March 25, 2011

It’s those simple things we use every day that I often wonder about how they got started. The toothbrush is one of those. There are several schools of thought on it, but you need to look far into the past for the first signs of oral hygiene. The Chinese were believed to create the first real toothbrush, but it wasn’t much like the ones we use today. Those first toothbrushes, crafted in the 1400s, didn’t use nylon for bristles, or plastic for the handles.

Bamboo Handles, Animal-Hair Bristles, and Early Toothbrushes

Instead, the handles were crafted from bamboo, one of the most readily-available regional plants. Attached to the bamboo handle was a set of bristles, taken from the tough hair of the Siberian wild boar — specifically, from the back of his neck. This toothbrush is the ancestor of all the brands we use today. But there’s evidence that another form of toothbrush dates up to 3000 years before the birth of Christ. So the history of the toothbrush proves that this version was one of the oldest tools used by man, only truly outdated by the wheel. This style of toothbrush, crafted from sticks, was found inside Egyptian pyramids. Unlike the Chinese version, the end of the stick was flayed, softening the wood fibers. The user then rubbed the stick against his teeth. But this version wasn’t as popular as the Chinese type — it didn’t catch on. The Chinese version spread to Europe, where the Siberian wild boar took the brunt of its growing popularity. The only downside to the hairs of the Siberian wild boar was the fact that they were very rough on the gums. So some people began to use the hairs found on the backs of horses instead, as this was much easier on their gums. Despite the softness of the horse hair bristles, boar hairs were more popular, since horses were so valuable to Europeans. The boar hair toothbrush continued to be used until the early 1900s. In 1937, Wallace H. Carothers, a DuPont chemist, created nylon. This invention forever changed the history of the toothbrush, as well as every other device that required a fibrous material, including ropes. In 1938, nylon became synonymous with “modern,” from the creation of nylon stockings to Dr. West’s first nylon toothbrush. This brush was called Dr. West’s Miracle Toothbrush. Even with this breakthrough in the toothbrush, it wasn’t until World War II that Americans began to take oral hygiene more seriously, as a direct result of the war. This influence spurred the development of even better toothbrushes. Now, there are tons of options, including electric/motorized toothbrushes. My favorite is the Oral-B Triumph that has Bluetooth technology. It has a little digital display that sits on the counter and when the toothbrush turns on, the digital display tells you where to brush and for how long. This way there is no cheating. And here I thought the toothbrush was invented in Maine. Why? Because if it was invented anywhere else it would have been called the teethbrush. Just kidding, those from Maine. In fact, I think one of my patients from Maine actually told me that joke.

March 22, 2011

March is a busy month for me. Last week I was in Atlanta at a national study club I was invited to be a part of. Today I leave for my son’s hockey tournament in Lake Placid and next week I’m off to Haiti for 7 days. I have to find some time to work!! The study club meeting last week was great. I presented some material but got the most out of just talking with other dentists from around the country. A major discussion was the economy and how it has affected our dental practic

Spreading Dental Treatment Costs During a Difficult Economy

es. The common thread amongst most dental offices was patients putting off treatment due to finances or needing to spread treatment out over time if they needed more extensive dental work. We discussed some great techniques on sequencing treatment over multiple years. This allows the patient to spread the treatment out, maximize their dental insurance (if they have it) and get the treatment they need. Another common theme was holding ground on our philosophy of care. As I have said in the past, there are many different ways to do things and for that matter practice dentistry. This particular group of dentists were all very similar in their philosophy of care. They all hold very high standards, are exceptional clinicians and have a patient base that come to them because they realize the level of care is above average. They believe the philosophy of practice revolves around treating the person as a whole and not just a tooth. It means patients, their overall health & well-being, must be foremost in the practitioner’s mind. Yes, it also means cleanings, fillings and crowns. These are often inescapable outcomes to dental disease. However, in this type of economy, it just means that sometimes the dentist has to be a little more creative without sacrificing standards and quality. Too often the dentist views a patient as just a mouth. The goal is to fix as many problems in as many mouths in as short a time as possible. The patient becomes the object of the “fix” instead of a participant in the treatment. How degrading is it for a patient to experience that type of environment? Where is the quality, attention and care when the dentist is busy running room to room? Although for some, this is the type of care they desire because the fees are often lower in this type of setting. The dentist also suffers. How satisfying can it be for a dentist who sees 40 patients a day? What kinds of relationships can that dentist build with his or her patients? How can that dentist spend the necessary time with the patient to really know the patient’s needs and desires? In a truly health-centered practice, each patient should be treated as a unique, whole person. Each patient should be treated with dignity and respect. The dentist gives each patient his/her most important gift: TIME. Taking the time to listen; taking the time to do a complete examination; taking the time to teach the causes of existing and potential dental problems and taking the time to explain alternative treatments and modes of prevention. It means that each patient be given the opportunity to choose the highest level of health consistent with their values and life circumstances. In difficult economic times you may need to postpone certain things that you would like or need. Your health is not one of those. Despite what I hear sometimes – it is not “just a cleaning”. Your mouth is the gateway to your overall health.

