Tolerating a Fenestration

Nancy came for a cleaning, but it had been quite a long time since her last cleaning due to some medical issues she was dealing with. When I examined her, I noticed what is apparent in the photo above (mirrored image). This "fenestration", or "window" through her gums was caused by slow, steady pressure on her gums from an ill fitting removable partial denture.

The term fenestration comes from the Italian word for window: finestra. Through the window, you can see the roots of her lower front teeth. She also has clefting on a couple of her teeth. This is similar to a fenestration, but communicates all the way up to the crown of the tooth.

An unusual cause for this fenestration was the fact that Nancy's partial put pressure in that area, and she just tolerated it. I guess you can tolerate alot when it comes at you slowly. As her lower partial settled down in back due to slow bone loss in her lower jaw, her partial rotated down and forward behind her front teeth. This caused the pressure and loss of gum tissue in that area.

Our treatment for this is to first take the pressure off of the gums from the partial. Today, I placed a medicated liner under her partial which lifted the back of the partial up, and rotated the metal from the partial back and away from this area. She will soon be healing, and returning for long-term relining of her partial. She may need periodontal care for repair of the fenestration, and certainly she will need these teeth cleaned up!

Who Shot the Sialolith?

"I shot the sheriff, but I did not shoot the deputy..." The song lyrics remind me somewhat of the photo I received recently from my brother Peter Jacobs, DDS. Pete practices near me in the small northern city of Manistique, Michigan.

You don't need to live in a large metropolitan area to see unique things in a dental office. This is one that I have never seen, so I thought it might be interesting to others. Pete sent me a photo of a sialolith, that is - a calcareous concretion or calculus of the salivary gland or duct. He had a patient come into his office with a swelling below his chin and under his tongue. On an xray examination, an artifact somewhat like a tooth was present. After some investigation, Dr. Pete made a small incision under the patient's tongue, and out popped what you see in the picture. The sialolith looks somewhat like a tooth that is tapered on each end. Over time, calcium deposits can build up in the salivary duct, and start to obscure it, causing a backup of saliva in the gland.

Note the size of the sialolith in comparison to the bullet laid alongside it in the photo. My brother is very passionate about hunting, and happened to have the bullet nearby to easily use as a size comparison. He says it's a 30.06 shell. I'm waiting for the deputy to confirm that!

Experience the Difference

Zig Ziglar once said that there is something that millions of Chinese schoolchildren can do that you and I can't. Namely, speak Chinese! That doesn't make them smarter than us, it just demonstrates that they have had different experiences than us.

Recently I was visited by a young adult from Minnesota who was interested in Invisalign. She had been to a dental school in Minn. in hopes of getting her teeth straightened, but was left undecided after hearing the differing opinions of the dentists at the school. There are many smart people teaching in professional schools, but there are as many different ways to approach dental problems as there are dentists.

After evaluating this young lady, I realized there was more to her problem than just straightening her teeth. The confounding situation for the dentists who had seen her before was that she had developed a compensating bite, commonly referred to as a "Sunday bite". She would push her lower jaw out forward so it looked like she had a better bite relationship than she actually did. Her teeth did not fit well together in this position, but because of having done this for so many years, her teeth didn't fit well together in a retruded position either. Consequently, she was getting headaches and jaw aches frequently.

From my experience, I know that orthodontic treatment could be the attempted treatment for this, OR it could seal the deal on capturing this problem for a long time. From my experience, I felt that she first needed to have her jaw joint and muscles neutralized and in harmony, and then her bite stabilized in some position before beginning Invisalign treatment.

Invisalign is on hold temporarily, and she has been started on NTI appliance therapy. I met the inventor of the NTI appliance Jim Boyd, DDS years ago while attending a dental conference with him in Hawaii. I remember Jim making this appliance for other attendees who had headaches daily. The next day at the seminar, these people were interviewed and explained that the majority of their headache and neckache problems had dissipated almost immediately.

Now, this NTI appliance is a good treatment, but not for all cases. Dentists still need the experience to know when it will help, or when it could cause more difficulty.

I recieved an email yesterday that our patient is having changes for the better almost immediately. She wore the appliance on her way home to Minn. while driving, and told her mother that she already was feeling positive differences. I'll see her again in a couple of months, and hopefully we can start to stabilize her bite and eventually get her the straight teeth she wants.

More later, as the story develops.

100% Government Free Health Care

I just read a linked story on CNN about the current health care debate. People out West in Big Sky, Montana stated that they were concerned about government intervention in their health care coverage. They didn't want government to get too involved in their own choices and care. One person interviewed was at a low-cost dental clinic stating that government intervention was bad. The interviewer elucidated the fact that the U.S. government was financing about 50% plus of the costs of the clinic.

Wait a minute! It's obvious that another idea needs to get more press. Since January of 2008, the Care Free Dental Clinic, Inc. has been in operation in Delta County, Michigan. We have provided over 350,000 dollars in free dental services to over 1500 patients. The population we serve are the uninsured, homeless, and low-income residents of our county.

