J. Peter St. Clair, DMD Blog

Dental practices are as different as people are different.  Some practices may feel clinical and efficient, while others feel somewhat more home spun and laid back.  The dentist’s personality is reflected in his or her treatment preferences as well.  The fact that different dentists will suggest different plans to treat your condition does not necessarily mean that one plan is better than another. 

As I ended last week, the most important thing any health care provider can give is their time. Listening to patient desires and expectations is the key to a long-lasting dentist or other health care provider relationship. Patients who feel comfortable with their provider are able to be better participants in health care decisions. While insurance benefits are a consideration, it is most ideal to pick your health care provider based on other factors.

I’m sure with rare exception, dentists in general will suggest what they feel to be the very best for any given patient.  The differences between the treatment suggested by one dentist and that of another reflects that dentist’s preferences based on his or her experience. Thus, differing treatment plans do not necessarily reflect any deficiency in either dentist’s judgment.  

It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances.  A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is helpful if the dentist takes the patient’s ability to pay into account. 

Think of treatment plans like various models of cars offered by different dealers.  All of the models are new, have warranties and will work well out of the lot.  The higher end models, however, have some advantages not found in the less expensive models.  Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it. 

Dental treatment plans are like that too.  Saving a badly damaged tooth with a root canal and a crown will preserve it for a long time, but it is a significant investment, and the patient may opt for a much less expensive extraction instead.  Replacing a missing tooth may be done with a more costly implant or a much less expensive removable partial denture.  A dentist should be able to explain the advantages and disadvantages of the various options, and allow the patient to make the decision. 

We are all different. We all have different personalities, skill sets, interests and faults. No two dentists can perform exactly the same technical procedure in exactly the same way.  As a matter of fact, no single dentist can perform exactly the same procedure exactly the same way twice in a row!  There are many variable factors that determine how well something is done, and how long it lasts. The patient does not have control of many of these factors, but what you do have control of is your ability to choose your provider.

Whether or not you have any dental benefits from an employer or other situation, finding an office you like and trust is the best investment you can make for your dental health. Consistency with personal and professional maintenance is key!

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.

I attended a continuing education course a while back entitled “Hit Man or Healer?” The course was given by a well-known leader in the dental profession. The basic premise of the course was the notion that we have a lot more science, studies and data available today to be able to make better decisions about the treatment that we dentists recommend to patients. The concept is called evidence-based dentistry.

The idea is that if a very structured examination and diagnosis is done, treatment recommendations can be made based on science. The problem is, all too often the diagnosis leads to suggestions that without the proper dialogue can make the dentist look like a “hit man” (ie. patient perception of over-treatment) vs. “healer” (intervention with the intention to preserve the teeth better for the long-term).

The lecturer started by putting an image of a person’s teeth on the screen and asking the audience to guess how old the person was. My father and brother are veterinarians. They use the appearance of teeth to estimate an animal’s age. Although it is relatively easy to estimate a person’s age during transition from the primary teeth to permanent teeth, it is apparently a little more difficult when all the permanent teeth are in. I guessed the age of the patient on the screen to be between 50 and 60.

The patient had great looking teeth. You could tell the person was a mature adult by the darkening of the teeth, but there was very little wear and very minimal dentistry. The patient ended up being 94 years old, which was more evident when her full face was projected on the screen…..although she looked great in general for 94. The lecturer said, “Is this the way teeth should look at 94 or is this woman a freak of nature?”

While there are definitely genetic factors that may play a role, many of the problems we see today with teeth are 100% preventable. For example, dental decay is 100% preventable. However, it is still not uncommon today to have a patient (maybe a teenager or an older person on multiple medications with dry mouth) come in for a routine dental hygiene appointment and be told they have decay, or multiple areas of decay, which were not present 6 months ago. In that scenario the dentist would be considered the “hit man”.

The “healer” may have taken a different approach, and may have done a more thorough evidence-based evaluation and made recommendations based on diet, homecare habits and maybe even familial history that could prevent the decay in the first place. Dentists have gotten good at telling patients how they can “fix” the problem, but need to consider changing their thinking and get more training in how to “prevent” the problems we see today in dentistry.

Many of the basic principles learned in dental school are used on a routine basis. However, there is continuous new data emerging that we as health care providers need to expose ourselves to and decide on what and how to implement for the benefit of our patients. I hope to see major advancements in our approach to oral health care in my career. There is no reason you can’t live to 94 and have a great set of teeth.

As I have said numerous times over the last few weeks, and you will hear it again next week too: Unfailing routine professional maintenance is a key factor in achieving and maintaining dental health. Don’t just hope you’re a freak of nature.

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.

I attended a continuing education seminar before COVID entitled, “Making it Easy for Patients to Say Yes”. The name of the seminar is a bit deceiving. You might think that it was about how to “sell” people into dental treatment. It was quite the opposite.

