Dear Terrified

Dear Dr. H,
 
My 9 year old daughter got her two front teeth knocked out in a soccer game yesterday! She was knocked unconscious, so we went to the hospital. I found her teeth.
 
What can be done?
 
Terrified Mom
Dear Terrified,
 
I am so glad you took her to the hospital first! Research has shown that head injuries can be deadly, so your first priority is always her brain health. If anyone is knocked unconscious, it is important to follow up with a healthcare provider.
 
In most cases, the teeth can be placed back in the mouth if they are intact. Transporting the teeth in milk will help this process. Don’t rinse the teeth with water or attempt to clean them.
 
IF the teeth can be placed back in the mouth, they will need to be stabilized with a brace and they will need to have root canals.
 
If the teeth cannot be placed back in the mouth- don’t be afraid that she will go toothless! In 2016 we have many options for replacing missing teeth that look natural and are comfortable.
 
I know the two of you are frightened right now. I want to assure you that many patients have dental work on their front teeth. It is not uncommon.
 
Let her get better and trust that her dentist will put her smile back.
 
Dr. H

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Dear Heart Broken

Dear Dr. H,
 
I just got back from the dentist and I have a ton of cavities! The frustrating thing is that I did not have any cavities a year ago when I last went to see him.
 
I had a heart attack last August. Could this cause me to have cavities?
 
Heart Broken
Dear Heart Broken,
 
I am glad you have recovered from your heart attack. What a frightening experience! I hope you are following your doctor’s instructions to prevent having another heart attack.
 
The heart attack itself did not cause your cavities. Without seeing you, I am going to guess that your doctor put you on a number of medications and one (or more) of those medications is a blood pressure medication.
 
Blood pressure medications are notorious for drying out the mouth, making you more susceptible to cavities.
 
You MUST take your medications, so your mouth care will need to be more involved. You will need to brush and floss two or three times a day. You will need a heavy duty fluoride toothpaste and you will need to be diligent about drinking lots of water.
 
There are many lifestyle changes that people make after having a major health event. A change in your oral care will be hard at first, but it will become routine- just like eating differently and exercising.
 
Take care!
 
Dr. H

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Dear Annoyed

Dear Dr. H,
 
I am having a new crown done after the first one failed. I only had the crown 6 years! How long is dental work supposed to last?
 
Annoyed
Dear Annoyed,
 
I understand your frustration. We, as dentists, need to give patients more information on what they can expect from dental work.
 
I am going to use the car example for this question. Let’s say you buy a new car. You have an expectation as to how long that car will last before you buy a new one. That expectation depends on a number of factors:
 
1. The quality of the car. A Honda is expected to last about 200,000 miles, but a Kia will only last 163,000.
 
This means the quality of your dental work makes a difference! The dentist has control over this part. So please don’t get upset when we send crowns back to the lab or redo something! Most dentists want to do quality work and they take pride in their work. Choose a dentist that you trust, pay them a fair fee, and allow them to do their best.
 
2. The way you take care of the car. A car will last longer if you change the oil regularly and do the maintenance at the prescribed intervals.
 
This means you must brush and floss twice a day and get regular cleanings to maintain your dental work.
 
3. The way you drive your car makes a difference in how long it lasts. A car that is driven by a little old lady who never drives it anywhere but to the grocery store and church will last much longer than a car that is driven by an 18 year old that speeds and goes “off roading”.
 
This means people who grind their teeth, drink soda regularly, and/or chew on ice will wear their dental work out faster than people who don’t do those things.
 
4. Taking care of small problems before they become big problems will lengthen how long a car lasts. A car will last longer if you find out why it is leaking oil and fix the problem rather than waiting for the engine to blow up.
 
This means if your teeth suddenly become sensitive to cold or a crown feels loose, you go have it checked out rather than waiting until an expensive problem develops.
 
I hope I helped you figure out why the crown only lasted 6 years. BTW, that is not a terrible length of time. Keep in mind that even your dental insurance company will cover for the replacement of a crown every five years. My personal goal is to make sure my work lasts as long as possible. However, I only have control over the quality of the work I put in – the rest is up to the patient.
 
Dr. H

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Dear Curious

Dear Dr. H,
 
Why do I need to get my teeth cleaned every six months? Why not every 2 months or once a year? Who decided on 6 months?
 
Curious
Dear Curious,
 
I love this question!
 
Let me start with some history:
Decay and tooth loss have been a problem since prehistoric times. (We have evidence of dental fillings being placed to stop cavities since about 3700 BC.)
As our food became more plant based and more sugar was used, tooth decay and loss got worse.
 
Many, if not most, adults in Colonial America suffered from tooth decay and tooth loss.
 
This continued to be a huge problem until WWII. (It may shock you to know that most people did not brush their teeth every day until after World War II.)
 
After WWII, the dental community stepped up and began to market how to keep teeth.
 