The Care Free Dental Clinic is unique. There are no paid employees. Rent, heat, and lights are donated. We don't even have a phone. The clinic is staffed by community volunteers. Eleven dentists donated their time to keep the clinic staffed for two half days every week. About 50 volunteers comprised of dental assistants, receptionists, and dentists work together to the common goal of serving others. "Nobody should seek his own good, but the good of others." is our motto.

Funding for the clinic is by private and individual donations. We have an annual fund raiser which raises much of the money for materials and disposables. Every dollar of money coming into our clinic goes directly to patient care. Our local St. Vincent DePaul Society has housed the clinic since its inception, and is presently adding on two new rooms for our clinic expansion.

Now, if this simple but effective clinic has demonstrated our community's ability to care for its own, why can't the idea spread to other areas. We know it can! It will take time. It will take good people. It will take miracles, but it can come to fruition. This idea is certified 100% Government Free. Pass it on.

We The People must be the answer to our own problems. Let's not wait for someone else to take care of us. Let's not wait for someone else to solve the problem. Let us do as our forefathers did and take ownership for our own problems. Encourage others around you to get involved. Keep an open heart and mind when people around you try to do good for others. Donate to a cause. Your monies will come back ten times to you.

Share this miraculous, encouraging story with others. Please forward this to your friends in the hope it may inspire someone else to join in the fight to continue our independence from government intervention. Together we can care for each other, save our American way of independent living, exercise the freedoms we are so blessed to enjoy, and not just sit back and wait for someone else to throw small coins into our laps.

We are also encouraged by the possibility that our potential Surgeon General is aware of the power of volunteerism. (Read also: Sherpa Nell.) Dr. Regina Benjamin has also given selflessly of herself in tending to the needs of her patients in Alabama, many times donating her services.

For further information on the Care Free Dental Clinic, Inc. or to learn how you can help support the growth of clinics like this, contact Paula Jacobs, R.N. at pjacobs@hughes.net.

Sherpa Nell

I was destined to meet two extraordinary people in the fall of 1993.


My favorite holiday - Thanksgiving would have to arrive in the States without my presence. I had given up my annual duck hunting trip, and the warmth and comfort of our usual family turkey and stuffing fest to participate in a much needed Christian mission trip to Flores, Honduras. Separation from Paula and Bryan and Allison was troubling to me, as our children were only 10 and 8 years old, but I was compelled by the dental need I had heard about in Honduras.


On arrival in our first major airport, I was cheerily greeted by a pair of unlikely, but obviously very close women. "Hi, my name's Nell, and this is my doctor, Dr. Benjamin." I introduced myself in response to their welcome, and asked where they were from. I believe that they were traveling from somewhere down South. We joined with the remaining 16 or so people and completed the final leg of our flight into Tegucigalpa, Honduras.



We drove on to Flores, a small mountain village with one church and a boys' and girls' school and orphanage run by a Christian non-profit organization. The tiny cement block "clinic" building would be our office for the next two weeks. We unloaded all of our supplies, arranged our dental and medical treatment areas, and prepared medications for the first day of service.


Nell and her doctor, Dr. Regina Benjamin spent alot of time working together organizing the pharmacy, packaging gauze, labeling drug envelopes, and sorting through numerous bottles and jugs of donated pills to be ready for the next day's onslaught of patients. Wherever I would see Regina or Nell, I would see them together - hardworking, cheerful, and getting the job done.


The next few days were a blur, as patients lined up at the clinic at 5:00 a.m., through the gates of the school and down the highway. We took a short break in the heat of the afternoon, and then continued on into the evening, ending sometimes at 9:00 at night. We had a trickle of water in our faucet, and limited unreliable electricity, but we were able to take care of alot of people. I didn't see Nell and Regina often during the day, as they worked the other side of the clinic. I spent most of my time extracting unrestorable and abscessed teeth in a small room on the right side of the clinic.


It was in the evening hours that I got a better chance to visit with Nell and Regina. After dinner, we would sit outside in the cooler evening air on ramshackle folding lawn chairs and talk about the day's experiences and speak of home. Sitting with Nell was one of my most memorable experiences. Nell was pleasant, outgoing, and spoke in a matter-of-fact way. Her humility was overwhelming to me, as she constantly referred to how wonderful "her doctor" - Dr. Benjamin was. Nell had worked with Regina for three years in a small rural health clinic. Nell related to me about how Dr. Benjamin worked tirelessly for her poor patients. She told me stories of her doctor's generosity and compassion. She had a sparkle in her eye every time she relayed another story of how she and Dr. Benjamin had helped the needy people from their area. I knew Dr. Benjamin must be special, but I was also convinced that Dr. Benjamin's success was at least in part due to the passion and dedication of her nurse Nell.


