Distinctive Smiles of Dublin Blog

My son, Logan, just turned 6 years old a few days ago. You can see below that he was having a lot of fun at the zoo.

Lots of fun at that age and lots of questions about school, sports, life, etc. This is one reason why I love Wikipedia. If he asks a question that I may not know the answer or wants a little more info then we can go there and then we can discuss. Well I’m sure all of you out there have heard the term “cosmetic dentist” because that term gets thrown around a lot in our world. So I thought I’d looked that up that term on Wikipedia and here is the first paragraph.

“Cosmetic dentistry is generally used to refer to any dental work that improves the appearance (though not necessarily the function) of a person’s teeth, gums and/or bite. Many dentists refer to themselves as “cosmetic dentists” regardless of their specific education, specialty, training, and experience in this field. This has been considered unethical with a predominant objective of marketing to patients. The American Dental Association does not recognize cosmetic dentistry as a formal specialty area of dentistry. However, there are still dentists that promote themselves as cosmetic dentists.”

While the term “cosmetic dentistry” is not in our logo or tagline, we strive everyday to improve a person’s appearance by providing dentistry that not only increases the strength and health of a person’s teeth, but also looks good. You can see some of the before and after pictures in our smile gallery which demonstrates how healthy teeth can also look better. At our preventative appointments, we look at the shade of the teeth and discuss if the patient is happy with their smile and we offer whitening, porcelain veneers, cosmetic bonding, Invisalign, Six Month Smiles, or even Botox and Juvederm.

The term “cosmetic dentistry” should really be considered a philosophy. I strive everyday to make a patient’s teeth healthier, but also make them look better at the same time with everything we do. Our philosophy also includes letting a patient know what is possible with their smile and their teeth then let them decide. For example, a lot of patients don’t know that we perform Botox and Juvederm procedures. Many times we use those procedures to frame a new, beautiful smile and sometimes we use them because a patient wants to feel younger or gain more self esteem. Or they want a solution that doesn’t require the expense of porcelain veneers so we discuss the pluses and minuses of cosmetic bonding.

Regardless, the staff and I decided to be trained to do these procedures because it gives the patient more options. So the next time you see us or any other dental professional and you are looking to improve your smile, make sure they give you some cosmetic options. A dental professional that only offers one or two solutions is not giving the full story. They’re your teeth and you should have all the information to make an informed decision.

I just got back from a few days in Scottsdale, AZ where I took a great three day seminar at the Scottsdale Center for Dentistry. We were in class from about 8a until 530p each day. Which were long days, but don’t feel too bad, it was great weather, had some great mexican food, and had a good time (although I didn’t get to hit the little white ball around). This isn’t my first time to the Scottsdale Center. I’ve actually been out there about 10 times in the past six years and am re-energized everytime I come back. Dr. Frank Spear, who is a mentor of mine, leads the Spear Education curriculum in which dentists learn a high level of education including dealing with how teeth come together the correct way (or lack thereof), patients with joint disorders, larger cosmetic and functional cases, case presentation, and practice management. If that sounds like a lot, it is and probably more. I’m part of the Spear faculty club and a member of a local Spear study club. I also take courses once or twice a year in St. Pete’s, FL at the Dawson Center (another big name in dentistry). I am part of the Academy of General Dentistry and one of the services this group provides is keeping track of the hours of continuing education over the years. Once you have over 500 hours, you are eligible to take the fellowship exam to become a fellow of the AGD. I just passed that mark a couple months ago. This means that I have taken over 500 hours of my life to sit and learn about what I what I love to do…dentistry. So I will start studying the rest of this year and take that test early next year although I am not excited to start studying again.
I am boasting a little about my history of continuing education because I’m proud of the fact that I’ve furthered my knowledge of my field and that’s a benefit to our patients. But the fact remains that unless your dentist is seeking to improve his ability to provide you with the best care possible, then I firmly believe that you should seek a new dentist. There are so many opportunities out there beyond taking just the minimum requirements to further your education that there is no excuse not to.
The Ohio State Dental Board requires that in order for a dentist to keep his license, he/she must take 40 hours of continuing education at minimum every 2 years. You can take it online, go to a lecture, take a hand on course, or take a dental continuum (almost like a residency). I chose the latter because I feel my patients, staff, and I can benefit most from that. Another interesting note is the amount of investment in continuing education by the dental community. And I don’t put these numbers out there because of the amount, but because of the discrepency of the numbers. The average American dentist spends $900 every 2 years in CE. A dentist taking a continuum, such as Dawson or Spear, spends about $10,000 in that 2 years. The people who benefit most from that are the patients. These doctors have an much higher level of understanding of not just the teeth, but of the whole chewing system. “A physician of the mastigatory system”, not just “a tooth doctor” as Dr. Dawson says.

