Dear Fearful

Dear Dr. H, 

How can I find a good dentist? 

Fearful

Dear Fearful, 

There is no easy answer to this question. I can tell you this:

If you see an American dentist who is licensed in your state, you can rest assured the dentist has a college degree and 4 years of dental education. American dentists are very well educated. 

American dentists are required to ” keep up” with their profession and must do classes every year to stay on top of new trends. 

If you see an ADA dentist, you should know that they are bound by a higher set of ethics than what the state requires. 

However, I think the most important thing about choosing any healthcare provider is finding someone you are comfortable with. There are many competent dentists out there, but they all have different personalities and different values. Choose one that matches you and then really communicate with them about your health. 

Dr. H

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Dear Not A Tooth Model

Dear Dr. H, 

I am a competitive fitness model. I eat very healthy and I work out. I actually thought I was the epitome of healthy. However, I just found out that I have 10 cavities! ( TEN!) How can this be? I brush my teeth every day. 

Not a tooth model

Dear Not a tooth model,

A 2013 study published in The British Journal of Sports Medicine looked at athletes who visited the dental clinic for Olympians at the 2012 London Games. 

Oddly 55% of them had cavities, 45% had dental erosion, 76% had gingivitis, and 15% had serious periodontitis! And these people are truly the epitome of physical health. 

It is also interesting to note that Michael Jordan had significant dental issues during the 1984 Olympics. His dental issues were severe enough that they could’ve kept him from playing in a game. 

There are numerous reasons why athletes could have such bad teeth: 

1. Athletes burn an enormous amount energy while exercising, so they eat and drink more frequently than the average person — and the more food that comes in contact with teeth, the greater the chance for tooth decay. 

2. The type of food and drink that athletes consume often comes in the form of sports drinks, energy drinks and nutrition bars, which can wreak havoc on teeth. Note that Gatorade may actually erode teeth faster than soda. 

3. Athletes often suffer from dehydration caused by extensive sweating. The lack of water in the body means less saliva in the mouth, and one major function of saliva that few people know about is to protect enamel on teeth. 

4. Many people (not just athletes) grind their teeth during intense physical effort. It is possible athletes grind more because of the stress of playing at such a high level. 

Please get your cavities filled, change your brushing and flossing habits to 3 times per day, and keep training! 

Sincerely, Dr. H

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Dear Furious

Dear Dr. H, 

I am so annoyed! This new dental hygienist spent 10 minutes of my appointment teaching me how to brush and floss! I know how to brush and floss- I am a grown woman! I need her to clean my teeth! Is this really what I am paying for? 

Furious

Dear Furious, 

This is a common concern that I hear. I would like to change the discussion to skin and then explain: 

I was taught to wash my face with soap when I was a little girl. My primary goal in doing this was to remove enough dirt to keep my mother from coming in and washing my face! 

Then, in fifth grade, I started to get acne. This prompted me to use Clearasil. 

In college my face got dry AND I had acne. I switched to Proactive. 

After I had my first child, I noticed the acne had changed and that I was getting sun spots. I changed products again. 

Then I turned 40 and … wow! I have a whole crazy regime of products to keep my skin healthy! 

Now back to teeth: 

Most of us were taught to brush and floss our teeth when we were little children. We were taught when we had a mouth full of baby teeth and brushing was fairly easy. 

Hopefully in middle school someone taught you how to brush your adult teeth.

It is likely that you have received no instruction since that time. However, your mouth and teeth have continued to age- just like your skin! By aging, I mean that you probably have more fillings than in childhood and perhaps you even have a crown or two. You probably have lost bone around some teeth and a few teeth have shifted out of place. This is normal aging. 

It is important that someone teaches you how to manage this aging in your mouth in order to keep you healthy. 

I am sorry the hygienist did not fully explain this to you. You deserve to know what is happening and why. 

Sincerely, Dr. H

 

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Dear Busy Working Mommy

Dear Dr. H,
 
I need a deep cleaning. I understand why and I want to get it done. However, I have very limited time off and I need to do the whole procedure at one time. The dentist will not schedule it in one sitting. I have to come back twice. Why? And how can I convince her I need this done all at once?
 