I found myself that Dr. Regina Benjamin was an incredible human being. Nell was right. She did work tirelessly for her Honduran patients. With Nell at her side, they accomplished great things for those needy people. They took care of each person like they were the most important people on earth. Always smiling, always waiting anxiously for the next patient, always caring about the people around them, they worked on together.


It's been many years since I have heard from or of my nurse and doctor friends from the Honduras medical - dental mission trip. As I read the news a couple of days ago, I did notice a familiar name and face: Regina Benjamin, M.D. The news also talked about her nurse, Nell. The still white-haired 79 year old Nell Stoddard, LPN predicted that someday "her doctor" who had worked so hard for her patients and endured so many hardships would become very important someday. Nell continues at the side of Dr. Benjamin in the Bayou La Batre Rural Health Clinic in Bayou La Batre, Alabama. They've been together for about 19 years now.


Nell's prediction is at hand. Recently, President Obama announced his selection of Dr. Regina Benjamin for the position of Surgeon General of the United States. This is a most fitting position for a person (team) that has served so selflessly. I am proud to have served with Nell and Regina. Congratulations to you both, for we know that noone can reach the summit alone.


Sherpa Nell - I liken the journey of Dr. Regina Benjamin and her Sherpa Nell to that of Sir Edmund Hillary and his Sherpa guide. They could only reach the summit together, relying on each other. In some stories of Everest, the unknown sherpa guide would not only carry much of the provisions on their back, but would on occasion carry their explorer as well. I'm sure that Nell and Regina have carried each other through much that life has brought their way.

(BBC News:) 1953: Hillary and Tenzing conquer Everest

The New Zealander Edmund Hillary, and the Nepalese Sherpa Tenzing Norgay, have become the first to reach the summit of Mount Everest on the Nepal-Tibet border.

They reached the top of the world at 1130 local time after a grueling climb up the southern face.

The two men hugged each other with relief and joy but only stayed on the summit for 15 minutes because they werre low on oxygen.

Mr. Hillary took several photographs of the scenery and of Sherpa Tenzing waving flags representing Britain, Nepal, the United Nations and India.

[On the return,] Col Hunt saw the two men looking so exhausted that he assumed they had failed to reach the summit and started planning another attempt.

But then the two climbers pointed to the mountain and signalled they had reached the top, and there were celebrations all around.

Lip Repositioning - A Reason to Smile

Jean was in today for her final "glamour shots" after her lip repositioning surgery. In both photos, she is forcing a large smile. The "after" photo shows a beautiful result, and she's most pleased with it.

Jean says that she's smiling all the time! It's hard to believe that she wasn't smiling all the time before.

NEW PHOTOS! Temporary Lip Repositioning at:

http://dentalnation.blogspot.com/2010/09/reversible-lip-repositioning-surgery.html

A Picture is Worth . . . Sending You to Prison

Usually a picture is worth a thousand words, but this time a picture is worth a few more visits to the Liberty Hotel in Boston.

Paula and I just returned from Boston visiting our son Bryan for the 4th of July. We chose to stay at the Liberty Hotel which seemed aptly named for a visit during the Independence Day Holiday. When Paula made the reservations, she was asked what the occasion was for our visit. She mentioned that we were visiting our son who was attending the Harvard School of Dental Medicine.

On arrival in our hotel room, we were pleased to find a personal, hand-written note welcoming us to the Liberty Hotel and wishing us a nice time visiting with our son. Wow! That's customer service. About 15 minutes later, we realized this was only the beginning of our special experience in the Liberty. I looked over to the night stand, and saw a framed photo of the Harvard School of Dental Medicine propped in a prominent position. Now that was impressive. That is a quality of customer service that demands to be recognized.

The Liberty Hotel was a great place to stay. The staff was accommodating. The restaurant was fabulous, and they had a unique motif. Did I mention that the "Liberty" Hotel had at one time been a prison? Yes, if you're ever in the Boston area, I'd recommend you spend your weekend in this prison.

Kudos to the people at the Liberty Hotel in Boston. I guess a picture is worth . . . well, alot.

Overcoming 1980's Dentistry

Hey, the 80's called. They want their teeth back!

When I first started practicing dentistry in the 1980's, the most common, least expensive thing we could do for someone who had a large space between their front teeth was to fill the space with two large crowns.

Quickly, we realized that running around flashing two humonstrous chiclets wasn't exactly sexy.

Our next generation solution for this problem was to crown the front four teeth instead to divide out the extra space between more teeth. This worked better, but the teeth generally owned two faults: They looked wider than they were tall, and there was a funny shape to the gum tissue beteween the two front teeth due to missing tissue.

Enter the 2000's . . . Contouring the gingival tissue to make the teeth look larger, and to create a natural "emergence profile" combined with fabrication of murano veneers and crowns really produces a smile that shines on. The gum tissue is contoured with a laser to simulate natural gum contours and "points" between the teeth. Murano veneers and crowns are computer designed to capture natural size and shape relationships between all the smiling teeth.

