone and act as root support for the abutment and crown. There are some generic implants in the market that may cost $95 to $150. The catch: Important characteristics such as titanium composition, machinery, surface type, design, and sterility of these “copy” implants are not well documented. They also have not undergone evidence-based testing or trials. There is little or no literature on their success and healing. Complications such as infections, fractures, non-bony healing, and bone loss may be at increased risk.
  • Use of stock (generic) abutments: The abutment is the extension that is attached to the implant and supports the crown. Stock abutments are manufactured by the implant companies and are available in several standard sizes. These are cheaper than the recommended custom abutments. The catch: Stock abutments do not provide proper form and contour of a natural tooth. The cosmetic results are unpredictable and hygiene may be difficult. Custom abutments have clear advantages and are recommended by every experienced prosthodontist, dentist, surgeon, and laboratory technician.
  • Re-using implant drills that are used to prepare the bone where the implant is placed. Drill’s sharpness, sequence, and surgical technique are crucial to achieve a stable implant with healthy bone and proper healing. To save money, some dentists reuse old drills that have become too dull. This can result in heat damage to the bone, poor healing, and implant failure.
  • Use of inexpensive lower quality labs: It is commonly accepted that work performed by the lab is just as crucial as the work by the surgeon and the restorative dentist for long term success. Laboratory cost can be significant for quality prosthetic work, whether it's a crown, bridge, veneer, or denture. Some labs offer special fees to the dentists for doing the work, like a “$95 monthly special” for the crown. Here is the catch: Quality laboratory work requires careful attention to details, communication with dentist, precision fit, accurate margins, custom angulation and form of the abutment, and artistic porcelain work for a crown that looks good and functions well. All of this takes time and expertise, which is why a quality laboratory charges $225 to $350 just for the abutment and another $250 to $500 for the crown fabrication. The longevity and success of implant supported crowns depends on accurate and high quality work. Non-fitting components and poor quality materials will cause crowns or implants to fail.
  • Not using a surgical guide that is mandatory during placement of an implant for accurate positioning and angle. This requires custom impressions of a patient’s teeth. Next, study models are poured in stone and a guide is fabricated in the laboratory or by restoring dentist or surgeon. Many do not do this because it takes extra time, materials, and lab fees. The catch: While it saves time and money, it frequently results in poor implant placement that can be too close to other teeth, tilted outward or inward, or set too deep. The result is an abnormal looking crown that may be difficult to clean, cause potential gum recession and bone loss, and increase the risk of implant failure.
  • Same dentist placing the implant and the crown: Sounds convenient and nice, but here is the catch: Implant placement and fabrication of a crown are separate disciplines, and it is nearly impossible for any dentist to master both. It takes years of training and experience to place a dental implant. Similarly, in-depth knowledge and skills are required for the prosthetic part of the procedure. Implant dentistry is predictable, but not easy.

"Implants Starting at $995!"

This is the “a-la-cart” approach. Sounds cheap, but here is the catch: Frequently, every aspect of the treatment, component, materials, and services are itemized. This means, you'll probably pay for the consultation, every X-ray, every screw, every part, and material used. And this does not include the crown or abutment. In addition, if something happens and an implant has to be replaced, you'll end up paying for it again. Add this to the money-saving strategies discussed, above and you'll see how it’s offered at low cost.


This has become a new craze, and yes, I believe, it’s largely a marketing fad. Teeth-in-A-Day means you have your teeth removed, implants placed, and receive crowns, bridges, or dentures all in one day. Here is the catch: While promising, the current science, knowledge, literature, research, and expertise is not sufficient to achieve predictable results in every individual. The approach may be successful, but only in very few candidates who present with no infection around their teeth, have great amount of bone, and all conditions are ideal. If conditions were this perfect, why would they need to have their teeth extracted to begin with? Many commercial “implant centers” do a hard sell to fit a patient into a treatment plan. Healthy natural teeth end up being extracted in order to place multiple implants and connect them with an immediate prosthesis on the same day! There are some evidence-based studies on this approach, but there are too many variables not yet thoroughly understood. While successful in some, use of this approach in poor candidates results in high rates of failure and implant loss.

