Our lives are a series of choices. If we feel we don’t have a choice in a particular situation, think again. We usually do have a choice because our actions are based on how we think. How we think is a choice. While not necessarily easy, we can choose to think differently. 

Dental Choices Beyond Your Insurance Company’s Rules

I am going to use dental insurance as an example, since this is supposed to be a dental column. Dentists hear all the time, “My insurance only covers ____”, or “My insurance says they don’t cover that”, or “My insurance company says I can only see a dentist on their list”, or “I can’t do that because I don’t have insurance.” The response that most dentists think, but are usually afraid to say is, “Who is in charge of your dental health, you or your insurance company?”

The first thought you may have when you read this is about money. “If my insurance company doesn’t cover it, I guess I can’t do it.” While you may think you cannot “afford” something, it is a choice. There are varying degrees of dental health. Maybe everyone can’t “afford” optimal care; crowns on teeth that need the protection, esthetic enhancements, replacement of missing teeth, etc., but basic dental care to improve your health is available to everyone. If you are committed to better dental health but have not found that to be true, you are not looking in the right place.

The money barrier to getting the care you need evokes emotions. Emotions in and of themselves have no real value; they are neither good nor bad. They are just sirens alerting us to something we should pay attention to. If we learn to listen to them instead of blindly obeying them, they can be very good teachers. If money evokes a negative emotion when it comes to dental care, it is because you know your dental health is important. You need to make the choice for better dental health, and find the place to help you overcome the barrier of money, or anything else that is holding you back.

I am sure you are aware, especially if you have read these columns over the years, that medical insurance and dental insurance are totally different. Both are broken systems, in my opinion. The fact of the matter is, we (who are ultimately responsible for our own health), have to see it like it is now. We can’t “afford” to wait for politicians and insurance bureaucrats to “figure it out.” Dental insurance has continued to get worse since its inception over 40 years ago. What are we waiting for?

I certainly do not have the answers to fix the problem.  While we wait for everything to miraculously change, you have the freedom to choose what is best for you. It would be nice if you had dental insurance that allowed you to go to whoever you wanted, and get the things done that you need (or want) without asking permission from the insurance company. Can you wait for the system to change? Regardless of insurance, whatever is holding you back, you can change the way you think about dental health.

I am sure this column produces different “emotions” for different people. I would love to hear your comments so I can address them in another column.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating sleep apnea and TMJ problems. 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

Bad breath is breath that has an unpleasant odor. It’s also known as halitosis. This odor can occur from time to time, or it can be long lasting, depending on the cause.

Tongue Bacteria and Other Causes of Bad Breath

Millions of bacteria live in the mouth, particularly on the back of the tongue. In many people, they are the primary causes of bad breath. The mouth’s warm, moist conditions are ideal for the growth of these bacteria. Most bad breath is caused b1y something in the mouth.

Some types of bad breath are considered to be fairly normal. They usually are not health concerns. One example is “morning mouth.” This occurs because of changes in your mouth while you sleep. During the day, saliva washes away decaying food and odors. The body makes less saliva at night. Your mouth becomes dry, and dead cells stick to your tongue and to the inside of your cheeks. When bacteria use these cells for food, they produce a foul odor.

In addition, bad breath can be caused by the following:

Poor dental hygiene – Infrequent or improper brushing and flossing, allows bits of food that are stuck between the teeth to decay inside the mouth. Poor oral hygiene eventually will lead to periodontal (gum) disease, which also can cause bad breath.

Infections in the mouth – These can be caused by either a cavity in a tooth or by periodontal (gum) disease.

Respiratory tract infections – Throat, sinus or lung infections.

External source – Garlic, onions, coffee, tea, cigarette smoking, and chewing tobacco, all contribute to halitosis.

Dry mouth (xerostomia) – This can be caused by salivary gland problems, medicines or “mouth breathing.” A large number of prescriptions and over the counter medicines cause dry mouth. Xerostomia is a major contributor to bad breath and advanced dental decay.

Illnesses – Diabetes, liver disease, kidney disease, lung disease, sinus disease, reflux disease and others.

Bad breath caused by dental problems can be prevented easily with proper home and professional care. Your dentist will review your medical history for conditions that can cause bad breath and for medicines that can cause dry mouth.

Your dentist may refer you to your family physician if an illness is the most likely cause. In severe cases of gum disease, your dentist may suggest that you see a periodontist (a dentist who specializes in gum problems).

If the cause is systemic, you will need diagnostic tests to check for lung infection, diabetes, kidney disease, liver disease or Sjögren’s syndrome. The type of tests you get depends on the suspected illness. You may get blood tests, urine tests, X-rays of the chest or sinuses, or other tests.

The treatment for bad breath depends on the cause. As with all medical issues, it is best to follow regular professional maintenance appointments.

One of the best things you can do daily is scrape your tongue with a…..you guessed it……tongue scraper. Brushing the tongue is not advised as this pushes bacteria further into the tongue. A tongue scraper is designed to pull and collect millions of bacteria that accumulate on the tongue. If you don’t have one, ask your dentist for one at your next appointment.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating sleep apnea and TMJ problems. 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 have sleep apnea, it’s likely that you feel pretty exhausted throughout the day. In fact, daytime sleepiness is one of the most common warning signs of this sleep condition! It may seem pretty tempting to take a nap to catch up on your sleep, but experts say don’t do it! Napping could be problematic for people who are already struggling to get quality sleep at night, and could potentially even make you more tired. Read on as we go over why you may want to consider avoiding naps, especially if you have sleep apnea.

