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J. Peter St. Clair, DMD Blog

THE SMARTEST OF TEETH

November 13, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 2:33 pm

Most people who visit the dentist hope they leave the dental office hearing the final salutation from the dentist, “Everything looks great!” Teenagers who have made it without any cavities get used to hearing this…..until the wisdom teeth come into play.

Mother Nature is generous when it comes to our teeth. First, we get 20 baby teeth; next we grow 28 permanent teeth; and finally around age 16-18, we start getting our 4 wisdom teeth (unless of course teeth are congenitally missing).

There are usually 4 wisdom teeth, although some may have as few as none. The removal of wisdom teeth is usually recommended for one of the following reasons:

  • When the jaw is not large enough to accommodate the wisdom teeth, causing the teeth to become impacted (unable to grow in) or misaligned.
  • When wisdom teeth only partially erupt, leaving an opening for bacteria to enter around the tooth and cause infection.
  • When there is a chance that poorly aligned wisdom teeth will damage adjacent teeth.
  • When the wisdom teeth, because they are difficult to clean, cause periodontal (gum) problems with adjacent teeth.
  • When a cyst (fluid-filled sac) forms and destroys surrounding structures, such as bone or tooth roots.

As soon as it is determined that the wisdom teeth are, or will become partially or fully impacted, they should be removed. This usually occurs between ages 16 to 18, as soon as the jaw has attained the majority of its adult size. Although it is less common, there are times when wisdom teeth will fit and do not need to be removed. You need either a large mouth or small teeth for this to occur.

Removing impacted wisdom teeth at this time has several advantages. First, at this age, the roots are seldom fully formed, even though the tooth has become impacted. If left in place, the tooth will not erupt any further into the mouth but the roots will continue to grow.

Removing an impacted wisdom tooth before the roots are fully formed is easier and less traumatic for the patient. Also, at this stage in the patient’s development, the bone surrounding the impacted tooth is more pliable. Typically, patients having wisdom teeth removed in their mid-teens heal more rapidly and have a shorter and less complicated postoperative recovery.

There are many adults who still have their wisdom teeth. In my experience, I have seen very few adults who are able to keep their wisdom teeth for their lifetime. They usually cause some kind of problem, which often times does not hurt, as the problem develops. For example, my father-in-law recently needed a partially impacted wisdom tooth removed (which should have been removed about 50 years ago) and lost the molar in front of it because of the damage it had caused.

Today, the vast majority of patients have their wisdom teeth removed in an oral surgeon’s office. It’s not something anyone really wants to do, but the result in most cases is a lifetime of less potential issues.   If you still have your wisdom teeth, ask your dentist about their status.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

DENTURE MAINTENANCE

November 5, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 7:51 pm

Contrary to what many denture-wearers believe, dentures require regular maintenance, including relines, repairs, and replacement. In fact, the average denture should be relined every two to three years and replaced every five to seven years for the most optimal fitting prosthesis. There are many reasons for this maintenance interval and for regular dental examinations, whether or not the patient perceives any problem.

The first problem has to do with the basic function of the bone surrounding natural teeth. Natural teeth are held in their sockets by thousands of “cables”, called the periodontal ligament that tug and pull on the supporting bone during function. The bone is designed to be strengthened and stimulated in this manner. When the teeth are removed, the bone no longer has appropriate stimulation, and shrinkage occurs unless it is directly loaded again with dental implants. Bone atrophy is accelerated by inappropriate forces caused by loose and ill-fitting dentures.

Relining, or replacing the tissue surface of the denture, helps preserve bone by adapting dentures to the gums as they shrink, but it is only helpful for dentures that are otherwise in good condition, which includes a proper bite relationship. Relining also helps to encourage health of the soft tissues because dentures plastic is porous and becomes heavily laden with bacteria and yeast over time. Relining refreshes the tissue surface of dentures with new acrylic. Sometimes a more advanced type of relining, called rebasing, is the treatment of choice when all of the pink portion of a denture is in poor condition and needs to be replaced.

New dentures should be made when relining or rebasing of dentures can no longer re-establish proper fit and function. Often this is obvious by wear or fracture of the denture teeth. When dentures contribute to headaches or when the patient’s face begins to look “collapsed” or “old”, the need for new dentures is likely.