"One-Hour Dental Implants"

This is a frequent advertisement and it means absolutely nothing. Every patient is different with varying needs, different complexities, and treatment approach. Even in the most ideal conditions, procedure can take 15 minutes to several hours based on the treatment which can and should vary from patient to patient. Even Domino's pizza no longer guarantees delivery of a pie in 30 minutes or less.

“No Pain, No Bleeding, No Sutures”

Yes, this is possible, but a few things need to occur! First of all, there is always some discomfort with an implant placement, although mild in most cases. A surgery without bleeding or sutures means that a dental implant was placed without an incision and gum tissue flap. This is absolutely possible. But here’s the catch: The team must use a CT-scan for 3-D work-up, and fabrication of a special guide to aid the surgeon for precise implant positioning. I have used this technique many times with great success. It does add to the cost, though, often by as much as $750 to $1000. It is well worth the extra cost if there are multiple implants, compromised bone anatomy, and a need for great accuracy in difficult cases. To have no bleeding or suture, without use of this technology, requires a “blind” implant placement that is difficult and challenging, even in the hands of most skillful surgeons. Even if there is bleeding, it usually stops in a few hours and sutures fall out in few days. I don’t recommend compromising implant positioning and accuracy to avoid slight bleeding and sutures.

“Free implant (with purchase of crown)”

This offer suggests that patients get a free dental implant when they pay for their crown. The '”free” offer is a common marketing tactic designed to hook a consumer into trying a product. This may be all right for marketing a new facial moisturizer, but not for dental implants. Here’s the catch: First it implies that implant placement and the crown are being done by a single ‘super-dentist,’ and as already discussed it is practically impossible for one person to have mastered both disciplines. Also, it suggests possible use of no-frills implants and itemizing all other aspects of treatment to make up for the ‘free’ implant cost. This means you'll pay for every X-Ray, part, piece, visit, replacements, etc. In most instances, you will end up paying more for the ‘free’ implant.

The reality is that implants work. While it’s a highly successful and predictable procedure, it’s not simple, requiring the skills of a trained specialist and restorative dentist working as a team. Implants have a more than 98 percent success rate when performed by the right team of dentists that use quality implants, customized components, and reputable labs. This saves patients money by preventing complications and re-dos, and improving longevity.

The old rule “If it's too good to be true, it probably is” applies to dentistry too. When looking for tooth replacement options, do not fall victim to misleading marketing tactics. Do your research, ask the right questions, and know what you are getting. It’s a lifetime investment and shouldn’t be taken lightly.

In part 2 of this report, we will discuss the right questions patients should ask when searching for implant treatment providers.

Please send all correspondence to:

DC Alliance for Dental Implant Awareness
4825 Bethesda Avenue, #310
Bethesda, MD 20814

Monday, August 24, 2009

Denture Wearers Seek Better Options

Mrs. S. was a 65 year old female who had been wearing a denture for about 10 years. She lost a number of her teeth due to gum disease and decay at early age and was given a full dentures. She talked about a time when she first got the dentures: "big, clonky pieces of plastic which was really tough to get used to! It caused me to gag a lot and best I could eat was mash potato and puree apple. It never really fit well so I started getting sore spots all the time. My dentist tried to reline them a few times, but it would only remain comfortable for a short time. Over the next several years, I had to get more relines as the dentures seemed to have less hold on my jaw bone. Just slipping all the time. It was not till recently that I realized my jaw bone was gradually being lost due to the denture. I tried using denture glues, but did not really work well and I was spending a lot of money on them. The denture is so loose now that I can not keep it in even during normal talking. It's really embarrassing. I like to go out a lot and spend time with family and friends. And like to also eat. But just can't! It's just horrible......."

Stories like this are not uncommon. People are living longer and healthier lives and dentures are simply not compatible with an active and healthy life style. Aside from social aspects, denture wearers may have problem getting proper nutrition affecting their overall health.

