Alcohol and Parties Friday, 20 October 2017

I hate to be a Party Pooper but I must point out the perils of alcohol on your teeth.  It is acidic and it causes your mouth to feel dry, so you tend to drink more to take away this feeling.  This could lead to impairment.  It’s fine if you drink water to counteract the dry mouth, but not fine when you drink soda, lemonade, orange juice, or any other acidic beverage.  They compound the problem. Of course, parties often include yummy desserts and cracker snacks that are loaded with sugar, even when they taste salty.

At the risk of being a Party Pooper for a second time, you also need to brush your teeth with a fluoride toothpaste and floss them after the party. The recently-eaten food has placed a layer of sugar between your teeth and it will create acid all night long.  This is the quickest path to a cavity.  The ones that form between your teeth are often larger, since I must go through the top of the biting surface of the tooth to reach the decay.

My final Party Pooper warning is for those who have receding gums or periodontal disease, now or in the past.  Part of your root surface is exposed to the acids in your mouth.  The root surface has no enamel, the “armor” that protects teeth from acid attack, so cavities form easily.


Peter Had a Gag Reflex Tuesday, 17 October 2017

Peter had gagged then vomited profusely in the dental chair as a teen, during an x-ray procedure, so had concluded that he should avoid that embarrassment again.  He didn’t go to the dentist for almost 18 years but then developed a toothache. His medical history, paperwork filled out prior to the appointment, listed his concern about gagging four different times.  

My goal is to make every patient comfortable, all the time, so I told Peter how I recognized his concern and kept him seated upright during my exam. I reminded him to take long breaths, and just let his lower jaw drop where it wanted. We took an x-ray of the tooth with a modern technique that didn’t require a large device in his mouth, and I used a different angle to view the tooth with my mouth mirror. He made it through the exam!

The x-ray revealed that his toothache was caused by an infection, which we had to get under control with antibiotics for several days.  I offered to fix an additional cavity, toward the front of his mouth, which showed up on the x-ray. I knew that this would build his confidence in our practice and demonstrate that history wouldn’t repeat itself. Peter agreed.  We proceeded, telling him what we were going to do before it happened, and giving him a few rests. He had absolutely no trouble during the procedure. This success set the stage for Peter to return with less anxiety for his next appointment, and increased the likelihood that he would have the tooth treated rather than face continual infections and then an extraction when the tooth was beyond hope.

Peter has been my patient, without vomiting, for 17 years.

Why Are My Teeth Shrinking? Friday, 13 October 2017

I have been asked several versions of this question during my years in practice, and it is always from someone over fifty years old. Teeth don’t shrink, unless you have a habit of rubbing your front teeth together over several years’ time, and even that is considered excessive wear rather than shrinking.

The illusion of shrinking teeth is created because skin loses its elasticity as you age. When the upper lip sags, it covers up more of your delightful smile.  Today, one has options to counteract the aging process but I am most in favor of lengthening, and sometimes reshaping, 6-8 front teeth with crowns. These are placed over your natural teeth and they feel the same - sometimes better!

Here’s my only caution with crowns.  A dentist can choose the color of the crown and the dental lab will make it.  The natural tendency for patients who opt for a new smile is to make the teeth very white and, sometimes, wider than their originals.  The result looks artificial, and many don’t like the result. It is smarter to match the color to one’s complexion and complement the remaining teeth.  So resist the temptation to have that Movie Star smile, often created though digitized images in magazines, and work with me to find a shade that is youthful and natural.

Contact Winterset Dental today to find out which treatment is right for you.


Ben was partial to his Partial Denture Tuesday, 10 October 2017

Ben had lost his bottom four front teeth in a car accident 23 years ago and wore a “partial denture” to fill in this gap.  It was held in place by metal clasps. He’d had the same denture all this time and considered it able to function until his death. Then, a clasp broke.  I sent the partial to the dental lab for evaluation and they didn’t have encouraging news.

Before the introduction of implants, this type of partial denture was one of only two options for missing front teeth. However, there were issues with the design.  It could come loose and become a hazard in one’s throat, or is was a magnet for stringy food and lettuce wrapping around the clasps.  Seeds or food under the partial felt like painful boulders.

I asked Ben to come back to discuss his options and showed him how dental implants in this area were the best, safest, and most comfortable solution. Of course, I could make another partial denture, if he really insisted.  Ben instantly saw the improvement in function and appearance and we placed implants a short time later. 

