When your entire mouth is in disrepair, your whole being suffers. Along with physical pain, there is emotional pain. Rather than unabashedly smiling or laughing, you might find yourself covering your mouth—too embarrassed to show your teeth. Being unable to express your joy is a serious matter.
Dr. Renee Camara, a periodontist at Wayzata Periodontics and Implants, remembers a patient in her mid-60s whose gums were covered in amalgam tattoos, benign tissue discoloration due to exposure to small silver filling fragments from extensive dental work done throughout the years. They were easy to spot when she smiled, since she had a high lip line. She also needed crowns on her two front teeth, along with implants to replace some missing teeth. “One of the first procedures that I did was try and remove all these tattoos,” Camara says. “And it was night and day. Right after that surgery she said, ‘Oh, I’m already better. I’m done.’ I’m like, ‘No, you’re not.’”
Camara’s patient was determined to complete her oral care plan. That was 12 years ago. Since then, her demeanor has completely changed. “She used to cover her mouth when she smiled,” Camara recalls. “And she used to put her face down. She suddenly became this person that laughed out loud.”
Dental specialists are helping change the mouths—and lives—of many Twin Citians. We interviewed some of them: two periodontists, a prosthodontist, and an oral and maxillofacial surgeon. See how they help patients navigate the stages of care and challenges in treating highly problematic dental issues.
Read on to discover the nearly 250 dentists who have been named to the 2023 Top Dentists list.
Tackle Gum Disease
Patients with problematic gums need to get their gums—the foundation of their oral health—in working order before moving forward with crowns, veneers, or implants. “Fifty percent of the bacteria in your body is in your mouth,” says Dr. Shahir Malek, a periodontist at Twin Cities Periodontics in St. Louis Park.
“The first line of defense is always to do a deep clean,” Malek says. “Then we usually wait about four to six weeks. And then we reevaluate and see how everything’s going.”
“Periodontics is the branch of dentistry that helps the body heal,” Camara adds. “More than replacing a tooth, most of the treatment is helping the body heal from disease from local factors. For example, a patient that hasn’t been to the dentist for a long time might have plaque and bacteria around their teeth and root surfaces, or their gums bleed when they brush. The periodontist does a deep cleaning—scaling and root planing. By removing all that plaque and calculus [tartar], and by reducing the levels of bacteria in your mouth, your gums are going to heal, and they are going to feel so much better.”
Before moving on to the next phase of their dental plans, patients must prove they can sustain oral hygiene habits. “Some patients are really eager to move ahead,” Camara says. “[But] we can’t be responsible for all the extra work that we’re going to put in there unless they can maintain it.”
Work Together to Solve Issues
Dr. Lisa Fedor James, a prosthodontist at James Prosthodontics in Plymouth, calls fixing mouths a team effort. Patients with multifactorial needs will likely require one or more additional dental specialists working toward a common goal. “A good example is a patient who will need a comprehensive reconstruction with dental implants,” she says. “I don’t do surgery in my practice. So for these patients, I’ll plan a type of restoration or prosthesis that’s going to fit their situation. Once that’s been determined, I’ll refer a patient to an oral surgeon or a periodontist to assess their surgical needs.
“I tell patients it’s like building a house,” she continues. “The surgeon does everything that eventually you will not see. And I’ll do everything that you’re going to see. The surgeon will build a foundation, and I build and decorate the house.”
One of these foundation builders is Dr. Kirby Johnson, an oral and maxillofacial surgery specialist at OMS Specialists. “There’s a lot of discussion that goes into coming up with the best plan, and then we’ll oftentimes have two or three plans,” he says. “And then the patient decides, ‘Well, this is the direction I’d like to go.’”
An example of this is when a 42-year-old patient who was “at her wits’ end” visited Johnson. She was in pain due to tooth decay (on most of her teeth), and the recommended treatment plan was to have dentures. “You could see how this really had affected her,” Johnson says. “So we talked about her life and what she wanted to do if she could wave a magic wand. In two or three years, where would she like to be? And it wasn’t with dentures.”
However, she didn’t understand there were alternatives. Johnson discussed all of her options, including trying to restore her teeth with some fixed bridgework, removable partial dentures, and implants to support a lower denture or a lower fixed bridge. “She was most interested in restoring her missing teeth with implant-supported crowns and doing veneers and crowning some of the teeth,” he recalls.
