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Dentists

9
How Your Dentist Knows You're Not Flossing
©Cheryl Casey/Shutterstock.com

A recent survey by the American Dental Association found that just under half of all Americans floss their teeth daily.

What about the other half?

My guess is that they’re the ones who floss twice a year — right before their dental checkups.  They think they can pull a fast one on us, but here’s a little secret: dentists can tell when you’ve been  flossing and when you haven’t.

How Dentists Can Tell When You’re Not Flossing

Woman Flossing Before Dental ExamThe way we can tell if you’re not flossing is if your gums are bleeding.  Although there are other, less common conditions that can make your gums bleed, gingivitis is the main cause.  Gingivitis is when the gums are inflamed due to all of the bacteria in your mouth collecting right between the gums and the teeth.

The problem is that it takes about a week of daily flossing for gingivitis to go away and make it so your gums don’t bleed when they are cleaned.

The most authoritative book on the gums — that’s 1,328 pages dedicated to your gums! — states the following:

The presence of plaque for only 2 days can initiate gingival bleeding on probing, whereas once established, it may take 7 days or more after continued plaque control and treatment to eliminate gingival bleeding.

So, if you end up brushing and flossing really well right before your dental cleaning and exam, your teeth will be clean, but your gums will still show the main sign of inflammation: bleeding.

If you really want to trick your dentist into thinking you’re brushing and flossing regularly, you’ll have to do it for at least seven days before your visit. And if you’re gonna do that, why not simply brush and floss every day?

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Tooth Drawer Dental History

Imagine living in a remote village 300 years ago.  After suffering with a toothache for weeks, you see an advertisement about a traveling dentist who will be performing in the village square next weekend.  You feel relieved, but somewhat nervous.

Who were these dentists that traveled around the countryside putting on loud, raucous shows whereever they went?

They were known simply as tooth drawers (pronounced draw-ers).

The Tooth Drawer

Tooth DrawerThe tooth drawer would generally travel to different villages and set up shop temporarily.  Usually a tooth drawer would set up a stage with lots of decorations as you can see in the picture above.

Many people had to be in extreme pain before they would dare go to a tooth drawer.  Tooth drawers ended up getting a bad reputation because many of them weren’t very good dentists and simply craved fame and attention.  Also, as you can see in the picture above, someone was picking the pocket of the tooth drawer’s patient.

On stage, they would act like they were great dental surgeons, but they often did this by tricking their audience.

How The Tooth Drawer Would Trick the Audience

Once a tooth drawer set up shop in a town, they would call someone from the audience who was suffering from a toothache.  The tooth drawer actually planted actors in the audience who would pretend to be suffering from a toothache.

After calling the actor up, the tooth drawer would pretend to extract the painful tooth and the patient would then cough out a bloody tooth.  In reality, the tooth drawer would give his actor an extracted tooth with blood on it and tell him to cough it out.  The actor would then exclaim, “I didn’t feel a thing – Thank you for taking me out of pain!”

After the tooth drawer finished with his actor, he would call another toothache sufferer up.  Those who really had a toothache would scream in agony at the tooth drawer’s rough methods.  Unfortunately, by this point, the crowd would be so loud and rowdy that nobody noticed how much suffering the tooth drawer was causing.

Was Every Tooth Drawer Dishonest?

Not every tooth drawer was dishonest.  There were some that truly wanted to help people get out of pain.  The problem was that way back then, nobody knew about local anesthesia.  Nobody knew that teeth could be saved by doing root canals.  The main problem was that there was simply a lack of scientific knowledge in the field of dentistry.

In her book Tooth Worms & Spider Juice, Loretta Ichord states, “Even the honest tooth drawers had limited skills and were capable of tearing large pieces of bone off with a tooth, breaking jaws, and causing facial deformities.”

If you take anything away from this article, I hope that you’ll realize that dentists aren’t as scary as they used to be.  With modern technology, your visit to the dentist no longer has to be painful or dangerous.  And by the way, with the HIPAA privacy act as one of your dental patient rights, you no longer have to worry about dozens of spectators coming to watch you during your dental visit like in the picture below.  Thanks for reading!

