Is Seeing Believing?
October 24, 2012
Last night I heard a commercial for a cholesterol medication in which the person playing the doctor says, “I wish my patients could see what I see.” I believe there are two ways to look at that statement.
The commercial showed an image of animated artery walls clogging with particles of plaque clinging to one another making the opening of the artery smaller and smaller. This is a visual that is easy to understand.
The second, and more subtle way to take this statement, is the doctor wishing that patients could see what happens to patients over time with and without compliance to taking medication or changing their diet. If patients could only understand and use the vast experiences of the doctor to make better decisions for themselves, wouldn’t everyone choose to do all the “right” things for a better and healthier life? Conventional wisdom would say “yes” but reality says something different.
I have been photographing teeth for over 18 years. When I tell a patient that I am going to take a series of pictures of their teeth the response I often hear is, “I just had x-rays taken.” When I explain that they are pictures and not x-rays it is not uncommon for the patient to ask, “Why?”
I had a new patient in yesterday for a consultation who said these exact words. The patient then said something that I also hear frequently, “No one has ever done this before.” My response is that I take pictures of teeth for two reasons. The first is for my own documentation and the second is to be able to show the patient what is in their own mouth.
Showing a patient visual images of their own teeth is by far the most powerful tool I use in practice. How many times have you been to a dentist where treatment is explained and recommended but you can’t see it? A picture is truly worth a thousand words.
When I started displaying the images and giving the patient above a tour of her own mouth the patient said, “Wow, that doesn’t look good. I can’t believe that is in my mouth.” I hear that a lot too. After the “tour” I continued to explain why things look a certain way and what to expect in the future. I proposed both long and short-term plans for the patient to consider. Photographs are invaluable for this exercise and most patients appreciate being able to see what I see.
The next part of my consultation is to try to get the patient to look beyond the pictures and envision where they want to be 5, 10, 20+ years down the road. My goal is to bring my own experience of knowing, based on all the patients I have seen in practice, where the patient is headed and give them the opportunity to potentially change the course of their future.
This approach may be different for some people. It is easy to get overwhelmed by any new approach and I always encourage patients that this is the beginning of a relationship and decisions to do or not do something do not have to be made today. My new patient said, “I am X years old and I don’t know if I am even going to be around in 10 or 20 years.” Crystal ball or not, it still seems like a long time to me.
You, as a patient, should look beyond today and make choices for ANY aspect of your health based on where you want to be in the future. Take advantage of the knowledge you gain from all your experiences and make decisions that you feel are right for you.
The Soda Ban
October 5, 2012
On Sept. 13, at New York City’s Mayor Michael Bloomberg’s urging, New York City’s Board of Health approved what’s believed to be a first-of-its-kind ban on the sale of supersized sugary beverages. In six months, if there’s no lawsuit filed to block it, containers of Coke, Pepsi and sugar-laden flavored drinks larger than 16 ounces will be outlawed at restaurants, movie theaters, food carts and sports arenas. Business violators would be subject to a $200 fine.
This ban doesn’t stop someone from buying two 16-ounce cups or bottles of soda. Nor does it apply to convenience stores or grocery stores. And, of course, New Yorkers are free to drink however much they want at home.
It is said that at worst, the new soda ban will inconvenience some hard-core soda drinkers. However, my contention is whether or not this is the right way to approach the war on obesity? Critics contend that this ban is an assault on our freedom to choose. I have mixed feelings on the subject. Does the ban on large beverages and the previous Bloomberg-inspired ban on trans fats lead to a ban on the number of hamburgers one can purchase at the same time?
Last week, the American Dental Association (ADA) gave a thumbs-up to Mayor Bloomberg’s initiative. ADA president, Dr. William Calnon said, “Health professionals, including dentists, have long stressed the importance of a healthy diet; yet obesity and lack of exercise — associated with chronic diseases and conditions such as heart disease, cancer, diabetes and hypertension remain high.”
On the ban itself Dr. Calnon said, “When it comes to a ban related to a particular food or beverage, is a stick rather than a carrot approach the best way to get people to adopt healthier diets? Perhaps not, but the attention alone that the mayor’s ban has generated on this issue is certainly a huge step in the right direction.” Dr. Calnon seems to believe that the attention to the subject is worth more than methodology. Most of us are aware that super-sizing anything is probably not in the best interest of our health. If we ban certain food products to fight obesity, should we make exercise mandatory?
As with any lifestyle choice, the lessons need to start early in the home. What we choose to buy in the grocery store to provide for our families on a consistent basis is the backbone of the impressions our children get, which will help them make better choices on their own. Our children need to grow-up in an environment where we respect what we put in our own bodies and take care of ourselves with exercise. It seems to me that banning or limiting what can be purchased is an attempt to make up for the lack of discipline in the home. But, will that work?
Is the limitation of allowing smoking in public places the reason for a decrease in smoking? Smoking in public places puts others at risk and is the main reason, but smoking in general has decreased because of the increased awareness of health risks. Does the ability to buy a 32-ounce soda have a direct effect on anyone surrounding the person buying it?