It was an expensive path, so she staggered the procedures. Four years later, she’s happy with the results. “She’s been done for about a year and loves her smile. And she has a really good job now,” Johnson says. “She’s smiling all the time.”
Before a periodontist or an oral and maxillofacial specialist places the implants, a prosthodontist will communicate where they want the teeth to be located “so that we can plan the implant depth and trajectory to make things meet the expectations of what they should be,” James says.
She continues, “A common situation for [a periodontist or an oral surgeon] is congenitally missing lateral incisors. They’re the two smaller teeth next to your upper front teeth. We see a lot of precollege and college-age women and men who can have these teeth restored or replaced. Because they’ve never had the teeth, they’ll generally need some bone grafting, and then they’ll need the implant placed [both of which the periodontist or oral surgeon will do]. So, it’s kind of going back and forth and making sure the team has planned everything.”
Address Failing Teeth and Irreversible Bone Loss
Unfortunately, a deep cleaning won’t restore bone loss caused by gum disease. However, the grafting of bone and soft tissue can restore your mouth’s architecture—soft tissue grafting improves recession; bone grafting corrects other defects. “You get rid of the recession so that it looks like you didn’t have recession,” Camara says.
For patients with a healthy bone base, an immediate implant with an immediate provisional (i.e., temporary) crown might be the ticket (or at least a traditional implant is an option). Malek is one of only a few periodontists who do the procedure.
The traditional procedure requires the removal of the tooth, then doing a bone graft and letting it heal for three months; then the implant is placed in the jawbone, where it heals for another three months; after that, the permanent tooth is ready to be placed.
With an immediate implant, Malek can do the bone graft, place the implant, and attach a temporary tooth all in the same day—as long as gum disease and bone loss hasn’t occurred. Malek believes it looks more natural. “It is the most aesthetic thing you can do for patients,” he says. “Recent studies have found that it is better if you can do it the same day. If you do it the same day, I’m not doing any incisions, I’m not opening anything, I’m just taking the tooth out. So there’s minimal surgical procedures. Every time you go in and open up the area, you lose some gum tissue and you lose some bone. So if we have to do this over two to three procedures, things are going to shrink a bit. And they’re not going to look as natural.”
One caveat: Not everyone is a good candidate for the procedure. The patients who are can expect to be able to bite or chew on that tooth in just three months, after which apples and corn on the cob are all fair game.
Allow for the Healing Process
The time it takes to heal will vary depending on the procedure and the complexity of the treatment. “A patient that needs crown lengthening—the lifting of the gum tissue to make the tooth longer by exposing more tooth—might take six to eight weeks,” James says. “For patients who are undergoing implant care, it might take three to six months after the implant is placed until I can restore it because the bone has to grow into the pores of the implant.”
Because the entire process—from start to finish—might take up to a year or longer, James makes sure her patients stay as comfortable as possible. “One of my jobs is to make sure that throughout the course of that year, they always have teeth in their mouth,” she says. “I need to make sure they can always speak, they can always enjoy a meal, they can always smile with confidence. Almost always, I will make some sort of interim prosthesis or a temporary prosthesis that the patient is wearing while things are healing.”
Due to time constraints, there are patients who opt for quicker fixes. For example, a parent whose son or daughter is getting married in a few months might choose to get six new crowns instead of 12 months of braces. “Sometimes getting to the ideal smile takes a lot more steps than patients want to take,” Camara says. “And so if there are some of those steps that they don’t want to take, we can have a different end point and be realistic.”
Of course, there are anomalies. Camara remembers when she was in grad school, she had a patient who wanted a tooth fixed in record time. “She actually needed an implant,” Camara recalls. “She said, ‘I want it before I get married.’ And I’m like, ‘When are you getting married?’ She said, ‘Saturday.’ I ran upstairs to the prosthodontist. She and I figured it out. I gave her an immediate implant; she gave her this fantastic-looking tooth. That might have been, like, ’98. And I think I saw her three or four years ago. She still has the tooth.”
Rebuild Good Habits and Protect Progress
As with almost everything, “education is key,” James says.
For example, what are the issues that led to the patient’s unhealthy mouth? Could it be because they suffer from Sjögren’s syndrome or medication-induced dry mouth? Oftentimes, people with these etiologies will have significant dental decay because they lack the saliva needed to dilute the sugars and the acids in the food they eat, so they can never beat the decay.
For these patients, James might suggest replacing the broken-down teeth with dental implants to stop the decay loop. “I think a really good predictor of your dental future is your dental past,” James says.
