J. Peter St. Clair, DMD Blog

This is a phrase we hear far too frequently when patients call to cancel or change their dental hygiene appointments. When the patient is told that there are no open hygiene appointments for 4-6 months, the response is often, “Oh, that’s okay, it’s just a cleaning.” This lack of concern is only partly to blame on the patient; most of the accountability falls in the lap of the dental team.

If you read this column with any frequency, I am sure you have seen me report that 75% of the population has some form of periodontal (gum) disease. I’m sure you have also read that periodontal disease has been linked to heart disease, stroke, pre-term, low birth-weight babies, diabetes, and possibly even some types of cancer. The problem is the dental team is not discussing this enough with their patients.

Here’s the way I see it: If a patient has made the decision to seek the services of a dental office, we must assume that the reason is based on wanting to improve and/or maintain their dental health. If that’s not the reason you go to the dentist, what is? Patients will often say during an exam, “Please don’t find anything.” Our response may be, “Well then, I better not look.” Assuming the reason for going to a dental office is to improve and/or maintain dental health as part of overall health, it is the obligation of the dental team to “find stuff” if it’s there, communicate that with the patient, and have a conversation about whether any steps should be taken.

For example, based on your level of periodontal health, there are different levels of frequency recommended for hygiene visits. The majority of patients should be seen every 6 months. Some are lucky enough to have yearly visits recommended to them. For others, every 3 or 4 months is recommended. This frequency is determined by your dental team to maintain your dental health. Regardless, if you put off your routine care by 1, 2 or even 6 months, that is a lot of time to have bacterial growth accumulate and put your body into a defensive mode due to increased inflammation. This brings me back to the reason you have chosen to be an active dental patient.

Remember, gum disease is not only bad because it makes your breath stink and your teeth fall out; it is bad for you systemically because of chronic inflammation. You may very well not notice an increase in inflammation, but your body does. There are measurable indicators of this.

If your goal is optimal health, routine maintenance is essential. I tell my team all the time that we must continue to educate the people who put their trust in us to maintain their dental health.

Depending on your car, there is a recommended maintenance schedule. If you ignore the recommended maintenance, only bad things can happen. You may be able to “stretch it out” a little, but must understand there are risks associated with that decision. If you knew how bad chronic inflammation really was for you, you would want to be seen more frequently than you are.

There are obviously valid reasons why patients need to change an appointment. Most dental offices understand that. It is the frequency, attitude (It’s just a cleaning), and lack of commitment that causes both disruption within the dental office and discontinuity of care.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

I’m sure we all agree that keeping up with technology is not easy. From computers to cell phones to cars, and everything in between, changes take place at lightning speed. No matter what we buy, there is always something right around the corner, or already there, that is better.

I purchased a digital x-ray system back in January of 2008 to replace film and chemicals to develop. By June of the same year, the same company came out with a smaller, thinner sensor.  This didn’t make mine obsolete, but my $10,000 investment made six months before could now be purchased for half the price. I thought I was “jumping in” at the right time.

As with most, if not all industries, technology is sweeping the dental field. We are digitizing everything. Offices that are not already “paperless” are moving in that direction. Automated systems for appointment confirmation via text or email, scheduling appointments, paying bills online, filling out online forms, and digital patient charts have been commonplace in dental offices for a while.

Digital radiology is transforming the way we treatment plan and deliver services such as dental implants. This 3-Dimensional technology allows accurate evaluation of biological structures to provide almost pinpoint placement of dental implants that may not have been able to be done using traditional methods. Notice I said “almost” pinpoint accuracy. It’s still not perfect, but it keeps getting better and better.

You may be aware that some dental offices can make crowns chairside without the use of gooey impression materials or the need of a dental laboratory. This technology has been around for over 25 years. The first generation of this technology was pretty cool back in the day, but delivered less than stellar results. Today, it is safe to say, this technology has greatly improved, continues to get better, and is not going away.

