Are You a Patient or a Person?

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FOR PEOPLE WHO COULD BE PATIENTS:

The lawn service can’t talk to me as a person.  I’m a client.  I can’t be treated as an individual- as one would treat one’s friend.  I have to fit in to the company’s policy.  We cannot have a conversation about what I really want.  I’m not asked.  My voicing such is always a complaint, a thorn not fitting in to policy.

Companies are not held to a standard of relationship that friends hold each other to.  Friends WANT to have those standards: to be known as an individual, to know another as an individual, to celebrate and respond to those differences.

Company policies justify such obtuseness by saying they can’t make money treating everyone as individuals, policy is required.  The company could not exist without a standard policy giving average service satisfactory to most of the people most of the time.  It’s never about excellence, something one would want to give a friend.

Excuses for such diminishing treatment: the company has to see too many people to treat people as individuals.  It would cost too much.  The company couldn’t make a profit.  It would go out of business doing that.  It would take too much time.

We tolerate such generic treatment.  Just average me into your schedule and give me your average service.  You are an average company, caring an average amount.  I’m only worth average treatment and consideration.  That’s all I want and expect.

How disappointing a life!  Most of our interactions are with such companies treating us like this.  We expect to BE a PATIENT, rather than being a PERSON having a feeling of being patient.  Moo.  Don’t stand for it!

Expect more. Ask for more.  You’re worth more than that!  It’s definitely OK to ask for better treatment. We are worth it.

FOR US, GIVING YOU SERVICE:  (Here’s how we talk to ourselves:)

If I don’t like getting treated as a client, with crummy policy brush-offs, instead of as a person, I CERTAINLY don’t want to slip into this mindset when I’m acting as a company’s (my practice’s) representative having a relationship with a person.  Really listen to each person.  Want to hear her individual concerns and values and respond appropriately- because you went off automatic to listen and hear what she just said.

Don’t be a policy wonk.  You have to think.  Be yourself, with this truly exceptional mindset.  Be genuine and authentic.  Policy, jobs, companies, businesses AND OUR PRACTICE should be a starting point to get real: a guideline only so you can be individual, prescriptive, authentic and genuine, wanting to catch differences that pull your best out of you to give a person something of value TO THEM.

Almost nobody’s doing this.  It’ll be exceptional and pretty sensational, really.

Giving like this to another person, your best, you are giving it to yourself as well.

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W Bryon Satterfield, DDS, MAGD

General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

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Do You Grind Yo…

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Do You Grind Your Teeth?

It’s a 99% chance the answer is “Yes,” whether you know about it or not!  It doesn’t always cause damage, but most of the time it does.  Here’s what gets damaged and how:

1. Teeth: early wear, cold-sensitivity, broken cusps or fillings, and “abfractures” (deep notches on the sides of  teeth).

2. Jaw Joints: clicking, popping, grinding or pain when chewing.  This causes headaches and ringing in the ears.

3. Gum tissue: visible recession, pocketing and tenderness.

4. Bone: invisible bone loss and mobility of teeth.

Many, if not most, people I ask about grinding their teeth don’t know they are doing it.  It normal and expected, occurring during dream-state sleep.  Your dentist has to tell you if there are any signs of damage.

 A nightguard prevents damage from occurring.

If damage is already present, this appliance can stop it from worsening.  This is important to help you keep your teeth, jaw joints, gum tissue and bone healthy and comfortable for your entire life.  Wear and damage slowly accumulates over your lifetime.  The nightguard is a very simple means to take care of yourself in an important way.  The earlier you start, the better.

How Does a Nightguard Work?

It relaxes muscles in your jaw.  Grinding usually stops.  If you still grind, your teeth are protected, forces are spread out, preventing damage.  The appliance looks like a retainer and covers all of one arch.  The acrylic surface of the nightguard prevents teeth from fitting into the grooves of teeth in the opposite arch.  This makes it impossible to contract the strong muscles of the jaw because there is nothing to lever against.  Grinding stops or is reduced to a harmless level.