I’m sure some of you were watching the Today Show several weeks ago and heard the story about how dental x-rays are causing brain tumors and that cancer is in the waiting after your next dental check up. We’ve had several inquiries about this issue in the past (even more since that story ran) so I thought I would give you some numbers and my take as a dentist. First off, one thing that I agree with the story that was aired is the fact that x-rays should only be taken when necessary. Contrary to some belief, we don’t just snap these things because “dental insurance” says it’s covered or because we want to add to the bill. As a dentist, I can only diagnose what I can see. I cannot see in between your teeth during your exam. The only thing that shows me a view of in between two teeth that are in contact with one another is an x-ray. In essence, I cannot perform a complete exam without x-rays. In my opinion, bitewing x-rays should be taken once a year at a minimum. If you have fillings that are in between your teeth, it might be a good idea to get them every 6 months whether your “insurance” covers it or not. Patients always want us to be conservative and get upset when we tell them they need a crown or root canal. Well in order for us to be conservative, we need to catch things early. Many times when a cavity that is in between the teeth becomes apparent in the mouth, we are usually talking about crowns. Remember that I can only diagnose what I can see.
The other type of x-ray that we utilize is the panoramic x-ray. This is the one that goes around your head and gives us a view from the right joint to the left joint including sinuses, carotid arteries, jawbones, and teeth. We recommend that x-ray every 3 years (although many “insurances” cover it only every 5 now). This x-ray does not have the fine resolution it takes to diagnose cavities, but it is great for diagnosing abnormalities including infection and cancerous lesions plus if a blot clot or plaque is big enough in the carotid then it’ll show up as well (BTW, we’ll drive you to the ER if we find one of those). So the next time we recommend a panorex x-ray, think about it’s ability to catch things early. It could help save your life.
Lastly, let’s talk some numbers. Everyone is scared that they are getting too much radiation. And if they’ve had a bunch of tests and x-rays in the hospital, they are worried that the dental x-rays may be the tipping point in causing cancer. These numbers come from the Department of Radiation so I’m not making them up. The maximum amount of occupational exposure for US radiation workers is 5000 millirems each year. High dose x-rays include mammograms (1000mr), spinals (around 450mr), and pelvimetry (875mr). The low dose group includes cervical spine (52mr) and femur (21mr). A film based panorex is 2mr (these are the ones we like to take once every 3 years). A digital bitewing (the kind we take) are less than 0.05mr meaning the series of 4 that we usually take each year is about 0.2mr. One last analogy, if you fly from coast to coast on an airplane, you get 4mr of background radiation. That’s equivilent to 80 digital bitewing x-rays. Don’t let the media hype scare you. The benefits of detecting cavities, gum disease, abscesses, and oral cancer far ourweigh the risks involving dental x-rays. They are safe and effective.

*BTW, if you were wondering why I put the quotation marks around the word insurance above, take a look at my previous blogs about “dental insurance”

Our patients ask great oral hygiene questions. What toothpaste should I use, which electric toothbrush is best, how much should I brush and floss, etc.? However, one question we don’t hear very often is when should I brush? Most of our patients are brushing two to three times daily, which is great and actually what I recommend! But I’ll also bet most of you have heard to brush after each meal.
Research has recently shown that brushing immediately after each meal may not be such a good idea after all. You can take a look at the article that I attached to get this authors perspective and it references the president of the Academy of General Dentistry, Howard R. Gamble.