At his next check-up, I noticed that Ben had put on a few pounds.  He blamed his new front teeth, which made it easier for him to enjoy the food that he’d been unable to eat when he’d had the partial denture!

Contact Winterset Dental today to find out which treatment is right for you.


Halloween Makes Dentists Afraid Saturday, 07 October 2017

I am not the Grinch who stole Halloween but I do have a suggestion to modify your tactics when the doorbell rings in a few weeks.  Pass out a small item that is not candy or, perhaps, spare change to the older ones. In my experience, kids love a mini-pack of crayons or chalk, bookmarks, character pencils, or a small book.

From conversations with parents, that bag of collected candy isn’t monitored well.  Kids snack on it between meals, act up after they’ve hit their sugar rush from 7 bars in a row, or sneak candy after they go to bed. Recall the stickiness of most candy.  As a dentist, I don’t encourage any of these behaviors because they lead to decay. That is permanent damage to permanent teeth.

I encourage you to join me in the effort to reduce junk food in our kids’ diet!

Contact Winterset Dental today to find out which treatment is right for you.

Fear of the Unknown Wednesday, 04 October 2017

Do you recall the stress involved in air travel?  You don’t know whether something will delay the flight.  What about that connecting flight? You don’t know what your seat neighbors will do to annoy you. That’s because you have no control of the situation.  My experiences with flying have made me a conscientious dentist.  I try to eliminate the fear of the unknown for patients like Monica. I also insist that my dental assistants, front desk, and hygienists are highly trained to listen and understand patient concerns, not just dismiss their comments.

First, I never just walk in, greet the patient, and recline the dental chair.  I talk a bit, but mostly I LISTEN to people. That’s how I learn their emotional issues or objections. I don’t start a procedure until I’ve explained it to their level of satisfaction and answered their questions. After this, I ask them to summarize what they’ve heard, and often just watch their fears disappear. If they remain fearful, I suggest I.V. sedation or a similar alternative.

Monica was concerned about experiencing pain and the shrill sounds when we had to fill her deep cavity.  She was convinced that she needed I.V. sedation to get through it. Her friend had told her that our practice assures pain-free dentistry and that patients listen to music of their choice to muffle the noises. We also asked her to wear our dark glasses to diffuse the bright lights necessary for me and my staff to accurately work inside the mouth. She remained calm, cool, and collected.

My experience has been that about 90% of the patients who appear really scared, like Monica, rarely end up needing sedation because we listen, answer their questions in advance, and care about their physical and emotional comfort from start to finish.

Contact Winterset Dental today to find out which treatment is right for you.


Flexing Your Muscle Sunday, 01 October 2017

The hinge that joins the top and bottom jaws of your mouth together has an elaborate name. It is the temporal mandibular joint, often shortened to TMJ, and a joint exists on each side of your head.  If you place your fingers in front of each ear, and chew, you’ll feel this complicated muscle flexing. It doesn’t get much attention, or appreciation, until it hurts.  One of my patients, Tom, was playing football with family last Thanksgiving.  His 6-foot, 4-inch nephew bashed into his TMJ during a tackle and Tom was still in pain on the following Monday.  He called my office, concerned that he’d damaged a tooth, or several teeth, during that incident. I checked the teeth and they were intact, but I advised Tom to avoid crunchy food and cut his meat in much smaller pieces for a while. 

Aside from impact injury, I’ve also seen avid gum-chewing patients with chronic tenderness. That is their choice, as long as they chew sugarless gum!  

My third concern about the TMJ is related to patients who no longer have most of their back molars.  When those powerful chewing surfaces are gone, the joint functions differently. It wears out, changing the function of muscles at the same time, and cannot repair itself. Patients with missing molars often have chronic headaches from this wear and tear. Some require surgery, which I don’t perform, to rebuild the joint. Instead of deteriorating to this point before acting, I strongly encourage patients to consider dental implants to replace their back molars. 

Contact Winterset Dental today to find out which treatment is right for you. 

Familiar and Fabulous Wednesday, 13 September 2017

I’ve practiced dentistry long enough to now treat the grown children of patients that I’ve cared for since first opening my practice.  Which brings me to Margaret, a patient who had escaped our Chicago winters for the Florida sun slightly more than 20 years ago.  I’d completed a smile makeover on her mouth when she lived here. Her daughter would brief me about mom’s activities when she came to my practice, but hadn’t mentioned that Margaret might move back to Illinois.

