The word is out – taking care of your oral health is better for your whole body, including your mind. However, statistics still indicate only about half of the population goes on a regular basis. For those that do go, most patients usually stay with a dentist unless there is some kind of personality conflict or philosophical discrepancy in the perceived need for treatment. How do you know if another opinion is right for you?

When it comes to larger purchases, such as a car, a house or even home improvements, it’s not uncommon to get a second or third opinion/quote. We use the information we gather to make a more informed decision about where and what we are going to spend our money on.

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.

Routine dental care is generally not that complicated. However, 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 with the relationship to make the decision without the need for another opinion. It is when there is a lack of trust, a personality conflict, or the inability of the dentist to properly communicate with the patient effectively, that often stimulates the desire for another opinion.

Another important factor, which falls in the communication area, 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 effectively communicated to the patient, they have a better ability to decide on the direction to proceed that is right for them. If a dentist presents treatment options and the patient decides to do nothing, that is the patient’s choice. It is when treatment presented 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 between dental offices. 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. As a consumer, you have very little control in your ability to evaluate this.

You do have the ability to know whether you feel comfortable to make an informed decision. Regardless of the situation, if you need more information to make the best decision for yourself, get more information. If you feel pressured to make a decision, don’t make it until you feel comfortable.

The doctor-patient relationship should be an open two-way conversation. Find your dental home…..and stay there.

Dr. St. Clair maintains a private dental practice in Rowley 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

Dental hygienists love it when they make suggestions to patients about home care and their dreams are answered when the patient returns 6 months later with noticeable improvement. It might be as simple as adding a good electric toothbrush or waterpik to the patient’s regimen. I would like to say that we are amazed daily by the fruits of our counseling, but that isn’t the case. For whatever reasons there are, changing routines is often difficult.

Over 10 years ago I wrote a column about an article I saw in a magazine, which is apparently also a book, entitled “Change or Die”. What if you were given that choice? What if the doctor said you had to make tough changes in the way you think and act – or your time would end soon? Could you change? Here are the scientifically studied odds: nine to one. That’s nine to one against you. I don’t think we have made much headway on this over the past 10 years.

It’s a pretty common theme. As Americans, we’re dying at a rapid rate from five basic self-induced health problems. We eat too much. We drink too much. We smoke too much. We have too much stress. And, we don’t exercise enough. These five poor choices, manifested in scores of ailments, consume the vast majority of the nation’s healthcare budget. The article is an outpouring of concern from healthcare experts and doctors, all looking for a way to change the behavior of people who love their lifestyle so much that they literally die from it.

In a Johns Hopkins study a while back, 9 of 10 heart surgery patients chose to return to their unhealthy lifestyle, rather than make the changes needed to live longer. Only a few are convinced by their doctors to make radical daily changes. One of the more successful doctors with this is Dr. Dean Ornish, founder of the Preventive Medicine Research Institute. He says NO to meat, fatty dairy products, alcohol and oil. His vegetarian diet is low-fat, high-maintenance and strict. And, it has been shown to reverse heart disease and other factors in patients who were destined for quadruple bypasses – or worse, eternal sleep.

When 90% of patients are back to their old tricks within weeks of open-heart surgery, his program is the one making a difference. How does he do it? Well, it’s easy, really. Dr. Ornish coaches his patients to make changes strictly for the benefit of making them. Instead of telling them they must change or face death, he encourages them to change so that they can enjoy the endless beauty of living. With dedicated support, three-quarters of his patients are still going strong three years into their drastic lifestyle shift. I’m sure it is deeply gratifying to know that it only takes words said a certain way to make a true change in someone’s life.

Why is it so difficult to get people to change? Well, it depends. You have to be sick and tired of being sick and tired, usually, before you’ll make the leap and let go of whatever the resistance is to change. For many, doing more preventively never happens. We wait for chest pain to strike or a toothache to occur before seeking help to solve our crisis problem. Then we hope, and many times expect, that our problem can be solved easily and not too much will have to change to prevent it from happening again.

Dr. Ornish would tell you the change must be profound. He would tell you to never have another cheeseburger. Your hygienist would say you need to follow a new strict homecare routine, radically different than what you currently do. Making changes like these has to mean more to you than the change itself. You must be invested in improving the quality of your life.

Dr. St. Clair maintains a private dental practice in Rowley 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

Let’s use this hypothetical situation: You have not been to a dentist in a while (pick a time frame), you are well aware you need some dental work, you were given the recommendation of a dentist by a friend…..and, you decide to visit that dentist and four other dentists to compare and make a decision who is the best fit for you. (I realize that most people don’t want to and/or don’t have the time to visit five dentists….but play along).

