Dental Economics 101

I love good value.  Who doesn’t, especially in this time of economic fragility?  In fact, just this week, while noticing that my skiing equipment seemed a little outdated, I demo’d and priced out new equipment.   Now I know I want to update, but it’s going to be expensive.  This year, I decided to just get a tune-up, and start saving now for new gear next year.

This can work for dental care, too.  Most non-emergency type dental work can be staged to fit a person’s budget.  Also, as in many other aspects of our modern lives, preventive maintenance can help contain costs.

Here is my Top Ten List for getting value (and saving money) at the dentist’s office

1.       Check to see if your dentist provides discounts.  We offer a senior discount, and a “pay-in-full-at-time-of-treatment” discount.  You might also be able to get a discount if you agree to schedule your appointment as a last-minute fill-in for somebody else who canceled.

2.       Ask your dentist or hygienist if you might be able to schedule your cleanings annually instead of semiannually.  We have patients whose oral hygiene is consistently excellent, so they just come in for an exam every six months and save the cost of one cleaning (but be careful – some insurance plans require 2 cleanings a year to keep benefits at their highest level.)

3.       Take care of your body and don’t abuse drugs.  Diabetics have a higher rate of periodontal disease, as do alcoholics and regular marijuana smokers.

4.       Use your dental insurance – it’s free money.  Ask your HR person at work or your dental office insurance specialist for help with the details.

5.       Protect your teeth against night-time grinding with an occlusal guard, and against injury with a sports guard.

6.       Use an oral irrigator to help clean between your teeth and under your gums.  The old-fashioned Waterpik™ your parents used has been updated and improved to help keep your teeth and gums healthy. Any brand will do.

7.       Eat less sugar and strengthen your teeth with prescription strength topical fluoride or Amorphous Calcium Phosphate (ACP).  Sugar feeds the acid-producing bacteria that cause the holes, fluoride strengthens the surface of the tooth to resist holes and ACP rebuilds tooth lost to acid attacks. Anyone can get cavities; everyone can prevent them.

8.       Don’t smoke.  Smokers have higher rates of oral cancer and periodontal disease.

9.       Get regular dental exams .  Your dentist can detect problems early, while treatments are easier and less expensive.

And, the top way to save money at the dental office…

10.   Brush and floss gently but thoroughly, every day.  No need to explain this one, right?

Keep Smiling!

So, How Much is Enough?

Here’s a shocking secret.  I do not like to floss my teeth.  I don’t like getting my fingers wet with saliva, and think it would be weird to wear gloves to floss my own teeth.  So, I’m not as regular a flosser as I’ve been told I should be.  But wait?  How often should I, or anyone, floss?

Here’s what I know: I have many patients who floss daily and still have gum disease and cavities between their teeth.  I also have many patients who only floss a day or two before their dental visit, and get no cavities between their teeth and haven’t lost a whisper of bone.  No fair, huh?

I guess the answer to the question “how often do I need to floss to stay healthy?” is “it depends”.  If you happen to be “gifted genetically” when it comes to your mouth (no tooth decay or periodontal bacteria and a super immune system), then you probably don’t need to floss much.  One to two min/day with a toothbrush might get you by. Just be careful that you don’t contract the bad oral bacteria from someone more average, like the rest of the 70-80% of us.  Visit your dentist yearly, just to be safe—because things can change.

If you are one of the “unlucky” ones at the other end of the bell curve, flossing daily will not be enough to keep your teeth, mouth (and body) healthy.  You will need to fight an all-out war against your oral bacteria, which will include daily mechanical removal of all biofilm (plaque) off your teeth (toothbrush, floss, picks, irrigator, etc.), as well as chemically controlling the bacteria with rinses, gels or pills.  You may also need dental treatment to eradicate infected tissue from around your teeth.  You will probably do better if you get enough sleep, keep your stress managed and eat a diet high in antioxidants and low in simple and processed carbohydrates.  Plan on spending 10-20 min/day on your teeth.  See us every 2-4 months for evaluation and maintenance.

What if you are somewhere in the middle like most American adults?  Then you don’t have to work quite as hard as the “unlucky” group, but certainly more that the “gifted genetically” one.  You can pick and choose what works best for you to remove your biofilm daily, possibly with the help of an anti-microbial. You should plan on spending 4-6 min/day on oral care.  Check in with your dentist and hygienist every 4-6 months, and make adjustments in your homecare or recall schedule as needed.

Not sure what group you fit into or what combination of homecare tasks will keep you healthy?  Just ask.  And in case you were wondering, even though I don’t floss regularly, I clean between my teeth daily with a Philips Airfloss™ and wear PerioProtect™ trays with 1.7% hydrogen peroxide gel for 10-15 min., and my gums have never been healthier.  Keep smiling!

Oral Cancer is on the Rise

I am a regular newspaper scanner.  I’m always looking for tidbits of interesting health information that I can use to increase my knowledge and help educate my patients.  I hit the mother lode last Friday when I read an article in the Seattle Times that summarized findings in an oral cancer study recently published in the Journal of the American Medical Association.

