Every dentist has experienced it before. Patients refuse x-rays because they don’t want to be exposed to too much radiation. What is “too much radiation?” That’s a great question.
Medical professionals have been taught since the 1940’s that medical and dental imaging carries a tiny chance of increasing a person’s cancer risk, no matter how low the dose. The model that we were taught is called the “linear no-threshold model” (LNT) and it basically claims that any dose of radiation, no matter how small, carries an increased risk of causing cancer. As dentists, we are supposed to weigh this tiny (but not zero) increase in risk against the benefits of whatever x-ray image we wanted to see.
New research published in the American Journal of Clinical Oncology has re-evaluated the original research that we based the LNT model on and has found it to be unconvincing. The original research was performed by exposing fruit flies to various doses of radiation. The damage at each level was measured and the research made the assumption that there is no completely risk-free level of radiation.
In the LNT model, the well-established cancer-causing effects of high doses of radiation are extended downward in a straight line to very low doses. The LNT model assumes there is no safe dose of radiation, no matter how small. However, the human body has evolved the ability to repair damage from low-dose radiation that naturally occurs in the environment.
Basically, the radiation doses that were studied in the 40’s were much to high to extrapolate into low dose medical uses of radiation. We’ve based our concerns about x-ray radiation on doses that are much higher than those experienced by patients. The recent paper was specifically about CT scans, which actually have a much higher exposure to radiation than dental x-rays.
As a profession, dentistry has gone out of its way to expose patients to as little x-ray radiation as possible. But many patient still balk. The effectiveness of x-rays for dental diagnosis cannot be underestimated. But not only are they effective, current research suggests that they are completely safe.
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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.
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.
Back 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.
We’ve just put away the Halloween decorations. It’s less about ghosts and goblins now and more about turkey and stuffing.
But I hear this noise. It’s a quiet, barely audible ticking. But it seems like it’s getting a little louder. And a little louder.
You see, although the calendar says we have 1/6th of the year left, it kind of lies. Because time in the last two months of the year becomes much more precious. The holidays bring their own special kind of busy. Whether it’s stocking up for a Thanksgiving feast or Christmas shopping for the grandkids, everything takes time.
If you’re anything like me…you’ve let things pile up. You’ve got a lot of things you were hoping to get done in 2015 and now we’re getting close to the end of the year.
A lot of you probably left some needed dental work until now. Now is the time you can use benefits without worrying about the fact that you “might need them for an emergency.” Your benefits run out at the end of this year and you’re leaving money on the table. You’ve already spent those dollars on premiums or spend downs. My friends, that money is gone.
If you’ve got benefits left and treatment that’s been diagnosed…it’s go time. It’s “let’s use the benefits we paid for time.” Let’s do this.
Call (989) 799-9133. As of now (November 1st…and counting) we’ve still got a little room on the schedule. But it’s going to fill up.
Do. Not. Wait.
That ticking you’re hearing…it’s going to get louder.
Did this make you feel urgent? Are you feeling like you need to get some dental work done? 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.
A couple of days ago a friend was complaining to me that he had gotten something stuck between his teeth. He’d had lunch at a barbecue joint and wouldn’t you know it he had some brisket jammed between his molars. He was looking for a toothpick or a straw to get it out because it was kind of uncomfortable.
If you’ve ever suffered the same fate you’ll know what I’m talking about. It isn’t necessarily painful, but it’s a kind of persistent pressure that doesn’t really let up until you get whatever is jammed in there out. There are a lot of nerve endings in the gums and the tissues that support the teeth that tell you brain, “hey, something funny is going on here.”
So I whipped out the floss that I carry in my pocket and rescued him. It took him about to seconds to snap the offending piece of brisket out and he was good to go.
“I’m lucky you’re a dentist,” he said as if it’s a given that dentists don’t go anywhere without floss, a toothbrush and maybe a spare dental mirror for good measure. The reality is my dirty little secret.
