"Why You Should Never Get a Root Canal!!!...unless, of course you need one."

"Why You Should Never Get a Root Canal!!!"

 

    Well, except for maybe a few reasons, that I explain below.  I will later explain why my title mocks a lot of other blogs or circulating articles on social media.  A quick word of advice to those individuals:  Don't use an excessive amount of punctuation.  It's juvenile and unprofessional.  Also, the God Father of dental research, Gordon Christensen, DMD, warned me about "W.A.F."

 

Worry.

 

Anxiety.

 

Fear.

 

    Any "doomsday" or mellow-dramatic title may clue you into the fact that you may not be reading a reputable article from a reputable source.  They are aiming for shock value, more clicks, more advertising money, etc. What are reputable sources?  Shockingly enough, Wikipedia is not one.  The Mayo Clinic, the American Dental Association, the National Institute of Dental and Craniofacial Research or other peer-reviewed articles utilizing evidence based dentistry or medicine are reputable sources.  The only way we can all have professional discussions is if we all pull knowledge from fair, unbiased sources.  Googling a bunch of blogs that favor one's opinion isn't a viable debate.  If you have distrust in the aforementioned organizations, I cannot debate some of these issues.  We will be like Mars and Venus!  It is good to be skeptical and raise concerns over certain issues.  But anecdotal occurrences and random blogs do not make a talking point.  I say this respectfully, and urge you to seek second opinions if you do not agree with a first opinion. 

 

 First up, what is a root canal? 

 

    When bacteria infiltrates a tooth and it goes deep enough, it may reach the nerve or pulp.  This deep infiltration cannot just be eradicated by systemic antibiotics.  Why?  The nerves, blood vessels and fluid operate on a one way street in a tooth.  Once bacteria invade the nerve, even in very small numbers, the tooth will eventually become painful or symptomatic.  It's like a closed pressure cooker of bacteria spreading.  The only way to make the tooth pain free yet functional at that point is to remove the nerve inside the tooth, disinfect it, and seal the chamber with a rubbery, bio-friendly material called gutta percha. The term "root canal" describes the anatomical area or tunnel inside the roots of a tooth that houses the nerve.  The presence or absence of a nerve will not adversely affect the day to day functions of a tooth.  Hot and cold thermal sensations will no longer be functioning from within the tooth.  A root canal tooth can still get decay -- so brush and floss. 

 

How successful are root canals?

 

Most studies show a 95% success rate for people of average health, non-smokers, while under regular dental care.

 

1. Decay has spread so deep that you are having unbearable symptoms: throbbing, chronically dully ache, sporadic sharp pain, lingering cold pain (more than just a few seconds) or the feeling of a very "hot" tooth that only ice cold drinks will resolve. In this case, a simple filing won't suffice.  As long as there is enough of a "shell" of tooth left, it will most likely be worth saving.
2. You want to be out of pain, but choose a more conservative, less invasive procedure.  The alternative to doing a root canal is getting a tooth extracted.  This is not always such a easy, painless procedure.  Especially if the tooth is acutely abscessed and you are swollen, etc.  There is an extended period of healing for bone and soft tissue versus getting a root canal.
3. You want to preserve your jaw bone. The only reason you have alveolar bone or jaw bone is because of the presence of teeth.  If no trees were on the side of a river, the soil would wash away, right?  Unfortunately, I see some elderly patients who had lost all their teeth by age 40 or 50.  As you can imagine, there is virtually no ridge of bone left on the lower jaw.  So even the most expensive "Cadillac" of all dentures won't be comfortable.  Eating and chewing with something that moves constantly and has no retention isn't a lot of fun.  I used to work in a nursing home periodically, and it  was very sad to see frail, elderly patients lose weight due to loss of teeth and poor fitting dentures.  Just get them some implants, you say? Depending on their medical status, that may be risky.  Also, implant overdentures are excellent compared to conventional dentures, but are very expensive.  Families have to pay out of pocket for these procedures at a surgeon's and dentist's private office.  They also have to pay for transportation of immobile patients.  Finally, there just may not be enough bone height and width to even do implants on an atrophied jaw.  The World Health Organization recognizes edentualism or loss of teeth as a physical disability.  This is especially true in our elderly population.
4. You want to choose a more economical option in the long run. Replacing a tooth via a dental implant or doing a bridge and cutting into teeth that may be perfectly healthy, is always more expensive than doing a root canal. Depending on the situation:

