J. Peter St. Clair, DMD Blog

As of the writing of this column, on Wednesday March 25, 2020, the state and much of the country is shut down. Since information is changing so rapidly, and this print is a week old, I am going to concentrate this week on things that will occur regardless of how long it takes for things to return to normal.

Dental offices will NOT be open for routine care for many more weeks at the rate we are going. Dental problems will continue to arise. It is important that you understand what general dentists are considering emergencies vs. non-emergencies.

In addition, all dental problems, including any questions you have, should be directed to your general dentist. Many of us are doing consultations via video (FaceTime, Zoom, etc.). I have found these to be very helpful in determining who needs to be seen, and who can wait. 

If you do NOT have a general dentist and have a dental problem, PLEASE do NOT go to the emergency room.

Please ask family members or friends for recommendations to a general dentist. Check their website. Call their office to listen to their message. Check their Facebook page. You should be able to get in touch with a general dentist to assess your particular situation. They should be the one who determines if you should be seen and/or if you need a referral to a specialist for care. 

What constitutes a dental emergency? Is a dental emergency different than an urgent dental need?

True dental emergencies are not as common as urgent dental care. Dental emergencies are potentially life threatening, require immediate treatment to stop ongoing bleeding, or alleviate pain or infection. Trauma would also be included in this category. This would typically not include routine toothaches. The general dentist can use their referral network of specialists as needed for these situations. The emergency room should be used as an absolute last resort.

Urgent dental care focuses on management of conditions that require attention to relieve discomfort and/or risk of infection. These should be treated by a general dentist or specialist. Severe tooth pain, dental abscess or tooth fracture, missing temporary fillings, or anything else you have concern about should be directed to the general dentist and left to their discretion on how to handle. 

Please keep doctors, nurses, all people in healthcare, and anyone else who is potentially at higher risk of exposure due to their profession, in your thoughts and prayers during this time. 

Please do not hesitate to send any non-urgent questions to my email below. You can also get more up-to-date information at my blog, also listed below. 

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.

https://www.ada.org/~/media/CPS/Files/COVID/ADA_DentalEmerg_Patient_Flyer.pdf?utm_source=adaorg&utm_medium=covid-resources-lp&utm_content=cv-pm-emerg-def-patients&utm_campaign=covid-19

On April 30, 2009 I submitted a column to The Town Common entitled, “The Swine Flu and You”. Here is the first paragraph from that column:

Who knows where this pandemic will be today as you read this. At the time of writing I had just heard the first confirmed case in Massachusetts.

I don’t know about you, but apparently the Swine Flu wasn’t that big a deal, because I don’t really remember it. THIS ONE you are going to remember.

At the time of this writing on Tuesday March 16, 2020, my dental practice is scheduled to be closed for non-urgent patient care from yesterday until at least April 6^th. As I said 10+ years ago – who knows where this pandemic will be next week.

Information is coming at us from all different directions. I am not an expert on pandemics, nor do I plan on playing one on TV. Listen to your federal, state, and local officials. Trust in the system in a situation like this. Follow the rules and we will be fine.

Even though you are reading this over a week after it was written (unless you somehow see it digitally before), my psychic powers are telling me that this latest national/world situation is going to have far-reaching effects on many. At the time of this writing, I have been in constant contact with many of my colleagues, about how we plan to “weather the storm”, both as small business owners and employers. There are difficult decisions ahead. Personally, I am embracing it.

One of the ways I am embracing this time is to catch up on some of that back-logged reading I’ve been trying to get to. Patients will often ask me what I read in my “spare time”. I usually tell them that my reading list may not be particularly interesting to them. However, it amazes me sometimes how many connections I make with people regarding reading interests. My dental assistant talks about reading with patients all the time, and although I never seem to know anything they are talking about, they often make a connection through the discussion of their reading interests.

This will be a great time to make some deeper connections with people through mutual interests. Conversations with people via phone, or better yet something like Skype, Facetime or Messenger, where you see and hear the person, are so much richer than typing it with your fingers.

