J. Peter St. Clair, DMD Blog

Dental decay is a bacterial disease that disintegrates tooth structure. Although there is a genetic component, and decay rates can change over an individual’s lifetime, I believe that decay is almost 100% preventable. Other factors in one’s decay rate are diet, home care, medications, xerostomia (dry mouth), and some other medical conditions. The product described below is an effective way to combat dental decay for anyone.

 

What is xylitol?
Xylitol is a natural sugar alcohol that helps prevents cavities. You may recognize other sugar alcohols used in sugarless products, such as mannitol and sorbitol. Xylitol is the sugar alcohol that shows the greatest promise for cavity prevention. It is equal in sweetness and volume to sugar and the granular form can be used in many of the ways that sugar is used, including to sweeten cereals and hot beverages and for baking (except when sugar is needed for yeast to rise).

How does xylitol prevent cavities?
Xylitol inhibits the growth of the bacteria that cause cavities. It does this because these bacteria (Streptococcus mutans) cannot utilize xylitol to grow. Over time with xylitol use, the quality of the bacteria in the mouth changes and fewer and fewer decay-causing bacteria survive on tooth surfaces. Less plaque forms and the level of acids attacking the tooth surface is lowered.

Studies show that Streptococcus mutans is passed from parents to their newborn children, thus beginning the growth of these decay-producing bacteria in the child. Regular use of xylitol by mothers has been demonstrated to significantly reduce this bacterial transmission, resulting in fewer cavities for the child.

What products contain xylitol and how do I find them?
Xylitol is found most often in chewing gum and mints. You must look at the list of ingredients to know if a product contains xylitol. Generally, for the amount of xylitol to be at decay-preventing levels, it must be listed as the first ingredient. Health food stores can be a good resource for xylitol containing products. Additionally, several companies provide xylitol products for distribution over the Internet.

How often must I use xylitol for it to be effective?
Xylitol gum or mints used 3-5 times daily, for a total intake of 5 grams, is considered optimal. Because frequency and duration of exposure is important, gum should be chewed for approximately 5 minutes and mints should be allowed to dissolve. As xylitol is digested slowly in the large intestine, it acts much like fiber and large amounts can lead to soft stools or have a laxative effect. However, the amounts suggested for cavity reduction are far lower than those typically producing unwelcome results.

Has xylitol been evaluated for safety?
Xylitol has been approved for safety by a number of agencies, including the U.S. Food and Drug Administration, the World Health Organization’s Joint Expert Committee on Food Additives and the European Union’s Scientific Committee for Food.

Xylitol has been shown to have decay-preventive qualities, especially for people at moderate to high risk for decay, when used as part of an overall strategy for decay reduction that also includes a healthy diet and good home care. Consult your dentist to help you determine if xylitol use would be beneficial for you.

 

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.

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 can not only be annoying but can also ruin your teeth. Next week I will provide information about one thing that everyone with dry mouth should do.

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.

Many of us are guilty of stretching the truth when we’re talking to the dentist about things regarding our oral hygiene and health. Even if you think you’ve gotten away with it, the truth is that your dentist isn’t so easily fooled. In fact, they can often tell when you are lying by the state of your mouth and other clues that give it away. Continue reading to learn more from your dentist about which lies they can always tell that patients are telling during their regular cleanings.

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If you missed any of this series, they can be found at www.thetowncommon.com.

Is there a solution to the dental insurance problem we have in this country? Solo dental practitioners may look at it one way, large dental chains see it from a different angle, consumers have varied opinions, and many insurance companies see it in their own very different perspective.

Ask someone how they feel about their medical insurance, and they might say that premiums are too high, deductibles are too high, they can’t go to who they want, it’s tough to get appointments sometimes (especially with specialists), etc. Employers looking to cut costs obviously tend to choose lower cost plans. That usually increases deductibles and may limit which providers the employee is able to see. Depending on your insurance, you may have decreased benefits or none at all, if you see a provider outside of “your network”.

