Word Of Mouth – A Dental Blog

As I’ve said before, as dentists we wear many different hats; we’re clinicians, biologists, artists and scientists.  As scientists and clinicians we should be basing our treatment decisions and recommendations on scientific facts and evidence, not hearsay.  That’s the basis of evidence based science.
Two articles in this past Sunday’s newspaper caught my attention.
The first article, on the front page of the href=”http://www.nytimes.com/”>New York Times, addressed the relatively new technique of robotic surgery.  The pros and cons of robotic assisted surgery vs. the old fashioned way of using human hands were evaluated.  The author, Gina Kolata, discussed the lack of scientific studies proving that robotic assisted prostate surgery resulted in better results for patients.  Only one long term study has been done that included robotic surgery, but that study didn’t really differentiate between robotic results vs. non-robotic results. 

In the absence of definitive conclusions, the author goes on to discuss the role of marketing in the patient decision making process; newer being interpreted in many instances as being better.  She also discusses how popular robotic surgery is becoming even in the absence of studies citing its clinical superiority!  And finally, she points out the pressure placed on medical institutions to provide these services because of the huge initial investment in the robotic technology.  All with no evidence that robotic surgery gives better results.

The 2nd article, also in the New York Times (Style section),  dealt with stress and tooth grinding.  Michael Winerip, the author, relates several discussions he had with various dentists and dental professionals in an effort to support his premise that these stressful economic times are causing more tooth grinding; a plausible hypothesis indeed.  But once again, show me the evidence!  Where is the science behind the conclusion that increased stress in causing increased grinding?  Indeed, Mr. Winerip states in his article that “there are no studies about grinding and its relation to the recession.”

 There is no reason to dispute that one dentist in the article made 65% more night guards in 2009 than the year before.  But just because we are living in extremely challenging economic times may not be the only reason the number of night guards made increased.  Nor is polling 3 or 4 dentists a sufficient scientific pool on which to conclude that increased stress is causing more grinding.  The entire subject of tooth wear is extremely complicated; indeed the vast majority of teeth wear occurring not during the night, but during the day.
Our goal as health care providers should be to evaluate our patients concerns, evaluate conditions that exist, and come up with treatment solutions that can address the problems based on scientific evidence, not just the solution “du jour”.  That’s what scientists do.
Just my thoughts, thanks as always, for listening.

RMS

For several years I’ve been talking to my patients about a comprehensive integrated approach to dental care that evaluates how comfortable it is to chew and how the “chewing machine” is working. This is the “comfort” part in the Health-Comfort-Beauty” triangle. How nice to see that in the JOHN HOPKINS MEDICAL LETTER “HEALTH AFTER 50”, this same topic is covered in the January 2010 issue.
“Putting Jaw Pain to Rest-Without Surgery” describes the prevalence of temporomandibular disorders in the U.S. and discusses some of the signs, symptoms, and treatment modalities available. Here are some of the more important facts from this article:
1. Up to 10 million Americans suffer from TMD (temporomandibular disorder) which can leave chronic sufferers     unable to sleep well and can interfere with normal speaking and eating.
2. TMD is associated with the complex anatomy of the temporomandibular joint which connects the upper jaw to the lower jaw.
3. Dr. Anthony Tufaro at Johns Hopkins talks about musculoskeletal problems relating to the repeated movements of jaw bones and muscles as one of the most common causes of TMD.  And while misaligned teeth can contribute to this type of pain, for some patients, bite problems have nothing to do with the TMD symptoms they are experiencing.
4. Self care for the TMD may consist of:
• Rest
• Heat
• Medication
• Behavioral counseling
• Jaw appliances (orthotic bite plates/night guards)
• Physical therapy
What is left unsaid in this article is that often times we can see the signs of muscle or bite imbalance by observing teeth that are loose, broken, or worn and /or jaw muscles that are tender to touch. A comprehensive evaluation of all the structures inside and outside the mouth is important to determine not only how healthy we are, but what are the correct steps to take to achieve and maintain a healthy bite and jaw.
Further questions? Call us in the office or drop us an e-mail.
Thanks for listening.
RMS

As I’ve said before, in a world that is changing so rapidly in terms of technology, social interaction and economics, we’re trying hard to remain ahead of the curve.  How do we change and stay in touch with our patients?  How have their dental  concerns about health, comfort and beauty changed over the last 18 tumultuous months and how does that affect the way they perceive what we do?  And how do we remain relevant in their lives?  Do they want us to remain relevant in their lives?

