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Browsing 13 posts in medicine and dentistry.

Gum disease doesn’t cause heart disease

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 wegum-diseasell 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
  • stay active

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.

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!

 

Choose dental health. It’s much cheaper.

I recently had a patient cancel her appointment at the last minute. This happens sometimes. It’s frustrating for a dentist or hygienist when we’ve set time aside for a patient and they don’t come. Usually there’s a good reason. In this case, no reason was given.

As I sometimes do…I took it personally. Why did this person choose not to have the treatment done that we discussed? What could I have done better?

This particular patient has been coming to our office for years. She is someone you might describe as “skeptical” of dental treatment. I suspect she had some bad dental experiences before I even came into the picture. She’s at least mildly phobic of dental treatment, too. However, I think she’s probably one of those people that believe that when I come in the room that I’m simply looking for work to do, probably to line my pockets.

-Do I really need this crown--It’s a difficult spot for a dentist. Often times we’re both the internist that diagnoses the problem and the surgeon that fixes it. Patient see this as a conflict of interest. The guy who is telling me that I have cavities is also the guy who benefits from them being fixed. I completely understand this. I take my role as a doctor very seriously and I put my patient’s needs first. But can you blame a patient for being skeptical of a doctor’s motivations?

When I examine a patient I’m looking to see what level of dental health the patient has. And when I see a problem, I’m obliged to tell them about it. I have found what I believe is the most effective way to do this. I do all of my recall exams with a dental operating microscope. This microscope magnifies what I can see and has a very bright light that allows me to see parts of the mouth that don’t get lit up very often. I’ve attached an HD camera to the microscope with a monitor mounted over the patient to allow them to see exactly what I’m seeing…as I see it. I feel like this is a great solution to the problem of showing the patient what I see instead of me just describing it. I like it more than still photos because I can show it to them “live” as I’m describing it.

blog post scopeBack to my patient that chose not to come in today. I definitely examined her with the microscope and I definitely showed her what I was seeing. I recommended to some treatment because I saw some problems. I try and do this dispassionately. I try not to “sell” a patient on treatment by showing them what I’m seeing. I try to help the patient choose dental health by showing them what I’m seeing and describing what we can do to correct dental problems.

I have a suspicion that this patient still thinks what I’m describing isn’t a real problem. Like many dental problems, what I’m describing probably doesn’t hurt. Most cavities don’t hurt. Gum disease almost never hurts. Even broken teeth often aren’t painful. If you use pain as the threshold for dental treatment, you’re probably going to end up choosing the most expensive way to fix the problem or worse, sometimes the problem can’t be fixed leading to the loss of a tooth. A small cavity left untreated almost always becomes a bigger cavity, so what may have been easy to fix with a filling could end up needing a crown or even a root canal. This sounds like a scare tactic used by a dentist. Ask any dentist and they’ll explain that they see it. All. The. Time.

So I’m going to suggest that you listen to your dentist’s recommendation. The choice to treat is always yours. But almost always, the sooner you treat a problem, the less expensive and potentially painful the fix is.

Did this make you feel skeptical? Are you feeling put under the microscope? 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!

 

 

Cavemen didn’t need hip replacements

If you were born in the paleolithic era, you could expect to live to be 33 years old. The global average life expectancy in 2010 was more than double this number at 67 years. Advances in hygiene, food production, medical care are among the reasons for this and we should all be thankful for this.

Primitive man

His hips are the last thing on his mind.

But on the bright side for the cavemen…they didn’t need hip replacements. If you were 35 years old you were likely the oldest person in your tribe and had probably outlived everyone you’ve ever known. But you hadn’t really lived long enough to wear your joints out.

Fast forward to the United States in the early 21st century and you’ll find that 2.3% of Americans have had a hip replaced and 4.6% have had a knee replaced. More than a million joint replacements will be done this year and that number continues to grow. Hip and knee replacements are surgeries that improve a patient’s quality of life in a big way. And we Americans are all about quality of life!

I want you to picture your lower molars. Your lower “first molars” came in somewhere around 6 years old. So for that same 50 year old we talked about above, these teeth have been tolerating chewing, hot coffee, cold ice cream and the occasional unpopped kernel of popcorn for 44 years. Think about that. 44 years! How old is your car? If you’re like most people it’s probably less than 5 years old and maybe 10 on the outside. But if you’ve got your first molars, they’ve been laboring for you since you were 6 years old!

a molar that could use some help

This molar has a long life to live…if it gets a little help.