In a perfect world, the contacts between your teeth are tight enough that normal chewing doesn’t wedge food between them. Too tight makes it so flossing to remove plaque and food debris is difficult or impossible, but too loose means food can become impacted. Food impaction is an inconvenience to be sure, but it can become a problem. A spot where food impacts is more prone to decay simply due to the fact that you cannot remove the debris. The bugs (and by bugs, I mean bacteria) that sit there will metabolize the sugars in the impacted food into acid. When the pH of that part of the mouth reaches a critical level (5.5 to be exact) then the enamel of your teeth will start to dissolve. The longer impacted gunk sits there, the greater the chances that the pH can drop into dangerous levels and cause cavities.
Impacted food can also cause gum problems. I’ve spoken with periodontists (gum specialists) that have removed popcorn kernels from gum abscesses. People with gum disease are more prone to food impaction because their teeth are slightly more mobile than those without bone loss around their teeth. The bottom line is that places where food gets impacted are at greater risk for cavities and gum disease.
Why do we have spots where food gets stuck? Well, some people have naturally loose contacts between their teeth. As I mentioned, people with gum disease are definitely more likely to get stuff stuck in their teeth. If you have a broken or badly decayed tooth they will often be a spot that holds food debris. Finally, dental restorations like fillings or crowns can have inadequate contacts and be a risk factor on their own.
How do we fix it? Well, if you have naturally loose contacts between your teeth I’m not going to “fix” them if they don’t have disease. Those folks need to be extra careful in their brushing and flossing habits. Contacts that are particularly annoying to a patient can usually be “closed” in a minimally invasive fashion if the patient chooses. But if the loose contact in question is caused by decay or worse, the tooth is broken, we better fix it pretty fast!
Dentists probably floss more often than regular folks, but there is no law that requires dentists to carry floss. I carry floss because I have two very loose contacts. Both of them are caused by restorations that have opened up over time. I need to get them fixed and I’ve been procrastinating. That’s my dirty little secret. It may surprise you that dentists are like other human beings…some of us put off treatment that’s necessary, too. But that’s no excuse! Let’s unite in our commitment to close open contacts! No more food impaction!
Did this make you feel ashamed? Do you feel differently about dentists? 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.
Let me get this out of the way. I think it’s deplorable that someone would want to trophy hunt a lion. My understanding is that it is legal if properly permitted. So I don’t believe it’s criminal. But I believe it is a horrible thing to do. You may disagree with me and I respect your opinion, but you’re not likely going to sway me on this one.
Here’s the problem. Every story I’ve seen about Cecil the lion leads with the fact that the hunter who killed him is a dentist. It seems important to the media coverage that he’s a dentist. In fact, it’s making a lot of dentists I know kind of defensive.
You may be interested to know that dentists aren’t monolithic on the topic of trophy hunting lions. In fact, I think you’ll find most of them feel strongly that it’s a terrible idea. But apparently it’s a very important part of this breaking news that the guy who killed Cecil the lion is a dentist. Why would this be?
First, most people think dentists are overpaid. Most of the news stories describe the amount the hunter paid to hunt and kill Cecil the lion. Most of the accounts I’ve read claim that he paid over $50,000 for the privilege. Of course it’s not very far from that to “if he’s got $50,000 to spend on that then he makes too much money.” Perhaps there is an argument to be made that dentists are overpaid, but it’s patently unfair to make that argument in the context of this story. This is one guy. One guy who (in my opinion) chose to do something very stupid and reprehensible with his time and money. The fact that he spent a ton of cash to go kill a lion has nothing to do with the price of your crown and it doesn’t mean that dentists get paid too much.
Secondly, many people have had bad experiences with dentists. I can say with confidence that every dentist I know tries their hardest to make the experience as painless and comfortable as possible, but it’s not always possible. If you have an abscessed tooth, they often times hurt. And it’s not our fault that they do. It’s mostly yours. We do our very best to get you out of pain. But unfortunately, dentists get associated with that pain. All dentists carry this burden with them.
But that doesn’t make us bad people. It makes us the people that try to help you when you’re in a bad situation. Dentists can be bad (or more often, very good) people. But it’s completely separate from our profession.
You can defend the guy that killed Cecil the lion or you can hate him. But don’t do either simply because he’s a dentist.
Did this make you want to roar? Do you feel differently about dentists? 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.