“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!
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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 mouth, remineralize 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 email@example.com. I always answer my own emails!
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 togetherto 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.
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.
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 firstname.lastname@example.org (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!
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.
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!
This is the second installment I'm writing about dental insurance. The first one is here. I'm fascinated by medical insurance. I'm fascinated by "health insurance reform." Am I fascinated by dental insurance? No. Not at all. Mostly annoyed, really.
I have to admit that there are probably a lot of teeth that have been saved by dental insurance. But the incentives that it sets up for patients are damaging in a similar way.
(Delta Dental of Michigan's headquarters—–>)
Let's say a patient has stayed away from dental treatment for a lot of years "because they didn't have dental insurance." Unfortunately, this is an everyday occurrence. They may have a lot of different dental problems from years of neglect. They might have decayed or fractured teeth, gum problems or missing teeth. They're excited to get in and use their new dental benefits and get back to dental health. They have a yearly maximum benefit of $x that they can put toward this dental care.
After examining the patient and diagnosing their dental situation we find that the patient needs $4x of dental work.
So their dental insurance might cover 25% of the cost of their needed treatment and they've decided that they don't have extra money outside of what their insurance will cover. What does this do?
First, it makes the patient prioritize what's "most necessary" for treatment. It also makes the dentist attempt to prioritize what would benefit the patient the most knowing that the entire treatment plan won't be done at once. Although prioritizing isn't necessarily a problem it is almost always a compromise in treatment.
Secondly, it reinforces the idea that dentistry is "expensive." Dental insurance is meant to help with the costs of regular maintenance of dental health. It's not meant to completely pay for dental treatment.
Finally, it adds an unwelcome aspect to the dentist/patient relationship. Why doesn't my insurance cover more of this treatment?
Dental treatment is expensive. But costs can be controlled and planned for when a patient sees the dentist regularly and there is an open and honest communication between the dentist and patient. The insurance companies often complicate this relationship.
I think one of the problems with this dynamic comes from the confusion between dental insurance and medical insurance. Medical insurances rarely have a cap on how much will be covered in any given year. If a patient has an expensive diagnosis like cancer, medical insurance generally doesn't limit how much will be paid out for a patient's condition. However, cancer treatment costs much more than what a company receives in premium payments for an individual patient. They lose money on that, but society wouldn't stand for an insurance company choosing to limit this payout on a cancer patient.
A question that's worth asking is "when was the last time that money was discussed with you prior to treatment in a medical situation?" In most cases the answer is "never." We don't talk about money when it comes to medicine. Our insurance covers most of the treatment costs most of the time. So we accept this "we don't talk about money" stance from our medical establishment.
Dental insurance defines how much they'll pay in a given year. The patient makes more decisions about what and how much dental treatment they'll receive, because they're making choices about more of their own money.
So, as frustrating as it is to the dentist wanting to offer awesome treatment to their patients, dental insurance requires that we talk about money. At my office, we talk about money before we start treatment so everyone is on the same page. As much as I wish it weren't the case, money determines dental treatment options as much as anything.
Why don't we have the same talk about medicine? Why is health reform such a political hot potato? I would suggest it's because we don't talk about money with patients. Patients will make the best choices for themselves when they're given all the information. I don't pretend to offer solutions to our health care problems, but I do promise to make sure you know how much stuff will cost in my office before we do it.
Surprises are great at Christmas, not at the dental office!
Questions or comments? Feel free to email me at: email@example.com. I read and answer all of my own email and love to hear from readers of the blog!
Dental insurance companies make a LOT of money. Even the non-profits. The way that they do this is to pay out less in dental treatment than they take in from patient premiums. Their goal is to take in more in premiums from their average subscriber than they pay out in dental fees. There are a lot of tricks the dental insurance companies can use to create patient incentives to limit dental treatment. The strategy I’m going to talk about in this post is “the predetermination.”
As a dentist, I’m excited by all of the cool and innovative treatment options that I can offer patients. Patients are sometimes excited by treatment options, but usually have concerns over the costs of treatment.
Let’s say I diagnose a failing filling with a new cavity underneath it. I recommend that the patient restore this tooth with a crown before the decay gets any larger and causes a need for more extensive treatment (like a root canal, or worse…loss of the tooth). The patient has to work through several concerns before they go ahead with treatment:
How much time will it take?
Can they work it into their schedule? If so, when? Will they need to arrange different rides for the kids’ soccer and football practices?
Will it hurt?
How much will it cost? Will the insurance that they take money out of my check for help pay for it?
Often, my office team can help explain the procedure well enough and arrange the timing conveniently enough that it comes down to the $$$. Kathy does an amazing job at predicting if insurance will cover treatments and how much. But the insurance companies make it as difficult as possible for us to guess. Often the patient wants to get a “guaranteed predetermination” of how much will be covered. This is a huge opportunity for the insurance companies to save money for themselves.
First, a predetermination takes time. Even though we are completely connected via the internet, the insurance companies like to take a couple weeks to get back to the patient. By this time the patient has long since forgotten about the decay (which is usually painless while it’s growing) under their filling and the patient didn’t make an appointment for the crown.
By making the patient wait for the estimate of how much the insurance company will pay for their specific treatment the insurance company keeps a certain percentage of patients from going ahead with treatment.
How do I know this? I see patients every day that I’ve discussed treatment with who “slipped through the cracks” and didn’t complete treatment at the time we diagnosed a need. Sometimes the timing wasn’t convenient for the patient, but often we have a copy of the “predetermination” sitting in the chart but no appointment was made. This is the plan of the insurance company…and it often works.
Adding insult to injury…predeterminations aren’t binding. If you read the fine print, in most cases the insurance can still choose to not cover the treatment. I’m not going to say that happens often, but it can.
So, what’s the solution?
1) Make sure you trust your dentist’s opinion and that you believe they have your best interest at heart. If you believe your dentist is trying to push treatment on you for financial gain you need to ask the dentist more questions or find another dentist. Your dentist shouldn’t be annoyed when you ask questions…they should rise to the challenge! It’s great if you trust your dentist’s judgement on their word alone, but they should be able to show you what they mean and explain all the treatment options, even doing no treatment. If they balk at this…you should get a second opinion.
2) Make an appointment. Kathy and/or Shelly can usually guess when any predetermination will arrive via the mail as well as a rough estimate of your out of pocket costs for most treatment. Make your appointment for a couple of days after this. By that time we can discuss any concerns you have and change our plans if necessary. But at least you won’t have fallen through the cracks.
Questions or comments? Email me at firstname.lastname@example.org. I read and answer all of my own email and I’m always glad to hear from patients and prospective patients alike! Also, keep checking back for the other parts to this series on dental insurance! Part 2 will be published here.
This research was a literature review or a "study of studies." Many of these studies had hypothesized that there was a causative connection between asthma and tooth decay but data didn't support this hypothesis.
Inhalers used in the treatment of asthma can cause a dry mouth. Dry mouth is a major risk factor for tooth decay. To be clear, this research determined that having asthma isn't a risk factor for tooth decay, but using inhaler medications is a risk factor for dry mouth and dry mouth is a risk factor for tooth decay. If you use inhalers I would recommend chewing sugarless gum after their use to bump up your saliva flow. Along with regular brushing and flossing these precautions should help protect you against any drying that might occur from this medicine.
Do you have dental topics you'd like me to research and discuss? I'd be happy to! Feel free to drop me an email at email@example.com. I take requests!