The New Year brings renewal. Every year we think to ourselves…what am I going to do differently this year? And every year we make unrealistic resolutions about running 5 miles per day, losing 50 lbs and never eating fast food again.
This year should be different! If you’re going to make resolutions, why not make them the easy kind? I mean “falling off a log” easy. The kind where you almost can’t help but succeed. In the spirit of easy resolutions for the new year I give you three easy things you can do for healthier teeth this year.
Drink less sugar: It’s pretty trendy to be anti-sugar. I’m not someone who believes that all sugar is evil, but I think that moderation is a good idea. As a dentist, I tend to see sugar differently than dietitians. When you take sugar in, the bacteria (aka: bugs) in your mouth’s natural flora (aka: plaque) take that sugar in, too. The bugs turn this sugar into acid, and this acid starts to dissolve your teeth. So before the sugar ever makes into your bloodstream, we dentists are concerned about the acid that it’s creating in your mouth. Furthermore, the sugar found in drinks like soda and fruit juice is concentrated and easily absorbed by the bugs. Plus, people often sip these sugary beverages over a period of time, which creates an acid attack that lasts much longer. If you’re careful about the sugar in your beverages, you can make a big difference in the amount of acid those bugs can create! So instead of that 20oz. Coke or tall can of Red Bull, why not reach for something sugar free? Water is probably the best, but I won’t fault you for sugar free options like diet sodas and “Crystal Light-like” beverages as well. Carbonated beverages like diet sodas can cause a problem if you drink a lot of it, to be sure. But we’re interested in reducing your risk for cavities, not sainthood!
Put floss in the shower: The second easy thing you can do to make your teeth healthier this year is putting floss in your shower. That’s all. Just put it in your shower. I’m not talking loose pieces of floss or anything. Just put the spool somewhere that won’t get too wet, preferably next to your shampoo. Every time you take your shower, you’re going to look at that spool of floss. Maybe you’ll just look at it. But probably you’ll realize that brushing your teeth alone only stirs up 60% of the bugs on your teeth. If you snuck some floss in between those teeth a few times per week, you’d be making a change for the better. I mean, you’re already in the shower washing up your other parts, why not take a minute to clean up the spots in between your teeth?
Sugarless gum or mints: The last easy thing you can do for healthier teeth is sugarless gum. Or mints. Whatever makes your hair fly back. If you chew sugarless gum or suck on a sugarless mint for 5 minutes (but only five minutes) after meals and snacks you can stimulate your mouth’s natural clean up crew! Chewing sugarless gum stimulates your saliva glands to go to work. Stimulating your saliva flow can stop acid damage caused by the bugs in your mouth as well as acidy foods. And all you have to do is enjoy delicious sugarless gum or mints! See, I told you. Super easy!
So put down the barbells and diet books and realize that success in New Year’s resolutions is three easy steps!
Did this post seem easy? Did it give you resolve? 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’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.
Chronic 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.
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.
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.
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
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:
history of heart attack/stroke
suppressed immune system
history of radiation of the head and neck due to cancer
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.
You 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 firstname.lastname@example.org. I always answer my own emails!
“Roger. We have a tooth in trouble. We’re going to need a holding pattern. Do you copy?”
“I can’t do it right now, Doc. That’s just more than I can afford right now.”
I’ve heard this before. A lot, actually. Usually after I’ve shown a patient a photo of one of their teeth that is in trouble. Most times the patient understands my concern at this point in the conversation. We’ve probably just reviewed the digital photos that April and I took and beamed over to the iPad. They say that a picture is worth a thousand words, and a high resolution photo of a tooth in trouble usually brings the problem home like nothing else. I’ve recommended a crown that costs just under $1000 and it’s not in the patient’s budget.
So what are the options? Sometimes, we can get away with doing nothing for a little while. The teeth often aren’t causing the patient discomfort but often there are signs of tooth decay that can be seen, either with my eyes or when I review x-rays. Doing nothing means we may be letting an active decay situation get worse.
If a tooth could use a crown or an onlay and the patient can’t afford to do it right away, there is often another option. It’s a kind of middle ground between doing nothing and placing a crown.
Imagine you’re a pilot of a jet liner flying across the country toward Detroit Metro airport. It’s late January. You’ve been following the weather forecasts since you left Los Angeles and it looks like southeastern Michigan is getting some snow. You know that you and the other planes heading toward Detroit are going to have to land sometime soon, but you also know that the snow causes delays while they make the runway safe. So what are you going to do?