Tooth Drawer

Top Image “Le Mal De Dente” by Charles Aubry

2
Dental Patient Rights
©Candybox Images/Shutterstock.com

I got an email yesterday from a reader named Harris, who stated, “I paid $5000 to replace a broken crown. The dentist did not tell me what the cost would be until he had already started the procedure.”

Harris wanted to know what kind of rights he had as a dental patient when you’re not told the cost of dental treatment in advance.  I told Harris that it is generally accepted that a dental patient has a right to know an estimate of the cost of a procedure before treatment begins.

I’ve received many other questions about dental patient rights in the past, and I thought that it would be a good time to discuss the rights of a dental patient. I have listed below what I believe to be 20 core rights that every dental patient deserves, and I’ll probably use something similar to this as the patient bill of rights in my future dental practice.

Dental Patient Rights

Dental Patient RightsKeep in mind that these are not legally-binding rights, although they are good recommendations for a dentist to establish a positive, successful relationship with his or her patients.

I have provided links to many other dental patient bill of rights at the end of the article if you want to take a deeper look into the world of dental patient rights.

The Right to Choose Your Dentist

You have a right to choose your own dentist.  Many dentists have different philosophies regarding the best treatment and you have the right to choose the dentist with whom you feel most comfortable.

The Right to Quality Dental Treatment

You have a right to receive treatment that meets or exceeds the accepted dental standard of care.

The Right to Know the Education and Training of the Dental Team

You have a right to know about the education and qualifications of the entire dental team, including the dentist, dental hygienist, assistants, and staff.  Many dental practices that believe in lots of continuing education post this information on their practice website.

Most states require that a dentist complete 15-25 continuing education “credits” every year.  You can ask your dentist how many he or she has taken.  Some dentists get by on the minimum, and other dentists take more courses than required.

The Right to a Clean Treatment Environment

The dental team should be using appropriate infection-control and sterilization techniques.

Learn how to tell if your dentist has a good infection control program.

The Right to Confidential Treatment

You have the right to expect that no member of the dental team will discuss your treatment with anyone else unless you authorize it.  This is a right granted under the HIPAA privacy rule.

The Right to Know the Cost of Treatment

You have the right to know how much treatment will cost before treatment begins.  Sometimes we don’t know what we’ll find before we start working on a patient, so it can be difficult to give an exact fee.

If this is the case, the dentist should be able to provide you with an estimate of the fee based on the various outcomes and treatment options.

Curious about dental fees?  Find the average dental fee in your area.

The Right to Know Why You Need Treatment

You have the right to know why treatment is necessary for your particular condition.

The Right to Know Treatment Risks

You have the right to know what risks are associated with treatment as well as the risks of not proceeding with treatment.

The Right to Know Treatment Alternatives

There’s more than one way to skin a cat — You have a right to know what other treatments are available that would also solve your dental problem as well as knowing how long the various treatment alternatives will last.

The Right to Decline Treatment

You have the right to decline treatment if you so desire.  You also have a right to know what may occur if you choose not to accept the treatment that your dentist proposes.

The Right to Know Expected Treatment Results

You have the right to know what the expected outcome of your treatment will be.

The Right to Emergency Dental Treatment

You have the right to receive emergency treatment from your dentist within a reasonable time-frame.  Many dentists set aside a certain amount of time each day to see emergencies.

The Right to Be Treated Respectfully

The dental team should treat you respectfully and considerately.

The Right to Not Be Discriminated Against

You have the right to not be discriminated against.  You should receive quality treatment no matter your ethnicity, sex, religion, disability, or age.

The Right to See the Dentist at Every Visit

You have a right to see the dentist every time you receive dental treatment.  Different states have varying laws regarding this, and thus you can clarify this with your dental office if you wish to see the dentist at every visit.

The Right to Know How to Resolve Disputes

You have the right to know what actions you can take to resolve any disputes that might arise between you and your dentist.  There are many ways to resolve disputes with your dentist.