I am also embracing this “time-off” to re-charge and re-focus on what is most important in my life. I think I’ll freshen-up that gratitude journal I’ve been meaning to update as well.

Ok, back to dental news. All general dental offices should be closed for non-emergent care as of now and until at least April 6^th, unless that information has changed by the time this is read.  If you have a dental problem, I would urge you to either call your dental office or visit their website. Your general dentist should have instructions on how to contact them should you need to.

At the present time, specialists have been working to treat true dental emergencies. True dental emergencies include things like toothaches, infections, etc. If you have a true dental emergency, you should contact your general dentist first. PLEASE DO NOT GO TO THE EMERGENCY ROOM. It is important to not strain the healthcare system with things that should be dealt with by a dentist.

If you do not have a general dentist, I am looking into the logistics of offering my services of consultation via secure email or telemedicine. I will be updating my blog on a regular basis with this and other information to hopefully help you with any dental issues during this time.

https://www.jpeterstclairdentistry.com/blog/

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 referring to a healthy smile, many people think about a gleaming set of pearly whites. However, great oral health takes more than clean teeth! Your gums play an essential role in keeping your mouth healthy and your teeth in place. In fact, unhealthy gums could increase your risk of rheumatoid arthritis, diabetes, and heart disease. Thankfully, you can easily improve your gum health with these dentist-approved snacks!

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Xylitol is a sugar substitute that possesses 40 percent fewer calories than sugar and has been shown to decrease the amount of cavities that people get. It can be found in specifically formulated things like gum and mints, but can also be in chips, Jell-O, peanut butter and foods. It is important to know that xylitol, even in small quantities, is toxic to dogs.

The dental benefits of xylitol have been known since the 1970’s. Xylitol is not metabolized by the decay-causing bacteria Streptococcus mutans (S. mutans), making it nonacidogenic and thus noncariogenic (not decay causing). Studies have also indicated xylitol decreases the levels of S. mutans in both plaque and saliva. As a result, patients who use xylitol have demonstrated a reduction in decay.

Xylitol is slowly absorbed by the human intestines; as a result, it has minimal side effects on humans. There are some minor side effects, mainly diarrhea, although this generally occurs after ingesting large amounts xylitol (four to five times the recommended amount for cavity prevention). A 1982 study suggested that the body can adapt to higher dosages of xylitol and that symptoms can subside as the body’s tolerance increases.

While the dental community embraces xylitol for its cavity prevention, most people, including dental professionals, are unaware of its toxic potential – not to humans, but to dogs. While xylitol has little effect on insulin production in humans, dogs can experience rapid and severe increase in insulin production after just a small amount of xylitol ingestion. A dog that ingests a xylitol equivalent of three to four pieces of gum is at risk for hepatic (liver) failure and necrosis (tissue death).

Dogs tend to be scavengers by nature and their likelihood of encountering potentially toxic substances in and around the house is common. The ASPCA web site lists a multitude of substances, many of which are harmless to humans but potentially dangerous to dogs. Chocolate, grapes, raisins, avocado, onion, and citrus fruits make the list. However, xylitol is unique in that it is contained within foods; as a result, consumers may not even be aware that a product or food item contains xylitol.

For dogs suspected of ingesting xylitol, early intervention is paramount. Prompt medical treatment for uncomplicated xylitol-related hypoglycemia can yield a good prognosis. Xylitol hepatic toxicosis yields a much graver prognosis.

While veterinarians have been aware of the potential danger of xylitol to dogs for several years, that awareness has escaped most of the dental community – and the general public. This has become a more significant issue as more dental professionals promote products that contain xylitol for its human benefits.

It is important for dog owners to know the different foods and products, such as xylitol, that can be harmful to their pooches. Make sure to keep these items out of a dog’s reach – and that includes the garbage. If you suspect ingestion of any of these foods, including xylitol, contact your veterinarian immediately.

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.

Mouthguards are nothing new, but there are still far too many sports related injuries. Although most youth sport organizations have cracked down on making kids wear mouth protection, there are still injuries occurring. Taking the appropriate protective measures while on the court, field, rink, or ring can save mouths from serious injury and costly dental repairs.