While the technology has gotten significantly better, there are still limitations. Currently, this technology uses a reduction method to fabricate restorations. This means that the restoration is milled from a solid block of material. The material choices are somewhat limited but getting better. What’s next? Maybe 3-D printing of whatever material you would like to use.

I read an article recently about 3-D printing technology where the CEO of this particular company working on dental applications said, “If 3D printing hopes to break out of the prototyping niche it has been trapped in for decades, we need to find a disruptive technology that attacks the problem from a fresh perspective.” I think this technology will be a game-changer.

I have always struggled with when to “jump-in” with certain technologies. It’s not an easy decision. The high cost, the learning curve, and knowing there is always something better right around the corner have been the barriers for me. The more I read about what is on the horizon, the more I want to wait for the “next best thing.”

Dentistry is moving fast forward in technological advances. However, two things come to mind about technology and dentistry. The first, is to keep in mind that sometimes the best option may be an older model. For example, gold is still used in dentistry, and definitely has a place in certain circumstances. The second thing, is that someone has to pay for all this advanced dentistry, and the dental insurance companies haven’t changed their model since the 1970’s. Many insurance companies will pay for more of your filling if get a “silver” one than a tooth-colored one.

We not only need to find “disruptive technology” to help prevent dental disease and treat it earlier and better, we need to have a disruptive revolution of dental insurance.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

You’ve had your dental visit planned for a few months now but suddenly, you discover that something else is vying for your attention and time. You know you shouldn’t reschedule, but it’s no big deal. After all, you’ll see your dentist in another few months anyway, right? Unfortunately, this mindset can spell disaster for you later on. Keep reading to learn about 3 potential repercussions that can occur should you choose to skip your dental cleaning.

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

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

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

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

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

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

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

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

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

I attended a continuing education course a while back entitled “Hit Man or Healer?” The course was given by a well-known leader in the dental profession. The basic premise of the course was the notion that we have a lot more science, studies and data available today to be able to make better decisions about the treatment that we dentists recommend to patients. The concept is called evidence-based dentistry.

The idea is that if a very structured examination and diagnosis is done, treatment recommendations can be made based on science. The problem is, all too often the diagnosis leads to suggestions that without the proper dialogue can make the dentist look like a “hit man” (ie. patient perception of over-treatment) vs. “healer” (intervention with the intention to preserve the teeth better for the long-term).

The lecturer started by putting an image of a person’s teeth on the screen and asking the audience to guess how old the person was. My father and brother are veterinarians. They use the appearance of teeth to estimate an animal’s age. Although it is relatively easy to estimate a person’s age during transition from the primary teeth to permanent teeth, it is apparently a little more difficult when all the permanent teeth are in. I guessed the age of the patient on the screen to be between 50 and 60.

The patient had great looking teeth. You could tell the person was a mature adult by the darkening of the teeth, but there was very little wear and very minimal dentistry. The patient ended up being 94 years old, which was more evident when her full face was projected on the screen…..although she looked great in general for 94. The lecturer said, “Is this the way teeth should look at 94 or is this woman a freak of nature?”

While there are definitely genetic factors that may play a role, many of the problems we see today with teeth are 100% preventable. For example, dental decay is 100% preventable. However, it is still not uncommon today to have a patient (maybe a teenager or an older person on multiple medications with dry mouth) come in for a routine dental hygiene appointment and be told they have decay, or multiple areas of decay, which were not present 6 months ago. In that scenario the dentist would be considered the “hit man”.

The “healer” may have taken a different approach, and may have done a more thorough evidence-based evaluation and made recommendations based on diet, homecare habits and maybe even familial history that could prevent the decay in the first place. Dentists have gotten good at telling patients how they can “fix” the problem, but need to consider changing their thinking and get more training in how to “prevent” the problems we see today in dentistry.

Many of the basic principles learned in dental school are used on a routine basis. However, there is continuous new data emerging that we as health care providers need to expose ourselves to and decide on what and how to implement for the benefit of our patients. I hope to see major advancements in our approach to oral health care in my career. There is no reason you can’t live to 94 and have a great set of teeth.

