Liz H:  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 $3500! 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, or if treatment needs to be spread out over time. The last thing you want to do is spend $3500 on one tooth, and then be out of funds to address the other problems.

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 might 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.

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 there are options to stretch the payment out over a period of time.

Tom Q: 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 for the problem. 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.

Each person’s situation is different. Many of us complain about not having enough time to do things. Then, when we examine how we spend our time, we realize that re-prioritizing our time (getting rid of time suckers) frees up time to do things that are most important to us. The same can be said about where we spend our money.

One thing is for sure; ignoring is never a good option.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. 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

Isn’t tooth loss inevitable in the later years?

Today, older adults are keeping their natural teeth longer because of scientific developments and the preventive emphasis in dentistry. This improvement was seen in the results of a survey released by the National Institute of Dental and Craniofacial Research. They showed that among persons in their 50’s and 60’s, the rate of losing all teeth has dropped 60 percent since 1960.

Good oral hygiene and regular dental care are important throughout your life, whatever your age. By practicing good oral hygiene at home and visiting your dentist regularly, you will prevent dental problems and save time and money as well.

There are two things that cannot be disputed when it comes to oral health:

• Quality of life is better with a healthy mouth full of teeth
• Your mouth is the gateway to the rest of your body. If you care about being healthy, you should take the steps necessary to have optimum dental health

At my age, why should I bother with oral hygiene and going to the dentist?

Thorough daily brushing and flossing of your natural teeth are essential to keep them in good condition—especially as you age. Plaque, the sticky, colorless layer of bacteria that causes tooth decay and periodontal (gum) disease, can build up quickly on the teeth of older adults, particularly when they neglect oral hygiene. This can increase your risk for tooth decay and periodontal disease.

A few simple steps can help you maintain good oral health throughout your life. Brush your teeth twice a day with a fluoride toothpaste, and clean between your teeth daily with floss or interdental cleaners. Be sure to see your dentist regularly for exams and professional teeth cleaning. Professional monitoring of your oral health status is essential.

Should adults be concerned about cavities?

Tooth decay is not just a child’s problem. Adults of all ages can have cavities. The causes for tooth decay are the same for everyone, regardless of age. Decay results when the bacteria in plaque feed on the carbohydrates (sugar and starch) in our diet to produce acids that can cause cavities.

Decay rates can change throughout our lifetime for various reasons.  Adults are more likely to have decay around older fillings or other dental work.  Decay of the tooth root is also common among older adults. Root caries (decay) occur when the gums recede, exposing the softer root surface, which decays more easily than tooth enamel.

Tooth decay is also promoted by dry mouth. This condition, called xerostomia, occurs when the supply of saliva is greatly reduced. It can be caused by many types of medications (such as anti-histamines, anti-hypertensives, and anti-depressants) or radiation therapy to the head or neck. Saliva is needed to lubricate the mouth, wash foods away and neutralize the acids produced by plaque.

 Allowed to continue, dry mouth can lead to rampant tooth decay. If you think you have this problem, be sure to discuss it with your dentist or physician. They may recommend a saliva substitute and/or fluoride products to help prevent decay.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. 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

This week the topic has nothing to do with dentistry. It is a topic that some will be able to relate to and others may not. It is a topic that some may appreciate and others may criticize. It may be something you have thought about before or maybe have never thought about. It is about thinking outside the box and being comfortable with the uncomfortable.

Regardless of your line of work, there comes a point when we all get comfortable with where we are and how we do things. Initially, that is a good feeling, but eventually it is a feeling that challenges us in our own growth. It is impossible to go through life doing things the same way and feel content forever.

In my 25th year in this profession, I do very few things the same as the way I was originally taught. I am constantly learning, but often struggle with how to apply things I learn, or whether to apply them at all.  However, being uncomfortable with being comfortable challenges me to grow.

Many of us, and especially people in a service-related industry, which I can relate to the most, can exhaust ourselves trying to predict and control what other people think about us as individuals and about the work we do. This feeling is a trap and very self-limiting.

