I remember seeing a commercial for a cholesterol medication in which the person playing the doctor says, “I wish my patients could see what I see.” I think there are two ways to look at that statement.

The commercial showed an image of animated artery walls clogging with particles of plaque, clinging to one another, making the opening of the artery smaller and smaller. This is a visual that is easy to understand.

The second, and more subtle way to take this statement, is the doctor wishing that patients could see what happens to people over time, with and without compliance to taking medication or changing their diet. If patients could only understand and use the vast experiences of the doctor to make better decisions for themselves, wouldn’t everyone choose to do all the “right” things for a better and healthier life? Conventional wisdom would say “yes”, but reality says something different.

I have been photographing teeth since dental school in the 1990’s. Of course, back then I was using slides, and had to get them developed. Digital changed everything.  When I ask a patient if I can take a series of pictures of their teeth, the response I often hear is, “Sure, I just have never had anyone do that.” I explain that the photographs are used for documentation and communication.

Showing a patient visual images of their own teeth is by far the most powerful tool I use in practice. Patients often get frustrated when a dentist explains and recommends treatment they can’t see.  Pictures help in telling the story, and help patients make better informed decisions.

When displaying the images and giving the patient a tour of their own mouth, the patient will often say, “Wow, that doesn’t look good. I can’t believe that is in my mouth.” Photographs help in explaining why things look the way they do. From there it is easier to explain to patients what to expect in the future. Photographs are invaluable for this exercise, and most patients appreciate being able to see what I see. For the ones who don’t want to see images of their own mouth, the photos are still needed for documentation and treatment planning.

If a patient has not been to a dentist in a while, or is seeing a new dentist who is doing a complete exam, photographs help patients with decision making. It is important to try to get the patient to look beyond the pictures and envision where they want to be 5, 10, 20+ years down the road. The goal is for the dentist to tie their experience together with where the patient is currently, where they are headed, and give them the opportunity to potentially change the course of their future.

This approach may be different for some patients. It is easy to get overwhelmed by any new concept, but it is important to keep an open mind. Photographs of your own mouth in the dental office are an important part of the doctor/patient relationship, because communication and trust are the keys  to any relationship.

You, as a patient, should look beyond today and make choices for ANY aspect of your health based on where you want to be in the future. Take advantage of the knowledge you gain from all your experiences and make decisions that you feel are right for you.

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.

Dental decay is a bacterial disease that disintegrates tooth structure. Although there is a genetic component, and decay rates can change over an individual’s lifetime, I believe that decay is almost 100% preventable. Other factors in one’s decay rate are diet, home care, medications, xerostomia (dry mouth), and some other medical conditions. The product described below is an effective way to combat dental decay for anyone.

 

What is xylitol?
Xylitol is a natural sugar alcohol that helps prevents cavities. You may recognize other sugar alcohols used in sugarless products, such as mannitol and sorbitol. Xylitol is the sugar alcohol that shows the greatest promise for cavity prevention. It is equal in sweetness and volume to sugar and the granular form can be used in many of the ways that sugar is used, including to sweeten cereals and hot beverages and for baking (except when sugar is needed for yeast to rise).

How does xylitol prevent cavities?
Xylitol inhibits the growth of the bacteria that cause cavities. It does this because these bacteria (Streptococcus mutans) cannot utilize xylitol to grow. Over time with xylitol use, the quality of the bacteria in the mouth changes and fewer and fewer decay-causing bacteria survive on tooth surfaces. Less plaque forms and the level of acids attacking the tooth surface is lowered.

Studies show that Streptococcus mutans is passed from parents to their newborn children, thus beginning the growth of these decay-producing bacteria in the child. Regular use of xylitol by mothers has been demonstrated to significantly reduce this bacterial transmission, resulting in fewer cavities for the child.

What products contain xylitol and how do I find them?
Xylitol is found most often in chewing gum and mints. You must look at the list of ingredients to know if a product contains xylitol. Generally, for the amount of xylitol to be at decay-preventing levels, it must be listed as the first ingredient. Health food stores can be a good resource for xylitol containing products. Additionally, several companies provide xylitol products for distribution over the Internet.

How often must I use xylitol for it to be effective?
Xylitol gum or mints used 3-5 times daily, for a total intake of 5 grams, is considered optimal. Because frequency and duration of exposure is important, gum should be chewed for approximately 5 minutes and mints should be allowed to dissolve. As xylitol is digested slowly in the large intestine, it acts much like fiber and large amounts can lead to soft stools or have a laxative effect. However, the amounts suggested for cavity reduction are far lower than those typically producing unwelcome results.

