There are many people who suffer with pain involving some area of the head. Toothaches can cause pain, but these are mostly avoidable with proper diet, home care and regular visits to your dentist. Teeth can also play an indirect role in facial/head pain.

Orofacial pain includes a number of clinical problems involving the chewing (masticatory) muscles and/or temporomandibular joints (TMJs). Problems can include TMJ discomfort involving muscle spasms in the head, neck, shoulders and/or jaw, migraines or other types of tension headaches, pain with the teeth, face or jaw; and can even play a role in anxiety and/or depression.

You swallow approximately 2,000 times per day, which causes the upper and lower teeth to come together and push against the skull. People who have an unstable bite, missing teeth, or poorly aligned teeth can have trouble because the muscles work harder to bring the teeth together, causing strain. People with seemingly good teeth/bite are also susceptible. Pain can also be caused by clenching or grinding teeth, trauma to the head and neck, or poor ergonomics. Temporomandibular disorders (TMD) affect more than 10 million Americans. Your TMJ’s are located where the skull connects your lower jaw to the muscles on the sides of your head and face controlling the joint’s movements. Women between the ages of 20 and 40 are often more frequent sufferers because of the added estrogen in their bodies.

One in eight Americans suffers from headaches. Experts estimate that 80 percent of all headaches are caused by muscle tension, which may be related to the bite. Clenching the jaw muscles creates tension in the muscles that close the jaw, the main one of which is the temporalis muscle. Signs that may indicate a headache from dental origin include: pain behind the eyes, sore jaw muscles or “tired” muscles upon awaking, teeth grinding, clicking or popping of the jaw joints, head and/or scalp is painful to the touch, earaches or ringing, neck and/or shoulder pain, and dizziness. Keep in mind that in a 24-hour period of time, your teeth should only touch 10 minutes total. If you clench or grind your teeth, your teeth are touching much more than that and I can promise you that something in the masticatory system is being affected.

Sleep disorders can also play a role. I am not just talking about sleep apnea. There are a wide range of sleep disorders and some of them will cause people to clench and/or grind as a defense mechanism of the body to achieve proper air flow.

Dentists have a variety of ways to help relieve orofacial symptoms. One way to treat these problems is called an orthotic, or splint, that is worn over the teeth to help stabilize the bite; kind of like an orthotic some wear in their shoes for alignment and balance when standing. Permanent correction may require equilibration (reshaping teeth), prosthetic dentistry and/ or orthodontics. Many use a splint on a daily basis to avoid having these other treatments done.

Orofacial pain can range from tolerable to debilitating. Maintaining or correcting your bite ensures optimal health, and proper care will help reduce or eliminate orofacial pain or discomfort. If your dentist can not help you, ask for a referral.

Most important lesson of the day: The optimal rest position of the jaw (minus the 10 minutes the teeth touch in 24 hours) is lips together, teeth slightly apart, the tip of the tongue resting just behind your upper front teeth, and you should be breathing through your nose.

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.

Want to enjoy healthier gums? Start by watching what you eat. Onions, leafy greens, and reduced-fat dairy products are great choices. These foods are rich in vitamins and minerals and low in sugars and simple starches. All of them can help you to enjoy a better report from your dentist.

The word is out – taking care of your oral health is better for your whole body, including your mind. However, statistics still indicate only about half of the population goes on a regular basis. For those that do go, most patients usually stay with a dentist unless there is some kind of personality conflict or philosophical discrepancy in the perceived need for treatment. How do you know if another opinion is right for you?

When it comes to larger purchases, such as a car, a house or even home improvements, it’s not uncommon to get a second or third opinion/quote. We use the information we gather to make a more informed decision about where and what we are going to spend our money on.

 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.

Routine dental care is generally not that complicated. However, 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 with the relationship to make the decision without the need for another opinion. It is when there is a lack of trust, a personality conflict, or the inability of the dentist to properly communicate with the patient effectively, that often stimulates the desire for another opinion.

Another important factor, which falls in the communication area, 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 effectively communicated to the patient, they have a better ability to decide on the direction to proceed that is right for them. If a dentist presents treatment options and the patient decides to do nothing, that is the patient’s choice. It is when treatment presented 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 between dental offices. 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. As a consumer, you have very little control in your ability to evaluate this.

