J. Peter St. Clair, DMD Blog

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 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 hear. 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 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.

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 patients and dentists face a decision-making process when it comes to keeping a natural tooth with root canal therapy vs. removal of a tooth and replacing it with a dental implant. The introduction of dental implants has proven to be a pivotal technology in dentistry. In a profession that strives to help patients keep their dentition, the point when it becomes necessary to opt for dental implants is a judgment call.

So, is one treatment better than another? There have been many scientific papers written on this subject. In one more recent study published in the Journal of Dental Research, the authors noted, “Both options should be seen as complementing each other, not as competing, and should serve the overall goal in dentistry, the long-term health and benefit of the patient, being least invasive and incorporating function, comfort, and esthetics. A tendency exists toward a simplified approach of ‘extraction and implant,’ but this is not always simple or ethical.”

In comparing many of the research studies, there seems to be a difference in what the implant studies define as their “survival” rate vs. “success” rate. Many dentists will tell patients that the survival rate for dental implants is in the 95% range but when looking at the research, the success rates of these same implants falls into the low to mid 70% range. Meanwhile, there are strict guidelines for root canal (endodontic) success.

In another study the authors compared the prognosis for implants and root canal treated teeth, and noted that “natural teeth exceed the life expectancy of implants at 10-year observation points, including root canal treated or periodontally compromised teeth.” Note: Periodontally compromised teeth are those with at least moderate bone loss.

In yet another study that compared root canal treated teeth with single-unit implants, researchers observed a positive outcome in 74% of the implants and 84% of the root canal treated teeth after seven to nine years. They also found significantly higher rates of complications and necessary interventions in the implant group, and patients needed more time to adjust to implant restorations.

Treatment outcomes differ significantly, depending on the experience of the clinician, and it is more significant in implants than in endodontic treatment. In one study, implant specialists achieved a 96% survival rate, while inexperienced practitioners only had a survival rate of 73%.  Meanwhile, researchers observed less of a difference when it came to clinician type and endodontic treatment in a multicenter study with 350 teeth meeting the inclusion criteria: General practitioners had a 90% survival rate, while root canal specialists had a 98% rate.

Now that you are thoroughly confused, how do you make a decision when posed with the question to keep a natural tooth with root canal therapy vs. a dental implant? There are many factors to consider and each situation is unique. It is important to discuss the pros and cons with your dentist.

While dental implant treatment is absolutely the treatment of choice for many situations, keep in mind that many of the studies comparing the two treatment options suggest that “too many teeth are extracted in favor of dental implants”.

It’s common, when thinking of oral care, to direct your attention to your teeth, but your gums are just as significant. That’s because they supply the blood and nutrients that are vital to sustaining the health of your teeth. Thus, your Rowley dentist wants you to know about some simple foods you can eat that will make a big impact on your soft tissues. Continue reading to learn what they are.

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Last week I introduced you to a patient who has been struggling with dental decay (cavities), gum recession, and dental erosion (the chemical breakdown of tooth structure). I discussed how these dental problems are complex multifactorial diseases of epidemic levels affecting both children and adults.

I ended with the idea that a healthy mouth 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. If “we” continue to think the same way about dental issues, we will continue to have the same struggles and same results.

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.

Dental decay is on the rise. Why the increase? 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. The problem is that changing our thinking and behavior, the nemesis of all that is bad, is difficult to do unless there is an awakening among us.

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 one way to do this is to use 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 and dietary issues, a caries-preventive strategy can be established. 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. The bottom line is that if you want to be decay-free, you can be.

For those at high risk, specific behavioral modifications are almost always necessary. To become aware of these often requires an assessment by your doctor. Doctors need to shift time away from treating things to be able to assess more and discuss the specific behavior modifications necessary for each individual patient. The patient needs to be receptive to hear and act on these changes.

There are also some great products currently available and others on the horizon. 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.

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.

Changing our behavior, habits, attitude, or any aspect of our lives can be a difficult thing to do. I am not writing as an expert on this subject as I have the same struggles as everyone else with change. However, repeated awareness of changes we want to make is one strategy to move us closer to making that change.

A good example is Mary, a patient of mine. Mary is an adult who has had issues with decay (bacterial disease that breaks down tooth structure), dental erosion (chemical breakdown of tooth structure), and gum recession (loss of the supporting structures of the teeth). When people like Mary present with these problems, we dentists present treatment to “fix” the problems. However, the reasons “WHY” these issues are occurring are just as important, if not more so, than the “fixes” we propose.

Mary drinks diet soda. In fact, Mary doesn’t just drink diet soda; she has a diet soda by her side all day long. At a recent event I saw Mary sitting and listening intently to the presentation. At her side was her diet soda. Every few minutes Mary would unscrew the diet soda cap and take a swig.

The three main dental issues Mary has: decay, erosion, and recession, have many different etiologies. One common denominator is pH, which is a scale used to describe the acidity or alkalinity of solutions or environments. The lower the pH the more acidic the solution or environment is. In order for any of the three disease processes described above to occur, the pH of the oral environment has to be acidic.

