J. Peter St. Clair, DMD Blog
Are You Getting Ripped Off?
May 12, 2011
If you are an expert in a particular field it tends to mean you know quite a bit about that subject. It doesn’t mean you are always right, but you can usually at least have an intelligent conversation about your field. When a “journalist” writes a story about your area of expertise, I would be willing to bet, the expert (you), often cringes about the content. So goes the latest thing I have seen written about dentists and dentistry.
“Is Your Dentist Ripping You Off?” is the title of an online column that was forwarded to me. One of the best parts of this type of column are the comments to follow from such a wide range of people. Dentists commented, patients commented, hygienists and assistants commented, and many who don’t go to the dentist commented. Over the next few weeks I am going to take little pieces of the column and the comments and discuss them. I think it will make for some interesting discussions that I hope you will weigh in on.
Let’s lay the groundwork with summarizing the column itself. The author describes a “person near and dear” who returned from the dentist and was told they need two crowns for around $3000. The author called some other dentists in the area and found that there was a range of fees. Some of her comments follow:
“When I look at this bill, I wonder why I obsess about the weekly price fluctuations of Cheerios or the shrinking size of a can of tuna. All the economical choices a family makes in a year can be wiped out by a trip to the dentist.” She continues by questioning how there can be such a range in fees.
“So how can the first guy explain why his price is $450 higher? The office assistant told me ‘not all dentists are created equal,’ and of course, this dentist is one of the best in the area, using a great lab. But how can someone who is not a medical professional know if their dentist is worth their fees?”
I think these questions are excellent questions and are things that many people wonder about. Of course, there is no easy explanation. We will get deeper into that in another column. There is no doubt, dentistry can be expensive, but is it relative to everything else in life?
One of the most important suggestions the author had was, “don’t select a dentist on price alone.” While I believe this is true, the next logical question would be – What other factors do you use in selecting a dentist or health care provider? The author provided some other good information.
“Fees are one part of evaluating a dental practice, but you want to have confidence in the office, the people there, how they sterilize instruments, and the training and continuing education of the dentist. Does he or she seem to be looking out for your best interests over the long haul? What’s the dentist’s philosophy for keeping your teeth healthy for a lifetime?”
That is great advice. I would add to that looking at the practice website, reading testimonials of existing patients, and asking to visit the practice and meet the dentist and staff before committing. That should be done at no charge.
Next week I will discuss some of the comments written after this column. That will be interesting. Looking forward to your comments as well.
To Seal or Not to Seal
May 9, 2011
If you have kids and you take them to the dentist, I am sure you have heard about sealants. I don’t know what the statistics are, but I would assume that most dentists recommended dental sealants. In case you are unaware, a dental sealant is a flowable resin generally placed on permanent 6 and 12-year molars. It is placed on the top of the tooth in the grooves of the teeth. Its purpose is to help prevent decay from forming in this area, which happens to be the most common place for dental decay to occur. It does nothing in the prevention of decay between teeth or on any of the other 20 teeth in the mouth – although the molars are generally the first teeth to decay.
Make sense so far? Now for the controversy. In my opinion, sealants have a very limited application. Let me take a step back and give you some information to help you see where I cam coming from.
There are actually many different techniques to place sealants. The way I was taught in school, and the way many if not most sealants are still placed, is that if that little picky thing that everyone hates doesn’t stick in the tooth, the tooth is cleaned and the sealant is placed. The first problem is that the little pick is not very accurate – about 57% according to studies I have seen. The statistic shoots to over 90% accuracy with the aid of laser cavity detection. This is a relatively inexpensive tool that sends a beam of light into the top of the tooth and measures density of tooth structure.
So yes, there are teeth that get sealed that have decay. However, according to studies, sealing over minimal decay is clinically acceptable. These studies say that the sealant can actually stop or prevent the decay from progressing. Would you want that in your mouth?
That is not the main problem though. Once that sealant is placed, the laser detection tool is ineffective. You then have to rely on x-ray detection, which is also not very accurate, unless the decay is moderately large. I cannot tell you how many teeth I have done moderate size fillings on that had clinically acceptable sealants in place.
The main problem is that a sealant is a dental restoration and ALL restorations leak over time. Whether it be a filling or a crown, they all leak and allow bacteria in which may potentially cause decay. So, my position is, why would you place a restoration on a seemingly healthy tooth? A healthy diet, good home care, and regular professional care are the keys to dental decay prevention. So, do sealants prevent decay? They aid in not getting stuff stuck in the grooves of teeth which can cause decay, but they do not guarantee you won’t get decay.
For the few adults out there that still have sealants in place and don’t have decay, you probably wouldn’t have decay even if the sealants hadn’t been there. I would rather have a healthy tooth remain restoration free and be able to be monitored by a laser. If decay is detected early with the laser, the tooth can have a very conservative tooth-colored restoration. This can then be monitored clinically and by x-ray.
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.
