Sunday, June 17, 2012

Don Draper's Dental Disaster: When a Toothache Won't Go Away

               Have you ever had a tooth pain that comes and goes, and you debate whether you should call the dentist or not? Then one day the tooth pain comes again, but this time it doesn’t go away. It rages on and on until it gets your full attention. Such was the case in the recent season finale of Mad Men, when Don Draper had the return of a toothache that this time would not go away. He had been avoiding the call. The call he needed to make with the dentist. He said a few times that he thought it would get better, that it always did, but not this time. The pain went away only after he visited the dentist.

               Although Mad Men is a fictitious television show, the story of this toothache could have been very real. No one wants a dental emergency or a toothache. So how can you avoid an incident like Don Draper’s? How can you know the signs of a real dental problem that needs the immediate attention of a dentist?

               The best way to prevent a toothache is to handle dental problems early on when they are treatable. The two major reasons that a tooth needs attention are either decay  or periodontal (gum) problems. Many times these dental problems don’t bother you, don’t exhibit any symptoms, which can be misleading. Many times you can not see the problems either, which is why routine dental x-rays are valuable. A thorough exam can detect these problems and they can be treated before they turn into something larger.

               Decay at its start can be easily removed and treated with a filling or restoration. Sometimes sensitivity isn’t decay, but an exposed root surface, which can be treated with a brush-on desensitizing varnish that gives immediate relief.  

               But let’s say you are experiencing some discomfort now. Try to pay attention to the pain and see if you can answer the following questions: 1) the duration of the pain – when it hurts is it for a few seconds, a few minutes or longer,; 2) whether the pain starts on its own, or only when stimulated, and does it wake you while you are sleeping:; 3) what makes the tooth hurt – hot, cold, or biting; and 4) can you identify exactly which tooth it is? 5) Does anything make it feel better? Over the counter pain medications like Advil, or Tylenol, or does cold actually make it feel better?

               The signs that a tooth pain will not go away on its own, and you need the help of a dentist, are:       

1)      The pain lasts more than just a few minutes, or is even constant.

2)      The pain starts spontaneously, on its own

3)      The pain wakes you at night

4)      You can identify the tooth the is the culprit

5)      Cold things like ice make it feels better

               If you have an episode of pain like this, even for days, and you leave it untreated, it probably will subside, but it will return with a vengeance. Don’t ignore the symptoms. Get the treatment you need. I don’t like seeing patients in pain as much as you as a patient don’t like seeing The Dentist, so let’s help each other out. The more regularly you go for a routine dental check-up , the less likely you are to have a Don Draper incident.

               Don Draper ended up losing a tooth because he had constant pain, that was occurring unprovoked, and he did get some relief from applying cold ice to the area, but the tooth in his case was beyond the treatment of a filling or root canal treatment, had probably infected the bone surrounding it, and it’s only hope was extraction.  Let’s hope that this information helps you to avoid this!

Monday, June 11, 2012

Sweet 16

Sweet 16

The number 16 is a special number for many reasons. It is the age at which most teens in America can legally get a driver’s license. It is also the magic number of basketball teams in the NCAA that make that elite status of being the Sweet Sixteen during March Madness. Then there is the Sweet Sixteen birthday party for many girls. Now, the number 16 is of special significance to the people of New York City, because Mayor Bloomberg announced recently that he is planning on banning the sale of sugary drinks larger than 16 ounces.

I don’t want to turn this writing into a political commentary, but when it comes to a tooth-related issue, I have an opinion. Hearing a few minutes on the radio about this plan of the mayor’s sent me looking at his website, and the entire report on this pending legislation that was prepared by The Mayor’s Task Force On Obesity. ( The report is very straightforward. It states that, “Americans consume 200-300 more calories daily than 30 years ago, with the largest single increase due to sugary drinks.”  It went on to stress that “High consumption of sugary drinks is linked to an increased risk of heart disease and diabetes.” The report immediately had me question what was their definition of “sugary drinks”? How did they come up with this size of 16 oz limit? And really, we are a free country, and as adults do we not have the right to drink whatever we want and as much of it as we like? (Although I wish people would drink less of this type of thing, I didn’t think a law should restrict it.)

