J. Peter St. Clair, DMD Blog

Every once in a while, someone will say, “There must be a lot less cavities today than there were years ago because of improved home care, fluoride, etc., right?” Maybe in general, but there is still way too much decay. Poor diet and home care are the two most common culprits leading to decay. Dentists have seen a significant increase in decay during COVID.  When and what you eat and drink is important. Improvement in home care means changing what is being done now, and requires discipline.

Yesterday, I went into one of my hygienist’s rooms to check her patient, a 13-year-old boy, and asked the hygienist how his home care was, because his gums were bright red. She said to me, “Jack, why don’t you tell the doctor how often you told me you brush your teeth.” The boy answered, “About once a week.” ONCE A WEEK?!?! Add the fact that he is in braces, which makes it even more important to keep the teeth clean.

It’s important sometimes to step back and review the basics, so here they are. At a minimum, you should brush with a fluoride toothpaste at least twice a day for two minutes. A good electric toothbrush is preferable to a manual toothbrush. When I say “good”, I mean one that sits on a charger, and not one that takes AA batteries. There are two major brands out there. I prefer the one that starts with an “O”.

It amazes me how many people don’t floss their teeth. I have heard every excuse in the book; “My fingers are too big”, “I don’t have the time”, “It’s too hard”, “My dog ate the floss”. Just like anything else, it is always hard to start a new ritual. There are so many different kinds of floss and gadgets to help floss that there is something out there for everyone. And if you can’t seem to make it work, use a water pik; it works better than floss anyway.

Bacteria, which accumulates on and between the teeth, forms that white film called plaque. Plaque contains billions of colonized bacteria. The right kind of bacteria, along with the wrong king of diet and the wrong genetics can produce cavities. Plaque that is not removed with thorough daily brushing and flossing can harden and turn into calculus (tartar). These colonized bacteria can then lead to tissue inflammation (gingivitis), the early stage of periodontal (gum) disease.

Brushing your teeth helps get rid of most of the plaque, except for the stuff that accumulates between the teeth. That is what floss and the water pik are for. I know it sounds gross but if you want to know what your breath smells like, floss a few teeth and then smell the floss. That should turn you into an avid flosser.

The routine should be, floss (water pik), brush, rinse. The whole event should be around five minutes. Believe me, you have five minutes. Cleaning between the teeth first allows the fluoride from the toothpaste to contact a cleaner tooth surface between the teeth. I prefer a non-alcohol-based rinse, as alcohol is drying and creates a better environment for bacteria to thrive.

If you do choose floss, technique is important. Proper flossing is not popping the floss between the teeth and shooting it right back up. The proper way to floss is to get the floss between the contact of the teeth, slide the floss gently under the gum tissue around one tooth, “shoe-shine” the side of the tooth, gently move the floss over the papilla (the little piece of gum between the teeth), “shoe-shine“ the side of the other tooth and then bring the floss up. At your next dental visit, ask your hygienist to evaluate your flossing skills to make sure you are doing it correctly.

You have the 5 minutes twice a day.

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.

Valentine’s Day is a widely celebrated holiday in February, but there is another reason to be thinking about your heart. This month is Heart Health Month. There is no better time for you to learn about how your cardiovascular and oral healthy are related. In order to keep your heart strong, you should be focusing on your oral hygiene routine. Continue reading to learn about their connection.

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This is a phrase we hear far too frequently when patients call to cancel or change their dental hygiene appointments. When the patient is told that there are no open hygiene appointments for 4-6 months, the response is often, “Oh, that’s okay, it’s just a cleaning.” This lack of concern is only partly to blame on the patient; most of the accountability falls in the lap of the dental team.

If you read this column with any frequency, I am sure you have seen me report that 75% of the population has some form of periodontal (gum) disease. I’m sure you have also read that periodontal disease has been linked to heart disease, stroke, pre-term, low birth-weight babies, diabetes, and possibly even some types of cancer. The problem is the dental team is not discussing this enough with their patients.

