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Recipe for a popping jaw

recipe cardI’ve recently had several patients complaining of a “popping jaw.” In many cases, it’s not them who are complaining. It’s anyone that they have to eat with.

“It doesn’t hurt or anything. It just makes a popping sound when I’m chewing. My mom is really grossed out by it.”

When I do an exam I find that their jaw has a very noticeable clicking when they open. Sometimes it’s both sides, but more often it seems like it’s only on one side.

Then, I ask the most important question that can be asked about a painless jaw pop.

“Do you chew gum?”

9 times out of 10 I get the sheepish look. Busted.

“Yes. I chew gum.”

“How often. Every once in awhile?”

“Maybe a little more than that.”

In fact, for some gum chewers it’s most of the time. If I were to generalize about who are my most common gum chewers/jaw poppers I would have to say that they’re probably female and in their mid 20’s. Sometimes a little older. And they probably needed a paper towel to throw their gum out before we cleaned their teeth. Luckily for them, they don’t have pain associated with the jaw pop. But as they age, that can change.

I know what you’re thinking. I’ve written about the magic of chewing sugarless gum for reducing tooth decay. It’s true. But if you go back and read closely I recommend 5 minutes or so. Not longer than it takes for the flavor to run out, anyhow.

close up on a beautiful girl while enjoying a candyChronic gum chewers are working out their chewing muscles and jaw joints. A lot. These are muscles that don’t need the extra workout, though. Since we have to eat to survive, our regular day to day chewing, talking (or yelling, if you have small children) and living are plenty of exercise. Overuse of the muscles of mastication (chewing muscles) and jaw joints creates greater risk for a popping jaw, headaches and even chronic pain of the neck.

Have your knees ever popped when you run up the stair? I know mine do. That popping is a similar thing that goes on in your popping jaw joint. It’s a disk of cartilege and connective tissue that’s slipping between two bone surfaces. I know that’s gross sounding, but it’s exactly what’s happening.

Now, did your knees do that when you were a little kid? Probably not. But as we age and, in some cases gain weight, we continue to put more and more stress on our knees. We’re overusing them. So these joints react. Sometimes they pop when they’re used. And sometimes they can become painful and need treatment.

Gum chewing as a habit if a near perfect storm for jaw popping. I’m O.K. with a person chewing sugarless gum for a few minutes after meals and snacks. That can help prevent tooth decay and it can give you nice, fresh breath. But not for more than a few minutes. You could unintentionally causing problems for yourself down the road.

Did you find this post snappy? Did it make you crackle? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

The Question

Jacob washes a fork

More enthusiasm than skill. (Yes, that is a horse you can see out the window.)

My son Jacob is a bit of a neat freak. I mean, for a four year old. Sure, there are Legos strewn across the floor most of the time and his bed has a giant pile of trucks on it. But he likes to clean. What he really likes is the idea of cleaning. He likes the cool tools you can use to clean (vaccum cleaners, sink sprayers) and he likes to hang clean pans up on their hooks in the kitchen.

So this morning he came up to me asking me to put soap in the dishwasher. At first I was a little worried at what I would find, but I was pleasantly surprised to find that he had simply put a glass in the dishwasher. He was ready to turn the dishwasher on and wanted me to help. So we proceeded to finish filling the dishwasher and started it. Then, he asked to help with the hand wash dishes.

Naturally, he dragged a chair into the kitchen so he could be right in the middle of the action. We filled the sink with soapy water (extra bubbles, of course) and dove into the pots and pans.

Like I said, the kid likes to clean. He grabbed a dishcloth and scrubbed with feeling! He was covered in bubbles and smiling, but the dishes weren’t really that clean. He missed the tougher spots. The pans were still pretty greasy. His little four year old hands didn’t quite have the manual dexterity that was necessary to get the job done. What he lacked in skill he made up with in enthusiasm, yet at the end of the exercise, I had to clean where he had missed.

