Coronary heart disease is the leading cause of death in the
United States. What does that have to do with dentistry? A lot, actually. Your
mouth can tell you a lot about your overall health because oral health and
overall health are closely linked. The link between coronary heart disease and
periodontal disease (gum disease) is well established in the medical community.
Whether one causes the other and how is still a matter of study. One theory is
that when you have periodontal disease, bacteria accumulates in the mouth
including deep in your gum tissue. Because gum tissue is vascular, bacteria can
easily get into your bloodstream and make its way to your heart. This bacteria,
doctors and researchers theorize, might be a cause of both periodontal disease
and heart disease.
Regular dental visits and proper home care including brushing and flossing your teeth daily will help you remove plaque buildup from your teeth and prevent periodontal disease. For people who already have periodontal disease, it’s not too late. Dentists and dental hygienists can treat periodontal disease through Periodontal Therapy. If you haven’t seen a dentist for a long time or worry about your risk for periodontal disease, call (208) 467-9271 to set up an appointment to see us today!
This post is in response to a recent article published in Atlantic magazine entitled “The Trouble with Dentistry” by science writer Ferris Jabr
By: Bryan Mansfield
Dental Office Manager & AADOM Member
In a recent Atlantic article, Ferris Jabr describes the following horrific scene: “A masked figure looms over your recumbent body, wielding power tools and sharp metal instruments, doing things to your mouth you cannot see.” No, this is not a description of enhanced interrogation methods. It’s a description of a visit to the dentist. While not strictly inaccurate, it’s clear that Jabr (pronounced like neighbor) has calculated his words to conjure a terrifying image of dentists and dentistry. The article doesn’t get any more flattering from there.
Jabr, a science writer and a self-proclaimed naturalist, clearly has strong opinions about dentistry and he backs them up with anecdotes and studies from the Cochrane organization and the Swiss Dental Guidelines. The article’s centerpiece is a single anecdote–a true story about a dishonest dentist named John Roger Lund whose unethical practices resulted in thousands of unnecessary dental procedures which ultimately cost his unsuspecting patients outlandish sums of money. At best, Jabr characterizes dentists as pseudo-doctors who tinker with unpredictable solutions. At worst, he paints them as greedy charlatans whose primary goal is to pay for their Mercedes by scamming you. The problem is that, like any industry, there are excellent dentists and dishonest ones. Jabr’s article makes the dishonest ones the face of the entire industry.
As a dental office manager and a member of AADOM (American Association of Dental Office Management), I disagree with both Jabr’s approach and several of his assertions. But he’s not all wrong. He points out that many dental procedures lack rigorous scientific studies. No one would like to have more such studies of their methods than dentists themselves. Most dentists would enthusiastically welcome increased scientific data to bolster their explanations to their patients about necessary procedures. Jabr also raises the issue of second opinions, placing blame on dentists for their patients not seeking a second opinion. He uncovers a problem that exists in dentistry, which is that sometimes dentists are too quick to move forward with a procedure without fully considering all available options or allowing their patients the chance to make a fully informed decision. In addition, it’s possible for dentists to be overly aggressive in diagnosing dental treatment. These are all strong points that I praise Jabr for observing and bringing to consumers’ attention. Nevertheless, I find much of his approach dishonest and biased.
Jabr’s most egregious error is his unfounded (and incorrect) assumption that the reason dentists don’t do more preventive sealants is because “they are too simple and inexpensive to earn dentists much money.” A simple conversation with anyone who has worked in a dental office could have helped him avoid this error. I’m confident that if polled, 99 out of 100 dental office managers would likely give some variant of the following answer to the question of why dental sealants are not used more frequently: “Patients choose not to get sealants because they don’t want to pay for them. And when it comes to dental sealants, insurance policies have strict limitations.” Understandably, patients don’t want to spend $30+ dollars to protect a single tooth that has shown no signs of problems. If anything, dentists have an incentive to do more dental sealants. They are effective, take little time to place, and are typically placed by a hygienist during a hygiene visit. Jabr’s bad assumption betrays his negative bias toward the entire dental industry.
One relevant challenge facing dentists eludes Jabr’s narrow field of view: The high-risk legal liability assumed by dentists every day simply by doing their job. Early in the article, Jabr says: “Consider the maxim that everyone should visit the dentist twice a year for cleanings. We hear it so often, and from such a young age, that we’ve internalized it as truth. But this…has no scientific grounding…An increasing number of dentists acknowledge that adults with good oral hygiene need to see a dentist only once every 12 to 16 months.” After all, people sometimes go years without visiting the dentist and often have one cavity (or zero). So what’s the big deal? Well, suppose I have a regular dentist and on a recent visit, he diagnoses a cavity. Instead of fixing it right away, he says “let’s watch it for now.” I decide to follow Jabr’s advice and skip my next checkup, waiting a full year (or more) to come back. By that time the decay spreads and gets deep enough to damage the pulp of the tooth. Unfortunately now the problem is worse than before, and could have been prevented by more frequent checkups.
