Got Cold Sensitivity?

     Cold sensitivity can really hurt! It usually happens because the gums recede and root surface is exposed. A cavity can also cause it. Make sure it's not a cavity before you take any of the advice in this post. The root of the tooth has pores that open to the nerve inside the tooth, so cold will cause the nerve to hurt.

Sensitivity Toothpaste

     Sensitivity toothpastes contain chemicals that are supposed to get to the nerve and prevent the nerve from firing. It seems like a goofy strategy but they can be somewhat effective. The effect won't last very long.

Crest Sensi-Stop Strips

     The strips contain oxalates which form crystals which block the pores. "1 strip, 10 minutes, 1 month protection." That will depend on the amount of exposure to acids that dissolve away the crystals. That includes mostly acid from plaque and also from foods- citric acid from fruit, phosphoric and carbonic from soda, acetic from pickles. They come in a 3 pack for about $35.

Fluoride

    This is my favorite solution. When the gums recede beyond the enamel, the root surface is not only susceptible to cold but also to decay. Fluoride protects against both. It will block the pores and also soak into the tooth for decay protection. 

   Crest Pro-Health and some of the Sensodyne pastes have stannous fluoride which I think is best. Boring chemistry alert! The rest of this paragraph is only for nerds. It's too boring for normal people. Stannous fluoride is better because it has substantivity- meaning it will chemically bond to teeth and gums so everything is exposed to fluoride for hours. Other forms of fluoride wash away in minutes. Crest had stannous in it in the 50's, but it caused staining. The staining would polish right off with a professional cleaning, but that didn't help sales much. Now the genius chemists at P&G have solved the problem. It's something about a ring structure that surrounds the stannous fluoride molecule, still gives the protection but prevents staining.

   The strategy is to use the Pro-Health every time you brush. At night, don't rinse after you brush, go to bed, salivary production decreases and you get several hours of fluoride exposure. Continue to use the stannous paste because acids continue to etch it out of the tooth. For severe cold sensitivity, you can rub a bit of the toothpaste on the spot several times a day. It might even sting a little, that's just the fluoride going into the pores. Keep using the toothpaste and cold things should be much more confortable.

How to have Perfect Teeth

   I love doing a checkup and telling a patient their teeth are perfect. Here are the things you need to do to hear me say that at your exam.

Clean your Teeth

   Clean your teeth every time you eat something. Brushing is best; mouthwash or even swishing water helps. Brush for a full two minutes twice a day. It's almost impossible to brush that long without a timer.  A good ultrasonic electric brush is better. It can disrupt plaque better, and it has a timer.
   The type of paste used is less important than how well you brush, but we like Crest Pro-Health the best. It has a modern version of stannous fluoride, which is better for some really boring chemical reasons.
   Mouthwash? Everybody wishes there was a magic one but there isn't.
   You need to clean in between the teeth every day- floss, water pik or toothpick. Only a small percentage American's floss. I think that one reason is because of the learning curve, if it feels awkward it's hard to keep doing it. We'd be glad to work on your technique with you. A water pik will do a great job. The technology is better now than the one your Grandma has on her bathroom counter. We love a model that's only $25 and will stow away in a drawer. European dentists recommend toothpicks, but then they have awesome European toothpicks. Fortunately they're also available here. Don't use too large of a pick for a space or it will create a space- the gums will recede.

Fluoride

   Fluoride for kids- Fluoride helps a lot when it's built into developing teeth. It's great that fluoride is in the water, but it's hard to tell how much your child is getting. Is there fluoride in bottled water? Does your fridge or other filter remove it? It's difficult to tell. Here are some things to do that help- Drink tap water. Use a little fluoridated tooth paste even for the little ones. Fluoridated water is good for adults, too. You get a little fluoride to soak into your teeth every time you drink water. Again, drink tap water.