The photos above illustrate a recent success at the Jacobs Smile Center. The before photo shows the 80's style dentistry, while the after photo highlights what can be accomplished with the technologically superior murano veneers and crowns and laser recontouring - gum lift - of the tissues. The photos have been taken about 3 weeks apart.

Oh, yeah, I also did some ZOOM! whitening to round out the brilliance of her smile.

This lady is very active publicly, and tells me that many people have commented on her beautiful new smile. "I can't believe I waited so long," she tells me. I'm glad it was worth the wait.

20/20 Vision

This week marked the 20th anniversary of Vickie's partnership with the Jacobs Smile Center. We celebrated the occasion with an outdoor party complete with tent, cake, and Schwann's ice cream for our guests.

Vickie came to our practice with the retiring Ed Kuivinen, DDS in 1989. Ed said, "You'll want to keep Vickie. She knows everyone, and everyone likes Vickie." Vickie has been a true partner in the growth and development of our dental practice. She has understood the importance of serving each and every one of our patients in a sincere, caring way. The importance of each individual's welfare is most important to her.

20 years has seen the advent of new things in dental care. Vickie has transformed successfully through the change from 2-handed dentistry to 4-handed dentistry. She has seen the change from "cleanings" to comprehensive periodontal therapy. She has ushered in the technologies of computers in every treatment room, digital patient charting, digital xrays, laser cavity detection, and laser gum therapy.

Vickie has developed a keen eye for matching tooth color, and has become an educated critic about the perfection of cosmetic dental results, holding us all to a higher standard!

Vickie has cared for patients in need, anxious patients, patients suffering personal loss or trauma. She has given of herself to patients who have lost a loved one. She's shared the hurt of a patient having to commit their loved one into nursing home care after many years of trying to take care of them at home. She's counceled the parents of children sent to jail. She's shared her testimony and the Word with children returning from long term addiction treatment.

Thank God for Vickie, and for all the Vickies in the world. You make each day easier. You elucidate and validate the value and purpose of those you touch daily.

20 years comes and goes quickly. Thank you Vickie for having the trust in our vision to serve our patients in many ways. Thank you for helping shape our vision for the 20 years that are yet to come.

Lip Repositioning

NEW PHOTOS! Temporary Lip Repositioning at:
http://dentalnation.blogspot.com/2010/09/reversible-lip-repositioning-surgery.html


What can you do when your lips and your gums are fighting for attention, and your gums are winning? Now you have an option of a little-known procedure called lip repositioning surgery.

The photo above shows Jean's smile one week ago immediately before the procedure. This is not an exaggerated smile, but rather an easy smile she exibits in conversation. I had previously performed a laser gum lift to remove some of the tissue covering up her teeth. This helped her smile a great deal, but she still had an excessive amount of gum tissue displaying when she smiled.

Jean shared with me that she had been conscious of her gummy smile all of her life. "I try not to smile too big when I can help it," she declared.


In this second photo is Jean's smile one week postoperative to her lip repositioning surgery. I asked her to give me the highest smile that she could for this photo. "That's all I've got," she said, smiling and beaming simultaneously. "It looks great. I can't thank you enough." (Did I mention that I got a hug?)

This is remarkably simple and life changing!

During this procedure, I removed a small, shallow strip of inner cheek tissue from under Jean's upper lip. Removing this small strip of tissue and suturing the area into a new position immediately gave this result. The procedure generally takes about 20 to 30 minutes, and is painless. Jean did say that she had some discomfort for the first day or two, but that it was relieved with ibuprofen. She also said that she would do it again in a heartbeat. "I know a lot of people who could use this," she told me.

I've recently added this procedure to the list of things I like to lecture about. Contact me for further information about this if you desire.

Also visit: http://dentalnation.blogspot.com/2009/07/reason-to-smile.html for Jean's final glamour photos.

NEW PHOTOS! Temporary Lip Repositioning at:
http://dentalnation.blogspot.com/2010/09/reversible-lip-repositioning-surgery.html

Love it to Death

I talked to Bryan last night (Harvard School of Dental Medicine 2010) and he had an interesting case. He had recently restored a tooth for one of his patients, and the patient returned with much sensitivity. On evaluation, Bryan noticed that the new filling was showing signs of wear already. He asked the patient when it bothered her and she replied that it hurt when she flossed around it. "How do you floss?" he asked. She replied that she occasionally wrapped the floss all the way around the tooth like a lasso. Since she was having a little sensitivity in that new filling, she was not only wrapping the floss completely around the tooth, but she was also "crossing" the floss and then stripping it back and forth. This was remarkably like using one of those pocket chain saws that you can buy in Cabellas for removing small limbs from a tree in a minute! Bryan told her to stop abusing her tooth that way, before she had worn the tooth out completely.

