J. Peter St. Clair, DMD Blog

Now is a very exciting time in the dental service industry! As patient needs evolve, so must techniques, instruments and technology. Within the next decade, it is expected that many new dental trends will emerge to provide better, more reliable care to all patients. Keep reading to learn what may become the new normal in the next 10 years. (more…)

In a recent poll, people were asked if they would choose a cosmetic makeover, liposuction, facelift, or teeth whitening if money was no object. 52% of those surveyed said they would choose teeth whitening. While there are many ways to whiten teeth, including professionally in the dental office, consumers are spending over $1 billion per year on over-the-counter (OTC) whitening products. People want whiter teeth because it makes them look better.

Almost all whitening products will lighten teeth to a certain extent because they all contain hydrogen peroxide or a derivative. The controlled environment of the dental office and the quality of the materials used usually provides the most predictable and most effective results. If you choose to use OTC products you may not get nearly the same result you would with having it professionally done. However, I will admit, I have seen some good results with certain OTC many products. Just beware – there are many gimmicks out there.

All forms of tooth whitening can have side effects, including gum irritation and sensitive teeth. These side effects are normal and usually subside once the treatment has stopped or shortly thereafter. We will often recommend the use of a “sensitive” toothpaste a month or so prior to starting whitening to help ward off tooth sensitivity. Another advantage to having it done professionally, is the support you have from the dental staff guiding you through the process. This makes the treatment faster and more effective.

The issue with overusing whitening products is the continuous assault of the pulp or nerve of the tooth through any exposed dentinal or root surface by the bleaching gel. If the whitening is causing tooth sensitivity it means the gel is affecting the pulp of the tooth in some way. In the short-term that’s usually not an issue and the pulp recovers. Whitening products should be used as an initial treatment, and then for occasional “touch-ups”.

In my experience, I have never seen permanent damage done to teeth if the whitening products are used properly. It is important to note that different kinds of teeth require different strengths of bleaching to get the desired result. These different “types” of teeth also have varying levels of sensitivity to the bleaching products.

Teeth in patients 30 and under, and teeth that are yellow in appearance, typically take less time to achieve the desired result. These teeth are also the most susceptible to the side effects of bleaching. People with recession are also more susceptible to sensitivity. This group will usually see great results with professional at-home tray whitening in about 2 weeks.

The older and darker teeth are, the more time it takes to lighten them and the less susceptible they are to side effects. For example, I treated a patient with severe staining due to tetracycline medication as a child who was told his teeth would not lighten all that much. He did at-home professionally monitored bleaching every night (or almost) for 9 consecutive months and got amazing results. That is atypical and should never be done without supervision.

There is nothing quite like a bright beautiful smile. The simple process of teeth bleaching can completely change a smile. There are some OTC products that are perfect for some patients as long as the included directions are followed. For those who have more bleach challenged teeth or want more predictable results, professional whitening is advised.

Teeth Whitening makes a great present too!

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.

In the first segment of this series I discussed the role of caregivers in early dental care. Prevention starts as early as 6 months into pregnancy and continues with essential steps early in a child’s life. The second segment discussed dental care for children as they develop. In this final segment I will discuss easy prevention and maintenance steps to take to help ensure dental health for a lifetime.

As I stated a few weeks ago, in preventive-based dental practices we go far beyond saying to patients, “you need to brush and floss more.” We truly believe that dental disease, both dental caries (cavities) and gum disease, is very preventable. However, we recognize that not every individual is equal when it comes to susceptibility. Each person presents with their own unique genetic pool, good and bad habits, number and position of teeth, and willingness to truly make a change. The one constant is that most of us have room for improvement.

Here are 4 simple things that will help maintain dental health for a lifetime:

Professional Maintenance – It is easy to put professional hygiene visits on the backburner. We are pulled in many different directions in life, and the absence of pain in our mouths sometimes grants us permission to skip regular dental appointments. Some people will use the excuse of lack of insurance for not going on a regular basis. The most important thing you can do to prevent dental disease is to commit to a lifetime of professional dental visits. This is a choice. Your cell phone costs more per year than these visits will. Some people require four visits a year to maintain health and others may only require one. There are no set rules. However, it is up to you to make the commitment.

Home Care – Most people have significant room for improvement with their home care. Coaching, in anything, increases an individual’s potential for improvement. Think of us as your dental coach. We routinely ask patients to bring their toothbrushes with them to their appointments to review technique. As simple as it sounds, constant evaluation and improvement of your home care can only decrease your chances of dental disease.

Diet – What we put in our mouths, when we do it and how often are all choices as well. As with everything, some people can get away with things that others cannot. Decay rates are different for different people and can change during the course of a lifetime. This is an important topic to routinely discuss at regular visits.