One Tuesday, I had a new, elderly patient in my schedule and I really appreciated the dental work that someone had completed on her teeth. The margins, or edges, of the crowns fit so well and the gums were healthy. She flossed daily. So, told her that she had the teeth of a 50-yr-old! Then I commented on the workmanship and asked her how long she’d had these crowns.  She replied, “well you tell me”. It turns out that Margaret, now using the name “Marge”, had moved closer to her daughter.  However, each woman had assumed that the other one told me about the move! I was admiring my own work. Embarrassing – yet rewarding! With thousands of patients over the years, I didn’t recognize Margaret because she’d aged, changed her hair color and style, and had shifted her weight to other locations.  But her smile still lit up her face.

It is not often that a dentist is treated to a Deja Vu experience.  But it points out the fact that the investment in a Smile Makeover can continue to deliver big returns, sometimes for 20 years, with proper home care and check-ups. Marge could easily pass for someone much younger. That’s the amazing effect of a healthy smile, that I’ve seen again and again. 

Contact Winterset Dental today to find out which treatment is right for you.


Fred Was Afraid Thursday, 28 September 2017

Fred had recently retired and broken a tooth.  No longer with employer’s insurance, he knew that it would become an expensive repair so he’d decided, in advance, to just have it removed. Fred had never had a tooth extracted in his life. This situation is fairly common, for several reasons that I won’t cover here.  

We took an x-ray, while he was seated upright, and found the root intact and the nerve healthy. But Father Time would not keep it this way, unless action was taken.  Then it was my job to LISTEN. I put this in capital letters for a reason. I need to feel, personally, what patients are currently going through. Though Fred seemed calm on the outside, he was a bundle of nerves on the inside.  The conversation revealed his fear about upcoming discomfort and the concern about his appearance.  To him, a “toothless grin” described a poor person. But he also rationalized that retirees are expected to have missing teeth, so maybe his appearance didn’t matter. Then I spent time discussing these perspectives, helping him work through them, and answering any questions. We had a ten-minute conversation, including my plan to make his experience completely pain free.  This is our office Promise, for which I am very proud. Finally, we talked about his fear and signals that he could use when we were in his mouth. I gave him a headset for music and dark glasses to wear, and told him to consider our discussion and let my assistant know when he was ready to proceed, and with which option we’d just discussed. 

We didn’t remove Fred’s tooth that day. Once he recognized that I’d listened attentively and problem-solved alongside him, he knew that I care for each patient in our practice.  I need them comfortable and fully aware of their options for treatment, AND during treatment. Because I took the time to listen carefully, he opted to have this tooth crowned rather than removed. 

Contact Winterset Dental today to find out which treatment is right for you.


Dental Phobia Monday, 25 September 2017

All of a sudden, Matt jumped out of the dental chair and was breathing rapidly. He started pacing in the treatment room, then he headed toward the reception desk. He stopped short of it. He leaned against the hallway wall and crossed his arms. The dental assistant in charge of Matt notified me that he wanted to leave. Matt was having a panic attack about the upcoming procedure.

There are several reasons for panic attacks, and a multitude of ways that upcoming treatment causes them. Here are several: 

1.     Unaddressed turmoil exists in their personal life.

2.     Claustrophobia when reclined with two people close to their head, or when reclined too far back.

3.     Holding their breath to avoid smells, or just out of fear.

4.     The shrill sound of the dental drill, or other odd sounds in their mouth.

5.     Their decision not to swallow because they may interfere with a procedure or, worse yet, ingest a “bad thing”.

6.     A provider that doesn’t give them a break during the procedure, or doesn’t communicate.

7.     Their mindset that, if the same procedure hurt before, it can hurt again. This is even true when someone remembers a friend’s story, not their own. When I diagnose the need for a root canal, I often see eyes bulge!

8.     Their anxiety from running behind schedule, either because they arrived late or the office kept them waiting way too long.

9.     And, of course, the almost-universal dislike of needles placed into their body.

Over the next several weeks, I’ll tell you how our practice has modified the conventional approach to chairside procedures and has received training to recognize and adjust our techniques for patient comfort and confidence. By the way, Matt chose to have treatment that day, and has probably referred more than a dozen colleagues to our practice.

Contact Winterset Dental today to find out which treatment is right for you.


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