The control tower radios in that they’re putting you in a “holding pattern.” This means that all the planes that need to land at DTW are given flight instructions that keep them close and ready to land, but keep them safely away from other planes. So although they can’t land now, they are in a stable flight pattern and they’re ready to land once the runway is clear.
That sounds a bit like what we need for our tooth in trouble. We know that we can’t do our preferred treatment right now, but we need our tooth to be stable and ready for treatment when the time is right. What we really need is a dental “holding pattern.” Is there such a thing?
Absolutely! In most cases we can remove failing restorations, take out existing decay and place a bonded core buildup that will last for a couple of years, if necessary. It’s not a replacement for our definitive treatment, because this core restoration isn’t as structurally sound as covering the tooth. However, it can often last long enough to allow the patient to scrape up the resources to take care of the tooth.
Is there a down side? Actually, there is. First, you’re going to add about 25% in cost to the overall treatment. A core restoration used as a “holding pattern” is less expensive than a crown, but it does add a few hundred dollars to the complete treatment cost. Furthermore, the less times you need to operate on a given tooth, the better. By placing a holding pattern restoration and then going in to make the final crown, you’re operating on the tooth twice instead of once. There is a risk of damage to the pulp of the tooth whenever we operate, so it’s definitely something to think about.
At Mead Family Dental we strive to give our patients the options they need to keep their teeth as well as their budget happy! This Saginaw dentist understands that life is often about compromise, so we offer ways to help sick teeth even when finances are a problem. Most times, we can put a tooth in trouble in a holding pattern so it’s ready for more definitive treatment when we’re able!
Did you find this post loopy? Did it make you take off and spread your wings? 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.
The sudden drop, the wind racing through your hair, the speeding around the curves and some loop the loops. You’re on a thrill ride of a lifetime! If you’re a fan of roller coasters, you know exactly what I’m talking about. Most coaster fans really like the giant drop at the beginning more than any other part.
Did you know that you have a kind of roller coaster in your mouth every single day? The pH of your mouth is constantly going up and down all throughout the day.
Ideally, your mouth is at a pretty neutral pH, around 7. When you consume something that the bacteria in your mouth can eat, they will metabolize this into an acid. Have you ever noticed after eating a candy bar or something else really sweet that you get a sour taste in your mouth for awhile? “Sour” is the taste that detects acidity. When you notice that sour taste in your mouth, you should realize that there has been a drop in your mouth’s pH. If the pH in your mouth drops below the critical pH (about 5.5 or so), you are at risk for tooth enamel and dentin to start dissolving!
When you draw the drop in pH against time on a graph, it looks like a very steep roller coaster. Once this roller coaster drops past a pH of 5.5, your teeth are at risk for cavities! How quickly does the roller coaster rise past that critical pH again? Well, that depends. In a healthy person with normal saliva flow it’s somewhere around 25-30 minutes. Someone with xerostomia (dry mouth) might stay below this critical pH for significantly longer. Saliva has the ability to buffer the pH in your mouth. A buffer solution keeps the pH more stable and helps to restore the pH in your mouth to a neutral level. So, if you have a healthy saliva flow, you’re at less risk for cavities due to the pH roller coaster!
So, let’s say you want to make this roller coaster ride a little more predictable and a lot less bumpy for your teeth. What should you do?
avoid sweets and acidy foods: sweets and acidy foods (like pop) cause a steeper and deeper roller coaster drop. Whenever possible, avoid these foods. When you are going to eat or drink them, do it along with regular meals.
avoid lots of snacking: you jump on the pH roller coaster every time you eat or drink something. The less often you do, the less time your mouth spends below the critical pH.
chew sugarless gum after meals and snacks: chewing sugarless gum will stimulate saliva flow, and saliva flow can bring a low pH back up to a safe level more quickly than without.
Roller coasters in real life are a blast. The pH roller coaster that goes on in your mouth isn’t as much fun. But, you can take control with these simple rules and you’ll reduce your risk of cavities!
Did you find this post thrilling? Did it make you scream out loud? 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.
This is the story of a tooth. A very groovy tooth. It’s also about the patient who is attached to that tooth. You see, I saw this patient last week. She presented to my office with a “broken tooth.”
All dentists know that what a patient thinks of as “a broken tooth” can range from a tiny chip to a huge piece missing. When I saw her on the schedule I didn’t know what to expect, but I did know that she hadn’t been seen at our office for almost 5 years and she had some previous treatment recommended that hadn’t been completed.
The patient told me that she had broken the tooth when she was chewing on something kind of hard. The tooth hadn’t been hurting her before it broke, but now that it was broken, it was kind of sensitive. Especially when she chewed.