Your dentist has to adjust the appliance very precisely, actually better than your natural bite.  If it’s not, the muscles won’t ever relax completely and the appliance can’t do its job.  Nightguards should be comfortable, making jaw muscles feel a lot more relaxed.  You need a dentist who gives particular attention to detail to get this result.  Without adjustment, it can’t work.  I expect my nightguards to last an average of 10 years.

Ask your dentist to evaluate your need for a nightguard, especially if you have any of the symptoms described.  It will pay a priceless lifetime benefit for your health and comfort.

W Bryon Satterfield, DDS, MAGD

General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

Good Questions on Replacing Amalgams

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A reader wrote in with some very good questions and specific concerns.  Many people need the same information. So here is more on replacing amalgams as I answered John’s questions:

Dear Dr.Satterfield:   I’m in the process of replacing all of my amalgams. They replaced all single surface fillings with composite.  Several teeth had fractures and required gold crowns.  The dentist recommended replacing a very large filling with composite, then covering it with a crown.  Does this sound OK?  I would personally like the whole thing done in gold.

The crown procedure sounds exactly right.  Too-large fillings can’t get necessary support from the tooth. Cracks form under fillings, unseen. When doing a crown, all old filling material must be removed. The tooth must be verified strong and all decay removed.  Composite is excellent for building up the missing tooth structure prior to placing a crown.  It is bonded to tooth structure (sticks to enamel and dentin very strongly) and supports the tooth.  Even with very large composite build-ups, a crown covers it all.  A well-done crown should last 18-20 years.  I see 30 and 40-year-old crowns every day.  It’s a proven and time-tested combination.

For a number of years I did not do build-up fillings before I did crowns. I now do build-up fillings on every tooth that needs it before a crown (some don’t).  I learned the laboratory technician who makes the crown can do better fit and accuracy when the tooth has an ideal shape.  No build-up means the tooth cannot be shaped ideally.

A 2nd question:  Which is best:  replacing large multiple-surface amalgams with composite fillings, inlays and onlays, or should I just do the crowns?  I have been to 4 dentists asking this question.

Narrow composite fillings can last as long as a crown, 10-20 years (they have more variation).  Medium and large size fillings do not last a long as a crown.  I would get inlays and onlays from a dentist who does them regularly and is good at fitting them.  Usual treatment is to have a filling last as long as possible, then go to a crown.  The best inlay still allows the tooth to fracture.  Very many fractures are invisible until the filling is removed.   A crown is then necessary to prevent splitting.  There is no other way to stop the fracture. A crown makes the tooth stronger than original.

3rd Question: I am getting a lot of info slanted toward the abilities or expertise of the dentists rather than what is the best solution for my problem.

How to tell:  It is important to have your dentist (as well as the lab technician) do what he or she is best and practiced at doing. I want the least amount of treatment that truly makes your teeth stronger for your specific bite.  That is not always a crown.  It needs to be prescriptive for you as an individual.  I know what Dental Schools are teaching, having taught for 16 years.  I do clinically what the best- studied dentists at Dental Schools recommend.  You need a dentist who recommends treatment specifically to add strength for your teeth and bite, as well as for your circumstances.  Your dentist should always use magnification.  I would never go to a dentist who didn’t.

Other things to consider:  What is your age?  A filling makes sense, now, in your 20’s, then a crown 10 years down the road.  Dentists should always consider all restorations might need replacement after 10 or 20 years.  We just can’t tell which restorations at the time of placement.  Two replacements of a crown is pushing the limits of the tooth restorability.  Do you grind your teeth?  Wear on teeth and broken or worn fillings indicate a strong bite and faster breakdown of fillings and even some crowns.  A nightguard is a requirement to help stop night grinding damage to teeth and bone structure around teeth.  How are you choosing your dentist?  Often Dental Schools have a recommendation for a conservative, quality dentist trained in doing a thorough, comprehensive exam and treatment plan designed specifically for you.  Ask questions.  I welcome all questions.  A competent dentist should discuss all possible treatment and options, including treatment weaknesses, without pressure, answering all your questions.  He or she should ideally act as an advisor, giving you enough information to allow you to help 50% on deciding what treatment is best for you and the reasons why.

