October 2023 - J. Peter St. Clair, DMD, PC Blog

October 30, 2023

Carol’s Second Opinion and Her Questions About Treatment

Dental professional reviewing digital dental scans on a computer monitor with a female patient seated beside her. Multiple dental images appear on the screen during the consultation. This is the story about a woman I met recently named Carol. Carol’s story is the reason I do what I do every day and brings me back the next day. The interesting thing is that it has absolutely nothing to do with performing the actual physical work of dentistry.

Carol is in her 70’s and has gone to the dentist infrequently for most of her life. She presented to my office a couple of months ago for a second opinion. At our first appointment Carol brought her most recent x-rays, a treatment plan from another dentist, and a page-long list of questions. She was well-prepared for the consultation and seemed to know exactly what she wanted.

About 8 years ago, Carol visited a “holistic” dental office. Carol had about $10,000 of dentistry done at that time. Her reason for visiting that particular office was because she was/is very concerned about her health and believed that a “holistic” office could provide her with what she was looking for. Now, only 8 years later, her teeth are falling apart.

Carol had eight crowns done on her back teeth at that time. The crowns, still in her mouth, were failing due to recurrent decay. More importantly to Carol, her front teeth were in severe breakdown. Carol had her mind made up; she wanted full dentures.

Carol sought out a local dentist, presented her desires, got a written treatment plan with fees, and then came to me for a second opinion. She brought that treatment plan with her and it appeared very reasonable – take out all remaining teeth and place full dentures.

The first thing I noticed was that Carol had 6 lower front teeth that have been decay-free and have had excellent bone supporting them for 70 years. However, her mind was made-up, she wanted everything taken out. She did not want to have to deal with maintenance of teeth any more.

Over the next two consultation appointments I had with Carol, we discussed many different treatment options. We thoroughly reviewed the advantages of keeping these lower front teeth each time we met. Carol brought a list of questions to each of these meetings, which we discussed in depth. It was decided – Carol was moving forward with full dentures.

At each appointment during the process, I discussed a different aspect of why it would be such an advantage to her to keep those lower front teeth. Her mind was not changed, until yesterday. Yesterday, Carol walked into my office to tell me that she has decided that she wants to keep her lower teeth.

Okay, so what’s the point? The point has nothing to do with what Carol’s final treatment is. Carol has every right to decide on what she feels is right for her.

The local dentist she got the treatment plan from provided a very reasonable treatment proposal. They had one visit, decided on treatment and her next step was to go to the oral surgeon and have all her teeth out.

Far too many times I see patients and dentists rush into treating teeth. Taking the time to engage in conversation and treat the person as a person and not just a head with teeth, is the truly holistic approach.

My point of this story is not that I got Carol to do what I felt was best for her, but that I gave her my time, answered all her questions, and allowed her to decide what was best for her. There was no reason to rush into treatment, and she ended up making a good decision, that will positively affect her quality of life going forward.

October 23, 2023

Money, Time, Fear, Trust, and Perceived Need

Young woman with long blonde hair and blue eyes covering her mouth with one hand. She stands in front of a gray stone wall with a concerned expression. There are five major reasons that people do not get the necessary dental care they need; six if you count the recent pandemic. The other five are money, time, lack of concern, fear and trust. Let’s take a quick look at each one and see if any of them fit you, and what dentists often try to do to overcome these obstacles for patients.

Although you may think that money would be the number one reason people avoid ideal dental treatment, it is not. Even in tougher economic times, money, although a significant barrier for many, is still not the number one issue for most. Dental health, and good health in general, always requires some kind of investment.

Lack of dental insurance is a poor excuse for not getting regular dental maintenance. As I have said numerous times, dental insurance in not insurance; it is a benefit. If it were “insurance”, it would cover treatment that patients need. While not bad to have, the advantage is limited, based on insurance company’s unwillingness to raise the bar and change a system that hasn’t changed since the 1970’s.

Unfortunately, as of now, we have to face these facts, and it does not mean avoiding the dentist. Many dentists offer in-office payment plans, as well as plans through third party carriers, so patients can finance needed treatment. Two dental hygiene appointments a year costs way less than many other things people spend money on. If you drive your car for 20,000 miles without maintenance, something is bound to happen. The better you take care of your car, the less problems you’ll have.

Time is another excuse. We all use time as an excuse for many of the things in our lives we want to avoid or procrastinate on. The reality is, however, if we place something high enough in our value system, there is always time for it. In order to move something higher up in our value system, we must be enlightened enough to realize that this particular thing is of benefit to us. This brings me to the most common reason people avoid ideal dental care.