While there are many reasons the pH of the oral environment can be acidic, such as medications or disease, dietary factors play a significant role. A pH lower than 5.5 in the oral cavity puts you at risk for dental disease. Most tap water, for example, has a pH of 7. The average diet soda has a pH of 3.28. Stomach acid has a pH between 1-2. Diet soda is very acidic.

Having a diet soda with a meal on occasion is most likely not a problem. Typically, after consumption of an acidic beverage, your saliva will neutralize (make your mouth more alkaline and less acidic) within about a half hour. That is why you may have heard that you should wait at least a half hour before brushing your teeth after meals. The problem with Mary sipping the diet coke all day long is that the pH of her mouth is always acidic. This creates a very dangerous environment.

Quieter drills, new materials and technologies will not solve these problems. While etiologies such as medications that can cause dry mouth and a very acidic environment are difficult enough to manage, behavioral issues are often not discussed in enough detail, or at all, because they can be more difficult to manage.

Avoidable dental problems are the last thing a patient wants to hear about and a dentist wants to see.  In addition, we as providers need to adopt a more preventive approach to the conditions I discussed in this column. Next week I will introduce you to one way I am currently studying.

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.

You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth, or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. People with seemingly good teeth/bite are also susceptible. Pain can also be caused by clenching or grinding teeth, trauma to the head and neck, or poor ergonomics.

Temporomandibular disorders (TMD) affect more than 10 million Americans. Your TMJ’s are located where the skull connects your lower jaw to the muscles on the sides of your head and face. They control the joint’s movements. Women between the ages of 20 and 40 are the most frequent sufferers because of the 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 may be related to the bite. Clenching the jaw muscles creates tension in the muscles that close the jaw, the main one of which is the temporalis muscle. Signs that may indicate a headache from dental origin include: pain behind the eyes, sore jaw muscles or “tired” muscles upon awaking, teeth grinding, clicking or popping of the jaw joints, head and/or scalp is painful to the touch, earaches or ringing, neck and/or shoulder pain, and dizziness.

Sleep disorders can also play a role. If you have gone through treatment and still experience orofacial pain, you may have a sleep disorder, such as bruxism (grinding), or a sleep-related breathing disorder, such as snoring or sleep apnea.

Your dentist has a variety of treatments that can help relieve your orofacial symptoms. One device is called an orthotic, or splint, that is worn over the teeth to help stabilize the bite. Permanent correction may require equilibration (reshaping teeth), building crowns, or orthodontics. Many use a splint 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, being conscious to keep teeth slightly apart except when chewing and swallowing, sleeping on your back and not resting your hand on your chin.

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

You make sure to fill your diet with lots of fruits and vegetables, brush your teeth twice a day, and even use mouthwash pretty often. But when it comes to flossing your teeth—you like to drag your feet. If there’s any oral hygiene habit that you should stay consistent with, it’s flossing your teeth!

Rather than skipping this crucial step in your dental care routine any longer, take a few moments to review this week’s blog post from your local dentist. It could just save you time, money, and your smile in the long run!

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Alcohol consumption causes approximately 20,000 cancer deaths in the U.S. annually, especially oral cavity cancer in men and breast cancer in women, according to a study in the American Journal of Public Health. It is the first comprehensive analysis of alcohol-attributable cancer deaths in the U.S. in more than 30 years, the study authors noted.

Notably, even moderate drinkers who consume 1.5 drinks daily or fewer accounted for 30% of alcohol-caused cancer deaths, according to researchers from the Boston University School of Medicine and the School of Public Health.

Cancers of the mouth, throat, and esophagus were common causes of alcohol-related cancer deaths among men, resulting in a total of about 6,000 annual deaths, they noted. Breast cancer was the most common cause of alcohol-caused cancer deaths in women, resulting in about 6,000 deaths annually, or about 15% of all breast cancer mortality.

In addition, alcohol was cited as a prominent cause in the premature loss of life, resulting in the loss of about 18 years among people who died of cancers attributed to alcohol, the study found.

Previous research consistently shows that alcohol increases the risk for cancers of the oral cavity and pharynx, larynx, esophagus, and liver. And recent studies show that alcohol also increases the risk of cancers of the colon, rectum, and breast. While estimates have shown that alcohol accounts for about 4% of all cancer-related deaths worldwide, there is a lack of attention focusing on cancer-related deaths in the U.S., the researchers noted.

The study’s estimate that 3.5% of all cancer deaths are alcohol-related was slightly higher than previous estimates of 3% for the U.S. and probably stems from including additional cancers, especially women’s breast cancer, the researchers noted. “Nevertheless, our findings demonstrate there has been little, if any, progress in reducing alcohol-attributable cancer deaths in the United States,” they wrote.