As I have said numerous times over the last few weeks, and you will hear it again next week too: Unfailing routine professional maintenance is a key factor in achieving and maintaining dental health. Don’t just hope you’re a freak of nature.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

If you missed Part 1 and/or 2 of this series, you can find it at www.thetowncommon.com.

I have been writing the past couple weeks about the growing evidence that links oral and systemic disease, and the need for more collaboration between dentists and physicians. All of this, of course, is in the best interest of the patient.

The discussion has been primarily about gum disease and its relationship with systemic disease. The body is a complex system – and everything is connected. In addition to the need for dentists and MD’s to collaborate more on the oral/systemic connection, we also need to collaborate better about our patient’s sleep problems. 

As part of a comprehensive approach to care, we screen for sleep issues with our patients. it amazes me how many people have issues with their sleep. It amazes me even more when I learn that many of these people have never even had a conversation with their doctor about sleep. Experts in sleep medicine agree that there is much room for improvement in this vital part of our health care.

Periodontal issues and sleep are just two areas where more information should be shared between dentists and physicians. We have to be open to the fact that everything is connected, and needs to be taken into consideration when we are trying to diagnose, monitor, or solve our patient’s problems.

For example, I had a patient in last week who has been a patient of mine for about 7 years. I noticed in the patient’s notes that bruxism/grinding had been discussed at most hygiene appointments in the past, due to the noticeable wear patterns on the patient’s teeth. There was also a quote in the notes several times stating that the patient would never wear a dental appliance at night.

As I did my exam I kept thinking to myself that there must be more to the story behind this patient’s dental issues. It happened to be around our lunch break, so I asked the patient if she had a few minutes for us to talk. She seemed interested in what I had to say. I photographed her teeth to compare them with photos taken 7 years ago. We talked for an hour.

Aside from learning that the patient was on 7 medications for the past SEVEN years and had never reported any of them to us, I also learned that the reason she was also resistant to wearing something to protect her teeth at night was because she had sleep issues. She felt there was no way she could handle the extra stuff in her mouth. I also learned that both of her parents are treated for sleep apnea.

So, here are some bullet highlights from the past 3 weeks:

1. Periodontal (gum) disease is bad. Just because it doesn’t hurt doesn’t mean you don’t have a problem. If you care about your general health, you must take care of your mouth.
2. Delaying care of dental problems always leads to more treatment and more cost.
3. Don’t leave information out when discussing your health with your doctors. Everything is important.
4. For better patient care, doctors and dentists should have more collaboration.
5. Time is the most precious gift a health care provider can give their patients.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

If you missed Part 1 of this series, you can find it at www.thetowncommon.com.

I ended last week with a statement that I have used numerous times before – just because it doesn’t hurt doesn’t mean there isn’t a problem. We keep learning more and more about the link between the mouth and the rest of the body. It is essential that dentists and physicians do a better job at co-managing patients, and learn more about the relationship between oral and systemic disease.

It is clear that if you want to take better care of yourself, you need to take better care of your mouth. Familial history is very important. If you know of any family history of dental problems, you are at higher risk. Higher risk individuals need to be treated differently, and may need a more aggressive preventive protocol to help ward off progression of disease. In addition, an otherwise healthy person who presents with a sudden increase in gum inflammation should possibly be evaluated by their physician to rule out any systemic causes if there is not a simple explanation for the change.

Salivary biomarkers are among the tools being researched to help determine the particular disease path that a person is on. Although in their infancy, this precision approach to the prevention and treatment of periodontal disease accounts for variability in a person’s genes, environment, and lifestyle. Because it is more personalized to the individual, it results in more accurate treatment planning, as well as improved outcomes for the patient.

Considering the aging population, periodontal (gum) disease has the potential to become the most prevalent dental disease in the near future. It is more important than ever for dentists to take the time to develop and incorporate a comprehensive periodontal examination and treatment protocol for adults.