They say that the title of any article or blog post should grab your attention so hopefully that’s why you are reading this. Did you know that April is oral cancer awareness month? No, well that’s not a surprise because we don’t really hear about it in the media. We seem to hear about cancers such as lymphoma, cervical, thyroid, and testicular cancers more routinely. However, cancers of the head and neck (not including brain cancer) cause many more deaths than those cancers. Over 640,000 cases are diagnosed each year worldwide with about 54,000 being diagnosed here in the US. Of those here at home, 13,500 deaths are due to head and neck cancer each year. The biggest reason why it leads to such a high death rate is because it’s usually not caught until the later stages which usually means it has spread or metastasized. I’m getting a lot of these facts from the Oral Cancer Foundation (http://oralcancerfoundation.org/facts/index.htm). Check out the site, it can give some other scary facts and some gruesome photos.
The point is that you need to be screened for this on a routine basis. Just like women get breast exams and colonoscopies are recommended, the goal is to catch it early so it can be erradicated from your body conservatively. Oral cancer screenings are a lot less invasive and not difficult at all. There are some devices out there that can help, but screening for oral cancer mainly involves using your eyes and your tactile sense. When I do an oral cancer screening, I begin by pulling out the tongue with a piece of gauze then look and feel the sides of the tongue. I look at the tonsils and the roof of the mouth, check the cheeks, feel the floor of the mouth and bottom of the tongue, then feel the gums around the teeth. Total time is about 30-60 seconds. I do that with every patient that has a hygiene appointment. You should be screened every 6 months especially if you are a smoker. This is why it annoys me when people say “it’s just a cleaning”. A good exam has the potential to save your life. It’s one thing to have a cavity, but it’s a whole other to possibly have cancer.
A couple of last points. Smokers and tobacco users are more at risk, but there are a lot of non-smokers that get diagnosed each year as well. There are a lot variables that cause cancer, smoking is just one of them. Screening and diagnosis are two different things. I am looking and feeling for abnormalities or lesions in the oral cavity, I am not diagnosing cancer. The only way to truly diagnose cancer is to biopsy the area and look at the tissue under a microscope. We would send you to an oral surgeon to have that done. If your dentist is not doing an oral cancer screening, you need to ask or find another dentist. If you’re still not getting a regular screening, come in to see me and I’ll do it for free. Lastly, doing a good screening on yourself is a little difficult, but if you see something that doesn’t look right or it hurts, go see your dentist. Especially if it’s been there over 14 days. Don’t think it’s going to get better on it’s own. Remember the best way to survive cancer is to catch it early.

So I’ve discussed dental insurance in our blog before, but one question that we get quite often is “Why are not on my insurance plan?” So I felt the urge to discuss this and rant a little, so bear with me. First off, dental insurance is a misnomer, it should be called dental benefits. Insurance, by definition, is designed to help in a catastophe. If you crash your car, you get it totaled or repaired (after paying your deductible). Your house burns down, the insurance company gives you money to rebuild your house. Dental insurance sure doesn’t pay for a full mouth rehabilitation if you’ve ground your teeth down flat and you’re now developing subsequent joint problems. That could cost $20-30K. What does “dental insurance” cover, around $1K depending on your yearly maximum. So dental benefits subsidize some of the cost, they don’t pay for dentistry. That’s the first point I want to make.
The second point is about “preferred provider plans”, aka PPOs. These are plans that your employer has agreed to be a part of. Many time this allows your employer to pay less for dental coverage. As a client of a PPO, you are encouraged by your employer and insurance company to go to a practice that participates in your plan (some insurance companies actually are quite forceful in their encouragement and make it sound like you cannot go to a non-participating practice).
So you have dental practices and clinics out there that accept pretty much every PPO that is available. From an outsiders view, why wouldn’t you participate in every PPO? But what a lot of the public does not realize is that in order to be a participating provider, you have to agree to set fees on what the insurance company decides. Well we all know that insurance companies make money by not paying out any more than they absolutely have to (see my post about end of the year benefits, “use ’em or loose ’em”). In order for a practice to participate with the PPO, the practice has to discount their fees 40%-60% in most cases. So why should a patient care about that? Especially if it means that you have to pay less for that crown.
A dental practice is a small business and it has bills to pay just like any other business. So if a practice has to discount their fees 40%-60% and still have those bills to pay, they have to make some choices. They can use lower quality/less expensive materials, not improve their dental equipment and facility, reduce staff, or see more patients. Most practices that accept those PPOs choose to see more patients. This means that you spend less time with the doctor, the doctor seems rushed, the staff is not as friendly (because they are rushed and tired), you are spending more time in the waiting room, and your dentistry doesn’t look as good as you want it to. It boils down to the fact that the customer service is not as good as it could be. And this is not true of every practice that accepts PPOs. We accept a couple PPOs that allow us to acquire some new patients yet still keep our quality at a high level. As a patient, you can save a little money by going to a provider that participates with your insurance that your employer purchased or pay more to get the quality that you are hoping for. It just depends on your lifestyle and your priorities. Obviously, I’m biased and do not like the insurance companies, but it always aggavates me when I see and hear stories about sub-par dentistry and the customer service provided. So thank you for letting me rant. Dental benefits can be confusing so if you have any questions, just let us know.