Teeth wear out, too. If you happen to be particularly kind to them (avoiding sugary or acidy foods, not grinding your teeth, not chewing ice cubes, not smoking, not drinking super hot liquids followed by freezing cold ice cream, etc.) they may well last your entire lifetime. But if your dentist tells you you’re going to need a crown, don’t feel too bad. Crowns are kind of like the knee replacements of dentistry. Dentists can give that tooth a new life with a procedure that’s a heck of a lot easier than a hip replacement! Even more…if you happen to lose a tooth, we can replace that tooth with an implant that looks and functions almost exactly like the real thing!

If you were a caveman, your first molars would have only had to last about 27 years. And since cavemen didn’t have refined sugars in just about everything they ate, most of them did just fine. You are not a caveman. Your life expectancy is very likely well over 70 years old. You are going to wear your parts out. That’s not disease. That’s the awesome nature of living twice as long as a caveman!

The next time your dentist diagnoses you with a cracked tooth that needs fixing  you shouldn’t be upset at all. Let it be a reminder that you are benefitting from all the advances that the cavemen didn’t have.

And get that crown done. Those molars have to last a long time yet!

Did you find this post all ageless? Lively? 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!

How is gum disease like the Incredible Hulk?

"I never pictured gum disease being this green before."

“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."

“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.

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!

Punching tooth decay in the face

Everyone knows that tooth decay is caused by bacteria in your mouth. The bad bacteria eat the sugar that you ingest and poop out acid onto your teeth. This acid eats holes in your teeth and those holes are the cavities that dentists fix. That’s what we’re good at. Fixing cavities. We do it all day long.

Does your dentist just find cavities and fix them? Or does your dentist punch tooth decay right in the face? I do!

“Take that, tooth decay!”

How do it do it? I destroy that bad bacteria and support the good bacteria. It’s almost like the bacteria are those aliens from “The Avengers” and I’m like the Hulk. Or maybe the Captain America. Yeah. Probably more like Captain America.

But instead of a gamma ray enhanced strength or a shield made of vibranium, I use chemical warfare. Specifically, I use the Carifree system. Carifree is different than any other toothpaste, mouth rinse or dental hygiene tool I’ve ever seen. Carifree kills bad bacteria with a strong antimicrobial. But the products also treat the pH of  your mouthremineralize tooth structure that’s started to break down and even provide a source of Xylitol. All these different things contribute to a healthier, less decay-prone environment in your mouth.

Removing decay and fixing cavities is called the “surgical model.” When you have a filling it’s actually a micro surgery on your tooth. Treating the bacteria and the biofilm on the surface of your teeth and gums is sometimes called the “medical model” of tooth decay treatment. When you use a system like Carifree, it’s actually medicine to treat the bacteria on the surface of your teeth that cause decay. Most dentists aren’t familiar with this “medical model” and limit their treatment to surgical interventions. By adding the the medical model to a high risk patient, we can effectively limit how much “surgery” we need to do in the future.

Do you have new cavities each time you have your teeth cleaned? Are you tired of having to have cavities treated? Let us help you fix your tooth decay problem. Come see us and we’ll team up to punch tooth decay in the face!

Did you find this post heroic? Spine tingiling? 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! Especially ones that want to punch tooth decay in the face! 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!

 

Dentistry is not a commodity

Commodity: A basic good used in commerce that is interchangeable with other commodities of the same type… The quality of a given commodity may differ slightly, but it is essentially uniform across producers.

Q: When is a patient like a bushel of corn? A: When they're treated like a commodity!

I recently made an appointment to have an esophageal scope procedure done. I have GERD pretty bad, and it’s finally my turn to have a GI specialist take a look. I got a referral to the specialist from my physician, whose opinion I really trust. I had to change the date of this procedure and when I called to change it the receptionist told me, “Dr. X won’t be in that day, so I’ll schedule you with Dr. Y.” 

For the most part, I’m O.K. with that. I was sent to have a procedure by my regular physician and the procedure is a commodity. The procedure will be done more or less the same way no matter which trained specialist does it. Or at least that’s what I’m assuming. I have found no positive or negative reviews of my specialist online and I don’t know anyone else who has seen this particular doctor. I don’t expect to have much of a relationship with this doctor as I’m not going to go back to see them unless I need specific follow up from the procedure. Also, they’re going to put me to sleep soon after I meet them!

I would be upset if I went to my regular doctor for an appointment and someone I didn’t know walked into the exam room, but I have no expectation for my upcoming appointment, because I’ve never met this doctor, nor have I ever been to their office.