• Root canal plus a filling: $800-$1200.  If you need a crown, that may be an additional $1,000.
• Extraction at a surgeon plus sedation: $300 - $700.  If you have lost a lot of bone: a bone graft can add additional cost, but is a necessary procedure.  Placement of an implant, sedation again by a surgeon: $1,800 - $2,000.
• The fee from a general dentist for fabricating an abutment (what the "tooth" or implant crown sits on) and a crown: $1,600 or more.
• A partial denture to replace the teeth or tooth: $1,200 - $1,500.
• Brushing, flossing, keeping up with regular check ups every six months and periodic x-rays to hopefully avoid these scenarios: priceless.

Keep in mind that maximums per year for most dental insurances are $1,000 to $1,500.  So this money gets eaten up quickly with any of the above options. The fees I quoted are a generalization.  They may vary highly depending on the region, specialist, quality of work and needs of each patient.  I'm not getting into "fee wars" but feel free to call offices with general quotes for procedures.

 

 But I will be fair and say that there are a few reasons why you may not get a root canal. 

"I may not need a root canal if..."

 

1. The tooth is not restorable.

    Sometimes there just isn't enough solid foundation to build a house.  Would you spend a lot of money building a house near a sinkhole? No.  If you have a tooth that has had many fillings or the decay has gone far below the gum line, rendering only a sliver of natural tooth remaining, it is not wise to invest heavily in a root canal and a full coverage cap or crown.  Also, sometimes an endodontist will see a rather large internal crack in a tooth.  Most endodontists use powerful microscopes which allow them to see down the tiny canals of teeth.  If a tooth is restorable, it needs to have a cap or a crown placed (usually, not always) on top of it.  Studies have shown that if the tooth is sealed properly with a full coverage cap or crown, this is the best way to ensure longevity and success of a root canal treated tooth.

 

2.  There is significant bone loss compromising the tooth.

    Remember the house we were building?  What if we had a solid foundation, but the wood being used to build the house was hollow?  Still not a great long term prognosis.  Your periodontium, or your soft tissue and alveolar bone, is something we always need to address.  You could have no cavities, but if you have periodontal disease that is untreated, the teeth become prematurely mobile and eventually are lost because of lack of support. 

 

3.  You have rampant, uncontrolled decay.

    Now, let's build our house.  It's a wonderful, beautiful functional house.  However, all of the other houses in the neighborhood are foreclosed and vandalized.  So our property value is decreased exponentially.  In some patients who have gone through chemo and radiation treatments, or engaged in methamphetamine abuse, etc., we find extensive "wrap around" decay on nearly every tooth.  Every clinician must work with each patient individually to weigh whether or not one should invest money into saving certain teeth.  If the patient has been in and out of the hospital or has a nomadic lifestyle, they may not necessarily commit to long term follow through care.  So doing a more definitive treatment like an extraction or a denture, is wise.  This leads me to  the last point...

 

4.  You cannot or you have no intention of engaging in routine, preventive dental care.

    I can't tell you how many times I have seen patients who presented to our office with the chief complaint of "my root canal went bad."  Surely, there are times where the quality of work on a root canal can vary and can contribute to a root canal failing prematurely.  But this very rarely occurs.  As a side note, most root canals treatments at our office are referred out to endodontic specialists.  I do smaller anterior teeth and lower premolars.  I firmly believe that if you are a restorative dentist, you ought to spend most of your time doing restorative dentistry.  Of course this philosophy of care may differ if I were in a very desolate area and no other dental care providers could be found for hundreds of miles.