I’m all for increased awareness of what science has shown is good or not good for us. Armed with that information, we have the personal responsibility to make choices that we feel are right for us as individuals.
Routine Change
September 10, 2012
Summer is unofficially over with the passing of Labor Day. For many, especially those heading back to school, this means a change from the summer routine. One of the routines I changed this past summer is to read more outside of my typical dental journals. The latest book I read was the revised edition of “The Slight Edge” by Jeff Olson. I highly recommend this book for anyone looking to change their routine to make positive improvements in their life.
We all have our own routines. Routines are important for both mental and physical health. Some think my daily routine is crazy, but if you look at them, most people’s daily routines look crazy to others. In “The Slight Edge” the author discusses that change or improvement in our lives comes one day at a time. It is the small decisions that we make daily, that we often consider insignificant, which mold who we are.
When our routines are broken by a vacation or lack of motivation, it is always difficult to get back into it. I’m sure you can relate. I am always thinking of different ways to change my routine to spend more time with my family, eat healthier, and have more “free” time. Changing routines is probably one of the hardest things to do. However, changing routines is probably one of the most important things to do. Striving for improvement in our lives by changing our routine usually improves the quality of life.
Going to the dentist is a routine. It is not part of your daily routine but it should be part of your overall routine for staying healthy. One of the biggest challenges I see in the practice of dentistry is changing people’s routines.
When someone comes into my office with a problem and has not seen a dentist for one, five, ten, or twenty years, it is easy for me to “fix” the problem they are having and get them back to a comfortable state. That comfortable state however, does not necessarily mean health. That comfortable state usually means status quo, which often times translates into the fact that there are other problems brewing, just waiting to become a crisis. The thing that is not easy to do, for any dentist, is to get those people to come back – to change their routine.
For some people it is financial, but for the vast majority it is the lack of pain or lack of concern. Regardless of the reason, it always comes back to changing routines. Our priorities dictate our routines. Priorities need change just as much as routines. If our priorities include health, we will spend money on a gym membership or home fitness equipment, go to the doctor or dentist on a regular basis, and eat things that are healthy. If the lack of pain is the reason you don’t exercise or frequent the doctor or dentist, it can lead to everything from the loss of teeth to the loss of life. If long-standing hypertension could have been controlled by regular exercise and/or medication doesn’t that beat an early heart attack? If long-standing periodontal disease, which doesn’t hurt and 75% of the population has some form of, could have been controlled by regular visits to the dentist, doesn’t that beat losing your teeth?
Changing your routine to improve your quality of life is worth every penny you may spend on it. As Jeff Olson says in his book, “You can’t change the past. You can change the future. The right choices you make today, compounded over time, will take you higher and higher up the success curve of this real-time movie called ‘your life’.”
Spleep Apnea – Part 1
August 22, 2012
Why is a dentist writing about sleep problems? More and more dentists are getting training in this area of medicine because they can be of help in the treatment of some of the problems associated with sleep-related issues. There also seems to be a large part of the population who are un-diagnosed or are diagnosed but have issues with treatment modalities they are using.
Sleep problems need to be diagnosed by a trained professional. Although there are many dentists who are providing treatment for sleep apnea, there are certain channels to consider for proper diagnosis. For example, a sleep study is a must in diagnosis and a dentist alone cannot provide this.
What is sleep apnea? It is a serious, potentially life-threatening sleep disorder that affects approximately 18 million Americans. It comes from the Greek meaning of apnea which means “want of breath”. People with sleep apnea have episodes in which they stop breathing for 10 seconds or more during sleep. Since many people see their dentist on a regular basis, if there is any concern of sleep apnea, the dentist can work closely with a physician to implement and manage a prescribed therapy.
There are two major types of sleep apnea, both of which can severely disrupt the regular sleep cycle.
Obstructive sleep apnea is when the muscles in the walls of the throat relax to the point where the airway collapses and prevents air from flowing into your nose and mouth. However, as you continue to sleep you also continue to try to breathe. This is the most common type of sleep apnea.
Central sleep apnea is the other type. This is when breathing interruptions during sleep are caused by problems with the brain mechanisms that control breathing.
What are the symptoms associated with sleep apnea? People with sleep apnea usually do not remember waking up during the night. Some of the potential problems may include morning headaches, excessive daytime sleepiness, irritability and impaired mental or emotional functioning, excessive snoring, choking/gasping during sleep, insomnia, or awakening with a dry mouth or throat.
So, what is the difference between snoring and sleep apnea? Unlike mild/moderate snoring, individuals with sleep apnea stop breathing completely for 10 seconds or more, typically between 10 and 60 times in a single night. If the person sleeping in the same room hears loud snoring punctuated by silences and then a snort or choking sound as breathing then resumes, this could be sleep apnea.
Studies have shown that people with diagnosed sleep apnea can be so fatigued during the day that, when driving, their performance is similar to that of a drunk driver. If left untreated, sleep apnea can lead to impaired daytime functioning, high blood pressure, heart attack, or stroke.
Next week we will discuss the diagnosis of and treatment options of this potentially life-threatening disorder.