You already have an idea of what you are looking for. It might be the dentist who says you need the least. It might be the dentist who is the cheapest. It might be the dentist who is closest to where you live. It might be the dentist who gives you the most options, or maybe the least. It might be the dentist who listens to you the best. Be prepared, because you are likely to hear a few different styles/opinions visiting five dentists.

Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back.  The dentist’s personality and experience are reflected in his or her treatment preferences as well.  The fact that different dentists will suggest different plans to treat your condition does not necessarily mean that one plan is better than another. Have an open mind and play an active role in the treatment planning process.

It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances.  A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is important for the dentist to discuss costs and options for payment.

Think of treatment plans like various models of cars offered by different dealers.  All of the models are new, have warranties and will work well out of the lot.  The higher end models, however, have some advantages not found in the less expensive models.  Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it.  Having said that, dentistry is not a commodity. There are many factors that need to be taken into consideration when choosing your provider or the treatment you choose for yourself.

What makes sense for you? What are your objectives?  Saving a badly damaged tooth with a root canal and a crown may preserve it for a long time, but what are the circumstances of how the tooth got to that point?  If you haven’t been to a dentist in many years and have many other dental needs, does it make sense?

We have so many great dental providers in our area. Think about what you are looking for in a dental care team Read that list in the second paragraph again.

The focus should be on long-term objectives and prevention. If you are a regular dentist-goer and have a dentist you like, you’re all set. If you haven’t been in a while, consider making the decision to change how you look at your dental health. Start with finding a place that fits your particular needs, and make the commitment to make routine preventive dental care part of your life.

Dr. St. Clair maintains a private dental practice in Rowley 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

I have had a few patients ask recently about the order of oral hygiene activities. Does it matter if you brush or floss first, and should this be done before or after breakfast? Based on available research, it seems opinion matters as much as scientific facts.

A spokesman for the American Dental Association and a professor of restorative dentistry at the University of California, Los Angeles, recommends flossing first. His rationale? Get the unpleasant task out of the way to avoid the temptation to not do it. “Let’s face human nature, if you’re going to skip one, which one will you skip?”

By contrast, a professor of oral health sciences at the University of Washington in Seattle, advises her patients to brush with a fluoride toothpaste, then floss. She says that way your mouth will be awash with fluoride as you are maneuvering the floss.

So, what’s my opinion? I was taught and have always maintained that flossing before brushing is better. The rationale behind this is that plaque and other debris is dislodged during the act of flossing allowing toothpaste and the mechanical action of brushing to better penetrate the different surfaces of the tooth. Does it really matter? I don’t think so.

Have you heard your dental hygienist or dentist tell you to floss to prevent cavities between your teeth? Based on research, the main reason for flossing is not for prevention of cavities. Rather, flossing’s main benefit is stimulation of tissue to reduce gum inflammation known as gingivitis. Gingivitis can lead to more advanced gum disease and things like bad breath. That is why I believe that regular use of a water pik and an electric toothbrush is most ideal.

A review of 12 randomized controlled trials found that people who brushed and flossed regularly had less gum bleeding than the brush-only camp. No surprises there. There have been no studies, that I am aware of, reporting a reduction in cavities from flossing. Of course, these are difficult studies to conduct. There are many factors that contribute to decay occurring between the teeth.

There are also different schools of thought whether to brush and floss before or after breakfast. I don’t know about you, but I cannot eat or drink anything (especially orange juice) after I brush my teeth. So, although you might expect the solution to be brushing after breakfast, there is some risk with that.

If you eat or drink something sugary or acidic—like the fruits, juices, and other breakfast foods many of us eat in the morning— the mouth is in an acidic environment for at least 30 minutes after consumption. These acids weaken tooth enamel, and brushing too soon can cause damage to the enamel. If you know you’re going to eat or drink something very acidic ahead of time, you may want to brush your teeth first.

Alternatively, you can wait 30 minutes after you eat for your saliva to neutralize the pH of your mouth. Or, re-balance your oral pH right away with an alkaline mouth rinse and then brush. In the end, it depends a little on what you eat. Take stock of what you’re eating for breakfast and judge when you should brush based on its sugar or acid content.

Everyone, well…..almost everyone, can stand some improvement with their oral hygiene. Many dental problems are completely avoidable with excellent home care, which is in your control. Ask your dentist or hygienist how to improve your home care. Strive for constant improvement.

Dr. St. Clair maintains a private dental practice in Rowley 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