 

    Usually with the root canals that have "gone bad," there is untreated decay that grew and grew over months or years.  This decay spread to the root and caused an abscess or a fractured, non-restorable tooth.  Or sometimes the patient may still have a temporary filling with sterile cotton in the tooth.  We recommend getting a permanent filling in those root canal treated teeth within several weeks after the procedure.  A temporary filling is just that -- temporary.  So after months or years, I'm not shocked to see that it has worn down, or completely worn away.  Then you have a compromised tooth, unprotected, collecting food and debris, causing decay from within an already root canal treated tooth.  This is almost always a bad scenario for patients.  They either have to spend the money to have a re-treated root canal, or spend money for an extraction an implant replacement. 

 

    I'd be remiss without mentioning the importance of preventive and proactive careversus reactive care.  Except for trauma or severe cracks, root canals are not pure "destiny" for everyone.  At one time, an infected tooth was a tooth with a small, manageable cavity.  A relatively easy procedure would have been detected if routine dental care and exams had been done every six months.  A routine filling may be $200 - $400.  Now, a root canal and a crown may be about $2,000 and entail several longer appointments. Like any branch of medicine -- proactive care and preventive care is preferred over reactive care.

 

    And a final segment on what spun me into writing this article. 

 

    A few weeks ago, you may have spotted an article circulating.  The article was written by a Dr. Mercola.  He is a physician of osteopathy.  He is not a dentist.  I will save you the thirty minutes or so that I sacrificed to read it by summing it up.  He says that 97% of terminally ill patients have had root canals.  So by inference, we should believe that all root canals cause terminal illness, or at the very least, are bad.

 

    Please DO NOT google this guy or give him any more hits on the article.  I will re-capitulate a few things about who he is and why his main points are baseless and a bit reckless.

 

•    Dr. Mercola is an alternative medicine proponent.  He is a doctor of osteopathy, not a dentist or endodontist.
•    His main business venture seems to be the "Dr. Mercola Natural Health Center" in Illinois.
•    He was featured on Quackwatch.com due to FDA warnings (2005, 2006, 2011) for "unsubstantiated claims that clash with those of leading medical and public health organizations..."  Specifically, he suggested nutritional supplements could cure or treat cancer.

    So who is this modern day Henry David Thoreau?  A real cowboy of civil disobedience at its best?  Or self serving financial gain?  It's your call.  I'm not into name calling.

 

    One thing is for sure.  He has created quite a following by questioning established norms in medicine.  He's also created wealth and fame along the way. 

 

A few of the extreme claims from his article are listed below.  I may paraphrase, but I'm saving you from trudging through all the minutia:

 

    "Root canal teeth become one of the worst sources of chronic bacterial toxicity in your body."

 

    A root canal treatment debrides the infiltration of bacteria into the vital pulp.  It's a physical removal of the organic tissue within a tooth.  By removing the affected tissue, the bacteria have no "food" and are thus, obliterated.  A diluted solution of bleach is used to eradicate any remaining tissue and bacteria.  An aseptic, biological compatible, material called gutta percha is used to fill the canals, along with an aseptic sealer.  If words like "all natural" or "organic" get you excited, then this material is a party starter.  It's derived from the sap of a tree which produces a rigid, natural latex.

 

    Another newsflash: our bodies normally harbor tons of bacteria.  Most, kept in a delicate equilibrium, are favorable and necessary.  Your gut, colon, and mouth are homes to many bacteria.  They are necessary to the homeostasis of your metabolism and body.  So, my question is: what specific strain of bacteria is exacerbated by a root canal?  If said bacteria is proven to be present in significantly higher amounts in someone's jaw bones, has this bacteria infiltrated other tissues?  How can you accurately test this in vivo?  And what are the specific diseases or conditions that may arise from these chronic bacteria?  Until any of those questions are answered by a double blind placebo non-biased and reputable study, I'm kind of a skeptic.