I told Bryan "she was loving it to death". He chuckled, but that is how I have described this phenomenon over the years. I will frequently have a dental patient that presents to the office with a complaint of a severely receding gumline on one or two teeth. For some unexplained reason, the gum tissue continues to move further and further away from the tooth. I have learned over the years that when someone focuses on a percieved problem, they may concentrate all their efforts on it. When questioned, the patient usually relays that they are concerned about the recession and that they are "cleaning it really good several times a day so that it doesn't get worse." I tell them that they might be "loving it to death." In their attempt to keep the area healthier, they are in effect causing great damage and trauma to themselves. They think that more is better, but in these cases they need to stay away from the area to let it heal.

I cared for a man about 20 years ago who was losing weight at an alarming rate. His doctors were dumbfounded and couldn't explain why this man was dying a slow inevitable death. He told me that he was a religious man, and that he had visited Lourdes France a couple of years before to pray for good health. He had believed that the healing waters of the fount were alkaline like peroxide water, and thought that the healing waters were not of God so much as they were in the chemicals in the water.

He said, " I use that water every day, and I'm still losing weight. I can't figure it out?" I asked what he meant by using the water every day? He explained that he was mixing up some peroxide and water every day, and bathing in it like at Lourdes. He was also drinking a quart of that peroxide water every day. "I am consumed by this healing water, so I have to get better soon."

I told him that this was not healthy, and that if he kept drinking this water every day like this, he would do great damage to his body. I spoke with his wife, and she also had been trying to tell him this - to no avail.

God rest his fragile body. He loved himself to death.

With Knowledge Comes Responsibility

I have kind memories of the old days in dentistry. There was no HIV-AIDS. Gloves were optional, and masks were mostly unthought of. My father owned one periodontal probe he had received in dental school, and the sum total of knowledge about gum problems was neatly compacted into a one eighth inch thick pamphlet. I'm talking about the dentists' knowledge, not just a patient brochure.

When I graduated from the University of Detroit Dental School in 1983, that small pamphlet of facts on gum disease became three hard covered books an inch and a half thick on the principles of periodontal diseases. We certainly had more to know, but the treatments for periodontal disease were essentially the same. Unfortunately, until about 5 years ago, the only difference in treatment procedures for gum disease was that dentists and hygienists were greater proponents. There was greater emphasis on the diseases, but most treatments remained the same.

Enter 2009 - with the advent of DNA testing and bacterial testing for periodontal bacteria, we have turned a new page in the treatment and responsibility for treatment of periodontal diseases. When our patients reported for their dental cleanings in the past, we may have noticed that they had swollen gums or bleeding when we probed their gums. Our general solution was to scold them that they had to floss more and see us more regularly. Most people were agreeable, as they weren't really flossing like they should have. Six months later, they would return with the same problem.

Really bad cases got sent to the gum surgeon. The usual procedure there was to cut away some of the swollen gum tissue, put the patient on more frequent maintenance appointments, and to scold them that they had to floss more. Every five to ten years the surgery might be repeated as long as they still had some teeth left.

Newsflash: I've tested several hundreds of these so called non-flossers over the past year for the possibility that they might be actually infected by a known badly pathogenic bacteria. Results of these tests have confirmed harmful bacteria present in all but one case. Eyeopener #2: I've tested about 21 couples or family groups in the past 3 months, and have found that each group shares an almost identical amount and type of harmful bacteria in their mouths.

No longer are we able to treat our patients with periodontal disease as individuals. There is such a strong correlation between close individuals and their periodontal bacteria, that we now need to look past just the individual.

With Knowledge comes responsibility! When I see Mr. Jones' bleeding, swollen gums, I have to take into account the health of Mrs. Jones. The children of parents with gum diseases need to be watched more closely. As dentists and hygienists, we can no longer deny the health of other family members in making treatment decisions.

Except for the introduction of technology like lasers and ultrasonic scalers, many of our periodontal treatments remain the same. However, the emphasis on who we treat has moved past the individual in the dental chair at the time. We all know to change our toothbrush after we get over a cold or the flu. It's not as easy to change a spouse, partner, or child just because they are infected with one or more of the harmful periodontal bacteria.

Will dentistry move toward the model of "group therapy?" I propose that this may be what we find in our future. More on this as it develops.

Allison Requests Oral Cancer Info

"Dad, you should write something about oral cancer. My friends are interested in it, and they want to know what's new." This text message came to me from my daughter Allison who is presently serving in Peace Corps Jordan. She had heard about the VELScope examination we do at our office and was interested in passing on some of the newer information to her friends. Well, here's the latest:

Oral cancer kills one person every hour, 24 hours a day in the United States.

Oral cancer is one of the human cancers that is not decreasing in occurence in the last few years. The incidence of oral cancer is about twice that of skin cancer and about three times that of cervical cancer in women. Oral cancer is the sixth most common diagnosed cancer in the U.S. According to the American Dental Association, oral cancer strikes an estimated 34,360 Americans each year. Approximately 7,550 people (5,180 men and 2,370 women) will have died of these cancers in 2007. African-Americans are especially vulnerable; the incidence rate is 1/3 higher than whites and the mortality rate is almost twice as high (American Cancer Society statistics).

