J. Peter St. Clair, DMD 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.

Last week I discussed clenching, which is vertical force put on teeth. Grinding or bruxism is lateral (excursive) forces put on teeth that cause teeth to rub together and wear. Both of these are very destructive to teeth, joints, and muscles.

Some people present with symptoms relating to these two issues, but more often than not, people do not have symptoms. We dentists know that patients who present with signs of tooth wear are riskier to treat. Riskier because the “issues” are often times, and maybe even most often, not treated. This is a significant reason for tooth structure breakdown and shorter life-span dental work.

There are many reasons people grind or clench their teeth. Sometimes these problems are preventable with simple lifestyle changes, and other times they need more aggressive treatment because they are coming from the central nervous system. They can also be caused by certain medications.

In today’s world, everyone is being pushed to their limits in just about every aspect that you can imagine. More is demanded with fewer resources and less time. All this becomes a source of stress, anxiety, and even depression for the population as a whole.

This “epidemic” of depression and anxiety spurred the development of newer medications with fewer side effects to help manage these conditions, and hence, the SSRIs (selective serotonin reuptake inhibitors) were born in 1988. Since then, recent reports show that the use of the SSRIs (i.e. Paxil, Zoloft, Prozac, Celexa, Effexor, etc.)  has increased more than 400 percent!

Dentists see the signs of clenching and/or grinding of the teeth on a regular basis, and some of it is the result of stress and anxiety. But another factor to keep in mind is that patients are now taking more anti-anxiety and antidepressants than ever before in history. It is often overlooked, but the SSRIs and even some of the SSNRIs (Selective Serotonin Norepinephrine Reuptake Inhibitors) often increase bruxism or clenching and grinding effects at night.

This can lead to an increased frequency of headaches, jaw pain and other symptoms of clenching/grinding. In my own practice, I have seen many patients who have presented with increased frequency and intensity of symptoms shortly after starting on these medications. I have found that sometimes a change in medication or reduction in the dosage with the help of the prescribing medical doctor can help, but sometimes there seems to be little to no improvement.

In recent studies, there is support for a theory of how these medications cause an imbalance in the brain, leading to a drug-induced bruxism that sometimes does not go away with a decrease or cessation of the medication and may even require other medications to help alleviate the bruxism.

So, if you are on any of these medications, the next time you see your dentist you should ask if you have any signs of tooth wear. And, by all means, if you are having any symptoms that you do not feel are normal, you should bring those up too.  If your dentist can show you pathological tooth destruction, you might want to keep in mind that not treating the underlying cause may contribute to unwanted future dental issues.

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.

Of the many issues that this pandemic is causing, stress may be at the top of the list. Dentists are seeing a sizable increase in patients complaining of symptoms of joint, muscle and/or tooth pain directly associated with an etiology of grinding and/or clenching.

Although methods of relaxation are important to get through the stresses of life, it may not be enough to prevent symptoms in the TMJ, muscles and teeth, especially in the subconscious (i.e. sleeping). Many times, patients are aware of the symptoms, but don’t realize the origin of the problem.

Studies have shown a link between tooth grinding, clenching and headaches. For people who grind or clench, the muscles that open and close the jaw can become painful from overuse, causing a range of symptoms from tension to migraine headaches to jaw joint (TMJ) problems to tooth pain.

Bruxing (grinding) and clenching teeth is defined as abnormal tooth contact (parafunction). Ordinarily, teeth are in contact while eating and swallowing, only about 10 to 15 minutes on a daily basis. People who grind or clench their teeth during the day, or while sleeping, can have their teeth in contact for as much as six hours a day or more. Researchers say that one night of grinding is equivalent to 80 days of normal wear.

Clenching can be just as bad, and in some cases worse than grinding. The average person puts about 200 lbs. of force on back molars during function but a person who clenches can put up to 1000 lbs. on the molars. This is a lot of force for the teeth to withstand. Fractured teeth are seen on a regular basis in dental offices due to clenching.

The American Dental Association estimates that 95 % of the American population suffers from a grinding or clenching problem at some point in their lives. Some people do so much damage over time that to restore their teeth back to normal function takes a significant amount of dentistry. The key is early diagnosis and treatment.

Many patients do not realize, or refuse to accept the fact that there is a problem. Many do not have symptoms. The dentist may mention wear and that usually ends the conversation. Or a person may have symptoms, such as a tooth that is sensitive to chewing. That can be fixed, but how often is the question of “why” is this happening come up? The masticatory system is a very adaptive and forgiving system. However, lack of symptoms does not mean there are no problems. Intervention can help prevent problems in the future.

Therefore, successful therapy starts with acceptance of the pathology present. In addition to behavior modification, nighttime bite splints can be very effective. They should be worn every night, not just when it “seems” like you have been grinding or clenching. There are many types of nightguards for different problems. Over-the-counter appliances are not recommended and can be dangerous to use. Some types of nighttime appliances can be extremely effective in treating people who suffer from headaches due to clenching.

Headaches are only one of the symptoms associated with clenching. Everything from sore muscles, sensitive teeth, worn teeth, broken teeth, and sore joints can be caused by clenching. Ask your dentist whether you have any of the signs associated with grinding or clenching. Treatment can be easy, relatively inexpensive, and save you from potential future problems.

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