W Bryon Satterfield, DDS, MAGD

General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

How Old are Your Silver Fillings?

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How Old are Your Amalgam Silver Fillings?

   Sound Filling? – Maybe

      The American Dental Association recommends against replacing sound amalgams (silver fillings).  I agree­.  Is the tooth itself sound, though?  We can’t tell.  Neither a visual exam or x-rays show hidden cracks.

 I have been surprised by blackened, leaking and fractured teeth under amalgams so many times in 30 years, it’s not true.  I now expect those problems.

 5 Good Reasons to Replace Amalgams:

(Photos of my own actual patients)

1. Age of the filling.

Old amalgams leak, wear and discolor teeth.

2. Fractures.

Normal chewing fractures teeth, more from grinding.  Some amalgams expand after 15-20 years, causing hidden cracks.

 3. Leakage.

 Amalgams weren’t bonded.  Tooth-colored composite fillings are bonded to both enamel and dentin.  This stops leakage.  It’s better technology.

4. Discolored teeth.

Most amalgam leakage turns the tooth underneath very black.  It’s not decay, but it’s usually permanent and can discolor the entire tooth.

5. Extra-large size.

Any excessively large filling weakens the tooth.  Teeth with big fillings break more often than teeth with smaller fillings. Often a crown is required to add strength back.     This shows the amalgam removed and cracks under both outer cusps.

 It is so much better to fix a small problem than wait until part of the tooth is lost completely.  Ask about replacing your old amalgam filllings.  Your teeth deserve it!  Take care of yourself!

W Bryon Satterfield, DDS, MAGD

General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

Temporary Crowns Coming Off?

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Temporary Crowns Coming Off?

What’s with temporary crowns coming off?  Last week I tried to remember the last time a temporary crown I made came off.  I couldn’t.  More than five years ago?  It’s been a really long time.  One patient fractured the back quarter of one off last year.  The rest of it stayed on.

ImageTemporary Crowns Should Fit as Good as the Permanent Crown!

I get temporaries to stay on even very short teeth.  The keys:  superb fit, retention grooves in the real tooth, solid contact between teeth, anatomic grooves restored in the temporary crown and polished to super smooth.  They just don’t come off.

What an inconvenience, losing a temporary crown!  The tooth is sensitive, an extra appointment, maybe with numbing.  Temporary crowns should stay on with no problem.  I don’t use any super cement for them.  It has to be weaker than the permanent cement, but it should not be an excuse for the temporary crown to come off.

Here’s what you should expect from your temporary crown:

        1. Stays in place securely until the permanent crown is ready.

        2. No sensitivity.

        3. No food trapping.

        4. Looks and feels like your own natural teeth, or better!

If cold drinks, food or air cause discomfort, the edge of the temporary crown is probably short of the margin.  Shouldn’t happen.Image

If food traps between teeth, there is a gap allowing it.  Shouldn’t happen.  The gum tissue will get sore and bleed easily.  Not a good thing when the permanent cr own is being cemented.

My goal for how good a temporary crown should look on a front tooth is this:  it shouldn’t attract attention at normal speaking distance and look like it could be one of your own teeth.  Any temporary crown can be veneered with composite to get it to blend in with your natural teeth.  I have to do this regularly to put the three natural shades in the temporary crown.

I take literally my job to “restore” teeth.  Even temporary crowns.  They should stay on- and be at least reasonably like your own or better.  Don’t settle for less!  Your teeth are too important.