These patients are seeking better options!

For Mrs. S., two dental implants were placed, a 30 minute procedure under IV sedation and allowed to heal for 6 weeks before a new overdenture was made. She has been using the new prosthesis for about a year now and is extremely pleased and happy with it. She has become more social again and is enjoying her favorite foods much more than before.

Dental implants have transformed dentistry and oral health in ways we could have never imagined and they are certainly transforming lives of many denture wearers who are suffering as Mrs. S. did. The solution is amazingly simple and predictable: Placement of 2 or 4 implants to support an overdenture.

The simplest design is placement of two implants, one one on each side. After a 6-8 week healing, special attachments are placed allowing the dentures to 'snap' on to them. The implants provide great support of an overdenture allowing the patient to eat and speak comfortably. It also prevents further bone loss. It can also be easily removed for cleaning. No more relines, No more glues, No more slipping and sliding!

The second option is placement of 4 implants, two on each side. This give improved stability of the overdenture and therefore allowing patients even more freedom in their choice of diet and overall function. This is the most common design for patients with full denture.

Implants have 98%+ success rate and have extremely low complications when properly done. Patients report minimal pain after the surgery and recovery is remarkably fast. Sometimes the denture can be placed on the same day as the implant surgery or in 6-8 weeks once healed.

Patients of any age can have dental implants successfully, even with osteoporosis. There is no reason to have to live with limitations that regular denture bring; There are better options to help many live a better and more happy and active life.

Dr. H. Ryan Kazemi
(301) 654-7070

Wednesday, August 19, 2009

Fear of Nerve Damage with Wisdom Teeth Extractions!

Over the years, I have treated a number of patients for their wisdom teeth who were initially discouraged to have it done because as they were told: "their teeth is on top of the nerve!". The nerve spoken of is a sensory nerve that runs in the jaw bone just below the lower wisdom teeth and in very rare occasions may be in contact with the roots of the wisdom teeth. In all of these patients, the recommendations were made solely based on a panoramic x-ray or a small dental x-ray that appeared to show close proximity of the lower wisdom teeth to the canal that carries this sensory nerve. The concern during any wisdom teeth surgery is possible close relationship between the nerve and tooth, and the potential nerve irritation that may result in some degree of numbness over the lip and chin region.

The question is how valid is this concern and the recommendations given?

First, it is a known fact that in majority of patients there is a separation between the nerve and the wisdom tooth, even though it may appear otherwise on the x-ray! It's important to realize that a panorex or a small dental x-ray is a 2-dimensional image and overlapping structures on these images do not necessarily mean they are in contact.

As mentioned, there is often a separation between the nerve and roots of the wisdom teeth despite the x-ray appearance and therefore risk of nerve damage is extremely low. Even in rare instances where they are in contact, meticulous and careful techniques used by surgeon can minimize any chances of long term problems. Therefore, fear of nerve disturbance, although always possible, is largely unsupported and not removing the wisdom teeth carries much more real and significant complications in the long term. I have personally treated thousands of patients whose x-rays showed the typical 'tooth on top of the nerve' and yet the nerve was not encountered and surgery was successful with no sensory deficits.

Panorex has been considered the radiograph of choice for oral and maxillofacial surgeon when treating impacted third molars. There are 9 radiographic signs associated with an intimate anatomic relationship between the canal and the lower third molars: Radiolucent band , loss of cortex of canal, change in canal direction, canal narrowing, root deviation, bifid apex, superimposition, and contact of canal with roots of the mandibular molars. Without these positive signs, the risk of injury is considered miniscule, whereas the presence of 1 or more positive signs is not a good predictor of injury to the nerve.

Icat and three dimensional imaging is an alternative technique that can demonstrate anatomical relationships between teeth and nerve and improves diagnosis, however, there is an ongoing debate in the literature about the need for CT scans before third molar removal, even when 1 or more of the signs is noted on the panorex.

