J. Peter St. Clair, DMD Blog
Wanna Be a Dentist?
February 15, 2012
I’m sure you have heard that dentists are always at the top of the list for suicide, divorce, and substance abuse. I did a little research just to verify that is actually accurate…..and yup, it is. I could go into why I think that is the case, but I’ll let you ponder that one on your own.
Despite the many challenges of this profession, if I could do it all over again, I would still choose to be a dentist. I didn’t decide to go to dental school until late in my senior year of college. People ask me all the time, “What in the world made you decide to look inside of mouths every day?” Believe me, I asked myself the same question when I decided to apply to dental school. It was a last minute decision.
Today, I am glad I went into a profession that allows me to problem solve and can be both easy and challenging. I guess it is my approach. I see myself as an educator and a health care provider who wants to help people decide to what level of health they wish to achieve. I have also made the conscious choice to enjoy what I do every day. When things occur that I do not enjoy, I try not to focus on the negative. It is always a work in progress.
For a dentist, and for that matter anyone in any profession to be successful, they must know themselves and have standards they are able to communicate with passion and energy. One thing is very clear, behavior, with its impending results, is a choice. We make choices every minute of every day. What we choose to do with the paths presented to us is a choice. Being frustrated with your job, trying to copy others instead of discovering yourself as well as dental care is a choice.
All dental care is elective. There is nothing that you have to do. That is what makes this profession the most fun and rewarding for me. A dentist who worries about how much of a particular procedure they do, or tries to sell dentistry as a commodity will become frustrated. That is why there tends to be a high burn-out rate in this profession. It should be about education. It should be about people and caring about their health.
It is also about building trust with people. If any of my patients out there ever had a thought that I was trying to “sell” them something, there is an issue with trust there. I use the car analogy often. First, you decide that you are buying a car. It is only after you decide that you are buying a car that you pick the style, the brand, and the options. It is with that information that you make a decision on what car you are buying, based on what you want and feel is right for you. I look at dentistry the same way.
Dentistry combines health care, artistry, psychology and business all into one. As in any job, there are good times and not so good times. There is always room for improvement in all aspects of the profession and the options for continuing education to improve are limitless.
If you, or if you have kids in high school or college who are wondering about what to do with their life, introduce the possibility of a career in dentistry. Ask your dentist if they would talk to you or them about the profession or even do mentorship. It’s a wonderful profession.
What Your Mouth Says
February 2, 2012
A few weeks ago there was a large article in The Wall Street Journal entitled, “If Your Teeth Could Talk.” It was a basic review of some of the connections between oral and systemic health and also offered some newer research that I was unaware of.
I have written many times on the growing evidence linking periodontal (gum) disease with many systemic issues. The fact of the matter is the mouth is truly the gateway to the rest of the body. While some early signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalance and drug issues can show up in the mouth long before the person discovers that there is a “problem”, an unhealthy mouth also puts you at greater risk for things like heart disease, stroke, diabetes, and pregnancy complications.
A study done at New York University in 2009 reported that 93% of people who have periodontal disease are at risk for diabetes. The issue is inflammation and the fact that periodontal disease and diabetes exacerbate each other. Inflammation from periodontal disease, a chronic non-symptomatic disease, makes it more difficult for people with diabetes to control blood sugar levels. High blood sugar accelerates tooth decay and gum disease, which elevates inflammation. It is a vicious cycle.
However, more recent studies show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes. The estimates are that six million Americans have diabetes and don’t know it. The risk of not treating either disease can have irreversible consequences.
If you have ever had a planned surgery you probably were asked about your dental health, how often you visit a dentist and asked to get “clearance” from your dentist prior to surgery. The reason for that is because the type and quantity of bacteria present in uncontrolled gum disease is much higher than in periodontally healthy individuals. Bacteria from the mouth can travel through the bloodstream and cause problems elsewhere. Far too often patients come to me a month before surgery and say they need to get their mouth in shape prior to their procedure….an often impossible task.
There are also an increasing number of people on medication and the number of medications they are taking. Many drugs, including but not limited to blood thinners, bisphosphonates (ex. Fosamax), blood pressure medications, antidepressants and chemotherapy drugs can all have effects on the mouth that can be devastating if not closely monitored.
This is all “real” stuff. I deal with these issues in the office every day. I use this analogy a lot, “Periodontal disease is like diabetes, it is not curable, but in most cases it is controllable.” For most patients, good home care combined with good professional care can control this disease. Just as in the lottery, “you can’t win if you don’t play”. However, the consequences for not playing the dental game are more risky.
