One Patient’s Story
July 25, 2012
This is the story about a woman I met recently named “Carol”. Carol’s story is the reason I do what I do every day and brings me back the next day. The interesting thing is that it has absolutely nothing to do with performing the actual physical work of dentistry.
Carol is in her 70’s and for most of her life has gone to the dentist infrequently. She presented to my office a couple of months ago for a second opinion. At our first appointment Carol brought her most recent x-rays, a treatment plan from another dentist, and a page-long list of questions. She was well-prepared for the complimentary consultation I was giving her and seemed to know exactly what she wanted.
About 8 years ago, Carol visited a dental office that touts itself as “holistic”. Carol had about $10,000 of dentistry done at that office and unfortunately had not seen a dentist since. Her reason for visiting that particular office was because she was/is very concerned about her health and believed that a “holistic” office could provide her with what she was looking for. Now, only 8 years later, her teeth were falling apart.
Carol had eight crowns done on her upper back teeth at that time. The crowns, still in her mouth, were failing due to recurrent decay. More importantly to Carol, her front teeth were in severe breakdown. Carol had her mind made up; she wanted full dentures.
Carol sought out a local dentist, presented her desires, got a written treatment plan with fees, and then came to me for a second opinion. She brought that treatment plan with her and it appeared very reasonable – take out all remaining teeth and place full dentures. The first thing I noticed was that Carol had 6 lower front teeth that have been decay-free and have had excellent bone supporting them for 70 years. However, her mind was made-up, she wanted everything taken out. She did not want to have to deal with maintenance of teeth any more.
Over the next two consultation appointments I had with Carol, we discussed many different treatment options. We thoroughly reviewed the advantages of keeping these lower front teeth each time we met. Carol brought a list of questions to each of these meetings, which we discussed in depth. It was decided – Carol was moving forward with full dentures.
We have had two more appointments since then. Because of the location of the dental laboratory that I use, those appointments were spread-out over a few weeks. At this point, we had done some procedural steps to get her ready for full dentures, but the teeth are still there. They would not get taken out until the dentures were ready to be delivered.
At each appointment I discussed a different aspect of why it would be such an advantage to her to keep those lower front teeth. Her mind was not changed. Yesterday, Carol walked into my office to tell me that she has decided that she wants to keep her lower teeth.
Okay, so what’s the point? The point has nothing to do with what Carol’s final treatment is. Carol has every right to decide on what she feels is right for her.
The dentistry Carol received 8 years ago was good technical dentistry on the teeth that were treated. However, the “holistic” dentist did not treat her as a whole person and left the rest of her mouth destined for failure.
The local dentist she got the treatment plan from provided a very reasonable treatment proposal. They had one visit, decided on treatment and her next step was to go to the oral surgeon and have all her teeth out.
Far too many times I see patients and dentists rush into treating teeth. Taking the time to engage in conversation and treat the person as a person and not a tooth is less common than it should be in my opinion. My point of this story is not that I got Carol to do what I felt was best for her, but that I gave her my time, answered all her questions, and allowed her to decide what was best for her. She needed the time.
There are few things we have to rush into in life.
Should you be worried about nuking your thyroid?
October 18, 2010
There is a lot of stuff out there, especially having the web at our fingertips, concerning what is good and bad for you. The only problem is, if you read about all the stuff that supposedly is bad for you, you would be eating raw organic carrots for every meal with a glass of water. Okay, maybe not that bad, but it has made me think more before I put just about anything in my mouth.
I bring up Dr. Oz because apparently last week on his television show they were discussing dental x-rays and the thyroid. Based on my phones lighting up at my office after this aired, I came to two conclusions. The first is that there must be a lot of people who watch Dr. Oz. The second is that Dr. Oz must have made it seem that if you do not protect your thyroid when you have dental x-rays you will get cancer. I did not see the show so I do not know exactly what was said but I will tell you what I know about dental x-rays and the thyroid.
Dental x-rays have come a long way in the sense that radiation exposure has been greatly reduced over the last few decades. It started with a change in the machinery used to take the x-rays; then the film speed was increased which decreased the amount of exposure time needed to capture the film. Now we have digital x-rays. Depending on where you start the comparison, dental radiation exposure has decreased 60-90% with the move to digital.
My feeling about the protection of the thyroid with dental x-rays is that it can’t hurt to cover the neck when taking the films. However, with some films, the thyroid lead collar is in the way and can affect the diagnostic quality of the film.
It is interesting to note that the Health Physics Society, which is a scientific and professional organization whose members specialize in occupational and environmental radiation safety, and the American Thyroid Association both state that thyroid cancer is NOT caused from routine radiographs, including dental x-rays. In other things I have read, the increase in thyroid cancer is most likely due to better diagnostic tests and earlier detection.
Based on all the information out there, one thing is clearly expressed in many of the scientific literature pieces; the benefit of regular dental x-rays far outweighs the disadvantages. I still have patients who come in and say, “I would like to skip the x-rays today because I have had too many x-rays lately.” Of course it depends on the specific situation with each patient. If a patient has been lucky enough to have minimal restorative dentistry in their mouth and has had a low decay rate, I do not mind putting off x-rays for 6 months – even though the exposure is so minimal.
However, more commonly, the patient that refuses radiographs has a mouthful of dentistry. Skipping regular radiographs is extremely risky for both the patient and the dentist. Remember, the dentist is responsible for diagnosis and diagnosis cannot be complete without proper x-rays.
Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@dentalhealthforlife.com. You can view all previously written columns at www.dentalhealthforlife.com
