J. Peter St. Clair, DMD Blog
Does your Face Hurt?
May 3, 2011
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; or anxiety or 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 to your lower jaw to the muscles on the sides of your head and face 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.
One in eight Americans suffers 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 roll. 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.
Everyone Needs a Mentor
April 20, 2011
In the 15 years I have been in Rowley, there has not been one time when I have wished I lived anywhere else. My wife is from Indiana, and every time we go out there to visit, the scenery has changed. The population has grown tremendously over the 20+ years I have been going out there. And the stores……you would not believe the amount of shopping plazas there are. I always wonder how so many stores can survive with all of their surrounding competition. Everything is new, there are tons of golf courses, the church is much more active, etc. However, I still always love coming back to this area and wouldn’t want to live anywhere else.
It is the same for my profession. 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. When I am asked that question now, I tell people that I don’t look at it like that. 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 they want their health to be.
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. If you are a dentist who worries about how much of a particular procedure you do or tries to sell dentistry as a commodity, you 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. If you care, they will come.
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.
Having said that, I had someone ask me recently if my son (a high-schooler next year) showed any interest in dentistry yet. He has not and really needs more education and life experience to think about what to do with his life after school. Although I would not discourage him from choosing dentistry as a profession, I am forcing myself not to push him in any particular direction.
Mentorship and internship are important for every person considering a profession. Just as choosing the dental care you receive, the more information you have, the better it is for you to make a decision about what is right for you as an individual.
I mentioned this in a column a while ago, but if you a high school or college-age student who needs help with direction, there is a great program to consider in Scottsdale, AZ. For more information check out www.youngandmotivated.com.
Hotter than Haiti!!
April 15, 2011
Well, I am back from Haiti and yes it was hot! I had such a wonderful experience I cannot wait to go back. It was no Caribbean vacation by any stretch of the imagination, but so much good work was done by everyone in my group.
I want to share my experience with anyone who is interested and will figure out a way to do so with some kind of public presentation. It is impossible to get the real feel for the condition of this poverty-stricken country without being there. However, between the 212 photos I took and the daily diary I kept, I think is possible to get an idea of how the people of Haiti live.
I am not going to share too much in this column about the trip because I want to give Stuart from The Town Common the opportunity to do his post-trip interview with me. However, I will share one aspect of the trip that touched me.
There are so many things that I learned about the Haitian culture and about how lucky I (we) are to live where we live. We all take many of the things we have for granted. Simple things most Haitians don’t have like running water, electricity, toilets, etc. The one basic thing we rarely think of on a daily basis is life itself. The Haitian people do not have to prioritize too many other things in their life other than basic survival.
There is no Best Buy or Home Depot where you can go to get that 50” flat screen or power tool you have been dreaming of. Although cigarettes are available, there aren’t teenagers smoking on the corner or behind the school. It’s too expensive and not needed for survival. Most of their monetary resources go to basic necessities such as clean water and basic food.
The Haitian people live for survival, their family and their health. As a society, they have a lot to learn in order to be able to make progress. However, it amazed me how many people came to my daily clinic and just wanted to have their or their child’s teeth cleaned. They know enough that their teeth are important to them. They know what it is like to live with pain and wanted those situations rectified but wanted to do whatever they could to keep the rest of their teeth.
Many, if not most, of the people of Haiti believe that they are being challenged for a reason. The earthquake last year took their situation from bad to worse but from what I gathered from my short stay, their faith in better things to come has allowed them to move forward.
Don’t get me wrong….I am not going to sell my house and live in a tent on the side of a barren mountain. However, I do think it was an experience that will make me think a little differently about certain things. I also think that although I am not going to be the one that changes the country around, I do have the ability to make the lives of some people a little easier. I am looking forward to returning and many of them are looking forward to my return too. It is tough to say you wouldn’t go back after having such a rewarding experience the first time.
If you have any desire to learn more about opportunities in Haiti or from home, send me an e-mail.
Doctors And Dentists Need To Work Together
April 10, 2011
Dentists play a key role in screening patients for many disorders relative to nutrition and in providing appropriate referrals into the health care system. Although the importance of integrating diet and nutrition guidance into dental care has been advocated for decades by educators, it continues to be ignored except by a handful of prevention-oriented practitioners.
