By: Michelle Alford for Dental1
Teresa Cody, D.D.S., graduated from The University of Texas Health Science Center at Houston in 1992. She is a co-owner of Cashion and Cody Family Dentistry, where she has worked as a dentist and orthodontist for eighteen years. Dr. Cody specializes in orthodontics, the study and treatment of improper bites. When her daughter needed braces and the orthodontists she spoke to wanted to pull out teeth, she knew there must be a better way. Now, hundreds of hours of orthodontic training later, she has implemented a policy of non-extraction braces whenever possible.
In addition, Dr. Cody has a special interest in treating children with special needs. She understands the difficulties parents of these children can face getting dental treatment. She and her husband have also started a non-profit organization to support further research and treatment of individuals with Down syndrome.
Cavities actually form from the inside out. Not long ago, it was commonly believed that cavities formed from the outside in. However, once fluoride was introduced into the population, it made the outside of the tooth harder like it was expected to – but people still got cavities. So, dentists looked at the tooth and discovered that the cavity starts on the inside, in the second layer of the tooth called the dentin, and then when it becomes big enough, the outside enamel falls off and it becomes visible. “Just using a probe to find cavities is probably not enough. We use a laser cavity scanner. It scans a laser beam in and reflects back the hardness of the tooth. That way, you can find them early when they’re little cavities so you don’t get big holes and big fillings which are destined to break down and lead to crowns and possibly root canals.”
Some people are more prone to cavities. Cavities can be caused by sugar, acid, and bacteria. Bacteria is opportunistic. If someone is sick, that bacteria may move into the teeth. In addition, some people’s saliva is acidic, which puts them at higher risk of developing cavities.
Microdentistry is a philosophy in which the goal is to make the smallest hole to clean out decay possible. The old philosophy was called ‘Extension for Prevention.’ Dentists extended the preparation into all the grooves and all the pits on the tooth so that patients couldn’t get decay in those pits again. Unfortunately, this led to teeth breaking down and patients needing crowns. Microdentistry takes the opposite approach. Instead, dentists take out only the diseased part of the tooth and leave as much sound tooth as possible. For that, dentists need equipment that will make a very small hole. “We have two pieces of equipment in our office. One, called air abrasion, has a very small head and sends out small particles of sand that clean the tooth out like a sand blaster. The other one is a laser called waterlase that actually activates water particles and the water cleans out the tooth. Between those two pieces we don’t need to pick up the drill too often.”
There are two philosophies in orthodontics of how to treat people with overcrowded teeth. One philosophy is to wait until all the permanent teeth have erupted and either fit them together as best as you can or extract four teeth to make room. “My philosophy,” says Dr. Cody, “is to try to treat the patient as early as possible and expand the bone so that there’s more room for the crowded teeth. I have found that to be a more aesthetic smile, a bigger smile. It’s more pleasing, and it works better, if you keep all the teeth.”
As a child, Dr. Cody was terrified of dentists. She has since made it her goal to make visiting the dentist as pain-free, even pleasant, as possible. She is continuously researching, developing, and implementing new technology to improve the atmosphere and experience for her patients—including providing movie goggles to watch videos during procedures and utilizing the latest laser dentistry technology. When she couldn’t find a topical cream to numb gums that worked well enough, she had one specially formulated and made at the compounding pharmacist.
Breathing incorrectly could cause common mouth and jaw conditions. People should breathe through their noses with their mouths closed and their tongues sitting on the top of their mouths. That keeps their maxillas—their top jaws—open and big because people have muscles on the outside pulling down all the time. However, if people breathe through their mouths instead of their noses, they put their tongues on the floor of their mouths and the tongue never touches the roof. This causes a very high palate and the teeth become sunk in and usually stick out. “I treat many developmentally disabled children with orthodontics because they tend to have this problem. They often breathe or swallow incorrectly, and many times they’re much more severe and require more appliances. My philosophy is, if I can get them a better shape, they’ll have better speech, better swallowing, better function, and maybe they’ll be able to breathe correctly.”
A special dental appliance can help patients with sleep apnea. Sleep apnea in adults is caused by the throat muscles becoming floppy and collapsing during deep sleep. The current gold standard of treatment for sleep apnea is a C-pack, which pushes air down the throat, but many people have problems with it. “What we can do in dentistry is I use a sonogram that goes down and measures the opening of the throat. We can simulate you sleeping, see how you collapse, and I can make a dental appliance that you wear at night that keeps the throat muscles more toned. If it’s severe, that’s usually not enough so people will use the C-pack as well as the dental appliance. This may sound like a lot, but they can turn the C-pack way down so it doesn’t require as big of blasts of air.”
The sleep apnea dental appliance works by slightly moving the jaw. Studies show that when patients sleep, often their jaws move backwards and collapse part of their throats. Moving the jaw helps to tone the throat muscles. “What we’ve seen in practice is that the more the patient wears the appliance, the more the throat will stay toned during sleep, but as soon as you stop wearing it, it goes away. It’s not a permanent change, but some patients are now able to wear their appliance three nights a week instead of every single night.”
It’s possible for a patient to help their sleep apnea by learning how to breathe correctly. Patients can train and relearn how to breathe. The problem with breathing is people don’t usually think about it. The same is true for patients who don’t swallow correctly. “Swallowing and breathing are very hard to retrain, but it is possible if the patient is willing to work at it.”
Certain speech problems are related to the way the mouth is built. If people’s mouths are more normal shapes, they can utilize it more normally. If their mouths are so narrow that they cannot fit their tongues in, they cannot fit their tongues in no matter how much they try. “I have a patient who wasn’t developmentally disabled, but she just didn’t talk. She couldn’t make the sounds properly and she knew it. We have now expanded her and she talks beautifully. She doesn’t need speech therapy because she can physically do it—she just didn’t have the right structure to do it. I also saw a little boy whose tongue was tied down and he gave up. There are little fibers that hold your tongue between your lip and your bone. As soon as those were released, he started talking. It was there, but I guess he just got frustrated. He was only four, but he gave up.”
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