Tobacco and alcohol combined account for about 75% of oral cancers, while the segment of the U.S. population growing disproportionately in new oral cancers is women under 40 years of age. It is speculated that this newer group is related to HPV-16 or one of the forms of human papilloma virus. Human papilloma virus is a sexually transmitted virus, infecting about 40 million Americans, and also causing an increased risk of cervical cancers. The HPV affects tissues that have direct contact with a lesion or sore, and does not circulate through a person's system.

Oral sex is also being tagged as a cause of oral cancer because of contact with HPV lesions. "There is absolutely a link between oral sex and oral cancer," said Dr. Ellen Rome, of the Cleveland Clinic. Although no proof exists yet, there is a chance that HPV can be transmitted mouth to mouth.

NON-smokers and people who are not in traditional risk groups are also experiencing an increase in oral cancer rates. Researchers are still working on finding out what these new risk factors may be.

Oral cancers start as a small white or red spot or sore anywhere in the mouth or on the lips. Other signs of oral cancer could be: a sore that bleeds easily or does not heal; pain, tenderness or numbness that doesn't heal; or difficulty chewing, swallowing, speaking or moving the jaw or tongue. Prolonged exposure to the sun can increase the risk of lip cancer.

Half of the people who are diagnosed with oral cancer die within five years. This is mostly due to the cancer being undetected until it is too large to treat easily. Early detection and intervention allows nearly 90% of all cases to be treated.

Detection of oral cancer starts at the dentist's office. A careful visual examination is performed at least annually. The dentist may use an adjunctive screening tool like the VELScope we have in our office. The VELScope shines a blue light into the mouth, and normal healthy cells fluoresce and appear green while looking through a filtering lens. Suspicious cells look jet black or darker through the scope. Final confirmation or diagnosis of cancer can only be accomplished by biopsy or removal of the lesion for microscopic examination. Many more lesions can be detected by using the VELScope than can be seen with the unaided eye.

Studies suggest that diets high in fruits and vegetables may prevent the development of potentially cancerous lesions. Yes, your mother was right again!

Allison, I hope this helps. Let me know if you need more specifics. Also, text your Dad sometime, and we can discuss that "budget thing."

Shirt Crazi

My father told me that it's human nature for people to perform as well as they feel, and that the way a person is dressed affects how they feel. It was always important for him as a practicing dentist to come to work each day looking his best. His shoes were always polished and his tie sported a distinctive symmetrical knot.

At the Jacobs Smile Center, we have a dress code that I feel contributes to a feeling of teamwork. Our clinical team coordinates their scrub and jacket combinations depending on the day of the week. Front office members wear either a coordinated business suit or our signature blue logo cotton blouse and dark dress pants.

Yesterday I found that this concept is thought important in the least likely of places. It was my day to volunteer as a dentist at the Care Free Dental Clinic, a volunteer clinic whose mission is to serve the homeless, low income and uninsured people of our county. Our fourth patient presented for treatment, sat in the dental chair, and said she was told by C. J. to say hello to me.

"Do you mean C. J. Skerbeck?" referring to the owner of our regional traveling carnival. "Yup, she's the one," the lady replied.

I asked, "what do you do for the carnival?" I was given a brief explanation of a job I had never heard of before. "I am the person who gives out the clean shirts every day to the carnival workers. You know, nobody gets a clean shirt unless they are wearing clean, dark bluejeans or black pants. They must be clean and in good condition. It's important that they look good everyday, because they are all representatives of our carnival. If I don't give them a clean shirt each day, they have to go home and change or they just plain-out can't work for us that day. Every day, every worker gets a fresh, clean shirt. I'm the one who washes every shirt. I'm the one who decides if they work today or not."

I thought for a moment. "Your job sounds important. What do the other carnival workers call you? Please don't use any words I can't repeat."

"They call me the Shirt "Crazi" she laughed. "I don't care. I make sure they all look good, and C. J. counts on me to make sure that's how it is. My second most important job that I do is selling tickets and handling the money." At this point I understood that the Shirt Crazi must be really important. I guess Dad was right, even the important people at the Skerbeck Carnival know that looks are important in your job.

Gumdog Millionaire

What do the slums of Mumbai, India and your mouth have in common? Beside the fact that they can both be dirty places, your mouth is also a place inhabited by mostly "good" residents. Like the occupants of the Mumbai slum in the recent award winning movie Slumdog Millionaire, your mouth also may house some really "bad" characters.

Dental research has identified nearly 700 different bacteria living in the human mouth, most of them "good". Newer technology has allowed us to identify with great accuracy thirteen "bad" pathogenic bacteria believed to be involved with degenerative periodontal (gum) infections. My first exposure to this technology was through a course I took by Lou Graham, DDS about 3 years ago. In the past year I have sampled about 200 people with signs of periodontal disease or infection looking for these horrible critters.