If you didn’t take the survey last week that I discussed, go to the Facebook page below to take it. I will be reporting the results in the next couple of weeks. So far, not one respondent would give up their teeth for a million dollars. Would you?
What would you do?
January 10, 2012
In last week’s column I talked about the trend over the past few years of dentistry taking on a new look. This” new” look is a resurgence back to the days of prevention and maintenance and involves less elective procedures such as cosmetic veneers.
There are still many patients who would like to improve the appearance of their smiles with these elective procedures but are postponing treatment due to the economy. There are also many people who have taken professional dental care completely off their radar for the same reason. This group is in danger of many future dental problems.
I have a hypothetical question to propose. This question assumes you are not missing more than (2) of your natural teeth (not including wisdom teeth) and under the assumption that you are dentally healthy. Here is the question:
If you were offered 1 million dollars to have all of your teeth removed, would you do it?
Obviously this is not realistic but I want you to think about how important your teeth are to you. For that same $1 million, would you give up driving or riding in a car for the rest of your life? Would you give up your bed and resort to sleeping on the floor the rest of your life?
Teeth, cars and beds are things we use all day long. They are an important part of our lives and are often taken for granted. I know there are denture wearers out there who would encourage people to take the million bucks…..but there is no comparison between natural teeth and plastic.
Now, with that million, you could replace the teeth with a number of different options. Typically those options are a denture, an implant-supported denture, or multiple implants with teeth (crowns) attached. If you wanted to come out of this with the most minimal expense, you would be getting a poorly fitting denture the day your teeth were taken out (there is a lot of estimation when all the teeth are present and a denture is being made), months of healing and then a better fitting denture would be made for you.
If you chose the last option and wanted to replace your teeth with implants, you would need to have all your teeth removed, that same poorly fitting denture made, the same months of healing, and then multiple appointments to finish. The total treatment time would be about a year. Of course you would have to pay for this; but you do have the million dollars from having all your teeth removed.
Realistically, no one is going to offer you a million dollars to take all your teeth out. My point is meant to be simple. A healthy mouth is such an important part of life. Think of the discomfort, aggravation, inability to smile confidently, inability to eat properly and enjoy food. The quality of life is undoubtedly better with natural teeth. However, a million dollars is a lot of money. The question definitely made me think.
So, I would love to hear what you would do. I have set up a survey on my Facebook page (www.facebook.com/dentalhealthforlife). Take the survey and I will report back on the findings in a few weeks.
In the meantime, please visit a dentist regularly. Maintenance of dental health is so important. Don’t wait until you have a “problem”, because often times that problem is a sign of many bigger issues. Life is better with teeth!
Looking Forward
January 6, 2012
The end of 2011 is here and it is time to reflect on the good and not so good of the past year. We are in a very unstable time in the history of our country and the world. Even if 2011 was not the best year for you, there are always things that we can find to be grateful for.
“If you continue to do what you’ve always done, you will continue to get what you’ve always got.” I’m not exactly sure where this quote came from but it is a good way to reflect on the past year and think about the year to come. I also always publish the list below every year because it is a great compilation of some of the most important things in life.
These 21 suggestions for success are authored by H. Jackson Brown, Jr. I have a framed picture of these hanging in my office and read them every day. I get comments about them all the time from people saying how much they like them. Cut this column out, hang it on your refrigerator and read it frequently.
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.
22. (my own) Strive for optimal health……and that includes dental health.
Read this list often and take these suggestions to heart. They will be sure to make your 2012 great. Happy New Year!
Bridge vs. Implant
December 28, 2011
Over the past few weeks I have had numerous new and existing patients who have had the need to replace single and multiple teeth. Based on the conversations I have had with these patients, there seems to be some common misconceptions about replacing teeth. I would like to share my thought process that I communicate with patients when they are forced to decide between different treatment rationales.
Let me start by using an example of a new patient I had in yesterday. The patient presented with the chief complaint of pain. The diagnosis was an infection of a previously root canal treated tooth which was deemed non-restorable. The only treatment was extraction. The teeth adjacent to this tooth are in good condition. There are four treatment options: extract and leave the space, extract and replace missing tooth with a removable appliance (partial denture), extract and do a fixed, cemented bridge (non-removable), extract and replace missing tooth with a dental implant.
Extracting the bad tooth and leaving the space is always an option. There are, of course, esthetic concerns as well as concerns about other teeth moving and loss of function. Replacing the missing tooth with a removable partial denture is an option but is not one that most people choose due to the fact that they have to wear something in their mouth. That leaves the last two options that most people contemplate: a bridge vs. a dental implant.