Lastly, but certainly not of least importance, denture wearers need to stay current with regular dental examinations for inspection of not only the dentures but the tissue for pre-cancerous lesions. Since most people feel they do not need to go to the dentist once they have dentures, many early pre-cancerous lesions are missed.

Everyone is at risk for oral cancer, whether they have teeth or not. In fact, the constant “trauma” and lack of blood circulation caused by chronic denture wear increases the risk for oral cancer development. For this reason alone, annual dental examinations are recommended for denture wearers.

Many patients with older dentures report their dentures fit fine. You can relate this to the fit of shoes. Shoes get broken in over time and seem comfortable. However, the fact is, over time shoes lose their ability to provide proper support. Even though they may be comfortable, they may be causing other problems due to this lack of support.

If you are a denture wearer and have not seen a dentist in a year or more, it’s time to consider a dental visit. Learn about how your dentures are fitting and whether relining or replacing them makes sense. For most, it is also never too late to consider the benefits of dental implants to help preserve bone and secure dentures in place.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

ASK THE DENTIST

October 29, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 2:27 pm

Recent questions from readers answered.

Mary D:  I was recently told by a dentist that I need a root canal, a post, periodontal crown lengthening surgery and a crown. The total cost of treatment is $4500! Do I have any alternatives?

That is a difficult question to answer without seeing the specific case, but here are some thoughts. There are quite a few things to consider. The first is the general condition of the teeth. If you have numerous other dental problems that need to be addressed, you must prioritize these and decide if the cost of doing them all is something you can afford. The last thing you want to do is spend $4500 on one tooth and then be out of funds to address the other problems. This could lead to more serious problems in the future.

Let’s assume that this is the only tooth that needs to be addressed. I would look at your past history of dental problems. If you have had limited problems with a low rate of dental decay in general, this treatment may be the best option. If you have had a problem with dental decay, the best alternative may be to extract the tooth and do a dental implant. The cost of the treatment would be about the same and there would be no chance of recurrent problems with decay. Dental implants are a highly predictable treatment in this case.

Extracting the tooth and not replacing it can lead to teeth shifting, bite problems and a decrease in function. If the cost of treatment is beyond your means, ask the dentist if they have options to stretch the payment out over a period of time. Another alternative would be a retainer to hold the position of the other teeth until you are able to replace the missing tooth.

Jim G: My son has been in braces for over a year and has multiple teeth with decay. What should we do?

My first question would be – Why does he have so much decay? Although there are many factors, diet and home care are most likely the culprits. If the decay can be easily fixed, the diet can be controlled (i.e. decrease sugar intake), and his home care can improve (including a prescription fluoride toothpaste). That would be the best way to go and the braces treatment can move on. If the decay is extensive and his compliance is poor, the best thing to do may be to remove the braces and wait until improved conditions are met before continuing with the braces.

Linda T: My dentist keeps telling me that I need a bunch of crowns. I don’t have any pain and the crowns seem excessive and costly. Why can’t I just wait until something happens and fix the problem when it arises?

You can wait. However, there is probably a good reason the treatment is being suggested. Often, being proactive in replacement of aging large fillings can prevent bigger problems to come. The purpose of a crown in this situation is to protect the tooth. Waiting for “something to happen” can often mean more treatment down the road such as root canals or gum surgery. If you have multiple teeth that need this treatment, ask for a treatment plan to sequence the treatment over time. This is better than waiting.

Please send me more questions to the email below.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

A PATIENT’S PERSPECTIVE

October 25, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 4:58 pm

I recently read a book called “A Few Words from the Chair: A Patient Speaks to Dentists” by David Clow. This is a book written by a patient (journalist) for dentists. Here is how the book starts.

“Dentistry offers people so much that they want and need. Why don’t people get it? What would permit someone to have this resource available, and fail to use it? What would cause them to misunderstand it so thoroughly that they fear it more than they fear the consequences of not collaborating with a dentist?”

