J. Peter St. Clair, DMD Blog

This is the story about a woman I met recently named “Carol”. Carol’s story is the reason I do what I do every day and brings me back the next day. The interesting thing is that it has absolutely nothing to do with performing the actual physical work of dentistry.

Carol is in her 70’s and has gone to the dentist infrequently for most of her life. She presented to my office a couple of months ago for a second opinion. At our first appointment Carol brought her most recent x-rays, a treatment plan from another dentist, and a page-long list of questions. She was well-prepared for the consultation and seemed to know exactly what she wanted.

About 8 years ago, Carol visited a “holistic” dental office. Carol had about $10,000 of dentistry done at that time. Her reason for visiting that particular office was because she was/is very concerned about her health and believed that a “holistic” office could provide her with what she was looking for. Now, only 8 years later, her teeth are falling apart.

Carol had eight crowns done on her back teeth at that time. The crowns, still in her mouth, were failing due to recurrent decay. More importantly to Carol, her front teeth were in severe breakdown. Carol had her mind made up; she wanted full dentures.

Carol sought out a local dentist, presented her desires, got a written treatment plan with fees, and then came to me for a second opinion. She brought that treatment plan with her and it appeared very reasonable – take out all remaining teeth and place full dentures.

The first thing I noticed was that Carol had 6 lower front teeth that have been decay-free and have had excellent bone supporting them for 70 years. However, her mind was made-up, she wanted everything taken out. She did not want to have to deal with maintenance of teeth any more.

Over the next two consultation appointments I had with Carol, we discussed many different treatment options. We thoroughly reviewed the advantages of keeping these lower front teeth each time we met. Carol brought a list of questions to each of these meetings, which we discussed in depth. It was decided – Carol was moving forward with full dentures.

At each appointment during the process, I discussed a different aspect of why it would be such an advantage to her to keep those lower front teeth. Her mind was not changed, until yesterday. Yesterday, Carol walked into my office to tell me that she has decided that she wants to keep her lower teeth.

Okay, so what’s the point? The point has nothing to do with what Carol’s final treatment is. Carol has every right to decide on what she feels is right for her.

The local dentist she got the treatment plan from provided a very reasonable treatment proposal. They had one visit, decided on treatment and her next step was to go to the oral surgeon and have all her teeth out.

Far too many times I see patients and dentists rush into treating teeth. Taking the time to engage in conversation and treat the person as a person and not just a head with teeth, is the truly holistic approach.

My point of this story is not that I got Carol to do what I felt was best for her, but that I gave her my time, answered all her questions, and allowed her to decide what was best for her. She needed the time.

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 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 and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating 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 think it is safe to say that our healthcare system has some flaws. Wouldn’t it be nice to have a healthcare system that realized that everything in the body is connected? Unfortunately, there are no reasonable solutions for this in the near future. Therefore, it is important for you to take your health into your own hands and plan appropriately.

Patients will sometimes balk at treatment not covered by their dental insurance. Dentists will often hear, “Just do what my insurance covers. I don’t want anything extra.” In fact, a recent ADA poll showed that a lack of dental insurance was the #1 reason most patients gave for not visiting a dentist. Here are some frequent questions patients often ask about dental insurance.

Why doesn’t my insurance cover all of the costs for my dental treatment?

Dental insurance isn’t really insurance (defined as a payment to cover the cost of a loss) at all. It is a monetary benefit, typically provided by an employer, to help their employees pay for routine dental treatment. “Dental Insurance” is only designed to cover a portion of the total cost.

But my plan says that my exams and other procedures are covered at 100%.

That 100 percent is usually what the insurance carrier allows as payment towards a procedure, not what your dentist may actually charge. Dentist’s fees are usually a reflection of the level and quality of care in a particular office. Some cost more, some cost less, depending on the costs of running their office, how much they pay their staff, the materials they use, etc. An employer usually selects a plan with a list of payments that corresponds to its desired premium cost per month. Therefore, there usually will be a portion not covered by your benefit plan.

If I always have to pay out-of-pocket, what good is my insurance?

Look at medical insurance. Many people have been forced into high deductible plans ($2000 or more). Most dental plan deductibles are $50. While dental insurance is far from ideal, any amount that reduces your out-of-pocket expense helps.

Why is there an annual maximum on what my plan will pay?

Although most maximum amounts have not changed in 30+ years, a maximum limit is your insurance carrier’s way of controlling payments. Dental plans are different from medical plans, in that dentistry is needed frequently. Medical emergencies are rare. It is your dentist’s responsibility to recommend treatment based on diagnosis and treatment planning of what is appropriate for your dental health, not necessarily what your dental plan covers.

If my insurance won’t pay for this treatment, why should I have it done?

It is a mistake to let your benefits be your sole consideration when you make decisions about dental treatment. People who have lost their teeth often say that they would pay any amount of money to get them back. Your smile, facial attractiveness, ability to chew and enjoy food, and general sense of well-being are dependent on your teeth.