Here’s the way I see it: If a patient has made the decision to seek the services of a dental office, we must assume that the reason is based on wanting to improve and/or maintain their dental health. If that’s not the reason you go to the dentist, what is? Patients will often say during an exam, “Please don’t find anything.” Our response may be, “Well then, I better not look.” Assuming the reason for going to a dental office is to improve and/or maintain dental health as part of overall health, it is the obligation of the dental team to “find stuff” if it’s there, communicate that with the patient, and have a conversation about whether any steps should be taken.

For example, based on your level of periodontal health, there are different levels of frequency recommended for hygiene visits. The majority of patients should be seen every 6 months. Some are lucky enough to have yearly visits recommended to them. For others, every 3 or 4 months is recommended. This frequency is determined by your dental team to maintain your dental health. Regardless, if you put off your routine care by 1, 2 or even 6 months, that is a lot of time to have bacterial growth accumulate and put your body into a defensive mode due to increased inflammation. This brings me back to the reason you have chosen to be an active dental patient.

Remember, gum disease is not only bad because it makes your breath stink and your teeth fall out; it is bad for you systemically because of chronic inflammation. You may very well not notice an increase in inflammation, but your body does. There are measurable indicators of this.

If your goal is optimal health, routine maintenance is essential. I tell my team all the time that we must continue to educate the people who put their trust in us to maintain their dental health.

Depending on your car, there is a recommended maintenance schedule. If you ignore the recommended maintenance, only bad things can happen. You may be able to “stretch it out” a little, but must understand there are risks associated with that decision. If you knew how bad chronic inflammation really was for you, you would want to be seen more frequently than you are.

There are obviously valid reasons why patients need to change an appointment. Most dental offices understand that. It is the frequency, attitude (It’s just a cleaning), and lack of commitment that causes both disruption within the dental office and discontinuity of care.

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.

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 it 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. I think that some of this technology 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 car company, 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.

 

Dental offices can be like that too. If the dentist spent all their time talking about the array of technological gadgets and how they were right for you, how would you feel? You would feel like you were trying to be “sold” something. Having said that, there are many great technological gadgets that improve the whole experience of patient care out there. There are also many ways to do most things, but technology is not the solution; it is simply a tool used in patient care.

 

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, such as “invisible” braces. However, there are many different brands of cars and dental aligners that would satisfy your 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 most 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.

 

Dental care is such an important part of overall wellness. Remember, just because it doesn’t hurt does NOT necessarily mean everything is okay. Collaboration with a dental team who puts the patient’s best interests first is key to good dental care.

 

Dentists and dental team members 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 and dental teams need to spend time with patients, be involved with co-diagnosing issues with patients, not hard-selling with little information. This creates a caring environment where the patient can be involved in the process of choosing the level of care that is right 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 see things differently than dentists. Often, what is important to dentists is not important to patients, and vice versa. This seems like the obvious, but dentists often have a blind spot when it comes to seeing things from a patient’s viewpoint.

 

We often have a similar blind spot in our ability to communicate with patients. When asked to rate their ability to communicate with patients, 60% of physicians rated themselves in the top 10%.

Dentists would probably have similar results.

 

Communication is key to any relationship. Why then do healthcare professionals, dentists specifically, often have poor communication skills with their patients? There is no one answer to this question, but we (dentists) all struggle with communicating with patients at some level…..and COVID doesn’t make it any easier by always needing to have a mask on during conversations.

 

Dentists often get a bad rap – in the media, interpersonally, and even in the movies. We (dentists) are often starting at a disadvantage in the relationship with our patients. Some patients, who may really need and want care, have preconceived notions, such as fear without basis, an unpleasant past experience, or the idea that they just can’t afford it. It is more difficult to build a trusting relationship in these situations. Of course, there are many patients who love their dental office, but there are still even many of those patients who dentists have trouble communicating with.

 

I think the biggest problem we (dentists) have in many of these communication issues is time. Dentistry is a business, and an expensive business to run efficiently. When time is money, dental income to support the business comes from work being done in the chair. This creates yet another blind spot for the dentist.