While there is no consensus or standard of care on this issue, it is felt that CT scans should be considered in selected cased, chiefly when 1 or more of the telltale signs are present on the panorex. It is also recommended to discuss it during informed consent; including potential risks and benefits of undertaking third molar removal using a CT scan compared to no CT scan. Patient should ultimately make the decision considering all the facts and involved cost.

For more information, contact Dr. H. Ryan Kazemi at

Visit our site:

Office Telephone: (301) 654-7070

Office location: Bethesda, MD

Visit our video podcasts on:
1) iTunes: search word- 'dr. kazemi'
2) search 'dr. kazemi's oral surgery channel'
3) YouTube: search 'implantguru'

Wednesday, July 22, 2009

Choosing the Right Dentist For Your Needs

With rapid advances in dentistry, evolution of specialization, and marketing trends, choosing the right dentist for a specific need has become increasingly difficult for many people. Here is a simple guide in understanding various dental specialties and what they do best to help you ‘pick the right dentist for the job’:

General dentist: A general dentist has graduated from a 4-year dental school with no additional formal post-doctorate residency. Some may have completed a 1-year general practice residency program following dental school, providing them additional clinical experience and expertise. Some general dentists may have also taken extensive courses on specific disciplines, such as cosmetic dentistry, periodontal surgery, dental implants, endodontics, or orthodontics. Therefore they may perform these specialty procedures with great proficiency and can provide excellent treatment even in the most complex patients. As there are no specific regulations, It is best for patients to inquire about the proficiency and experience of a general dentist regarding complex procedures that are more often performed by specialists.

You will benefit from a general dentist if you have the following needs:
  • General restorative needs (fillings, crowns, bridges, dentures, etc.)
  • Routine periodontal care (Cleaning, management of early or moderate periodontal disease)
  • Cosmetic procedures (bleaching, bonding, veneers, etc)
If a general dentist has additional training and experience, they may provide:
  • Simple extractions, root canals, orthodontics, periodontal procedures, and some pediatric dentistry.
  • Complex restorative, cosmetic, and surgical procedures per their experience, proficiency, and personal comfort.
** Most general dentists choose to refer all or most of the specialty or complex procedures to specialists **

Specialties Recognized by the American Dental Association

Prosthodontics: A prosthodontist has received three additional years of post-doctoral training in dentistry gaining advanced skills in both cosmetic and restorative procedures. Some may also perform common periodontal or oral surgery procedures, but most focus on treatment of patients with complex cosmetic and restorative needs. In a patient with multi-disciplinary needs (e.g a patient who needs crowns, implants, root canal treatment, and gum surgery), a prosthodontist will act as both the restorative dentist and the coordinator of the overall treatment and other team dentists.

You will benefit from a prosthodontist if you have the following needs:
  • Both simple and complex restorative needs (crowns, bridges, veneers, etc.)
  • Dental implants and reconstructive dentistry
  • Rehabilitation of patients with partial or complete missing teeth
  • Advanced cosmetic procedures (bleaching, veneers, tooth reshaping, bonding)
  • Multi-disciplinary complex dental needs

Oral and Maxillofacial Surgery: Oral surgeons receive 4-6 years (6 years for combined DDS / MD programs) of post-doctoral training in accredited residency programs. They receive hospital-based training in oral and facial surgical procedures and anesthesia, in addition to extensive medical training to care for the medically compromised patients. Most are board certified as necessary for obtaining hospital privileges. Oral surgeons are limited to performing surgical procedures and anesthesia and offer key role in the overall care of dental patients.

You will benefit from an oral surgeon if you have the following needs:

Endodontists are root canal treatment specialists. They receive 2-3 years of post-graduate training on treatment of conditions affecting tooth’s root canal system. Endodontists have advanced surgical and non-surgical skills that make them uniquely qualified to treat routine as well as complex cases. The root canal contains the blood supply and nerve tissue vital to a healthy tooth. Insults such as decay, trauma, or other infections can compromise its health, therefore requiring root canal treatments. Current techniques, instrumentations, and technology (such as microscopes) allow endodontists achieve high treatment success.

