Dr. Arlet Dunsworth has been practicing Oral and Maxillofacial Surgery in Dallas since 1975. When he completed his residency at Baylor Medical Center in 1973 he became the Chief of Oral and Maxillofacial Surgery at Maxwell Air Force Base in Montgomery, Alabama. In 1975, he returned to Dallas as a full-time faculty member in the Department of Oral and Maxillofacial Surgery at Baylor. He opened his full time private practice in 1982.
Dental1: When did you first know you wanted to be a dentist?
Dr. Dunsworth: I knew that when I was a junior in high school. I had a wonderful science teacher that encouraged me to look at the medical and dental professions. My Cub Scout den mother’s husband was our family dentist in Wichita Falls, Texas.
Dental1: What was it that attracted you to the profession?
Dr. Dunsworth: Well I think it was the ability to have a really independent job where you could make your own decisions about what you do and the hours that you work. Part of it was also not being on call at the hospital like a physician would be.
Dental1: What do you find the biggest challenge as a dentist?
Dr. Dunsworth: I think one of the biggest challenges is trying to organize the scheduling and keep the office running smoothly. Another big challenge is staff in the office, especially finding and keeping qualified staff. That’s one theme that runs throughout our profession.
Dental1: When your patients come in to see you what is their number one concern?
Dr. Dunsworth: How much is it going to hurt?.
Dental1: How do you handle a question like that?
Dr. Dunsworth: I tell patients there are multiple ways to make the procedure absolutely and completely comfortable. If patients are really apprehensive, we start an I.V. and use sedation to get them to the point where they don’t care about anything that I am doing. Sometimes we will use a general anesthetic for patients. There are multiple modes of sedation including oral premedication to sedate patients before they actually arrive at the office. There is nitrous oxide sedation as well. Obviously we have a lot of patients here who come in and say “Doc you can’t work on me unless I am asleep. Period.” So those are the patients we know right off that need to be sedated. I try to discuss this in detail with patients.
Dental1: Why do you think dentists are among one of the highest suicide groups?
Dr. Dunsworth: Dentistry is a profession where you start off in dental school in an environment where everything you do is judged on a level of perfection that is almost unattainable. Every tooth you carve, every filling you do, every procedure is looked at, checked off and graded against this standard of perfection. You are under a compulsion to try to achieve that, which I think is very difficult to do. Although, if you don’t strive for perfection you don’t attain excellence in anything you do. But there is a lot of stress trying to achieve that amount of perfection working on a human being. Many times when your best work is really, really good, it’s not perfect. And folks tend to have a lot of stress until they realize they can’t make things perfect.
Dental1: How do you handle that stress?
Dr. Dunsworth: Well I think that comes from longevity of practice. I’ve been in oral surgery for over 30 years now and I think the longer you are in practice you develop a sense that you are working with patients who are human and not everything you do is going to turn out perfectly every single time. Coming to that helps you realize that you’re not perfect and neither are your patients, and sometimes complications are going to occur and you have to make the best of it that you can and try to fix the problem as it occurs. Always talk to patients and keep them informed as to what the problems are. This really helps me. I still get upset when things don’t go right.
Dental1: What’s the biggest change you’ve seen in the 30 years of working in this field?
Dr. Dunsworth: Technology. The major thing that has changed for us is the ability to do implants for patients very effectively and successfully. That’s definitely a real big change. Also in the field of radiology - having digital x-rays. Not having to process film with darkrooms and chemicals.
Dental1: Do you have a favorite piece of equipment or technology?
Dr. Dunsworth: Well, I think the implant system that has been designed and produced by the Straumann Company in Switzerland is one of the best on the market and that’s the one we like using. It’s effective, it’s successful and it’s very easy to use.
Dental1: How do patients find a qualified practitioner to do implants?
Dr. Dunsworth: We view the implant process as a team approach between a surgeon and a patient’s dentist. I think the first approach is for the patient to seek advice from their personal dentist. Their dentist will be working with surgical specialists, hopefully oral surgeons, to have a team approach where the dentist decides how many implants need to be done and then works with the surgeon to design a plan to put those implants in the right position so they fit appropriately.
Dental1: Is there any special training needed to do implants?
Dr. Dunsworth: Yes. Many dental schools today are offering implant training. They are many continuing education courses offered within the dental schools and by all of the implant companies around the country. There are also many surgical practices that have on-site, practical, hands-on training. Most all of the surgical specialists who have completed graduate training will be very competent to place implants.
Dental1: Do you think the level of pain has been lessened with all this new technology and procedures?
Dr. Dunsworth: With the implant procedures most people tell us afterwards that it was not as uncomfortable as they thought and certainly not as uncomfortable as getting the tooth taken out. This is probably related to the fact that when you take a tooth out you have an open socket that has to heal. When you put an implant in you don’t have a real opening and you have it all sealed up. The skill and dexterity of the surgeon placing the implant helps to minimize the surgical trauma.
Dental1: Aside from the cost factor is there any other reason to get removable implants?
Dr. Dunsworth: Not really.
Dental1: Is there any special maintenance required afterwards?
Dr. Dunsworth: Most patients for whom we do implants are extensively counseled about the need for care and cleaning and having excellent oral hygiene. They’ve lost their teeth for one reason or another. The main reason for implant failures is infection and the main reason for infection is that some patients don’t really have good oral hygiene. After the procedure, patients need regular visits to their dentist so the implants can be cleaned like regular teeth using special plastic instruments. You don’t want to use metal equipment or you can scrape the surface of the implant.
