Recent questions from readers answered.

Mary D:  I was recently told by a dentist that I need a root canal, a post, periodontal crown lengthening surgery and a crown. The total cost of treatment is $4500! Do I have any alternatives?

That is a difficult question to answer without seeing the specific case, but here are some thoughts. There are quite a few things to consider. The first is the general condition of the teeth. If you have numerous other dental problems that need to be addressed, you must prioritize these and decide if the cost of doing them all is something you can afford. The last thing you want to do is spend $4500 on one tooth and then be out of funds to address the other problems. This could lead to more serious problems in the future.

Let’s assume that this is the only tooth that needs to be addressed. I would look at your past history of dental problems. If you have had limited problems with a low rate of dental decay in general, this treatment may be the best option. If you have had a problem with dental decay, the best alternative may be to extract the tooth and do a dental implant. The cost of the treatment would be about the same and there would be no chance of recurrent problems with decay. Dental implants are a highly predictable treatment in this case.

Extracting the tooth and not replacing it can lead to teeth shifting, bite problems and a decrease in function. If the cost of treatment is beyond your means, ask the dentist if they have options to stretch the payment out over a period of time. Another alternative would be a retainer to hold the position of the other teeth until you are able to replace the missing tooth.

Jim G: My son has been in braces for over a year and has multiple teeth with decay. What should we do?

My first question would be – Why does he have so much decay? Although there are many factors, diet and home care are most likely the culprits. If the decay can be easily fixed, the diet can be controlled (i.e. decrease sugar intake), and his home care can improve (including a prescription fluoride toothpaste). That would be the best way to go and the braces treatment can move on. If the decay is extensive and his compliance is poor, the best thing to do may be to remove the braces and wait until improved conditions are met before continuing with the braces.

Linda T: My dentist keeps telling me that I need a bunch of crowns. I don’t have any pain and the crowns seem excessive and costly. Why can’t I just wait until something happens and fix the problem when it arises?

You can wait. However, there is probably a good reason the treatment is being suggested. Often, being proactive in replacement of aging large fillings can prevent bigger problems to come. The purpose of a crown in this situation is to protect the tooth. Waiting for “something to happen” can often mean more treatment down the road such as root canals or gum surgery. If you have multiple teeth that need this treatment, ask for a treatment plan to sequence the treatment over time. This is better than waiting.

Please send me more questions to the email below.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

I recently read a book called “A Few Words from the Chair: A Patient Speaks to Dentists” by David Clow. This is a book written by a patient (journalist) for dentists. Here is how the book starts.

“Dentistry offers people so much that they want and need. Why don’t people get it? What would permit someone to have this resource available, and fail to use it? What would cause them to misunderstand it so thoroughly that they fear it more than they fear the consequences of not collaborating with a dentist?”

I have written numerous times on the five barriers that patients face in getting ideal dental treatment: fear, money, lack of concern due to absence of pain, using lack of time as an excuse, and lack of trust. Clow offers a statement that gets to the “root” of the issue. “Dentists and patients have extended interactions but hardly any conversations.”

A dentist may be a great tooth fixer, but also a poor communicator at the same time. When was the last time a dentist sat down with you for an extended conversation to discuss your personal situation, the importance and relevance to getting good dental care, and its significance to systemic health? When was the last time a dentist helped you work through your particular barrier to getting a healthier mouth?

Clow goes on to say to us (dentists), “There are gaps here, and like the gaps you work on in your practice, they are problems. The obvious one is between us, between dentist and patient. There’s another between what I really need and what I think I need. Yet another divides what you think you do and what I think you do. And there’s a serious one between the value most dentists have and the value they feel they can discuss.”

Clow says that we (dentists) spend too much time on things that don’t get treatment done in the chair. Technology is one of those things. Dentists tend to be techno-geeks. We’ve got to have digital x-rays, machines that make crowns in the office, and fancy chairs that give massages. That stuff is okay and serves a purpose for some patients, but what about the patients that aren’t committed to any care?

Our time is the greatest thing we have to offer, yet many dentists overlook this. Anyone can drill on a tooth but not everyone has meaningful communication skills.

Have you ever heard the old joke, “How many psychiatrists does it take to change a light bulb? One- but the light bulb has to want to change.” One of the goals I have every day is to change one person’s perspective on dentistry – to just get one person to realize the importance of a healthy mouth. It is not always easy, but these conversations are often the most meaningful and rewarding parts of the day.

The key for us as dentists is to slow down and have more meaningful conversations with our patients. We are often pushed in the wrong direction trying to run a small business, but it is important for us to realize that the human element – the doctor/patient relationship – will always be the most important part of what we do.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Halloween is a great time for building family memories and enjoying delicious treats. But all that sugar consumption can add up to one big toothache unless you follow some tips from your local dentist. Here’s how to keep this witching season both fun and tooth-friendly.

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Choosing a health care provider is not always the easiest thing to do. There are many factors and sources to consider. When most people finally choose a health care provider, they will stay with that person unless there is some kind of personality conflict or philosophical discrepancy in the perceived need for treatment. Or, there is an insurance issue; we will discuss that in a different column.

It is not uncommon to get a second opinion or a second or third quote for things like car repairs and home improvements. When it comes to our health, it usually depends on the nature of the issue. More complex issues in medicine, such as a diagnosis of cancer, an unknown diagnosis, or other major medical issues in which we have to make decisions about significant treatment, tend to stimulate people to get more than one opinion. In dentistry, it seems that the incidence of second opinions is not as great.

Routine dental care is generally not that complicated. There are many different ways to do the simplest things in dentistry. The method is a function of the dentist’s beliefs and training. It is relatively uncommon for a patient to get a second opinion for this type of maintenance dental care. Although there is some subjectivity as to what different dentists might deem as “needing” to be done, patients usually base their decision on their perceived need. Often times, this perception of need comes from the dentist’s ability to communicate the reasons for treatment.

The patient’s trust in their provider is a big factor. If a patient trusts and genuinely likes their dentist, they may not necessarily do or want to do what the dentist wants them to, but they are comfortable enough to make the decision on treatment. It is when there is a lack of trust for one reason or another that patients tend to venture out for another opinion. This lack of trust usually stems from a personality conflict or the inability of the dentist to communicate with the patient effectively.

Even when there are more complex dental issues, it is my feeling that patients base the need for another opinion on the above. Another important factor is that the patient is given choices. Patients always have the right to choose what treatment they feel is right for themselves. If choices are given and the treatment is properly communicated to the patient, they have the ability to decide in which direction to proceed.

If a dentist properly presents the treatment and the patient decides to do nothing, it is the patient’s choice. It is when treatment is properly presented and this aligns with the patient’s perception of need or desire, that the patient moves forward with treatment.

Fees tend to be a less common reason for patients to seek another opinion. Fees for treatment can definitely vary. The problem with seeking treatment based on fees is that the same treatment in two different offices with different fees can also vary in the level of expertise and precision in which it is done. There are many factors.

A higher fee does not always mean a higher quality product. Fees are generally based on the time involved, the materials used, and the perceived expertise of the provider. Be cautious when seeking treatment based on fees. The fee for treatment should definitely be considered, but the entire treatment presentation should be used to determine your decision. It is always important to ask to see pictures of similar treatment that a particular provider has done and not just common stock photos.

I hope this helps.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at