Image   W Bryon Satterfield, DDS, MAGD

General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

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The Myth of No-Prep Veneers

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The Myth of No-Prep Veneers

What do these pictures tell you?

Whiter, larger teeth. Actually too-white, but

still improved looks. Not much else.

I couldn’t find out:

1. Is this healthy for gum tissue?

         2. What maintenance is required?

         3. Will veneers have to be replaced?  When and why?

         4. Can I still bite into anything?  (No)

 There are two main concept flaws with “no-prep” veneers:

         1. The sides of teeth MUST be reduced:

                  a) to avoid the finished veneers being too bulky (over-contour is bad for gum tissue long-term), and

                  b) to have a significantly lighter shade.  Too-thin veneers can’t mask dark teeth.

         2. A groove on the front of the tooth is REQUIRED for a healthy finish line at the gum level.  A no-prep finish line veneer is jagged and leaves rough cement; both are irritating to gum tissue.

Seek out a dentist who helps you fully consider all treatment options in harmony with YOUR values.  Be sure to consider the maintenance necessary and the possibility of replacing all veneers completely in 15 years.

Getting veneers to slightly improve already good looks is short-sighted.  Consider bleaching and recontouring first, because neither requires tooth reduction.

I place excellent and healthy veneers when necessary.  They are the right treatment when done meticulously, correcting spaces, shapes, fractures and very discolored teeth.  For veneers to be healthy and predictably last as long as a crown (18-20 years or more), preparation is ALWAYS required.  No-prep is a myth when health and longevity are considered.  (Actually for looks, too.) The most advertised no-prep veneer laboratory required shortening all lower teeth 1 millimeter.  That is OK for a conventional porcelain veneer, but 100% too much for a veneer claiming to require “absolutely no preparation.”

My highest guiding principle is: PRESERVE AND PROTECT WHAT WE DID NOT CREATE.  Hold the health of your teeth as your highest priority. Don’t get your teeth reduced if you don’t have to.  No-Prep veneers are not the answer.

 

W Bryon Satterfield, DDS, MAGD General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

Why You Should Use Fluoride Toothpaste

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Below is an example of an article I read to use for reference when making recomendations to my patients.  It is independent and done by degreed researchers.

Bottom line in this article:  using toothpaste without fluoride allows decay that otherwise would not occur.  13% more decay occurred in school children who used a low-fluoride toothpaste. Stopping use of fluoride toothpaste is not a good idea.  It does not cause fluorosis.

I promise not to subject you to any more scientific articles!-)

www.medscape.com

                          Authors and Disclosures:  Journalist:

Laird Harrison; Laird Harrison is a freelance writer for Medscape.
Laird Harrison has disclosed no relevant financial relationships.

From Medscape Medical News > Conference News

Studies Show No Advantage to Low-Fluoride Toothpaste

Laird Harrison

March 30, 2012 (Tampa, Florida) — Low-fluoride toothpastes do not reduce the risk for fluorosis but increase the risk for caries in very young children, according to a meta-analysis presented here at the American Association for Dental Research (AADR) 2012 Annual Meeting.

“There is no evidence to support the use of low-fluoride toothpaste in preschoolers,” said principal investigator Ana Santos, DDS, MS, PhD, a professor of dentistry at the University of the State of Rio de Janeiro, Brazil.

Recommendations from professional organizations around the world vary widely in the concentration of fluoride recommended for preschool children’s toothpastes, with some recommending “low” concentrations — below 600 ppm — and others recommending “standard” concentrations of 1000 to 1500 ppm, Dr. Santos said.

Toothpastes with less than 600 ppm of fluoride are available in many countries, including Europe, Australia, and Brazil, whereas in others, including the United States, fluoride toothpastes must contain a higher concentration.

The debate about fluoride concentrations in toothpaste is intensifying as more fluoride has been introduced in community water supplies and mild fluorosis is diagnosed in more children.