Fifteen years ago, when I started practice, the standard of care was to replace the missing tooth with a bridge. A bridge is a laboratory fabricated restoration where the teeth on either side of the missing tooth (abutments) are prepared for crowns. An impression is taken of the prepared teeth and the final product, a one-piece “3-tooth” porcelain bridge, is cemented onto the two teeth that were prepared. The advantages of this are: typically can done quicker than an implant and if the abutment teeth need crowns anyway, all is accomplished with that one procedure. One major disadvantage is that if you get decay on one of the abutment teeth, the entire bridge is typically lost. So, if you are prone to decay (especially if you do not visit the dentist on a regular basis), a bridge is probably not the best solution. Another disadvantage is that if the abutment teeth do not “need” crowns, a bridge requires perfectly good teeth to be ground-down. Because the bridge is one piece, flossing requires a special tool to thread the floss under the bridge.
Today, I would consider a dental implant to be the standard of care. A dental implant is a titanium “post” that replaces the root of the missing tooth. A single crown is then placed on that “post”. The procedure is typically less invasive than removal of a tooth. You cannot get decay on a dental implant. If something goes wrong with one of the teeth on either side of the dental implant, you only have to deal with the one tooth and not three teeth as in the example of the bridge. The teeth are all separate so flossing is normal. The cost of a single dental implant vs. a 3-unit bridge is about the same.
Although there are other things to consider, I am out of space this week. I encourage your questions.
Interdisciplinary Dentistry
December 21, 2011
Last week I was invited to attend the annual North Eastern Society of Orthodontists (NESO) meeting in Boston. You may ask why I attended an orthodontic meeting when I am not an orthodontist? The reason I was invited was because of the strong interdisciplinary component of the meeting. What is interdisciplinary dentistry?
I’ll use the example of a 38 year old woman I saw just yesterday as a new patient. She had not been to a dentist in a couple of years and wanted to have her teeth cleaned. She saw one of my hygienists, had her teeth cleaned, and then saw me for an examination. My examination of new patients usually includes a set of photographs of the teeth. Over the years, this has proven to be invaluable for me to be able to discuss a patient’s dental status. It is much easier to show and explain than just explain.
I evaluate 4 areas in every patient. Those areas are the biology, esthetics, function and structure of the teeth. The biology is the health of the gums and bone that support the teeth. This is important because this is the foundation of good health. I always evaluate the esthetics of the teeth because the smile is the most prominent feature of the face. The function of the teeth is an evaluation of how the muscles, joints and teeth are working together – does the patient have any muscles or joint (TMJ) issues and do the teeth show any signs of wear? Lastly, the structure of the teeth is the condition of the teeth themselves – what is the patient’s dental history and what is the condition of the existing restorative dentistry in the patient’s mouth?
As I was taking this new patient on a “tour” of her mouth, I simply described what I saw. As often happens, my patient started asking a lot of questions. The bottom line is that she always wondered why she had repeated dental problems and had a list of things she did not like about her teeth. Her dentists in the past had never looked this deep into her dental issues, so she was never given the opportunity to do anything about it. In the past, if there was a problem, the problem would get the quick fix, a crown or a filling, and life would go on until failure occurred again.
This patient, who came in just to have her teeth cleaned, announced that she was ready to fix her teeth correctly. As her dentist, I need to be able to deliver the level of care she expects. This is only possible with effective collaboration between a group of dentists. Her treatment will probably be phased over the course of a few years. It will require collaboration between me, an orthodontist, a periodontist and an oral surgeon. This is interdisciplinary dentistry.
Much of the NESO meeting was about treatment like this. The dentist must have the educational background of the many different disciplines of dentistry and be able to communicate their findings in simple terms that patients can understand. Doing a complete exam and reporting findings is the obligation of the dentist to the patient. This at least gives the patient the opportunity to choose the level of health that is right for them as an individual.
When it comes to actually doing the dentistry, it is essential that the general dentist, the quarterback of the team, has the right players assembled to make the entire treatment a homerun.
Amesbury Nixes Fluoride
December 5, 2011
Last week, Amesbury residents voted in a relatively narrow margin against the re-introduction of adding fluoride to the public water supply. Fluoride has been added to many public drinking water supplies all over the country for decades in an attempt to combat dental decay. The theory is that ingested systemic fluoride strengthens the developing teeth and makes them less susceptible to decay.
I would bet you would think that I am a proponent of public water fluoridation given my profession. I am not. In fact, I think it is unethical, unnecessary, ineffective, unsafe, inefficient, and unscientifically promoted. Although there is not enough space in this column to go into this in depth, let me give you an example of each.