The Top Ten
July 13, 2012
This season is often the time there is an influx of new patients being seen in dental practices. Many of the new patients I have seen this spring are people who have not been to a dentist in five or more years. Here is a list of the top ten reasons these patients say they have stayed away from the dental office:
10. Fear of pain
9. Missing work time
8. Moved and haven’t “found” a new dentist
7. Have been out of work
6. My dentist retired
5. Can’t find an office I am comfortable in
4. I don’t like the dentist
3. Economy
2. Lack of concern
And…….the #1 reason people have stayed away from the dentist – Didn’t have insurance.
One of the new patients I saw yesterday (a 40-year-old) said to me, “I haven’t been to a dentist for over five years because I didn’t have insurance. I haven’t had any problems but now I have insurance”.
After examination, this patient was very glad to hear he did not have any cavities. He was not so glad to hear that he had moderate periodontal (gum) disease. When questioned on his familial history he said, “My mother has dentures and I know my father is missing some teeth but I think he’s okay”.
Despite the fact that most people do not know the details about their familial dental history, most seem to know if their parents had/have their own teeth, go to a dentist on a regular basis, and a general knowledge of any problems they have encountered. I always ask this question because it is a good general guideline as to potential dental issues facing the person sitting in front of me.
Luckily for the new patient described above, he will be able to regain most of his dental health with appropriate non-surgical periodontal therapy. However, he was made aware that he has bone loss that will not come back, and because of his genetic pre-disposition for periodontal disease (which affects some75% of the population), life-long maintenance, including hygiene visits every 3 months will be essential to maintain his fragile periodontal status.
And……if his goal is to be healthy and keep his teeth for his life-time, this means every 3 months for the rest of his life…..regardless of whether he has insurance or not. We talked about the annual cost for this maintenance with or without insurance and he was surprised to hear how affordable it is to maintain health.
As I have predicted, due to people staying away from the dentist, dental emergencies are on the rise. I have seen more emergencies (broken teeth, pain, etc.) this spring than I can remember in the recent past. Emergency room dental visits have risen at a staggering rate…..and just so you know, the hospital cannot do anything for you other than prescribe pain medication which often helps only minimally.
I urge you not to put off dental visits. If you have any of the “excuses” listed above, I would suggest re-prioritizing and putting your health at the top of the list. Many dental offices offer complimentary….FREE…initial visits. Talk to the dentist and dental staff about your concerns. There are ways to manage any of these concerns. If the dental office you go to does not listen or does not have a solution, move on to another office. Get a plan that is manageable for YOU!
Made in China
May 29, 2012
I just returned from my semi-annual journey to my dental lab in Georgia where I meet with a group of dentists who share both the laboratory we use and the passion for excellence in what we do. The topic of dental restorations made overseas came up. Mr. Terry Fohey, certified dental technician and owner of NuCraft Dental Arts, one of the finest dental laboratories in the country, believes that a dental patient should have the right to know where the materials are coming from that are being put in their mouth.
China and other countries can claim to use specific materials, but there are no regulations in place to verify the information. There are also no regulations that allow a dental patient the right to know where the materials came from that are being placed in his/her mouth.
With the help of a State Senator from Georgia, Mr. Fohey is proposing legislation requiring dental laboratories to disclose to the dentist the material contents and point of origin of every dental restoration. It would also require the dentist to disclose the information to the patient should the patient ask. Would it make a difference to you whether or not your crown was being made in the United States or not?
Why are some dentists and dental laboratories farming out dental restorations overseas? Like everything else in the world, money is the reason. I get advertisements in the mail daily of dental laboratories able to make crowns for ridiculously low prices. It apparently sounds enticing to some practitioners.
Wonder why some dentist’s fees are higher or lower than others for this service? There are actually many factors that go into the creation of a fee for a procedure that requires a laboratory expense. The patient never sees the laboratory expense in most cases because it is built into the total fee. Clinical experience, clinical skill, office overhead, time required, and nature of the practice are all things that go into the creation of a fee.
The cost of the laboratory procedures also greatly affects the cost for the dental procedure. Let’s take crowns for example. I have seen laboratory fees advertised as low as $39 per crown and know of other dental labs whose fee is a few hundred dollars per tooth. Some patients would accept a lower quality product going into their mouth for a lower cost and others would not.
There are even machines you can buy that can fabricate crowns while you wait. There are many choices. It is basically up to the dentist to decide what he/she feels is in the best interest of the patient based on knowledge and skill.
In my experience, laboratories that cost more tend to make a better product. That better product which gets put in your mouth is a direct reflection on the dentist placing it. Excellent lab work, however, does not make up for less than perfect clinical skills. I have been in practice for 16 years. It took me a good 7 years to find a laboratory that meshed with what I try to accomplish for my patients…..and believe me, it was painful getting there.
We live in an ever-changing world. I try to buy American as often as possible, but realize that it is not always feasible. Mr. Fohey summed it up this way, “This bill is simply about disclosure. It does not restrict anyone from importing dentistry. Instead, it just makes us all play by the same rules.”