You do have the ability to know whether you feel comfortable to make an informed decision. Regardless of the situation, if you need more information to make the best decision for yourself, get more information. If you feel pressured to make a decision, don’t make it until you feel comfortable.

The doctor-patient relationship should be an open two-way conversation.

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.

I recently had the opportunity to do some dental hygiene appointments for a hygienist who was out for a family emergency. While at first I was not particularly excited about doing this because I have my own busy schedule, I have to say, it was both gratifying and eye-opening.

Typically, when I check a patient after a hygiene exam, I am examining clean teeth and will briefly discuss any concerns the patient or the hygienist has. But on this day, I got to spend much more time with patients who I normally only see for five minutes after they see the hygienist.

My first patient was a 20-year-old, very pleasant and bright young man, who has not had to spend very much time in “my” chair. As I read through his chart to look at the notes the hygienist had made from previous appointments, I noticed that there had been repeated discussions about his homecare. As we started our appointment, I realized I was up against the same issues the hygienist had seen on previous appointments.

I asked this young man, “When was the last time you brushed your teeth?” He replied, “It’s been a few days because I have been busy.” Of course, I had the reaction that you are probably having right now – how in the world can you go a few days without brushing your teeth? As I worked my way through the plaque and heavy bleeding due to inflammation from the debris, we talked about the Bruins game we both watched the night before.

I know what you thinking – If you have the time to watch the Bruins, you have the 2 minutes it takes to brush your teeth – I thought the same thing. However, instead of approaching it this way and trying to convince him that he needs to work on his priorities, we discussed some of the health consequences of long-term inflammation as he gets older. We will have to see if this discussion had any impact on him the next time he comes in.

Another patient I saw was an adult woman who has also spent little time in “the back” with me. Over the past few years, the hygienist’s notes had indicated a history of severe headaches and jaw muscle tension as well as my recommendation to consider a nighttime appliance. She took daily medication to manage her headache issues and even had occasional injections to treat her symptoms.

On this day she was in severe muscular pain. In addition to completing her dental hygiene services, I had the opportunity to do a more complete exam and have a more in depth discussion about her problem. In spending more time with her I was also able to ask more questions and learn much more about her symptoms and possible etiology. We discussed her concerns about moving forward with treating both her headaches and looking further into some sleep related issues which could be causing her other symptoms. She is still reluctant to move forward with my recommendations because she feels her issues are from another origin.

Changing our habits, like brushing habits, or making a change to improve any aspect of our health is difficult for many. My experience with these two patients, as well as other patients I saw that day, reinforced that making a change is often not as easy as just briefly mentioning it. It is important for providers and patients to take the time to discuss what the barriers are that are holding them back from making improvements in their health.

Time is the most important gift a health care provider can give.

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.

Have you broken any of your New Year’s resolutions yet? Essentially, it is just another “to-do” list. As with many to-do lists, some of the items on it keep getting pushed down in the ranking of priorities because of the constraints of time. So, I have a suggestion to keep in mind when making pledges to yourself about what you are going to do this year; make purifying your time your first resolution.

Many driven people pride themselves on how many tasks and commitments they are able to take on. This is difficult to sustain. Eventually, this philosophy of always doing more becomes counterproductive, as you inevitably have to approach your growing list of commitments from a different perspective.

The reality of it is that getting more done is not a matter of doing more things; it is a matter of doing the right things with your time. In that sense, the answer is often found in identifying and relieving yourself from the low-value time wasters that hold you back from giving your full attention to the things that truly matter to drive you forward.

You can’t buy more hours in a day, but you can reclaim time for yourself. You can choose to delegate and/or choose to streamline and purge yourself of recurring nuisances that eat away at your productivity. You can choose to say “no”. If there is something that does not fit your criteria for being worthwhile, don’t do it. By purifying your time priorities in this way, you amplify the value of your time. And the best part is that you end up getting more significant things done and get more out of life.