Oral Appliances – This is in reference to any oral appliance typically worn while sleeping. This is another situation where absence of any symptoms sometimes allows us to ignore what is really going on. It is easy to get someone to wear an appliance in their mouth if they present with TMJ issues or headaches. On the other hand, it is often difficult to convince someone to routinely wear a nighttime appliance if they have no symptoms. For example, people who have had braces should be wearing retainers. People who have sleep apnea may have the option of wearing an oral appliance. However, those who have evidence of clenching and/or grinding are the most undertreated. It is my firm belief that if more people committed to unfailing routine use of a properly made nighttime appliance, many potential dental problems could be avoided.

I believe that most dental disease is preventable. What it takes to prevent dental disease in one person may very well not be the same for another. Choose and commit to these four things and you are guaranteed fewer dental problems over your lifetime.

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.

In preventive-based dental practices we go far beyond saying to patients, “you need to brush and floss more.” We truly believe that dental disease, both dental caries (cavities) and gum disease, is very preventable. However, we recognize that not every individual is equal when it comes to susceptibility. Each person presents with their own unique genetic pool, good and bad habits, number and position of teeth, and willingness to truly make a change. The one constant is that most of us have room for improvement.

It goes without saying that preventive care includes regular visits to the dentist. Based on my experience, even many of those who visit the dentist on a regular basis have significant room for improvement. However, it is up to your caregivers, hygienists and dentists, to have that preventive frame of mind to go beyond just telling you to brush and floss more.

Technique is vital when it comes to home care. Although daily removal of plaque (the thin, sticky film of bacteria that creates cavities and gum disease) can be accomplished with a manual toothbrush, the proper power toothbrush is more appropriate and effective for most people. We routinely ask patients to bring their toothbrushes with them to their appointments to review technique. Think of your dentist and/or hygienist as your dental coach. Coaching, in anything, increases an individual’s potential for improvement.

The same approach goes for kids. Although we do the same thing with children, they need that additional coaching from home. The best way to guide your family to good oral health is to lead by example. Parents should supervise toothbrushing by children younger than age 8 to make sure they are doing a thorough job. This also goes for flossing. This is done until the child is consistently getting good homecare reports at dental visits.

The challenge of good home care increases with the addition of braces. Children and adults in braces need extra coaching on technique and more time spent on their daily routine. I am a firm believer that preventive visits to the dentist should increase during orthodontics. There is too much at risk during this time and the extra professional care and coaching are vital to escaping the pitfalls of poor homecare while braces are on.

As life goes on, your genetic make-up, the amount of professional care and coaching you receive, your effectiveness at home, and your willingness and ability to improve, will shape your oral health. The fact of the matter is, there are those who need more professional care and more rigorous homecare than others.

As I stated earlier, I believe that most dental disease is preventable. What it takes to prevent dental disease in one person may very well not be the same for another. Between finding the right fit with a dental office, utilizing the coaching expertise of those individuals, using the right homecare products, and always striving to improve, excellent oral health for a lifetime is possible.

In the final segment of this series next week I will discuss some simple ideas to maintain good dental health for your entire adult life. It is simpler than you think.

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.

Research shows that babies are born without any harmful bacteria in their mouths. However, once bacteria colonize in the mouth, children are more prone to cavities in their baby teeth and permanent teeth. How do they get the bacteria? Caregivers.

Most parents don’t know that they can pass harmful bacteria from their mouth to their baby’s mouth. The most critical time is during the child’s first 2 ½ years of life. Most children are born without a single tooth. Can bacteria passed to children without teeth affect their decay potential for their whole life? According to research the answer is yes.

Here’s a shocker…..If you have a history of poor oral health, including many fillings in your mouth, you are much more likely to transfer these harmful bacteria to children. How? Typically, this takes place through common parental or caregiver behaviors such as sharing utensils or cleaning a baby’s pacifier with your own saliva.

Prevention starts as early as 6 months into a pregnancy. Research shows that expectant mothers who chewed gum containing the sweetener xylitol are much less likely to have decay-causing bacteria in their saliva. So, take-home point number one, it is essential for expectant parents and caregivers to keep their own mouths healthy. If you reduce the bacterial levels in your own mouth, you are not only benefiting yourself but also that of your unborn child. Visiting a dentist regularly, even more often when you are pregnant, improving your homecare, and using products that specifically reduce bacteria are all essential.

Your baby is born; now what? First, eliminate potential ways of transferring saliva to your baby. Do not share utensils or let grandma or grandpa lick a cloth to clean around a baby’s mouth. Wiping your baby’s gums with a clean cloth after meals is also good practice to help reduce bacterial levels.

