J. Peter St. Clair, DMD Blog

Last week I introduced you to a patient who has been struggling with dental decay (cavities), gum recession, and dental erosion (the chemical breakdown of tooth structure). I discussed how these dental problems are complex multifactorial diseases of epidemic levels affecting both children and adults.

I ended with the idea that a healthy mouth 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. If “we” continue to think the same way about dental issues, we will continue to have the same struggles and same results.

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.

Dental decay is on the rise. Why the increase? 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. The problem is that changing our thinking and behavior, the nemesis of all that is good or bad, is difficult to do unless there is an awakening among us.

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 one way to do this is to use 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 and dietary issues, a caries-preventive strategy can be established. 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. The bottom line is that if you want to be decay-free, you can be.

For those at high risk, specific behavioral modifications are almost always necessary. To become aware of these often requires an assessment by your doctor. Doctors need to shift time away from treating things to be able to assess more, and discuss the specific behavior modifications necessary for each individual patient. The patient needs to be receptive to hear and act on these changes.

There are also some great products currently available, and others on the horizon. Everything from new toothpastes and gels with ions in them to rebuild tooth structure, sprays to neutralize pH, and probiotics are on their way. 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.

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

Last week we discussed changing our lifestyle to improve our health. As we all know, changing our behavior, habits, attitude, or any aspect of our lives can be a difficult thing to do. I am not writing as an expert on this subject, as I have the same struggles as everyone else with change. However, repeated awareness of changes we want to make is one strategy to move us closer to making that change.

A good example is Mary, a patient of mine. Mary is an adult who has had issues with decay (bacterial disease that breaks down tooth structure), dental erosion (chemical breakdown of tooth structure), and gum recession (loss of the supporting structures of the teeth). When people like Mary present with these problems, we dentists present treatment to “fix” the problems. However, the reasons “WHY” these issues are occurring are just as important, if not more so, than the “fixes” we propose.

Mary drinks diet soda. In fact, Mary doesn’t just drink diet soda; she has a diet soda by her side all day long. At a recent event I saw Mary sitting and listening intently to the presentation. At her side was her diet soda. Every few minutes Mary would unscrew the diet soda cap and take a swig.

The three main dental issues Mary has: decay, erosion, and recession, have many different etiologies. One common denominator is pH, which is a scale used to describe the acidity or alkalinity of solutions or environments. The lower the pH, the more acidic the solution or environment is. In order for any of the three disease processes described above to occur, the pH of the oral environment has to be acidic.

While there are many reasons the pH of the oral environment can be acidic, such as medications or disease, dietary factors play a significant role. A pH lower than 5.5 in the oral cavity puts you at risk for dental disease. Most tap water, for example, has a pH of 7. The average diet soda has a pH of 3.28. Stomach acid has a pH between 1-2. Diet soda is very acidic.

Having a diet soda with a meal on occasion is most likely not a problem. Typically, after consumption of an acidic beverage, your saliva will neutralize (make your mouth more alkaline and less acidic) within about a half hour. That is why you may have heard that you should wait at least a half hour before brushing your teeth after meals. The problem with Mary sipping the diet coke all day long is that the pH of her mouth is always acidic. This creates a very dangerous environment.

Quieter drills, new materials and technologies will not solve these problems. While etiologies such as medications that can cause dry mouth and a very acidic environment are difficult enough to manage, behavioral issues are often not discussed in enough detail, or at all, because they can be more difficult to manage.

Avoidable dental problems are the last thing a patient wants to hear about and a dentist wants to see.  In addition, we as providers need to adopt a more preventive approach to the conditions I discussed in this column. Next week I will introduce you to one of those concepts.

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

Gum disease might seem like a mild dental issue at first, but if it’s left unaddressed for too long, it can result in major oral health complications. To keep your smile safe, you’ll naturally want to see your dentist as soon as possible to have your gum disease treated. But can the problem truly be cured for good? Here’s what you need to know to protect your gum health.

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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

Last week I discussed the importance of communication in any relationship, specifically the healthcare provider/patient relationship. Trust is mutually built as this relationship develops over time.

“There’s not enough time in the day.” Have you ever used this excuse? I said this yesterday to someone. We all tend to waste a lot of time, or at least don’t use the time we have as effectively as we could. You would think that in our technology-filled world, time management would be easier. Some of this technology actually gets in the way by adding even more of a time commitment to things that reduce interpersonal communication.

Here’s an example. It’s time to buy a new car. There are many different car brands and within those brands are many models. No matter what dealership you go to, they will gather a minute amount of information about you, or maybe none at all, but guaranteed, they have a car on their showroom floor that they tell you is the right car for you. They will spend a countless amount of time talking about the many new features that their brand has, and the options between different models. If the salesman worked for a different brand, or if you went to a different dealership, you would hear the same reasons why that brand is right for you. Their goal is to sell you a car.

If you went into a dental office and the dentist spent all their time talking about their array of technological gadgets and how they were right for you, how would you feel? If you went to a different office and that dentist had a different set of gadgets, they have a bias as to why theirs are right for you. You would feel like you were trying to be “sold” something.