Busy Working Mommy
Dear Busy Working Mommy,
 
First, kudos to you! am so glad you are taking care of yourself! So often busy moms put themselves last on their to do lists and, consequently, their self care is ignored.
 
I also want to let you know that taking care of this gum issue will improve your overall health, make your breath better, and will stop the spread of the bacteria that causes bone loss around your teeth.
 
As for your real question- the answer is yes. Sometimes a dentist will allow you to have your entire mouth “deep cleaned” in one day. However, there are a few things that must be true before a dentist will do it.
 
1. You must be the type of patient that follows instructions. Your entire mouth will be numb and it will be difficult for you to talk. Eating will be out of the question. The damage a bite can do to your mouth when you are that numb is significant. The dentist will want to know that you are safe.
 
2. The extent of your gum disease is an important factor. The dentist will want to know he/she has enough time to do a good job and that you are not so fatigued that he/she cannot complete the procedure.
 
3. Some insurance companies will not pay for a full mouth deep cleaning in one session- for ANY reason. This would leave you with the entire bill.
 
You should also know that I (if I was the patient) would not have this procedure done in one sitting. My mouth would be too tired. And my life is insane right now! (This “having it all” isn’t what I thought it was going to be. We all need a nap! But that is a different discussion.)
 
If you still want the deep cleaning done in one day, call your dentist and tell him/her that you are willing to assume these risks. The dentist will most likely do it.
 
Happy Holidays!
 
Dr. H

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Dear Soft Teeth

Dear Dr. H,
 
I hate the dentist! Every time I go in he finds yet another cavity! It is so frustrating, as I feel I have put a small fortune into my mouth. Is it really possible that I get a new cavity every six months?
 
Help! I dread going now.
 
Soft Teeth
Dear Soft Teeth,
 
I hear you and I understand your frustration. I hate telling patients they have more cavities, because they get so upset with me!
 
However, I am ethically obligated to tell patients the truth about their dental health. ( BTW, it does stink to be hated.)
 
If I was in your shoes, I would make a consult appointment with the dentist. I would keep a diary of everything I ate or drank for 3 days prior to the appointment. I would bring a list of all the medications I was taking and I would bring all the oral hygiene products that I was using. Then I would ask the dentist what he/she thought about my diet, my medications, and my hygiene.
 
Why?
 
The diary would give the dentist an idea if acid or sugar was getting on your teeth on a regular basis. Patients are shocked at how acidic and full of sugar many foods actually are.
 
The list of medications is helpful because many medications dry out your mouth, which causes cavities.
 
Finally, showing the dentist your oral hygiene products and explaining your hygiene routines would allow him/her to give you tips on what you, personally, need to use to keep your mouth healthy and cavity free.
 
I hope this helps you and maybe at the next visit you won’t hate us quite so much!
 
Best.
 
Dr. H

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Dear Confused and Fillingless

Dear Dr. H,
 
I went to see my dentist today and he told me I have a tooth with a small cavity. However, instead of filling it, he told me to use fluoride to heal it. I don’t understand. If I have a cavity, don’t I need a filling?
 
Confused and Fillingless
Dear Confused and Fillingless,
 
I understand the confusion and I am so glad you asked!
 
First, a cavity is a hole in your tooth. When bacteria is left on a tooth for a long time and fed sugar, the bacteria secrete acid. The acid actually dissolves the tooth, creating a hole in the tooth. It is then easier for bacteria to hide in the hole and continue to secrete acid, making the hole deeper and/or wider.
 
The outside of the tooth, the part you see and that everyone wants very white, is called enamel. It is very hard and can resist acid for a long time. It can also be healed with fluoride. Fluoride bonds with crystals in the enamel and makes the crystals grow. The crystals fill the hole, making it disappear or “heal”.
 
The enamel is much like the peel on an orange. It is tough and resilient, but it covers a softer and weaker part of the tooth called the dentin.
 
Once bacteria has dissolved the enamel and penetrated the dentin, the tooth must have a filling. The dentin dissolves easily and the hole will grow quickly.
 