Public water fluoridation is unethical because it violates an individual’s right to informed consent to mass medication. It is okay to put substances in the public water to make it safe, but not to medicate, and especially not a heavy metal that accumulates in the body. Public water fluoridation is also unnecessary because people, including children, can have healthy teeth without being exposed to systemic fluoride. This is different than topical fluoride which I will touch on later in this column.
Public water fluoridation is ineffective as research has shown that fluoride’s benefits are primarily topical and not systemic. Countries that have halted water fluoridation generally do not see increases in decay. It is unsafe as systemic fluoride accumulates in the pineal gland and in bones, making them more brittle. Also, where the fluoride comes from is an interesting topic of discussion. Many municipalities get their fluoride from China.
Public water fluoridation is inefficient for many reasons, one being that more and more people drink bottled water (which is loosely regulated) and most of the public water ends up washing dishes, in the shower or watering the lawn. If ingestion of fluoride did make sense there are better ways to make it available to people who want it. But, is it really necessary?
Lastly, public water fluoridation is unscientifically promoted. As stated by the US Centers for Disease Control, “Laboratory and epidemiologic research suggests that fluoride prevents dental caries predominately after eruption of the tooth into the mouth, and its actions primarily are topical for both adults and children”. I am a proponent of topical fluoride such as the fluoride found in toothpaste. And, as we age, the decay rate often increases due to exposure of more root surfaces of the teeth which are more susceptible to decay.
Research continues on the effect that fluoride has on teeth, both systemically and topically. The research also continues on the effects that ingested fluoride has on the rest of the body. There is also mounding research on products other than fluoride that show promise in combating dental decay.
I have a fair number of patients on prescription level topical fluoride that I feel are more susceptible to decay. My protocol may be changing soon due to pending research. However, one thing is certain, those with a good diet, impeccable homecare, and who visit a dentist at least twice per year, are much less susceptible to decay no matter what they brush their teeth with.
Dental Insurance Benefits Expiring
December 1, 2011
I don’t know how you feel but I think this year is just flying by. I guess I feel like that every year. Only one more month left in 2011. For those of you with dental insurance, only one more month to use your dental benefits before they disappear and go toward the bonuses for the insurance executives. That is kind of a joke and it is kind of not.
As you know, if you have dental insurance, you have a yearly maximum amount of money that can be used for dental care. Although that yearly maximum (typically $1000-1500 per year) has not changed for 40 years in most situations, if you don’t use the money the insurance company keeps it. That’s right, if your insurance company doesn’t write a check out for your dental care, they keep whatever you don’t use.
On that note, if you have dental work that needs to be done, now is the time to do it. The only catch is that because many patients wait until the end of the year to use their dental insurance benefits, it is often difficult to get an appointment. Therefore, those reading this column will be one step ahead of everyone else. The big rush generally occurs in the next couple of weeks so book your appointments now.
This is especially true for patients who need multiple things done. Let me use a specific example. Let’s say your dentist has told you that you need a crown on a tooth but the tooth will need work done by a periodontist or even the dreaded root canal prior to doing the crown. Getting the “pre-crown” work done at the end of this year will allow you to finish the crown in the beginning of next year and maximize your insurance benefits.
It has always seemed crazy to me that we have to play these games with dental insurance, but that’s the way it works. If you have been told that you needed some work done and haven’t done it, call your dental office or insurance carrier to see how remaining benefits you have.
Just for clarification, as this is an area that patients sometimes get confused on, your yearly maximum is yours and not your spouse’s. If you and your spouse have dental insurance and a $1000 yearly benefit, you get to use $1000 and your spouse gets to use $1000. If you go over your maximum you cannot use any of your spouse’s benefits.
For those without dental insurance – you are not missing out on too much. Yes, dental insurance is nice to have, especially if your employer is paying most or all of the premiums. However, people tend to get into the frame of mind that if they do not have dental insurance they can’t go to the dentist.
I had a patient in just yesterday that had not been in for 5 years because he said he did not have insurance. Five years later the patient needs more work done than the insurance benefits will cover. It’s not worth it.
One thing is for certain, regardless of whether you have insurance or not, regular visits to a dentist is the key. If your goal is health you can’t do it alone. If the cost, or the fact you don’t have dental insurance is what is holding you back, talk with an office that offers financial arrangements that work for you. The longer you stay away the more difficult it is to catch-up.
It Starts Before They Are Born
November 9, 2011
Research shows that babies are born without any harmful bacteria in their mouths. However, once bacteria colonize in the mouth, children are more prone to cavities in their baby teeth and permanent teeth. How do they get the bacteria? Caregivers.