Diet

   Sticky foods are bad, they hang around on the teeth for a longer time. Acidic foods are bad: soda, pickles, citrus fruits. Even diet soda is acidic. Sweets are bad, even juice, because the bacteria in plaque convert it to acid. It's best to brush every time you eat.

Regular Professional Cleanings

   Gingivitis (inflamed gums) is the most common disease on earth. It needs to be controlled or it progresses to worse things.You can clean plaque off your teeth at home, although a hygienist can do it better. Tartar is the hard stuff, you can't get it off yourself. Some people form lots of tartar quickly, others not so much. Twice a year isn't necessarily best for everyone. Some might need 4 cleanings a year, others only one.

Xylitol

   This is a natural substance that can inhibit the bacteria that cause damaging plaque. It's available in mints, gum, and mouthwash. The amount in regular gum is probably not enough to help much. If you're going to try this you should use it 5 times a day, "strive for five."

Dry Mouth

   Saliva is very important to rinse away stuff, also to buffer acid attack. Decay can go crazy if your mouth is often dry. Most toothpaste contains detergent, which can be drying. Biotene is one of the few pastes that contain no detergent. It also has enzymes and other things that can be low if your mouth is dry. Biotene also makes a rinse, spray, and gum. Sipping water all through the day will also help.

Crooked Teeth

   There are a lot more little places for  trouble to start if the teeth aren't lined up straight. These days there can be easier ways to straighten teeth than 3 years in braces.

Now It's Mom's Turn

Here's a scenario we see quite often- Mom is finally turning the last of her little chicks out of the nest. She has been totally sacrificing herself for the last 25 years or so; sacrificing her time, her own interests, even her body. She has been keeping up with dental checkups for everyone, all the wisdom teeth are gone. Her teeth have been sacrificed too. She has been maintaining her teeth, but now they need more. It's time to get her smile to where it looks good, feels good and will last a long time. Sometimes it needs a lot of work, sometimes it really doesn't take that much.
   We fixed Tatiana's smile 8 years ago. It was quite a commitment to get her smile to where she wanted it to be. Her youngest son was just finishing High School. When we fixed her smile she looked like a new woman. Her oldest daughter has a gorgeous smile so we used her teeth as a guide. At Tatiana's last checkup she said, "I still love my teeth! I still get a comment about my smile every week! You're the best."
   Last summer Kathryn's youngest son had just graduated from high school. Another son had just finished his mission. We fit veneers into her schedule just in time for her to travel to Amsterdam before her son's wedding. She loves her new smile; Amsterdam, not so much!
   Sondra was totally committed to her husband and nursed him through a terminal illness. It took several years. When she was able to take care of herself, she had her smile overhauled. We admire her so much. She is the most amazing woman. Now she has an amazing smile.
  God bless the Mom's. All of us are grateful for the sacrifices they have made for us. If it's Mom's turn for the woman in your life, we'd be glad to show you what the options are.
  

Wisdom Teeth War Erupts in Utah

   The oral surgeons of Utah County have their underpants in a great big bunch. At issue is a general dentist operating as "Wisdom Teeth Only." You may have seen his billboards along I-15. The oral surgeons paid for a billboard that says "Heath Hendrickson of Wisdom Teeth Only is NOT an Oral Surgeon." They have made a website called trooth.com, get it? Don't you love the photo? I believe that one of the most important things that I do is to help people get over their fears. It's one of the most rewarding things I do. I love it when I can build a more trusting relationship with those who have been traumatized, usually by schlocky dentists. Then these idiots put out this picture.

   Last Friday they actually picketed his office!! For those who may care why a bunch of highly educated "professionals" would be acting like 2nd graders, here's the explanation.