I have written numerous times on the five barriers that patients face in getting ideal dental treatment: fear, money, lack of concern due to absence of pain, using lack of time as an excuse, and lack of trust. Clow offers a statement that gets to the “root” of the issue. “Dentists and patients have extended interactions but hardly any conversations.”

A dentist may be a great tooth fixer, but also a poor communicator at the same time. When was the last time a dentist sat down with you for an extended conversation to discuss your personal situation, the importance and relevance to getting good dental care, and its significance to systemic health? When was the last time a dentist helped you work through your particular barrier to getting a healthier mouth?

Clow goes on to say to us (dentists), “There are gaps here, and like the gaps you work on in your practice, they are problems. The obvious one is between us, between dentist and patient. There’s another between what I really need and what I think I need. Yet another divides what you think you do and what I think you do. And there’s a serious one between the value most dentists have and the value they feel they can discuss.”

Clow says that we (dentists) spend too much time on things that don’t get treatment done in the chair. Technology is one of those things. Dentists tend to be techno-geeks. We’ve got to have digital x-rays, machines that make crowns in the office, and fancy chairs that give massages. That stuff is okay and serves a purpose for some patients, but what about the patients that aren’t committed to any care?

Our time is the greatest thing we have to offer, yet many dentists overlook this. Anyone can drill on a tooth but not everyone has meaningful communication skills.

Have you ever heard the old joke, “How many psychiatrists does it take to change a light bulb? One- but the light bulb has to want to change.” One of the goals I have every day is to change one person’s perspective on dentistry – to just get one person to realize the importance of a healthy mouth. It is not always easy, but these conversations are often the most meaningful and rewarding parts of the day.

The key for us as dentists is to slow down and have more meaningful conversations with our patients. We are often pushed in the wrong direction trying to run a small business, but it is important for us to realize that the human element – the doctor/patient relationship – will always be the most important part of what we do.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Some Tips from a Dentist for Tooth-Friendly Trick-or-Treating

October 24, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 6:53 pm

children in Halloween costumes

Halloween is a great time for building family memories and enjoying delicious treats. But all that sugar consumption can add up to one big toothache unless you follow some tips from your local dentist. Here’s how to keep this witching season both fun and tooth-friendly.

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ONE DENTIST’S OPINION

October 15, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 4:26 pm

Choosing a health care provider is not always the easiest thing to do. There are many factors and sources to consider. When most people finally choose a health care provider, they will stay with that person unless there is some kind of personality conflict or philosophical discrepancy in the perceived need for treatment. Or, there is an insurance issue; we will discuss that in a different column.

It is not uncommon to get a second opinion or a second or third quote for things like car repairs and home improvements. When it comes to our health, it usually depends on the nature of the issue. More complex issues in medicine, such as a diagnosis of cancer, an unknown diagnosis, or other major medical issues in which we have to make decisions about significant treatment, tend to stimulate people to get more than one opinion. In dentistry, it seems that the incidence of second opinions is not as great.

Routine dental care is generally not that complicated. There are many different ways to do the simplest things in dentistry. The method is a function of the dentist’s beliefs and training. It is relatively uncommon for a patient to get a second opinion for this type of maintenance dental care. Although there is some subjectivity as to what different dentists might deem as “needing” to be done, patients usually base their decision on their perceived need. Often times, this perception of need comes from the dentist’s ability to communicate the reasons for treatment.

The patient’s trust in their provider is a big factor. If a patient trusts and genuinely likes their dentist, they may not necessarily do or want to do what the dentist wants them to, but they are comfortable enough to make the decision on treatment. It is when there is a lack of trust for one reason or another that patients tend to venture out for another opinion. This lack of trust usually stems from a personality conflict or the inability of the dentist to communicate with the patient effectively.

Even when there are more complex dental issues, it is my feeling that patients base the need for another opinion on the above. Another important factor is that the patient is given choices. Patients always have the right to choose what treatment they feel is right for themselves. If choices are given and the treatment is properly communicated to the patient, they have the ability to decide in which direction to proceed.

If a dentist properly presents the treatment and the patient decides to do nothing, it is the patient’s choice. It is when treatment is properly presented and this aligns with the patient’s perception of need or desire, that the patient moves forward with treatment.