Do people understand me? Do they like me? Do they know how much I care about what I do? Do they care? These questions can paralyze us into inaction. These feelings can cause us to never even come close to reaching our full potential. We “play it safe” too often, and need to consider going outside our comfort zone to realize growth, both personally and with our work.

Has this thought ever crossed your mind: “What in the world is my purpose while I’m here on this planet?” We have to have purpose, otherwise we are lost, and we have to have faith or we remain lost.

We all go through the various stages of life and experience joy and happiness, sorrow and pain, confusion and temptation. Some struggle with these things more than others, which can also impede our growth as individuals.  Each of us looks for the things in life that brings us more joy and happiness rather than other things listed above. However, focusing on “what’s in it for me?” can be just as destructive.

Constant growth in mind, body and spirit are essential to mature as individuals. We need to be mature enough to recognize that each of us has our own set of resources, and be able to determine how these resources can help others versus being a roadblock.

We all have our faults, admitted or not. Most of the time we are unable or unwilling to express our faults to anyone because of pride. We want everyone around us to think that we have no “issues”. It takes awareness to allow for self-reflection and at least admitting to ourselves where we need to improve in our personal and professional lives.

This is difficult to do alone. Your best bet is to work together with someone close to you who also has similar intentions so that you can hold each other accountable. Perhaps one of those areas you wish to improve is your own health.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. 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

In last week’s column, I wrote about some specific differences between dentists and dental practice philosophies. But, what makes for an ideal doctor, dentist, nurse, physical therapist, or any other care giver? Patients shared their views in a study which appeared in an issue of Mayo Clinic Proceedings. It’s based on nearly 200 patients treated at the Mayo Clinic in Arizona and Minnesota.

In phone interviews with people who had no professional ties with the Mayo Clinic, the patients described their best and worst experiences with their Mayo Clinic doctors, with confidentiality guaranteed. The doctors seen by the patients came from 14 medical specialties.

Here are the seven traits listed by the patients, along with the patients’ definitions of those traits:

• Confident: “The doctor’s confidence gives me confidence.”
• Empathetic: “The doctor tries to understand what I am feeling and experiencing, physically and emotionally, and communicates that understanding to me.”
• Humane: “The doctor is caring, compassionate, and kind.”
• Personal: “The doctor is interested in me more than just as a patient, interacts with me, and remembers me as an individual.”
• Forthright: “The doctor tells me what I need to know in plain language and in a forthright manner.”
• Respectful: “The doctor takes my input seriously and works with me.”
• Thorough: “The doctor is conscientious and persistent.”

That list isn’t in any particular order. The researchers didn’t check whether confidence was more important to patients than respectful treatment, for instance. The Mayo Foundation funded the study.

The traits covered doctor’s behavior, not technical know-how. That finding “does not suggest that technical skills are less important than personal skills, but it does suggest that the former are more difficult for patients to judge,” the researchers write. They add that patients may tend to assume that doctors are competent unless they see signs of incompetence, the researchers add.

One patient put it this way in the study: “We want doctors who can empathize and understand our needs as a whole person. We want to feel that our doctors have incredible knowledge in their field. But every doctor needs to know how to apply their knowledge with wisdom and relate to us as plain folks who are capable of understanding our disease and treatment.”

The opposite of those seven traits would be: timid, uncaring, misleading, cold, callous, disrespectful, and hurried. Can healthcare ever be high-quality if the patient-doctor interaction is any of these?

I hear so many deeply touching stories from patients who have had such positive experiences with doctors and nurses during tough medical situations. People who are cared for in this way receive much more than physical wellness.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. 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

Exposure to poison ivy, getting food poisoning, having a toothache arrive seemingly out of nowhere – these situations sure bring about unpleasant thoughts. Watch where you step and be careful about what you eat, but for now, get ready to focus your attention on those toothaches. If you’ve ever bitten down too hard, been hit in the mouth while playing sports, or woken up due to a toothache, it is a tough situation to endure. When you experience any of the tooth pain symptoms or other issues discussed below, you should act instead of ignoring them. Read on to learn what problems necessitate you should call your emergency dentist in Rowley.

(more…)