 

    "93% of women with breast cancer have had root canals."

 

        Wow. Okay, that's a staggering statistic.  However, which study is he referring to? How many women were surveyed or studied? 10? 100?  With a disease that affects so many thousands of women each year, 1,000 or 10,000 aren't enough subjects to draw a general consensus. 

     If a cancer patient has had chemo and radiation, their salivary glands have been obliterated. That means they have no saliva, and no protection against buffering acids. The result? Decay spreading quickly and necessitating a root canal.

 

    If this were such a pervasive and daunting statistic, why have we not seen it studied by the many independently operated non-profit breast cancer research foundations?  These organizations certainly have no motive to sabotage or cover up true concerns like this. 

 

    Additionally, according to the National Cancer Institute, the average age of a woman with breast cancer is 61.  So the average woman with breast cancer is a baby boomer.  One thing that I can tell you anecdotally is that there are many, many baby boomer patients with root canals.  The older one gets, the more likely he or she is to have had a root canal.  What if I said an arbitrary statistic (even if it were proven by a reputable study) like:

 

    "50% of people with a hip replacement have deep fillings."  Therefore, by Mercola's logic, hip replacements must cause teeth to really decay at a fast rate.  No. 

 

    You cannot arbitrarily draw unrelated correlations like this.  I call it "selective statistic editing."  Making the foot fit the shoe instead of the other way around.

 

    "Leaving a dead body part in your body is not a good idea."

 

    We finally agree!  Except that, well, a tooth that has a root canal is not quite "dead."  We don't need to argue about the moral status of the dental pulp here.  However, without the pulp or nerve tissue in a tooth, it becomes more brittle, less hydrated, and lacks sensory ability to hot or cold.  It still "feels' and functions like a real tooth.  True, it is clinically "non-vital." 

     It is actually held in place by a ton of vital, connective tissue and ligaments while in the jaw bone - which are all vital.  Your hair is non-vital protein.  So, my wonderful locks should be plucked out of my head because they are a "dead body part?"  Sinead O'Connor must be INCREDIBLY healthy and progressive in her thinking then.

 

    On a serious note.  Mercola compares the "dead" tooth to leaving a non-vital fetus in the womb forever.  This is so offensive and wrong on so many levels.  I respect teeth - they are my livelihood.  But to compare a complex, ethical, and palliative dental treatment to a lost child in pregnancy, is no comparison at all.  For women who have gone through that sort of awful experience, the mere comparison takes advantage of deep seeded emotions.

 

    I really do believe that Dr. Mercola believes these accusatory statements.  I also believe that he realizes that he has found a cash cow in the industry of dietary supplements.  He is afforded the "luxury" of flying under the radar of the FDA.  But thankfully, he has been appropriately reprimanded for making claims that are a bit too egregious.  I respectfully disagree with him and wish that he would speak with respected and qualified endodontists before spreading more W.A.F.

 

"Rather than love, than money, than fame, give me truth."

Henry David Thoreau

 

 

 

 

 

Jacquline R. Owens, DMD, MBE

Why I "Pool" Teeth Like a Dentist and Drill Like a Swimmer

Next up: 10 Reasons why I Pool Teeth Like a Dentist...and Drill Like a Swimmer

 

No, I didn't misspell this subject line.  This is a tongue and cheek look at life as a competitive swimmer and a career as a dentist.  If you are a high school swimmer in the state of Pennsylvania, this weekend was a BIG weekend.  It's District Championships.  The last step before State Championships.  My nephew, Ryan Owens, is an extremely accomplished freestyler - much better than I ever was! He won the 100 freestyle and placed a close second for the 200.   He's a great competitor and I wish him the best at states.

 

So let me convince you that this is an interesting topic...