This is why we take xrays every year. A small cavity in the enamel can sit there a long time, but a cavity in the dentin can get big and cause problems.
 
I hope this information helps you. It sounds like your dentist is conservative and wants to try fluoride before he does any surgery to the tooth ( ie the filling).
 
Be sure and brush 2-3 times per day and floss every night before bed to remove the bacteria. Then use the fluoride as your doctor directed.
 
Best,
 
Dr. H
 

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Dear Unhappy Bride

Dear Dr. H,
 
My new dentist insists on taking xrays before I can get my teeth cleaned. All I really want is to have clean and white teeth for my wedding next month. Why can’t she just clean my teeth?
 
Unhappy Bride
Dear Unhappy Bride,
 
Congratulations on your upcoming wedding! What an exciting time!
 
I hear this concern about xrays often from patients and I understand the frustration.
 
First, let me explain the why. Dentists cannot see cavities in between teeth, the bone around the teeth, or any bone abnormalities just by looking and feeling the teeth. It’s essentially the same issue physicians have with breast exams. The physician can look and feel breast tissue, but they cannot see cancerous lesions without the help of a mammogram.
 
Second, the American Dental Association has made recommendations on how often xrays should be taken on a patient based on their age and cavity risk. Dentists follow these recommendations because they are regulated by something called the standard of care. When dentists don’t follow the standard of care and a patient suffers harm, it is a bad situation for everyone. Again, the same situation exists with a physician who allows a woman to skip her mammogram. If the patient had cancer that went undetected because no mammogram was ordered for another full year, it is bad for everyone involved.
 
So, you see, your dentist is not trying to be mean! She wants to catch problems early so you don’t end up with bigger problems later.
 
Best,
 
Dr. H
 
BTW: If you have had xrays at another dentist’s office within the last year, you can have them sent to your new dentist. The dentist doesn’t have to take the xrays to be within the standard of care, they just have to have them and read them.

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Dear Soon To Be Toothless

Dear Dr. H,
 
My dentist told me I need dentures. Needless to say, I am devastated. I knew this was coming, but I am only 51 years old! I asked him if I could do implants and he said I could not because I am diabetic and I ” don’t have good bone”. Is this true? What are my options? Do I have to do this?
 
Soon to beToothless
Dear Soon to be,
 
I am sorry to hear you are devastated and I understand the fear you are expressing. And, please understand, you will never be toothless. Your new teeth will just be artifical, much like a new hip or a new knee. (We don’t refer to people as “kneeless”!)
 
I do hear your question about implants, and I will answer it, but I want to address your biggest fears first:
 
1. This will be a transition for you, just like getting a new hip or a new knee is a transition. There will be things you cannot do that you could do when you had a full functioning set of natural teeth. However, you will be able to smile and eat in a way that a partial set of natural teeth has not allowed you to do in a long time. Just like getting a new hip, you will have to follow your dentist’s recommendations after surgery and give yourself some time to heal and adjust. There will be a new normal after all the work is done and
it will be ok.
 
2. Be upfront and honest about your concerns with your dentist. Are you afraid of your teeth looking fake? There are things that can be done to make your denture look more natural. For example, teeth should not be white (like a lab coat white) and they should not be perfectly straight and all the same length. Bring a picture of yourself with natural teeth to help guide your dentist. Are you afraid they will fall out? Talk about how that concern can be relieved.
 
3. You would be surprised at how many people are in full dentures. If they are made well, you cannot tell. Most people think of their grandfather’s dentures, but technology in dentures has come a long way since your grandpa got his dentures.
 
4. Wearing dentures does not reflect a defect in your character or a failure of any sort. It is simply a medical condition that needs to be addressed. Again, much like a new hip does not reflect a defect in someone’s character. Yes, if any of us could go back in time, we would most likely take better care of ourselves. But that is a lesson learned from having lived life. You cannot tell a young person this truth and have them listen!
 