Well it’s taken me a week or so to get back to normal, but my Guatemala hangover is over now. While things are still fresh in my head, I wanted to post some of my experiences and lessons learned. First, I would like to thank Dr. Byron Henry, his wife, Stacy, and all my new Free to Smile friends for making it such a fun and productive trip. Just a brief synopsis of what we did. Both a dental and surgery team went on the trip, about 30 of us all together. Both teams went to the surgery center the first two days where we triaged the cleft lip/palate kids to make sure they were healthy enough for surgery. Then the dental team went out the next four days to some of the villages in the mountains to do extractions and fillings (even a handful of cleanings). Then the last day we came back together and did some relaxing and sightseeing (most of the sightseeing for me was about 400ft up on a zip line…awesome!)
The Guatamalans were very appreciative that we were there. And I could go on about the several hundred teeth that the dental team took out. And many said that we have changed their lives for the better and those experiences I had with those people were amazing. But I want to talk a little about the cleft lip and cleft palate surgeries. Those parents who kids had their cleft deformities fixed were the most amazed and appreciative. In the States, cleft lips and palates are things that are corrected within the first couple months of life, but in Guatemala, kids might not get those deformities fixed until much later in life. Speech problems, chewing difficulties, and negative social stigma can occur through the years. Some folks that live in the remote areas of Guatemala feel these kids are possessed by bad spirits or demons. So when the surgeons use their skills to correct these clefts, it really is an amazing thing. I posted a few photos here and on our Facebook page (search Distinctive Smiles of Dublin). You may be surprised to see the extent of the deformity.

This is why this work that Free to Smile is doing is so important. If you or anyone you know wants to help out with donations to even go on one of these trips, please let me know. It really is a great adventure!

As some of you know, in a couple days, I’m headed to Guatemala. Not for vacation, but to do some dentistry and hopefully help some folks that don’t have access to the privileges that we have here in the good ‘ol USA. A friend of mine, Byron Henry, who is an oral surgeon here in Columbus, started a non-profit called Free to Smile several years ago. Through the years, he has set up clinics in Guatemala, Columbia, Nepal, Cambodia, and Mali in Africa. His wife is the president of the company and between the two of them they spend a lot of the year out of country. They make quite a sacrifice being away from family, their friends, and Byron’s practice.
Byron’s passion for pro bono work is infectious and if you’re around him long enough, you would feel compelled to help. Through the years, I’ve been supportive through monetary donations and participating in charity events such as the annual golf scramble (of course I would be golfing anyway). However, I feel I’ve been very fortunate to be in the situation I am in and decided it was time to do a little more. So on Friday, I’ll be hopping on a plane to Guatemala.
I’m not the only one that decided to do a little more. There are four surgeons, four general dentists, and about twenty support staff joining us on the 9 day adventure. The surgeons will be doing cleft lip/cleft palate surgeries. These surgeries will completely change a person’s life. In a third world country, some view a person with a cleft lip or palate to be possessed by demons and evil spirits and they can be banned from their village or community. So when the surgeons complete a surgery like this, those people many times are welcomed by to society. It’s a very powerful thing. The dentists such as myself, will be seeing adults and kids doing things such as fillings and extractions. We’ll be headed to the villages and setting up rooms in churches and schools with portable dental equipment. I doubt that I’ll be talking too much about whitening and veneers.
My hope is that this trip will put things in perspective and to demonstrate even further how lucky we are to have the things we have. I posted several times back about our trip to Greece and how there dental system was not quite to the standards we have here. Well I’m sure this trip will also demonstrate those differences even further. My other hope is that we help people. It really is the reason why we all got into the healthcare field in the first place. These people do not have access to care and may have never seen a dentist. So we’ll see how they react to receiving care. Regardless, I’m sure they will be appeciative for any care that can be provided.
I’ll post again with some photos when I return. In the meantime, give someone you care about a hug and be appreciative they are in your life.

December was a crazy month here at the practice and at home so I needed to make a resolution that I post more often. But resolutions are difficult to keep. I find that if I don’t write them down and post them in a conspicuous place, that I don’t keep them very often. I also have found that I can only really count on keeping one or two. But I enjoy posting to our blog, so this one will probably be a little easier to maintain. I know a lot of people out there make a resolution to stay healthy or improve their health. I’m biased, but I think maintaining your dental health or changing your not-so-great dental habits would be a great resolution. So I’ll give you a couple ideas for some dental health resolutions.