Many of the world’s most significant health problems are linked to poor dietary practices, including over-nutrition and under-nutrition. Nutrition plays a fundamental role in health, and dental professionals have the opportunity to be a critical link between discovery and wellness.
There is a great deal of evidence linking oral infections, including periodontal disease, nutrition and immunological response. We have clear evidence linking oral disease with adverse pregnancy outcomes, diabetes, cardiovascular disease and stroke. In addition, obesity, which is an epidemic facing our country, is significantly affecting the incidence of diabetes, cardiovascular disease and overall lifespan. We know there are direct connections between these problems and oral disease. What is the role of the dentist? Should the dentist just be a tooth fixer?
As the body of data linking systemic health conditions and oral infection grows, the expanding understanding of the gene-nutrient reaction may result in more profound discoveries. As of now, many dentists fail to fully appreciate that the scientific bridge between oral disease and systemic health is often mediated by diet and nutrition.
The beneficiary of this profound evidence should be you, the dental patient. It should not only be the responsibility of the physician or specialized nutritionist to incorporate this information into practice. The dentist should be playing a key role.
For the most part, the dentist is the only one who examines the mouth. It used to be that the dentist only looked at the teeth and only fixed problems if the arose. By now, most dentists screen for periodontal, or gum, problems as well as oral cancer. The trend is to address these problems earlier than ever before.
Patients will often say to me, “I’ve been going to the dentist all my life. Why have you or any other dentist never said anything about that before?” I always use the analogy of cholesterol. It used to be that 250 was the number to be at or under. As evidence grew that cholesterol plays a more significant role than thought before, that number quickly dropped below 200. People tend to have ingrained in their head that the dentist just looks at the teeth and treatment should be the same as 25 years ago.
As science continues and evidence grows, things change. It is the responsibility of all health care providers to work towards a more integrated health care system.
The History of the Toothbrush
March 25, 2011
It’s those simple things we use every day that I often wonder about how they got started. The toothbrush is one of those. There are several schools of thought on it, but you need to look far into the past for the first signs of oral hygiene.
The Chinese were believed to create the first real toothbrush, but it wasn’t much like the ones we use today. Those first toothbrushes, crafted in the 1400s, didn’t use nylon for bristles, or plastic for the handles. Instead, the handles were crafted from bamboo, one of the most readily-available regional plants. Attached to the bamboo handle was a set of bristles, taken from the tough hair of the Siberian wild boar — specifically, from the back of his neck. This toothbrush is the ancestor of all the brands we use today.
But there’s evidence that another form of toothbrush dates up to 3000 years before the birth of Christ. So the history of the toothbrush proves that this version was one of the oldest tools used by man, only truly outdated by the wheel. This style of toothbrush, crafted from sticks, was found inside Egyptian pyramids. Unlike the Chinese version, the end of the stick was flayed, softening the wood fibers. The user then rubbed the stick against his teeth. But this version wasn’t as popular as the Chinese type — it didn’t catch on.
The Chinese version spread to Europe, where the Siberian wild boar took the brunt of its growing popularity. The only downside to the hairs of the Siberian wild boar was the fact that they were very rough on the gums. So some people began to use the hairs found on the backs of horses instead, as this was much easier on their gums. Despite the softness of the horse hair bristles, boar hairs were more popular, since horses were so valuable to Europeans.
The boar hair toothbrush continued to be used until the early 1900s. In 1937, Wallace H. Carothers, a DuPont chemist, created nylon. This invention forever changed the history of the toothbrush, as well as every other device that required a fibrous material, including ropes. In 1938, nylon became synonymous with “modern,” from the creation of nylon stockings to Dr. West’s first nylon toothbrush. This brush was called Dr. West’s Miracle Toothbrush.
Even with this breakthrough in the toothbrush, it wasn’t until World War II that Americans began to take oral hygiene more seriously, as a direct result of the war. This influence spurred the development of even better toothbrushes.
Now, there are tons of options, including electric/motorized toothbrushes. My favorite is the Oral-B Triumph that has Bluetooth technology. It has a little digital display that sits on the counter and when the toothbrush turns on, the digital display tells you where to brush and for how long. This way there is no cheating.
And here I thought the toothbrush was invented in Maine. Why? Because if it was invented anywhere else it would have been called the teethbrush. Just kidding, those from Maine. In fact, I think one of my patients from Maine actually told me that joke.