Then I took a look. This was a seriously broken tooth! About half of the back side of the tooth had broken off and it was broken all the way down to the gum line. I was actually a little surprised that the tooth didn’t hurt more. Usually when you’ve got a break this big it’s because 1) there is a large cavity that had undermined that part of the tooth or 2) the tooth had a large filling that had come out. The records showed that the tooth had never had a filling before, but we had recommended cleaning out and filling the pits and fissures (aka: grooves) on the bite surface of the tooth. You’ll notice in the photo that this tooth has very darkly stained grooves. This patient is a high risk for tooth decay due to her diet and these deep grooves are a large risk factor for her as well.
You’re probably thinking, “hey wait a second, doc. Almost half of that tooth is broken off. Those pits and fissures couldn’t have caused that! They’re just little tiny grooves! It must have been an olive pit or something!” I was thinking the same thing. So I decided to do a little detective work.
I had a photo taken with an intraoral camera of this tooth from April 2008. It actually showed a little bit of failing pit and fissure sealant hanging in there. Even then you could see those dark grooves. This visit in 2008 was when we recommended she have those grooves cleaned out and filled.
Unfortunately, that didn’t happen. The story picks back up at the beginning of February, 2013. A big piece of the tooth came off when she was eating something hard while watching the Super Bowl. It started hurting a little bit after that, and she knew she’d have to do something.
The tooth did have a lot of decay, and the decay had undermined the broken part of the tooth. How do I know that? Take a look at this photo of the same tooth at a different angle. The hard, outer layer of tooth is called enamel and is much more resistant to decay than the softer, inner layer of tooth, called dentin. Grooves are weakened areas in the enamel and many grooves communicate right into the dentin.
Decay causing bacteria cover the teeth, but they prefer deep, dark wet places. Places like pits and fissures. And since these grooves are actually weakened areas, the bugs and the acid they produce can slip right through the harder enamel layer and start decaying the dentin. You can actually see the path the decay took over time, right through these deep grooves into the soft, defenseless dentin. Over a period of years, this decay grew into a big cavity and undermined the enamel layer above it. Then, on Super Bowl Sunday, the patient bit onto the tooth just right, and crack!The tooth broke away leaving this soft, affected dentin layer.
So that’s my groovy story. It’s kind of a sad story, because the patient is either going to need a root canal and a crown or she’s going to lose the tooth. But like all good stories, this one has a moral. The moral of this story is to have your grooves evaluated! If you’ve got deep pits and fissures, you have a greater risk for this type of decay. And, left untreated, it can cause a lot of dental strife!
Did you find this post groovy? Mysterious? 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.
My fuel light dinged on my way to work this morning. I stopped at the station where I normally fill up and went through the routine. I actually didn’t notice the price per gallon until I was already pumping. The price was $3.34/gallon.
First I thought, “wow! That’s 15 cents less than the last time I filled up! What a great deal!”
Then I thought a little harder, “actually, I remember when I could fill my talk for less than $20. Man, gas is expensive!”
I probably thought it was expensive back then, too. Gas is funny that way. I can’t remember a time where I ever felt like I was getting a great deal on gas. It’s probably because gas is something I need to run my car. If I don’t put gas in there, my car doesn’t run.
I’d prefer not to spend a single dollar on gas. Given my choice, I’d probably spend it on a new smartphone or some nice new shoes. I’d probably go online and research online which smartphone is the best and I’d probably post some photos of my new shoes on Facebook for my friends to see. I’ve never bragged to my friends about my new tank of gas.
Say you head to your dentist’s office to have your teeth examined and a “cleaning.” The doctor takes a ridiculously huge and ugly photo of one of your lower back teeth that shows a giant black filling. He says, “this filling is failing and there’s a cavity under it. In order to fix it, we need to do a crown. It’s going to cost about $1100.”
“Wow…I don’t know what to say. $1100 is a lot of money! And it doesn’t even hurt!”
Now pretend that the dentist said, “this filling is failing and there’s a cavity under it. In order to fix it, we need to do a crown. It’s going to cost about $800.”
I just saved you $300, so you’re probably psyched about the sweet deal, right?
Ummmm…not so much. Is there any number that the dentist throws at you that makes you think, “wow, that’s a fantastic deal on a time consuming and potentially uncomfortable procedure! I think I’ll have two?” Probably not.
Let’s face it…health care is expensive. The difference is that at a dentist’s office you actually know the price of the services that you consume. At your doctor’s office or a hospital, that kind of transparency doesn’t exist. They tell you what you need, you say, “O.K.” and then they send everything to your insurance company. Then you get to play “medical bill Bingo” in a few weeks to see how much you’ll have to write a check for.
