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

In a society increasingly focused on youth and a certain standard of beauty, more and more Americans are turning to reconstructive and dental cosmetic surgery to change the way they look. A new wave of reality television shows is fueling this trend. Recently Dr. Anthony LaBruna and I spoke at the Health and Wellness Seminar at Weill Cornell Medical College about the problems this trend causes by distorting the expectations of our patients. While television has informed the public about the possibilities of aesthetic-enhancing procedures, more often than not, however, “reality” shows are anything but reality.

An article about our presentation continues here >>>