Once a child starts getting teeth, diet plays a significantly greater role. Minimizing snacks and drinks with fermentable sugars is key. This starts with the bottle. Bottle syndrome, also known as baby bottle tooth decay, occurs when teeth become exposed, at length and frequently, to liquids containing a form of sugar. All liquids that contain sugar can cause bottle syndrome, including breast and cow’s milk (which contain the sugar lactose), formula, fruit juice (which contains the sugar fructose), soda and other sweetened drinks. It is caused by the constant presence of milk, formula, or fruit juice in a child’s mouth during the night, during breastfeeding, during naps, or for extended periods during the day. The liquid pools around the teeth and gums, providing food for the bacteria in plaque. The bacteria produce acid as a byproduct when they consume the sugar. This acid attacks your child’s teeth and causes decay.

When your child feels comfortable with a toothbrush, brush their teeth and gums twice a day with an extra-soft toothbrush. Use a pea-sized amount of toothpaste without fluoride until your child is old enough to spit.  If your child doesn’t like toothpaste, it’s fine to brush without it.

Prevention starts before babies are born. It starts with taking care of your own mouth.

Next week, in the second part of this 3-part series, we will explore some important issues to consider during the next phase of life.

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.

The winter season is a time that many people look forward to because it means holidays spent with family and friends and making fun memories, but for your mouth, the cooler months can be challenging. Winter mouth issues are extremely common, and your dentist in Rowley has some tips to share to help you combat the struggles you may experience this season.

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Last year I wrote a column about a study I saw in an article from over a decade ago. It was about the poor odds people have making changes in their life actually happen. The article was 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 were willing to literally die from it.

In the Johns Hopkins study, 9 of 10 heart surgery patients chose to return to their unhealthy lifestyle, rather than make the changes needed to live longer. Very few were convinced by their doctors to make radical daily changes.

Based on my own experiences trying to move individuals to change habits that are having negative effects on their oral health, I knew it was difficult, but was shocked by the 90% statistic, especially relating to a do or die scenario. There are two studies that I have seen relating specifically to dentistry which confirm that changing behavior is not easy.

The first study looked at whether dental hygienists were as effective as they thought they were with oral hygiene instructions. The role of the dental hygienist is to instill the need, desire and ability for patients to achieve optimum oral health. The purpose of this study was to determine if patients correctly understood oral hygiene instructions provided by the hygienist, and to see if the hygienists felt that they were giving patients individualized instructions.

No big surprise, the findings showed a disconnect between what the hygienists believed they were conveying to their patients, and what the patients actually heard. So, part of the problem with getting people to change starts with actually confirming that the person understands the call to action and the implications of not acting.

The second study was to determine if a simple follow-up contact with the patient would impact behavioral change. In this study, patients had a routine dental hygiene appointment and were given specific oral hygiene recommendations based on their individual needs. Contact was then made with patients one week after their appointment.

The patients were asked if they tried the specifically recommended products they had been instructed to use, if they liked using them, and why or why not. Only 50 percent of the patients replied to the call-out from their hygienist. Of those who did respond, most said they tried the specifically recommended product, but only 33 percent of them felt that they would continue to use it. The conclusion of the study was that follow-up contact alone is not an effective method to change behavior and does not increase compliance with oral health recommendations.

So, what does it take to get people to change their habits? I think it is safe to say that some will and some won’t, no matter the consequences. It is also safe to say that it is a choice.

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.

Do you have any problems with dental decay (cavities), gum recession, and/or dental erosion (the chemical breakdown of tooth structure)? These dental issues are complicated multifactorial diseases of epidemic levels affecting both children and adults. A healthy mouth sometimes 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.

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.

Why the increase in decay? 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. And don’t think that just because you don’t eat “sugar” that you are safe. If you are getting decay, something is causing it. The problem is that changing behavior can be very hard to do.

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 this is referred to as 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 issues, and dietary issues, a caries-preventive strategy can be established. There are many new products on the horizon to help combat and virtually eliminate this disease. However, 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, which can be challenging. The bottom line is that if you want to be decay-free, you can be.

For those at higher risk, there are some great products currently available from a company called Carifree. 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. You may also want to mention Carifree products to your dentist in case they have not heard of this company.

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.

It seems I have more and more patients telling me about their upcoming shoulder, hip, and knee replacement surgery. There are other parts that people have replaced, but those are the top three. Most of these people decide to go under the knife to improve their quality of life.

If you were born in the Paleolithic era, you could expect to live to 33 years old. The average global life expectancy in 2010 was more than double this number at 67 years. The main reasons for this are advances in hygiene, food production, and medical care.