   Heath Hendrickson is a general dentist. I guess he liked doing wisdom teeth. He bought a practice from an oral surgeon in Provo that was named Wisdom Teeth Only. Apparently his niche is lower prices, he can do it for less than the specialists. He takes even the crappy insurances. He and his brother now have several offices by that name. Apparently there are so many dentists in Utah that he has put the oral surgeons in more of a pinch.
   Here's the back story. Dental school is 4 years after college. You're called a general dentist and you can do root canals, wisdom teeth, whatever you're comfortable with; hopefully only what you do well. After that you can go to school for a few more years and be a specialist- orthodontist, endodontist (root canals), pediatric dentist. Or a few to a lot more years and be an oral surgeon. Most oral surgery programs now give you an MD degree.
   The bureaucrats have had endless meetings and decided that a general dentist can say they have a practice "limited to oral surgery." You must tell patients that you are a general dentist and that they have the right to go to a specialist. You also can't use the word special or specialist or specialize.  They have also decided that a patient can sue for malpractice if the general dentist did not do what a reasonable specialist would have done.
   There are, of course, turf wars. There can be turf wars between oral surgeons and plastic surgeons. One of the big advertising "plastic surgeons" in Utah is actually a dentist who became an oral surgeon. There are turf wars between insecure plastic surgeons and dermatologists.
  I think the bottom line is not what degree you have, it's how good you are. Most of us who went to school 20 years ago could no longer describe the front door of the place. I can't and I've been back many times. I've given them lots of money. It's not what you knew 20 years ago, it's what you know now. I have nothing against other oral surgeons. I don't like doing wisdom teeth. I'm not jealous of oral surgeons. I'm glad they're around. I'm pretty impressed with the surgeons that I refer patients to.
   A degree is no guarantee. The number of letters after the name is no guarantee. There is an oral surgeon right now in the south valley who has a drug problem. The records are public at dopl.utah.gov. He lost his license in New York, but is on probation here, working every day. There is an oral surgeon in Layton who the records describe as a drug and sex addict. He is not allowed to be alone with a patient of either gender. He's not even on probation anymore. An oral surgeon in Ogden used to have patients wake up with their clothes buttoned up wrong- just like the Seinfield episode! He finally quit. I know a periodontist (gum surgeon) who did so may drugs that she started surgery on a patient after she had forgotten the anesthesia! She is still working in Salt Lake.
   The other bottom line is that patients should research anyone who is gong to treat them. Most of the bad news is on google. Things like malpractice, license probation and crimes will show up. A single bad google review is not terrible, it's realistic. Someone gave me a bad review. If there aren't any bad reviews they may be stacking the deck. Good luck choosing, and research carefully

The "Adrian X-Ray Shoe Fitter" and Musings on Radiation

The Adrian fluoroscope was a popular device in shoe stores from the 1920's to the 1960's. They were used in the UK into the '70's! About 10,000 machines were in use in the US. It was a cabinet about 4 feet tall. You would put your kids foot into an opening in the base and look into a view port in the top. There was often 3 ports- one each for the child, the parent and the salesman.  As the x-rays poured through, you could clearly see the child's toe bones wiggle inside the new shoe. The exposure time was adjustable, usually about 20 seconds.

The dangers of x-rays were known much earlier. One of Thomas Edison's glassblowers, who made the tubes, would test the tubes on his hands. He developed such a tenacious cancer that his arms were amputated and he eventually died. Edison subsequently completely abandoned x-ray research in 1903.

Apparently the shoe fluoroscopes did not result in widespread public health problems. But in a worst case scenario (trying on multiple shoes, maybe damaged shielding in an old machine) a high enough dosage to result in radiation sickness could have resulted from a single visit. Several cancers were reported- salesmen who would test machines on their hands, even a shoe model whose legs had to be amputated. This silly technology was eventually banned.

Now this month we have the stoopid study from the American Cancer Society that resulted in stooopid headlines like "dental X-rays give you brain tumors." The study has resulted in widespread accusations of junk science. It was based on sick old people trying to recall how many dental x-rays they had in childhood. Dr. Nancy Snyderman's report on NBC was especially bad. I hope the x-rays they showed in the background were hers. They were a monument to poor decision making- multiple molars with root canals and no crown, root canal on a wisdom tooth. I think the radiation is going to be the least of that patients problems.