Now about implants: they are a wonderful option and the technology has made them very stable and strong. However, your body must be able to accept a foreign body to be implanted. Many patients with chronic illness, such as uncontrolled diabetes, cannot have a foreign object implanted without serious consequences. I highly recommend you talk to a specialist ( a periodontist or an oral surgeon) to see if controlling your diabetes could change the prognosis for implants.
 
I hope this information helps you. And I hope you will be able to smile a big toothy smile for your next family picture.
 
Best,
 
Dr. H

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Dear Phoenix Mommy

Dear Dr. H,
 
My dentist thinks my 7 year old daughter needs braces! I don’t want to put her in braces at 7, only to have to put her in braces again when she is a teenager. Why would we do this to our daughter? What is the dentist thinking?
 
Phoenix Mommy
Dear Phoenix Mommy,
 
There are a couple of reasons we put children in braces before they hit puberty. I have not seen your daughter, so I can only list the possible reasons:
 
1. The most common reason we put young children in braces is because we want to control their growth. – I know that sounds odd, but let me explain. If a child comes in with her lower jaw jutted out like Jay Leno or pulled back like Homer Simpson, we know that their adult face will be affected. Facial symmetry and alignment is what makes people attractive and we want to help a child grow up to look their best.
 
Technology has given dentists the ability to make a child’s face grow so that we can fix a jaw problem BEFORE puberty. Once a child hits puberty, we can no longer control their growth.
 
2. Children can be cruel. If a child has front teeth that they find embarassing or they are being teased about their smile, it’s time to intervene. This kind of bullying can have life long effects on a child’s self esteem.
 
3. Sometimes an adult tooth will erupt into the mouth in an inconvenient spot that disrupts where all the other teeth are supposed to go. When that happens, moving the problem tooth with braces allows all the other teeth to come in correctly.
 
I hope I helped you see why early braces makes sense in some children.
 
Sincerely,
 
Dr. H

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Dear Found You Out

Dear Dr. H,
 
My great aunt just had some dental work done in Mexico. It all turned out fine. What is the big fuss about crossing the border for health care? I think you dentists just don’t like how cheap they can do dentistry.
 
Found you out
Dear Found you out,
 
I appreciate your honest question, as many people are afraid to ask this one.
 
I think it is way too simple to say if you go to Mexico bad things will happen, where if you stay in the states all will be well.
 
I am going to use the analogy of my hair. I have very annoying, thick, and frizzy hair. My hair is complicated to cut and to style. I have been to Lotsofcuts R Us and I have been to a salon to have my hair done.
 
For this analogy, let’s say Lotsofcuts R Us is Mexico dentistry and a beauty salon corresponds to a private practice general dentist.
 
Truthfully, there have been times when Lotsofcuts R Us did a superb job. However, when I went to Lotsofcuts R Us on a regular basis, they were not consistent. I saw different stylists and their ability level differed. Sometimes there was not enough time for the stylist to deal with the amount of hair that I have. There were occasions when the stylist used a product with which he/she was obviously unfamiliar and my hair responded poorly.

It is also worth noting that when a stylist messed up my hair, it took months ( one time it took a year!) for my hair to grow out and look normal again.
 
(Remember that hair will grow back, but a tooth will not fix itself over a period of time.)
 
So, for me, I know that my hair is too complicated for Lotsofcuts R Us . My husband has hair that is about a millimeter long. Once a month he has a stylist take the clippers and cut all the hair he has off to about a half millimeter.
 
Lotsofcuts R Us works perfect for him. They are always consistent and the time alotted is always enough.
 
(There are people who have simple dental problems that are easy to fix. Mexico might work for them.)
 
When I go to the salon on regular basis, I get superb work. The stylsit is always the same and he is generally consistent. There is generally enough time for the stylist to deal with the amount of hair that I have. Most of the time, the stylist has handpicked his products and knows what will work on my hair.
 
However, there have been a couple times when the salon stylist messed up my hair. However, the problem was able to be corrected in a month or less.
 
Translating all this to dentistry: you can absolutely get quality care in Mexico and you can absolutely get a poor result at a private practice dentist in the states. But your odds of getting good care are much higher with the private practice USA dentist.
 
Dr. H

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