Any sport that presents the chance of contact or collision with another person, object, or surface can potentially cause injury to teeth, jaws, and oral soft tissue. These sports include, but are not limited to, football, basketball, soccer, hockey, boxing, and lacrosse. Individuals who participate in sports, such as biking, inline skating, or skateboarding are also at risk for injury.

Teeth get in the way. Other than your nose, front teeth are “out there” and your lips only provide minimal protection. For example, a student I saw this past spring was injured playing squash at a local private school. Squash is a non-contact sport, but the game is played in close proximity to another player with a swinging racquet. The student I treated had been hit in the mouth with the other player’s racquet. He required a root canal on one front tooth with a crown. The other front tooth needed to be extracted and replaced with a dental implant. All of this could have been prevented or at least damage lessened with the use of a mouthguard.

For some reason, baseball is one of those sports where kids do not wear protective mouthguards. No matter what age level, a player can misjudge a ball or a ball can take an unexpected bounce, causing serious injury.

In lacrosse, both boys and girls should always be wearing mouth protection. That ball is extremely hard and heavy. Boys are better protected than girls because they at least wear helmets; both should be wearing helmets, in my opinion.

A custom mouthguard made by your dentist covers the upper teeth with a soft, flexible material that prevents serious injuries such as broken teeth, jaw fractures, cerebral hemorrhage, and neck injuries. It decreases the chance of the lower jaw jamming into the upper jaw or being pushed back into the temporomandibular joint (TMJ). Mouthguards may reduce the severity and incidence of concussions as well.

Custom mouthguards, made by a dentist, fit 100 times better than anything you can buy in a store. This not only improves performance (making it easier to breathe), but also makes it more likely the athlete will keep the mouthguard in. They may cost more than the boil/bite generic ones, but they are better, and that is enough reason to consider them.

If you seek treatment immediately after the injury occurs, your dentist often can save knocked-out teeth and repair minor chips and cracks with appropriate dental materials. See your dentist for evaluation if your tooth changes color, if you experience any pain, or if you notice any swelling in or around your mouth following trauma.

Even if it isn’t “cool” to wear a mouthguard in the sport you are playing, I strongly recommend it. You only get one set of your own teeth.

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.

Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles or temporomandibular joint (TMJ). Problems can include TMJ discomfort, muscle spasms in the head, neck or jaw, migraines, cluster or frequent headaches, pain with the teeth, face or jaw, anxiety and depression.

The resting position of the jaw, which is the position it should be in most of the time, is lips together with the teeth slightly separated. Breathing should be through the nose. The teeth should be touching a total of about 15 minutes in a 24-hour period of time. People who clench or grind touch their teeth much more than this. This is the primary reason people get orofacial pain.  Pain can also be caused by things like trauma to the head and neck or poor ergonomics (posture).

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. They control the joint’s movements. Women between the ages of 20 and 40 are the most frequent sufferers of orofacial pain due to added estrogen in their bodies. Estrogen impacts the body’s natural pain fighters (endorphins), increases inflammation in the temporomandibular joints, and compromises the strength and adaptive ability of all ligaments.

One in eight Americans suffer from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which can 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.

Sleep disorders can also play a role in orofacial pain. If you have gone through treatment for orofacial pain and still experience problems, it is possible that a sleep disordered breathing problem such as sleep apnea could be contributing. People who have problems like this will often exhibit jaw pain due to the body moving the jaw around at night to get better air flow. Patients have no idea this is occurring usually until they wake with sore jaw muscles. Treating the sleep issues usually solves the jaw issues.

If the orofacial pain is not related to sleep, there are a variety of treatments that can help relieve symptoms. One device is called an orthotic, or splint, that is worn over the teeth to help stabilize the bite. Permanent correction may sometimes require equilibration (reshaping teeth), orthodontics or a combination of these and other restorative dentistry. Many use a splint (day and/or night) on a daily basis to avoid having these other treatments done.

