J. Peter St. Clair, DMD Blog

Dentists are taught the skills in dental school and beyond to diagnose and treat dental decay, gum disease, tooth loss, and other things to help preserve teeth for a lifetime. A more mystical area of dentistry for many dentists is the ability to identify, communicate and treat bite-related problems that occur over long periods of time.

The term in dentistry for how the teeth come together is called occlusion. The masticatory system is composed of the teeth, the joints (TMJs), and muscles. How the teeth occlude and what a person does with their teeth, determines what happens to the teeth, muscles and joints over time. If these three things are not working together in harmony, something has to give; teeth wear down, joints and muscles can become sore, etc.

Would you want to know that there is a potential problem or prefer to have it ignored and deal with the consequences when and if they should arise?

The fact of the matter is – every person is different and does different things with their teeth. How do you compare a 90 year-old with all of their teeth with minimal wear to a 30 year-old with 25% of their tooth structure missing (unknowingly in many cases)? Both individuals eat, sleep and breathe but present very differently. Theories abound; there is no question that some people put greater forces on their teeth when they sneeze, swallow, chew and sleep than others.

Greatly underdiagnosed, these forces help cause things like teeth wearing, teeth breaking, TMJ/muscle soreness, tooth loss, tooth sensitivity, gum recession, and poor sleep patterns. Many dentists (including myself) see the signs but often choose to avoid a challenging conversation with a patient about a disease process that is not fully understood. Unfortunately, ignoring these signs is not in the best interest of the patient. It is the obligation of the dentist to raise the patient’s awareness of these forces and to discuss strategies to combat them. It is only through this awareness that patients will be able to decide if they want to do anything about it or not.

Keep in mind that many of the bodies functions, including the forces put on teeth, occur without any cognitive thought. Patients will often say, “I know I grind my teeth in my sleep when I’m stressed”. Things like stress may have some effect on this, but is it important to look beyond specific instances and evaluate the bigger picture of what is really going on.

For example, breathing is perhaps the most essential of all life functions. If you are not getting the proper oxygenation when you sleep, there are some crazy things your body does as a defense mechanism to get air. Sleep-related breathing disorders are underdiagnosed and undertreated and may just be one of the leading causes of tooth wear and TMJ problems.

I am finishing my “mini-residency” at Tufts this week in dental sleep medicine so I will be bringing this topic up again in future columns with updated information. If you have any questions about this topic, or any other, please send me an email.

This is the final column of this series. If you missed any of the past segments, you can find them at www.thetowncommon.com.

I’ve heard of some new cosmetic techniques that can improve smiles. Are they appropriate for older adults?

Older adults can benefit from many of the options available today for improving the look of a smile. Your dentist can describe and discuss with you the range of treatments that would be right for you. Part of older adulthood is the acceptance of aging and the development of realistic expectations for appearance. In that context, dental treatment for older adults can be a healthy and adaptive way of maintaining dental health and emotional well-being.

Our teeth and mouth play a critical role in psychological development and well-being throughout our lives. Modern dentistry has expanded esthetic options for people of all ages. Coupled with good oral hygiene and regular dental visits, cosmetic techniques can help improve the appearance of your smile.

I’m on a limited, fixed income and can’t really afford regular dental treatment. Are there any resources available to help me?

Even if you cannot pay for dental care, you don’t need to live without it. Thousands of dentists across the country assist the elderly on fixed incomes by offering their services at reduced fees through dental society-sponsored assistance programs. The availability of such aid varies from one community to another, so call your local dental society for information about where you can find the nearest assistance programs and low-cost dental care locations, such as public health and dental school clinics. Other sources of such information are local social service organizations.

What is dentistry doing to better serve older adults?

Dentists are experiencing a quiet revolution in their offices as the number of older patients increases steadily. The profession knows that this burgeoning population group is wearing fewer dentures and is keeping natural teeth longer. Also, we know that some patients in this group require special consideration because reduced mobility and dexterity may make daily oral hygiene difficult. In addition, medical conditions and impairment are factors that dentists take into account for certain patients.

Sometimes, lack of awareness about available treatments and techniques leads older patients to make false assumptions about their dental health and tolerate conditions such as toothaches, bleeding gums and clicking dentures. Dentists are gaining practical information on how to effectively manage the treatment needs of older patients. Many dental societies have set up access programs to assist older adults, individuals with physical or mental disabilities or indigent persons to receive care.

The dental profession is increasingly sensitive to the special needs of and the importance of dental health in the older patient. Older adults are more health conscious as a group than ever before. Their oral health is an important part of their overall health and the dental profession is committed to providing the treatment and guidance older adults need to maintain it.

I find that some foods have become difficult to chew and swallow. Do I really need to eat the same amount or variety of food that I did when I was younger?

Maintaining proper nutrition is important for everyone, young or old. Many older adults do not eat balanced diets and avoid meats, raw vegetables and fresh fruits because they have trouble chewing or swallowing. These problems can be caused by painful teeth, ill-fitting dentures, dry mouth or changes in facial muscles. Others find their sense of taste has changed, sometimes due to a disease or certain medications.

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I understand that periodontal disease is a major cause of tooth loss in adults, but is there anything I can do about it?

Gum disease—periodontal disease—often progresses slowly, without pain, over a long period of time. This is one reason why it is common among older adults. The longer the disease goes undetected and uncontrolled, the more damage it causes to gums and other supporting tissues. Although periodontal disease is caused by bacteria, other factors can increase the risk or severity of the condition. These include food left between the teeth, smoking, smokeless (spit) tobacco use, badly aligned teeth, ill-fitting bridges or partial dentures, poor diets and some systemic diseases such as diabetes.

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Isn’t tooth loss inevitable in the later years?

Today, older adults are keeping their natural teeth longer because of scientific developments and the preventive emphasis in dentistry. This improvement was seen in the results of a survey released by the National Institute of Dental and Craniofacial Research. They showed that among persons aged 55 to 64, the rate of toothlessness dropped 60 percent since 1960.

Good oral hygiene and regular dental care are important throughout your life, whatever your age. By practicing good oral hygiene at home and visiting your dentist regularly, you will prevent dental problems and save time and money as well.

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When we ask for a Kleenex or a Ziploc we may not necessarily get that brand, but we know we will get a tissue or a sealable plastic bag. It is always interesting to me hearing the different things people say in the dental office that seem to be “standard” among the general population.

For example, most people use the term “Novocain”. Even dentists, including myself, use this term daily to describe the local anesthetic used to anesthetize or “numb” teeth before they are worked on. Novocain, apparently still available for purchase, has not been used in dentistry for probably 100 years, but we still use the term because everyone seems to know what we mean. We may say “Novocain” but that is not what we are writing in your medical record.

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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.

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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? I can tell you the way I see it, different groups of dentists may have different views, large dental chains see it from a different perspective, consumers have varied opinions, and insurance companies are leading the way with their solution. These are all very different perspectives.

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This is the second column my series about the state of dental insurance in our country. The information presented is intended to explain “dental insurance” from a perspective which may be different than most consumer’s view of insurance. I encourage you to read all the columns in this series. If you missed any they can be found at www.thetowncommon.com. I hope the information helps you to make more informed decisions about your dental health.

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The Merriam-Webster definition of insurance is “coverage by contract whereby one party undertakes to indemnify or guarantee another against loss by a specified contingency or peril.” We have insurance on our house and car. If our car gets damaged, we usually pay a deductible and the insurance picks up the rest. If our house burns down, we have insurance to help us rebuild it. Unfortunately, that is not the way it works in dentistry.

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