I realize that this sounds kind of silly coming from a dentist who actually enjoys restoring teeth. But you must realize that in a perfect world, there would be no dental decay. Gum disease would be nothing more than a bad dream. The perfect world would be one where no one would need the services of a dentist or dental hygienist. Teeth would be self cleaning, perfectly white and straight and I would be out of business.
It’s fine. I’d find something else to do. I could spend more time working on my podcast.
But it’s not a perfect world. Dental disease is still rampant. People have decay and gum disease. People break teeth and fillings all the time. So we dentists are doing fine.
The “no dentistry is the best dentistry” concept is still pretty great, though. The idea of doing the least to teeth makes me feel better. Every restoration I place, no matter how meticulously crafted and handled is still way worse than what mother nature originally gave you. In fact, I’m just as happy if you have boring teeth as I am with exciting cases!
Each treatment plan that we create takes this into account. If I’m going to propose a treatment to any part of your mouth it’s important that my treatment leaves you better off than when you started. Whether that is the placement of the very first restoration a tooth has ever had or me removing of a sick tooth I want it to improve the health of that patient. Which means we (the patient and I) have to consider how invasive any given treatment is before we embark upon any permanent treatment.
How do we do this? First, I’ll probably take photos, videos or x-rays of whatever condition we’re looking at. I use these images to explain to the patient what I’m seeing, what the condition is (the diagnosis) and whatever treatment options they have. This includes the option of no treatment with my best guess as to what would happen if the condition isn’t treated. This leads to a conversation between the patient, myself and usually our team.
These are “we” decisions, not “me” decisions. When we determine the best option for the patient, we move forward. The best option is almost always the least invasive for the situation whenever possible.
My favorite treatment? Doing an in depth, microscope based exam on a patient that’s making great choices and taking care of themselves in such a way that I can say, “you look terrific! I don’t have any treatment to recommend!”
Did this make you feel minimalist? Did it make you want to floss your teeth? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, or you can “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.
Contrary to what you hear from a LOT of dental marketing, heart disease isn’t caused by gum disease. It’s technically correct that gum disease and heart disease are correlated or “linked,” but there is currently no evidence that gum disease causes heart disease. Or stroke. Or other health problems.
Here’s the thing…a lot of these diseases have similar risk factors. For instance, if you are a smoker you are at greater risk for heart attack and stroke as well as gum disease (as well as countless other health problems). So the correlation between these maladies may have more to do with similar risk factors than the actual expression of the disease.
I’m not saying that treating gum disease is unimportant. It absolutely is important and worthwhile! Treating gum disease early and thoroughly (which includes teaching patients how to maintain their gums and teeth at home) could help patients avoid pain, infection, tooth loss and expensive dental work in the future. A few years ago I compared gum disease to one of my favorite comic book characters:
“So imagine this calculus on the surface of the roots of your tooth like a bunch of tiny slivers. Your innate immune system recognizes it as a bad guy, but cannot remove it. This makes the innate immune system mad. Kind of like when Bruce Banner gets mad. And the madder your innate immune system gets, the stronger the reaction it creates to try and remove this invader. It starts dumping the toxic chemicals it uses to kill bad bacteria and other bugs into the tissues supporting your teeth! These chemicals, along with toxins from the biofilm itself, start to break down the tissues that support your teeth. It’s kind of like you have an angry Hulk smashing around in your gum tissues, but he’s not able to get rid of the bad guys. And this makes him really angry! So instead, he starts attacking YOU!”
Essentially, gum disease is a combination of bacterial build up in your mouth and your immune system creating inflammation that breaks down the tissues supporting your teeth. Localized inflammation around the structures of the teeth causes the problem. Can this localized inflammation cause inflammation in the rest of your body?
The best answer at this point is, “maybe.” Ongoing research could indicate a more direct causative effect in the future. But for now, it’s not there. Even the American Heart Association agrees. The best way to prevent heart disease still continue to be:
quit smoking (and if you don’t smoke, don’t start!)
maintain a healthy weight
control your blood pressure
For the moment, treating gum disease isn’t on their list.