I went on to read that the proposed plan defines sugary drinks as soda, sports drinks, energy drinks, sweetened teas and coffees, sweetened fruit drinks, vitamin water , and any other drink that had more than 25 calories per 8 oz serving. It also excludes diet beverages, unsweetened teas and coffees, alcohol, dairy drinks and any beverage that was over 70% fruit juice without added sweetener. Who would be restricted in selling these drinks in larger than 16 oz portions? Restaurants, movie theaters, street carts and sports arenas in New York City. What I learned from the study is that the serving size that is being offered to the public is the problem here. When drinks such as Coca-Cola first came out, the suggested serving size was 6 ounces.  Now bottles or cups of 16 oz are routinely sold as the medium or small size, and when offered, people will buy the 16 oz or larger and consume the entire portion.

I did a lot of thinking about this issue. I didn’t appear to be the only one, either. Most major news shows on television covered the story ( ABC, NBC, CBS, CNN) and The New York Times ran an Op-Ed by Daniel Lieberman on June 6, “Evolution’s Sweet Tooth”.

I encourage you to read this, along with the Mayor’s plan, and make some decisions for yourself. I can tell you what I have concluded from all of this. Government has its own reasons for limiting our sugar intake, and it seems those reasons stem from the fact that an overweight, unhealthy population costs them more than a healthy population. I am disappointed in the task force that was set up to tackle this agenda, in that they repeatedly take issue with fighting obesity and its consequences of diabetes and heart disease, but make no mention of sugar and tooth decay, which should be a most obvious correlation. So what if you don’t live in New York City and your sugar consumption will not be limited? What if that bottle of soda is less expensive than a bottle of milk or filtered water? What if you choose to continue to drink these type of drinks?

Think about this. On average, 16 oz serving of one of these sugary drinks has about  49 grams of sugar.   That comes to about 12 teaspoons of sugar or about 12 packets of sugar.  

 So you might say you gave up soda long ago. Soda is not the only culprit. Sweetened iced teas, sports drinks and flavored iced coffees are in the running in this group too.

The sugar content isn’t the only problem. Try looking at the pH, or acidic level of these drinks. That is something that is not listed on the label, but should be. (For the record, the pH of water is about 7, milk is about 6.8, saliva is 7.4 and battery acid is about 2) The pH of soda, diet or regular, is below 3. Sports drinks come in around 4, and sweetened teas about the same.  This combination of sugar and acid is deadly for tooth enamel.

Now in the survey I referenced in my previous writing, in which people told me quite a bit about what they did not like about The Dentist**, one thing that was very clear was that they do not like to be lectured to about brushing, flossing  or their dietary habits. So, if you want to curb your sugar consumption that would be great, and if not, here are some suggestions to help your teeth combat the effects of what you are drinking. (Not a lecture!  Just suggestions)

  1. Drink the sweetened beverages while you eating. The combination of food and beverage in your mouth will neutralize the pH, and the solid food being chewed and contacting your tooth surface will help to not have it settle and remain on the enamel. Constant sipping throughout the day, constant exposure of the tooth to sugar and low pH is very harmful. Really, the best thing to drink by itself is water.
  2. If you feel you must drink a sugary drink alone, follow it up with water or chew a piece of gum that will neutralize your mouth, like Trident Xtra Care, or any other gum with Recaldent in it. This ingredient is absorbed by the tooth and strengthens the enamel.
  3. When you brush your teeth, use a toothpaste like Sensodyne Pronamel, which you can buy over the counter, or you can get a prescription from your dentist for a higher fluoridated toothpaste. These pastes promote re-hardening of enamel that has been softened by acid erosion.

I hope this information is helpful to you. Think about what you are drinking, whether you live in NYC or not. Make smart decisions on your own as to portion size and read the labels. Less sugar means fewer cavities, healthier mouths and more smiles.

**The Dentist is a reference to a prior posting in which in response to a survey I conducted for this blog, many people reported they didn’t like The Dentist, who I referred to as that entity that causes them pain, discomfort and expense. Certainly not me! I may be a dentist, but I am not The Dentist.

Thursday, June 7, 2012

When I say DENTIST, you say..........???

When you hear the word DENTIST, what is the first word that comes to mind?

I asked this question to 50 people. Although I myself am a dentist, I tried to get honest answers. I didn’t  ask patients who were sitting in my chair while I loomed over them in my white coat. I sent e-mails to people from my address book, most of whom are not my patients. The answers I received were more than I asked for.