Most parents don’t know that they can pass harmful bacteria from their mouth to their baby’s mouth. The most critical time is during the child’s first 2 and one-half years of life. Most children are born without a single tooth. Can bacteria passed to children without teeth affect their decay potential for their whole life? According to research the answer is yes.
Here’s a shocker…..If you have a history of poor oral health, including many fillings in your mouth, you are much more likely to transfer these harmful bacteria to children. How? Typically, this takes place through common parental or caregiver behaviors such as sharing utensils or cleaning a baby’s pacifier with your own saliva.
Prevention starts as early as 6 months into a pregnancy. Research shows that expectant mothers who chewed gum containing the sweetener xylitol are much less likely to have decay-causing bacteria in their saliva. So, take-home point number one is, it is essential for expectant parents and caregivers to keep their own mouths healthy. If you reduce the bacterial levels in your own mouth you are not only benefiting yourself but also that of your unborn child. Visiting a dentist regularly, even more often when you are pregnant, improving your homecare, and using products that specifically reduce bacteria, are all essential.
Your baby is born, now what? First, eliminate as many potential ways of transferring saliva to your baby. Do not share utensils or let grandma or grandpa lick a cloth to clean around a baby’s mouth. Wiping your baby’s gums with a clean cloth after meals is also good practice to help reduce bacterial levels.
Once a child starts getting teeth, diet plays a significantly greater role. Minimizing snacks and drinks with fermentable sugars is key. This starts with the bottle. Bottle syndrome, also known as baby bottle tooth decay, occurs when teeth become exposed, at length and frequently, to liquids containing a form of sugar. All liquids that contain sugar can cause bottle syndrome, including breast and cow’s milk (which contain the sugar lactose), formula, fruit juice (which contains the sugar fructose), soda and other sweetened drinks. It is caused by the constant presence of milk, formula, or fruit juice in a child’s mouth during the night, during breastfeeding, during naps, or for extended periods during the day. The liquid pools around the teeth and gums, providing food for the bacteria in plaque. The bacteria produce acid as a byproduct when they consume the sugar. This acid attacks your child’s teeth and causes decay.
When your child feels comfortable with a toothbrush, brush their teeth and gums twice a day with an extra-soft toothbrush. Use a pea-sized amount of toothpaste without fluoride until your child is old enough to spit. If your child doesn’t like toothpaste, it’s fine to brush without it.
Prevention starts before babies are born. It starts with taking care of your own mouth. Visit your dentist regularly.
Google YOUR Dentist
November 7, 2011
It amazes me how far technology has come in the course of my lifetime. To think that I made it through my whole educational career without a cell phone and without the use of the internet is mind-boggling. I also never thought that my children would get to the point where I was asking them how to do things.
For many of us, technology consumes us. I spilled coffee on my cell phone this past weekend and spent the better part of a gorgeous day running around trying to replace it. I felt like I couldn’t live without it. Another morning this week my website was down and I could not post some new information on it. I panicked and spent over an hour on the phone with tech support trying to resolve the issue.
Technology is not going anywhere. In fact, it seems like it gets more and more complicated every day. I feel like I can’t keep up. Do we really need to keep up? I guess that depends on the individual.
One of the simplest forms of technology is the use of Google. You can Google anything and have an unlimited source of information instantly at your fingertips. However, just like listening to the news, it is up to the viewer to decide how to use the information. Much of the data we hear on the news or view on our computer is distorted somehow or other.
In my world, Google has replaced the phonebook. I can’t remember the last time I looked in a phonebook. Other than finding someone’s local phone number, the phonebook has very limited information. Today, if I am looking for a service and have not had a personal referral from someone I trust, I “Google it”. Even if I had a personal referral, I do my research on the computer.
Need a dentist? Google it!! As I have said in previous columns, a personal referral is usually the most reliable way to find a dentist, but just because your friend likes the dentist doesn’t necessarily mean you will. Do your own research. Most dentists have a website. You can learn a lot from a website and it is just that much more information to help you make your decision.
One of the more recent additions to the digital world is the use of reviews. Reviews are comments written by individuals on various products and services. Google has its own review system and there are many more out there including Yelp, Trip Advisor, Citysearch and AngiesList. Although reviews can be helpful, they should be used to get a flavor of what other people are saying about a product or service. Every product or service should have good and bad reviews: that is reality.
In the dental world, many dentists, including myself, use a service to collect reviews from patients. In my office, an e-mail is automatically generated and sent after appointments. It gives people the option of writing a review about their appointment or our office. These reviews are then published to the web as well as evaluated by my staff to help improve the service we provide.
No matter what you are looking for, there are people out there in cyberspace who have commented on it. Take them for what they are worth, but I think they are helpful.
