Very often the ideas that I have for articles in this blog come from real-life experiences in my dental practice. One of the things that caught my attention most recently was the prevalence of patients who come in for emergency treatment of broken dentures (typically rather old dentures) and who only have the single set to work with.
Now this creates a real problem for them because it is difficult to go out in public without teeth. People at work who may not know they wear dentures will suddenly become acutely aware of the fact. This can create considerable embarrassment and, even for a retiree, is often enough to prevent attendance at important milestone events such as a graduations, weddings, or anniversaries.
Some repairs can be handled quickly and relatively easily in the office, whereas others have to be sent to a dental laboratory. Depending upon the severity of the problem, that can take time: days, or even up to a week with certain types of dentures.
If you don’t wear dentures, this post may not appear to have anything to do with you. That is, until your mother, father, or grandparent call you in a panic, reporting they just dropped and broke their denture. (Or lost it.) You may find yourself pressed to leave work to bring them to the dentist’s office.
While it may be easy to say that every denture wearer should have a spare set, I understand the economics of the situation. Since I started practice some 20+ years ago, I have seen the cost of producing dentures nearly triple. Nevertheless, there are still many good reasons to think about having a spare set made.
Very often, when making a new denture, your doctor can manufacture a spare set at a reduced cost because he does not have to do the work twice. Similarly, an “economy” version can sometimes be produced by the laboratory which can make a duplicate of your existing denture. It may not be as cosmetic or “perfect” as the original, but it sure is nice to have something to go out and eat with while your main set is being repaired.
And sure, a denture costs more than your average article of clothing — but can you imagine having only one set of pants?! How do you even go out to buy another if you lose it? I suspect that even people who wear hair-pieces have back-ups. They may not want to go out in public without hair, but at least they can still eat.
If you or a loved one only have one denture, seriously consider a spare. And if the denture is older than seven years, it is a good idea to think about a new one. (For more information about why this is recommended see our earlier blog post on the subject.) No one needs the stress or embarrassment caused by having to be without teeth.
What?! Is the sky falling? What dentist would dare utter such blasphemy!
Stick with me for a moment. You may learn something about flossing.
Here are the facts as I see them after more than twenty years in dental practice:
Most patients don’t floss.
Most patients don’t like to floss.
Most patients won’t floss even if you explain the benefits of flossing at every checkup visit for ten years.
Most patients are convinced flossing makes their gums bleed and is uncomfortable to do.
Most patients will tell you they floss, but “probably not as much as I should.”
So really, why bother?
Another observation I have made about flossing regards what people think flossing is. I will sometimes hand a patient a piece of floss and ask them to show me how they floss. Without exception, I have seen patients pass the floss between their teeth and then pop it back out.
That sounds right, doesn’t it? Special effects department please sound the buzzer. That’s not flossing.
Add to this the fact that most patients will only perform this routine once in a while. If you call that “flossing” I say don’t lose sleep over the fact that you are not flossing regularly. That can be effective at pulling food out from in between your teeth, though, so feel free to do so. But if that’s not flossing, just what is it, really?
Flossing is the action of taking a length of floss – either the conventional “string” kind or pre-threaded on a fork-like device – and then passing it between your teeth while holding it in a “C-shape” against the side of the tooth. You then take the floss and rub the edge of the tooth, sliding it all the way under the gum-line in an up and down motion. How often can one do this? After every meal would not be too much. But if people did this at least once a day, the average case would see dramatic results after an average of two weeks of daily flossing.
If you haven’t been flossing regularly here is what you can expect: your gums will bleed when you start to floss. It is also likely to be a little uncomfortable at first. But over time, the bleeding should stop. If you haven’t had a dental checkup and cleaning for a while, it is a good idea to do so this first. Flossing against existing tartar will be an unending battle. Once the teeth are clean, however, daily flossing will usually result in pink, firm and healthy gums that don’t bleed. Other benefits? Fresher breath and reduced inflammation – which also means a lowered chance of heart attack and stroke.