March 17, 2011

Last month, Boston Globe columnist Beverly Beckham wrote a column with the above title. I contacted Beverly and she gave me permission to reprint her column. Due to the size of my column, I am printing an excerpt from her original.
I will tell him tomorrow. I will pick-up the phone and call his office and talk to his receptionist and say, “I have to cancel my appointment.” And she will say, “When would you like to reschedule?” And I will say…..What will I say?

The Difficulty of Leaving a Dentist After Thirty Years

I am trying to break up with my dentist, and I don’t know how. I don’t want to hurt his feelings. We’ve been together for 30 years, longer than most marriages.
“How about I tell him I’m moving?” I ask my friend Beth, who is the reason I’m in this mess in the first place. We were walking and she was laughing, and I noticed her back teeth. “How come you don’t have any fillings? Your teeth look perfect.” “ I used to have fillings. These are crowns.” I made her open her mouth. I peered inside. They didn’t look like crowns.
I should have said right then, don’t tell me anymore. I should have blocked my ears and said I have a dentist. I like my dentist. I am not going to leave him. Who sees the inside of my mouth anyway?
But Beth kept talking, and I kept staring at her molars and bicuspids thinking, wow. So I went to meet this dentist. It was just a consultation. Everyone should have a second opinion, right? Trouble is, I liked her. We clicked. Now I have to call the Man who has taken care of my teeth for three long decades and tell him I’m moving. “You can’t tell him that,” Beth says. “Why not? Maybe I will move.” “We’re not moving,” my husband says.
Not too many years ago, I cheated on my hairdresser. A friend, as a birthday present, took me to hers. She watched gleefully as he cut and styled my wild hair and morphed me into a more refined rendition of me. I went back to him once, twice, maybe five times. And then I returned to my hairdresser. Why? Because I missed her. Maybe I’ll miss my dentist too.
In the meantime, though, there’s now. The breakup. The fess up. The records that have to be transferred. The phone call that has to be made.
“Yes, it’s me calling from New Zealand. We moved. It was sudden. I know, I know. I’m going to miss you, too.”
I am sure that many of you can relate to Beverly’s story. I know I can….maybe not with my dentist but with other service providers. We often get caught in a comfort zone. We like the person and there is no real reason to leave. Don’t get me wrong. There is nothing wrong with loyalty. The point is – there are many different ways to do the same thing.
It is difficult for us as consumers to randomly pick people to work on our teeth, cut our hair, service our car, etc. There are so many options. What if we are comfortable where we are? What if we are missing something by not going somewhere else? The only thing we really can do is to keep an open mind and to take the information we learn to make a decision on what we feel is right for us as individuals.