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I’m sure we all agree that keeping up with technology is not easy. From computers to cell phones to cars, and everything in between, changes take place at lightning speed. No matter what we buy, there is always something right around the corner, or already there, that is better.

I purchased a digital x-ray system back in January of 2008. By June of the same year, the same company came out with a smaller, thinner sensor.  This didn’t make mine obsolete, but made me mad because my $10,000 investment made six months before could now be purchased for half the price.

As with most, if not all industries, technology is sweeping the dental field. We are digitizing everything. Offices that are not already “paperless” are moving in that direction. Automated systems for appointment confirmation via text or email, scheduling appointments, paying bills online, filling out online forms, and digital patient charts have been commonplace in dental offices for a while.

Digital X-Rays, Records, and 3D Treatment Planning

Digital radiology is transforming the way we treatment plan and deliver services such as dental implants. This 3-Dimensional technology allows accurate evaluation of biological structures to provide almost pinpoint placement of dental implants that may not have been able to be done using traditional methods. Notice I said “almost” pinpoint accuracy. It’s still not perfect, but it keeps getting better and better.

You may be aware that some dental offices can make crowns chairside without the use of gooey impression materials or the need of a dental laboratory. This technology has been around for over 25 years. The first generation of this technology was pretty cool back in the day, but delivered less than stellar results. Today, it is safe to say, this technology has greatly improved, continues to get better, and is not going away.

While the technology has gotten significantly better, there are still limitations. Currently, this technology uses a reduction method to fabricate restorations. This means that the restoration is milled from a solid block of material. The material choices are somewhat limited but getting better. What’s next? Maybe 3-D printing of whatever material you would like to use.

I read an article recently about 3-D printing technology where the CEO of this particular company working on dental applications said, “If 3D printing hopes to break out of the prototyping niche it has been trapped in for decades, we need to find a disruptive technology that attacks the problem from a fresh perspective.” I think this technology will be a game-changer.

I have always struggled with when to “jump-in” with certain technologies. It’s not an easy decision. The high cost, the learning curve, and knowing there is always something better right around the corner have been the barriers for me. The more I read about what is on the horizon, the more I want to wait for the “next best thing.”

Dentistry is moving fast forward in technological advances. However, two things come to mind about technology and dentistry. The first, is to keep in mind that sometimes the best option may be an older model. For example, gold is still used in dentistry, and definitely has a place in certain circumstances. The second thing, is that someone has to pay for all this advanced dentistry, and the dental insurance companies haven’t changed their model since the 1970’s. Many insurance companies will pay for more of your filling if get a “silver” one than a tooth-colored one.

We not only need to find “disruptive technology” to help prevent dental disease and treat it earlier and better, we need to have a disruptive revolution of dental insurance.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating sleep apnea and TMJ problems. 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

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.

Bone Changes and the Need for Denture Relines

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. He has a special interest in treating sleep apnea and TMJ problems. 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

Disease is defined as, “a disorder of structure or function in a human, animal, or plant, especially one that produces specific signs or symptoms or that affects a specific location and is not simply a direct result of physical injury.” Symptoms are those which are felt and signs are those which are seen. Disease may show signs but no symptoms. Two areas dentists see signs of, often without symptoms, are bruxism (grinding)/clenching and GERD or gastroesophageal reflux disease, causing chemical erosion of the teeth.

Some people present with symptoms relating to these two issues, but more often than not, people do not have symptoms. Dental patients who present with signs of tooth wear or acid destruction 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 of dental work.

However, that’s not really what I wanted to highlight in this week’s column. There are many reasons why people have these two issues. Sometimes these problems are preventable with simple lifestyle changes; other times they need more aggressive treatment because they are coming from the central nervous system or related to something else going on in the body. 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 less time to accomplish. All this can become a source of stress, anxiety and even depression.

This “epidemic” 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!

SSRIs, Teeth Grinding, and Jaw Pain

Dentists see the signs of bruxism or clenching/grinding of the teeth on a regular basis, and some of it is the result of stress and anxiety. But another factor that we have 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 leads to patients having an increased frequency of headaches, jaw pain and other symptoms of clenching/grinding. I have seen many patients who have presented with increased frequency and intensity of symptoms shortly after the patient starts 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.

Sleep can also be affected by all this clenching/grinding going on. Again, symptoms may or may not be present. Dental splints, or orthotics, which are custom-made to treat specific issues, are very underutilized. Often times, patients try generic mouthguards or nightguards with poor results. The right appliance can make all the difference in the world.  

You should certainly discuss any symptoms you have with your dentist and physician. If you don’t have any symptoms but your provider can show you evidence of disease, be open to digging deeper to try to determine the underlying cause. Everything is connected.

Dr. St. Clair maintains a private dental practice in Rowley and Newburyport dedicated to health-centered family dentistry. He has a special interest in treating sleep apnea and TMJ problems. 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.jpstclair@stclairdmd.com