If you only floss once in a while, though, inflamed gums will likely never get up to a point where the occasional activity makes any difference. So, if you don’t make it a discipline, why bother? But if you would like healthy teeth and gums for a lifetime, start flossing today!
There are a number of factors that can contribute to the formation of dental cavities. One fundamental that will apply to most everyone concerns the reduction of dental plaque. If you want fewer cavities, reduce your plaque levels.
Dental plaque can be defined as a complex microbial community, with greater than 10 to the 10th power bacteria per milligram. (That’s really a lot of bacteria.) Just to keep things simple, though, the problem is that these bacteria produce acids on your teeth – and the acids dissolve the enamel, leading to tooth decay.
After only a few years of practice, it became obvious to me that most people have difficulty identifying plaque. Even now, I’ll begin a dental exam or cleaning on a person and start removing large areas of plaque. If I casually ask the patient about their cleaning regimen, often I’m told “I brushed just before I came in here!”
Since that much plaque can’t form in an hour, the obvious conclusion is that the patient missed it or simply doesn’t see it. Just to be clear, plaque is the soft, sticky film that occurs on the surface of teeth – not the hard substance your dentist or hygienist has to pick away, which is tartar. Though it is basically mineralized plaque, virtually no amount of tooth brushing and flossing will remove tartar after the fact (dentists call it ‘calculus’). Once formed, calculus needs to be removed at your office visit.
It is useful to know that if you control your plaque well, calculus won’t be much of a problem. So let’s focus on that for a moment. What do you do if you feel you are brushing, but the dentist tells you he still sees plaque? Stain it!
Lately, I have been seeing more commercials advertising products for children that stain their teeth blue after they have rinsed with it. The child then brushes until all of the blue stain has been removed. What the liquid is staining is plaque. I think this is a great way to simplify the process of identifying the problem. Whether you are six or sixty, the principle is the same.
If you want to be certain you have gotten the plaque off, rinse with the stain after each meal and then brush (and floss) until you have removed the discolored areas. Barring other systemic or external contributory factors (such as medications leading to a dry mouth), you and your dentist should see a big improvement in the cleanliness of your mouth, and fewer cavities over time!
Recently, a great deal of attention has been placed on economizing in all different aspects of life. Some people have even considered cutting back in the area of health care by putting off routine maintenance care. While this is a little like playing Russian roulette when it comes to dental health — for reasons I’ll explain shortly — there may be a better way to dodge the financial bullet. And it may be a much simpler one.
After more than twenty years of practice I have seen people consider all sorts of ideas to deal with rising dental costs. Often, people become fixated upon dental insurance as the primary solution to the majority of their dental needs. Because dental insurance generally tends to be pretty expensive relative to what it pays out, especially if you are buying it yourself, patients that rely on it exclusively often end up worse than when they started. Dental insurance typically has waiting periods before it can be used, during which time existing conditions advance, becoming more expensive.
In these cases, you have to wonder – if the premiums are costing you more than what the company pays you back – what’s the point? Obviously, this arrangement is a much better deal for the insurance company than for the patient. Let’s also consider that when I first started practice, dental insurance maximums averaged $1,000 to $2,000 annually. Twenty years later, they average . . . $1,000 to $2,000 annually. If insurance kept up with inflation alone, the annual maximum should easily be over $5,000. Don’t hold your breath for that one though. Patients would be better off just setting aside the amount they pay for premiums. They usually come out better in the end.
Putting off dental care often becomes more costly to patients for several reasons. Firstly, many dental conditions are actually painless in the early stages. Periodontal disease is a prime example. This is a condition in which the bone surrounding the teeth becomes lost, leading to a variety of circumstances including bleeding gums, loose teeth, bad breath and, eventually, tooth loss. It is the number one reason that people loose teeth world-wide. For the most part, it doesn’t hurt. When it does, if it does, it is usually too late. The tooth or teeth have to come out.