Does this look like a root canal?
The more needs you have, the more expensive your treatment will be. A GMC dually pickup has much greater fuel needs than a Prius, and so it’s much more expensive to drive. If you have high risk factors for decay (lots of existing fillings and crowns, lots of mouth drying medications, drink a lot of pop, only visit the dentist when something hurts, etc.), you’re totally driving that dually. Would you prefer the fuel costs of that Prius? Here’s a few tips:
Visit your dentist often! At least every 6 months!
If you have a tooth problem, don’t wait! Call us right away…even if it doesn’t hurt!
Drink pop sparingly. And when you do, consume it at meals or use the “two minute warning” technique.
Ask questions about your dental condition and especially any treatment recommended by your dental team. Make sure you understand the costs of treatment before it starts!
Of course you’d rather not pay for dentistry. Just like gasoline, it ends up on the needs shelf rather than the wants shelf. At least it does if you want to keep your teeth! However now, every time you are waiting for your tank to fill, you’ll think of these hints to keep dental costs down. Curse you, Mead! I used to use that time for deciding what to have for lunch.
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I’ve received quite a bit of reader feedback about myposts about dental x-rays. A lot of people have a lot of strongly held beliefs about x-rays, how harmful they are and how dentists overuse them. One reader recently wrote me an email on the topic:
“Hi Alan, First I would like to say, that no amount of radiation is safe.. No one has done long term studies to tell us what is happening to patients being x rayed… Every six months to a year.. We know what happened in 3 mile island, Chernobyl, Hiroshima, sodium reactor disaster in Chatsworth California and many others… We see thousands of patients coming in to hospitals with brain tumors, thyroid tumors , acoustic neuromas. I’m not implying there all related to dental x rays, I’m just using common sense. Radiation near these vital areas don’t mix.. We must change the way we view radiation!!! It’s not safe.. It’s very dangerous!!”
The reader believes that no radiation is safe. He compares radiation from nuclear blasts and meltdowns (Hiroshima and Chernobyl) to the radiation one is exposed to at the dental office. He further goes on to imply that dentists overuse x-rays and that we should only use them when a patient is having a problem.
“I’m my opinion, dentist are using too much radiation and don’t care if patients get cancer or tumors. The central nervous system, thyroid, pituitary, parotid glands are extremely too close! I can’t tell you how many times I’ve gone to the dentist ( I go every six months ) and he or she want x rays I understand dentists have a duty, to make sure there is no bone decay or obscured cavities, but we definitely need a more relaxed approach. In diagnostic radiology we only take x rays when patient has a problem, we don’t just take to try and find something….”
I run into this argument often. In fact, much of radiology (medical or dental) is about taking diagnostic radiographs in patients with risk factors to “try and find something.” How about mammograms? Bone density scans? Medicine does use x-ray imaging as a diagnostic test all the time, even before “problems” arise.
“Nothing to see here. Just minding my own business…”
I recently was examining a patient during their recall appointment. My attention was focused on a restoration that had broken. The tooth right next to it didn’t appear to have any problems at first glance. It appeared innocent, but it was hiding an insidious secret. Once I reviewed the x-ray images that had been made I could see a cavity hiding in between the teeth. And it wasn’t a little one! It was pretty decent sized and needed attention, even though the patient didn’t complain of any pain or trouble! Luckily, the patient had made an appointment to deal with the broken tooth next door that very day and we were able to address this insidious hiding cavity.
“No x-rays, please.”
The reason we take dental x-rays is to help us see things that we can’t see with our eyes. Patients with low risk (e.g.–have never had a cavity, haven’t had a cavity over a period of years, good oral hygiene) don’t need them as often. This particular patient had a lot of risk factors, including recent cavities and many previous fillings, crowns and root canals. So we take regular x-rays on her.
So, we gave the patient appropriate anesthesia, placed a rubber dam and opened up the tooth. I just so happened to take some video of the procedure, so you can see what a hidden cavity looks like from a “dentist’s eye view.”
This innocent looking tooth was hiding a whopper of a cavity! The x-rays helped me find the hidden cavity and probably spared the patient a painful toothache and root canal treatment. A small dose of x-ray radiation saved this patient a lot of trouble. Dentists don’t take x-rays for fun. We use them as tools to show us parts of your teeth that we cannot see directly with our eyes.
By the way…there was a happy ending to this story! I cleaned out the decay that we found and was able to place a bonded filling in both teeth!