As with most diseases, delaying the treatment of periodontal disease until the advanced stages results in treatment that is more expensive, more complex, and less predictable. Most early to moderate stage disease can be treated in a general dental office if the inflammation is easy to control, the patient doesn’t have numerous systemic issues, and is determined to do their part at home. If all these things have been done without resolution, or if the periodontal disease is more severe, it may be in the patient’s best interest to be referred to a like-minded periodontist. A periodontist is a specialist who treats disease of the gums and bone that support the teeth.

When half of the US population is still affected with periodontal disease, despite decades of research and treatments, something is still missing. That missing key is a more collaborative approach involving, dentists, periodontists and physicians.

….and remember, just because it doesn’t hurt doesn’t mean there isn’t a problem. To be continued.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

The connection between oral health and systemic health is well-established and ever-evolving. One thing we know for certain; we are living longer, but with more chronic diseases and medication than ever before.

The latest statistics are alarming. Forty-seven percent of US adults who are age 30 or older – an estimated 64.7 million Americans – have either mild gum disease (8.7%), moderate gum disease (30%) or severe gum disease (8.5%). As the population ages, the prevalence rises with 70% of individuals over the age of 65 exhibiting some level of gum disease. And, since we are on statistics, by 2030, it is estimated that the number of people over 70 years of age will have doubled from 35 million to 71 million.

So, as we age, our risk of developing disease increases. Interestingly, there is also a direct correlation between the regions of the US with the greatest concentration of gum disease, and those that have a high incidence of cardiovascular disease and diabetes. Although a direct cause-and-effect link is still in the process of being established between gum disease (periodontitis) and other systemic diseases, inflammation is often a common denominator. And it is always important to remember that the mouth is the gateway to the rest of the body.

We used to think that if people didn’t brush their teeth well, or didn’t visit a dentist often, they would automatically get gum disease. However, there are patients who have poor home care who never develop gum disease, and there are also patients who have great home care, visit a dentist regularly, and continue to experience breakdown from gum disease – albeit at a slower rate than they would if they had poor habits.

We now know that managing gum disease and other chronic inflammatory diseases like cardiovascular disease, diabetes, respiratory disease and arthritis are more patient specific based on an individual’s “inflammatory mediators”. These are molecules released by immune cells and are largely responsible for individual responses to disease susceptibility and progression. This is why probiotics are likely to play a significant role in treatment of chronic inflammation in the future.

As we wait for research development for different ways to combat chronic inflammation, it is without dispute that people should do all they can to minimize inflammation in the mouth. The mouth is very accessible and with proper training, coaching and monitoring, a healthy mouth is better for your whole body.

Although some may say that the associations between gum and systemic diseases are statistical by nature, not causal, the data is fairly strong that there is a link between gum disease and cardiovascular disease – such as heart infarction and stroke.  This supports diagnosing and treating oral infections, including lifelong professional maintenance and good home care.

Remember – just because it doesn’t hurt doesn’t mean there isn’t a problem. More next week.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Our lives are a series of choices. If we feel we don’t have a choice in a particular situation, think again. We usually do have a choice because our actions are based on how we think. How we think is a choice. While not necessarily easy, we can choose to think differently. 

I am going to use dental insurance as an example, since this is supposed to be a dental column. Dentists hear all the time, “My insurance only covers ____”, or “My insurance says they don’t cover that”, or “My insurance company says I can only see a dentist on their list”, or “I can’t do that because I don’t have insurance.” The response that most dentists think, but are usually afraid to say is, “Who is in charge of your dental health, you or your insurance company?”

The first thought you may have when you read this is about money. “If my insurance company doesn’t cover it, I guess I can’t do it.” While you may think you cannot “afford” something, it is a choice. There are varying degrees of dental health. Maybe everyone can’t “afford” optimal care; crowns on teeth that need the protection, esthetic enhancements, replacement of missing teeth, etc., but basic dental care to improve your health is available to everyone. If you are committed to better dental health but have not found that to be true, you are not looking in the right place.