Let’s be honest…medicine is more or less a commodity. Or at least procedure based specialty medicine is. The medical establishment as well as medical insurance companies see the procedure that I’m having is the same thing wherever it’s done. The service will be O.K., probably not great. I will receive a mystery bill some time later for an undisclosed amount which will not have been discussed with me prior to the procedure. My primary care physician will receive a report which she will discuss with me. Perhaps we’ll change my medications. I will be a cog in the machine. How I feel about the process isn’t important to the process. At all.

The procedure is a commodity. And yes, I (the patient) am a commodity.

I don’t mean to sound so bleak, but that’s been my experience with medicine. There have been a few bright spots. Certain docs or nurses that were amazing because they were amazing. Not because the system is amazing. For the most part medicine tries to get you through the process quickly and efficiently, but it’s not so worried about the experience.

Welcome to our dental family!

I’m not O.K. with that. Acceptable service isn’t good enough. As a general dentist, I feel that it’s important that I provide the best in dental care along with the very best experience possible. Most dental patients in our office see us at least twice per year, so the experience you have as a patient is really important! My goal is to develop a relationship with each patient so that we work together to keep your mouth healthy. But don’t take my word for it. Check out some reviews that our patients have left for us on Google (and leave one for us while you’re there!). Or, better yet, come experience the office for yourself. I promise you won’t feel like a commodity. You’ll feel like family…a very well taken care of member of our dental family!

Did you find this post helpful? Silly? Earth shaking? 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!

 

 

 

Bad rebounds

It’s basketball season. So we’re seeing a lot of fans. MSU fans, U of M fans, Pistons fans and a whole lot of different high school basketball team fans. Those fans LOVE rebounds! Those aren’t the rebounds that I’m talking about.

Quite a few of our patients 50 and older are taking some kind of anticoagulant medication.  Aspirin, Coumadin, Plavix or even the newest ones like Exanta are used to prevent the buildup of plaques in the arteries of the heart. And they work. They cause the blood to be less “sticky,” which can help reduce the risk of heart attack, stroke and embolism in those with artery blockage. The side effects are that they can cause bruising and extended bleeding from wounds. Some dental treatments, particularly surgeries like tooth removal, can cause mild to moderate bleeding. Since bleeding is the first step in wound healing, this is O.K.

In the past, those taking anticoagulant medications were sometimes told to stop taking them 2-3 days prior to a tooth extraction. It was a gray area. Some docs said 2 weeks, some docs said a couple days and some docs said “don’t worry about it.” A lot of patients have been taking these medications for awhile and what they remember is that they stopped taking them for an extraction.

More recent research has described the “Plavix rebound.” It happens when someone discontinues anticoagulant therapy suddenly. Like 2 days before an extraction. This rebound effect puts the patient at significantly higher risk of stroke, heart attack and embolism for the NEXT 90 DAYS! Although most of the current research is with Plavix, the same effect has been known for quite some time with older anticoagulants.

So let’s say you’re on an anticoagulant and you need a tooth removed. My experience has been that in most cases we can remove the tooth and control any bleeding in the office without taking you off your medication. We have a lot of techniques including more minimally invasive surgical techniques as well as wound closure techniques that make postoperative bleeding a non-issue. If you or your doctor have concerns about wound healing I’m happy to discuss it with your doctor. But my guess is that now the risk of “rebound” is much greater than the risk of postop bleeding.

So here’s the deal: DON’T STOP TAKING YOUR ANTICOAGULANT MEDICATION WITHOUT TALKING TO YOUR DENTIST AND YOUR DOCTOR. Even if you stopped it in the past.

Did find this post helpful? Awe inspiring? Annoying? 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!

What’s the diagnosis?

25_house_lg Here's how it's supposed to work.  The patient comes in with a problem.  The dentist (that's me) looks at the patient, evaluates the x-ray, examines the tooth or teeth in question and tells the patient in no uncertain terms "you need a filling," "you need a root canal," or "this tooth can't be saved."  The doctor knows and tells the patient what they should do, right?

Here's the problem.  Each of those treatment recommendations kind of jumps a step.  I shouldn't recommend treatment without first explaining the diagnosis.