“Brush twice a day and see your dentist every 6 months” .
 
The decison on every six months is because that is the time it takes to develop a new cavity that can be detected on an xray or in the mouth.
 
Today, most patients go to their dentist every 6 months because that is what insurance covers.
 
However, the dental community knows that every 6 months is not appropriate for every patient. The dentist’s role is no longer just to detect cavities and fill them. We are also concerned about gum disease, oral cancer, joint problems, acid reflux, sleep apnea, tooth wear and breakage, along with cosmetic concerns.
 
Every patient should be assessed for their risks of the things mentioned above. Some patients really don’t need to be seen but once a year and some patients need to be seen every 3 months.
 
(I would say that every patient needs to be seen at least once a year to make sure there are no problems brewing. People seem to forget that new medications, the aging process, and diet changes will affect the mouth.)
 
The answer to your question is that 6 months is arbitrary and every individual needs to be assessed to see what recall should be for them.
 
Dr. H

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Dear No Root Canals

Dear Dr. H,
 
My dentist says I need a root canal on a tooth, but I don’t have any pain.
 
I have heard that root canals are dangerous, so I can’t figure out why I should do this to my perfectly healthy tooth.
 
Also, my mom said that metal in the mouth is bad and that I should have any bad teeth pulled and replaced with implants.
 
No root canals for me
Dear No root canals,
 
You have really asked three separate questions, so bear with me!
 
1. Can a tooth need a root canal when it doesn’t hurt?
 
Yes. A tooth needs a root canal when the nerve in the tooth has been injured and it cannot recover, or when the nerve of a tooth has died. Over the years, I have learned that some teeth die with alot of pain and infection and some teeth die quietly and the patient doesn’t notice. I have also learned that some people have a very high pain tolerance and some people have a very low pain tolerance.
 
If you don’t think your tooth needs a root canal, I would suggest you get a second opinion.
 
2. Are root canals dangerous?
 
It is true that a poor root canal can lead to alot of infection and problems for a patient. However, root canals that are done well allow patients to keep teeth. The only alternative to a root canal is to have the tooth pulled.
 
Be aware that some root canals are technically difficult. If your dentist suggests a specialist, go to the specialist for the root canal.
 
3. Should a tooth be pulled and an implant placed instead of having a root canal?
This is one of those questions where it depends on the situation.
 
Most of the time the answer is no. If you can save a tooth with a root canal, you should save it. Teeth that God gave you are always better than teeth that are man made.
 
However, if a tooth has other problems it is important to consider how long the tooth will last if a root canal is done. It is upsetting to have a root canal done only to have the tooth pulled a year later. Dentists are not omniscient, but sometimes we can predict that a tooth is on its way out.
 
Finally, the cost of an implant is significant and must be considered when the less costly option of a root canal is still possible.
 
I hope I helped you make a decision.
All the best!
 
Dr. H

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Dear Scaredy Cat

Dear Dr. H,
 
I have a lot of dental problems, but I am just too afraid of the shot to come in and have anything done. I had a bad experience as a kid and I am just terrified.
 
Can you offer any advice?
 
Scaredy Cat
Dear Scaredy Cat,
 
The truth is that even people who are covered in tatoos and piercings don’t like the shot. You are not alone in this fear.
 
Remember how big your dad’s hands were when you were a child? Now his hands just look normal to you. The same is true with all the dental tools- they looked huge when you were a child! Today all those tools will look normal (perhaps even small) to you.
 
Don’t let that childhood perception of size hold you back.
 
The other thing people tell me is that , as a child, their old dentist didn’t listen to them.
 
Dentistry ( and medicine) has changed in the last 15 years to a much more proactive and patient centered practice. You can expect that your dentist will listen to you and stop if you need something.
 
Let your dentist know that you are afraid and he/she will walk you through all the things we do to make getting numb more comfortable.
 
Finally, know that new technology has improved the shot technique and most people find that getting numb is not such a big deal now.
 
If you just can’t get past this childhood fear – and I respect that a lot of kids have been traumatized by old techniques- there are options for the use of laughing gas or even sedation to help you get your teeth done.
 
Dental problems only get worse if you ignore them. Find a compassionate dentist and ask for solutions.
 
Sincerely,
 
Dr. H

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Dear Diseased

Dear Dr. H,
 
My dentist says my gum disease can be due to stress. This seems ridiculous, and yet it is also true.
How do you catch gum disease?
 
Diseased
Dear Friend ( I can’t call you diseased! ),
 
Do you remember when your mom told you to wear a coat or you would catch a cold? Or that if you went outside with wet hair you were asking for the flu?
The truth is that you catch a cold from being exposed to a cold virus and you catch the flu by being exposed to the flu virus.
 
However, you are more likely to get sick from the virus if your immune system isn’t working well and you can’t fight off the virus. Your immune system doesn’t work as well when you are cold and tired and stressed. ( Mom was pretty smart!)
Gum disease is caused by bacteria. You must “catch” the bacteria from someone or something. Most of us have been exposed at one time or another to this bacteria.
 