March 11, 2011

Why the Same Patient May Receive Very Different Treatment Plans

Last week I told you about a Reader’s Digest headliner from 1997 called, “Exclusive Investigation: How Dentists Rip Us Off.” The author had traveled around the country with his dental x-rays to different dental offices requesting treatment plans. The recommended treatment ranged from nothing to $30,000. How could this be? Was he really getting “ripped-off”? I bring this up from so long ago because this magazine was sitting in my reception area of my “new” practice back in 1997 and I still see the image every once in a while. I am sure that most dentists do not want people to think that they are trying to rip them off. Every dentist has been on both sides of the fence; patients presenting to us with treatment needed, in our opinion, which is more or less than previously recommended. A substantial proportion of the variation in treatment plans stems from the differences in dentist’s beliefs about dental diseases and the fact that there is never just one right or wrong way to treat any particular patient. A dentist’s philosophy of care is built over his/her entire career dependent on education and personal experience. With that philosophy, the dentist uses diagnostic criteria, knowledge of risk factors, rates of incidence, and prevalence and progression of disease to formulate treatment recommendations. While dentistry is definitely science-based, no one dentist has all the answers. To my knowledge, no dentist can predict the exact longevity of any particular dental treatment. Dentists, as individuals, use their own knowledge and expertise to recommend treatment which they feel, I would hope, is in the best interest of the patient. Don’t anticipate definitive information about risk, progression of disease and outcomes of treatment in the near future. Dental research still channels most of its resources into the development of new and better dental materials. Until a significant portion of these resources is diverted to investigate outcomes of dental treatment, dentistry will remain vulnerable to public scrutiny. As in any profession, there is a wide range of talent in dentistry. There is never any one right way to treat any particular issue. There are so many different factors that go into what is the appropriate treatment for any individual patient. What may be right for one patient may not be right for another. In fact, the treatment a patient agrees to should always be treatment the patient wants and not what the dentist says the patient needs. For the patient to make an educated decision, often times treatment plans ranging widely in cost must be discussed. It is the responsibility of the dentist to diagnose and properly communicate to the patient, in terms they understand, so that they may make the decision that is right for them. It is the patient’s responsibility to make sure they understand their condition and to understand the consequences in doing or not doing any kind of recommended treatment. The most important thing for a patient to have is a solid relationship with their dentist. If a patient thinks they are being “ripped-off” they do not trust their dentist and should move-on to someone else……unless they have a preconceived notion that dentistry in general is a “rip-off”. That would be a subject for another column. I Would love to hear some feedback on Facebook.

March 4, 2011

I remember the date well.

A Dentist’s Response to the 1997 Reader’s Digest Investigation

I had been out of dental school two years, had been in Rowley one year, and the February 1997 issue of Reader’s Digest hit the stands. The front cover read “EXCLUSIVE INVESTIGATION: How Dentists Rip Us Off “. Not only that, it was delivered to my office and was sitting in my reception area. I immediately read the article to make sure I was aware of the contents. Inside, was the all too-familiar graphic depiction of a dentist menacingly hovering over a patient with the dreaded drill in hand. Add to that picture an accumulation of non-complimentary adjectives about dentists. By the author’s skillful manipulation of words, variations in dental practice patterns were presented as evidence of dishonesty. The author’s “investigation” was him bringing x-rays of his teeth to different dentists around the country and getting treatment plans for his own mouth. The treatment plans ranged from nothing to an amazing $30,000! Had the presentation suggested anything about the fact that dental treatment plans can be quite variable between practitioners and encouraged the public to seek additional opinions, it wouldn’t have been so bad. Judging by the public response logged on the Reader’s Digest website, the dental expose more than fulfilled the magazine’s desire to generate controversy and boost sales. One reader commented, “Dentists cannot be trusted! I do not let anyone mess with my teeth. I remove my own tartar…anyone who sees a dentist should have their head examined….not their teeth! They are all crooks!!” Another wrote, “I was hoping that I would be living in one of the cities that had one of the good dentists listed.” Responses from dentists, while strongly admonishing the magazine for inflammatory reporting, often degenerated into windy rhetoric as they tried to refute the article’s charges. To be honest, it was apparent from the dentist’s responses that it rattled the nerves of the individuals who actually cared enough to write in to Reader’s Digest. Could there really be a swing of $30,000 between dentists? Sounds like a lot to me. However, I can tell you that there can be significant differences between dentist’s treatment plans. That is not to say that there are a bunch of quacks out there though. Although there are always some, most dentists give you their honest opinion based on their educational background and philosophy of care. And, this article had nothing to do with the range of fees between dentists. In other words, let’s assume the “treatment plan” was the same for all dentists and there was a comparison of fees between dentists. There can be a wide range there as well. Why is that? Next week I’ll give you my response to “How Dentists Rip Us Off.” I will explain why I feel this “investigation” was unfair as well as a wake-up call from a dentist’s perspective. I will also look at it from your (the patient’s) side and give you some thoughts on how you can protect yourself from being “ripped-off”.