Dental peer review is one of these means — here’s what it takes to win a lawsuit against your dentist.

The Right to Timely Dental Treatment

If a dentist accepts you as a patient, you have a right to expect that you can make appointments in a timely manner and not have to wait many months before receiving treatment.

Keep in mind that sometimes this is beyond the dentist’s control.  For example, if you require IV sedation or anesthesia in a hospital setting, it may take a long time to schedule your appointment so that you can have all of the health professionals available to provide you with safe, effective treatment.

The Right to a Conversation With Your Dental Team Regarding Your Treatment

You have a right to receive answers to any questions that you may have regarding your current oral health status and your proposed treatment.

You also have the right to discuss any concerns you may have regarding the proposed treatment.

The Right to Your Dental Records

You have the right to have your dental records and x-rays transferred to another dentist of your choice either for free or for a nominal fee.

Learn more about how to get a copy of your dental records.

The Right to Reasonable Accommodations for Your Disability

If you have a disability, you have a right to expect your dentist to make reasonable accommodations.  For example, I have treated patients in their wheel chair when they are unable to move themselves into our clinical dental chairs.

Dental Patient Rights Available Online

There are a number of dental patient bill of rights available online.  My dental school and the ADA have made copies of their dental patient bill of rights available on the internet.  Here’s a few:

It’s interesting to note how Boston University’s dental patient rights differs from the other schools’ since they are a private university and appear to be more selective at accepting patients.

Questions About Dental Patient Rights?

Do you have any questions regarding your rights as a dental patient?  Leave them in the comments section below and I’ll do my best to answer them.

Thanks for reading!

6
Comprehensive Dental Exam
©Sheff/Shutterstock.com

Have you ever wondered how thorough your routine dental exams are?

A dentist that I shadowed prior to dental school told me that he used to rush through patient exams trying to get as much done as he could.  Eventually, he got tired of this because he really wanted to spend more time with his patients.  He doubled the price of his exams and spent twice as much time with each patient, being as thorough as he could.  Rather than losing patients, he said that he gained many more patients because his exams were complete and his patients felt they were getting a quality exam at each visit.

What Is a Dental Exam?

At my dental school, we do our exams by-the-book — we’re pretty thorough!  We examine just about every possible thing that a dentist can.  I thought I’d write a post about what our comprehensive dental examination includes, so you can gauge thorough your dentist’s exams are.

What Is a Dental Exam?

A dental exam consists of several different parts.  Each part helps to ensure that you and your dentist understand what is going on with your oral health.  In order to better describe a routine dental exam, I’ve simply written what I do when I see a new patient at the dental school.

I’ve divided it into 10 parts.  You can read over them all to see what we do, or simply jump to the sections that interest you.  If you have any questions when you’re done, scroll to the bottom to leave a comment, and I’ll get back with you.

1 – Introduction

I meet the patient in the waiting area, introduce myself and then ask them a little bit about themselves to get to know them better and put them at ease with me as their student-dentist.

2 – What Does the Patient Want?

I ask the patient why they came to the school for treatment.  I also ask what they expect from their treatment and what kind of dental work they want to have done.

3 – Medical History

I next obtain a very detailed health history, including which medications they are taking and any past or current medical conditions.  I then take a blood pressure and pulse.  It’s important to get the patient’s health history because certain things, like joint replacements and certain heart conditions can affect your dental treatment.  Also, there are over 300 medications that can cause dry mouth, affecting dental health.  Finally, an accurate health history is important because the dentist needs to ensure that there are no systemic problems that will affect the dental treatment that will be provided.

4 – Dietary Survey

We then complete a dietary form that indicates whether their diet places them at a high risk of getting cavities.  Although there are many things that can influence your risk of getting cavities, (here’s 25 things that increase your risk of cavities), diet is one of the most important factors.

5 – Risk Factors

We complete a “risk factors” form that tells us the patient’s risk for developing certain diseases, such as periodontal disease and oral cancer.  This form also gives us a general idea about the patient’s risk for fracturing or knocking out a tooth.