I am a firm believer in educating patients about their own dental health with the help of things like photography, which I discussed last week.  I also think it is important to spend as much time as necessary to bring the patient’s dental I.Q. to a level that allows them to make more educated decisions about the degree of dental health they wish to achieve. Some people require more time than others, and some are not interested in the dialogue.

Although this seminar did confirm that educated patients make better decisions, it highlighted the fact that it is more important for the dentist to understand the patient, and where they are in their life. In order for this to happen, time is needed to build relationships with people.

This sounds pretty basic. However, the presenter of this seminar, who is a well-known figure in the dental world, felt that this relationship-based aspect of dental care is missing in most dental offices. Why? The cost to run a dental business, and many times the influence from insurance companies, creates the need to speed things up. Shortening the time the dentist/physician spends with the patient is a common goal in health care these days.

Most patients who require extensive dental treatment know that they have issues. They may not understand the extent of their issues, but they know things are not right. It is easy to move patients toward treatment if they have pain or something is broken. However, patients who may not have pain or broken teeth, but still have dental needs, require a different approach.

Before any educating is done, or before any treatment is discussed, it is vital for the dentist to understand more about the person behind the teeth. Sure, there are patients who come into an office and just want a tooth extracted, or know they need a root canal, but most people who go to the dentist have the desire to keep their teeth and be healthy. The fact of the matter is, even if the patient knows they need extensive work, they may not be in the right place in their lives to accomplish this goal.

There is no disputing that dentistry can be expensive, especially if you are in need of significant work. I wish there were more affordable options out there for people who require more extensive care. You can choose lower cost options such as franchised dental offices, where you may not see the same dentist every time, or you can choose one of the many great private dentists we have in our area.  However, the key is – what is suitable for you? The dental insurance industry is a broken system, and it is unfortunately getting worse. Your provider should be who you want to take care of you, not who a company says you have to see. Use whatever dental benefits you have but develop a relationship with a provider who takes the time to understand your specific situation.

Does a real estate agent show everyone the same house? Do they show everyone the most expensive house? No; they show them what fits into their life at that particular time. Dentistry should be approached the same way. It may not be the right time in your life to have the four-bedroom house and the three-car garage. But, having a good solid roof over your head that is comfortable is important to everyone. You can always upgrade.

The absolute key to better dental health is regular maintenance.

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 of us like a sweet treat or beverage every once in a while, even though we have always been told that sugar impacts oral health. But how bad is it? It seems like sugar is added into everything these days which makes it incredibly difficult to avoid. Continue reading to learn exactly what sugar does to your teeth, what you should cut out of your diet, and what you can use instead that won’t cause harm to your smile.

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I remember seeing a commercial for a cholesterol medication in which the person playing the doctor says, “I wish my patients could see what I see.” I think there are two ways to look at that statement.

The commercial showed an image of animated artery walls clogging with particles of plaque, clinging to one another, making the opening of the artery smaller and smaller. This is a visual that is easy to understand.

The second, and more subtle way to take this statement, is the doctor wishing that patients could see what happens to people over time, with and without compliance to taking medication or changing their diet. If patients could only understand and use the vast experiences of the doctor to make better decisions for themselves, wouldn’t everyone choose to do all the “right” things for a better and healthier life? Conventional wisdom would say “yes”, but reality says something different.

I have been photographing teeth since dental school in the 1990’s. Of course, back then I was using slides, and had to get them developed. Digital changed everything.  When I ask a patient if I can take a series of pictures of their teeth, the response I often hear is, “Sure, I just have never had anyone do that.” I explain that the photographs are used for documentation and communication.

Showing a patient visual images of their own teeth is by far the most powerful tool I use in practice. Patients often get frustrated when a dentist explains and recommends treatment they can’t see.  Pictures help in telling the story, and help patients make better informed decisions.

When displaying the images and giving the patient a tour of their own mouth, the patient will often say, “Wow, that doesn’t look good. I can’t believe that is in my mouth.” Photographs help in explaining why things look the way they do. From there it is easier to explain to patients what to expect in the future. Photographs are invaluable for this exercise, and most patients appreciate being able to see what I see. For the ones who don’t want to see images of their own mouth, the photos are still needed for documentation and treatment planning.

If a patient has not been to a dentist in a while, or is seeing a new dentist who is doing a complete exam, photographs help patients with decision making. It is important to try to get the patient to look beyond the pictures and envision where they want to be 5, 10, 20+ years down the road. The goal is for the dentist to tie their experience together with where the patient is currently, where they are headed, and give them the opportunity to potentially change the course of their future.

This approach may be different for some patients. It is easy to get overwhelmed by any new concept, but it is important to keep an open mind. Photographs of your own mouth in the dental office are an important part of the doctor/patient relationship, because communication and trust are the keys  to any relationship.

You, as a patient, should look beyond today and make choices for ANY aspect of your health based on where you want to be in the future. Take advantage of the knowledge you gain from all your experiences and make decisions that you feel are right 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.

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.