Other than complaining to your dental insurance company or your Employee Benefits Coordinator, your best defense is to budget for dental care. First, find a provider based on a personal fit for you. That is the single most important thing you can do.  If that office can’t work with you financially then I would find another office.

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 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 jpeterstclair@stclairdmd.com,

50% consider the smile the first facial feature they notice.

80% are not happy with their smile.

Smile enhanced procedures outnumber eyelid surgeries 5 to 1.

32% of Americans cite bad breath as the least attractive trait of their co-workers.

38.5 total days an average American spends brushing teeth over lifetime.

73% of Americans would rather go grocery shopping than floss.

60% of people don’t know that a sore jaw, when combined with chest pain, can signal a heart attack, especially in women.

Dentists recommend that a toothbrush be kept at least six (6) feet away from a toilet to avoid airborne particles resulting from the flush.

A toothpick is the object most often choked on by Americans.

Every year, kids in North America spend close to half a billion dollars on chewing gum.

The number of cavities in the average mouth is down and people are keeping their teeth longer. People, on average, have healthier mouths than even 10 years ago.

The decline in tooth decay was greatest among kids but holds across every age group.

Only 40% of young people age 6 to 19 have ever had a cavity in their lives.  That’s down from 50% a decade ago.

Over the last ten years the proportion of people age 60 that had lost all their teeth had decreased from 33% to 25%.

Adults with post-high-school degrees had an average of three more teeth than those without a high school diploma.

Smokers remain three times more likely than non-smokers to lose all their teeth.  This figure has not changed from a decade ago.

Socio-economic status plays a definite role in one’s general and dental health.

33% of low-income adults have untreated decay.  This compared with 16% of middle- and higher-income adults.  19% of kids living in poverty have untreated decay compared with 8% of higher-income kids.

More people use blue toothbrushes than red ones.

Like fingerprints, everyone’s tongue print is different

The average woman smiles about 62 times a day! A man?  Only 8!

Kids laugh around 400 times a day. Grown-ups just 15.

Smilers in school yearbooks are more likely to have successful careers and marriages than their poker-faced peers.

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 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 and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating 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 falls 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 and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating 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 are five major reasons that people do not get the necessary dental care they need; six if you count the recent pandemic. The other five are money, time, lack of concern, fear and trust. Let’s take a quick look at each one and see if any of them fit you, and what dentists often try to do to overcome these obstacles for patients.

Although you may think that money would be the number one reason people avoid ideal dental treatment, it is not. Even in tougher economic times, money, although a significant barrier for many, is still not the number one issue for most. Dental health, and good health in general, always requires some kind of investment.

Lack of dental insurance is a poor excuse for not getting regular dental maintenance. As I have said numerous times, dental insurance in not insurance; it is a benefit. If it were “insurance”, it would cover treatment that patients need. While not bad to have, the advantage is limited, based on insurance company’s unwillingness to raise the bar and change a system that hasn’t changed since the 1970’s.

Unfortunately, as of now, we have to face these facts, and it does not mean avoiding the dentist. Many dentists offer in-office payment plans, as well as plans through third party carriers, so patients can finance needed treatment. Two dental hygiene appointments a year costs way less than many other things people spend money on. If you drive your car for 20,000 miles without maintenance, something is bound to happen. The better you take care of your car, the less problems you’ll have.

Time is another excuse. We all use time as an excuse for many of the things in our lives we want to avoid or procrastinate on. The reality is, however, if we place something high enough in our value system, there is always time for it. In order to move something higher up in our value system, we must be enlightened enough to realize that this particular thing is of benefit to us. This brings me to the most common reason people avoid ideal dental care.

Lack of concern about dental health is prevalent with a large percentage of the population. Absence of pain is the biggest reason for this lack of concern. Other than a severe toothache and need for a root canal or extraction, there are few things that cause enough pain to bring someone to the dental office. Take gum disease; about 75% of the population has some form of this disease, but only 50% of the population goes to the dentist. Why? No pain. Absence of pain is a poor indicator of health.

Some people have fear about going to the dentist….and for good reason, due to bad past experiences or bad information. However, dentistry today should be a comfortable experience most of the time. For those that are still fearful, there are different medications dentists can use to ease the experience.

The last barrier to ideal treatment is trust. For a patient to move forward with treatment, it is essential the patient both like and trust the dentist. Although I am sure that the skills of your dentist are important to you, I am willing to bet that you would not stay with a dentist who you did not like or trust. Find someone you can connect with and build a strong doctor-patient relationship.

I believe that one of the best things a patient can do for their dental health is to find an office they like and trust……and stay there. Continuity of care is in the patient’s best interest. Find your dental home.