Fees tend to be a less common reason for patients to seek another opinion. Fees for treatment can definitely vary. The problem with seeking treatment based on fees is that the same treatment in two different offices with different fees can also vary in the level of expertise and precision in which it is done. There are many factors.

A higher fee does not always mean a higher quality product. Fees are generally based on the time involved, the materials used, and the perceived expertise of the provider. Be cautious when seeking treatment based on fees. The fee for treatment should definitely be considered, but the entire treatment presentation should be used to determine your decision. It is always important to ask to see pictures of similar treatment that a particular provider has done and not just common stock photos.

I hope this helps.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at

THE END IS NEAR

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 2:30 pm

October is here!!  This means only 3 months left in 2018. It’s crunch time to get everything done that we haven’t gotten done during the rest of the year. For those with remaining dental benefits, it’s also the time of year to consider utilizing those so you don’t lose them.

Unused dental benefits go directly back to the insurance company, which generates hundreds and hundreds of thousands of dollars for the insurance companies each year. Dental insurance companies count on the fact that many people will not claim their $1000 or so in benefits by the end of the calendar year. Those with dental benefits should look for legitimate means to use these benefits before they are lost.

For example, maybe a crown has been recommended by your dentist but you have procrastinated about it. It would make sense to consider using those dental benefits before the end of the calendar year. This allows a whole new round of dental benefits to be used for unexpected dental needs and maximizes the value of the premiums paid.

Remember, insurance companies are in the business to make money. They don’t want you to use your dental benefits. If the balance (co-payment) you will owe for the dental work that needs to be done is too much for you, consider financing options through your dental office. Most dental offices offer interest-free financing to patients for up to 12 months. Financing your balance in this way may make more financial sense than throwing money away to fund the insurance company’s pocketbooks.

Another thing to consider as the end of the year approaches is the use of flex spending accounts. Many employers now offer pre-tax flex spending accounts for healthcare expenses. Often underutilized, these are excellent mechanisms for saving about 20 percent on needed dental care. If you are paying for your dental insurance premiums, it may even make sense to fund an available flex spending account with that premium money instead of, or in conjunction with it.

For example, if you are anticipating the need for $3000 in dental care, opting to place the $3000 in a flex spending account can save the income tax on those monies and can usually be used as soon as January 1st. If you have money left in a flex spending account, remember to check with your employer to determine if that money needs to be used by the end of the year. You don’t want to lose that money either.

As you begin to make financial decisions for the end of this year and for the upcoming year, consider a discussion with your dental office’s financial person. They are often an untapped wealth of information and can usually thoroughly and knowledgeably discuss your dental financial options with you.

And, don’t wait too long. Dental office schedules get full quickly this time of year with patients trying to use dental insurance benefits and unused flex account money. Maximize your hard earned dollars.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

BACK TO SCHOOL QUIZ

October 1, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 2:57 pm

Students have been back to school for a few weeks now, so it’s time for a quiz. Good luck!

Question #1: The risk factors for gum disease are the same as for heart disease (genetics, smoking, weight, lack of exercise, and high cholesterol).

Answer: False. Genetics and smoking tobacco are major risk factors, but stress, medications, lack of proper hygiene, and systemic problems, such as diabetes, are additional risk factors. Just like heart disease, management of gum disease requires strict maintenance visits to monitor and control the disease.

Question #2: Less than one in ten people will experience a fractured tooth.

Answer: False. About one in four sustain a fracture to a front tooth by the age of 18. If you have older amalgam (silver) fillings, you are at much higher risk for fracture of back teeth.

Question #3: Precancerous lesions are common in the mouths of smokers.

Answer: True. The red and white patches precede malignancy and require biopsy. Precancerous lesions are also common in the mouths of heavy drinkers. Again, regular maintenance visits are essential for monitoring and appropriate referrals to be given for such lesions.

Question #4: Your toothbrush should be changed every six months.

Answer: False. Your toothbrush should be changed every 8-12 weeks. Bacteria accumulation and effectiveness of the bristles make it necessary to change it this often. It should also be replaced after you have been sick. This goes for manual as well as power toothbrush users.

Question #5: The average person will lose less than six teeth by age 72.