“In Brazil, we are in the middle of a discussion because it’s very difficult to convince people that all children should use standard toothpaste,” said Dr. Santos.

Toothpaste is a major source of fluoride in young children. “As we know, children tend to swallow a substantial amount of toothpaste when brushing,” said Dr. Santos.

Although low-fluoride toothpaste is not available in the United States, some standards-setting groups in the United States are debating whether to allow it, session moderator Clifton Carey, PhD, professor of cariology at the University of Colorado, Denver, who is involved in the discussions, told Medscape Medical News. “The FDA [US Food and Drug Administration] is awaiting clinical data,” he said.

To see what research has already been determined on this issue, Dr. Santos and her colleagues systematically reviewed 1932 records and 159 full-text articles on the subject. From these, they found only 5 clinical trials that measured caries or fluorosis.

Pooling the results on 4635 participants in 3 of the studies that looked at primary teeth, they found that those brushing with low-fluoride toothpastes had 13% more decayed, missing, or filled teeth than those brushing with standard toothpaste (relative risk, 1.13 [95% confidence interval (CI), 1.07 – 1.20]).

Combining data from 2 of the studies with a total of 1963 participants, they found that the low-fluoride toothpaste did not significantly reduce the risk for aesthetically objectionable fluorosis in the upper anterior permanent teeth (relative risk, 0.32 [95% CI, 0.03 – 2.97]).

“It would be reasonable to accept that using toothpaste with low fluoride should reduce the amount of fluorosis, but that’s not what the studies show,” said Dr. Santos.

A high concentration of fluoride in toothpaste may be important because the fluoride comes into direct contact with teeth, Dr. Carey pointed out.

But he said it might be possible to change the formulation of toothpastes so that they reduce the risk for fluorosis while maintaining their power to fight caries. One approach might be to change the other ingredients, which affect the bioavailability and stability of the fluoride, said Dr. Carey, who was not involved in Dr. Santos’ study.

Dr. Carey and Dr. Santos have disclosed no relevant financial relationships.

American Association for Dental Research (AADR) 2012 Annual Meeting; Abstract #1176. Presented March 24, 2012.

Medscape Medical News © 2012 WebMD, LLC
Send comments and news tips to news@medscape.net.

W Bryon Satterfield, DDS, MAGD   General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

Gum Tissue Recession

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GUM TISSUE RECESSION

   Gum Tissue Recession on Two Teeth 

4 things cause the most recession and root exposure:

1.Age

         Slight, level recession is normal.  Healthy gum tissue is a fixed distance from the bone.  Your gum tissue level reflects the bone level underneath.

2. Brushing Too Hard

   Abrasion and Recession on Two Teeth

         Never use a hard toothbrush!  Soft or extra soft only.  The Sonicare electric toothbrush is the kindest to gum tissue.  Never use a toothpaste without the ADA Seal of Approval, either.  The Seal assures the abrasive is not too rough.

3. Periodontal Disease

  Note no recession in Early Stage

          This is bone loss underneath the gum tissue, caused by bacteria, not brushing and flossing enough and genetics.  Get checked at your dentist to be sure you don’t have it.  Recession here is advanced disease.

 4. Your Bite       

   Normal Contact Between Teeth      

          Hitting too hard on one tooth causes recession, and often notches in the root of the tooth itself.  Grinding your teeth can cause recession around all your teeth.  A nightguard made by your dentist is needed to stop it.

         A deep overbite can cause gum tissue recession, too.  The teeth actually contact the opposing soft tissue, exposing the roots of teeth.  Braces are usually required to fix the cause; sometimes a nightguard is enough.

 Most recession does not need treatment.  To tell if it does, answer these 4 questions:

          1. Is the tooth sensitive?

         2. Is the gum tissue sensitive?

         3. Do food particles stick to the area after eating?

         4. Does it look bad to you?

If any ‘yes’ answer is important enough to you, see your dentist and hygienist and get it fixed!  Most fixes are one appointment.  Your teeth are important.  Take care of the surrounding gum tissue and bone to keep them your entire life.  You have only one chance!