Lack of concern about dental health is prevalent with a large percentage of the population. Absence of pain is the biggest reason for this lack of concern. Other than a severe toothache and need for a root canal or extraction, there are few things that cause enough pain to bring someone to the dental office. Take gum disease; about 75% of the population has some form of this disease, but only 50% of the population goes to the dentist. Why? No pain. Absence of pain is a poor indicator of health.

Some people have fear about going to the dentist….and for good reason, due to bad past experiences or bad information. However, dentistry today should be a comfortable experience most of the time. For those that are still fearful, there are different medications dentists can use to ease the experience.

The last barrier to ideal treatment is trust. For a patient to move forward with treatment, it is essential the patient both like and trust the dentist. Although I am sure that the skills of your dentist are important to you, I am willing to bet that you would not stay with a dentist who you did not like or trust. Find someone you can connect with and build a strong doctor-patient relationship.

I believe that one of the best things a patient can do for their dental health is to find an office they like and trust……and stay there. Continuity of care is in the patient’s best interest. Find your dental home.

October 16, 2023

The two things you’re supposed to do to clean your teeth: Brush & Floss. Any of you have your hygienist get on your case about not flossing? You may be the best brusher in the world, but if you’re not cleaning between your teeth, we know it. Cleaning between the teeth is essential for good oral health, AND good overall health.

Water Flossers for Surfaces a Toothbrush Can't Reach

Water Flossers for Surfaces a Toothbrush Can’t Reach

To reiterate, we need to think about brushable surfaces vs. non-brushable surfaces in the mouth. Floss, which is basically a piece of string, is great after eating corn-on-the-cob. Other than that, using an oral irrigator (water flosser), is much better at cleaning the non-brushable areas in the mouth.

Clinically, we usually see significant improvement in patients who add oral irrigation to their homecare routine. However, if you look at the research available, it is weak, just like that for flossing. There are just not a lot of studies that have been done. But anecdotally, I can tell you it is a game-changer for many.

The Waterpik® packaging says that oral irrigation is 3X more effective than floss. These claims are from “independent” studies; basically, their own research. While floss can be effective for some, many people get much better results with oral irrigation. Disease starts in the areas that you cannot brush. Brushing alone is not enough for anyone. A jet stream of water is great at disrupting the millions of bacteria living under your gumline.

Stimulation of the gum tissue is essential to a healthy mouth. Oral irrigators do a great job of this. Like anything else, it takes a little getting used to. It takes a little time to build up tolerance and be able to increase the pressure of the stream of water. Once you get used to it, it seems to be very effective in stimulating healthy tissue.

Oral irrigators are essential for both kids and adults with braces. They are also great for those with crowns, bridges, larger spaces between the teeth, people battling periodontal disease, or anyone trying to achieve healthier gums. The units come with an assortment of tips for different applications.

There are both counter models and cordless hand-held models. The counter models have a wider range of pressure settings and a larger tank to hold water. The cordless models are very convenient for obvious reasons but the water compartment is very small. You typically have to fill it up about four times for each use. I prefer the counter-top models.

Here is the bottom line. If you brush and floss impeccably, and your dentist or hygienist says your gum tissue is as healthy as it could be, a “water flosser” is a tougher sell to add to the routine. In my experience, that is a very small portion of the population. Most people have room for improvement with their homecare.

The newest independent research I have seen, which was not done by a product manufacturer, shows that using a water flosser is significantly better than brushing alone. So, if you don’t floss, have braces, have any type of implants, any crowns, bridges, or veneers, have diabetes, or have been told you have gingivitis or any other type of periodontal disease, this product will most likely improve the report you get when you visit the dental office.

Like anything, compliance is the key. Research shows that only 2-10% of the population flosses regularly and effectively. The average brushing time is 37 seconds, as opposed to the recommended 2 minutes. Improvement comes with the effective use of the tools you have. An oral irrigator is a giant step to a healthier mouth!

Dr. St. Clair maintains a private dental practice in Rowley dedicated to health-centered family dentistry. He has a special interest in treating snoring, 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 White countertop water flosser with a transparent water reservoir and handheld flossing nozzle. The device is designed to clean between teeth and along the gumline using a stream of water.

October 13, 2023

Woman with jaw pain due to TMJ disorder There are roughly 10 million people in the United States who have a TMJ disorder. This condition can cause quite a bit of discomfort, but it can typically be managed with the right steps. Since November is TMJ Awareness Month, now is a good time to become more familiar with the warning signs of TMJ disorder as well as how it can be treated; that way, you can make sure that you’re well-prepared when it comes to keeping this potentially painful problem under control. (more…)

October 10, 2023

Woman sitting in a dental chair with her eyes closed while pressing one hand against her cheek. Her uncomfortable expression illustrates tooth pain that may require urgent dental care. I have focused the majority of my career on family preventive and general dentistry. While I enjoy most aspects of what I do, I firmly believe that a good percentage of dental problems are avoidable, which means that dentists shouldn’t be as busy as we are with routine fillings, removal of teeth, and many other procedures. While there are other factors at play, such as genetics, personal responsibility is often at the head of the pack.