Answer: True. According to the Academy of General Dentistry, 5.4 teeth are lost by age 72. This number has declined over the years but there is still room for improvement. Remember, studies show that the quality of life decreases with each tooth lost.

Question #6: Regular use of dental floss may help you live as many as six years longer.

Answer: True. While just 10% of households floss regularly, researchers at SUNY-Buffalo estimate longer lives for flossers. A healthier mouth means less chronic inflammation and a decreased chance of heart disease.

Extra Credit: (True or False) Ancient teeth, with small perfectly round holes in the biting surface may be the earliest archaeological evidence of prehistoric dentistry. Researchers believe a stone bit was used to drill through teeth, as holes of the exact same diameter were found in beads made for jewelry 8-9000 years ago. Scientists speculate that the holes had been filled with plant matter to treat tooth decay.

Answer: True. Feel lucky you live in the 21st Century.

DO YOU CLENCH? – PART 2

September 25, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 7:46 pm

Last week I discussed clenching, which is vertical force put on teeth. Grinding or bruxism is lateral (excursive) forces put on teeth that cause teeth to rub together and wear. Both of these are very destructive to teeth, joints, and muscles.

Some people present with symptoms relating to these two issues, but more often than not, people do not have symptoms. We dentists know that patients who present with signs of tooth wear are riskier to treat. Riskier because the “issues” are often times, and maybe even most often, not treated. This is a significant reason for tooth structure breakdown and shorter life-span dental work.

There are many reasons people grind or clench their teeth. Sometimes these problems are preventable with simple lifestyle changes, and other times they need more aggressive treatment because they are coming from the central nervous system. They can also be caused by certain medications.

In today’s world, everyone is being pushed to their limits in just about every aspect that you can imagine. More is demanded with fewer resources and less time. All this becomes a source of stress, anxiety, and even depression for the population as a whole.

This “epidemic” of depression and anxiety spurred the development of newer medications with fewer side effects to help manage these conditions and hence, the SSRIs (selective serotonin reuptake inhibitors) were born in 1988. Since then, recent reports show that the use of the SSRIs (i.e. Paxil, Zoloft, Prozac, Celexa, Effexor, etc.)  has increased more than 400 percent!

Dentists see the signs of clenching and/or grinding of the teeth on a regular basis, and some of it is the result of stress and anxiety. But another factor to keep in mind is that patients are now taking more anti-anxiety and antidepressants than ever before in history. It is often overlooked, but the SSRIs and even some of the SSNRIs (Selective Serotonin Norepinephrine Reuptake Inhibitors) often increase bruxism or clenching and grinding effects at night.

This can lead to an increased frequency of headaches, jaw pain and other symptoms of clenching/grinding. In my own practice, I have seen many patients who have presented with increased frequency and intensity of symptoms shortly after starting on these medications. I have found that sometimes a change in medication or reduction in the dosage with the help of the prescribing medical doctor can help, but sometimes there seems to be little to no effect.

In recent studies, there is support for a theory of how these medications cause an imbalance in the brain, leading to a drug-induced bruxism that sometimes does not go away with a decrease or cessation of the medication and may even require other medications to help alleviate the bruxism.

So, if you are on any of these medications, the next time you see your dentist you should ask if you have any signs of tooth wear. And, by all means, if you are having any symptoms that you do not feel are normal, you should bring those up too.  If your dentist can show you pathological tooth destruction, you might want to keep in mind that not treating the underlying cause may contribute to unwanted future dental issues.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. If there are certain topics you would like to see written about or questions you have please email them to him at jpstclair@stclairdmd.com. You can view all previously written columns at www.jpeterstclairdentistry.com/blog.

Your Dentist Says Ask These Questions at Your Next Visit

September 20, 2018

Filed under: Uncategorized — Dr. J. Peter St. Clair, DMD @ 11:55 am

young man smiling dentist chair

Visiting your dentist every six months for cleanings and examinations is one of the main ways to protect your mouth, teeth and gums from bacteria growth and the many problems that come along with it. However, your local dentist says you stand to gain even more from preventive dentistry – it’s an educational opportunity for you as well. As you read on, you’ll discover what questions you should be asking at your next visit so you can maximize your time.

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