 

1. "Eyewear is critical...and personal."

If you were a swimmer in the 90's and early 2000's like I was, two types of swimmers existed: those who wore Swedish goggles and those who did not.  I would watch the Olympics and idolize those, chic, aerodynamic lenses suctioned around the eyeballs of those athletes.  Maybe it was because anything "Swedish" must be sexy and stylish yet effortless and victorious. These so-called "Swedish goggle wearers" probably sipped organic hipster energy shakes between sets, driving their eclectically decked out SAAB's home from practice, listening to 90's alternative rock.  So progressive, I know.  Maybe they drove a convertible, and the wind recklessly yet artistically disheveled their hair. (Oh, those were the days!) 

 

That wasn't me. 

 

I wore the utilitarian, yet comfortably reliable large-rimmed goggles.  I wear contacts.  Come on, right?  I'd like to hold onto my eyeballs, thank you.  Honestly though, I probably never learned how to correctly wear the Swedes.  But in 14 years of competitive swimming and open water triathlons, I have yet to have these work horses fail.  And on the way home from practice, I rolled through town in a '92 Cavalier.  A four door, mind you.  Anyway, every swimmer has a back up set of goggles, and will profess his or he faith on their philosophy of style and speed.

 

In dentistry, I personally would be hesitant to see a dentist who didn't wear magnification loupes or at least protective eyewear. You can't see what you can 't see.  

Loupes are glasses with high index magnification lenses custom fit and sized according to your hand to eye distance and eye structure.  Because my eyes are close set, I could not wear the incredibly stealth, "Swedish" sporty lenses.  Again, I found myself clinging to the utilitarian yet work horse model of eyewear.  I'm waiting for the Aviator lenses, by the way.  According to In Style magazine, my oval face shape would be best complimented by those lenses.  Priorities.

 

I started using loupes in dental school, but never really appreciated them until private practice. Working on a mannequin in pre-clinic didn't really force me to face the fact that I will need to work around the tongue, saliva, chin tilt, limited range of opening, etc.  Once the mannequins left my life and real, live humans were seated in my chair, I realized that loupes were incredibly vital to keeping my posture (most of the time) and seeing SO much more.  Of equal importance is my light mounted on the loupes.  Imagine going spelunking with no light.  The mouth is a cave and I need some sunshine.

 

2.  "My hair is a mess at the end of the day."

 

Swim caps, pony tails, chlorine, plus highlighted hair = disaster.  This is pretty self explanatory.  After a long workout, I needed about a half bottle of conditioner just to separate my hair so it wasn't a stiff, log on my head.  Then brushing out long hair after my shoulders had been on fire for two hours? It was like my second workout.  Oh, and cap lines on the forehead? Yes, but if you were lucky, they would dissipate after a few hours.  Otherwise, non-swimmers may have just assumed that you like to wear rubber bands on your head like a hipster headband of sorts.

 

Although you see I took time to have professional "glamour" head shots done, I resort to the utilitarian ponytail for my day to day spelunking.  Wearing a light and loupes on my head tend to give the oh-so-desirable fuzzy-wuzzy look by the end of the day.  Besides being OSHA compliant, I just don't think people want your long hair grazing their incisors - no matter how much your locks resemble Heidi Klum or Beyoncé. 

 

3.  "Even though we are on the same team, you're all individually accountable."

I love this one.  A real pearl for your life.  Simply stated yet oh so complex.  Swimming is surely a team sport.  How you perform and rank against others is surely black and white, objective, and unforgiving at times.  The smallest increment in time can be all the difference.  Yet, you are part of a team at the end of the day.  Every swim meet has many individual winners but only one team wins.  You may have gotten first place in every event, but lose as a team because of lack of depth. By having your own race, you have the opportunity to win for yourself, but also for the team.   Creating and fostering discipline in this grueling mental and physical sport, can pay dividends in your academic and professional life.  Swimming attracts certain personality types, that's true, but it also formulates the building blocks for those personalities.  I attribute a lot of my drive in life to this sport.