The Ohio State University Comprehensive Cancer Center led the study, which was the first to discover the prevalence of oral human papilloma virus (HPV) infection in the U.S.  What’s the connection, you ask?  HPV, especially HPV-16, is strongly linked with oral and cervical cancers.  HPV-16 was found in 1% of the people studied, which would translate to about 2 million Americans.

It is estimated that 80 percent of Americans have been infected by the virus (all HPV strains), and that 7 percent if Americans carry the virus in their mouths.  There are usually no symptoms associated with this infection and the virus in not likely to be transmitted by casual contact or kissing.  In fact, the study goes on to say that most cases of oral HPV infection can be traced to oral sex.  Luckily, at this time, fewer than 15,000 Americans contract HPV-linked oral cancers a year, but experts warn that this number could and probably will increase.  It is estimated that by 2020, there could be more HPV oral cancers in men and women than cervical cancers in women alone.  Oral HPV is more common in men than women (10% vs. 4%), smokers and people with a history of multiple sexual partners.  People between the ages of 55 and 59 were the most at risk.  Unfortunately, diagnostic techniques for detecting oral cancer are not as advanced or widely used as that for cervical cancer-- the Pap smear.

Here’s how your dentist and hygienist can help: since HPV-linked tumors are often located on the back of the tongue or tonsil area, a thorough annual oral cancer exam is extremely important.  There is new technology that can also help your dentist visualize these “difficult to see” areas.

Common symptoms of oral cancer include sore throat, hoarseness, difficulty swallowing, ear pain and swollen lymph nodes in the neck.  A red or white spot in your mouth that doesn’t heal in a week should also be checked by your dentist. If your dentist is concerned, you might be referred to an oral surgeon for a biopsy. A clear diagnosis from a pathologist, who will examine the tissue under a microscope, will then be available.

So, please, see your dentist every year for a cancer exam and report any symptoms right away,  because oral cancer discovered early has a very high cure success rate.  Keep smiling!

The Only New Year's Resolution You Will Need

I really don’t like the idea of making New Year’s resolutions—they are just so hard to keep for a full year.  Of course, like most people, I do like adopting new habits that benefit me (eating healthier), those I care about (cleaning up after myself) or the world (remembering to bring my reusable shopping bags to the grocery store), but I prefer to start these positive changes throughout the year and one or two at a time, so as not to feel so overwhelmed.

I just found one resolution, though, that seems really easy, and not just for me, but for anyone.  It’s to “smile” more.  Scientists tell us that emotions can be reinforced, and possibly even driven, by their matching facial expressions.  One recent study compared brain scans of two groups of subjects, one with facial Botox treatment (who could not fully frown) and an un-treated control group.  When asked to express anger with their faces, the Botox group had less activity in the parts of their brains involved in emotional processing.  This same group reported feeling “happier,” even when the facial esthetics issue was factored out.

Another study supports the flipside, and the same theory that emotions and corresponding facial expressions might be a feedback loop in the brain.  People, who were asked to frown when subjected to application of heat to their arms, reported feeling more pain than groups asked to make either a neutral or relaxed expression.

This report in Scientific American Mind  (Sept. 2009) was quick to point out that this doesn’t mean people should regularly repress negative emotion and facial responses.  Other studies indicate that suppressed negative emotion can creep into other aspects of a person’s life, and cause them to be “negative people”, or experience decreased cognitive abilities. 

The way I understood this report supports the old adage “fake it ‘til you make it”, or more accurately but less snappy,” gently force a smile until it comes naturally”.

One aspect of smiling that, surprisingly, was not mentioned, was the contagiousness of smiles.  I know that many a sour mood of mine was reversed by a friendly store clerk or stranger on the street who smiled.  Or, how about the cute child with the toothless grin?

What if you aren’t happy with how your smile looks, you ask?  No problem.  There are countless options in dentistry today to improve the look of a smile, and many are simple and affordable.  There is simply no need to wait any longer if your smile is holding you back.  If you like your smile, you’ll smile more and (maybe) be a happier person.

Keep smiling!

Cavities on a Stick

I really do like Halloween, and not just because it marks the beginning of what I like to call “candy/cavity season”—the time between October 31^st and January 1^st, when almost all Americans over-consume sweet treats.  I like it because it gives me the opportunity to remind people about the right way to eat holiday goodies, and ways to limit the possible destruction of tooth enamel.

First, a little peek into the history of my obsession against certain types of candy.  Imagine being the child of a dentist around Halloween.  My kids hated it when they were school aged.  I used to insist that they deliver a toothbrush to the nice person handing out candy in the neighborhoods that we canvassed, in exchange for their treat.  They knew their collection would be inspected by me, and then sorted by "the potential for said candy to cause cavities".  I wasn’t a complete Halloween Grinch; after we returned home from trick-or-treating, I allowed each of them to chose a small handful of their favorite treats, and eat them in 20 minutes or so, then go brush and floss and off to bed.  Then I got to work.  All lollipops were the first to go.  I call them “cavities on a stick”.  Next were the hard candies like Jolly Ranchers, Sweet Tarts and Lifesavers.  Lastly, all of the sticky candies like caramels and Starbursts were removed from the bags, and kept where I could monitor their consumption—offering as special treats throughout the next several months, with the requirement of post-indulging brushing.  Don’t worry—there was still quite a bit left.  All of the chocolate bars, M&Ms and sugar-free gum passed the test, and were allowed back in the bag, becoming a prized possession of the child who collected them.