Healthy skepticism about radiation is quite reasonable, but a small dose of radiation can yield big benefits to patients without causing harm. If you have concerns, talk to your dentist. And maybe don’t believe everything you read!
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I sit down next to my patient who has just had her teeth cleaned. The hygienist gives me a quick update of the patients health history, how the patient’s teeth and gums look and alerts me to a couple of teeth that we’ve been keeping an eye on. One tooth has a big silver filling in it with some pretty suspicious looking cracks and the tooth behind it has a pretty suspicious looking shadow around another large silver filling.
The patient says, “I’m not having any troubles with any teeth, doctor.”
I take a look at the teeth. They’re in trouble. Although I don’t have a functioning crystal ball, I can see that one tooth is at risk of breaking. I can follow a crack down the side of the tooth and I can see some discoloration along the crack. Not a good sign. And the filling looks like it’s starting to break down at the edges. The other tooth has a small to moderate sized cavity under the filling. The hygienist and I take a photo of the offending teeth and show it to the patient on the iPad.
I point out the fracture, the broken down filling and the suspicious discoloration. The patient can see my concerns. I explain my treatment recommendation: place a crown on one tooth and replace the filling in another.
So, she immediately makes an appointment to have the work done, right?
Well, sometimes. Sometimes it’s not enough to just describe the problem. Sometimes it’s not enough to show them the problem in living color. Sometimes, patients have objections.
Assuming the patient understands the problem and understands the solution I’m proposing, there are four main objections patients typically have: time, fear, cost and trust.
Time: Sometimes the patient is just too busy to do anything about it right now. It’s not that they won’t do anything, but right now isn’t good. Perhaps they have their daughter’s wedding coming up. Maybe they’ve got everyone coming to Thanksgiving dinner at their house. Often, it’s other medical issues that are just more pressing at the moment. It’s happened many times that a patient breaks a tooth a couple days before they’re scheduled to have a hip replacement or some other surgery they’ve been waiting to have for awhile. When time is the issue, it’s rarely a big problem.
Fear: Some people are going to avoid dental work because they’re afraid of the process. No surprise there. A lot of adults had bad experiences at the dentist when they were younger. Some folks have had experienced negative stuff in the dental office as adults. It seems like everyone has a horror story of their experiences in the dental office. Technology and techniques in dentistry have come a long way over the years. We can usually keep patients comfortable through procedures and afterwards. For those that need help with their anxiety, dentistry has various pharmacological options to help keep patients relaxed throughout procedures. However, this fear is real. It keeps a lot of people out of the dentist and in pain. It takes a lot more good experiences to outweigh past bad experiences, so we go out of our way not to be the bad experience that a patient remembers for the rest of their life! If fear is your objection, we’re happy to talk to you about it and see what we can do to help control that fear.
“Wait one minute there, Doc!”
Cost: Cost is always a concern. It’s not always an objection, but no one wants to spend any more than is necessary to get a great result. Dentistry can be expensive. Especially if you’re surprised by something that you can’t plan for. That’s why we believe strongly in preventive visits. If you come in regularly and have us look things over, there’s less likely a need for the expensive stuff. And if there is need, we can plan for it so it isn’t such a financial hit. On the other hand, if there is one objection that keeps most people from getting the best dental care, it’s cost. Many people can’t or won’t spend any more than the absolute minimum on dental health. I’m frustrated by this on a daily basis. There are some pretty amazing treatments that dentistry has to offer that people don’t choose because of money. I often have to remind myself of my duty to patients, which is to diagnose their problems, explain treatment options (including the financial arrangements) and let the patient choose. Sometimes it’s hard not to take a patient’s rejection of these awesome treatments personally.
Trust: I’ve written about this on several occasions in the past. Sometimes a patient just doesn’t trust that the dentist has their best interests in mind. It’s not the timing, it’s not the fear and it’s not the cost. It’s just that they don’t believe that they need that treatment. I feel helpless as a dentist when this happens. When a patient feels that way, they probably need a change. Perhaps a second opinion or even a new dentist. If you don’t trust what your dentist is telling you, do yourself a favor and do something different. Whatever you do, don’t just keep feeling like your dentist is trying to sell you unnecessary treatment. If the relationship doesn’t work, move on. Seriously! It will be better for everyone!
These are the 4 main objections I run into on a regular basis. Sometimes I’m able to help a patient move past them. Other times, not so much. I keep coming back to what my duty is. I can’t make choices for patients. What I can do is: diagnose, explain the options and allow the patient to make the right choice for themselves. I’ll keep doing my best at that!
Did you find this post objectionable? Mind changing? 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!