 

Our staff is our "team" at the office.  With our software and charting, we know who saw the patient, who spoke to them on the phone and when they were spoken to.  We know who did what procedure and are made aware of any special extenuating circumstances.  When we review online comments and rankings, we all think of how we do things great as individuals but also how we can certainly improve as individuals within the context of a team.  Each team member has specific tasks, and the checks and balances ensure those tasks are carried out.  Whether we "win" or "lose," we all learn from each other's actions.

 

4.  "You live by the clock."

Obviously for swimming, this is a clear and present nugget of wisdom.  The clock is our un-biased judge at the end of the day.  It holds no prejudicial thoughts or considerations.  You may have practiced really hard all week, but if your Swedish goggles fill up with water when you dive in, the clock makes no exceptions.  When you are moving through your main set, and you are on the verge of vomiting, but the clock says you only have 3 seconds to rest and take off again, it's not copping an attitude.  The clock is just ticking away.  It's neither representing you nor ridiculing you.  It's Switzerland in a world war.  But it's always consistent and it never stops.  It's your friend some days, an enemy the next.  

 

A vital component to private practice is time management.  Our schedule is done in ten minute blocks.  We try to best estimate the time for a procedure based on complexity, special needs and volume of work.  Usually we are on time.  Sometimes we are not.  After waiting 30-60 minutes at other physician's offices, I can tell you that dental professionals are one of the few branches of healthcare that adhere to a schedule despite being under the gun to do invasive procedures, rather than just paperwork and talking.  We don't want to make patients run late, and I know they try not to run late themselves!  I aim for a calm, inviting environment where I can take my time, yet work efficiently to yield a good service.  If this means that we run a few minutes late, yet catch up in time for the next appointments, then all is well.  We have patients who have demanding careers and obligations, so we do our best to get them out in a timely manner, without making them feel like they are going through a "factory." 

 

5.  "You inhale your fair share of chemicals."

Everyone can smell a swimmer when he or she walks into the room. A wafting aroma of chlorine, bleach or another chemical cocktail of the day.  It's used in sanitation of waste water and drinking water, household detergents, etc.  We learned to live as co-habitants with this hostile warrior in the water.  It absorbed into our skin and our hair.  Yes- what a mess it created for long hair!  

In locker rooms, bleach was the detergent of choice.  Not sure if that was so smart since ventilation leaves much to be desired in most locker rooms.  When our college team went to the Dominican Republic, we noticed barrels of boric acid on the sides of the pool.  Maybe they were just hosting Bill Nye, the Science guy for the weekend.  In any event, if you are a pioneer of shedding toxins in our industrial nation, this may not be an ideal sport for you.

 

Perhaps the same can be said of dentistry.  Although we wear masks that are specified by OSHA, we still inhale our fair share of the chemical perfume counter.  We utilize sodium hypochlorite (yes, it's commonly known as "bleach" -  albeit a very diluted mix) to disinfect root canals and nerve exposures.  The tooth is copiously irrigated with water after disinfection.  

The classic smell of a dental office, classically comes from eugenol. It has a spicy, clove-like aroma.  It's combined with zince oxide to yield a useful temporary or sedative filling in compromised teeth.  If you enjoy a sweetness of sorts, we have Nitrous Oxide ("laughing gas") which some use to diminish their level of anxiety.  All in all, we are like the perfume counter at Macy's but not as glamorous.  

 

 

6.  "Latex is a savior."

And it ought to be.  We need those latex caps to allow our aerodynamic shape cut through the water. Any defect in technique when it comes to water yields far bigger problems versus running or cycling in a poor technique.  Water is much thicker than air, and much more difficult to navigate.  We mimic fish via our NASA-tested $350 body suits, and our $3.00 latex caps.  The alternative is silicone.  The cap is much thicker and longer lasting.  Again, if you are an organic, non-GMO kind of a person, avoid the silicone I presume. 