Now, I’m flashing back to a conversation I had with a mom about her 7 year old boy’s brushing habits. When I examined him I could see that his gums were pretty irritated and April told me that he had a lot of plaque on his molar teeth. Mom told me that she has him brush twice a day most days. The I asked her the question:

“Would you let him do the dishes by himself?”

She looked at me like was crazy. “Well, no,” she said.

I explained that he wasn’t quite ready to brush his teeth on his own. I use this analogy with most of the parents in my practice. Brushing teeth isn’t brain surgery, but it does need a certain amount of dexterity and attention to detail to get the job done right. Furthermore, a parent standing over a child looking directly at the surface that they are brushing (using the previously described “loving headlock” technique) is going to remove plaque and debris much better than the child can alone. 99% of the time you’ll find a clean mouth doesn’t get cavities, so it’s important that the job gets done well. When it’s a child, it’s less important who does the job.

girl brushing teeth

She’s adorable, but would you let her do your dishes?

I think it’s great that Jacob wants to wash dishes and I’m glad that he does it! It’s just that he’s not ready to do it solo. Some kids are probably conscientious enough to wash the dishes at 7 or 8. Some kids probably shouldn’t be allowed to wash dishes at age 16! The parents definitely know them best and should make the judgement. I think the same goes for brushing teeth. If you’re a parent, you need to ask yourself the question. If they aren’t ready to do the dishes on their own, they aren’t ready to brush their teeth without supervision.

Did you find this post soapy clean? Did it make you ask the question? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

“Did you take your premedication?”

I hear these words almost every day. Someone on my amazing and responsible team is either reminding a patient to take their premedication or asking them at the appointment if they did remember. They’ve gotten really good at it because we’ve been doing it as long as I’ve been a dentist. Dentists have been acting as if dental procedures are inherently risky for developing heart problems or artificial joint infections in certain patient populations. It’s time to set the record straight.

Virus infectionInfective endocarditis is a scary sounding condition. It happens when bacteria get into the bloodstream and end up infecting the lining of the heart, a heart valve or even a blood vessel. It’s a very uncommon infection. People who have certain heart conditions are clearly at greater risk than the rest of the population. But the one thing everyone seems to know is that dental treatment is almost always the cause. We know this because the mouth is full of bacteria, and dentists and hygienists cause bleeding with their treatment. So bacteria is definitely going to enter the bloodstream if you have dental treatment and if you are at greater risk for infective endocarditis, you better look out.

So what have we done for dental patients with these heart conditions? We preventively treat them with antibiotics. A LOT of antibiotics. We used to give them doses of antibiotics days before and after dental treatment. But then later we dropped the dosage down to an hour before and several hours after. And now, we just give it an hour before.

But it’s O.K. Because we have solid evidence that our intervention prevents infective endocarditis at these levels, so it is worth doing, right? Well. Not really. The American Heart Association has continued to change its guidelines for premedication to the point where we only rarely premedicate patients with certain very serious heart conditions. For instance, we premedicate people who have had a previous case of infective endocarditis. Also folks with prosthetic heart valves and a few other rare congenital heart problems.

One of the more bizarre aspects of our tendency to premedicate our patients is the assumption that dental procedures in particular cause a great risk of bacteria entering the bloodstream. If you’ve ever bitten your tongue, flossed a little too hard or bitten down on a Dorito in the wrong way and caused a wound in your mouth, you’ve had an “event” that cause bacteria to enter the bloodstream. But you don’t see us lobbying Frito Lay to start lacing their corn chips with amoxicillin! The evidence for dental procedures causing infective endocarditis has always been a little thin. Patients treated for endocarditis (yes, thank goodness it’s very treatable) are always asked if they’ve had recent dental treatment. Some patients may have, so it was assumed that the dental treatment caused the infection. What I really want to know is if cardiologists are screening for nacho chips or beef jerky.