There are some dental professionals that try and use this “connection” between gum disease and “whole body health” as a scare tactic in order to promote treatment. Some even want to teach this technique to other dentists to help “fatten the bottom line” for dentists. Which is just perfect, right? As if dentists need something else to wreck our reputation as a profession.
Again, I want to stress to patients that treating gum disease is worthwhile in its own right. We’re interested in your overall health as well…that’s why we screen blood pressure and do a thorough medical history. But treating your dental needs is worthwhile without the baggage of unscientific claims and scare tactics.
Did this make you feel anxious? Do you feel holistic? 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.
“I never pictured gum disease being this GREEN before.”
Most everyone knows about the Incredible Hulk. Mild mannered scientist Bruce Banner was accidentally exposed to deadly gamma rays, but instead of killing him the radiation gave him strange super powers. When he gets injured or angry, he turns into a gigantic, green, immensely strong and almost mindless rage monster. And the angrier he gets, the stronger he gets! Chaos ensues with him attacking and smashing anyone and anything that gets in his way. Cars are thrown, buildings are brought down and cities are often leveled. He only stops smashing things when his fury burns out, he calms down and he turns back into the mild mannered scientist again, wondering what he’s done this time.
The Hulk was one of my favorites when I was growing up. Reading through my comics I would cringe at the stupid bad guys, thinking “dude, you’re making him angry!” So how, exactly, is a comic book antihero similar to gum disease? Stay with me on this one…
Let’s start with the immune system. Your body is constantly being invaded by viruses (think cold season), bacteria and lots of other nasties that you can’t even see. Lucky for you, your immune system is constantly on the lookout and mostly takes care of these attacks without you ever being aware of them.
The immune system has two main parts: the adaptive immune system and the innate immune system. The adaptive immune system is what most people think of when someone mentions “the immune system” and its definitely the part that gets all the headlines. The adaptive immune system is the part of the immune system that learns to recognize individual types of invaders and remembers them so they’re easier to fight the next time they’re encountered. The adaptive immune system is the part that makes vaccines possible and our understanding of it has probably saved more lives than any other kind of medicine.
The innate immune system is a little bit different. It doesn’t recognize specific invaders, it only recognizes the things that it runs into as “self” and “not self.” If the cells of the innate immune system recognize something as “not self,” they attack the invader. In other words, this part of the immune system can’t say, “hey, I recognize you! You’re a chicken pox virus!” It only thinks, “this thing ain’t me! So I have to kill it!”
If you’ve ever had a sliver, you’ve seen the innate immune system hard at work. The redness, pain and swelling that surrounds a sliver are all signs that the innate immune system is fighting the good fight for you. These signs are called inflammation. Inflammation is your body’s reaction to some kind of injury or pathogenic invasion. The cells of your innate immune system have some amazing weapons, kind of like the Incredible Hulk. These cells will dump toxic chemicals on invading microbes or if they can’t to that, they’ll swallow them whole!
Inflammation is usually a good thing and can be the first step in healing an injury or an infection. However, too much of this inflammatory response can actually cause damage to the tissues that the immune system is trying to protect!
Gum disease is primarily a problem with inflammation. It’s actually an inflammatory reaction to biofilm on your teeth and below your gums. The plaque and debris that we try to brush and floss off of our teeth is pretty sticky stuff. It doesn’t really want to be removed. And if it’s left there long enough, it will harden. This hardened plaque is called calculus or tartar. This calculus acts kind of like a barnacle stuck to the surface of your teeth. Worse than that, it usually gets stuck below the gum line. It’s just about impossible for you to remove by yourself. To remove it a dentist or dental hygienist has to use special tools to break it loose from the surface of your teeth.
“Don’t make me angry. You wouldn’t like me when I’m angry.”
