Are dentists like mechanics? How can you trust them?

As I just recently started my career in private practice with Dr. Craig Christiansen in Orem, Utah I am starting to understand first hand the great amount of responsibility that I have as a dentist.

I know the feeling that you get when you are told something is wrong which you cannot personally verify, and that needs to be fixed by the person telling you there is a problem for a large amount of money.  It feels like you are being taken advantage of.

I recently purchased an older car and took it to an auto mechanic for a safety and emissions inspection and was told I had to have $800 worth of repairs or it would not pass safety or emissions.  I felt more than a little annoyed.  When I bought the car the people I purchased it from said it passed safety and emissions just a few months ago.  Why does this happen? Differences in interpretation of the safety and emissions guidelines? Conflicts of interest encouraging more work than really needs to be done in order to make more money?

I'm sure these are questions that arise in the minds of patients who come to see me or other dentists after switching from another dentist and more cavities or work is found than by a previous dentist. Sometimes there are differences in what one dentist would recommend versus another.  Sometimes there are differences in diagnostic technologies allowing one dentist to see what another has not seen.  There are gray areas in dentistry just like everything else.  Cavities that appear to be borderline may be watched by one dentist or treated with a filling by another.

I try to think to myself every time I diagnose a patient with dental work to be done: "What would I do if it was my wife, son, or daughter in the chair? What would I want to have done with my mouth/teeth?" This helps me to keep in mind the best treatment possible independent of what the cost would be.   Treatment plans do need to be adjusted depending on the decay rate, finances, etc but I will always try to treatment plan with the following motto: "Do unto others as I would have them do unto me."

I feel like I am a fairly conservative dentist.  Whenever possible I like to not treat anything that does not need to be treated.  I would love it if more of my patients showed up for their exams with no cavities.  I don't get a thrill out of finding cavities or doing fillings. I am thrilled when I find someone with healthy teeth and gums that do not need treatment.  I do enjoy my job and I take great pride in the work I do but I would never wish cavities on anyone, and I don't need to practice doing fillings.  I actually really hope they put Fluoride in the water here in Utah County because it would help decrease cavities in kids and among people with less income who cannot afford dental care not to mention save everyone else a lot of money.

At least right now I am not paid by production but by the hour so I don't have a financial incentive to diagnose things that do not need to be done.  That will not always be the case however, so I will have to maintain a high level of professional integrity and always remember to treat everyone like it was my family.  So how can you know if you have an honest dentist?  Go to dental school.  :) Just like finding an honest mechanic you have to rely on the experience of others and hope that the dentist is honest with you too.

There are other things too which help keep even dentist who are not prone to honesty more honest such as insurance company's which review cases and make sure the work was needed,  professional societies and boards of dentistry help regulate dentists in the community.

Other things could be a sign that a dentist has your best interest in mind.  Do they help give you strategies on prevention; brushing, flossing, Xylitol, prescription toothpaste, etc?  Do they ever mark down small cavities to be watched rather than immediately treated? 

Something else that sets dentists apart from mechanics. We take an oath to do no harm and treat others with fairness and honesty.  I will do my part to live up to that oath.  In the meantime I will find a good honest mechanic.

An ounce of Prevention

I was on call this past week at the Veteran's Hospital where I am doing a general practice residency. I got a call from the hospital emergency department about a patient who had an infected tooth that had caused a significant swelling of his lower jaw and neck. I had to go in late at night to take the tooth out because if left in place a tooth infection can be lethal. I understand that this patient likely did not have the means to see a dentist on a regular basis but to let a cavity turn into a life threatening infection should not happen.

Sometimes a toothache can be painful then go away because the nerve is dead. However, the infection can remain to erode the bone away from the roots of your teeth and cause swelling or an abscess that will not go away unless a root canal is done or the tooth is extracted. Often people will ask if an antibiotic will cure the infection. Unfortunately, it wont. The infection will always re-surface after the patient stops taking the antibiotic because the antibiotic cannot penetrate into the biofilm where the infection is located. The source remains: an untreated, infected tooth.

This patient I saw had to be admitted to the hospital to give him IV antibiotics and make sure the swelling did not close off his airway. I visited him again the next day and he was doing fine.

Just a reminder to take care of your mouth. It is less expensive, less painful, and less life threatening to go to your dentist on a regular basis and prevent or treat little problems before they become major issues.