 

Dentists may be great tooth fixers but in general are poor communicators. Anyone can drill on a tooth but not everyone has meaningful communication skills. When was the last time a dentist sat down with you for an extended conversation to discuss your personal situation, the importance and relevance to getting good dental care, and its significance to systemic health? When was the last time a dentist helped you work through your particular barrier (fear, money, time, lack of concern, trust) to getting a healthier mouth? I know I have room for improvement.

 

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.

You may have heard your dental hygienist tell you to brush and floss more, but what about chewing more gum?

In a study published in PLOS One, researchers found that chewing gum may remove as much bacteria as brushing without toothpaste or flossing. The study was funded by Wrigley……ok, but it’s still interesting.

“This study was initiated as a method development study to determine the number of bacteria that are trapped in a piece of sugar-free gum,” said one of the authors. “According to our knowledge, this is the first time that an estimate of the number of bacteria trapped in a piece of chewed gum is determined.”

For their research, Wessel and colleagues included five healthy volunteers from the department of biomedical engineering and asked them to chew two types of commercially available sugar-free chewing gums for varying amounts of time up to 10 minutes.

“We discuss [in the study] that by targeting different areas in the mouth, sugar-free chewing gum removes comparable amounts of bacteria to those removed by flossing and a clean toothbrush without toothpaste,” Wessel said. “This was done for perspective only and not meant to compare effectiveness of both techniques.”

The researchers used numerous methods to quantify and qualify numbers of oral bacteria trapped in chewed gum. What they concluded was that daily gum chewing reduces the bacterial load in the oral cavity over time.

The maximum bacteria were trapped during the initial chewing period, after which a slow decrease over time up to 10 minutes was observed. This decline was seen with both methods regardless of the type of gum involved.

While the initial gum bases are most adhesive to oral bacteria, continued chewing changes the structure of the gum and decreases the hardness because of salivary uptake and release of water-soluble components, the study authors noted.

“This presumably affects the adhesion of bacteria to the gum, causing a release of initially trapped, more weakly adhering bacteria from the gum,” they wrote.

They reported that, assuming a volume of saliva of around 1 ml, their results indicate that chewing one piece of gum removes around 10% of the oral microbial load in saliva. They compared this to use of a new, clean toothbrush without any toothpaste, and found that it removed about the same amount of bacteria as the gum chewing. The mechanical action of floss removes a comparable number of bacteria, as established in an unpublished pilot study.

The authors emphasized that brushing and flossing remain more effective in reaching many areas in the mouth, and that sugar-free chewing gum should not be seen as a replacement, but as an addition to both techniques. The study findings may promote the development of gum that selectively removes specific disease-related bacteria from the human oral cavity, for instance by using porous type calcium carbonate, the authors noted.

Chew in moderation.

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.

When we ask for a Kleenex or a Ziploc we may not necessarily get that brand, but we know we will get a tissue or a sealable plastic bag.  It is always interesting to me hearing the different things people say in the dental office that seem to be “standard” among the general population.

For example, most people use the term “Novocain”. Even dentists, including myself, use this term daily to describe the local anesthetic used to anesthetize or “numb” teeth before they are worked on. Novocain, apparently still available for purchase, has not been used in dentistry for probably 100 years, but we still use the term because everyone seems to know what we mean. We may say “Novocain” but that is not what we are writing in your medical record.

Another term that is commonly used by patients and those in the dental office is “cleaning”. This term is a poor choice of words to accurately describe the service that a hygienist performs. The problem with this word is that it downplays the actual procedure. “I need to cancel my cleaning appointment. Oh, you don’t have anything for me for 2 months? That’s okay, it’s just a cleaning”, is commonly heard in the dental office.

We say “cleaning” because it’s easier than saying, “We’ll see you Monday, Mary, for your periodontal maintenance and exam which includes a full periodontal exam, scaling and polishing of all surfaces of the teeth, full dental exam, oral cancer screening and an update from the doctor to review this information with you.” If you have, or should have your teeth cleaned every 3-6 months, the word “cleaning” to describe the service being performed is very inaccurate.