March Madness
March 22, 2011
March is a busy month for me. Last week I was in Atlanta at a national study club I was invited to be a part of. Today I leave for my son’s hockey tournament in Lake Placid and next week I’m off to Haiti for 7 days. I have to find some time to work!!
The study club meeting last week was great. I presented some material but got the most out of just talking with other dentists from around the country. A major discussion was the economy and how it has affected our dental practices. The common thread amongst most dental offices was patients putting off treatment due to finances or needing to spread treatment out over time if they needed more extensive dental work. We discussed some great techniques on sequencing treatment over multiple years. This allows the patient to spread the treatment out, maximize their dental insurance (if they have it) and get the treatment they need.
Another common theme was holding ground on our philosophy of care. As I have said in the past, there are many different ways to do things and for that matter practice dentistry. This particular group of dentists were all very similar in their philosophy of care. They all hold very high standards, are exceptional clinicians and have a patient base that come to them because they realize the level of care is above average.
They believe the philosophy of practice revolves around treating the person as a whole and not just a tooth. It means patients, their overall health & well-being, must be foremost in the practitioner’s mind. Yes, it also means cleanings, fillings and crowns. These are often inescapable outcomes to dental disease. However, in this type of economy, it just means that sometimes the dentist has to be a little more creative without sacrificing standards and quality.
Too often the dentist views a patient as just a mouth. The goal is to fix as many problems in as many mouths in as short a time as possible. The patient becomes the object of the “fix” instead of a participant in the treatment. How degrading is it for a patient to experience that type of environment? Where is the quality, attention and care when the dentist is busy running room to room? Although for some, this is the type of care they desire because the fees are often lower in this type of setting.
The dentist also suffers. How satisfying can it be for a dentist who sees 40 patients a day? What kinds of relationships can that dentist build with his or her patients? How can that dentist spend the necessary time with the patient to really know the patient’s needs and desires?
In a truly health-centered practice, each patient should be treated as a unique, whole person. Each patient should be treated with dignity and respect. The dentist gives each patient his/her most important gift: TIME.
Taking the time to listen; taking the time to do a complete examination; taking the time to teach the causes of existing and potential dental problems and taking the time to explain alternative treatments and modes of prevention. It means that each patient be given the opportunity to choose the highest level of health consistent with their values and life circumstances.
In difficult economic times you may need to postpone certain things that you would like or need. Your health is not one of those. Despite what I hear sometimes – it is not “just a cleaning”. Your mouth is the gateway to your overall health.
50 Ways to Leave Your Dentist
March 17, 2011
Last month, Boston Globe columnist Beverly Beckham wrote a column with the above title. I contacted Beverly and she gave me permission to reprint her column. Due to the size of my column, I am printing an excerpt from her original.
I will tell him tomorrow. I will pick-up the phone and call his office and talk to his receptionist and say, “I have to cancel my appointment.” And she will say, “When would you like to reschedule?” And I will say…..What will I say?
I am trying to break up with my dentist, and I don’t know how. I don’t want to hurt his feelings. We’ve been together for 30 years, longer than most marriages.
“How about I tell him I’m moving?” I ask my friend Beth, who is the reason I’m in this mess in the first place. We were walking and she was laughing, and I noticed her back teeth. “How come you don’t have any fillings? Your teeth look perfect.” “ I used to have fillings. These are crowns.” I made her open her mouth. I peered inside. They didn’t look like crowns.
I should have said right then, don’t tell me anymore. I should have blocked my ears and said I have a dentist. I like my dentist. I am not going to leave him. Who sees the inside of my mouth anyway?
But Beth kept talking, and I kept staring at her molars and bicuspids thinking, wow. So I went to meet this dentist. It was just a consultation. Everyone should have a second opinion, right? Trouble is, I liked her. We clicked. Now I have to call the Man who has taken care of my teeth for three long decades and tell him I’m moving. “You can’t tell him that,” Beth says. “Why not? Maybe I will move.” “We’re not moving,” my husband says.
Not too many years ago, I cheated on my hairdresser. A friend, as a birthday present, took me to hers. She watched gleefully as he cut and styled my wild hair and morphed me into a more refined rendition of me. I went back to him once, twice, maybe five times. And then I returned to my hairdresser. Why? Because I missed her. Maybe I’ll miss my dentist too.