The Two Sources of Truth

I recently listened to this book on CD by Francis Collins called: The Language of God a Scientist Presents evidence for belief. Dr. Collins who has a PhD in chemistry, an MD, and various other degrees and who was the head of the human genome project spoke at our dental school graduation this past May. I was stunned when a good portion of his speech was about God, Family, and making contributions to society. He said that eventually all of us will have to deal with the big questions of life like: "What is the purpose of life?" and "Why are we here?" The amazing thing about this renowned scientist is that he was once an atheist and it was not until his residency following medical school when he was confronted with patients facing imminent death that he came to question his lack of belief in God. He then said that a friend recommended the writings of C.S. Lewis which he read and began his logical basis for belief in God. I highly recommend Dr. Collins' book, he also has a website dedicated to reconciliation of Faith and Science called the BioLogos Foundation. I agree with Dr. Collins: you can be a firm believer in God and still be a good scientist, and the two main sources of truth are rigorous science and God himself.

How to save space on your hard drive and extend the useful life of your computer

I recently have been worried that my computer was running out of space on the hard drive. With all the modern files we store on our computer nothing takes up more space than digital video. I have been taking home videos of my family for about two years now along with digital photos. My little 160 GB hard drive only had about 7 GB left.

I found this amazing free utility that helped me save 30 GB of hard drive disk space in a matter of minutes: SequoiaView this amazing utility graphically displays all of the files on your hard drive by how large they are. You can use this utility to quickly locate where these large files are and if you don't need them you can delete away! I found an old episode of The Office recorded on my hard drive from my TV tuner that was taking up nearly 15 GB of space. I saved some space by disabling hibernation mode on my Windows XP machine. Finally, I am going to burn all of our home videos onto DVDs so they don't need to sit on our main hard drive. I have a large external hard drive but I use it strictly for back up so now I will have an external hard drive copy and a DVD copy of our family videos.

Other ways I could save space was by using the free Duplicates Killer which allows you to search by file type in a specified directory on your hard drive. By using this application I was able to find large duplicate files of video (AVI files), MP3s, and other large files. I recommend searching by file type starting with the largest file types first. I still have a lot of duplicates that I can find and get rid of so my 30 GB of saved space is likely to increase.

I was so glad I was able to save so much space on my hard drive and that I won't have to buy a new drive. It's not that expensive to buy more storage space but I'm on a tight budget and why waste the money if I don't have to. Maybe now I could install Windows 7 Beta but that is a whole new ball game.

Feeling sick?

Well just about everyone in the neighborhood is sick. If I remember correctly then it was about this time last year that we all got sick also. It seems to happen right after all of our many family & friend gatherings around Christmas time. I did get my flu shot which was said to be effective this year but I think I just have a common cold. In case anyone else is suffering from a cold here is an excellent website with good supporting research: http://www.commoncold.org/ another great website that has some conflicting views with the previous website but also provides a good evidence based and concise review of treating the common cold is: http://www.mayoclinic.com/health/cold-remedies/ID00036

I hope everyone has a great new year!

How to Prevent Tooth Decay Re-Visited

In a previous article I wrote on ideas for preventing tooth decay. I would like to re-visit this topic because despite the fact that we have the means available to completely prevent this disease it is still very rampant in our society. Take a look at this well-written article on WEBMD:

http://www.webmd.com/oral-health/guide/tooth-decay-prevention

I liked this article and thought it was a good practical summary of prevention ideas similar to my article on prevention. However, cavity prevention cannot be achieved simply by reading a list of instructions in every case. There is a reason why less educated and people with lower socioecconomic status have a much higher rate of tooth decay: more than likely they were never taught the habbits that lead to oral health and they probably don't understand how this disease process works. I would like to expound on this article and the one I wrote previously. Tooth decay is a multifactorial disease meaning there are a lot of causes. However, Understanding a few basic ideas of how tooth decay works can help you change your daily habits and prevent new cavities from forming.

We were taught in dental school that 3 conditions must exist for a cavity to form:
#1 an agent: bacteria
#2 a succeptible host: you
#3 an environment that supports the agent or reduces hosts defenses.

#1 Tooth decay is the result of a bacterial infection. Your mouth is chuck-full (yes this is a very scientific term) of bacteria! The specific types of bacteria that cause cavities like Streptococcus Mutans are passed from mother to child. Cavity causing bacteria eat and digest sugar and other easly broken down carbohydrates then they produce acid. This acid is what starts to brake down your tooth structure forming a cavity. The bacteria cannot be eliminated completely with our current treatments. Even after rinsing with Listerine (which does kill them) they will re-bound, antibiotics would have a similar effect except with more negative side effects.

#2 Tooth decay is the result of a succeptible host: you! These bacteria need a hard surface to attach to: your teeth! Newborn babies that do not have teeth yet have very low numbers of these cavity causing germs. As soon as infants get some teeth especially molars with grooves in them the levels of cavity causing bacteria go up exponentially. Part of your succeptibility to decay may be genetic. Some people may have natural cavity protection in the form of good anti-cavity saliva and less succeptible tooth anatomy. However there are aspects of you that you can change. "Soft teeth" is usually not the reason for your decay. There are very rare disorders where the dentin or enamel on your teeth does not form properly thus this person would truely have soft teeth.

