Gravity is precise in nature, governed by laws and formulas; it does not respond to individual circumstances or objectives. It’s easy because it always works. Clinical dentistry, on the other hand, is science for sure, but an inexact science at best. Inexact science requires the skill of an artist to create a consistent and predictable result, since it is not a matter of an equation; hence the “Art and Science of Dentistry.” This inexactness is something that dentists struggle with daily.

I am currently treating a patient who presented with a bunch of broken teeth. The patient is frustrated because these teeth have been “fixed” numerous times over the past few years. His previous dentist had tried to bond things here and there to keep the cost down for the patient, but they just kept breaking. The patient, an engineer, said that he even tried giving the dentist suggestions to make things “stronger”. Those suggestions only led to more failure. Predictable dentistry often requires doing things that you would rather not do.

I recently heard an ad on the radio with a famous actor talking about colon cancer screening. He describes that having a colonoscopy after age 50 is huge in finding and treating early changes that lead to colon cancer. Most people don’t want to have a colonoscopy, but also don’t want to get colon cancer, so there is a dilemma. These actions have now become inconsistent with the desired outcome, much like the patient I just described. He doesn’t want to have a complete exam and map out a precise treatment plan that will ensure a more predictable result, but he wants to save his teeth.

We have come to a fork in the road. If you don’t want to get colon cancer, you get screened and treat any early signs of problems to help avoid the cancer. If you want to risk getting colon cancer, you don’t get screened. If this dental patient doesn’t want to lose his teeth, he should get a complete exam and address the issues in a more logical and predictable manner. If he wants to risk losing teeth, he can keep putting band-aids on the teeth, but they may not hold up as he has already experienced.

Dentists often struggle with patients whose actions are inconsistent with what they want from dental treatment. It is important for dentists to listen to people to know what they want. A patient who says she doesn’t want to do a crown on a tooth has not said she would not do the crown. She is saying she doesn’t want to do it, would rather not spend the money to do it, won’t enjoy doing it, and will want it to be over as quickly as possible. What does she want the outcome to be?

Too many disappointments have occurred because a dentist compromised treatment and the result was not what the patient expected. The dentist and the patient need to be very clear on compromise. The patient must understand that, if there is failure, it is most likely the result of the decision not to do the more ideal treatment. The dentist needs to thoroughly explain to the patient the risks and benefits of any treatment they are doing so that everyone is on the same page.

Co-discovery, co-diagnosis, co-treatment planning. A mutually respectful and open (authentic) dentist/patient relationship will have less disappointments and be more gratifying for all.

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

Your dentist may have the best technology, may have gone to a top dental school, and do great clinical work, but none of those are the primary reasons people choose to stay with a dental practice or any service provider. Generally speaking, people stay with their provider because of the relationships they have built with individuals within the office.

When we have a problem, we all like the convenience of calling someone we know and are comfortable with. Whether that problem is a broken filling or needing to change an appointment, it is nice to deal with people who know us and are eager to help with solving our dilemma.

I recently had an appointment with an office that I needed to change. The appointment was a week and a half away. When I called the office to change the appointment, I was less than thrilled with the way I was treated. While I didn’t necessarily expect to know the person on the other end of the phone, I wasn’t expecting to feel like a criminal. The first question I was asked by the grumpy person answering the phone was, “Why do you need to change your appointment?” This was quickly followed by how inconvenient it was for their office that I needed to change my appointment.

I can completely understand how difficult it is for front desk personnel to have to deal with these kinds of issues all day long. In my office, we had over 40 appointment changes last month. That is a lot of conversations about the same thing, and stressful for any staff member who deals with a busy schedule.

We all have busy lives. Things change and sometimes we have to re-manipulate our schedules to accommodate all we have to do. However, there needs to be accountability on both ends. If we have a scheduled appointment with our dentist, our hairdresser, or anyone, it is our obligation to realize that they are relying on us to be there. Giving adequate notice (preferably as far in advance as possible – like 48 hours) of the need to change an appointment is common courtesy.