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 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

 

Did you know that keeping your toothbrush clean is just as important as keeping your mouth clean? After all, you use it every day to scrub plaque and bacteria off your teeth, gums, and tongue. That means after a brushing session, the bristles now carry all the germs and residue from your mouth. Unless the harmful substances are properly removed, your toothbrush won’t be as effective at cleaning your teeth. While you should be replacing it every three to four months, here are some ways you can keep it clean in the meantime.
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If you are an expert in a particular field it tends to mean you know quite a bit about that subject. It doesn’t mean you are always right, but you can usually at least have an intelligent conversation about your field. When a “journalist” writes a story about your area of expertise, I would be willing to bet, the expert (you), often cringes about the content. So goes the latest thing I have seen written about dentists and dentistry.

“Is Your Dentist Ripping You Off?” is the title of an online column that was forwarded to me. One of the best parts of this type of column are the comments to follow from such a wide range of people. Dentists commented, patients commented, hygienists and assistants commented, and many who don’t go to the dentist commented. Over the next few weeks I am going to take little pieces of the column and the comments and discuss them. I think it will make for some interesting discussions that I hope you will weigh in on.

Let’s lay the groundwork with summarizing the column itself. The author describes a “person near and dear” who returned from the dentist and was told they need two crowns for around $3000. The author called some other dentists in the area and found that there was a range of fees. Some of her comments follow:

“When I look at this bill, I wonder why I obsess about the weekly price fluctuations of Cheerios or the shrinking size of a can of tuna. All the economical choices a family makes in a year can be wiped out by a trip to the dentist.” She continues by questioning how there can be such a range in fees.

“So how can the first guy explain why his price is $450 higher? The office assistant told me ‘not all dentists are created equal,’ and of course, this dentist is one of the best in the area, using a great lab. But how can someone who is not a medical professional know if their dentist is worth their fees?”

I think these questions are excellent questions and are things that many people wonder about. Of course, there is no easy explanation. We will get deeper into that in another column. There is no doubt, dentistry can be expensive, but is it relative to everything else in life?

One of the most important suggestions the author had was, “don’t select a dentist on price alone.” While I believe this is true, the next logical question would be – What other factors do you use in selecting a dentist or health care provider? The author provided some other good information.

“Fees are one part of evaluating a dental practice, but you want to have confidence in the office, the people there, how they sterilize instruments, and the training and continuing education of the dentist. Does he or she seem to be looking out for your best interests over the long haul? What’s the dentist’s philosophy for keeping your teeth healthy for a lifetime?”

That is great advice. I would add to that looking at the practice website, reading testimonials of existing patients, and asking to visit the practice and meet the dentist and staff before committing.  That should be done at no charge.

Next week I will discuss some of the comments written after this column. That will be interesting. Looking forward to your comments as well.

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

Our lives are a series of choices. If we feel we don’t have a choice in a particular situation, think again. We usually do have a choice because our actions are based on how we think. How we think is a choice. While not necessarily easy, we can choose to think differently. 

I am going to use dental insurance as an example, since this is supposed to be a dental column. Dentists hear all the time, “My insurance only covers ____”, or “My insurance says they don’t cover that”, or “My insurance company says I can only see a dentist on their list”, or “I can’t do that because I don’t have insurance.” The response that most dentists think, but are usually afraid to say is, “Who is in charge of your dental health, you or your insurance company?”

The first thought you may have when you read this is about money. “If my insurance company doesn’t cover it, I guess I can’t do it.” While you may think you cannot “afford” something, it is a choice. There are varying degrees of dental health. Maybe everyone can’t “afford” optimal care; crowns on teeth that need the protection, esthetic enhancements, replacement of missing teeth, etc., but basic dental care to improve your health is available to everyone. If you are committed to better dental health but have not found that to be true, you are not looking in the right place.

The money barrier to getting the care you need evokes emotions. Emotions in and of themselves have no real value; they are neither good nor bad. They are just sirens alerting us to something we should pay attention to. If we learn to listen to them instead of blindly obeying them, they can be very good teachers. If money evokes a negative emotion when it comes to dental care, it is because you know your dental health is important. You need to make the choice for better dental health, and find the place to help you overcome the barrier of money, or anything else that is holding you back.

I am sure you are aware, especially if you have read these columns over the years, that medical insurance and dental insurance are totally different. Both are broken systems, in my opinion. The fact of the matter is, we (who are ultimately responsible for our own health), have to see it like it is now. We can’t “afford” to wait for politicians and insurance bureaucrats to “figure it out.” Dental insurance has continued to get worse since its inception over 40 years ago. What are we waiting for?

I certainly do not have the answers to fix the problem.  While we wait for everything to miraculously change, you have the freedom to choose what is best for you. It would be nice if you had dental insurance that allowed you to go to whoever you wanted, and get the things done that you need (or want) without asking permission from the insurance company. Can you wait for the system to change? Regardless of insurance, whatever is holding you back, you can change the way you think about dental health.

I am sure this column produces different “emotions” for different people. I would love to hear your comments so I can address them in another column.

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 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