When we ask for a Kleenex or a Ziploc we may not necessarily get that brand, but we know we will get a tissue or a sealable plastic bag.  It is always interesting to me hearing the different things people say in the dental office that seem to be “standard” among the general population.

For example, most people use the term “Novocain”. Even dentists, including myself, use this term daily to describe the local anesthetic used to anesthetize or “numb” teeth before they are worked on. Novocain, apparently still available for purchase, has not been used in dentistry for probably 100 years, but we still use the term because everyone seems to know what we mean. We may say “Novocain” but that is not what we are writing in your medical record.

Another term that is commonly used by patients and those in the dental office is “cleaning”. This term is a poor choice of words to accurately describe the service that a hygienist performs. The problem with this word is that it downplays the actual procedure. “I need to cancel my cleaning appointment. Oh, you don’t have anything for me for 2 months? That’s okay, it’s just a cleaning”, is commonly heard in the dental office.

We say “cleaning” because it’s easier than saying, “We’ll see you Monday, Mary, for your periodontal maintenance and exam which includes a full periodontal exam, scaling and polishing of all surfaces of the teeth, full dental exam, oral cancer screening and an update from the doctor to review this information with you.” If you have, or should have your teeth cleaned every 3-6 months, the word “cleaning” to describe the service being performed is very inaccurate.

The term “crown”, or “cap” as some people use, usually make patients cringe. “I need a crown? I thought I just needed the filling replaced”, is common to hear. Patients tend to think that they are losing their tooth if they need a crown. While this is not the case, what if the dentist said that you need an onlay? Have you heard that term?

I read an article in the paper recently entitled, “Are Crowns Made in a Day Worth the No Wait?” This article describes some of the uses of CAD/CAM (computer-aided-design / computer-aided milling) technology to produce “crowns” for teeth the same day in the dental office. The technology is used in about 10-15% of dental offices.

In the article mentioned above, there was not one mention of the term onlay. An onlay, or partial crown, for lack of a better description, is one of the major advantages of CAD/CAM technology. It often allows the dentist to perform more minimally invasive dentistry for specific teeth.

The primary focus of the article was to point out that these CAD/CAM crowns may not be the best choice for patients or dentists if used on front teeth. The argument is that a dental ceramist in a dental laboratory can make “prettier” teeth than a dentist can in a dental office. While this may be true for some circumstances, the column downplayed some of the major advantages I see with the use of this technology. We say “crown” but it really means, “an indirect, bonded, protective restoration.” A “crown” may cover the whole tooth or just part of the tooth.

The materials we use and the services we perform in the dental office are constantly changing. Let the dentist and dental hygienists use their knowledge, skills and technology to do great things to care for your dental health. Don’t get hung-up on words. Ask questions! Keep an open mind and become an active participant in your dental health.

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.

Do you have any problems with dental decay (cavities), gum recession, and/or dental erosion (the chemical breakdown of tooth structure)? These dental issues are complicated multifactorial diseases of epidemic levels affecting both children and adults. A healthy mouth sometimes requires more than brushing, flossing, and “fillings”. With current scientific evidence and new technologies, patients and practitioners need to begin to look at these problems not just from a drilling and filling approach, but also from a medical (preventive/therapeutic) approach.

There are over 19,000 different bacteria that have been found in mouths and every person has about 1,000 different types. Not all of them cause decay, but many of them have also been found to grow on artery walls. The medical/dental systemic connection is real and we must pay more attention to it.

Why the increase in decay? Most of it has to do with dietary trends. We snack more, eat more sugar/carbs, drink more soda, have more gastric reflux, take more mouth-drying medications, etc. Dental caries (decay) is a pH specific disease. The right bacteria, plus sugar, create acid which breaks down the enamel of the teeth. Add an already acidic environment and it is even worse. In most cases it is a preventable disease. And don’t think that just because you don’t eat “sugar” that you are safe. If you are getting decay, something is causing it. The problem is that changing behavior can be very hard to do.