Merriam-Webster gives us a few different definitions for the term diagnosis. First is: "the art or act of identifying a disease from its signs and symptoms."  This is probably the most typical way people think of diagnosis.  This is how we can tell a cavity from gum disease.  They present with different signs and symptoms.  A sign is an objective measure of condition in the mouth.  Examples of "signs" are periodontal (gum) measurements or x-rays.  These are collected by the doctor in order to form a diagnosis.  Symptoms are subjective experiences of the patient. Common symptoms of dental problems are pain, "discomfort" and pressure.  They aren't measurable in the same way that signs are but that doesn't make them any less real.  Symptoms are described by the patient and interpreted by the doctor in relation to the objective signs collected.  

Another defintion of diagnosis is: "investigation or analysis of the cause or nature of a condition, situation, or problem."  I prefer this definition because it describes an active search to get to the bottom of the problem presented.

Some dental diagnoses (plural of diagnosis) are very straightforward.  A cavity found on the x-ray and verified with magnification and lighting and recorded with an intraoral photo is dentistry's version of the slam dunk.  This is a very common finding and the likelyhood of a dentist getting it wrong is very low.  

Other conditions require us to be a bit like a detective.  Sometimes we find ourselves settling on a differential diagnosis.  The differential diagnosis is a list of the most likely things that could be causing our problem.  For instance, "the tooth needs a root canal" isn't a diagnosis.  That's a recommended treatment.  A differential diagnosis might be "the nerve of the tooth is inflamed from a deep cavity.  It may be able to heal from this trauma (reversible pulpitis) or it might be on it's way to dying (irreversible pulpitis).  There are some signs and symptoms that help us determine which way it's heading.  And sometimes, we just don't know!

Next time you're visiting your dentist or your doctor, ask them to talk about the diagnosis.  One thing I can promise, they'll be surpised that you asked.  You'll be letting them know that you're an interested patient who wants to take an active part in their care.  I promise that you won't regret asking!

Are you interested in working with a Saginaw dentist who explains the diagnosis?  Then I'm interested in having you as my patient!  Drop me an email at alan@meadfamilydental.com (I always answer my own email!) or call the office at (989) 799-9133.  We'll get you in right away and you won't believe a dental office can treat you so well!  

diet pop, obesity and stroke: evaluating medical claims critically

Recent headlines suggest that those who drink diet soda are more likely to have cardiovascular problems, specifically stroke.  Let's review some of the headlines:

"Diet pop can be hard on your heart"

"Want to have a stroke?  Keep drinking diet sodas"

"Diet Drinks Help Waist, But Still Lead to Heart Problems, Stroke"

"Drinking diet pop might increase risk or stroke"

Diet-soda If you don't look any harder you could walk away with the idea that drinking diet soda will lead to strokes.  And if you're anything like me, this will lodge in your mind until the next sensational headline tells you something else that many people do on a regular basis is unhealthy and damaging.

Does drinking diet soda really make you more likely to have a stroke?  A stroke is damage to the brain due to a temporary interruption of the blood supply.  It's very similar to the damage to the heart during a heart attack.  What exactly is it in diet soda that makes it more likely for a stroke to happen?  According to the articles this same risk isn't found in people who drink regular soda.  So are we to assume that it's the artificial sweeteners?  

This is a perfect example of preliminary "science" prevented as fact used as a scare tactic.  Many news sources have gotten honest about the source of this information, but many others have not.  Retractions or good explanations of the methods don't make headlines, but scare tactics do.  

The correlation between diet soda and stroke was made in a poster presentation at the "International Stroke Conference."  Poster presentations are not the same as peer reviewed medical journals and definitely do not carry the weight of medical consensus.  This misinterpretation is not the fault of the scientists presenting the poster so much as the media drawing unsupported conclusions.  Simply stated, the connection presented has not been studied enough to make the statements that a lot of news sources are making.

Corr-297x300 Most news stories do not bother to mention that correlation isn't the same thing as causation.  There very well could be a correlation between intake of diet soda and stroke, but by no means does that mean drinking diet soda causes strokes.  It's that the individual data points of stroke risk and diet soda intake are often found together.   Perhaps overweight and obese people, who are clearly more likely to have strokes and heart attacks, are more likely to report drinking diet soda because they are attempting to lose weight.  Perhaps there really is some stroke inducing ingredient in diet soda.  The study that is referred to really doesn't make that evident.  There needs to be a lot of research and verification to reach a point where causation of disease can be determined.

The news media and others reporting the "drinking diet soda = greater stroke risk" are jumping the gun.  They're not interested in reality as much as a good story.  A story that might frighten you, but will hopefully be forgotten until the next scary headline.  

Is this ever done in dentistry?  I think it is.  I'll discuss that in another blog soon!



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