Talk with your Dentist Introduction

Happily my 93-year-old mother recently decided to be fitted for a hearing aid. Before this event we often experienced amusing but sometimes frustrating conversations when I would ask a question and she would reply with information about something totally unrelated. Its important when we communicate with one another to be discussing the same subject otherwise the results may be a shock to you and possibly problematic. My belief is that patients are often frustrated by dental conversations  so before you speak be sure you and your dental professional are referring to the same exact topic. O.K.? We should be able to assume a dentist knows we want to keep our teeth for a lifetime correct? Yes, but the difference may be the expectation of your gold standard Ultimate Oral Health.

Wellness Dentistry
The Ultimate Oral Health goal is to keep as many natural, pristine, and untouched-by-dentistry teeth in perfect and comfortable health - for a lifetime. This is not always the exact goal of traditional, biologic or biomimetic dentistry, because many dentists do not believe it is possible. Only a limited number of dentists seem to understand that cavities and gum disease can easily reverse, and most believe teeth deteriorate with time and fillings get infected with secondary or inexplicable decay.

CAMBRA (Caries Management by Risk Assessment) dentists come close to the goal and understand reversing decay, but they often endorse products like extra strong fluoride, chlorhexidine or sodium hypochlorite, that I believe can harm healthy biofilm and upset colonies of bacteria necessary for sustainable oral health.

Agreeing to Treatment
You will probably not be able to find words to explain Ultimate Oral Health to most normal everyday dentists. You may find a discussion is easier if you stand up, out of the dental chair and view the person you are talking with eye to eye. It is much harder to be confident lying down in the chair with the dentist or hygienist talking down to you.

My advice is to be self-educated about teeth and ask questions about their diagnostic evaluation results ask to know what they see and why they suggest treatment. Personally I would not agree to any treatment until you have had time to quietly decide if it is truly necessary.

Your Responsibility
The problem is that theres almost no financial incentive in a patient who does not want any treatment. Most patients want what insurance pays for. It is hard to say you dont want a free cleaning. It is hard to decide you are going against professional pressure and advice. Its a scary time to be a patient not because you are a financial contributor to dentistry - but because tooth decay and gum disease are on the rise. Oral disease cannot be ignored because it affects body health even to the point of being associated with problems that can kill you. Yes, you need to know what is going on in your mouth and sometimes you will truly need treatment.

Reversal of Decay and Gum Disease
Always keep in your mind at every dental visit that most early dental problems are easily reversible with a few dietary changes, Zellies xylitol products, and correct oral care. A little effort can often erase an area of concern in a couple of months. Re-evaluation of a potential problem is the best use of experienced dental advice. If a cavity showed on X-ray then maybe another X ray is taken to see if there is any sign of re-mineralization. If there is any improvement it means you are doing well - so if you continue a little longer the cavity should disappear. Once a cavity has reversed, or a periodontal pocket has gone away, you and your professional should rejoice in the fact you eradicated the need for the filling, deep cleaning or surgery. If they dont celebrate your success maybe you should consider a change of office and find another. Dentists may read my personal list of demands and laugh. Here is my view on what should happen at dental visits:

What I dont want at dental visits:

  • I dont want X rays unless there is a reason (maybe one every 5 years at most)
  • I dont want unnecessary cleanings (Ive had one in the course of 30 years)
  • I dont want to change my few silver fillings for white (I believe the body can detoxify 10 silver fillings and white ones are not kind to health either).
  • I dont want a filling if I can reverse the problem and re-mineralize the tooth
  • I dont want a scaling or laser treatment for my gums until I have had time to work on the problem with good home care for at least 8-12 weeks.
  • I want as little treatment as possible for me and especially for my children
  • I dont want fluoride treatments (there is no Evidence Based science to show any benefit unless a child has gross decay or is at high risk)
  • I dont want X rays or cleanings for my kids (unless there is a reason for it)
  • I dont want sealants - I would rather visibly monitor fissures (because I am prepared to work and reverse any decay).