So, as you put together your list of things you want to do over the coming year, be sure to work on another list at the same time: a list of things you don’t want to do anymore. Think of it as a “To-Not-Do” list.

Some of the items on this list may take time and effort to detach from, such as delegating others to take over certain duties. Some of them you will find you can drop right away. Of course, this does not include things that you are passing on to say your spouse, like laundry and grocery shopping. Eliminating things from your life does not mean burdening someone else with daily personal responsibilities.

Be persistent with it, keeping in mind that this is your most precious resource we are talking about. Examine each recurring demand on your time and ask yourself if it’s adding value to your life in an intangible way? Is it enhancing your productivity and improving your life? If the answer is no to both of those questions, the next question becomes obvious: Then why are you doing this?

Challenge yourself right now to sit down and create your own list of things to not do in 2019. Try to come up with at least five items. This is a great way to start the year with a feeling of liberation. This allows you to clear your mind of clutter and award yourself more time and energy to embrace the really important possibilities.

You can create specific lists for different aspects of your life, like your health. Changing your habits takes effort and the awareness that you want the change in your life.

If you have been neglecting your dental health, make this a priority to get in order this year. It doesn’t matter if you “think” everything is okay. As with every single thing on your list, there needs to be accountability.

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.

Thanks again to the The Town Common for another great year. At the end of each of the past 13 years, I have used this space to publish these 21 Suggestions for Success authored by H. Jackson Brown, Jr. It is the perfect time to reflect on the year past and prepare for any changes we need to make for the year to come.

How was 2018 for you?  While reflecting on the past year is important, thinking forward to the year to come is even more important. The past is in the past.

Cut this out and put it on the refrigerator. Read this list often and take these suggestions to heart. They will be sure to make your 2019 great.

1. Marry the right person. This one decision will determine 90% of your happiness or misery.
2. Work at something you enjoy and that’s worthy of your time and talent.
3. Give people more than they expect and do it cheerfully.
4. Become the most positive and enthusiastic person you know.
5. Be forgiving of yourself and others.
6. Be generous.
7. Have a grateful heart.
8. Persistence, persistence, persistence.
9. Discipline yourself to save money on even the most modest salary.
10. Treat everyone you meet like you want to be treated.
11. Commit yourself to constant improvement.
12. Commit yourself to quality.
13. Understand that happiness is not based on possessions, power or prestige, but on relationships with people you love and respect.
14. Be loyal.
15. Be honest.
16. Be a self-starter.
17. Be decisive even if it means you’ll sometimes be wrong.
18. Stop blaming others if it means you’ll sometimes be wrong.
19. Be loyal and courageous. When you look back on your life, you’ll regret the things you didn’t do more than the ones you did.
20. Take good care of those you love.
21. Don’t do anything that wouldn’t make your Mom proud.

Best wishes for a successful 2019. Happy New Year!

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.

I recently attended a dental continuing education course entitled “Hit Man or Healer?” The course was given by a well-known leader in the dental profession. The basic premise of the course was the notion that we have a lot more science, studies, and data available today to be able to make better decisions about the treatment that we dentists recommend to patients. The concept is called evidence-based dentistry.

The idea is that if a very structured examination and diagnosis is done, treatment recommendations can be made based on science. The problem is, many times the diagnosis leads to suggestions that without the proper dialogue can make the dentist look like a “hit man” (ie. patient perception of over-treatment) vs. “healer” (intervention with the intention to preserve the teeth better for the long-term).

The lecturer started by putting an image of a person’s teeth on the screen and asking the audience to guess how old the person was. Although it is relatively easy to estimate a person’s age during transition from the primary teeth to permanent teeth, it is apparently a little more difficult when all the permanent teeth are in. I guessed the age of the patient on the screen to be between 50 and 60.

The patient had great looking teeth. You could tell the person was a mature adult by the darkening of the teeth, but there was very little wear and very minimal dentistry. The patient ended up being 94 years old. The lecturer displayed the woman’s full face on the screen and said, “Is this the way teeth should look at 94 or is this woman a freak of nature?”