Analyzing these bacterial test results has been a large eye opener for my dental team and for me. We have found many more "Gumdog Millionaires" than I could ever had imagined. I see a gumdog millionaire as a person who is rich indeed. Rich and teeming with microorganisms too nasty to inhabit the slums of Anymouth, USA. Of all the bacterial tests I have done to date, only one person had a test returned with no periodontal pathogens. I even had to do a free retest to confirm to myself that this could have occured. Now keep in mind that I am only testing people with evidence of periodontal infection or disease, but impressive none-the-less!

Where, why, how? Research is still out on the final answer to these questions, but this is what we know so far. Periodontal pathogenic bacteria are probably passed from a caregiver to a child in a family setting at an early age - coughing, sneezing, kissing, tasting off the same spoon, drinking out of the same cup, sharing a straw. People with a stronger immune system are less likely to take on the new bugs, while those with lesser immunity will begin to host the bugs earlier.

As a person ages or their immune system is challenged, the "bad" bugs may overgrow, now showing the signs and symptoms of gum infection or periodontal disease. Present in larger quantities, these bacteria are next passed through saliva again to the person's spouse or partner.

Most recent shocking findings in my dental office are that married couples that we have tested in the past 4 weeks have all shown the same combination of pathogenic bacteria present in their mouths, and we have even found these bugs in the same quantity in each partner. I have tested about 6 couples and 1 family unit to date. Father, mother, and child demonstrated the same bacteria!

At a recent course sponsored by Hain-Diagnostics, I learned that four of these bacteria (called red complex) predispose people to a 700% greater chance of having heart disease. People with two other (called green complex) bacteria are more prone to diabetes. Orange complex bacteria can be related to inflammatory diseases such as rheumatoid arthritis. The presence of these bacteria shows a risk factor, not necessarily causal. Research is beginning to point to a causal effect, though in some cases.

These bad bacteria are difficult to get rid of, but it can be done. Removing pathogenic bacteria may not eliminate things like heart disease, cancer, diabetes and arthritis, but it will definitely remove some of the risk factors. The earlier in life that bad bugs are detected and treated, the greater chance of having a healthy adulthood, continuing into the "golden years".

Oh, yea - don't be kissing your dogs on the face either. Last Monday's patient informed me that he was taking his dog to the vet for periodontal treatment. The vet said that the dog would get heart disease if this kept up! Another dentist I met recently had a woman's dog tested for periodontal bacteria. Amazingly, the dog and owner shared the identical bad bugs. The dog's better now, by the way. The woman finally tested clean after the dog was treated.

"Now Jamal, your final question is worth a staggering 20 million rupees! Which periodontally pathogenic bacteria can raise your risk of heart disease by 700%? Is it A: Aggregatibacter actinomycetemcomitans? B: Porphyromonas gingivalis? C: Tannerella forsythia? or D: Treponema denticola? . . . . What is your final answer?"

"I know the answer is all of the above," spats Jamal, "as I have been a Gumdog Millionaire!"

Two Left Shoes

Yesterday was an amazing day. I had the first massage of my life at age 50. The entire experience was incredible except for a minute detail which will forever cast a toothpick of a shadow on this near perfect day.

Paula and I treated our office team to a Friday seminar which was followed by a "spa" experience. After the seminar, our team had their hair done professionally for dinner that night. The dinner was at one of the finest restaurants in this Midwestern town. It was a true moving culinary experience. This pampering set the stage for the following morning which was our day at the spa.

I was told to arrive promptly at 11:15 am, which I did. I was greeted by a pleasant young lady behind a counter who gave me a form to fill out, a robe to carry and a pair of shower shoes. "You can go through the door at the left into the men's locker room, and then continue on to the sanctuary where you'll have time to fill out the form." I found my locker, removed my street shoes, readied into my spa robe and sat down to put on the shower shoes I had been given. Nice shoes, I thought, even had little nubs on the foot side to give a little pre-massage for my feet. On with the left, and then - - another left? No problem. I opened the velcro strap, placed the second left shoe on my right foot, and it seemed to work well enough. And, I had already decided that it was no big deal and that it was just more work than I needed to think about going back out in to the crowded salon area and try and explain my dilemma.

Through the next door into the "sanctuary" I was pleasantly surprised to see Paula and three of our team lounging in quiet, near darkness on soft leather chairs and sofas. Curved walls, green trees, and soft music supplemented by the sound of trickling water from a large fountain began to set the mood for time of relaxation. Paula looked up, "what do you think?" I told her that it seemed pretty neat, but that I had something she didn't have. "Look, two left feet." Everyone chuckled. I explained that they were still comfortable, but there was sure to be a lesson there for us all.

After drinking copious amounts of fresh water in champagne glasses, Paula and I were ushered deeper into the confines of this quiet place by our two massage therapists. They introduced themselves, confirmed that we were there for our "signature full body massages," and left the room briefly while we made ourselves comfortable on our massage tables. I removed both of my left shoes, and climbed onto the massage table. Under warmed blankets, I began to realize Paula was right that this would be the experience of a lifetime.