W Bryon Satterfield, DDS, MAGD   General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

One Sensitive Tooth- Why?

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ONE SENSITIVE TOOTH- WHY?

    Recession of Gum Tissue

Do you have a sensitive tooth that looks like this?  If cold drinks or sodas cause pain that goes away quickly, it is probably root sensitivity.  Touch by a toothbrush or fingernail can be sensitive, too.  This is very common and can be stopped.

Use the easiest remedy 1st: Sensodyne toothpaste and cut down on acid drinks and foods. See my blog from March 3rd, Stop Teeth Being SensitiveIf this doesn’t work, your dentist has to help.

 

The easiest dentist treatment is sealing the root with a bonding liquid.  This works like magic most of the time.  No drilling, no numbing and it doesn’t hurt.  It’s amazingly simple.  Sometimes this is a lasting treatment.  Some teeth become sensitive again after 6-18 months.  Repeating the procedure is simple.

 When these 1st three treatments don’t work, a filling is required.

    Before         After

I expect root fillings to stop the root sensitivity completely.  They look good and match the enamel color of your tooth.

One tooth feeling very sensitive is not the same as when all your teeth are mildly sensitive.  Try simple fixes first.  They work most of the time!

Next blog:  WHAT CAUSES RECESSION, ANYWAY?

W Bryon Satterfield, DDS, MAGD   General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com

Do You Have a Cracked Tooth?

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DO YOU HAVE A FRACTURED TOOTH?

     Common Fracture In Molar

How can you tell if you have a fractured tooth?  The most common sign is pain when biting into something very hard.  You feel a sudden jolt, then it’s over.  You can chew most of your meal without that jolt.  It happens only occasionally.

The most described symptom is “rebound pain.”  That is when the jolt occurs after biting down, when you release pressure on the tooth.  I have not seen that symptom as often straight biting pain, but it happens.

As the fracture advances, the tooth becomes more sensitive.  The jolt starts happening while chewing everything, no matter how soft.

   Crown Makes Tooth Stronger

What’s the fix?  The tooth requires a crown.  A crown is the only restoration which actually makes the tooth stronger.  The crown surrounds the tooth 360° and stops the fracture from spreading.  It is a common but major remedy necessary because no filling can give that same protection.  In fact, most fractured teeth have a pre-existing filling.

Fractures very frequently occur without any discomfort at all.  A tooth section is suddenly and unexpectedly missing.  Fractures also occur silently underneath old amalgam fillings.  I see very many cracks in teeth when I’m replacing a filling for other reasons.  Sometimes the fracture is so pronounced that the tooth requires a crown after the filling has been placed. (Fillings can’t stop cracks.)

    Centerline Fracture Under Filling (Filling Removed)

A fracture very often occurs right in the centerline of the tooth.  I worry about this the most because it’s headed for the nerve and between roots.  It’s rare, but some teeth can’t be saved even with a root canal and crown because the fracture has gone too far.

     Treatable by Bonding        

What’s the best remedy?  Get the tooth checked by your dentist if you have pain that lasts more than a few days.  Avoid chewing on that tooth.  Don’t let the fracture get worse.

How to Prevent Fractures     

  1. Don’t chew ice.
  2. Avoid chewing on foreign objects like the caps of pens or fingernails.
  3. Avoid ridiculously hard foods like Corn Nuts or jawbreakers.
  4. Get a night guard if you grind your teeth.

     Root Exposure Can Be Sensitive Too!

Acute root sensitivity is sometimes difficult to tell from a cracked tooth.  More about that in the next blog!

W Bryon Satterfield, DDS, MAGD General dentist in The Woodlands with excellent care, skill and judgment from decades of experience in precision practice and teaching. Things work! 281-363-1571

Visit his website: docsatterfield.com