In the middle of the article, Jabr recites a claim made by the Swiss Dental Guidelines that when patients have minor cavities, dentists should not perform fillings, but rather “monitor the decay and encourage the patient to brush regularly, which can reverse the damage.” Most often, decay doesn’t stop by itself. It spreads. A small, simple filling is a safer way to ensure that decay will not spread, thus preventing a larger filling or even a root canal in the future. This is especially important if the patient is following Jabr’s advice to only visit the dentist once every 12-16 months.
As a naturalist, Jabr appears wary of root canals in particular. He describes them as “much more radical” than a filling and cautions “you may want to get a second opinion before getting that root canal.” He’s right that root canals are radical procedures. But what he fails to do is provide a plausible alternative. When a tooth becomes decayed or damaged to the pulp, a patient essentially has three options. The first option is to have the tooth extracted. Losing a tooth is never ideal. In addition to having a gap where the tooth was, extractions also result in loss of bone structure. Maintaining strong, healthy bone is crucial for keeping teeth later in life. The second option is to do nothing. This is likely to be a painful option, and the tooth will eventually be lost one way or another. The third option is to get a root canal. Until a future innovation makes root canals (or maybe teeth altogether) obsolete, they are the only reliable way to save teeth with damaged or dead pulps. Despite some fringe controversy surrounding root canals, they are strongly preferable to the first two options.
The picture painted in Jabr’s article is that dentists select their profession primarily based on its money-making potential. In reality, dentists tend to be hardworking professionals who are well compensated for their labor, but who nevertheless have a difficult job. Most dentists sincerely care about their patients’ well-being and sincerely want to pursue the treatment course that will be in each patient’s best long-term interest. There are dishonest dentists out there, just like there are dishonest people who become lawyers, doctors and even science writers.
*(This post refers to dental flossing, not the over-hyped and short-lived dance move).
In the last few years, the practice of dental flossing has been challenged by media sources. This post analyzes criticisms of flossing and gives the latest advice from dental professionals on the subject.
As dentists say, “you only brush and floss the teeth you want to keep.” But in recent years, media outlets have challenged the conventional wisdom of flossing with headlines like this one from British newspaper The Telegraph: “Flossing teeth does little good investigation finds as US removes recommendation from health advice”.
Critics of flossing argue that it really doesn’t do much and that the only people who benefit are dental floss companies. This post analyzes what we know about flossing and reviews guidelines put out by the American Dental Association and the U.S. Department of Health and Human Services on the subject.
What Do the Experts Say?
As oral health specialists, dentists are the experts when it comes to flossing. Leading professional dental organizations nationwide continue to recommend flossing.
The American Dental Association (ADA) states:
“The (ADA) recommends cleaning between your teeth daily with an interdental cleaner (like floss). Cleaning between your teeth may help prevent cavities and gum disease. Cleaning between your teeth helps remove a sticky film called plaque. Plaque contains bacteria that feeds on leftover food or sugar in your mouth. When that happens, it releases an acid that can eat away at the outer shell of your teeth (enamel) and cause cavities.”
The Department of Health and Human Services states:
“Flossing is an important oral hygiene practice. Tooth decay and gum disease can develop when plaque is allowed to build up on teeth and along the gum line. Professional cleaning, tooth brushing, and cleaning between teeth (flossing and the use of other tools such as interdental brushes) have been shown to disrupt and remove plaque.”
The American Association of Periodontology states:
“The accumulation of plaque bacteria beneath the gum line may cause an inflammatory response which ultimately leads to gingivitis, a mild form of periodontal disease. If left untreated, periodontal disease can worsen, leading to tooth loss and increased risk for other systemic disease such as diabetes and heart disease.”
So… I Still Have to Floss?
Well, much to your dental hygienist’s chagrin, no one is (probably) going to force you to floss. But if you want to have optimal oral health, dental professionals strongly recommend flossing. Everyone has a brother or a cousin or a friend who never flosses, but still has “perfect” teeth. There’s always an anomaly. It’s true that some people’s teeth are uniquely impervious to decay. But that’s the exception.
On a cautionary note, it is possible to damage gum tissue by flossing too aggressively. It’s important to find a balance between flossing gently and flossing thoroughly. Flossing shouldn’t typically be painful.