Has xylitol been evaluated for safety?
Xylitol has been approved for safety by a number of agencies, including the U.S. Food and Drug Administration, the World Health Organization’s Joint Expert Committee on Food Additives and the European Union’s Scientific Committee for Food.

Xylitol has been shown to have decay-preventive qualities, especially for people at moderate to high risk for decay, when used as part of an overall strategy for decay reduction that also includes a healthy diet and good home care. Consult your dentist to help you determine if xylitol use would be beneficial for you.

 

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.

Most people take saliva for granted, but saliva is necessary for proper digestion of food. Saliva also helps protect the mouth from dental decay, gum diseases and bad breath, because it has the natural ability to stop bacterial growth. Having a dry mouth can lead to a metallic taste in the mouth, and the ability to taste food properly decreases. Saliva acts as a major defense mechanism that our bodies need to maintain good oral and systemic health.

Many people don’t realize they have dry mouth, otherwise known as xerostomia, and others find it debilitating. Regardless of whether you feel the effects or not, dry mouth can be very dangerous to your dental health. The most significant issues are rampant dental decay and gum disease.

So, what can cause dry mouth? There are multiple health related conditions and habits that can cause or add to a dry mouth, dry skin and general dryness of the entire body. One cause can be medications. There are over 3,000 prescription and over-the-counter products or medications that can cause dry mouth. You can be on a medication for years before the side effects show up. Dry mouth side effects can also last for a long time after you stop taking a medication.

What else can contribute to dry mouth? Here is a list: hypothyroidism, rheumatoid arthritis, lupus, anemia, Sjogren’s Syndrome, chemo therapy, alcohol consumption, ineffective salivary glands, stress, Alzheimer’s Disease, Parkinson’s Disease, diabetes, allergies, vitamin deficiencies, hypertension, radiation therapy, menopause, depression, smoking, and last but not least, aging.

How do you know if you suffer from, or are at risk for dry mouth? Here are some questions to assess your risk: Has your physician or pharmacist shared with you that a medication you are taking can cause dry mouth? Do you find that you wake up in the middle of the night with a cough, or have a choking feeling and need a drink of water? We produce at least 50% less saliva at night so the side effects are more intense.

Does your tongue feel rough or do you tend to get mouth sores? Does your tongue stick to the roof of your mouth? Do crunchy foods such as potato chips or crackers “scratch” your mouth? Do you have dry, cracked lips and cracks at the corners of your mouth? Do you have thick and sticky saliva? Are your eyes dry and eyes drops are relatively ineffective? Is your skin still dry after using moisturizing lotion?

If you have a positive response to any of these questions, you are at risk from the damaging effects of dry mouth. The first thing to do is to eliminate any of the things that I mentioned as potential causes that are in your control, such as alcohol consumption and tobacco use. I also recommend that patients stay away from alcohol-based mouth rinses, tartar control and whitening toothpastes.

You should also notify your physician and dentist that you have, or are at risk for, dry mouth. There are many products on the market that can be effective to help with the symptoms, and also help to protect your teeth and gums. In addition, there are other prescription products, such as high-fluoride toothpastes and anti-oxidant hydrating toothpastes, mouthwashes and gels that you can only get from your dentist or physician.

Please take dry mouth seriously. The effects can not only be annoying but can also ruin your teeth. Next week I will provide information about one thing that everyone with dry mouth should 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.

Many of us are guilty of stretching the truth when we’re talking to the dentist about things regarding our oral hygiene and health. Even if you think you’ve gotten away with it, the truth is that your dentist isn’t so easily fooled. In fact, they can often tell when you are lying by the state of your mouth and other clues that give it away. Continue reading to learn more from your dentist about which lies they can always tell that patients are telling during their regular cleanings.

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If you missed any of this series, they can be found at www.thetowncommon.com.

Is there a solution to the dental insurance problem we have in this country? Solo dental practitioners may look at it one way, large dental chains see it from a different angle, consumers have varied opinions, and many insurance companies see it in their own very different perspective.