Another part of the form discusses the patient’s dental phobia.  We ask what kinds of things make the patient anxious about their dental treatment.  If you want to pinpoint your dental phobia, take a look at 15 common reasons why people are scared of the dentist.

The “risk factors” form also discusses other risk factors.  For example, this is the form I talked about in a previous article about how wearing your seat belt affects your dental health.

6 – Head and Neck Exam

6 – After that, we perform what we call a head and neck exam.  We feel the neck to note any enlarged lymph nodes or any suspicious lumps or bumps that could be cancerous.  We also feel the TMJ to evaluate whether or not the patient has any joint problems.  We note any popping or clicking in the jaw, which is fairly normal but which can cause problems.

7 – Oral Soft Tissue Exam

Next, we move on to the intraoral soft tissue exam.  The soft tissue exam consists of looking at every area in your mouth.  We look at the lips, the cheeks, the gums, the roof of the mouth, every side of the tongue, under the tongue, in the back of the mouth, the throat and the tonsil area.  Your tonsils can tell us if your body is fighting off a disease and sometimes your tonsils can cause bad breath if there is a tonsillolith present.

It is necessary to perform a very thorough soft tissue exam because this is where dentists check for oral cancer.  If your dentist isn’t very attentive during the soft tissue exam, he or she may miss the beginning stages of oral cancer.  It is important to catch cancer early because it improves your chances of beating it.  If something looks suspicious, your dentist may biopsy the area and/or refer you to an oral pathologist, one of the nine types of dental specialists.

8 – Periodontal (Gum) Health

Another part of the dental exam is periodontal probing.  This consists of sticking a little instrument between your teeth and your gums to see how healthy your gums are.  We measure the space between the top of the gums and where your gums attach to your teeth.  If it’s too deep, you won’t be able to clean it out well and it could indicate that you have periodontal disease, which is a leading cause of tooth loss in people over age 30.  If you do have periodontal disease, your dentist may recommend getting a deep dental cleaning, which is technically known as scaling and root planing.

9 – Hard Tissue Exam: We Finally Check Your Teeth

Next we perform a hard tissue (teeth) exam where we look at every side of your teeth and note any existing fillings, crowns, implants, root canals, cavities, fractures, or if there are any problems with your bite.  We also look at all of your dental work to make sure that it is still in good shape.  Depending on the health of your teeth, we may order x-rays to better diagnose any problems with the teeth and the area around the tooth.  Want to know if you need x-rays?  Read the article How Often Should You Get Dental X-Rays Taken?

During the hard tissue exam, we will also evaluate the patient’s bite.  If we will be making any crowns or dentures for the patient, we usually take dental impressions as part of the dental exam so that we can evaluate the patient’s bite and make sure we don’t cause any problems with the way that their teeth come together when we place crowns.

 10 – Treatment Planning

After gathering all of the above information, we create a treatment plan with all of the dental work that we recommend having done.   Sometimes this is as simple as getting a regular cleaning and providing instructions on how to maintain better oral hygiene or it can be as complex as getting dentures, crowns, bridges, root canals, implants, veneers, braces, and other dental treatment.

Conclusion

This is the comprehensive dental exam that each patient receives initially at my dental school.  Your dentist may choose to do things differently.  For example, some patients hate the “risk assessment” form and the dietary questionnaire.  At my dental school, we are required to complete these forms with the patient.  If you don’t seem interested in those things, then your dentist may choose to omit those parts of the exam.

Remember, all dentists are different, and most dentists want what’s best for their patients and will try to provide you with optimal dental treatment.  However, some dentists aren’t thorough, and hopefully this list will help you evaluate what you want your dentist to address during a dental exam.

If you have any questions, comments, or concerns about your dental exams, feel free to leave a comment below.  Thanks for reading!

1
Rockport Harbor Maine Dental Association

My wife and I traveled up to Maine this past weekend to attend the Maine Dental Association’s annual conference.  Since Maine doesn’t have very many dentists, they are trying to attract dental students to go and practice there after they have graduated.  It was really pretty (see the end of this post for some pictures), and they might have won us over…  but we’re still not quite sure where we’ll end up in 2012 when I graduate.  I’ll get to the links now, but scroll down to the end if you want to see some of the pictures we took in Maine.