Other things that can help alleviate pain are using ice on the painful area, eating a softer diet and avoiding chewing gum or ice. It is important to be conscious to keep teeth slightly apart except when chewing and swallowing. Use of anti-inflammatories is okay to use if it is an acute short-term problem. Chronic problems are best treated by determining and treating the source.

Orofacial pain can range from tolerable to debilitating. Most of these problems can be corrected and/or managed. If your dentist can not help you, ask for a referral to a specialist.

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.

Let’s use this hypothetical situation: You have not been to a dentist in a while (pick a time frame), you are well aware you need some dental work, you were given the recommendation of a dentist by a friend…..and, you decide to visit that dentist and four other dentists to compare and make a decision who is the best fit for you. (I realize that most people don’t want to and/or don’t have the time to visit five dentists….but play along).

You already have an idea of what you are looking for. It might be the dentist who says you need the least. It might be the dentist who is the cheapest. It might be the dentist who is closest to where you live. It might be the dentist who gives you the most options, or maybe the least. It might be the dentist who listens to you the best. Be prepared, because you are likely to hear a few different styles/opinions visiting five dentists.

Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back.  The dentist’s personality and experience are 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. Have an open mind and play an active role in the treatment planning process.

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 important for the dentist to discuss costs and options for payment.

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.  Having said that, dentistry is not a commodity. There are many factors that need to be taken into consideration when choosing your provider or the treatment you choose for yourself.

What makes sense for you? What are your objectives?  Saving a badly damaged tooth with a root canal and a crown may preserve it for a long time, but what are the circumstances of how the tooth got to that point?  If you haven’t been to a dentist in many years and have many other dental needs, does it make sense?

We have so many great dental providers in our area. Think about what you are looking for in a dental care team Read that list in the second paragraph again.

The focus should be on long-term objectives and prevention. If you are a regular dentist-goer and have a dentist you like, you’re all set. If you haven’t been in a while, consider making the decision to change how you look at your dental health. Start with finding a place that fits your particular needs, and make the commitment to make routine preventive dental care part of your life.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Here are a few common questions and answers regarding dental radiographs:

I had a dental x ray while I was pregnant. I am worried that my unborn child might have been exposed to the radiation. Can you please tell me if there are any risks to my baby from this?

There is no information suggesting any risk to an unborn child from dental x-rays received by the mother. We were taught in dental school to avoid dental x-rays on pregnant patients. However, with newer technology the radiation dose to the fetus is insignificant. Prudent practice would dictate limiting x-rays on pregnant women, but there is absolutely no harm in taking x-rays if needed to diagnose a problem.

Is there residual radiation in a room after a dental radiograph has been taken?

X-rays cease to exist when the machine is switched off, much like the light from a light bulb when it is turned off. No residual radiation remains.

How much has dental x-radiation been studied and how concerned should I be about having dental x-rays done? Is there a limit on how many I can have?

We now have very complete information on patient radiation doses from dental x-rays. They are among the lowest radiation dose exams of any diagnostic radiologic procedure in the healing arts. Current practices deliver patient doses from a full-mouth series of intraoral films (usually 14-18 films) that are less than what a person receives in a month from natural environmental sources (commonly called background exposure). Doses from bitewing or panoramic films are even less. New technology is reducing the doses still further. There is no limit on how many dental x-rays you can have. The decision to have a dental x-ray is based on the benefit of knowing whether or not there is a cavity, crack, or some other abnormality. So the decision to have them is based on what you and your dentist think.

I recently had some dental x rays and the operator forgot to place the lead apron on me. Is this a problem?

Use of the lead apron to protect the patient undergoing dental radiographic examination was recommended some 50 years ago, when equipment was crude. This was because x-ray beams were not restricted to the area of clinical interest, beams were not filtered, and x-ray film was slower, causing radiation exposures 10 to 100 times higher than received today. With the current technology reducing radiation exposure significantly, and the beam limited only to the area of interest, there is little or no measurable difference in whole-body dose whether a lead apron is used or not. The lead apron is no longer regarded as essential although some consider it a prudent practice, especially for pregnant and potentially pregnant females.

If you have any other questions on dental x-rays, please e-mail them to me.

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.