So imagine this calculus on the surface of the roots of your tooth like a bunch of tiny slivers. Your innate immune system recognizes it as a bad guy, but cannot remove it. This makes the innate immune system mad. Kind of like when Bruce Banner gets mad. And the madder your innate immune system gets, the stronger the reaction it creates to try and remove this invader. It starts dumping the toxic chemicals it uses to kill bad bacteria and other bugs into the tissues supporting your teeth! These chemicals, along with toxins from the biofilm itself, start to break down the tissues that support your teeth. It’s kind of like you have an angry Hulk smashing around in your gum tissues, but he’s not able to get rid of the bad guys. And this makes him really angry! So instead, he starts attacking YOU!
In the comic books the Hulk only stops his rampage when he calms down. And this goes for your inflammatory response as well. The very best way to calm our “periodontal Hulk” is to remove the junk stuck to the roots of the teeth. If we can remove this stuff, we can usually calm down that response and stop the active destruction of your gums. Just like the end of every Hulk comic, there’s often a lot of destruction to clean up after the Hulk is gone. Many patients have to deal with the severe loss of bone and the supporting tissues of the teeth even after we’ve cleared up the inflammation of active gum disease.
So, what’s the best way to prevent Bruce Banner from turning into the Hulk? Prevention! Don’t make him mad, right? Brushing, flossing and regular visits to the dentist can help you avoid the ravages of gum disease. Catching problems before they become destructive is the best, but even if you have gum disease, it’s not too late to treat it!
Did you find this post incredible? Did it make you angry? 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.
Two weeks ago the dental community was in an uproar. Morning news shows were making claims that “dental x-rays cause brain tumors” and “dental x-rays are linked to brain tumors.” What made dentists so mad? For one thing, dentists are an easy target. Many people have had bad experiences with dentists, many people are afraid of shots and a lot of folks associate toothaches with dentists. Dentists have baggage, and this news story didn’t help. So we’re kind of touchy.
There are a couple problems with the Yale research that these news stories were based on. First, the methods used in the study were questionable. But even if the results had been accurate, the news media took “x is related to y” to mean “x causes y.” This is a conclusion that the data do not support. There’s a lot more work that would need to be done before that conclusion would be fair. Just because red cars are twice as likely to be in accidents as blue cars, you cannot assume that the color of the car is what’s causing all the accidents!
Humans are kind of funny that way. Our brains love to “assign a cause.” We like to take two things that are proven to be related in some way and jump to a conclusion. Usually the conclusion we jump to is: “one thing is caused by another.” Dentists do it, too.
A recent statement from the American Heart Association has taken the dental world by storm over the last few days. Apparently the assumption that many dentists made about periodontal disease causing heart disease was firmly clarified by the AHA:
“The message sent out by some in health care professions that heart attack and stroke are directly linked to gum disease can distort the facts, alarm patients and perhaps shift the focus on prevention away from well-known risk factors for these diseases.”
Boom. That seems very clear to me. The statement continues:
“Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD [“atherosclerotic vascular disease” aka heart disease] or modify its outcomes.”
From what I can tell, the American Heart Association is saying “don’t use heart disease as a scare tactic about gum disease.” I think that’s fair. I’ve noticed for years that some dentists have played a little fast and loose with the relationship between gum disease and heart disease. The truth of the matter is that gum disease and heart disease share quite a few risk factors: smoking, age and diabetes to name a few. Gum disease is worth treating in its own right. Potential tooth loss, pain and bad breath are pretty compelling reasons to keep your gums healthy. It’s just that dentists were getting comfortable lumping potential systemic problems in with the other problems gum disease presents as a selling point to the treatment. This is intellectually lazy and we need to re-evaluate it.
The moral of the story is this: “is linked to” does not mean “is caused by.” Even when your brain really wants to take that leap, you need to take a step back and really look at the relationship between whatever variables are connected.
Did you find this post interesting? Thought provoking? Tedious? 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.