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Peggy Schmitt • Geriatric Dentistry

Ask Peggy Schmitt what led her to a career in dentistry, and she will take you back to seventh grade at Springer Middle School in Wilmington.

“I had a science teacher who lit the fire of loving science in me,” Schmitt says. “He took us to the Chesapeake & Delaware Canal to look for fossils. We put on our muck boots and just walked around in the water. I knew I loved science then.”

Schmitt later went to work as a candy striper and a dietary assistant at Foulk Manor North nursing facility while she was in high school. Most importantly, she befriended dentist Mervin Wahl, and he allowed her to observe him at work.

“He was having so much fun,” Schmitt says. “I saw that and said, ‘I want to do that.’”

So she did. Schmitt graduated from Temple University School of Dentistry in 1990. After completing a year’s residency at the Medical Center of Delaware (now Christiana Care Health System), she joined her old mentor’s practice, which he had started in 1948. Since becoming part of Wahl Family Dentistry, Schmitt has become a specialist in dealing with older patients, many of whom have been visiting Wahl Family Dentistry for decades. She loves helping them keep their teeth and gums healthy, but she also enjoys discussing their lives and American history, one of her favorite subjects.

“We have a lot of fun talking,” Schmitt says.

Yet, caring for geriatric patients is serious business. As patients get older, they must pay the same attention to their teeth as they do the rest of their bodies. Lack of care can lead to rapid decay. So can certain lifestyle habits. For instance, because many older people don’t eat enough—or well enough—they supplement their diet with drinks that provide protein but also contain a lot of sugar, which can rot teeth. Some medications also have deleterious effects on teeth.

“Some of their meds can give them drier mouths, which leads to more cavities,” Schmitt says. “That means they have to eat softer foods that don’t have as much nutrition.”

Schmitt works to help patients understand the links between good nutrition and oral care, but when there is a need for repair, she is glad the technology used for implants allows creation of strong teeth that can help older patients eat more robust foods. Mostly, she wants patients to keep giving close attention to their teeth as they age.

“We hear from older patients’ children about how they want to get them in to see us,” Schmitt says. “In some cases, we will go into retirement communities or assisted living facilities to help them.”

And to continue a love of science that began with a pair of boots and exploration.

Dan Kreshtool • Endodontics

Dan Kreshtool is a third-generation dentist.//Photo by Leslie Barbaro​

It wasn’t preordained that Dan Kreshtool would become a dentist, but with a father and grandfather in the profession, it is not at all surprising that he did.

Isadore Kreshtool, who began practicing in 1913, and Bernard Kreshtool, who practiced from 1950 to 1984, performed general dentistry. Dan Kreshtool went in a different direction, endodontics, which deals with problems found inside the teeth.

“When I was working during my hospital residency, I was exposed to a lot more than general dentistry,” Kreshtool says. “I found endodontics to be quite interesting.”

He works with Jung Kim at Kreshtool & Kim Endodontics in Wilmington and is fascinated not only by the procedures he performs, but also the improving technology.

One development is the use of the same kind of surgical operating microscopes employed by neurosurgeons and vascular surgeons.

“You probably would see most dentists using some form of magnification,” Kreshtool says. “Usually, it’s like a loupe a jeweler would use. But this has much greater magnification. It’s the No. 1 thing that is making our job easier.”

Kreshtool also believes use of more modern instruments, including lasers, has helped make root canal procedures less painful and prone to better long-term outcomes. Kreshtool also says ultrasonic waves are helping to “clean things up” throughout endodontic processes.

As the instrumentation and the magnification improve, so does imaging.

“We now have machines that can give us three-dimensional views of small, focused areas instead of the whole head,” Kreshtool says. “We can get a 3D view of a small portion of the jaw that includes the structures of the teeth. It’s very helpful for cases that aren’t average.”

The Cone Beam CT Scan allows for more precise work when placing dental implants, and it can provide a greater understanding of individual teeth and the mouth in general. The result is more precise procedures that provide long-lasting pain relief.

And more success for another generation of Kreshtool dentistry.

