J. Peter St. Clair, DMD Blog

If you have read these columns in the past you have heard me talk about periodontal (gum) health and its relationship to systemic health. There is a slew of scientific evidence that poor periodontal health is not good for you systemically. It has been linked to heart disease, stroke, low birth weight babies, diabetes and more.

Gum tissue health is an easy thing for patients to be lax about or even ignore. Why? The main reason is that gum problems do not hurt unless they are so severe that tooth loss is inevitable. It is the chronic inflammation in the gum tissue, regardless of whether it hurts or not, that has the potential to affect your teeth and your general health over time.

How many times have you been to the dentist and heard, “Mr. Smith, you have a lot more bleeding than you should around your gums”? You then respond by saying, “My gums don’t bleed when I brush.” And you hear, “You need to brush better.” Then it happens all over again the next time you are at the dentist.

If the goal is to keep your teeth and strive for good health, the scenario above is totally insufficient. We, dentists and patients, need to change our frame of mind about tissue health and really focus on the fact that chronic inflammation, anywhere in the body, is bad.  Tissue health is achievable in every single person. It is a matter of changing our views on what is acceptable and what is not acceptable that can make a difference.

Patients love dentists who say that everything looks fine. Sometimes that is the case. However, most of the time there is room for improvement. If there were things in your mouth that could be healthier, would you rather have a dentist say that everything looked okay, or one who made suggestions for better health? Keep an open mind and be willing to put the effort in to make a healthier you.

The oral cavity and the gum tissue around each and every tooth is a haven for bacteria. Everyone has bacteria. It is how well the bacteria are controlled that determines tissue health. Patients typically do not want to hear that they need treatment. If you went to the physician and you had signs of heart disease would you rather hear, “Mr. Smith, you have signs of heart disease. Let’s wait until you have a heart attack and then treat it.” vs. “Mr. Smith, you have signs of heart disease. These are the things that you should do to help prevent the progression of the disease. Let’s work together on lowering your risk of problems in the future.”

I have said it before and I’ll say it again – the best thing you can do for yourself when it comes to your dental health is regular maintenance. Depending on a person’s needs, regular maintenance might be once a year for some, but every 2-3 months for someone else. Even if you have no dental benefits and are worried about needing a bunch of dental work, the best thing you can do for yourself is regular maintenance. Many dental offices have plans that are very reasonable to help you achieve better dental health.

The mouth is the gateway to the rest of the body – don’t ignore it.

I attended a continuing education seminar this past week entitled, “Making it Easy for Patients to Say Yes”. The name of the seminar is a bit deceiving. You would 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 it takes time 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. There are many 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. If possible, choose your provider based on who you want to go to. 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? 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.

I remember one time 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. When I tell a patient that I am going to take a series of pictures of their teeth the response I often hear is, “I just had x-rays taken.” When I explain that they are pictures and not x-rays it is not uncommon for the patient to ask, “Why?” or say, “No one has ever done this before.” 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.

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 approach, 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 is the key 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.

You’ve decided to take your oral hygiene a little more serious, so you want to start by evaluating the type of toothbrush you usually buy. Is it the right one? And if not, what kind is better? Your dentist says there are some simple criteria that you can use to make the right decision. Continue reading to find out what he has to say.

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Dental practices are as different as people are different. The personality of the owner is probably the key to how that office “feels” when you walk in the door. 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. Many of these variables the patient does not have control of. What you do have control of is your ability to choose your provider.

Even if you don’t have “insurance” (in quotes because the system we have is broken) finding an office you like and trust is the best investment you can make for your dental health. Maintenance is key!

I recently had the opportunity to do some dental hygiene appointments for a hygienist who was out for a family emergency. While at first I was not particularly excited about doing this because I have my own busy schedule, I have to say, it was both gratifying and eye-opening.

Typically, when I check a patient after a hygiene exam, I am examining clean teeth and will briefly discuss any concerns the patient or the hygienist has. But on this day, I got to spend much more time with patients who I normally only see for five minutes after they see the hygienist.

My first patient was a 20-year-old, very pleasant and bright young man, who has not had to spend very much time in “my” chair. As I read through his chart to look at the notes the hygienist had made from previous appointments, I noticed that there had been repeated discussions about his homecare. As we started our appointment, I realized I was up against the same issues the hygienist had seen on previous appointments.

I asked this young man, “When was the last time you brushed your teeth?” He replied, “It’s been a few days because I have been busy.” Of course, I had the reaction that you are probably having right now – how in the world can you go a few days without brushing your teeth? As I worked my way through the plaque and heavy bleeding due to inflammation from the debris, we talked about the Bruins game we both watched the night before.

I know what you thinking – If you have the time to watch the Bruins, you have the 2 minutes it takes to brush your teeth – I thought eh same thing. However, instead of approaching it this way and trying to convince him that he needs to work on his priorities, we discussed some of the health consequences of long-term inflammation as he gets older. We will have to see if this discussion had any impact on him the next time he comes in.

Another patient I saw was an adult woman who has also spent little time in “the back” with me. Over the past few years, the hygienist’s notes had indicated a history of severe headaches and jaw muscle tension as well as my recommendation to consider a nighttime appliance. She took daily medication to manage her headache issues and even had occasional injections to treat her symptoms.