Oral Answers Featured in Glamour Magazine’s Blog

Oral Answers LinksRecently, an Oral Answers article, Don’t Treat Your Teeth Like Tools was the subject of a blog post on the Glamour Magazine Vitamin G blog – check it out here.

The author, Sarah Gio, commented that “dental health has never been so interesting!”  Hopefully you agree.

Are Dental Sealants Safe for Your Children?

A recent study showed that dental sealants, a thin layer of plastic placed over teeth to keep the bacteria from causing a cavity, can release a chemical called bisphenol-A (or simply BPA.)  BPA has been linked to cancer, diabetes, early-onset puberty, and obesity.  For more on bisphenol-A, you can read this information page from USA Today.

Here’s the American Academy of Pediatrics said in their statement on the BPA issue:

” On the basis of the proven benefits of resin-based dental materialsand the brevity of BPA exposure, we recommend continued usewith strict adherence to precautionary application techniques.Use of these materials should be minimized during pregnancywhenever possible. Manufacturers should be required to reportcomplete information on the chemical composition of dental productsand encouraged to develop materials with less estrogenic potential.”

Other media outlets also reported this story.  You can read what CNN wrote, what USA Today wrote, and what MSNBC wrote.

For now, it is accepted that the cavity-preventing benefits of dental sealants outweigh the risks posed from a BPA exposure.

Practicing Dentistry Without a License

Frank Cerebino wrote an entertaining article in Florida’s Palm Beach Post regarding the recent surge in arrests of people practicing dentistry without a license.  I’ve noticed this trend, but didn’t think much of it until reading his article.  Here’s a quick excerpt:

Doing dental work without a license has to be one of the least appealing crimes.  If I were going to impersonate a white-collar professional, a dentist would be somewhere near the bottom of the list, certainly ahead of a proctologist, but not by much.

Here’s a news report of someone practicing dentistry without a license, another one here, and one last one.

Pictures from Our Trip to Maine

Here’s a few pictures we took on our trip to Maine for the Maine Dental Association’s yearly conference.

In the picture below taken in Glen Cove, ME, you can see Clam Cove on the right, and the West Penobscot Bay on the left which leads to the Atlantic Ocean.

Clam Cove in Glen Cove, Maine

We took this picture on Highway 1 in Maine as we were driving over one of the many bridges.

Going over a Bridge on Highway 1 in Maine

We love seeing the leaves change colors in the fall:

Maine Autumn Leaves on the Trees

Here’s one more view of Clam Cove and the West Penobscot Bay

Another View of the Bay from Glen Cove, Maine

We loved the beautiful scenery and the wide open spaces in Maine!  It was a welcome break from dental school in the crowded city!

If you have any questions or comments, feel free to leave them in the comments section below.

9
Dental Specialties
©Lightspring/Shutterstock.com

When you go to your family dentist, chances are that you are visiting a general dentist.  This is a dentist that has completed four years of postgraduate dental school and has received the dental degree of DMD or DDS.  Upon graduation, I am planning to practice general dentistry.

An Old Dental Surgeon SignSome dentists choose to obtain two to six more years of education by entering a dental specialty.

While general dentists do have a wide array of knowledge in all areas of clinical dentistry, specialists are focused on one specific niche inside of dentistry and often have more knowledge than general dentists in that specific area.

Thus, when a general dentist encounters a patient with a problem that is beyond his or her skill level to treat, the general dentist will refer their patient to a dental specialist.

Continue

22
Dentists DMD and DDS Degrees
©OralAnswers.com

Have you ever noticed how some dentists have the abbreviation DMD after their name and some have DDS as their suffix? You’re not alone. I too had this question, and wanted to find out why there are two different degrees for dentists. Here’s the answer:

Dentist DDS DMDWay back in 1840 the world’s first dental school was established in Maryland.  It was called the Baltimore College of Dental Surgery (which has since merged with the University of Maryland School of Dentistry.)  The Baltimore College of Dental Surgery admitted students eager to become dental professionals.  Upon graduation, they were awarded the DDS degree, which stands for Doctor of Dental Surgery.