It is time for the dental professional to take a different approach when treating this disease. More focus needs to be shifted to prevention of decay rather just treating it. Filling teeth is treating the result of the disease but does nothing to prevent it. The dentist needs to take a more active role in assessing individual’s risk factors. In the dental world this is referred to as CAMBRA, which stands for Caries Management By Risk Assessment.

Based on assessing an individual’s risk factors such as quality of home care, quality of salivary flow, medication issues, and dietary issues, a caries-preventive strategy can be established. There are many new products on the horizon to help combat and virtually eliminate this disease. However, dentists must take some responsibility and be open to a different management of this disease. They must also be able to motivate people to change habits, which can be challenging. The bottom line is that if you want to be decay-free, you can be.

For those at higher risk, there are some great products currently available from a company called Carifree. Everything from toothpastes and gels with ions in them to rebuild tooth structure, to sprays for pH neutralization. Right now you can use things like the sweetener replacement Xylitol, which by itself is cavity-fighting, but also works synergistically with fluoride. Prescription level toothpastes are also available and there is strong research for the topical application of fluoride varnish, the same stuff the kids get, for adults.

The evidence is very clear – this is a preventable disease. Next time you go to the dentist and find out you have a new cavity, stop blaming the dentist or yourself, and ask to get a specific protocol for prevention of this disease based on your specific risk factors. You may also want to mention Carifree products to your dentist in case they have not heard of this company.

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.

There are many people who suffer with pain involving some area of the head. Toothaches can cause pain, but these are mostly avoidable with proper diet, home care and regular visits to your dentist. Teeth can also play an indirect role in facial/head pain.

Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles and/or temporomandibular joints (TMJs). Problems can include TMJ discomfort involving muscle spasms in the head, neck, shoulders and/or jaw, migraines or other types of tension headaches, pain with the teeth, face or jaw; and can even play a role in anxiety and/or depression.

You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth, or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. People with seemingly good teeth/bite are also susceptible. Pain can also be caused by clenching or grinding teeth, trauma to the head and neck, or poor ergonomics. Temporomandibular disorders (TMD) affect more than 10 million Americans. Your TMJ’s are located where the skull connects your lower jaw to the muscles on the sides of your head and face controlling the joint’s movements. Women between the ages of 20 and 40 are often more frequent sufferers because of the added estrogen in their bodies.

One in eight Americans suffers from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which may be related to the bite. Clenching the jaw muscles creates tension in the muscles that close the jaw, the main one of which is the temporalis muscle. Signs that may indicate a headache from dental origin include: pain behind the eyes, sore jaw muscles or “tired” muscles upon awaking, teeth grinding, clicking or popping of the jaw joints, head and/or scalp is painful to the touch, earaches or ringing, neck and/or shoulder pain, and dizziness. Keep in mind that in a 24-hour period of time, your teeth should only touch 10 minutes total. If you clench or grind your teeth, your teeth are touching much more than that and I can promise you that something in the masticatory system is being affected.

Sleep disorders can also play a role. I am not just talking about sleep apnea. There are a wide range of sleep disorders and some of them will cause people to clench and/or grind as a defense mechanism of the body to achieve proper air flow.

Dentists have a variety of ways to help relieve orofacial symptoms. One way to treat these problems is called an orthotic, or splint, that is worn over the teeth to help stabilize the bite; kind of like an orthotic some wear in their shoes for alignment and balance when standing. Permanent correction may require equilibration (reshaping teeth), prosthetic dentistry and/ or orthodontics. Many use a splint on a daily basis to avoid having these other treatments done.

Orofacial pain can range from tolerable to debilitating. Maintaining or correcting your bite ensures optimal health, and proper care will help reduce or eliminate orofacial pain or discomfort. If your dentist can not help you, ask for a referral.

Most important lesson of the day: The optimal rest position of the jaw (minus the 10 minutes the teeth touch in 24 hours) is lips together, teeth slightly apart, the tip of the tongue resting just behind your upper front teeth, and you should be breathing through your nose.

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