Our therapists returned to the room, and proceeded to provide a life-changing massage. She knew where every sore spot was, and claimed that in time she could even get my dentist's rolled shoulders to sit flat on the table. The hour passed quickly, and we were released back into the sanctuary to sip more fancy water with some other members of our team who were between spa services. "Nice shoes," one of the ladies quipped. "Thanks." They're special.

I have had few experiences in my life that were as relaxing and invigorating as my first massage treatment. I would return to this spa, because the people were very talented, attentive, and nice. We had, however, learned the day before about the importance of our team at the front desk of the dental office paying attention to detail. They are the front line in helping establish good relationships with our patients. They set the stage for the total experience that our patients remember in our office. We need to be vigilant to carefully avoid handing out two left shoes at the front counter or over the phone. We could be the greatest dental team in the world, but it won't help us one bit if we become known as the "two left shoes" smile center.

Awakening Times Three

I got hit on the side of the head last night. It started when one of my celebrity patients got hit on the side of the head. After her daughter got hit on the side of the head.

After an enjoyable dinner with friends last night, I had the pleasant opportunity to visit with one of my celebrity patients. "I just love my smile, but you don't know what happened the other day." She went on to say that her daughter saw her Murano Veneers TV commercial for the first time. In the commercial, Paris (name changed) gives heartfelt testimony that she has spent most of her life taking care of the needs of her husband and children, but having smile improvement with murano veneers is finally something she has decided to do for herself.

"Mom, did you really say that?" her daughter asked. "Why did you say that?"

Paris, in astonishment, relays to her daughter that she gave this testimonial because it was true.

At this point, Paris explained to me that she could see puzzlement in her daughter's facial expression. Paris did not need to explain any further, and within seconds her daughter realized for the first time that her mother had sacrificed much of her life for her family. An awakening!

Immediately, the second awakening occured as Paris came to terms with the fact that her daughter had no idea of the sacrifices Paris had made for the family over the years. The good news was that Paris also understood that she and her daughter were on the precipice of newfound understanding of love and appreciation for each other.

After their discussion, Paris took her daughter to the Jacobs Smile Center website and they looked at the before and after photos of her. Neither Paris or her daughter could even remember what she looked like before her transformation. It was as if they had both shut out the memory. Paris relived once again how painful it was for her to smile before she entered her new life. "People stop me everywhere. I know what they are going to ask. " "Can I see your smile?" Each time it gets easier, and more fun, and more special for Paris to have become the beautiful, confident celebrity that she is today.

Paris thanked me again, and of course it was only my pleasure. What a wonderful feeling to know that Paris's new smile has not only given her the celebrity of familiarity within her community, but more importantly (and surprisingly) the satisfaction in knowing that her family now appreciates her more for the great sacrifices she has made for them. What great love does a mother have for her children, but what great rewards when she knows they "get it."

Thanks, Mom!

Seeing is Believing

Brenda (name changed) was in to see me today, and we started fabrication of a new denture for her. She had previously been having severe facial pain, headaches, muscle aches, and was unable to get comfort even during her sleeping hours. Today Brenda is pain free, and ready to anxiously receive the smile of her dreams.

Three months ago, Brenda came into my office, and I could tell by her negative attitude and the deep anguish lines carved into her face, that she was in great pain. She explained that she had seen several doctors and two dentists trying to find a solution to her facial pain. Her doctors had tried putting her on some medication for headaches, and she got some minimal relief from that. She didn't like the way the medications made her feel, though. The dentists she saw recommended that they might be able to alleviate her pain through making her a new set of dentures, but she was not convinced that was the solution.

Understanding that the dentists she had seen were good dentists, and probably right, I immediately told her that this may be the needed solution for her. My approach to the situation was slightly different, though. I knew that she needed new dentures, and that her old dentures had worn excessively to the point that her nose and chin were closer together. Some people refer to this as "overclosure". This will occasionally cause sore jaws, ringing in the ears, and other facial pain problems. Before I would fabricate a new set of dentures for Brenda, I was sure to let her know that I couldn't guarantee that the problem would be solved, but that I would be able to let her see for herself if increasing the thickness of the dentures would make a difference.

At a subsequent appointment, I placed a temporary liner in her dentures, but did not alter her denture at all. If this wouldn't have helped, the liner could be stripped out, and she could continue with her dentures as they were. In this case, there was no risk for me or for her. Two weeks later, Brenda returned and was elated to tell me that she no longer had any facial pain. Confident that this overclosure was her ultimate problem, and after two more confirmation visits, she is well on her way to recovery.

Our paradigms can sometimes hinder us from accepting the cause of our problems. Many times we look for a complex solution to a simple problem. Allowing Brenda to see for herself that her problem was being caused by her dentures, allowed us to continue on with confidence. I didn't have to be a better or smarter dentist to treat Brenda, I just had to listen to her needs and help her find her way around the mental block that kept her from getting better.