Things were great in the mid-1800’s.  Those who were dentists had the suffix “DDS” hooked on to the end of their name.

Then, 27 years later, Harvard University decided to create a dental school.

It was the first dental school to be affiliated with a major university.  Since Harvard likes to be unique, and only grant degrees in Latin, they mulled over calling their degree “Chirurgae Dentium Doctoris,” or CDD.  In case you weren’t aware, that means Doctor of Dental Surgery in Latin.

Evidently, Harvard officials didn’t think that “Chirurgae Dentium Doctoris” had quite the ring that they were going for, so they consulted a latin scholar who suggested that they tack the word Dentariae onto their Medicinae Doctorae degree for doctors.  They came up with “Dentariae Medicinae Doctorae”, which means Doctor of Dental Medicine.  They abbreviated this DMD.

The Growth DMD Degree Awards

In 1900, only Harvard and the University of Oregon used the DMD degree.

In 1989, 23 of the 66 dental schools in the United States awarded the DMD degree.

Today, there are 58 dental schools in the United States.  According to the ADEA’s Official Guide to Dental Schools, 24 of the 58 award DMD degrees while 34 of them award DDS degrees.

After looking at the statistics in the Official Guide to Dental Schools, I looked at the class size of each school.  I used 50 as an estimate for Western University College of Dental Medicine, since they will be opening in the fall and I can’t find their “ideal class size” listed on their website.

So here’s the numerical breakdown of the population of first year dental students that will be attending DDS vs. DMD dental schools:

Number of DMD First Year Students: 1844
Number of DDS First Year Students: 3005

As you can see, DDS dentists on average, outnumber DMD dentists 3 to 2.

In Canada, there are ten dental schools.  Six award DMD degrees and four award DDS degrees.

Are DMD and DDS Dentists Different?

A dentist with DMD after their name and one with DDS after their name can perform the exact same procedures.  There is no difference or special privilege that one degree holds over the other.  In fact, both degrees have to use the same curriculum requirements that are designated by the American Dental Association.

The various dental schools are given the choice as to which degree they would like to award their graduates.

The DMD vs. DDS Controversy

Many people in the general public are confused by the two degrees that dentists have.  In some parts of the country, people may only recognize one of the suffixes as being a dentist.

There have been calls to the ADA to get rid of both degrees and create a new “streamlined” degree that everyone will recognize as a dentist.  However, there seems to be too much pride in one’s degree to completely get rid of them.  There is also a rich history in both degrees.

Those advocates of DDS say that dentists perform surgery daily by removing tooth structure, extracting teeth, performing gum surgery, etc.  Advocates of the DMD degree say that dentists are truly doctors of dental medicine and need to consider the scope of the whole body when planning a treatment for a patient.

It seems that for the time being, there will continue to be two different degrees that permit dental professionals to perform the exact same work.

Dental Schools Debate Which Degree to Offer

Even dental schools have been confused about which degree is best to offer.  One example is the Washington University School of Dental Medicine, which was started in 1866 and closed its doors in 1991.  They offered both DMD and DDS degrees to different graduating classes:

  • 1866 – 1891: Awarded DDS Degree
  • 1892 – 1900: Awarded DMD Degree
  • 1901 – 1972: Awarded DDS Degree
  • 1973 – 1991: Awarded DMD Degree

You can read about those changes and a history of the now-defunct school here.

Conclusion

I am currently enrolled in a University that grants DMD degrees.  In just over two years, I’ll have the DMD suffix on the end of my name.  When I was a kid, I always recognized dentists as the people with DDS on the end of their name.  Since DDS is still more common, perhaps that’s how most people recognize dentists.

Have you ever been confused by this?  If you have any questions or comments, please leave them below in the comments section.  Thanks for reading!

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