Keeping the bacteria from multiplying is how you control gum disease once you are infected. ( Sorry, you will never be able to totally remove the bactera. An antibiotic won’t even kill all of it.) Brushing and flossing keeps the bacteria in check along with having a healthy immune system. Stress, dry mouth, and many immune suppressing diseases ( example: diabetes) can make it harder to control the bacteria in your mouth. This is when extra brushing and flossing and a professional cleaning can help remove bacteria.
 
So, yes, your gum disease is acting up because of stress!
 
Dr. H

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Dear Sticker Shock

Dear Dr. H,
 
My husband went to see the dentist and it is going to cost $10,000 for his dental work!
Why is dental work so expensive and who actually spends this kind of money on their teeth?
 
Sticker Shock
Dear Sticker Shock,
 
I am sorry you were taken by surprise by the cost of dental work.
 
Since I don’t know what dental work your husband needed, I can’t tell you if that price is reasonable or not.
 
Generally, $10,000 would be alot for a single tooth. However, $10,000 would be a great bargain for the entire upper jaw!
 
I am going to go back to my standard car analogy:
 
If you buy a Mitsubishi Mirage (a Consumer Reports worst ranked car) for $14,000, you might be able to drive it 150,000 miles. You will more than likely spend a few thousand dollars in repairs to get it there.
 
However, if you buy a Honda Accord ( a Consumer Reports well ranked car) for $22,000 it will more than likely make 150,000 miles.You would be disappointed if you spent a few thousand dollars in repairs to get it there.
 
If you buy a Porsche for $100,000, I have no idea if it will make 150,000 miles or not!
 
It is the same with dentistry. Quality dental work will last longer and need less maintenance than poor dental work. However, quality work will cost more. There is, however, a point where more money does not buy better quality.
 
It is also important to note that making the 150,000 mile mark on any car will require that you drive the speed limit, stay on paved roads, and that you change the oil with some regularity.
 
It is the same with dental work, you still have to brush and floss in order to make it last.
 
If it were me, I would have my husband get a second opinion. I also would not necessarily choose the cheapest option. You want him to choose the option that he is most comfortable with.
 
I also like to remind patients that a car is expected to last 5-10 years and people are willing to spend upwards of $40,000 for it. Quality dental work will usually last longer than 5 to 10 years (just don’t go “off roading” and chew ice!) and the ability to chew is pretty valuable.
 
Dr. H’s 2 cents

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Dear Scared

Dear Dr. H,
 
I haven’t been to the dentist in 10 years. I am just too ashamed to go in and have the dentist yell about me about my current situation. I am also terrified of what they might tell me. I am sure I am the worst mouth he will ever see.
 
Scared
Dear Scared,
 
It is highly unlikely you are the worst mouth the dentist has ever seen. But, if you are, so what? The dentist is there to assess your mouth and give you options to get healthier. They are not there to judge you and make you feel bad.
 
Dentists have seen lots of mouths and heard the accompanying stories. We know and understand how people can get off track with their health.
 
You are human. Be kind to yourself and just begin the journey towards being healthier.
 
Chose a dentist that you are comfortable with and who will walk next to you and encourage you on your journey to health.
 
Dr. H

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Dear Concerned Daughter

Dear Dr. H,
 
Last week we took my 90 year old mother to the dentist. He said she needed 4 crowns! This seems like an expensive and unnecessary expense. Is he trying to take advantage of her?
 
Concerned Daughter
Dear Concerned Daughter,
 
This is a great question and I understand why you feel it might not be appropriate treatment.
 
First, your dentist’s primary goal is to have your mother keep her teeth until she dies.
 
This becomes tricky with elderly patients. We really encourage people to complete their dental work because we know an untreated cavity in a tooth will eventually mean the tooth is lost. And tooth loss often means a patient can’t eat healthy food and it can cause jaw pain.
 
We also know that before a tooth is lost, it will usually become infected.
The problem is that we really have no idea when the tooth will pass the point of no return and become infected and then have to be pulled.
 
In answer to your question, ask the dentist why the teeth need to be crowned. If it is preventing a broken tooth or cosmetic, you might skip the crowns. However, if your mother is at risk of infection or tooth loss, I would suggest you do something.
 
Older people don’t handle infection well and can end up in the hospital with an abscessed tooth. They are also not very adaptable and don’t do well with dentures if they have had their teeth all their life. It is just too big of a learning curve.
 
Analyze the situation the same way you would if your 90 year old mother needed a hip replacement. Is she young at heart? Does she swim and play golf every day? Get her the hip and allow her to keep enjoying her life. Is your mom bedridden in a nursing home? The hip won’t improve her quality of life and the surgery might actually kill her.
 
I hope that helps!
 
Dr. H

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