How many teeth do you want to save?

Sometimes patients avoid the dentist out of fear or shame.  They have let themselves go to a point where they cannot fathom anyone looking into their mouth and judging the condition of neglect.

Finding someone who will not judge but being excited about an opportunity to help another human is how most dentists should view the patient.  However, this is not always true.

Some dentists will come up with an ideal treatment plan that could lead to tens of thousands of dollars on the initial meeting.  This can be completely overwhelming for a patient who just meet you.  They have two questions in mind.

  1.  Are you going to hurt me?
  2.  Are you going to take advantage of me?

In all cases, a calming, non-judgmental spirit should be kept.

Initially, when a dentist evaluates the mouth, they will look for infection – tooth and gums.  They will look for abscesses, signs of periodontal disease and obvious decay as well as oral cancer.  Not all signs are obvious so x-rays are essential to see what the condition of the mouth is at that current state.

The big question is, how did the patient come to find themselves in this condition?  The next big question is if fixed, what will prevent it from starting again.

We love to do a “catch-up” session in order to just get back to base zero and then build upon that depending upon what the patient CAN and WILL do otherwise it is pointless.

Gaining momentum at the dentist is what we strive to do.  Many times decay can be like a flat tire – there is an optimum time to fix it where it is relatively inexpensive compared to the other alternatives – getting a new car.

So, how many teeth do you want to keep?  If it is just the front teeth, it won’t be long before they are gone as well.  Teeth need each other for support.  Even though we all want to look good and chew, there will be a time that replacements are necessary.  Sometimes it is essential that certain teeth are kept as anchors to replacement teeth.  Sometimes just because a tooth is fixable doesn’t mean that it will be there in five years.

How long will it last?  Well, that depends on how well you take care of it and when is the next time that it will be checked.


Why a “free exam” can cost you

Recently, a patient came to me because he was having trouble eating.  He had this sore on his lip that was not going away.  He had seen his primary care doctor who had placed him on antibiotics stating that he had sepsis in his lip from a hospital stay.  They were ready to place him on medication for herpes when his wife stated that wasn’t it.  They sought out a dentist.

There are chains of dental offices which are corporate owned who offer a free exam and x-rays due to the back end of the business.  They know cost is something that limits patients to seeking care.

This gentleman did not have upper teeth.  He had a stroke a while back and did not seek having them replaced.  He also had 8 remaining teeth.  He was given a treatment plan for a full set of dentures and was recommended to have the teeth extracted because they were the source of his pain.  The wife stated, he is not hurting in his mouth, it is his lip which was a sore spot and not healing.

Had they proceeded with treatment, it would have cost thousands of dollars and the sore would not likely go away.  Being that he had a stroke, it was very unlikely that he would have the coordination to wear dentures.  This would have handicapped him and further impacted the nutrition he would have been able to injest.

I offered an exam that he would have to pay for which would give them at least some sense of direction how to proceed.  The wife was in desperate need of attention because he was in such pain and nothing was working so far.

I took out my oral pathology book from 30 years ago and looked up non-healing lip ulceration.  He led me to a differential diagnosis of oral cancer.  I suggested he get it biopsied either by an oral surgeon or a dermatologist to make sure of what it was.  I placed some topical numbing cream which finally gave him a little bit of relief.

They sought the dermatologist.  The PA came and said it was herpes and was ready to prescribe some Zovirax..again.  The wife stated she wanted to see the doctor.  The PA said he was busy with patients.  The wife demanded to see him because they too were patients and she had been seen by a “professional”.  The doctor came in and said, let’s do a biopsy.

This came back from the pathology lab as oral squamous cell carcinoma.  He had to have a very invasive surgery to remove it all but all is well now.

If it weren’t for this patient’s wife and questionable judgement, he might have died from this cancer.  There were signs in his history that led to it.  1. History of drinking and smoking, 2.  Prior cancer other places in his body.

Are we too busy or looking after our self interest too much in order to ask a few more questions?  Do we finally wake up and listen when someone refuses to be blown off by prescribing medications?  Do we just expect someone will go away when they don’t get the answer they hope to hear?

The corporate chains are doing what they want to – looking after the profit margin of their shareholders.  Some of these corporate chains are owned by doctors.  Most of them hire dentists right out of school.  They do not have the mentorship of another doctor.  They have the people in there running a mill to sell dentures and extractions and then not take care of them after the fact.