I have been a dentist for 25 years, and I honestly love what I do. Many people ask me why I became a dentist, and I have come to realize it is because it provides the perfect combination of science and art, and being able to deal with people personally every day.  I also have come to realize that most people hate “The Dentist”. Not me personally, but that entity that is a source of anxiety, pain and expense to them. I understand that their favorite part of a dental visit is the moment they are getting up from the chair and walking out the door. I thought I would start this blog to try to change the public’s perception of   The Dentist by telling them about dentistry from my side of the dental chair. My thought was that information could minimize that fear, that knowledge would help people make dental decisions, but after getting feedback to my initial question of the word association with DENTIST, this goal no longer seems that easy.

About the responses, first I have to say that the replies were quickly made (some within minutes) and the number of replies was better than if I was looking for RSVP’s to a party invitation (I don’t know where Miss Manners has gone, but we need her back to teach people the lost art of common courtesy and manners to such things as RSVP, but that is another subject all together).  These responders were indeed honest – their answers ranged from “pain”, “ouch!”, and “smelly”, to expletives I cannot repeat here. There were a total of 3 responses that I considered neutral, which were all “clean”. These people associated clean teeth or getting their teeth cleaned with DENTIST.  There were hardly any positive responses to DENTIST, except those people that made a personal reference to me. (Thank you!)

What amazed me the most was that the majority of the responders also felt the need to explain their answer, at great length. I read horrific stories of people who are now in the 40’s and 50’s, being held down in the dental chair as a child, had cavities filled without local anesthetic (novocaine), and when they cried out in pain they were yelled at, punished, and even hit by the dentist! One person even told me they jumped out of the chair, climbed through a window, fled from the dentist and rode his bike all the way home alone. Another person told me that due to a dental experience he had when he was 9 years old,  to this day, he starts every dental appointment by saying his personal mantra, to the dentist,  which is, “ If you hurt me, I will hurt you.” This may seem harsh, but at least this person goes to the dentist, on his own terms, and sets up boundaries.  These people were abused – physically and psychologically, and it has scarred them for life.  

As a dental professional, I would like to apologize for those dentists before me that caused all this horror. I am sorry for your pain.  I am sure those dentists were never told anything about a chairside manner or patient comfort.

So my mission of trying to create a positive association with dentistry now appears to be an arduous task! How can I expect you to smile and look forward to something that was torture? I am willing to give it a try, if you are willing to hear me out.   I want to know how I can break down this barrier between the dentist and the patient, how can we get a positive association with The Dentist. 

For those of you who have these terrible associations with The Dentist, here are some thoughts for you.

1.      First, before you even set foot in a dental office, think of what specifically bothers you the most about the experience. It could be the smell, the sound of the equipment, the pain of the injection, the fear you won’t get enough anesthetic, or the anxiety of not knowing how long it will take.

2.      Some of this you can try to control yourself, such as if it is the smell of the office or the materials while you are being treated, try putting on your favorite perfume or cologne just before you enter the office.  If that isn’t strong enough, you can put some type of mentholatum rub or lip balm on your upper lip or under your nose, to mask the other smells of the dental office.

3.      If the sound or noises bother you, bring headphones with your playlist ready with your favorite tunes.

4.      As for the other issues, tell your dentist or hygienist before they start that  there are a few things you just want to talk about to make the appointment easier for everyone.  I try to initiate this type of conversation especially before the first time I treat a patient and I appreciate if they can tell me what bothers them the most. 

5.      If the injection bothers you, there is a topical gel that can be rubbed on the area prior to the injection to make it more comfortable. There are also different types of anesthetic, or novocaine – some is stronger than another, and some last longer than others.  If a patient is afraid they won’t be numb enough, I joking tell them we will use the “high test” novocaine, which technically speaking is Articaine, and is stronger and lasts longer.  Other people don’t like to feel numb after they leave the office, so I have to be sure to use the shorter acting anesthetic for them.

6.         If it would make you feel better knowing how long it will take (approximately), kindly ask first if the dentist or hygienist could guess how long it will take.  Then you can look forward to that time when you get to take the bib off and walk out the door!

7.      Finally, and to me most importantly, you as the patient need to know that there is a way for you to have some control during the procedure and have a way of communicating with the dentist. I usually tell the patient that if for any reason they feel the need to stop and take a break, for them just to wave their hand at me.  You can ask the dentist if this would be OK with them, in case they haven’t suggested this to you already.  

I hope these ideas are helpful to you, whether you are a patient, a person who hasn’t been a patient in a long while, or even a dentist.   I hope we can all try together to make the dental office a place we can smile about.