While there are definitely genetic factors that play a role, many of the problems we see today with teeth are 100% preventable. Take decay for example; decay is 100% preventable. However, it is still not uncommon today to have a patient (typically a teenager) come in for a routine dental hygiene appointment and be told they have decay, or multiple areas of decay, which were not present 6 months ago. In that scenario the dentist would be considered the “hit man”.

The “healer” may have taken a different approach and may have done a more thorough evidence-based evaluation and made recommendations based on diet, homecare habits and maybe even familial history that may have prevented the decay in the first place. Dentists have gotten good at telling patients how they can “fix” the problem, but need to consider changing their thinking and get more training in how to “prevent” the problems we see today in dentistry.

There are very few things I learned in dental school that I still use today. Many of the basic principles are used but there is continuous new data emerging that we as health care providers need to expose ourselves to, and decide on what and how to implement for the benefit of our patients. I hope to see major advancements in our approach to oral health care in my career. There is no reason you can’t live to 94 and have a great set of teeth.

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.

Dentistry is one of those things in life….as with most things…. that people view in different ways. Some are interested in their appearance, some are interested in their health, some both,and others none of the above. A major role of health care providers is to make patients aware of the possibilities to improve their quality of life. When our services are perceived as a commodity, expectations are often not achieved.

Dentists play a key role in screening patients for many disorders relative to nutrition and in providing appropriate referrals into the health care system. Although the importance of integrating diet and nutrition guidance into dental care has been advocated for decades by educators, it continues to be ignored except by a handful of prevention-oriented practitioners.

Many of the world’s most significant health problems are linked to poor dietary practices, including over-nutrition and under-nutrition. Nutrition plays a fundamental role in health, and dental professionals have the opportunity to be a critical link between discovery and wellness.

There is a great deal of evidence linking oral infections, including periodontal disease, nutrition and immunological response. We have clear evidence linking oral disease with adverse pregnancy outcomes, diabetes, cardiovascular disease and stroke. In addition, obesity, which is an epidemic facing our country, is significantly affecting the incidence of diabetes, cardiovascular disease and overall lifespan. We know there are direct connections between these problems and oral disease. What is the role of the dentist? Should the dentist just be a tooth fixer?

As the body of data linking systemic health conditions and oral infection grows, this expanded understanding will result in more profound discoveries. However, we know right know that the scientific bridge between oral disease and systemic health is often mediated by diet and nutrition.

The beneficiary of this profound evidence should be you, the dental patient. It should not only be the responsibility of the physician or specialized nutritionist to incorporate this information into practice; the dentist should be playing a key role.

For the most part, the dentist is the only one who examines the mouth. It used to be that the dentist only looked at the teeth and only fixed problems if they arose. Most dentists screen for periodontal, or gum, problems as well as oral cancer. The trend is to address these problems earlier than ever before. Identifying developmental issues related to facial growth during childhood, for example, is much more than prescribing orthodontics. Lives can be changed with early intervention.

People tend to have ingrained in their head that the dentist just looks at the teeth and treatment should be the same as 25 years ago. The fact of the matter is, things change and there are no two dentists who practice identically. Each individual’s philosophy of care comes from personal experience, review of literature and the type and amount of continuing education taken.

One thing we all hope is that our health care provider, dentist or physician, has our best interest in mind. There is room for improvement in the communication between all health care providers. As science continues and evidence grows, it is the responsibility of all health care providers to work towards a more integrated health care system.

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.

Gravity is precise in nature, governed by laws and formulas; it does not respond to individual circumstances or objectives. It’s easy because it always works. Clinical dentistry, on the other hand, is science for sure, but an inexact science at best. Inexact science requires the skill of an artist to create a consistent and predictable result since it is not a matter of an equation, hence the “Art and Science of Dentistry.” This inexactness is something that dentists struggle with daily.

I am currently treating a patient who presented with a bunch of broken teeth. The patient is frustrated because these teeth have been “fixed” numerous times over the past few years. His previous dentist had tried to bond things here and there to keep the cost down for the patient but they just kept breaking. The patient, an engineer, said that he even tried giving the dentist suggestions to make things “stronger”. Those suggestions only led to more failure. Predictable dentistry often requires doing things that you would rather not do.