What does “in-network” vs. “out-of-network” mean? A long time ago, if you had insurance, you could go to anyone and use your benefits. PPO’s and HMO’s eventually formed and were able to provide lower premiums by contracting with providers who agreed to a discounted fee for their services – the “in-network” providers.  Providers who do not sign that agreement are considered “out-of-network” providers. Your insurance company decides your benefit level for both in and out-of-network providers. The goal for the insurance company is simple: pay-out as little as possible for the biggest profit.

This is the way dental insurance is trending in this country. There are fewer plans being offered that will allow you to use your benefits with providers outside of their network. Why? It depends on who you ask, but I believe the primary reason is to control costs. And that is understandable…if you’re the insurance company.

If you were running a business with a 70% overhead and a major supplier of your revenue decided they were going to pay you 30% less, would you be able to run your business the same way? Of course not. You would need to do things faster, do more of it, and control your costs by investing less in the business, using cheaper materials and paying people less. There is only one winner in that game. The alternative is to not accept the 30% less, have fewer customers, and run your business the way you see fit, in the best interest of your customers.

You can’t be very happy reading this, as a business owner, employee, and/or consumer. It is important to advocate for yourself, especially when it comes to your health.

I frequently get asked, “Should I consider getting dental insurance?” by patients who are either self-employed or are not offered insurance through their employer. In most cases, in my opinion, it does not make sense to purchase dental insurance on your own – at least the way that dental insurance currently works. You should definitely talk to your own dentist about that prior to purchasing something.

What happens if your dentist doesn’t take (or isn’t in network) with your insurance anymore? Should you stay? How do you find a provider in your network if you choose to leave? What other things do you need to consider in making a decision?

….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.

If you missed any of this series, they can be found at www.thetowncommon.com.

The dental insurance industry is getting more and more competitive. Insurance companies are looking to increase profits, and those purchasing dental insurance (usually employers) are mindful of the cost of plans. To increase profits, insurance companies either have to continue to increase the cost of their premiums, or decrease their expenditures. Employers certainly do not want to see an increase in premiums. So, most insurance companies are trying to remain competitive by keeping their premiums lower but paying out less in benefits.

This is happening at a rapid rate, and under the radar of those who are supposed to benefit most from the insurance – you, the consumer. Here is the typical scenario:

At the time of the year when employers are looking to renew their plans, typically the spring, they are presented with their options. When they look for the plan they had the previous year, they realize it is not available anymore. The choices they are now given are either to increase the premiums they pay out for each employee, or to choose a new plan that is at or below the cost of their previous year’s plan with less benefits and more restrictions.

What changes when the employer chooses the second option? These plans are typically those that dentists must “participate” in order to be a part of. Prior to insurance companies offering these plans to employers, they have approached dentists to try to get them to participate. It is up to each individual dentist to determine if they choose to participate. If they choose to participate, to be an “in-network” provider, they agree to accept the contracted fees set by the insurance company. That, in itself, is not necessarily is a bad thing. Some insurance companies offer reasonable and fair reimbursement.  However, there are often other compromises that interfere with the provider/patient relationship.

If an employer chooses one of these plans, the employee (and their family) may need to make a decision on what is most important to them when it comes to their oral health care. What happens if the dentist you have been seeing chooses not to participate in that particular plan? You have to decide whether to stay with that dentist as an out-of-network provider, or choose a new dentist who has agreed to be in that plan. Many of these plans have limited providers.

How do you decide whether to stay with the dental office you have been going to for years, or switch? It is your choice. It can be a difficult decision. There are many things which need to be taken into consideration to make this decision. My best advice is to talk to your dental office/dentist about it.

Although there may be financial differences between some providers, in most cases, it may not be as much as you think. There are many excellent dental offices and dentists on the North Shore. The most important consideration, in my opinion, is to be in an office where you like the people and feel comfortable and confident that you are being treated with your best interest in mind.