The American Heart Association continued to evaluate the evidence for taking a large dose of antibiotics prior to dental treatment Prescriptionand found little to no proof that the antibiotics prevented infective endocarditis. For that I say “three cheers for the AHA!” Many dentists and patients don’t think much about the megadose of antibiotics that their patients were routinely taking prior to routine dental treatments. What many don’t consider is that a hypersensitivity (allergic) reaction to antibiotics can happen at any time. Just because you aren’t allergic to amoxicillin now doesn’t mean you’ll alway s tolerate it. In fact, the more often you have to take it, the more chances you have to develop hypersensitivity to it. What I’m saying is even though taking antibiotics is common place for most people, there is still a risk involved. In fact, the AHA weighed the risk of taking a prophylactic dose of antibiotics agains the risk of developing infective endocarditis and determined that the risk was only worthwhile in a very select number of patients.

The AHA did what so many doctors, dentists and patients are unwilling or unable to do. They evaluated the evidence and changed their recommendations! Here at Mead Family Dental we follow the 2007 AHA guidelines for the very few patients that require premedication for a heart condition. A few patients who have been premedicating for a long time, find the change disconcerting. They assume that what they’ve been doing all along was correct and that the new recommendations are putting them at risk. However, most of these patients are tickled at the idea of not dealing with this premedication regimen.

A more complicated and less well defined problem is the risk of infection of artificial joints. I will tackle this problem the sequel to this post: “My surgeon told me to premedicate for life.”

Did you find this post heartwarming? Did it raise your heart rate a little? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

You’re pulling my oil: 3 reasons to skip oil pulling

Coconut oil for alternative therapy If you spend any time on Facebook, you’ve probably seen articles on oil pulling. The “ancient” practice involves swishing coconut or sesame oil in your mouth and through your teeth to increase your oral health. Not only is it claimed to be better than conventional oral hygiene, but many also claim numerous other benefits.

“…oil pulling is usually recommended for treating mouth-based conditions such as halitosis, gingivitis or oral plaque, it actually benefits the entire body. Long-term oil pulling has, for instance, also been linked to healthier hair, clearer skin, whiter teeth, elimination of parasites, improved body odor and the easing of joint pains. It is, in short, a full-body cleanse, and anyone with $5 to spare on good-quality oil can reap its benefits.”

So, should you use this technique for better health? Here are three reasons you should skip oil pulling.

  • It doesn’t do what they claim it does: One of my pet peeves is when alternative medicine proponents claim that a certain treatment can detoxify the body. If a treatment is meant to remove toxins, I think it’s important to specify what toxins are being removed. This is where much alternative medicine loses credibility. They convince otherwise healthy people that the environment around them is slowly poisoning them with toxins, but they don’t specify what toxins. In most cases, they don’t even use the term toxin correctly. A toxin is “…is a poisonous substance produced within living cells or organisms;[1][2] synthetic substances created by artificial processes are thus excluded.” Simply stated, a toxin is a biologically produced poison. Sometimes they’ll mention “heavy metals” or “chemicals.” Typically they insinuate that modern industry and technology is to blame for these toxins in our environment, but rarely do they get more specific than that. Motor oilBut let’s be honest, if you really needed toxins removed from your body wouldn’t you want to know exactly what toxins you have, how they got there and how a doctor is going to get them out? Rinsing your mouth with oil doesn’t remove toxins. At the most, the swishing action might mechanically remove some dental plaque. There is  some research that is suggestive that oil pulling can  have an effect on bad breath and  bacteria that cause tooth decay. However, the research is done on extremely small sample sizes with questionable experimental design. If there is an effect, it is likely from the mechanical effect of swishing the oil. Other liquids would likely have a similar effect. If coconut oil or sesame oil are good, wouldn’t a nice 5w30 motor oil be even better?
  • If it did work, it takes too long: Almost all of the proponents of oil pulling suggest 20 minutes of swishing oil around the mouth is required for the benefit. They’re actually quite specific about the 20 minutes…no more or no less. I don’t know about you, but 20 minutes is a long time to add to my normal routine. Brushing shouldn’t take more than 2 minutes. If you’re going to floss, there’s another two. If you choose to pass on oil pulling, I just saved you 16 minutes per day! And proper brushing and flossing is clearly more effective at cleaning your teeth and gums than swishing oil around. It’s true that I don’t make any claims of detoxifying your body with regular brushing and flossing, but oil pulling doesn’t really do that anyhow. No harm, no foul.
  • It isn’t risk free: Maybe you still aren’t convinced. You’re thinking, “sure, brushing and flossing is better and I might not be detoxifying my body, but what harm can it do?” There’s this thing called lipoid pneumonia. It’s a special kind of pneumonia that only occurs when someone inhales small amounts of aerosolized oil. Kind of like when you’re swishing coconut oil around in your mouth for 20 minutes at a time. Am I saying that oil pulling will give you lipoid pneumonia? Yes. Yes I am. O.K., I’m not really. I’m just saying that there is a risk of side effects that many alternative medicine proponents fail to mention.