Branding draws us in. You may have a preconceived notion that a particular make of car is what you “need”, or see a dental advertisement that attracts your attention.

It doesn’t take much to realize that there are many different brands of anything that would satisfy our needs.

Whether it is a car or teeth, there are often gaps between the “seller” and the “buyer”. There is a gap between what we really need and what we think we need. There is another gap between what the dentist or salesman thinks we need and what we think we need. And, more specifically, there is often a serious gap between the value some dentists have, and the value they feel they can discuss with patients. Sometimes we feel we don’t have the time to discuss these things, and other times we are afraid we will scare you away.

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?

Dentists need to communicate facts and truths. They need to convey expertise and enthusiasm. This goes back to the idea of time I have mentioned so often in the past. Dentists need to spend time with patients, not hard-sell with little information, and let the patient decide what the best line of treatment is for them.

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.

Patients and dentists sometimes see things. Often, what is important to dentists is not important to patients, and vice versa. While dentists may often have a blind spot when it comes to seeing things from a patient’s viewpoint, it’s important for both patient and doctor to have an open mind. Depending on what you are looking for, this is the start of a relationship, not a one-time transaction.

Dentists often have a similar blind spot in the ability to communicate with patients. When our particular “philosophy of care” doesn’t mesh with the patient’s current philosophy or desires, we have to determine how we’re going to approach each patient. Or, do we have the same approach for everyone?

Communication is key to any relationship. So why do many healthcare professionals have poor communication skills with their patients? There is no one answer to this question, but we all struggle communicating with others sometimes.

Let’s put it out there; dentists are often starting at a disadvantage in the relationship. While many people say they love to have their teeth cleaned, there aren’t too many who really want a crown.

Some patients who want and need care have a preconceived notion, maybe fear based on a past experience, or the idea that they just can’t afford it. It’s more difficult to build a trusting relationship when there are these types of barriers.

I think the biggest issue providers have with communication is time. Dentists run on a schedule and dentistry is a business. So, it’s up to the individual dentist, or someone else for a corporation-owned practice, to set the time parameters. Dentists don’t get paid to talk like lawyers; the drill needs to be spinning.

A dentist may be (or may think they are) the best tooth-fixer in the world, but communication skills are more important. For a dentist to sit down with a patient to discuss your personal situation, the importance and relevance to getting good dental care and its significance to systemic health takes time. It takes time for a dentist to work through your particular barrier to getting a healthier mouth. The time allotted for this in an office depends on philosophy of patient care and how the business is run.

Meaningful communication skills come more easily to some than others. For most of us, it seems it is always a work in progress. I’m sure you can think of numerous past experiences of poor communication and realize later how the situation could have been better handled. I can think of many. Our way of communicating is often engrained in us. If we wish to improve our communication skills we (dentists and everyone) must first become aware or more, mindful, of these interactions. Only then can we work on improving this skill. That takes time, and time is again a factor.

Dentists need to recognize, fully understand, and be able to manage the different barriers that prevent patients from getting the care they deserve. Every patient has their own issues, their own concerns, their own personality, and their own true or false notions about dentists and dentistry.

Relationships take time to develop. Talk with your dentist about anything that is holding you back from improving your dental health. These conversations build trust. Trust is the key factor in the dentist-patient relationship.

….to be continued

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.

We’re already a week into the New Year. Wow, does time fly! Do you have your list of New Year’s resolutions to make 2023 the best year ever? Throughout the year I’m always adding things to my list of things to do. As with many to-do lists, some of the items on it keep getting pushed down in the ranking of priorities because of the constraints of time. So, just like last year, my first New Year’s resolution is to take that list and purify it.

Many driven people pride themselves on how many tasks and commitments they are able to take on. This is difficult to sustain. Eventually, this philosophy of always doing more becomes counterproductive, as you inevitably have to approach your growing list of commitments from a different perspective.

The reality of it is that getting more done is not a matter of doing more things; it is a matter of doing the right things with your time. In that sense, the answer is often found in identifying and relieving yourself from the low-value time wasters that hold you back from giving your full attention to the things that truly matter to drive you forward.

You can’t buy more hours in a day, but you can reclaim time for yourself. You can choose to delegate and/or choose to streamline and purge yourself of recurring nuisances that eat away at your productivity. You can choose to say “no”. If there is something that doesn’t fit your criteria for being worthwhile, don’t do it. However, eliminating things from your life does not mean burdening someone else with daily personal responsibilities.

By purifying your time priorities in this way, you amplify the value of your time. So, as you put together your list of things you want to do over the coming year, be sure to work on another list at the same time: a list of things you don’t want to do anymore.

Be persistent with it, keeping in mind that this is your most precious resource we are talking about. Examine each recurring demand on your time and ask yourself if it’s adding value to your life in an intangible way? Is it enhancing your productivity and improving your life? If the answer is no to both of those questions, the next question becomes obvious: Then why are you doing this?