On this day she was in severe muscular pain. In addition to completing her dental hygiene services, I had the opportunity to do a more complete exam and have a more in depth discussion about her problem. In spending more time with her I was also able to ask more questions and learn much more about her symptoms and possible etiology. We discussed her concerns about moving forward with treating both her headaches and looking further into some sleep related issues which could be causing her other symptoms. She is still reluctant to move forward with my recommendations because she feels her issues are from another origin.

Changing our habits, like brushing habits, or making a change to improve any aspect of our health is difficult for many. My experience with these two patients, as well as other patients I saw that day, reinforced that making a change is often not as easy as just briefly mentioning it. It is important for providers and patients to take the time to discuss what the barriers are that are holding them back from making improvements in their health.

Time is the most important gift a health care provider can give.

I recently attended a continuing education course 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, often times 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 so I’m used to seeing them guessing an animal’s age based on the appearance of their teeth. 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 and 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. Take decay for example; decay is 100% preventable. However, it is still not uncommon today to have a patient (typically a teenager) come in for a routine dental hygiene appointment and be told they have decay, or multiple areas of decay, which was 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 may have prevented 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.

There are very few things I learned in dental school that I still use today. Many of the basic principles are used but 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.

Did you know that researchers have found Neolithic remains from 6,500 years ago that include a tooth filled with beeswax? Clearly, dental materials have evolved a lot since then! And while dental work has been further improved over the last 100 years or so, there are new advances all the time that mean an even better dental experience for patients. One example of this is a new filling material that researchers from the University of Pennsylvania have been studying that has huge implications for both dentists and patients. If you’d like to know more, a local dentist discusses how it might change the field of dentistry.

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I read somewhere recently – Insurance does not equal health. Health requires investment. The push in the dental insurance industry is to make “insurance” cheaper in an effort to have more people covered. However, according to a new study published in the American Journal of Public Health, providing people with dental insurance does not necessarily mean they will use it and seek dental care.

Researchers from the University of Maryland School of Dentistry analyzed nearly 13,000 people for their project. Those who had dental insurance and accessed dental care were more likely to be younger, college graduates, high-income workers, married, in very good health, and not missing all their permanent teeth. They were also more likely to be white, living in households of two persons, and living in the Midwest or Southern regions of the U.S.

Those who had dental insurance but didn’t use it tended to be younger and working, black or Hispanic, living in households with three or more people, and obese. They were also more likely to be male, high school graduates, poor, in fair health, and missing all their permanent teeth.

Those who didn’t have dental insurance but accessed dental care tended to be older (65 to 79 years), white, college graduates, married, living in households of two persons, in good health, not missing all their permanent teeth, not obese, with high incomes, living in the Midwest, and partly retired.

According to the lead researcher in the study, “You can’t just hand people coverage and say, ‘there, that’s better.’ You need to offer some inducements, some promotional campaign to change people’s attitudes and beliefs.” The researchers found that providing dental coverage to uninsured older Americans who do not tend to use dental care will not necessarily mean that, once insured, those people will seek dental care. Rather, if policymakers want people to use dental coverage and seek care, they have to go further than just providing insurance.

While many of the factors that keep people from seeking care — such as age and gender — can’t be changed, other factors could be influenced by outreach, the researchers found. These factors include knowledge, beliefs, attitudes, tastes, health status, and income. Education and marketing outreach about the importance of dental care to overall health could alter these factors and make people who have coverage more likely to use it, the study authors wrote.

Improving the economy and the unemployment rate also could help, the researchers concluded. In addition, the number of providers available could affect the likelihood that patients will use their dental coverage, supporting the development of programs that encourage people to enter dentistry.

The study findings also indicated that getting people to use dental coverage to seek care is not a short-term process. Oral health is a critical part of a person’s overall health and more research needs to be done to understand ways to motivate people to seek oral health care.

Thanks again to the The Town Common for another great year. At the end of each of the past 12 years, I have used this space to publish these 21 Suggestions for Success authored by H. Jackson Brown, Jr. It is the perfect time to reflect on the year past and prepare for any changes we need to make for the year to come.

How was 2017 for you?  While reflecting on the past year is important, thinking forward to the year to come is even more important. The past is in the past.

I thought last year might be the final year for posting this list. However, knowing that readership continues to grow for The Town Common, and realizing how powerful these words can be, I decided to republish. So, cut this out and put it on the refrigerator. Read this list often and take these suggestions to heart. They will be sure to make your 2018 great.

1. Marry the right person. This one decision will determine 90% of your happiness or misery.
2. Work at something you enjoy and that’s worthy of your time and talent.
3. Give people more than they expect and do it cheerfully.
4. Become the most positive and enthusiastic person you know.
5. Be forgiving of yourself and others.
6. Be generous.
7. Have a grateful heart.
8. Persistence, persistence, persistence.
9. Discipline yourself to save money on even the most modest salary.
10. Treat everyone you meet like you want to be treated.
11. Commit yourself to constant improvement.
12. Commit yourself to quality.
13. Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.
14. Be loyal.
15. Be honest.
16. Be a self-starter.
17. Be decisive even if it means you’ll sometimes be wrong.
18. Stop blaming others if it means you’ll sometimes be wrong.
19. Be loyal and courageous. When you look back on your life, you’ll regret the things you didn’t do more than the ones you did.
20. Take good care of those you love.
21. Don’t do anything that wouldn’t make your Mom proud.

Best wishes for a successful 2018. Happy New Year!