The money barrier to getting the care you need evokes emotions. Emotions in and of themselves have no real value; they are neither good nor bad. They are just sirens alerting us to something we should pay attention to. If we learn to listen to them instead of blindly obeying them, they can be very good teachers. If money evokes a negative emotion when it comes to dental care, it is because you know your dental health is important. You need to make the choice for better dental health, and find the place to help you overcome the barrier of money, or anything else that is holding you back.

I am sure you are aware, especially if you have read these columns over the years, that medical insurance and dental insurance are totally different. Both are broken systems, in my opinion. The fact of the matter is, we (who are ultimately responsible for our own health), have to see it like it is now. We can’t “afford” to wait for politicians and insurance bureaucrats to “figure it out.” Dental insurance has continued to get worse since its inception over 40 years ago. What are we waiting for?

I certainly do not have the answers to fix the problem.  While we wait for everything to miraculously change, you have the freedom to choose what is best for you. It would be nice if you had dental insurance that allowed you to go to whoever you wanted, and get the things done that you need (or want) without asking permission from the insurance company. Can you wait for the system to change? Regardless of insurance, whatever is holding you back, you can change the way you think about dental health.

I am sure this column produces different “emotions” for different people. I would love to hear your comments so I can address them in another column.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com

Contrary to what many denture-wearers believe, dentures require regular maintenance, including relines, repairs, and replacement. In fact, the average denture should be relined every two to three years and replaced every five to seven years for the most optimal fitting prosthesis. There are many reasons for this maintenance interval and for regular dental examinations, whether or not the patient perceives any problem.

The first problem has to do with the basic function of the bone surrounding natural teeth. Natural teeth are held in their sockets by thousands of “cables”, called the periodontal ligament that tug and pull on the supporting bone during function. The bone is designed to be strengthened and stimulated in this manner. When the teeth are removed, the bone no longer has appropriate stimulation, and shrinkage occurs unless it is directly loaded again with dental implants. Bone atrophy is accelerated by inappropriate forces caused by loose and ill-fitting dentures.

Relining, or replacing the tissue surface of the denture, helps preserve bone by adapting dentures to the gums as they shrink, but it is only helpful for dentures that are otherwise in good condition, which includes a proper bite relationship. Relining also helps to encourage health of the soft tissues because dentures plastic is porous and becomes heavily laden with bacteria and yeast over time. Relining refreshes the tissue surface of dentures with new acrylic. Sometimes a more advanced type of relining, called rebasing, is the treatment of choice when all of the pink portion of a denture is in poor condition and needs to be replaced.

New dentures should be made when relining or rebasing of dentures can no longer re-establish proper fit and function. Often this is obvious by wear or fracture of the denture teeth. When dentures contribute to headaches or when the patient’s face begins to look “collapsed” or “old”, the need for new dentures is likely.

Lastly, but certainly not of least importance, denture wearers need to stay current with regular dental examinations for inspection of not only the dentures but the tissue for pre-cancerous lesions. Since most people feel they do not need to go to the dentist once they have dentures, many early pre-cancerous lesions are missed.

Everyone is at risk for oral cancer, whether they have teeth or not. In fact, the constant “trauma” and lack of blood circulation caused by chronic denture wear increases the risk for oral cancer development. For this reason alone, annual dental examinations are recommended for denture wearers.

Many patients with older dentures report their dentures fit fine. You can relate this to the fit of shoes. Shoes get broken in over time and seem comfortable. However, the fact is, over time shoes lose their ability to provide proper support. Even though they may be comfortable, they may be causing other problems due to this lack of support.

If you are a denture wearer and have not seen a dentist in a year or more, it’s time to consider a dental visit. Learn about how your dentures are fitting and whether relining or replacing them makes sense. For most, it is also never too late to consider the benefits of dental implants to help preserve bone and secure dentures in place.

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, sleep apnea and TMJ problems. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com