Challenge yourself right now to sit down and create your own list of things to not do in 2023. Try to come up with at least five items. This is a great way to start the year with a feeling of liberation. This allows you to clear your mind of clutter and award yourself more time and energy to embrace the really important possibilities.

You can create specific lists for different aspects of your life, like your health. Changing your habits takes effort and the awareness that you want the change in your life. Quality sleep is probably one of the most important things to make sure is in check. Many people have sleep hygiene issues that greatly affect their life and how they feel. I’ll have more on that this year!

If you have been neglecting your dental health, make this a priority to get in order this year. It doesn’t matter if you “think” everything is okay. As with every single thing on your list, there needs to be accountability. Change is good for you!

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

Flossing is one of the most important things you can do to protect your oral health, yet it’s one aspect of dental hygiene that tends to be neglected. With the new year right around the corner, now’s a good time to try and incorporate flossing into your daily routine.

Of course, that’s easier said than done. Any time you try and commit to something new, there are bound to be some bumps in the road. Here are a few ways that you can make a flossing habit stick.

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At the end of each of the past 17 years, I have used this space to publish these 21 Suggestions for Success authored by H. Jackson Brown, Jr.

Cut this out and put it on the refrigerator. Read this list often and take these suggestions to heart. The more of these you achieve, the better place you are for having your best year ever in 2023.

1. Marry the right person. This one decision will determine 90% of your happiness or misery.
2. Work at something you enjoy and that’s worthy of your time and talent.
3. Give people more than they expect and do it cheerfully.
4. Become the most positive and enthusiastic person you know.
5. Be forgiving of yourself and others.
6. Be generous.
7. Have a grateful heart.
8. Persistence, persistence, persistence.
9. Discipline yourself to save money on even the most modest salary.
10. Treat everyone you meet like you want to be treated.
11. Commit yourself to constant improvement.
12. Commit yourself to quality.
13. Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.
14. Be loyal.
15. Be honest.
16. Be a self-starter.
17. Be decisive even if it means you’ll sometimes be wrong.
18. Stop blaming others. Take responsibility for every area of your life.
19. Be loyal and courageous. When you look back on your life, you’ll regret the things you didn’t do more than the ones you did.
20. Take good care of those you love.
21. Don’t do anything that wouldn’t make your Mom proud.

Best wishes for a happy, successful, and healthy 2023. Happy New Year!

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

Most people take saliva for granted, but saliva is necessary for proper digestion of food. Saliva also helps protect the mouth from dental decay, gum diseases and bad breath, because it has the natural ability to stop bacterial growth. Having a dry mouth can lead to a metallic taste in the mouth and the ability to taste food properly decreases. Saliva acts as a major defense mechanism that our bodies need to maintain good oral and systemic health.

Many people don’t realize they have dry mouth, otherwise known as xerostomia, and others find it debilitating. Regardless of whether you feel the effects or not, dry mouth can be very dangerous to your dental health. The most significant issues are rampant dental decay and gum disease.

So, what can cause dry mouth? There are multiple health related conditions and habits that can cause or add to a dry mouth, dry skin and general dryness of the entire body. One cause can be medications. There are over 3,000 prescription and over-the-counter products or medications that can cause dry mouth. You can be on a medication for years before the side effects show up. Dry mouth side effects can also last for a long time after you stop taking a medication.

What else can contribute to dry mouth? Here is a list: hypothyroidism, rheumatoid arthritis, lupus, anemia, Sjogren’s Syndrome, chemo therapy, alcohol consumption, ineffective salivary glands, stress, Alzheimer’s Disease, Parkinson’s Disease, diabetes, allergies, vitamin deficiencies, hypertension, radiation therapy, menopause, depression, smoking, and last but not least, aging.

How do you know if you suffer from, or are at risk for dry mouth? Here are some questions to assess your risk: Has your physician or pharmacist shared with you that a medication you are taking can cause dry mouth? Do you find that you wake up in the middle of the night with a cough or have a choking feeling and need a drink of water? We produce at least 50% less saliva at night so the side effects are more intense.

Does your tongue feel rough or do you tend to get mouth sores? Does your tongue stick to the roof of your mouth? Do crunchy foods such as potato chips or crackers “scratch” your mouth? Do you have dry, cracked lips and cracks at the corners of your mouth? Do you have thick and sticky saliva? Are your eyes dry and eyes drops are relatively ineffective? Is your skin still dry after using moisturizing lotion?

If you have a positive response to any of these questions, you are at risk from the damaging effects of dry mouth. The first thing to do is to eliminate any of the things that I mentioned as potential causes that are in your control, such as alcohol consumption and tobacco use. I also recommend that patients stay away from alcohol-based mouth rinses, tartar control and whitening toothpastes.

You should also notify your physician and dentist that you have, or are at risk for, dry mouth. There are many products on the market that can be effective to help with the symptoms, and also help to protect your teeth and gums. In addition, there are other prescription products, such as high-fluoride toothpastes and anti-oxidant hydrating toothpastes, mouthwashes and gels that you can only get from your dentist or physician.

Please take dry mouth seriously. The effects aren’t only annoying, but can also ruin your mouth.

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