The findings confirm previous research that oral cavity and pharyngeal, laryngeal, and esophageal cancers account for the majority of alcohol-related cancer deaths among men, and breast cancer for the majority of such deaths among women. Reducing alcohol consumption is an important and underemphasized cancer prevention strategy that receives surprisingly little attention among public health, medical, cancer, advocacy, and other organizations in the U.S., they added.

They speculated that one reason there has not been more of an effort to lower alcohol use is due to the purported cardiovascular benefits of low-level alcohol consumption, such as news reports about the beneficial effects of red wine.

The study authors urge medical and public health organizations and providers to make “clear and consistent” statements emphasizing that alcohol is a known human carcinogen, that there is no safe level of drinking, and that alcohol use should be lowered or avoided to reduce the risk of cancer.

On the lighter side, in an earlier study I found, most people have a highly effective natural repair mechanism for correcting the damage done to the DNA that causes the cancer. So, although most are unlikely to develop cancer from social drinking, if you are missing that gene that repairs the damage, you are at higher risk.

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.

No matter what you do for a living, the most important key to success is to be principled. Those who follow indisputable and grounded principles are much more likely to achieve successful outcomes and realize satisfaction from a job well done.

However, change is inevitable. And, change is not always easy. Let me use dentistry as an example, since this is what I know best.

Technology and techniques in dentistry change. Some dentists jump on the bandwagon right away with every new gadget. Sometimes it’s hard to resist because there are so many cool things available. There are others who are late adopters. Dental technology and techniques may change, but principles don’t.

Principles are based upon a sound foundation of trying to do what’s right and what’s fair. Incorporating innovations in the practice of dentistry enables a dentist to be successful and simultaneously remain principled. For example, a couple of years ago I invested in a piece of equipment that I had resisted for a long time. I was unsure of the amount I would be able to use it and continue to stick with my principles. Today, I can’t imagine practicing without it. It has made me a better, more conservative dentist.

However, I have seen and been on the other side as well, where there is a sense of urgency to “buy” the technology in order to just have it without completely understanding the relevance. This can lead to technology ending up as a coat rack and a relatively wasted investment.

For others, change might be difficult. It is easy to get bogged down with tradition. That can be good and that can be bad. Sometime the best solutions we have are tried and true. However, it is important to keep an open mind. If a new technology or technique is scientifically tested and the dentist feels it improves the core foundation of grounded principles they use to treat their patients, they almost have an obligation to adopt it.

Other than having a firm set of principles, another key to success is learning people skills. Interacting with people can sometimes be tricky. Everyone has their own set of “issues”, and everyone has their good days and their bad days. We don’t have to like everyone we come in contact with, but learning how to deal with all kinds of people is a valuable skill. When it comes down to it, this brings us back to our core set of principles. If we center our conversations around our principles and people see our interactions are genuine, trust and friendships can be made.

Those who have grounded principles and have achieved some level of success in their own eyes find themselves wanting to become better and better. It is important to become dedicated to the pursuit of excellence, no matter what you do, and to seek out the expertise and knowledge of others.

Your principles will guide you through whatever lies ahead, and your flexibility will enable you to handle whatever the future holds, which is something nobody knows for sure. Perseverance, one of my favorite words, is defined as, “steady persistence in a course of action, a purpose, a state, etc., especially in spite of difficulties, obstacles, or discouragement.”

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 is a summary of some facts I found from different surveys done over the last decade.

Are you happy with your smile?

• 50% consider the smile the first facial feature they notice
• 80% are not happy with their smile

• Smile enhanced procedures outnumber eyelid surgeries 5 to 1

Americans do not spend enough time on oral home care or professional care.

• 32% of Americans cite bad breath as the least attractive trait of their co-workers
• 38.5 total days an average American spends brushing teeth over lifetime (compared to (1) year of your life spent on hold)
• 73% of Americans would rather go grocery shopping than floss

Interesting stuff:

• It is recommended that a toothbrush be kept at least six (6) feet away from a toilet to avoid airborne particles resulting from the flush.
• A toothpick is the object most often choked on by Americans
• Every year, kids in North America spend close to half a billion dollars on chewing gum

The number of cavities in the average mouth is down and people are keeping their teeth longer.   People, on average, have healthier mouths than even 10 years ago.  Specifically:

• The decline in tooth decay was greatest among kids but holds across every age group
• 40% of young people age 6 to 19 have never had cavities.  That’s down from 50% a decade ago
• The proportion of people over age 60 who lost all their teeth decreased from 33% to 25%

• People who smoke remain three times more likely than non-smokers to lose all their teeth

Despite the fact that more Americans have dental coverage than ever before, dental visits are on the decline. There are many reasons for this.

• Regardless of insurance coverage, adults still report cost as the number one reason for not visiting the dentist
• Benefits from insurance carriers are decreasing despite increases in premiums
• More employers are choosing PPO (network) plans with limited providers leading to decreased visits
• Patients report they are less likely to spend discretionary dollars on dentistry vs. personal technology

And most important to consider:

• The average woman smiles about 62 times a day! A man?  Only 8!
• Kids laugh around 400 times a day. Grown-ups just 15

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.