Now my children are grown, and eat what they want, when they want, and I can only hope that some of what I taught them about consuming sweet treats remains.  Here’s what I tell my patients about diet and cavities:  sugar, naturally occurring or in processed foods, feeds the bacteria that produces the acid that causes tooth decay.  Limiting the oral exposure of sugar/carbohydrates or acidic foods or beverages (acid-producing bacteria love to live in an acidic environment) will limit your risk for tooth decay.  So, eat your candy/cookies and drink your mochas/lattes relatively quickly (within 10-15 minutes), then brush or rinse with water.  Follow these simple rules, and hopefully you will sail right thru “cavity season” unscathed.  Keep smiling!

Know Your Dental Numbers

Of course you care about your health.  You see your physicians yearly for blood pressure, cholesterol ,  blood work, and, if you are a woman, pap smears, and mammograms.  Important numbers such as triglycerides, BMI, and A1C indicate your relative risk for getting a heart attack, diabetes and other diseases.  You work hard to keep your numbers in check and be healthy.  Did you know that there are important new tests to identify your risk of getting oral cancer, periodontal disease, and tooth decay?  Preventing these conditions not only improves your quality of life, but might even save your life.

Oral cancer is on the rise.  Human Papilloma Virus- HPV, is a recently discovered cause of some oral cancers.  That means many more people are potentially at risk for this disfiguring and deadly disease.  A simple test will tell us if you are at risk, by detecting the presence or absence of the HPV virus in your mouth.   HPV infection can be contracted at any time, and the virus itself can lie dormant in a person’s body, so yearly testing is advised by some health professionals.  With a positive test result, we can determine appropriate referral and monitoring options earlier, even before a pre-cancerous or cancerous lesion forms.

Eighty percent of adults have some form gum disease.  There are genetic and bacterial components to this condition.  A sample of your saliva can be sent to the lab, and analyzed for the presence of a gene associated with periodontal disease—if you have it, you’re at higher risk to develop the disease and suffer the adverse effects (gum recession, loose teeth, and possible increased risk for heart disease and other serious health conditions).  If the gene is present, your dentist can monitor you very closely to control or eliminate the possibility of problems.   The same test sample allows us to identify the types and amounts of periodontal disease-linked bacteria present, so we can prescribe appropriate antibiotics and home care to treat your disease. 

Would you like to know if you and your family are at risk for developing cavities?   A simple, inexpensive swab test, will immediately tell us your risk factor.   While you may not have tooth decay currently, your mouth may be harboring the bacteria that cause decay.  These bacteria are contagious and are transmitted to your family through saliva (sharing spoons, drinks and kissing).  We can eliminate these bacteria from your mouth and eliminate the risk.

My goal for you: early, accurate diagnosis to achieve excellent oral health.  Your dental numbers--they can be as important as your medical numbers.  Prevention is the key to a healthy smile!

Lessons from a Local Farmer

 A colleague of mine recently told me about a weatherworn old farmer who came into is office one day. “Doc,” the man said, “I got a tooth in here I need you to take out.” 

Examining him, the dentist found that the man had only one single tooth in his mouth.  It appeared, however, that several nearby teeth had been extracted recently.  “Why didn’t you just get this one taken out with the others?” my friend asked.

“’Cause I couldn’t get any leverage with the screwdriver for that last one,” the farmer answered. “There wasn’t any other teeth in there in there to pry against!”

Evidently, this self-sufficient farmer had used a household tool to remove almost every remaining tooth in his mouth.  Although he was certainly resourceful, the method he chose for tooth removal was quite unwise.  In this particular case, the patient faired OK.  He was lucky to not develop an infection from his choice of non-sterile instruments, not break off a root tip of a tooth, not impale himself with his screwdriver, nor bleed heavily.  But another patient of mine was not so lucky.

This patient came to me with the complaint of a sensitive tooth.  On examination, I noticed that he had a significant amount of gum loss between the sensitive tooth and the tooth immediately forward.  The rest of his mouth looked fine.  I asked him about this and he replied “yea, I got something stuck between my teeth, so I tooth an Exacto ™ knife and got it out.”  Well it turns out he got more than that out from between his teeth.  He succeeded in removing all of the gum there, too, and it won't all grow back.  He has exposed an area of his tooth that is supposed to be covered by gums, and now it is bare, and sensitive to cold air and drinks, and probably will be for some time to come, or at least until he gets a crown on his tooth.

The moral of the story:  Leave the dentistry to the dentist.  And for my part, I promise to leave my screwdrivers and Exacto™ knife on the workbench in my garage where they belong.