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.
Friday, May 29, 2009
Saturday, May 9, 2009
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.
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.
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