On the other end, it is important for the provider’s office to realize that people have lives outside of their appointments. While it may be inconvenient for the office to have to reschedule an appointment, the request must be handled with respect and as much accommodation as possible.

An appointment is a commitment and it is important to take our commitments seriously. If you routinely have to change appointments to accommodate your busy schedule, it may make sense to make your appointments differently, such as being “on call” when you are due for an appointment vs. pre-scheduling.

Dental offices typically schedule your next dental hygienist appointment in advance. It may be 3, 4, or 6 months away. One of the reasons this is done is for patients to choose and reserve a time that usually best fits their schedule. Patients are often disappointed if they call to reschedule and the appointment time options are limited.

The need to change appointments happens. As long as it is not a frequently occurring issue, most providers’ offices understand. Mutual respect builds relationships.

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

Many patients and dentists face a decision-making process when it comes to keeping a natural tooth with root canal therapy vs. removal of a tooth and replacing it with a dental implant. The introduction of dental implants has proven to be a pivotal technology in dentistry. In a profession that strives to help patients keep their dentition, the point when it becomes necessary to opt for dental implants is a judgment call.

So, is one treatment better than another? There have been many scientific papers written on this subject. In one more recent study published in the Journal of Dental Research the authors noted, “Both options should be seen as complementing each other, not as competing, and should serve the overall goal in dentistry, the long-term health and benefit of the patient, being least invasive and incorporating function, comfort, and esthetics. A tendency exists toward a simplified approach of ‘extraction and implant,’ but this is not always simple or ethical.”

In comparing many of the research studies, there seems to be a difference in what the implant studies define as their “survival” rate vs. “success” rate. Many dentists will tell patients that the survival rate for dental implants is in the 95% range but when looking at the research, the success rates of these same implants fall into the low to mid 70% range. Meanwhile, there are strict guidelines for root canal (endodontic) success.

In another study the authors compared the prognosis for implants and root canal treated teeth, and noted that “natural teeth exceed the life expectancy of implants at 10-year observation points, including root canal treated or periodontally compromised teeth.” Note: Periodontally compromised teeth are those with at least moderate bone loss.

In yet another study that compared root canal treated teeth with single-unit implants, researchers observed a positive outcome in 74% of the implants and 84% of the root canal treated teeth after seven to nine years. They also found significantly higher rates of complications and necessary interventions in the implant group, and patients needed more time to adjust to implant restorations.

Treatment outcomes differ significantly, depending on the experience of the clinician, and it is more significant in implants than in endodontic treatment. In one study, implant specialists achieved a 96% survival rate, while inexperienced practitioners only had a survival rate of 73%.  Meanwhile, researchers observed less of a difference when it came to clinician type and endodontic treatment in a multicenter study with 350 teeth meeting the inclusion criteria: General practitioners had a 90% survival rate, while root canal specialists had a 98% rate.

Now that you are thoroughly confused, how do you make a decision when posed with the question to keep a natural tooth with root canal therapy vs. a dental implant? There are many factors to consider, and each situation is unique. It is important to discuss the pros and cons with your dentist.

While dental implant treatment is absolutely the treatment of choice for many situations, keep in mind that many of the studies comparing the two treatment options suggest that “too many teeth are extracted in favor of dental implants”.

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

There have been lots of changes over time in the materials used to restore teeth. Many of the materials I use today were not in existence when I started to practice. The most significant changes have been to materials that are tooth-colored.

There are very few patients who ask for gold or silver fillings any more. And, while some of these newer materials are tooth colored, there are factors which need to be considered in determining what material is appropriate for each individual situation. The longest lasting restorations I have ever seen are gold done by dentists who really knew the art of working with gold.

Prevention of decay and other factors that require teeth to be restored, is the best defense to not needing restorative dental work. Keeping up with maintenance cleaning appointments and listening to your dental team’s recommendations regarding diet, homecare and other forms of prevention, such as nightguard use, is key to avoiding many dental problems.