Are your expectations being met or exceeded at your current dental office? If they are, and all of a sudden your dentist is not on the list of your new insurance carrier, don’t jump ship until you consider everything. And, as I said, talk to your dental office team and get their take. If you do decide to leave and don’t like your new office, I’m sure they’ll take you back.

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.

This is the second column in a series about the state of dental insurance in our country. The information presented is intended to explain “dental insurance” from a perspective which may be different than most consumer’s view of insurance. I encourage you to read all the columns in this series. If you missed any they can be found at www.thetowncommon.com. I hope the information helps you to make more informed decisions about your dental health.

One of the statistics I presented last week was the fact that dental “insurance”, unlike medical insurance, has a yearly monetary limit that the company will pay out. For the majority of dental plans this number has not changed since the 1970’s. I know I don’t need to point out that you could get a lot more with $1000 in 1970 than you can today. So, why hasn’t the limit increased?

There are many answers to this question. The bottom line is that raising the dental insurance limits would be extremely unprofitable for insurance companies. Here are some reasons why:

First is the “use” factor. Many patients who have dental insurance use their insurance right up to that yearly maximum. This is generally not the case with other types of insurance. In fact, the entire dental insurance model is based on a certain percentage of those insured not using their benefits at all. A recent statistic I heard is 48% don’t use any of their benefits. If the yearly benefit was higher, the premiums would need to be much more expensive for the insurance companies to make a profit. This would destroy the model and there would be many fewer employers signing up for those plans.

Another reason dental benefit programs have not changed is pre-existing conditions. Many dental problems are often ignored for years, and patients will often wait until they have “insurance” to take care of their problems. This is why some insurance companies have a “wait period” for certain dental procedures. When that patient finally has dental coverage and the dentist tells them they need three root canals and three crowns, they are shocked to hear that their insurance will only cover a small percentage of the treatment. Again, there is no dental insurance available to cover situations like this because it would be extremely unprofitable for the insurance companies.

In order to run any business, revenue and expenses need to be managed to make a profit. In order for the dental benefit companies to remain profitable (the definition of profitable is debatable), they need to either increase revenue (charge more for premiums) and/or decrease their expenses (pay out less to dentists). They know that employers, or individuals looking for dental coverage, will not like escalating premium costs, so they form “discount plans” to solve the problem. How that works will be explained next week.

Is there a solution to the problem? To provide “full coverage” for dentistry, insurance companies would have to charge more for premiums than most people/employers would deem worth spending. Consumers, especially when it comes to insurance, seem to want to pay the least amount for the most coverage. It makes sense until you factor in quality and standard of care.

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 have probably heard the terms “gingivitis” and “periodontitis” come up when discussing gum health. But what’s the difference? Are they related? Which one is worse? Are they reversible? Continue reading to learn everything you need to know from your dentist about gum disease, what causes it, and what you can do to prevent it from occurring and progressing.

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The Merriam-Webster definition of insurance is “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.” We have insurance on our house and car in case of damage or loss. We have medical insurance to cover our care when we need it; especially if it is major care. Dental “insurance” has always been different, in that it is only meant to help with basic needs.

This series of columns will explain the current state of dental insurance, and how its trend is changing the way dental care will be delivered in the future. It may sound boring, but I encourage you to read them and pass them on for others to read. I feel it is important information to have in choosing how you receive your dental care.

It’s common for patients to ask, “What does my insurance cover?” After they get the answer to that question, their next question is, “Why is dental insurance so lousy?” And they have a point. There’s not enough coverage, too many things aren’t covered, the co-pays are too high, and many of the plans require you to go to a specific provider to get your lousy full benefits. Why is this so?

Medical insurance was first offered in 1850 by the Franklin Health Insurance Company of Massachusetts. Dental insurance was first introduced in California in 1954, and quickly rose in popularity. By the 1970’s, these plans were widely available and usually provided a maximum annual coverage of about $1000 per year (which is still the average maximum today).