Prevention often takes a back seat to fixing problems. Decayed, broken and worn teeth all had nothing wrong with them at some point. Granted, you have to fix what is already broken, but “How could it have been prevented?” has always been the question I ask myself, and try to make my patients understand.

Finding the Cause of Decay and Wear Before Repairing Teeth

What are the factors at play for the 6 new cavities? What could have been done to avoid the wearing-down of all the teeth? Could anything have been done during growth to alter how the airway develops? What factors are causing the chemical erosion of the teeth? These are important questions to be considered.

Much of what is being marketed to dentists today is technology; 20 years ago, it was cosmetics. The technology available today in dentistry is really cool, just like the technology available in most other areas of our lives. There are some things I would not want to live without since adding them to our office; digital x-rays, digital scanning instead of messy impressions, computer-generated restorations, telemedicine, etc. However, how much technology do we really need if we avoid the problems in the first place?

Let me give an example. If I had to pick the single most important “technology” that has impacted dentistry in the last 30 years, it would be dental implants. Grafting of bone and dental implants have changed the lives of many people, who would otherwise have been forced to wear something removable in their mouth to replace teeth. And, while this is a great service to patients, I’m still always thinking, “What are the lessons I have learned to help my next patient avoid needing all this dentistry?”

More dentists are being trained to place dental implants, not only to replace one missing tooth, but to replace ALL the teeth. You may have seen the commercials from a large dental franchise with stories from “real” patients who have had dental implants change their lives. What they don’t tell you is that they remove all the teeth, even ones that can be saved, remove a ton of bone to be able to place 4-6 dental implants, to then have a piece of plastic with plastic teeth screwed to it. They claim – “You can put an end to dealing with missing teeth or repetitive dental work with dental implants.”

You have to go in for the consultation to find out that upper and lower “All-on-4” dentures attached to implants will run you $60K+. They also fail to mention in any of the advertising that there is maintenance that can be costly. And, they don’t really feel like teeth. While this treatment may be acceptable for some patients, the clear choice, is to avoid it.

Keeping your natural teeth makes much more sense. Improving and maintaining any part of our health requires time, commitment and resources. There are many great dentists out there to help you maintain your teeth for a lifetime.

October 2, 2023

Finding a Dentist Who Fits Your Priorities

Large dark question mark printed on a crumpled white sheet of paper against a dark background. The question mark represents frequently asked questions about preventive dental care. Let’s use this hypothetical situation: You have not been to a dentist in a while (pick a time frame), you are well aware you need some dental work, you were given the recommendation of a dentist by a friend…..and, you decide to visit that dentist and four other dentists to compare and make a decision who is the best fit for you. (I realize that most people don’t want to and/or don’t have the time to visit five dentists….but play along).

You already have an idea of what you are looking for. It might be the dentist who says you need the least. It might be the dentist who is the cheapest. It might be the dentist who is closest to where you live. It might be the dentist who gives you the most options, or maybe the least. It might be the dentist who listens to you the best. Be prepared, because you are likely to hear a few different styles/opinions visiting five dentists.

Some practices may feel “clinical and efficient”, while others feel somewhat more home spun and laid back. The dentist’s personality and experience are reflected in his or her treatment preferences as well. The fact that different dentists will suggest different plans to treat your condition does not necessarily mean that one plan is better than another. Have an open mind and play an active role in the treatment planning process.

It is important to remember that there are numerous ways to treat the same situation, and it is always important for the dentist to tailor the treatment plan for each patient’s specific circumstances. A major part of those circumstances may be financial, and since different treatment plans can vary a great deal in cost, it is important for the dentist to discuss costs and options for payment.

Think of treatment plans like various models of cars offered by different dealers. All of the models are new, have warranties and will work well out of the lot. The higher end models, however, have some advantages not found in the less expensive models. Some options add years to the life of the car. Some add to the appearance and enjoyment of driving it. Having said that, dentistry is not a commodity. There are many factors that need to be taken into consideration when choosing your provider or the treatment you choose for yourself.

What makes sense for you? What are your objectives? Saving a badly damaged tooth with a root canal and a crown may preserve it for a long time, but what are the circumstances of how the tooth got to that point? If you haven’t been to a dentist in many years and have many other dental needs, does it make sense?

We have so many great dental providers in our area. Think about what you are looking for in a dental care team Read that list in the second paragraph again.

The focus should be on long-term objectives and prevention. If you are a regular dentist-goer and have a dentist you like, you’re all set. If you haven’t been in a while, consider making the decision to change how you look at your dental health. Start with finding a place that fits your particular needs, and make the commitment to make routine preventive dental care part of your life.