You will benefit from an endodontist if you have the following needs:
  • Saving a non-vital or irreversibly inflamed tooth and avoid extraction
  • Root canal treatment for teeth that exhibit temperature sensitivity or pain due to decay or trauma
  • Teeth with abscess due to necrotic root or other types of pathology (such as cysts) compromising its health

Orthodontics: Orthodontists receive 2-3 years of post-graduate training, specializing in straightening teeth and management of jaw relations in both children and adults. Crooked and crowded teeth are prone to decay, periodontal disease, and possible loss. Misalignment of the teeth and jaws can lead to premature wear, further damage and chronic facial and joint pain. Through use of braces or other techniques such as invisalign, orthodontists can align teeth for improved function and aesthetics. Orthodontic related treatments may start in patients in as early as 8 years old or adult patients.

You will benefit from an orthodontist if you have the following needs:
  • Straighten and align teeth for improved bite and aesthetics
  • Correction of misaligned or asymmetrical jaws
  • Retainers or night guards
  • Treatment of TMJ and facial muscles related pain

Periodontics: Periodontists receive 2-3 years of post-graduate training for treatment of gum disease, various gingival procedures (functional and cosmetic), and dental implants for teeth replacement. Periodontists often work along with general dentists or prosthodontists for long term periodontal care of patients (bone and gum tissue surrounding teeth). They provide both preventive periodontal care as well as both surgical and non-surgical management of periodontal disease. While some procedures are performed by both periodontists and oral surgeons, they often work in collaboration on patients with complex needs requiring both expertise.

You will benefit from a periodontist if you have the following needs:
  • Surgical and non-surgical treatment of gum disease
  • Preventive periodontal procedures
  • Treatment of gum recession via grafting procedures
  • Cosmetic gingival procedures
  • Minor bone grafting procedures for implants
  • Dental implants placement

Pediatric Dentistry: Pediatric dentists receive 2-3 years of specialized training after dental school, and are dedicated to the oral health of children from infancy through the teenage years. The very young, pre-teens, and teenagers all need different approaches in dealing with their behavior, guiding their dental growth and development, and helping them avoid future dental problems. Some may provide oral sedation for increased patient comfort. Pediatric dentists may work in collaboration with orthodontists to treat growth related teeth or jaw misalignment.

You will benefit from a pediatric dentist if you have the following needs:
  • Any dental related procedures in patients from infancy to early teen-age years
  • Fillings, crowns, and root canal procedures on primary teeth
  • Knocked out or fractured primary teeth (may require an oral surgeon)
  • Treatment of minor trauma to primary teeth
  • Routine cleaning and preventive dental procedures

The ‘DDS’ vs. ‘DMD’ Question

A common question is what is the difference between a dentist who is a DDS vs. one who is a DMD!

DDS: doctor of dental surgery DMD: doctor of dental medicine

DDS or DMD Indicates the degree awarded upon graduation from dental school to become a general dentist. There is no difference between the two degrees; dentists who have a DMD or DDS have the same education. Universities have the prerogative to determine what degree is awarded. Both degrees use the same curriculum requirements set by the American Dental Association's Commission on Dental Accreditation. Generally, three or more years of undergraduate education plus four years of dental school is required to graduate and become a general dentist. State licensing boards accept either degree as equivalent, and both degrees allow licensed individuals to practice the same scope of general dentistry. Additional post-graduate training is required to become a dental specialist, such as an orthodontist, periodontist or oral and maxillofacial surgeon.

Choosing the right dentist for a specific problem or need is an important part of our oral health. Everyone deserves the best treatment dentistry can offer and making engaged decisions is an integral part of this process.

For more information, contact Dr. H. Ryan Kazemi at

Visit our site:

Office Telephone: (301) 654-7070

Office location: Bethesda, MD

Visit our video podcasts on:
1) iTunes: search word- 'dr. kazemi'
2) search 'dr. kazemi's oral surgery channel'
3) YouTube: search 'implantguru'