Christopher Burns • Prosthodontics​

Even after 30 years, Christopher Burns is still passionate about his patients and his profession.//Photo by Leslie  Barbaro

In the 30 years that Christopher Burns has provided prosthodontics solutions to patients, his enthusiasm for the work hasn’t waned a bit. “It’s a great time to be in this profession,” he says.

Advancements in technology, materials and procedures have come rapidly in recent years, and they have enabled Burns to provide his patients at Delmarva Prosthodontics with better care, even if they have had serious trauma to their mouths or need major reconstruction due to the ravages of cancer.

New equipment allows for more precise measurements and better fitting of prosthetics. Improved materials provide greater durability. And the speed with which implants, crowns and other devices can be created has increased. Together, that means more efficient treatments and better outcomes for patients.

“All of this makes outcomes of procedures far more predictable,” Burns says.

When Burns started Georgetown University School of Dentistry, after completing pre-med studies at College of the Holy Cross in Worcester, Massachusetts, he had no idea he would go into prosthodontics. But after working with a fellow who described techniques used to help patients suffering from cancer and cleft palates, Burns decided to enter the field. Working part time in a lab making crowns, dentures and implants increased his interest significantly. “Georgetown’s requirements for the amount of practice you had to have were three times that of other dental schools,” he says.

After some time in private practice in Massachusetts, a residency at the Veterans Administration hospital in Elsmere and a stint as a professor at Temple University, Burns opened his current practice in Dover. During his time, he has seen the process of making crowns streamlined considerably, thanks to the ability to marry sharp photographs of the affected tooth with a milling machine that can make rough crowns in less than an hour. What’s more, the porcelain replacement tooth is stronger and better looking than previous iterations.

“In the 1920s and ’30s, you had all-porcelain crowns, but they were very, very fragile,” Burns says. “Now you have materials that are far stronger.”

Burns says the inlays can be fitted faster, fit better and are stronger than inlays of the recent past. They adhere better to gums and bond more reliably with tooth structures. Bone grafts are much better now, too, thanks to the ability to create more stable bases—especially the upper jaw—on which to attach new teeth. One more reason for Burns’ excitement is the three-dimensional CT scan, which allows for precise implantation and far better results.

As he says, it is a great time to be in the profession.

G. William Keller • Periodontics

G. William Keller has been practicing in Wilmington since the late 1980s.//Photo by Leslie Barbaro​

When it comes to crafting implants and replacing diseased teeth, G. William Keller is employing what he calls some especially “attractive” therapies.

Thanks to expanding research into human growth factors—natural substances that stimulate cell growth—Keller and other periodontists now have more precise methods of helping patients replace diseased, cracked or shattered teeth. Use of growth factors shortens recovery time and allows for a more fertile area to plant a new tooth.

“Growth factors are sort of like magnets,” says Keller, who has been practicing in Wilmington since the late 1980s. “There are all sorts of growth factors in the blood, and we use them to help regrow gum tissue.”

Growth factors are isolated by spinning blood in a centrifuge to create platelet-rich plasma that can be injected into many body parts to facilitate new growth and healing. “The PRP attracts bone cells to the site and begins the process of reconstruction,” Keller says.

Not long ago, periodontists would fashion replacement bone, insert it into the jaw, then hope for the best. When they add growth factors to the equation, the process becomes more predictable because the enhanced bone becomes a stronger base for an implant, Keller says. “The bone heals much faster around the implant.”

Keller is also excited about the improvement of materials used to make implants. Not long ago, the titanium that composed the new teeth repelled blood, which made it hard for the body to accept. New implant surfaces that attract blood allow for quicker reception. And thanks to new fastening materials and hardware such as stronger screws, implants have much longer lives inside the mouth.

“It’s definitely more reliable,” Keller says. “If we have to replace a tooth, a patient can rest assured that the new tooth will last a long time.”

Implant patients can also count on shorter recovery times, thanks to techniques that eliminate the need for stitches. “We are using what we call pinhole grafting,” inserting bits of tissue between the gums and teeth, which preserves the natural look of healthy gum tissue and lasts longer than the results of older grafting techniques. “I can do a full or a half of a mouth and have minimal post operative trauma because there are no sutures,” Keller says. “It’s a terrific technique, and the patients are much more comfortable.”

Something they no doubt find quite attractive.