#3 Cavities are the result of an environment conducive to the growth of specific bacteria. If I were a cavity causing bacteria I would love the following environment: a dry mouth and plenty of carbohydrates frequently placed in the mouth of my host throughout the day and especially right before bed. The frequency of carbohydrate or sugar consumption throughout the day is a risk factor for tooth decay.

We learned about something in dental school called the Stephen's curve which describes the pH or acidity of your mouth immediately after eating a sugary or carbohydrate rich food. In some people who have poor quality or low quantity of saliva it takes a long time (more than 30 minutes) for the acid to be neutralized or brought above the critical pH of 5.5 (the critical pH is the acidity level at which your enamel begins to dissolve or de-mineralize). If this type of person is snacking on crackers, sipping soda, eating bread, or cookies 5-6 times throughout the day then there teeth may be in an acidic environment all day long. People with very dry mouths may have an oral environment which is constantly below the critical pH of 5.5. However in someone with normal salivary function the acid is neutralized within 20 minutes but even in this case the person could spend a significant portion of the day with their teeth being dissolved!

Now a few things you can do about it: You can't completely eliminate the bacteria or change your genetics but you can drastically change the environment that the bacteria live in.

#1: Chew a piece of sugar free gum or suck on a sugar free mint after meals and snacks. The main goal here is saliva stimulation immediately following a meal... Why? Because saliva in most cases is very effective at neutralizing the acid produced by the bacteria and washing away excess bacteria and food debris. Unfortunately a great deal of our modern medicines have the side effect of inhibiting the production of saliva causing dry mouth. This is why people can go their whole life without having much decay then all of the sudden when they start taking medicines which cause dry mouth (Xerostomia) they get a lot of cavities. If you have a dry mouth then you need to see your dentist and ask him or her about how to prevent decay with aggressive high strength fluoride therapy and saliva substitutes.

For everyone with normal saliva flow the sooner you can stimulate saliva following a meal, snack or drink of soda the faster you will reduce the acid levels in your mouth to normal and thus prevent decay. So chew some xylitol sweetened gum! If you don't have any gum then buy some, if you can't buy some then get a drink of water after a snack or meal.

#2 Don't rinse with anything including water for at least 30 minutes after you brush your teeth (with ADA approved fluoride toothpaste). Fluoride has the opposite affect from sugar on your teeth, it re-mineralizes rather than dissolves the tooth structure. The problem with fluoride is that it has poor substantivity meaning it does not stick to your teeth very well. After brushing your teeth you should spit the remaining paste out THEN DO NOT RINSE WITH WATER! If you rinse after brushing you are washing away most of the protective fluoride. Fluoride needs contact time with your teeth and in your saliva to help repair the damage done by the acid producing bacteria. It is especially important if you have a high risk for cavities to expose your teeth to fluoride right before bed as the fluoride can remain in your mouth uninterrupted for 7-8 hours. If you don't brush and floss your teeth before you go to bed then you are letting the bacteria dissolve your teeth for 7-8 hours!

In short your teeth are constantly in a flux of either being re-mineralized or de-mineralized. Tooth decay depends on how well you keep your teeth in the re-mineralized category. Your job is to stop the teeth from dissolving by stimulating saliva with a sugar free gum or sugar free candy and help the teeth re-mineralize or solidify by allowing your fluoride toothpaste to sit on your teeth uninterrupted for as long as possible.

Or if you want it in even simpler terms... For cavities: Fluoride & Saliva GOOD, frequent sugar exposure without anything to neutralize the acid BAD!

I'm glad I don't have to go to school tomorrow it's getting late!

Here are some other suggestions for preventing cavities:

7 Ways to Prevent Cavities
http://dentistry.about.com/od/dentalhealth/tp/preventing_cavities.htm

Going the Distance

Last weekend I ran the Richmond Suntrust Marathon. I was standing back with the 3:40 pace team when the marathon started.

I stayed with the 3:40 pace team running an 8:30 mile for 13 miles...

Then I hit the wall...

I was still able to walk, then jog, then walk, then run until I finished the 26.2 miles with a time of 4 hours 36 minutes or a (10:35 per mile pace).

Running the marathon was probably the hardest thing I have ever done, I ran 745 miles in training and although I did not get a sub 4 hour time like I wanted, I was happy that I was able to finish. Out of the nearly 4,000 runners who signed up about 3,000 finished and I finished in 1,686th place.