The term “crown”, or “cap” as some people use, usually make patients cringe. “I need a crown? I thought I just needed the filling replaced”, is common to hear. Patients tend to think that they are losing their tooth if they need a crown. While this is not the case, what if the dentist said that you need an onlay? Have you heard that term?

I read an article in the paper recently entitled, “Are Crowns Made in a Day Worth the No Wait?” This article describes some of the uses of CAD/CAM (computer-aided-design / computer-aided milling) technology to produce “crowns” for teeth the same day in the dental office. The technology is used in about 10-15% of dental offices.

In the article mentioned above, there was not one mention of the term onlay. An onlay, or partial crown, for lack of a better description, is one of the major advantages of CAD/CAM technology. It often allows the dentist to perform more minimally invasive dentistry for specific teeth.

The primary focus of the article was to point out that these CAD/CAM crowns may not be the best choice for patients or dentists if used on front teeth. The argument is that a dental ceramist in a dental laboratory can make “prettier” teeth than a dentist can in a dental office. While this may be true for some circumstances, the column downplayed some of the major advantages I see with the use of this technology. We say “crown” but it really means, “an indirect, bonded, protective restoration.” A “crown” may cover the whole tooth or just part of the tooth.

The materials we use and the services we perform in the dental office are constantly changing. Let the dentist and dental hygienists use their knowledge, skills and technology to do great things to care for your dental health. Don’t get hung-up on words. Ask questions! Keep an open mind and become an active participant in your dental health.

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 toothpastes and gels with ions in them to rebuild tooth structure, to sprays for pH neutralization. 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.

There are many people who suffer with pain involving some area of the head. Toothaches can cause pain, but these are mostly avoidable with proper diet, home care and regular visits to your dentist. Teeth can also play an indirect role in facial/head pain.

Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles and/or temporomandibular joints (TMJs). Problems can include TMJ discomfort involving muscle spasms in the head, neck, shoulders and/or jaw, migraines or other types of tension headaches, pain with the teeth, face or jaw; and can even play a role in anxiety and/or depression.

You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth, or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. People with seemingly good teeth/bite are also susceptible. Pain can also be caused by clenching or grinding teeth, trauma to the head and neck, or poor ergonomics. Temporomandibular disorders (TMD) affect more than 10 million Americans. Your TMJ’s are located where the skull connects your lower jaw to the muscles on the sides of your head and face controlling the joint’s movements. Women between the ages of 20 and 40 are often more frequent sufferers because of the added estrogen in their bodies.

One in eight Americans suffers from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which may be related to the bite. Clenching the jaw muscles creates tension in the muscles that close the jaw, the main one of which is the temporalis muscle. Signs that may indicate a headache from dental origin include: pain behind the eyes, sore jaw muscles or “tired” muscles upon awaking, teeth grinding, clicking or popping of the jaw joints, head and/or scalp is painful to the touch, earaches or ringing, neck and/or shoulder pain, and dizziness. Keep in mind that in a 24-hour period of time, your teeth should only touch 10 minutes total. If you clench or grind your teeth, your teeth are touching much more than that and I can promise you that something in the masticatory system is being affected.

Sleep disorders can also play a role. I am not just talking about sleep apnea. There are a wide range of sleep disorders and some of them will cause people to clench and/or grind as a defense mechanism of the body to achieve proper air flow.

Dentists have a variety of ways to help relieve orofacial symptoms. One way to treat these problems is called an orthotic, or splint, that is worn over the teeth to help stabilize the bite; kind of like an orthotic some wear in their shoes for alignment and balance when standing. Permanent correction may require equilibration (reshaping teeth), prosthetic dentistry and/ or orthodontics. Many use a splint on a daily basis to avoid having these other treatments done.

Orofacial pain can range from tolerable to debilitating. Maintaining or correcting your bite ensures optimal health, and proper care will help reduce or eliminate orofacial pain or discomfort. If your dentist can not help you, ask for a referral.

Most important lesson of the day: The optimal rest position of the jaw (minus the 10 minutes the teeth touch in 24 hours) is lips together, teeth slightly apart, the tip of the tongue resting just behind your upper front teeth, and you should be breathing through your nose.

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