We’ve tried hard to ask these questions, both in the office and by surveying our patients on line.  My gut feeling has been that we need to remain supportive of what our patients are experiencing and need to be curious about the best ways to help them stay healthy and achieve their dental goals.  I’ve always believed strongly in relationship based and very personalized patient care. 

In the spring of ’09, I was interviewed by a writer for MY BUSINESS Magazine.  I spoke about my belief in patient centered care and how important it is in the world in which we now live where often the Dr-patient relationship has become depersonalized.  You can find some of my comments at http://www.mybusinessmag.com/fullstory.php3?sid=1970

Who’s listening? We are!

I came across this article in the recent edition of the AGD Impact Newsletter.
I thought some might find it interesting.

It’s a common theory that teeth need to be protected from the staining power of red wine. Wine drinkers often opt for white wine to avoid potential stains, but a recent study revealed that white wine simply may be the lesser of two evils.

Researchers discovered that white wine can also contribute to tooth discoloration. The common factor is acid, which is also present in many other beverages.

Researchers found that- no surprise- red wine left the deepest, darkest stains on teeth. However, a more interesting result revealed that the teeth soaked in white wine also showed signs of stains and were significantly more discolored than the set that endured a similar process with water.

Researchers concluded that the acids in wine, white or red, create rough spots and grooves in teeth that allow chemicals in stain- causing beverages, such as coffee, tea, or cola, to penetrate deeper into the tooth.

Acidic erosion isn’t a problem with wines. An abundance of citrus drinks, such as orange and grapefruit juice, lemonade, most sports and energy drinks, as well as sodas, also contain acids. The common threads in acid erosions and dental caries (cavities) are acid and loss of tooth structure. While organic bacterial acids lead to caries (decay), it is the extrinsic acids in foods and beverages and /or intrinsic acids from our stomachs that can lead to erosion. In both cases, early detection and prevention measures can keep an incipient problem from becoming irreversible.

RMS

Several years ago my office team and I spent some time attempting to redefine what we do and how we do it.  We had a general idea of what we felt was important to our patients and to us in terms of the care we deliver but felt we needed to better define our core values and become more focused.

 At the time there was a lot of press related to “cosmetic” dentistry and “spa” dentistry (whatever that is).  In an age of “Extreme Makeover” and almost instantaneous gratification, we chose another path.  I never wanted to be just a “cosmetic” dentist.  I felt our patients were entitled to more than just cosmetic care.  I felt comfortable based on my training and experience providing a more comprehensive kind of experience - one that was patient centered, relationship based, and that fully integrated health, comfort and beauty.

Two articles I read in the last week helped confirm that in a world that is rapidly changing my team and I are on the right track.

In New York Magazine, week of June 1, Beth Landman wrote in her article “Nipped & Tucked” about the changing reality of medical and dental practices that were only recently, cosmetically oriented.  She wrote about “lifestyle” medicine losing some of its allure as the result of changing economic times and the trials and tribulations of doctors who now have to provide more health centered treatment.  I apologize if I appear naïve here, but shouldn’t the health aspects of care have been considered all along? 

As I’ve said before, as dentists we’ve been trained to be scientists, biologists, clinicians, and artists.  But concentrating exclusively on the “cosmetic” aspects of care often times neglects the health and comfort of the patient.  Shouldn’t these clinicians have been addressing health issues all along as part of the “cosmetic work” they were doing?  Now they’re getting back to basics because the revenue stream from these cosmetic procedures has slowed to a trickle.

In the New York Times Business Section, June 7, 2009, Julie Weed wrote an article entitled “If All Doctors Had Time To Listen”.  She talks about changing models of health care delivery; new methodologies that allow physicians to spend more time with their patients, emphasize prevention, and decrease the number of referrals to specialists.   Ms. Weed  states that these “patient centered” practices are popular and growing.  That shouldn’t be a surprise.  Patients are looking to re-establish a more relationship based personalized kind of care where they feel cared about and cared for.

All in all, a good week that made my team and I feel comfortable that we are on the right track, trying to remain relevant in the lives of our patients.

As always, thanks for listening.

RMS