I recently heard an ad on the radio with a famous actor talking about colon cancer screening. He describes that having a colonoscopy after age 50 is huge in finding and treating early changes that lead to colon cancer. Most people don’t want to have a colonoscopy, but also don’t want to get colon cancer, so there is a dilemma. These actions have now become inconsistent with the desired outcome, much like the patient I just described. He doesn’t want to have a complete exam and map out a precise treatment plan that will ensure a more predictable result, but he wants to save his teeth.

We have come to a fork in the road. If you don’t want to get colon cancer you get screened and treat any early signs of problems to help avoid the cancer. If you want to risk getting colon cancer, you don’t get screened. If this dental patient doesn’t want to lose his teeth, he should get a complete exam and address the issues in a more logical and predictable manner. If he wants to risk losing teeth, he can keep putting band-aids on the teeth, but they may not hold up as he has already experienced.

Dentists often struggle with patients whose actions are inconsistent with what they want from dental treatment. It is important for dentists to listen to people to know what they want. A patient who says she doesn’t want to do a crown on a tooth has not said she would not do crown. She is saying she doesn’t want to do it, would rather not spend the money to do it, she won’t enjoy doing it, and she will want it to be over as quickly as possible. What does she want the outcome to be?

Too many disappointments have occurred because a dentist compromised treatment and the result was not what the patient expected. The dentist and the patient need to be very clear on compromise. The patient must understand that, if there is failure, it is most likely the result of the decision not to do the more ideal treatment. The dentist needs to thoroughly explain to the patient the risks and benefits of any treatment they are doing so that everyone is on the same page.

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.

There are very few dental practices that still use analog film and chemicals to produce dental x-rays. With digital technology around for decades, and improving along the way, there really is no excuse not to be digital.

However, patients still often express concern with overexposure from radiation from dental x-rays. While I could bore you with statistics, to put it into perspective, it would take almost 400 dental x-rays in one year to equal the amount of radiation a person picks up from background sources each year.

Here are a few questions answered about dental x-rays:

I had a dental x ray while I was pregnant. I am worried that my unborn child might have been exposed to the radiation. Can you please tell me if there are any risks to my baby from this?

There is no information suggesting any risk to an unborn child from dental x-rays received by the mother. We were taught in dental school to avoid dental x-rays on pregnant patients. However, with newer technology the radiation dose to the fetus is insignificant. Prudent practice would dictate limiting x-rays on pregnant women, but there is absolutely no harm in taking x-rays if needed to diagnose a problem.

Is there residual radiation in a room after a dental radiograph has been taken?

X-rays cease to exist when the machine is switched off, much like the light from a light bulb when it is turned off. No residual radiation remains.

How much has dental x-radiation been studied and how concerned should I be about having dental x-rays done? Is there a limit on how many I can have?

We now have very complete information on patient radiation doses from dental x-rays. They are among the lowest radiation dose exams of any diagnostic radiologic procedure in the healing arts. Current practices deliver patient doses from a full-mouth series of intraoral films (usually 14-18 films) that are less than what a person receives in a month from natural environmental sources (commonly called background exposure).

Doses from bitewing or panoramic films are even less. New technology is reducing the doses still further. There is no limit on how many dental x-rays you can have. The decision to have a dental x-ray is based on the benefit of knowing whether or not there is a cavity, crack, or some other abnormality. The decision to have them is based on what you and your dentist agree on being best for your specific situation.

I recently had some dental x rays and the operator forgot to place the lead apron on me. Is this a problem?

Use of the lead apron to protect the patient undergoing dental radiographic examination was recommended some 50 years ago, when equipment was crude. This was because x-ray beams were not restricted to the area of clinical interest, beams were not filtered, and x-ray film was slower, causing radiation exposures 10 to 100 times higher than received today. With the current technology reducing radiation exposure significantly and the beam limited only to the area of interest, there is little or no measurable difference in whole-body dose whether a lead apron is used or not. The lead apron is no longer regarded as essential although some consider it a prudent practice, especially for pregnant and potentially pregnant patients.

If you have any other questions on dental x-rays, please e-mail them to me.

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.