Oil pulling is just the latest in a long line of natural cures being offered by proponents of alternative medicine. Medicine and dentistry can be scary. Searching the internet for information about health makes sense. However, the internet has no filters for information. In many cases, bad and incorrect information is easier to find than accurate information about health. Remember what Jimmy Wales, the founder of Wikipedia, once said:

“We are still in the very beginnings of the internet. Let’s use it wisely.”

Critical thinking techniques are vital to finding health information on the internet. The best bet is to have a relationship to a trusted dentist and physician. Ask them questions! Answering your health concerns is what they should do best!

Did you find this post oily? Perhaps a bit swishy? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a Saginaw dentist, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

The future of dental insurance?

Delta Dental of Michigan just began offering a new kind of dental insurance to its employees. The insurance plan is being sold as “personalized care.” What a great service! They care about you as an individual! They actually test your genetic code to determine the best treatment for you, right? Well…sort of. Here’s a short version of how it works.

How the new "personalized dental insurance" plan works

How the new “personalized dental insurance” plan works

Adults will be given a baseline level of preventive coverage. This baseline includes one “cleaning” and two exams covered by insurance per year. Additional “cleanings” will be covered (a maximum of four) if you have one or more risk factors. The new program includes the following risk factors:

  • diabetes
  • history of heart attack/stroke
  • renal failure/dialysis
  • suppressed immune system
  • history of radiation of the head and neck due to cancer
  • pregnancy
  • a history of a periodontal disease/past periodontal disease treatment

Furthermore, a subscriber to this insurance policy may choose to have a genetic test done for the “periodontal disease gene.” If they test positive for this gene, they may qualify for more “cleanings.”

You may be wondering why I’m putting quotes around the word cleaning in the previous paragraphs. It’s because I kind of hate the term “cleaning.” It means different things depending on the patient’s gum (periodontal) health. So let me clarify. If you’re a healthy adult patient with no periodontal disease, you’ll most likely get a dental prophylaxis. This consists of a hygienist or dentist removing plaque and tartar that his harder to reach by regular home care as well as the crowns of your teeth polished. That’s the smooth and minty feeling you get after they finish up. If you have periodontal disease, which is to say that you’ve lost some supporting bone around your teeth, your cleaning is actually considered periodontal maintenance. This assumes you’ve had periodontal therapy (deep cleanings, aka: scaling and root planing). This is a much more in depth removal of tartar which may include local anesthesia and localized deep cleanings on the roots of the teeth. However, both of these things are (erroneously) being referred to as a cleaning, even though there are very specific insurance codes for each type.

At first glance, this really does seem like dental insurance  providing true personalized care. Delta Dental of Michigan designed the plan based on some recent research from the University of Michigan that may indicate that 2 preventive visits to the dentist each year are no better than one at preventing disease.