On the bright side, if you were born in the Paleolithic era, you would most likely never need a hip replacement. It usually takes longer than 33 years to wear out the joint.

Today, about 2.3% of Americans have had a hip replaced and 4.6% have had a knee replaced. More than a million joint replacements will be done this year and the number continues to grow. The longer we live, the more chance we have of parts needing replacement.

What about teeth? Your lower first permanent molars erupted into your mouth around the age of 6 years old. If you are 50 years old, these teeth have been tolerating chewing, hot coffee, cold ice cream, the occasional popcorn kernel, and maybe even grinding back and forth for 44 years. You have used them every day for 44 years!

What else can you use that much for 44 years that doesn’t require some kind of maintenance? How about that car you drive every day? The car certainly requires maintenance to function properly. The oil needs to be changed on a regular basis. Depending on several factors, the tires need to be rotated to wear evenly and usually need to be replaced after so many miles. I don’t know too many people who drive the same car for 44 years.

Of course, I am not insinuating that everyone needs replacement teeth at some point.  I am saying that it is naïve to think that a car, a furnace, a computer, or your teeth will run forever without maintenance, and that they will run better with routine maintenance.

What happens if you don’t do regular maintenance on your car? It will run for a long time, at some point its performance will decrease, and then when it finally decides to quit, it will be catastrophic. You will have to replace your car. How much will it cost to replace your car? Doesn’t it make sense to keep up with the routine maintenance?

Sometimes, even with regular maintenance, parts need to be repaired or replaced. We often have to make a decision on “how” to fix something. Do we patch it up to get some more miles out of it or do we replace the part to extend the serviceability? It may depend on the cost. It may also depend on the risk of the patch failing. You may decide that the risk is too high and go ahead and replace the part, even though it may cost more.

If you were a caveman, we wouldn’t be discussing this. You wouldn’t have a car and most of your own “parts” would make it to your expected 33 years….but you’re not a caveman. You are likely to wear parts out. You may need a hip replacement, or a filling, or a crown.

And remember: Regular oil changes and maintenance will help your car run well much longer.

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.

Like many dental practices today, our office sends an email request for patients to leave comments about their visit to our office. Most comments are positive, for which we are grateful. However, all comments are helpful to the business to understand what patients are thinking. If one person is thinking it, most likely there are others.

We recently received the following comment on our website from a patient who was in to see the hygienist:

“My hygienist is always very pleasant, conversational and professional in her services. However, I can do without the constant sales pitch to buy an electric toothbrush from your office. There is no evidence that an electric is any better than a good, manual 2-minute brush, and I don’t have any arthritis or dexterity issues.”

I really appreciate feedback from patients like this. Your own dental office would too. In my response to the patient, I explained that I didn’t like the fact that the patient had the feeling he was trying to be sold something. For the patient to feel that the only benefit was monetary to our office means the communication was inadequate, especially because we don’t make any profit.

We keep our preference of electric toothbrushes in stock for convenience and cost savings for the patient. The shared benefit for the seller and buyer is improved health. Most dental offices are not selling electric toothbrushes to make money.

Back in the beginning of my professional career, I was an advocate of the manual toothbrush. I was convinced that anyone could get the same results with a manual toothbrush, compared with any electric/power toothbrush. It wasn’t until I actually tried a power toothbrush, and stuck with it, that I was convinced there was s distinct difference.

It is now common practice for us, and likely most dental practices, to ask patients if they use a manual toothbrush or an electric toothbrush. When we ask this question, we have also found that it is just as important to ask what kind of power toothbrush is used. One that sits in a charger is far more effective than one that you put batteries in, though it does cost more.

There have been numerous studies that have compared the effectiveness of both rotating and sonic power toothbrushes. Recently, 131 individuals participated in a study; 65 randomly assigned to the oscillating/rotating group and 66 to the sonic group. Prior to the study, 63% and 58% were manual toothbrush users, respectively. Each participant brushed twice daily during a four-week period using their assigned powered toothbrush and a standard toothpaste.

Researchers graded effectiveness of their plaque removal using a specific plaque-grading index. While both groups showed significant improvement when compared to manual brushing, the oscillating/rotating brush was better. 97% of the oscillating/rotating group saw a reduction in whole-mouth plaque, compared with 64% of the sonic participants.

“The current study demonstrated superior plaque reductions with an advanced oscillating/rotating power brush compared to a novel sonic brush, corroborating previous studies demonstrating the superiority of oscillating-rotating power brushes relative to sonic brushes,” the researchers concluded.

While using a manual toothbrush can be effective, it is clear based on this study and others, that a good quality power toothbrush is better. It’s time to change if you still use a manual brush.

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.