The first plans didn’t distinguish between in-network and out-of-network providers. They simply established usual and customary rates for the area, and would pay (typically) 100% of preventative care, 80% of minor dental work (such as fillings) and 50 percent of major work (like crowns, bridges, etc).

Eventually, insurance companies started offering PPO plans. For these plans, insurance companies solicit dentists to sign an agreement in exchange for the referral of patients who have that particular plan. To get the maximum benefit, patients have to go to a dentist who has signed-up for that plan. For some of these plans, patients can go to an out-of-network provider but are responsible for the difference between the provider’s fees and the insurance reimbursement. Many of the PPO’s today penalize patients for not going to an in-network provider and some give no benefit whatsoever.

PPO plans peaked in 2011 with 65% market share but have been losing ground ever since. New insurance plans are less expensive for employers, but are putting more restrictions on both dentists and patients. Fewer and fewer smaller/private dental offices are able to accept these plans because they make it impossible to provide comprehensive care, which is in the best interest of the patient.

There are significant changes coming to the dental benefit world. As a patient, you need to decide what is most important to you regarding your dental health. To be continued next week.

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.

A couple of weeks ago I discussed different types of materials being used today to “fix” teeth. I broke them down into two main categories – direct vs. indirect materials. Direct materials are things like silver/mercury amalgam and tooth-colored resin/composite that are placed directly into the tooth after the tooth is prepared. Indirect restorations are things like crowns, gold and ceramics in which the tooth is prepared and a manufactured restoration is cemented or bonded to the tooth.

Whatever your feelings are on amalgam, there is no disputing that it proved to be a very successful material over a long period of time. Despite this, it has not been used in most of Europe in decades, and is used relatively infrequently in the United States. Its replacement, tooth-colored composite resin, has made much progress in its ability to look good, allow more conservative treatment, and hold up well if used within the recommended parameters. However, it often falls short when restorations get larger, cusps of teeth are involved, and/or when patients brux/grind their teeth. An acidic environment, whether from things going in the mouth or from reflux (diagnosed or undiagnosed), can also cause the life expectancy of a plastic resin restoration to be less.

Most patients don’t ask many questions about the materials that will be used to restore their teeth. However, if you wish to be more informed, it is a conversation worth having. The expected lifespan of the materials being used in your mouth is good information to know to help you make a decision about your treatment. If you had a moderate to large silver filling needing to be replaced (that’s been there for 30 years), and the dentist told you that your new composite resin had an expected lifespan of 5-10 years, would you be okay with that?

We live in a challenging time for our dental restorations. Teeth are under a lot of stress with the normal functions of eating. Throw in additional stress from grinding or clenching (knowingly or unknowingly), and an acidic environment from carbonated beverages or gastric reflux issues, and teeth are at a disadvantage.

This is why it is important for patients to be more active participants in their treatment decisions. Co-diagnosis, between the patient and the dentist, allows for more informed decisions to be made. What can be used that is the most conservative, yet adequately protective? More importantly, what is the etiology behind why the teeth are this way? Is it a home care issue? Is it a dietary issue? Is it a medical issue? There is always a reason.

CAD/CAM technology allows the dentist to perform less invasive, longer-lasting dentistry. Tooth-colored direct composite resin is great for smaller to moderate sized fillings. The traditional crown (which covers the whole tooth) should be done less frequently with the use of CAD/CAM technology. This chemically bonded restoration allows for more conservative preparations of teeth and can be done in one visit.

Ask your dentist about the materials being used in your restorations and if you have any choices.

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.

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

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

As I said last week – The best dentistry is No dentistry. Prevention of decay and other factors that require teeth to be restored is the best defense to not needing restorative dental work. Keeping up with maintenance cleaning appointments and listening to your dental team’s recommendations regarding diet, homecare and other forms of prevention, such as nightguard use, is key to avoiding many dental problems.

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

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

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

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

I strayed from my original intention of discussing more on CAD/CAM dentistry that I introduced last week. However, as you will see next week, CAD/CAM dentistry often aligns perfectly with making your situation worse at the slowest possible rate.

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.