What I do want:

  • I do want an annual evaluation of my oral health including an exam of the associated areas of my head, neck and tongue, looking for pathology.
  • I want careful assessment of my tooth health alerting me about areas of concern (a cavity takes about a year to form and about 6 months to reverse). I want to know if my dentist sees any possible decay and where this is. Visualization or photographs are great to understand what we are talking about. I dont want a diagnodent reading to be the only diagnosis, thanks (too many false positives)
  • Id love to measure the hardness of my enamel and check it against previous records (equipment called the Canary System can do this) and know if my teeth are getting softer or harder. This way I can work on problems or rejoice!
  • I want a thorough evaluation of my gum health bleeding areas, calculus, periodontal pockets. If there are any problems I need to know exactly where they are and what the readings are lets write this down.
  • If periodontal disease is a visible problem an Oral DNA test will be useful to learn more about the bacteria involved and ways to solve the problem.
  • Id like to be told about recession or gum abrasion but just discuss treatment options I need some time to decide if it seems necessary or not.
  • I respect evaluation of old fillings and suggestions if my dentist thinks a crown is needed and why. Visualization or a photo would be great for me to understand more.
  • If everything is good Id like to tell you about the products I have been using for home care and Id really like my dentist and hygienist to be interested in this.

Your Path to Healthier Dentistry.
Dentist Alex Shvartsman (a biomimetic dentist) has written an excellent book about dentistry, describing details of the techniques used for root canals, implants, extractions, orthodontics and fillings etc. I dont speak much about these topics, since my goal is to help everyone avoid treatments. On the other hand, if my advice comes to you a little too late, I highly recommend his book. Be aware, Dr. Shvartsman and I do not have identical views on prevention, toothpaste, or home care but his ideas are valuable and reading his book may prepare you for a conversation with your own dentist at some time in the future.

Glossary of some words your dentist may use:

anaerobic - existing in the absence of oxygen. Anaerobic bacteria can be very harmful

biofilm - bacteria meshed with proteins in a film that coats teeth and gums in the mouth. Healthy biofilm is protective, but infected biofilm can damage teeth and gums

buccal - tooth surface facing towards the cheek

calculus - a hard build up of calcified infected biofilm on teeth usually associated with too much acidity of some kind

caries - tooth decay a mixture of bacteria and softened tooth substance

cariostatic - acting to halt tooth decay

catalyst - an agent that provokes or speeds significant change

cavity - the caving in of a tooth following progressive weakening of the surface by bacteria and acidic attack

cementum - a material on the outer side of a tooth root and into which fibers are able to attach and help flexibly support the tooth in the jaw bone

cementoenamel junction - the place where tooth enamel joins the root surface of a tooth, and the point where gum tissues meet teeth in a healthy mouth

dentin - the inner part of a tooth that is hard yet permeated by cell extensions that travel through tubes radiating from the pulp to the outer part of dentin

demineralization - a loss of bodily minerals that weakens the structure

dental caries - a progressive and destructive disease that attacks teeth ( see caries)

denture  - a removable appliance designed to replace some or all teeth

distal - tooth surface that faces towards the back of the mouth

enamel - the outer layer of the tooth that is composed of mineral crystals in a collagen structure, with no live cells. Its strength is dependent on the concentration of minerals that diffuse in and out from the surface. Enamel can become soft, but can also become harder again.

erosion (tooth) - the act of teeth wearing away following a softening usually caused by acidity

explorer - sharp, pointed instrument that dentists use to check for cavities and tooth decay

facial -  the tooth surface on front teeth that faces towards the lips

fissure - the natural groove or crack in the biting surface of teeth

fluorosis - mottling of the teeth caused by fluoride as it interferes with enamel formation and results in a speckled or mottled appearance of enamel

gingiva - the part of the gums in contact with, and surrounding, the tooth

gingivitis - a reversible inflammation of the gums, most often seen as bleeding gums

halo effect - the spreading of fluoride from one geographic area to another when food or beverages produced in one place are bought and consumed in another

implant - a titanium or zirconia screw-like device used to attach a replacement tooth into the natural jawbone

inlay - a metal or ceramic device that is fabricated outside of the mouth and then cemented into a cavity, eventually looking like a traditional filling

interproximal - the area between two teeth

lingual - the tooth surface on lower teeth that faces towards the tongue

mesial - the tooth surface that faces towards the midline of the mouth

occlusal - the chewing surface of teeth the top surface of molar teeth

onlay - a metal or ceramic cover that is used to replace part of most of the biting surface of a tooth

palate - the roof of the mouth

palatal - the tooth surface on upper teeth that faces towards the roof of the mouth

pellicle - a vital protein layer that separates adult enamel from biofilm

periodontitis - a more severe progression of gingivitis that occurs when the fibers of tooth attachment become infected and disrupted below the gum line

porous - permeable to liquids

pulp - the nerves, blood vessels and liquids contained in the central chamber of a tooth

remineralization (tooth) - the rebuilding of minerals into enamel to repair and replace missing minerals and strength

tartar - encrustration of plaque on the teeth ( this is another word for calculus)

white spot lesions - the first stage of a cavity seen with the naked eye when minerals are lost and the tooth surface weakens and becomes porous


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