Likewise, dental decay usually doesn’t hurt in the early stage. Actually, I’ve lost count of the number of times it didn’t hurt in the advanced stage either – but this is usually the point at which the patient becomes aware of a problem. A piece of the tooth breaks off, or they actually experience pain. The tragedy of this scenario is that when it reaches this stage teeth often end up requiring more expensive root canal therapy or extraction. Dental costs can very quickly escalate as much as ten times from the cost of a simple filling to what it costs to complete a root canal and crown.
So what do you do? Focus upon prevention.
Here is a true story I hope will leave as big impression upon you as it did me at the time:
When I was a dental student, I recall a lecture give by one of my professors in which he made a powerful point on the subject of prevention. The seminar dealt with the subject of prosthetics – more specifically, the fabrication of crowns and bridges. This professor, however, was one of those rare dentists who actually had two recognized specialties. He was a professor of prosthetics, but he was also a periodontist. While this was a crown and bridge lecture, he taught us a very valuable periodontal lesson.
Here’s what he did. The seminar was pretty informal at this point. The professor told us he was going to put up some slides of patients and have us guess their ages – just by looking at their x-rays and then at pictures of their gums. As a student, I remember thinking this was a refreshing little game and most of the class was doing quite well calling out the ages. Looking at the x-rays, we would evaluate bone levels, tooth eruption patterns, tooth wear, number of restorations and similar factors to make our “guess.” Then we would look at the color and texture of the gums and appearance of the smile and offer up our estimate. The professor would then show us the face of the patient and tell us their age. This went on for a while and we all did pretty well.
He then put up the next slides and guesses rang out: “twenty-five,” “thirty,” “twenty-seven,” went the typical guesses. I don’t think I can remember seeing a single filling on those slides, though there could have been. Nothing changed when he showed us a picture of the gums. They looked like a teen-ager’s. Then he put up a picture of the face. The person pictured was obviously in their late seventies, maybe even early eighties.
Dead silence. Then there was a small commotion and most of the class pointed out that the slides got mixed up.
The professor paused, and said “No. This is correct. Let me tell you how I can be sure. This is a picture of my father. Those are actual x-rays and a recent picture of his gums. How is it that he has such excellent oral health?”
He then went on to tell us how when his father was a younger man, he had a visit with his dentist and he complained to him that whenever he ate, he would get food stuck between his teeth. His father wanted to know if there was anything he could do about it, because it was pretty annoying.
The dad’s dentist thought about it for a second and told him: “Well, I’ll tell you what I do when that happens to me. I go over to my wife’s sewing kit and take out a piece of silk thread and just pass it between my teeth.” As a student, I wondered when floss became invented. Evidently, it just wasn’t popular back in those days.
In any case, our professor went on to explain that his father did exactly that after every meal since he was a young man. His gums, teeth and bone levels were almost unchanged. That’s what he had to show for his efforts.
I filed the image in the back of my mind, but I have to be honest – I didn’t exercise the same level of commitment – just yet.
Oh, sure, I brushed, watched what I ate, and took vitamin and mineral supplements. But my flossing was sporadic. That is, until I really started looking at what happened to my patients and how those who flossed performed against those who didn’t. If you asked me today: do I floss regularly? Absolutely. You can’t buy cheaper dental insurance.
Flossing benefits your gums, your breath, your teeth, your lungs, your heart – in short, you.
Do you know that probably up to a third of the cavities I treat happen between the teeth? This is why regular exams are so important. You simply can’t see this area. For that matter, without x-rays, neither can I in most cases. But my point here is simply this: even if you brush after every meal and snack, without flossing this area never gets cleaned. Why would anyone become surprised that an area that never got cleaned could decay over time?
There are all sorts of reasons people don’t like to floss, but the reasons to do it are actually pretty compelling and very cost-effective. Think it over. Maybe floss is the most affordable dental insurance. . . .