Ask someone how they feel about their medical insurance, and they might say that premiums are too high, deductibles are too high, they can’t go to who they want, it’s tough to get appointments sometimes (especially with specialists), etc. Employers looking to cut costs obviously tend to choose lower cost plans. That usually increases deductibles and may limit which providers the employee is able to see. Depending on your insurance, you may have decreased benefits or none at all, if you see a provider outside of “your network”.

What does “in-network” vs. “out-of-network” mean? A long time ago, if you had insurance, you could go to anyone and use your benefits. PPO’s and HMO’s eventually formed and were able to provide lower premiums by contracting with providers who agreed to a discounted fee for their services – the “in-network” providers.  Providers who do not sign that agreement are considered “out-of-network” providers. Your insurance company decides your benefit level for both in and out-of-network providers. The goal for the insurance company is simple: pay-out as little as possible for the biggest profit.

This is the way dental insurance is trending in this country. There are fewer plans being offered that will allow you to use your benefits with providers outside of their network. Why? It depends on who you ask, but I believe the primary reason is to control costs. And that is understandable…if you’re the insurance company.

If you were running a business with a 70% overhead and a major supplier of your revenue decided they were going to pay you 30% less, would you be able to run your business the same way? Of course not. You would need to do things faster, do more of it, and control your costs by investing less in the business, using cheaper materials and paying people less. There is only one winner in that game. The alternative is to not accept the 30% less, have fewer customers, and run your business the way you see fit, in the best interest of your customers.

You can’t be very happy reading this, as a business owner, employee, and/or consumer. It is important to advocate for yourself, especially when it comes to your health.

I frequently get asked, “Should I consider getting dental insurance?” by patients who are either self-employed or are not offered insurance through their employer. In most cases, in my opinion, it does not make sense to purchase dental insurance on your own – at least the way that dental insurance currently works. You should definitely talk to your own dentist about that prior to purchasing something.

What happens if your dentist doesn’t take (or isn’t in network) with your insurance anymore? Should you stay? How do you find a provider in your network if you choose to leave? What other things do you need to consider in making a decision?

….to be continued

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.

If you missed any of this series, they can be found at www.thetowncommon.com.

The dental insurance industry is getting more and more competitive. Insurance companies are looking to increase profits, and those purchasing dental insurance (usually employers) are mindful of the cost of plans. To increase profits, insurance companies either have to continue to increase the cost of their premiums, or decrease their expenditures. Employers certainly do not want to see an increase in premiums. So, most insurance companies are trying to remain competitive by keeping their premiums lower but paying out less in benefits.

This is happening at a rapid rate, and under the radar of those who are supposed to benefit most from the insurance – you, the consumer. Here is the typical scenario:

At the time of the year when employers are looking to renew their plans, typically the spring, they are presented with their options. When they look for the plan they had the previous year, they realize it is not available anymore. The choices they are now given are either to increase the premiums they pay out for each employee, or to choose a new plan that is at or below the cost of their previous year’s plan with less benefits and more restrictions.

What changes when the employer chooses the second option? These plans are typically those that dentists must “participate” in order to be a part of. Prior to insurance companies offering these plans to employers, they have approached dentists to try to get them to participate. It is up to each individual dentist to determine if they choose to participate. If they choose to participate, to be an “in-network” provider, they agree to accept the contracted fees set by the insurance company. That, in itself, is not necessarily is a bad thing. Some insurance companies offer reasonable and fair reimbursement.  However, there are often other compromises that interfere with the provider/patient relationship.

If an employer chooses one of these plans, the employee (and their family) may need to make a decision on what is most important to them when it comes to their oral health care. What happens if the dentist you have been seeing chooses not to participate in that particular plan? You have to decide whether to stay with that dentist as an out-of-network provider, or choose a new dentist who has agreed to be in that plan. Many of these plans have limited providers.

How do you decide whether to stay with the dental office you have been going to for years, or switch? It is your choice. It can be a difficult decision. There are many things which need to be taken into consideration to make this decision. My best advice is to talk to your dental office/dentist about it.

Although there may be financial differences between some providers, in most cases, it may not be as much as you think. There are many excellent dental offices and dentists on the North Shore. The most important consideration, in my opinion, is to be in an office where you like the people and feel comfortable and confident that you are being treated with your best interest in mind.

Are your expectations being met or exceeded at your current dental office? If they are, and all of a sudden your dentist is not on the list of your new insurance carrier, don’t jump ship until you consider everything. And, as I said, talk to your dental office team and get their take. If you do decide to leave and don’t like your new office, I’m sure they’ll take you back.

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.