One of my favorite quotes in dentistry comes from a pioneer dentist who died in a plane crash back in the 1970’s named Bob Barkley. Aside from being the one who said “The best dentistry is No dentistry”, he also said, “The goal of dentistry is to make the patient worse at the slowest possible rate”. I think about this quote all the time when making recommendations and treating patients. Sometimes it leads me to recommend more extensive treatment, and other times it leads me to not recommend any treatment at all, even despite apparent need. Every individual has their own set of factors that need to be considered.

Dr. Barkley also coined the phrase “co-diagnosis”, which refers to the patient taking an active role in their dental health. It is the role of the dentist to not only educate the patient on their specific situation and different options for care, but to also extract (pun intended) from the patient, their goals for their dental health. It is so important to think beyond the immediate fix sometimes. Taking the time to talk to patients about why things are happening, and about their choices for prevention and treatment, allows patients to become active participants in their health. I wish I could say that was the norm.

There are barriers to this model. One of the biggest issues facing both dentists and patients today is the role of patient’s dental benefit companies. The trend is less costly plans with fewer benefits, and restrictions on providers. Oftentimes, to get the maximum (or sometimes any) benefit, the patient must seek a dentist who is participating in that particular dental plan. I would encourage staying away from any dental plan that forces you to see specific providers. You should always have a choice.

My simple suggestion is to take a more active role in your own dental health. Think forward and ask your dentist or dental hygienist about things that can make your situation worse at the slowest possible rate. You very well may be doing fine, or just need a couple of tweaks to your home care regimen. Find a dental team that listens to your concerns and takes the time necessary to establish a plan that makes sense and you are on board with.

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

You’ve heard it before – three in four adults over 35 have some form of gum disease. A preponderance of clinical research reveals that gum disease poses a far greater threat to health than just losing a tooth. Periodontal disease may actually increase your risk for a variety of health concerns including heart attacks, low birth weight babies, diabetes, stroke, and other bad things.

Dr. Isadore Rosenfield, noted cardiologist and media health consultant once said – “People with chronically infected gums have twice as much heart disease as the rest of us. We have an imperative to treat gum disease – to save not only teeth but also patients.”

Dr. Steven Offenbacher, former director of the Center for Oral and Systemic Disease at the University of North Carolina at Chapel Hill – “In many ways, periodontal disease is like high blood pressure – it’s painless and only becomes evident when it’s quite severe.”

All gum disease begins with the accumulation of plaque, a sticky deposit of bacteria, mucus and food particles that build up along the gum line and between the teeth. Plaque can cause gingivitis – inflammation of the gums. Plaque must be removed daily to prevent buildup. Excellent home care, coupled with a minimum of twice-yearly professional cleanings, will combat gingivitis in most people.

There is a strong genetic component to periodontal disease. One of the questions I always ask my patients is whether or not they know their familial history with regards to gum disease. If a patient says, “Well, my parents both had dentures”, there is a strong possibility that patient has the gene for gum disease. There are two main reasons that people lose teeth – gum disease and decay. Decay is 100% preventable. Gum disease, like diabetes, is controllable but not curable; it requires intervention.

If gingivitis is not treated, or is treated too late, the result can become periodontitis. This occurs when plaque invades beneath the gum, turning into a hard substance called tartar or calculus. Calculus can only be removed during a professional cleaning. At this stage, skilled care is essential to stave off tooth loss. In more advanced cases, a procedure called scaling and root planning (aka deep cleaning), is performed to remove hidden plaque and tartar from below the gum line.

Do you have gum disease? Warning signs may not be evident to you but may include red, swollen, tender, bleeding or receding gums, loose teeth, persistent bad breath, changes in tooth position, and the development of pockets between gums and teeth. Having said that, if you have any of those symptoms, you’ve waited too long.

For most people, good health requires investment. Today, periodontal disease can be successfully treated BEFORE teeth get loose from bone loss. Your hygienist can measure the pockets and bleeding points around your teeth and institute non-surgical treatment before you suffer the irreversible bone destruction of periodontal disease.

So, remember two things: First, lack of pain is NOT a good indicator that you don’t have problems – Second, the hygienists of the 21^st century don’t just clean teeth – THEY SAVE LIVES!

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