In the meantime, though, there’s now. The breakup. The fess up. The records that have to be transferred. The phone call that has to be made.
“Yes, it’s me calling from New Zealand. We moved. It was sudden. I know, I know. I’m going to miss you, too.”
I am sure that many of you can relate to Beverly’s story. I know I can….maybe not with my dentist but with other service providers. We often get caught in a comfort zone. We like the person and there is no real reason to leave. Don’t get me wrong. There is nothing wrong with loyalty. The point is – there are many different ways to do the same thing.
It is difficult for us as consumers to randomly pick people to work on our teeth, cut our hair, service our car, etc. There are so many options. What if we are comfortable where we are? What if we are missing something by not going somewhere else? The only thing we really can do is to keep an open mind and to take the information we learn to make a decision on what we feel is right for us as individuals.
The Dental Scam – Unveiled
March 11, 2011
Last week I told you about a Reader’s Digest headliner from 1997 called, “Exclusive Investigation: How Dentists Rip Us Off.” The author had traveled around the country with his dental x-rays to different dental offices requesting treatment plans. The recommended treatment ranged from nothing to $30,000. How could this be? Was he really getting “ripped-off”?
I bring this up from so long ago because this magazine was sitting in my reception area of my “new” practice back in 1997 and I still see the image every once in a while. I am sure that most dentists do not want people to think that they are trying to rip them off.
Every dentist has been on both sides of the fence; patients presenting to us with treatment needed, in our opinion, which is more or less than previously recommended. A substantial proportion of the variation in treatment plans stems from the differences in dentist’s beliefs about dental diseases and the fact that there is never just one right or wrong way to treat any particular patient.
A dentist’s philosophy of care is built over his/her entire career dependent on education and personal experience. With that philosophy, the dentist uses diagnostic criteria, knowledge of risk factors, rates of incidence, and prevalence and progression of disease to formulate treatment recommendations.
While dentistry is definitely science-based, no one dentist has all the answers. To my knowledge, no dentist can predict the exact longevity of any particular dental treatment. Dentists, as individuals, use their own knowledge and expertise to recommend treatment which they feel, I would hope, is in the best interest of the patient. Don’t anticipate definitive information about risk, progression of disease and outcomes of treatment in the near future. Dental research still channels most of its resources into the development of new and better dental materials. Until a significant portion of these resources is diverted to investigate outcomes of dental treatment, dentistry will remain vulnerable to public scrutiny.
As in any profession, there is a wide range of talent in dentistry. There is never any one right way to treat any particular issue. There are so many different factors that go into what is the appropriate treatment for any individual patient. What may be right for one patient may not be right for another. In fact, the treatment a patient agrees to should always be treatment the patient wants and not what the dentist says the patient needs. For the patient to make an educated decision, often times treatment plans ranging widely in cost must be discussed.
It is the responsibility of the dentist to diagnose and properly communicate to the patient, in terms they understand, so that they may make the decision that is right for them. It is the patient’s responsibility to make sure they understand their condition and to understand the consequences in doing or not doing any kind of recommended treatment.
The most important thing for a patient to have is a solid relationship with their dentist. If a patient thinks they are being “ripped-off” they do not trust their dentist and should move-on to someone else……unless they have a preconceived notion that dentistry in general is a “rip-off”. That would be a subject for another column. I Would love to hear some feedback on Facebook.
The Dental Scam
March 4, 2011
I remember the date well. I had been out of dental school two years, had been in Rowley one year, and the February 1997 issue of Reader’s Digest hit the stands. The front cover read “EXCLUSIVE INVESTIGATION: How Dentists Rip Us Off “. Not only that, it was delivered to my office and was sitting in my reception area.
I immediately read the article to make sure I was aware of the contents. Inside, was the all too-familiar graphic depiction of a dentist menacingly hovering over a patient with the dreaded drill in hand. Add to that picture an accumulation of non-complimentary adjectives about dentists. By the author’s skillful manipulation of words, variations in dental practice patterns were presented as evidence of dishonesty.
The author’s “investigation” was him bringing x-rays of his teeth to different dentists around the country and getting treatment plans for his own mouth. The treatment plans ranged from nothing to an amazing $30,000! Had the presentation suggested anything about the fact that dental treatment plans can be quite variable between practitioners and encouraged the public to seek additional opinions, it wouldn’t have been so bad.