More stoopidity- the American Dental Association has come up with this gem of a guideline in regard to radiation- "As Low as Reasonably Achievable." I can easily achieve zero exposure- don't take any! How's that! This is how I believe that you should decide how many x-rays to get- have a discussion with your dentist about the benefits and risks. Of course we should all limit the amount of radiation we receive. A  dental x-ray dose is about the amount the average US resident gets from living for 2 days. This comes from outer space, from materials in the earth and materials in our food. A coast to coast flight is 3 times higher, a hip x-ray about 65 times more, a shoe fitting fluoroscope about 85 times higher.  The benefits of dental x-rays is to find problems when they're small. Yesterday I saw the Director of one of the largest insurance programs in the state. He hasn't had an x-ray lately and a cavity progressed to the point that he needs a root canal and a crown. It will cost over $2,000. An x-ray and a small filling would have cost less than $200 and insurance would have covered over 80% of that. Not everyone should get the same amount of x-rays. It might be a good idea for someone who has recently had cavities to get x-rays more than once a year- even though insurance might not cover it. Someone who hasn't had a cavity in a long time might want to go 18 months- even though insurance would pay yearly.

The bottom line is to make smart decisions. Life is often harder for those who make stoopid ones.

If Auto Insurance was Like Dental

If auto insurance was like dental insurance-

The executives would make lots more money! My insurance, AutoOwners, pays it's CEO about $300,000. At the height of the recession, Delta Dental paid 5 execs over $3 million a year.

Your insurance would pay 100% for oil changes and wiper blades. They would only pay half if your car is wrecked , and only up to a total of $1,000/year; $500 if its a cheaper policy. They would try as hard as they can to get out of paying the $1,000- pre-existing conditions, non-duplication of benefits, waiting periods, etc.

Your benefits would not be indexed for inflation. The yearly max. was $1,000 in the 1960's, which would pay for a new Beetle. It would still be $1,000, which wouldn't even repair one bumper

Your employer would select your auto insurance company, and pay the premiums. There would not be any gecko ads, or the crazy Allstate guy.

So don't expect your dental benefits to be like insurance. It's actually an employee benefit that pays well for maintenance, but poorly for repairs, and next to nothing for overhauls.

Xylitol- Another Tool for Decay Prevention

Xylitol, pronounced zylitol, is a naturally occurring sugar substitute. It's extracted from corn husks in the US, rice straw in China, and Birch trees in Finland. Through a couple of very cool, to a dentist, mechanisms, xylitol is good for teeth and bad for plaque bacteria. If you're actually interested you can read all about it at xylitol.org. Several studies show a 60% reduction in cavities.

Who needs it? Anyone who doesn't floss or waterpik enough, has ever had a root canal, or ever had a checkup with more than one cavity. That includes children. Want to decrease the chance of your baby getting decay by 60%? One study showed that result for new moms who chewed the gum from the child's age of 6 months to 2 years. Amazing! It affects the transmission of decay causing bacteria.

So how do you get xylitol? If you're the type who reads ingredient lists you know that most sugarless chewing gum has it. The problem is that it doesn't have enough. Research shows that you need around 4 to 6 grams per day. Most gum has other sugar substitutes but only .1 grams xylitol . Gum and mints that are made for dental benefits have 1 gram of xylitol. So 4 to 6 pieces of the right gum or mints gives the recommended daily dose. Too much can give you the runs.

Where do you get it? The biggest producer is a company in Orem, surrounded by wacky multi-level nutritional companies. They claim to be the largest importer of xylitol in the US. To me that means they get it from China. Smart Sweet does not contain Chinese xylitol and is available online here. Ultradent is a Salt Lake dental company that makes a line of xylitol products- gum, mints, mouthwash. They have tested Chinese ingredients and will not use them. They are a great company run by great people. We will be stocking their products, and using them ourselves. We'll sell them at our cost which turns out to be less than the competitors. Ask for a sample at your next check up.