The basic concept is simple: You floss your teeth in order to clean the sides of your teeth that are inaccessible to the toothbrush. But there’s another benefit we don’t talk about often enough: better breath.
Flossing Gives You Better Breath
Plaque is not only sticky, but in most cases, stinky too. Flossing can improve your breath simply by removing foul-smelling plaque. When you floss AND use a tongue scraper, you’re on the fast road to fresh breath.
Flossing improves your breath, helps you reduce plaque buildup, and helps prevent gingivitis and the risk of periodontal disease. Dentists continue to strongly recommend flossing as an important practice for keeping your mouth healthy. When it comes to flossing, shoot for once per day. It doesn’t matter so much what time of day as it does that you’re consistent. Happy flossing!
**This post is not intended to be expert medical advice
Nobody likes bad breath. Have you ever wanted to get your hazmat suit ready because of someone else’s breath? In this post, we dive into 6 tips for fighting halitosis.
Halitosis is the technical term for chronic bad breath. Everyone has bad breath from time to time, but halitosis is a chronic condition. This means that it is persistent and long-term. Chronic bad breath can also be a symptom of an oral health problem. According to the American Dental Association, bad breath is primarily caused by 6 main factors: Bacteria, Dry Mouth, Gum Disease, Food, Smoking/Tobacco and Medical Conditions. Another less common cause of halitosis is tonsil stones. This post will give you a few tips for fighting bad breath and improving your oral health along the way.
Use Proxabrushes or Waterpiks – When you floss, focus on areas that tend to trap food. Sometimes gaps between certain teeth can trap more food than others because of the position or shape of the teeth. Consider using a proxabrush or a waterpik to reach hard-to-get areas. Ask your dental hygienist for more information on these products (which we carry at Nampa Dental). Making these areas a priority when you brush and floss can eliminate plaque and chunks of food that can cause bad breath.
Don’t Rely on Mints or Gum – Mints, mouthwash and gum can be useful in a pinch if you need fresh breath quick. Although mouthwash kills bacteria, it does not remove plaque and tartar, which are the usual sources of bacteria in the mouth. Attentive brushing, flossing and visiting the dentist for professional dental cleanings are the only way to eliminate plaque and tartar.
Stay Hydrated – Your oral health is connected to the health of the rest of your body. Staying properly hydrated will help keep your mouth from getting dry. Dry mouth is a condition when glands in the mouth stop producing saliva. It can be caused by nervousness, stress, certain medications, aging, and various autoimmune diseases. Smoking may also increase risk of dry mouth. Dry mouth can directly contribute to bad breath and other oral health problems. We recommend a special mouth lozenge called Salese for patients who suffer from chronic dry mouth. Ask your dentist or doctor for more information if you think you might suffer from chronic dry mouth.
Visit the Dentist Regularly – Visiting the dentist’s office for professional dental cleanings and exams is the best way to discover and eliminate the underlying causes of bad breath. Your dental hygienist is professionally trained to remove plaque and hard, calcified buildup called tartar (or calculus) that produce unhealthy bacteria. These bacteria can cause tooth decay and periodontal disease in addition to bad breath.
Use a Tongue Scraper/Cleaner – Our tongues are incredible muscles that allow us to speak, sing and eat the way we do. Unfortunately, they can also be a culprit of bad breath. Your mother was right when she told you to brush your tongue… But only half right. Brushing the tongue with a toothbrush is not sufficient to remove all of the bacteria and buildup that cause bad breath. A tongue cleaner is a small, flexible plastic instrument that can remove this layer. Brace yourself, this can be disturbing!
Check Your Tonsils – Tonsils are located at the very back of the throat, where most people’s gag reflex kicks in. As you probably know, tonsils can become infected and inflamed. What you might not know is that they also have nooks and crannies that can accumulate food, mucus and other debris. This debris can form “tonsilloliths” or tonsil stones. These stones are white or yellow in color and can become calcified. They are extremely foul smelling and can cause halitosis. If you suffer from tonsil stones, you are not alone. Some research indicates that between 16-24% of the population may suffer from tonsil stones, but the research is limited. Tonsil stones can be removed, but the best thing to do is consult a doctor who may refer you to an otolaryngologist to have the tonsils checked. Tonsillectomy (surgical removal of tonsils) is the only reliable method for permanently treating tonsil stones.
Keep in mind that everyone has bad breath sometimes. If you suffer from chronic bad breath, we hope these tips are helpful! As always, consult a doctor or your dentist for more detailed information and treatment.