Delta Dental seems to be indicating that this new, evidence based plan that treats patients based on their risk factors for disease is the way to go. I am very interested in letting good scientific evidence help guide the way we treat patients. I think this is in everyone’s best interest. That said, I think this plan is premature at best and disingenuous at worst. I think Dental Dental’s foray into personalized care is heading in the wrong direction for several reasons.

  • Weird Science: The new insurance policy is based on a University of Michigan study called “Patient Stratification for Preventive Care in Dentistry.” The study was designed to see if two recall appointments (“cleanings”) were better than one. The results would lead one to believe that two cleanings are no better than one. From what I can tell, this is the entire basis for reducing the number of baseline “cleanings” the patients with this insurance policy would receive. But there is a problem with this research. The outcome that the study measured was “tooth loss.” Which is to say, two cleanings is no better than one cleaning if your only concern is losing teeth to periodontal disease. Losing teeth due to gum disease is clearly a huge concern, but there’s a lot of other concerns (gingivitis, tooth decay, crooked teeth, tooth wear and dry mouth to name a few) that this research doesn’t address. “Tooth loss from periodontal disease” is a pretty blunt measure of whether 1 or 2 cleanings per year is better. It seems to me that most patients aim higher than just not losing teeth to gum disease.
  • No smoking?: Delta Dental listed many risk factors that they take into consideration when allowing for added “cleanings.” Diabetes, history of stroke/heart attack, suppressed immune system and even a genetic predilection toward gum disease. What didn’t they list? Smoking. Many believe that smoking is perhaps the most relevant risk factor of all when it comes to gum disease. Yet Delta Dental doesn’t list this as one factor that might qualify a patient for more covered recalls? What is that all about? Is it a moral stand against smoking? Whatever it is, they’re ignoring perhaps the most important factor in the development of gum disease. Since the new policy is based on research that judges tooth loss by gum disease, it seems that Delta Dental is picking the risk factors that benefit their bottom line more than the patients they serve.
  • What about tooth decay?: As I mentioned before, this research measured tooth loss due to gum disease. The elephant in the living room is the fact that they didn’t mention risk for tooth decay. Gum disease is common, but not nearly as common as tooth decay. For people with a lot of risk factors for decay (dry mouth, lots of medications, diet, soda consumption, poor home care), 6 months is probably too long to go without being seen by a dentist. For these folks, a year is practically a lifetime! Tooth decay can proceed very quickly in a high risk patient, yet they may not test as high risk for gum disease, which means that under a plain like this, they would likely only have one “cleaning” per year. While cleanings may not directly affect tooth decay, the fact that the patient is presenting to the dental office means that the dental team is much more likely to catch problems (e.g–cavities) while they are small and easier to treat.

cool looking dental hygienist clipYou might be thinking, “O.K. Doc. I hear you. But you’re missing the point. The insurance policies still pay for two exams per year. I can come in to see you twice and you’ll still get a chance to evaluate my teeth. Even though they won’t be as smooth and minty as before, I’m still getting all that preventive benefit. I think this is really about dentists losing all that revenue from cleaning teeth. So just pipe down.

Honestly, this is a semi-reasonable argument. The insidious part is what the insurance companies know that regular folks don’t think of. Whether you want to believe it or not, we human beings are driven by incentives. As much as I like to think that I can teach all patients about their needs, I’m still almost always limited in my treatment options by what the insurance will cover. Patients with insurance like to use their insurance benefits and they take seriously the limits that insurance policies place on them. If a patient has been used to coming every 6 months for a cleaning ever since they were a child, how likely are they going to set up for that second examination if they don’t get a cleaning? I can see it now: “So you want me to miss work so I can come over here and have you look at me for 15 minutes? I don’t get to spend quality time with April or Tanna gently polishing the plaque off my teeth? All I get is Doc shining that bright light in my eyes? Well, thanks but no thanks. I’ll pass until my next cleaning is covered.

I’ve written previously that cleanings are overrated. Apparently the insurance companies are beginning to agree with me. I hope I’m wrong.

Did you find this post ominous? Perhaps a bit scary? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a Saginaw dentist, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

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