Judging by the public response logged on the Reader’s Digest website, the dental expose more than fulfilled the magazine’s desire to generate controversy and boost sales. One reader commented, “Dentists cannot be trusted! I do not let anyone mess with my teeth. I remove my own tartar…anyone who sees a dentist should have their head examined….not their teeth! They are all crooks!!” Another wrote, “I was hoping that I would be living in one of the cities that had one of the good dentists listed.”
Responses from dentists, while strongly admonishing the magazine for inflammatory reporting, often degenerated into windy rhetoric as they tried to refute the article’s charges. To be honest, it was apparent from the dentist’s responses that it rattled the nerves of the individuals who actually cared enough to write in to Reader’s Digest.
Could there really be a swing of $30,000 between dentists? Sounds like a lot to me. However, I can tell you that there can be significant differences between dentist’s treatment plans. That is not to say that there are a bunch of quacks out there though. Although there are always some, most dentists give you their honest opinion based on their educational background and philosophy of care.
And, this article had nothing to do with the range of fees between dentists. In other words, let’s assume the “treatment plan” was the same for all dentists and there was a comparison of fees between dentists. There can be a wide range there as well. Why is that?
Next week I’ll give you my response to “How Dentists Rip Us Off.” I will explain why I feel this “investigation” was unfair as well as a wake-up call from a dentist’s perspective. I will also look at it from your (the patient’s) side and give you some thoughts on how you can protect yourself from being “ripped-off”.
Don’t Eat Your Denture Paste
February 24, 2011
The story begins when a healthy 63-year-old Miami man began having trouble walking. Within months, he was paralyzed below the waist and confined to a wheelchair. He was unable to move his limbs and, eventually, unable to get out of bed. His condition worsened and his paralysis extended to his diaphragm, which ultimately led to his death. What led to his symptoms and eventual death? ……his denture adhesive, Poligrip.
Just months after his death, a groundbreaking study published in the medical journal Neurology established a connection between the zinc found in popular denture adhesives brands and serious nerve damage. The study showed that patients who used heavy amounts of denture cream suffered zinc overload, which can purge the body of copper, a mineral needed for healthy brain and nervous system function. Copper deficiency can cause anemia, weakness, numbness in the limbs, difficulty walking and permanent paralysis.
Although the body requires small amounts of zinc to fight illnesses and promote cell growth, some denture-wearers were unknowingly consuming nearly forty-five times or more of the recommended daily dosage. The National Institutes of Health recommend between 8-11 milligrams of zinc per day. Poligrip contains 38 milligrams of zinc per gram of the adhesive. Unbeknownst to him, the man who died had been consuming these dangerously high levels of zinc for over 14 years.
And with no warning on the packaging, he had no way of knowing how much zinc he was ingesting. He was simply trying to keep his dentures secure so he could chew his food and look good.
This all happened back in 2008. At the time, facing over a hundred lawsuits over its failure to warn consumers of the risks associated with its products, GlaxoSmithKline announced in early 2009 that it would voluntarily remove zinc from its adhesives. The company cited “potential health risks associated with long-term excessive use” and announced plans to release reformulated denture creams by April or May of 2009.
This was a promising sign that the company was finally taking responsibility for the safety of its consumers. But for many denture wearers, the damage has already been done. Forty million Americans wear dentures and removing zinc from denture cream will hopefully prevent debilitating, and potentially fatal, medical problems in the future.
Well, this is back in the news again. The reports are that there is an association between the excessive zinc and health concerns which date back to 2006. Documents were written and went to reviewers before they were published. One of the reviewers apparently delayed the publication by saying, “much of the information is irrelevant…..little more than speculation”.
That delayed getting information to doctors and the public. As it turns out, this reviewer was found to be a paid consultant for Proctor & Gamble, makers of the popular denture adhesive Fixodent.
Zinc has been taken out of Poligrip but not out of Fixodent. Proctor & Gamble says that used as directed, there is no evidence of ill-effects from their product.
For most people, if an upper denture is made correctly and is relined when it should be, there is no need for adhesive. Lower dentures are a different story. A couple of implants or mini-implants and the problem is solved – no need for denture adhesive.