That said, many other patients get themselves into trouble due to neglect, which may be the result of a mental health issue, trauma, substance abuse, a lack of knowledge about oral health, or other factors. Perhaps they are caretakers and put themselves last, or they have anxiety about going to the dentist. So when they show up to their dental appointment, Camara is sure to commend them for their commitment, which is needed if they are to improve their oral health. In fact, she believes patients account for 80 percent of their total success.
“By removing all that plaque and calculus [tartar], and by reducing the levels of bacteria in your mouth, your gums are going to heal, and they are going to feel so much better.”
—Dr. Renee Camara periodontist, Wayzata Periodontics and Implants
Once a patient completes their treatment plan, it’s important that they care for their restorations. Sometimes people are under the impression that because dental implants don’t get decay, they’re good to go and don’t need to do anything, James says.
That’s simply not true. James recommends water flossing, good brushing habits, and yearly exams so that their new teeth last.
Gum disease requires a more stringent routine. People who have a history of gum disease require cleanings four times a year because they will always be at risk of relapse, Malek says. Additional cleanings help control gum disease.
Camara compares periodontal disease to other chronic illnesses, such as heart disease and diabetes. A good maintenance plan will make all the difference to the patients she sees every few months for their deep cleanings.
Patients who get the opportunity to have a nice new set of pearly whites usually make the most of it. “People are usually highly motivated when they spend a lot of money to take care of [the problem],” Johnson says. “They get a third chance—it’s a great set of teeth. You’re back on top of the mountain.”
Focus on the Future
Camara sees patients who regret not seeking help sooner. “‘We could worry about that, but you’re here now. And I can still help you. And you are helping yourself,’” she tells them. “I think by encouraging people to show up, no matter where they are in their lives with their mouths, it’s pretty big.” “Disease never gets better,” Johnson says. “It only gets worse. It only progresses, and the problems become bigger and more complex and more expensive.” But even if things seem beyond help, Malek says, “with today’s technology, it’s never too late. No matter what stage you’re in. There’s always a solution.”
Oral health can affect not only how we feel and function on the inside but also how confidently we face the world outside. No wonder we attach such importance to choosing the right professional for everything from routine checkups to specialized care and services. The following list contains approximately 10 percent of active dentists in the 10-county metro area. Dentists pass through a multistep process before their names appear here.
As you can imagine, research is essential. We started by asking Twin Cities dentists to nominate other dentists they consider to be exceptional in the field—peers they would consult if they were seeking care. From there, we grouped candidates into specialties and evaluated myriad factors, including (but not limited to) peer recognition, professional achievement, and disciplinary history. Dentists who amassed the highest scores from each grouping were invited to serve on a blue-ribbon panel to evaluate the other candidates. At the end of this process, we selected Mpls.St.Paul Magazine’s 2023 Top Dentists, picking only dentists who had acquired the highest point totals from the surveys, research, and blue-ribbon panel review.
Of course, no list is perfect. Many local dentists who provide excellent care may have missed this year’s list. However, if you’re looking for exceptional dentists who have earned the confidence and high regard of their peers, you can start your search here. In addition to our local list, this year’s class of Mpls.St.Paul Magazine Top Dentists will join a prestigious group of colleagues, Super Dentists®, from areas around the country. That full list appears at superdentists.com.
Finally, it’s important to note that there is a strict separation between our list and the advertising that appears in this publication. Advertising has no bearing on the names found here. For more on research and methodology, please go to superdentists.com.
© 2023 Super Dentists® is a registered trademark of MSP Communications. All rights reserved. Disclaimer: The information presented is not medical advice, nor is Super Dentists a dental care referral service. We strive to maintain a high degree of accuracy in the information provided. We make no claim, promise, or guarantee about the accuracy, completeness, or adequacy of the information contained in the directory. Selecting a dental care provider is an important decision that should not be based solely on advertising. Super Dentists is the name of a publication, not a title or moniker conferred upon individual dentists. No representation is made that the quality of services provided by the dentists listed will be greater than that of other licensed dentists, and past results do not guarantee future success. Super Dentists is an independent publisher that has developed its own selection methodology; it is not affiliated with any federal, state, or regulatory body. Self-designated practice specialties listed in Super Dentists do not imply “recognition” or “endorsement” of any dental specialty certification board, or that the dentist has been trained or has special competence to practice in that area. List research concluded November 1, 2022.