Dental1: Are you using immediate load implants?
Dr. Dunsworth: Occasionally. Again, this is something that where we really cooperate with the patient’s dentist. The immediate load technology and interest today is primarily motivated by our desire to get teeth onto the implant quicker. We usually use it when the implant is in the front of the mouth. You can place the implant, and if it is really solid and stable, you can put a temporary plastic crown on that implant right away. You have to make sure that the patient has no chewing or biting force on that tooth since you don’t want to put any stress or strain on the implant itself while the healing is occurring.
Dental1: Does it take longer for some people to heal from the procedure?
Dr. Dunsworth: Generally not. Certainly someone in their 80s will heal a bit slower than someone who is an adult in their early 20s. Most of the time in the lower jaw when we use the Straumann system we can put teeth on the implants after about six to eight weeks. And in the upper jaw, about three months post-operative. The company is working on some newer technology that has the potential to put crowns on the implants in a matter of weeks instead of months.
Dental1: Is everyone a good candidate for dental implants?
Dr. Dunsworth: A typical patient who would not be a good candidate would be someone with uncontrolled diabetes or a patient who is not well controlled with the medication they are taking, especially blood thinners like Coumadin. Patients with significant heart trouble or blood pressure not well controlled might not be good candidates.
Dental1: Aside from the infections that you mentioned earlier, are there any other complications that cause the implants to fail?
Dr. Dunsworth: The other complication that causes implants to fail is if teeth that are placed on the posts are not constructed correctly so when they are adjusted they don’t have the proper amount of biting force. Most practitioners can construct the crowns very, very effectively so there are very few problems like that.
Dental1: What is it about the Straumann procedure that you prefer?
Dr. Dunsworth: They were the first company to introduce a technique what we call One Stage Implant. The newest generation of implant technology was started over 20 years ago by Professor Brånemark in Sweden. His introduction of titanium technology was the revolutionary event that made the current implant technology possible. Professor Brånemark’s protocol was to put the implant in and sew the gum tissue completely over the top of the implant and leave it for six months, come back for additional surgery to uncover the implant, and then place the teeth on the posts. Straumann introduced a technique that left the top part of the implant uncovered with a special cover screw in place so that when you get ready to put the teeth in place all you have to do is unscrew the cover screw. You don’t have to anesthetize the patient and operate again. From a surgeon’s standpoint that really appealed to me since we were operating on people twice. Not to have to do that is better for us, less time consuming and certainly less uncomfortable for the patient. I think it was a great opportunity to make things easier for patients.
Dental1: Do you think that dental implants are eventually going to replace traditional bridgework?
Dr. Dunsworth: The main criteria for placing an implant has to do with whether or not there is enough bone to place the implant without getting into the sinus or injuring the nerve in the lower jaw. I’m very fortunate to work with several dentists in Dallas who construct the crowns and I do the implant surgery. They don’t advise their patients to have any kind of removable partial dentures or full dentures at all today. So we are looking at down the road at less and less removable type dentures and partial dentures just because they are not as stable as dental implants.
Dental1: What prevents more people from having this kind of dental surgery?
Dr. Dunsworth: Mostly the cost.
Dental1: Do you think we expect more from our dentists nowadays?
Dr. Dunsworth: I think so. Certainly in areas of the country where there is a high socio-economic level. Patients have come to realize from advertisements in the media the things available today in terms of tooth whitening, orthodontics, dental implants and cosmetic dentistry. Folks are ready to have that kind of dentistry done.
Dental1: Do you every have to draw a fine line between dental work that is necessary and dental work that is just vanity? Is that an ever an issue with you?
Dr. Dunsworth: Well I don’t do primary cosmetic surgery. I do some chin augmentation surgery from time to time. We do some jaw reconstruction surgery where certainly the patient looks better, but we usually do that mainly for functional improvement. My colleagues who are involved in the cosmetic dentistry have ways of accommodating a patient wants to have whiter, straighter teeth.
Dental1: What future improvements and new technologies would you like to see with dental implants?
Dr. Dunsworth: I think as the research and development proceeds we are going to see the time decrease from surgery to getting the final teeth, and that immediate loading will become the norm. Five years ago if you had told me we were going to be doing this I would have said you were just crazy. I think that as we become more confident that it is going to be successful we are going to do more of it. Certainly we want to do things that in the long term are going to be successful for patients. One of the biggest problems in the past was doing implants when the failure rate was very high.
Dental1: Do you have any heroes?
Dr. Dunsworth: I’ve really enjoyed working with a wonderful orthodontist, Dr. Michael Ragan, and an excellent restorative dentist, Dr. Tommy Ding. We’ve been taking care of one of the Lost Boys of Sudan. Mike has done his orthodontics, I’ve done his implant, and Tommy is going to do his final crown restoration. These are the boys and teenagers who walked miles and miles and miles out of Sudan across the dessert to the refugee camps. A number of them have settled here in Dallas. We’ve been taking care of them through Greater Dallas Association of Orthodontists. Straumann was been kind enough to provide the implant for our patient free of charge. It’s a neat story. We’ve been taking care of this young man and he is so appreciative of the help. He is going to be a great asset to the community.