If that is the care you seek for a dental professional, that is fine.  There is a place for you.

If you truly want to look after your oral health, insist on an oral cancer screening and offer to pay for a light assisted oral cancer exam.



Back Up Teeth? Why you need a spare set

Have you ever lost your glasses or had to have a new prescription in them?  Have you ever dropped your cel phone beyond talking on it?

What do you do?  With your glasses, hopefully you can go back to a former pair of prescription glasses until you had the new ones made or refurbished.  With your cel phone, you can transfer your number to an older phone until you get another updated one.

What do you do when you lose or break your denture or partial denture?

Many people have older sets of dentures.  Sometimes a repair or reline can happen within an hour.  I recently had a patient who accidentally flushed them.  She has to wait for my lab to create a new pair.  This will take a few weeks.

It is always good to have a back up set of dentures in case of a crisis, no one wants to be without teeth.  It is a good idea to have your dentures relined or remade every few years as your gums and bones remodel.  Dentures may also change the way they fit if you lose a substantial amount of weight or are on a new  medication.

Yearly dental visits are important whether your have teeth or not in order to check for growths or cancers and fitting of the teeth.


Help – I heard being pregnant makes you lose teeth

Why do pregnant women get decay?  Several women have come into my office stating the baby eats the calcium out of your teeth.  They state they had perfect teeth until they got pregnant and then they lost one tooth per pregnancy.

Is this true?  Do people believe this?  How can a baby take the calcium out of your teeth?  How do they dissolve the enamel from your teeth and make them soft?

Three things cause decay.  Bacteria which metabolizes acid, diet and the strength of the tooth.

Generally women when they find out they are pregnant love the idea of having a baby.  They sometimes develop morning sickness resulting in vomiting or nausea.  When this happens, the acids from your stomach come into your mouth causing the balance of the saliva to be more acidic.  Acid melts teeth.

Let’s be honest, when we throw up, we want to brush our teeth immediately.  We don’t like that icky feeling or taste.  This is crazy but brushing right afterwards causes the acid to be spread around more.

The fact of the matter is, the acid eats your teeth making them decay, not your baby.


ADHD or Sleep Apnea?

Hookah use linked to serious oral conditions

Researchers Link Hookah Use To Serious Oral Conditions.

PRNewswire (10/29) carries a press release on a new study which “found that waterpipe smoking is associated with serious health problems affecting the head and neck region,” according to study author Teja Munshi, BDS, MPH of Rutgers University. Researchers found hookah or “waterpipe smoking to be associated with gum diseases, dry socket, oral cancer and esophageal cancer among other conditions.” The World Health Organization found that “smoking a hookah is the equivalent of smoking 100 cigarettes, based on the duration and number of puffs in a smoking session.” The ADA “has long been a proponent of educating the public about its hazards and has urged for continued research into the adverse health effects of tobacco use.” Additionally, provides information on the dangers of alternative forms of tobacco and an editorial in The Journal of the American Dental Association “warned readers of the potential dangers of e-cigarettes.”

Radiation free way to check for cavities!

Recently, I have incorporated the Carivu dental imaging transilluminaton into my practice.

The first time I realized that dental x-rays were not quite diagnostic enough was my first month in practice twenty years ago.  A lady had come to me with a compact mirror and told me she had a cavity in one of her front teeth.  After examining the x-ray, I could not see decay on the radiograph.  This was before digital radiography so I couldn’t darken the image or enlarge it.  I saw of what she was speaking and she did not take no for an answer.   I anesthetized her and opened the dark area and discovered she was right.

Trans illumination teeth is a wonderful way to discover cracks and to check to see if decay is removed after complete excavation.  If patients could see what we could with our magnification, it would be a whole new world.  Now, with Dexis product, Carivu, you can capture an image so the patient may see it.

I have found this to be a great way of seeing shadows underneath of an existing composite, decay in cracked teeth as well as other previous restorations such as veneers and alloys.  Earlier diagnosis of cracks with decay is in our patient’s best interest.  It is also perfect to send to insurance companies to prove the decay and extent of the cracks which may not show up on an x-ray.

The following link contains a 20 second video that you may see a live patient demonstration seeing decay as well as cracks.  The shadows in between the teeth represent decay.  This is also a great idea for patients who refuse xrays on a regular basis since it does not emit radiation.

The link below shows a demonstration of this wonderful product.

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