A section where you can get to know me as a dental professional and hopefully have some food for thought. This is not a journal about my personal life. All confidentiality rules and regulations under HIPAA will be maintained.
Fluoride Controversy
I can only comment using my own experience because I obviously have no power over politics, media, or other people’s lives/experiences.
I know that topical fluoride mouthwash works well together with timely, systematic brushing and flossing techniques because I have not had a cavity yet on my adult teeth *knock on wood* and sensitive areas on my teeth are diminished or completely gone. I also know that fluoride is a poison because I get stomachaches if I accidentally swallow a bit of my fluoride mouthwash – plus there are warnings on the bottle! So I agree with the article that fluoride is a double-edged sword.
What I will do as a dentist:
- Use everything within my knowledge and skill-set to eradicate dental decay and disease from your mouth.
- Make recommendations to you, including things you might find controversial, if I believe the benefits outweigh the risks.
- Consider your opinion, values, and experiences while I do all the above.
What you should do for yourself (or your children) as a patient:
- Tell your dentist your opinion on fluoride.
- Tell your dentist whether or not you consent to fluoride treatment.
- Take responsibility. Understand that if you get a cavity, then something may be wrong with the way you take care of your teeth.
So all in all, if you have not gotten a cavity for 12 months using whatever regimen you have come up with, then I congratulate you and have nothing more to say! Otherwise you and your dentist have to work together to figure out what’s really happening.
Protect Your Teeth Part 2
Q: Wait a minute, I thought sugar is bad for my teeth? Why did you talk about pH and acidity?
A: Sugar is still bad for your teeth, but not just because it is sugar. Sugar is bad for your teeth because you are feeding the harmful bacteria (Streptococcus mutans or S. mutans for short) that live in all those little grooves and fissures on your teeth. To show how thankful they are, the harmful bacteria use the sugar to make … acid!
Lesson: So it’s much simpler to get to the root of the problem and just recommend eating less sugar.
Q: What other foods make my mouth more acidic?
A: Carbonated drinks (soda, diet soda); energy drinks; fruits and fruit juices (lemons have pH of 2!); coffee (careful how much sugar you add to these!); alcoholic drinks; starches (potato chips).
Don’t panic! I am human too and enjoy my share of these foods, but the lesson is this: indulge less often.
A View on Money
Probably biting off more than I can chew with this post, but I think it is worth mentioning.
Money should not be a barrier to dental care.
This is true for dental emergencies (i.e. pain, infection, bleeding) and even more true when those emergencies become life-threatening.
Your health and quality of life are more important to me than making a profit, but remember I have to be able to keep the doors to my office open. Because when it comes down to it, I want to keep serving as many people as I possibly can.
Protect Your Teeth Part 1
When it comes down to it, the main thing you want to try to control is the pH in your mouth. You may or may not remember much from chemistry class, but acidic substances have a pH less than 7 and basic (or alkaline) substances have a pH greater than 7. Water has a pH very close to 7, or neutral.
Two things to remember:
1. Acid weakens or de-mineralizes enamel.
2. Takes almost an hour for your mouth to return to normal pH.
Therefore, it would be better for your teeth if you drink three cans of soda in a short amount of time instead of sipping on one can over several hours. Frequency is more important than quantity.
Be Honest
Please do not lie, leave out, or otherwise provide misinformation to anyone in the health field. We are genuinely trying to help you as best as we can and we can only do that if we have a complete history from you.
It is not a morality issue either.
For example, what you tell us can change our diagnosis and therefore your treatment. In other words, depending on how you answer my questions, it may be the difference between a typical filling or a root canal+core build up+crown. And for people with financial concerns (that’s all of us, right?), the choice may actually be between a filling and an extraction.
Misinformation also means that I will not be as [mentally] prepared for medical surprises, if they were to happen. Why would you want to possibly risk injury, infection, or possibly your life just for a dental procedure? You and I both know dentistry is important, but not more important than your safety.
Break the Cycle
Do you hate the dentist?
Do you think you need a lot of dental treatment?
If you answered “Yes” to both questions, then maybe you don’t really hate dentists! Why would I say that? Because if you really hated dentists then you would minimize the number of times a year you have to see one, right? That means you would be keeping your mouth as healthy as you possibly can by brushing, flossing, rinsing, tongue scraping. So break the cycle by taking care of your mouth routinely, and you will see that you’ll need fewer, shorter, and less painful appointments with the dentist, AND save money.
There’s no point in trying to “punish” a dentist by not taking care of your own teeth because you are ultimately the one who has to live with the aches, pains, and inconvenience of missing teeth. We (dentists) are just trying to get you healthy again.
Importance of Hygiene
Almost nothing in dentistry is better than what Mother Nature gave you (depends on what Mother Nature gave you, of course).
Why do I say that? Because there are always seams where dental fillings and prosthetics meet natural tooth structure (“margins”) and can microscopically harbor plaque and bacteria. These margins do not exist on natural teeth in a vast majority of mouths. Thus, you need to be even more attentive with your oral hygiene at home once you have any dental work done or have to wear any kind of dental appliance. Read: Almost nothing a dentist does prevents new cavities from starting. Or for realists: Almost everything a dentist does actually promotes decay.
Your teeth are with you 24/7, so how you clean and maintain your teeth at home is one of the biggest factors in how long dental treatment lasts. But for the sake of keeping things real you should also know this: All dental work will fail eventually.
Take home: If you are not going to spend the time you need to keep your mouth clean and free of disease, then there is no reason for me to do any work. It would be a waste of our time, energy, and money.
Hygiene Guidelines
Hopefully someone in your life should have given you the lecture by now, but if not I’ll gladly pass it on here.
Minimally, you must properly brush twice a day and floss once a day to keep everything clean. If you want to go above and beyond then brush/scrape your tongue once a day and use a antibacterial and/or fluoride mouthwash right before bed because you should not eat/drink for 30min after fluoride treatment anyway. Proper technique as well as other information can be found here: http://www.dentalhealthonline.net/
Need more motivation? Then try some of these experiments! (Yes, I have done them.)
Experiments:
- Importance of brushing:
- Brush your regular way
- Press gently but firmly on your gums where they end right at the edge of your teeth (the gumline, or “gingival margin”). Your goal is to squeeze anything in the gum pockets (“sulci” or singular “sulcus”) up and out.
- If you see white material come out of your gums, then you could brush better.*
- Importance of flossing:
- Brush first.
- Floss as properly as you can
- Any junk on floss was left behind from brushing.
- Importance of tongue scraping:
- Just try it once. Results are self-explanatory.
- Compare the smell of your breath before and after scraping for extra motivation**
Oh, one more thing. Use the softest brush you can find with which to brush your teeth. It’s not about scrubbing, but gentle technique. Use enough pressure to get the job done, but remember that your toothbrush bristles should look nearly as good as new after 3 months!
*You could also use plaque disclosing solutions or tablets, but they are so hard to find!
**It is reported anywhere between 70-90% of bad breath is from the tongue, but who cares about numbers when results speak for themselves!
Trust
It is your right and responsibility as a patient to choose a dentist that you trust. Not every dentist is the same no matter what your past experiences (good or bad) tell you because every dentist draws from his/her own personal background, education, philosophy, experience, and techniques.
You will not offend me if you decide that I am not the dentist for you. And neither will I beg you to make me your dentist. Even if you are already sitting in my dental chair, I will not move forward with your treatment unless you are comfortable. Because when it comes down to it, I cannot provide the care you deserve if I have to worry about whether or not you trust me.
Milton Liu, DDS, LLC 