1. If you don’t have a dental check-up scheduled, call right now. Pick up your cell phone and call your dental office. Start the new year with a committment to get on a recare schedule (whatever your dentist recommends-every 6, 4, or 3 months). If you already have an appointment, promise yourself to pre-schedule your following recare appointment. People are many times more likely to keep an appointment that they already made than to pick up the phone and call to schedule.

2. Change your drinking habits, especially if you drink sugary liquids. Did you know that if you put an extracted tooth in a glass of Coke that within 1 day the tooth will be dissolved? Between the acid and the sugars, soda is very destructive to teeth. Even more destructive, are the energy drinks that are out there such as Gatorade, Redbull, Monster, etc. They are more acidic and usually have more sugar than sodas. You don’t have to stop drinking soda or energy drinks, but try to not sip all day or drink them right before you brush (see below). I’d rather see a patient gulp down a can of Coke than sit at their desk, sipping on it. At least after a big acid attack, the saliva has a chance to neutralize the mouth instead of a constant flow of acid and sugar sticking to the teeth.

3. Rethink the philosophy of your brushing habits. Research has shown that brushing teeth less than 30 minutes after acidic foods is actually more destructive to the teeth than no brushing at all. This means that if you have a Mountain Dew, eat an orange, or throw up from the flu or partying too much, you should wait until the acid level goes down in your mouth. You can chew some sugarless gum (or gum with xylotol is even better), swish with some baking soda/water mix, or just wait, but don’t brush the enamel because the acid has caused it to be in a weakened state. If you were to time your brushing to be the least destructive, you would brush as soon as you get up in the morning BEFORE eating breakfast and you should brush when you get home from school or work BEFORE you eat. This lowers the amount of bacteria in you mouth that cause cavities and your enamel is not weakened from those acidic foods.

4. Start flossing or improve your flossing technique or buy an Airflosser or WaterPik. Take 1 minute of you day to floss just once. You can floss in the morning or at night, before or after brushing (although before is what’s recommended), and use any type of floss that feels comfortable. See my previous posts for good technique and other tirades about flossing. Also, something that is new to the market, but seems promising, is the Airflosser from Phillips (same people that make the Sonicare). You place the tip, push a button, and it uses a high pressured mist of water directed between the teeth. I’ve been trying one out for the past couple months and it does seem to work. Give me a call if you want more information or want to purchase one because I’m not sure if they are out in the stores yet.

Good luck with whatever resolutions you make. I hope they make you healthier and happier with your lives. And I hope you have a great 2012!

So the stereotypical dentist works four days a week and goes golfing the other three. That’s not a huge stretch for some of us (although I know several collegues who could not care less about golfing). A recent survey of dentists revealed that about 52% of dentists golf at least once per year and only about 18% play more than 15 times each year. For some of us, it gives us the ability to decompress from our careers, hang out with friends, compete, or just get outside. However, when you look at it a little closer, dentistry and golf have several other similarities that probably draw dentists toward the game.

1. Golf is used as a segway to business meetings because it can reveal more about a person than just a business lunch. Put a person in a dental chair and you may learn things that his/her friends don’t know.
2. Golf has many highs and lows. You can lose your composure after a bad shot, but have to figure a way to get back on course. When working with a human being and human teeth, things can go awry, but a dentist has to figure out a solution.
3. Golf is game played with others, but the final result is yours alone (your score). There are hygienists, assistants, and front desk employees helping the dentist, but ultimately the dentist is responsible for the end results.
4. A small number of golfers have to have the latest driver or game improving golf ball. A small number of dentists will be the first to own the latest piece of equipment or newest material.
5. Even the same golf course will present new challenges each time you play it. The dental practice and its patients will challenge the dentist differently each day.
6. Golf will test your patience. Patients will test your patience (our practice has very few that test our fortitude however).
7. Sinking a long putt, hitting a great drive or recording a birdie will keep you coming back for more. Cementing a great fitting crown, finishing a extensive treatment plan, or seeing your patient almost to joyful tears when they see their new smile; those are some of the moments that bring a dentist back each day.
8. No matter how good of a golfer you are, you always want to get better. One of a dentist’s top priorities should be to never stay satisfied and always improve his/her ability to provide the best care possible.

Let me give credit to the great writers of Dentaltown magazine for helping me with some of these insights. I suppose you could say the more golf I play the better my dentistry will be. If only my wife would believe that…