Open Wide: What your dentist can really see.



An interview with local dentist George Mighion, DDS

A Picture of Your Health

The eyes may be the window to the soul, but it is the mouth that gives a true picture of a person’s overall health. 

“Dentistry is not just teeth anymore,” says George Mighion, DDS, of Mishawaka. “We don’t diagnose medical issues, but we do see indicators that call for further evaluation by a physician.”

Oral cancer is one example.

“It used to be that the typical oral cancer patient was a middle-age male, heavy smoker,” said Dr. Mighion. “But we are seeing a rise in oral cancer in teenagers because of HPV and oral sex. Yet the survival rate has not gone up.”

By the time oral cancer can be seen with the eye, it is already at stage 3 or 4. Using a special blue light called a Velscope®, dentists look deep into the oral tissues to catch cancer at its earliest stages and watch for other soft tissue abnormalities. 

Gum disease, also known as periodontal disease, is another indicator that correlates to numerous health issues. According to the American Academy of Periodontology, gum disease can indicate diabetes, inflammation, heart attacks, stroke, osteoporosis, pregnancy problems and respiratory disease.

“There is also some very new research indicating that Alzheimer’s may be linked to periodontal disease too,” adds Dr. Mighion.

Frequent dental visits are key to keeping gum disease from ruining oral health and leading to other complications. 

“With gum disease, it’s not just a six-month cleaning,” Dr. Mighion says. “You have to see the dentist every three to four months to keep the bacteria under control.”

For those who have trouble sleeping, it might seem that a visit to the dentist would be last on a list of possible treatment options. But just by examining the structure of a patient’s mouth and airway, a dentist can see indicators if sleep apnea may be the patient’s problem. A dentist cannot diagnose only an MD can do that and it is by a Sleep Study.

“I’m a snorer myself,” says Dr. Mighion. “So I started researching sleep apnea. I found that it can cut seven years off a person’s life due to a related heart attack, stroke or accident. It is something to take very seriously.” 

Dr. Mighion looks for other indicators—such as GERD (gastro esophageal reflux disease), high blood pressure, teeth grinding, morning headaches, enlarged tonsils, scalloped tongue and a large tongue—to determine if a sleep study or a referral to ENT (ear nose and throat doctor) is warranted. 

Some orthodontists and dentists wait on orthodontic treatment so it becomes necessary to extract the four first premolars to have room to straighten the teeth. This narrows the upper and lower arches hence the air way also becomes narrow. “For this reason, I like early orthodontic intervention (as soon as the six year molars erupt) where the orthodontist can do rapid palatal expansion as phase one treatment. This will open the airway more and the child will not have to have four healthy teeth extracted,” explains Dr. Mighion.

When called for, Dr. Mighion can recommend one of two basic oral devices to counteract sleep apnea. One is known as the CPAP, a breathing device that delivers “continuous positive airway pressure.” 

However, “Some people are claustrophobic when wearing it and the device is hard to travel with,” Dr. Mighion acknowledges.

An alternative may be an oral appliance, a device that comes in many versions.

“An oral appliance brings the jaw forward, preventing the tongue from collapsing at the back of the throat. It makes the airway wider for improved breathing,” he said. “Oral appliances are becoming more standard for mild to moderate sleep apnea. It is definitely more comfortable than the CPAP.”

Dr. Mighion cautions, however, that even though over-the-counter oral appliances or those sold on TV may stop the snoring, they don’t take care of the serious breathing issue associated with sleep apnea. They are not FDA approved for either snoring or sleep apnea.

Good oral health is tied to overall health in other ways.

“Digestion starts in the mouth,” says Dr. Mighion. “If your food is not chewed properly, you may have stomach and intestinal problems. If you have TMD (temporal mandibular disease), you can experience headaches or pain upon opening your mouth. Your body has to be balanced.”

Latest Technologies

As with other medical disciplines, dentistry continues to benefit from new techniques and procedures. One in particular that makes many “dentist-averse” patients happy is sedation dentistry, which can be delivered either orally or via an IV. Dr. Mighion’s practice offers oral sedation. 

He also cites the improvement in implant as another great advance.

“These materials have come a long way,” he says. An artificial root topped by a crown, an implant is the most lifelike substitute for a real tooth. “We used to do bridges for missing teeth. Bridges are cheaper than an implant and crown, but the implant and crown will last much longer and it looks better.” 

The improvement in implants benefits denture wearers, too.

“It used to be that your chewing capacity when wearing dentures was only about 20 percent,” Dr. Mighion says. “With implants, chewing capacity is much improved, especially with the lower as it will stabilize and secure it.”

Other medical advances are helping dentists peer much deeper than ever before. Take the 3D ConeBeam, for example. It sounds like something out of Star Trek, but is simply a quick and painless CT scan that provides remarkable views of the face, neck and teeth. These views help dentists create treatment plans for a variety of conditions.

“With the 3D ConeBeam, we can see everything much more clearly,” Dr. Mighion notes. “If a root canal keeps failing, for example, we can use the 3D ConeBeam to see if the failure is being caused by gum disease or something else. It’s a great tool to have to help our patients achieve the best oral health possible.”

CAD/CAM technology has made it possible for getting your crown in one visit. No more second appointments, worrying about your temporary, and you don’t have to get numb again.  Dr Mighion has the E4D CAD/CAM unit.

Back to Basics

Even with all the new technology and devices, the first step toward good dental health begins with two small objects: the toothbrush and floss.

Three times a day with the toothbrush is, and always has been, the standard. But just a swipe won’t do. You need up and down, side to side, and swirling motions to get at every nook and cranny.

As for flossing, “You want to disturb the biofilm, the bacteria between the teeth,” says Dr. Mighion. “Everyone has colonies of bacteria between their teeth, and flossing helps flush these colonies away. Toothbrushes cannot do this on their own. The bacteria can cause gum disease, which you can give to others through your saliva. Gum disease also causes bad breath.”

Unfortunately, gum disease is like a stroke. You don’t know you have it until it happens. 

“You realize you have it when your teeth start getting loose,” Dr. Mighion says. “Gum disease is a chronic condition that can become acute and produce an abscess, which is a huge infection that sometimes drains into the body, taking the infection elsewhere.”

So the next time you’re pondering a dental visit, remember that your dentist is a vital partner in maintaining good overall health. And that’s certainly worth smiling about.