 

We have phased out latex gloves in many offices due to allergies.  However, the close fit of latex gloves and thinness of them is hard to rival.  Our vinyl and nitrile gloves come close.  But I'd rather avoid an anaphylactic reaction for a patient and deal with gloves that are a bit thicker.  No contest there.

 

7.  "Water. My frenemy."

If it weren't for water, there would be no swimming.  And probably no life form at all, so water wins out here.  Whether you are learning why streamlining is so important or how to do a turn off a wall, or why a "faster pool" is a deeper pool, water is a quiet and mysterious yet powerful friend that you learn to understand.  Part of that is because of the density of water.  Water isn't just "big boned," it is "thick boned."  The most disastrous natural disasters are due to water.  Wind and fire can eventually be dealt with, but water is so powerful.

 

 Water is kind of high maintenance, too.  It can absorb a lot of heat.  But it is also becomes more dense, the cooler it is.  So, it would make sense to compete in hot pools, right? Wrong. As a swimmer, an ideal temperature for competing and working out is about 80-82 degrees Fahrenheit.  That's warm enough.  Recreationally, most of us would want it warmer.  In high school, there usually was a silent war between the swim team and the aqua-cise groups.  They'd make it a hot tub if they could!  But increasing your body heat and basal metabolic rate, results in an excess of body heat from inertia.  We need a sponge that is cool enough to buffer this heat out-put, you know?

 

Water. Such a finicky friend.

 

In dentistry, I have a love hate relationship with it.  I need it to disperse and remove debris or contaminants.  But it can cloud my vision if it's on my mirror and can be a contaminant itself if not kept away from cement and resin bonding.  But saliva is a sort of water, too.  We need saliva to buffer the constant acid attacks that our teeth face each day.  But we don't need saliva to mess with precise crown impressions or resin fillings.  All in all, we both need each other to survive.

 

8.  "Different strokes for different folks."

 

Since I am rather short, I was better suited for a short axis stroke like butterfly.  Obviously, swimmers "find their stroke" after some time. The same sort of idea can be applied in dentistry.  Dentistry is a high anxiety-ridden field of fear for some.  Therefore, it is important to identify those patients before starting out.  Some of them have an innate physically ill reaction to treatment due to fear or past experiences.  Some just get a little uneasy about treatment, but do better with reassurance and encouragement.  Determining what anti-anxiety strategies to employ is determined by the personality type of each patient. 

 

Different strokes for different folks.

 

9.  "Practice doesn't make perfect."

 

Perfect practice may make perfect.  But I don't believe anyone is ever really perfect.  Even if your stroke is technically perfect (very difficult to do), there are so many other variables to improve upon.  Strength. Endurance. Breathing patterns.  Starts and turns.  Mental toughness and performance psychology.  On and on.  Even Olympic Gold Medalists can look back at their races on video and find imperfections.  Complacency can be one's biggest road block to growth.

 

A venerable one once told me: "They call it dental 'practice' not dental 'perfect' for a reason."  I understand why.  Even the most respected and technically sound dentists are constantly working to improve the patient experience and their product.  Our office does at least one continuing education each month.  So many dentists "fly under the radar" and don't stay abreast of changes in the profession.  If you aren't careful, years go by and suddenly find yourself miles behind other practices. For today's savvy consumer, one is made aware of this eventually and may jump ship.  Dentistry changes day to day, and a lack of adaptation to this reflects a feeling of complacency and apathy.  That never leads to perfection.

 

 

10. "Your loved ones are your biggest fans."

 

Period!  If you need this one explained, just email me.

Jacquline R. Owens, DMD, MBE

Teeth Whitening and Bleaching...Not So Black and White!

If you live in the Northeast as I do, you have had your fair share of snow lately.  I LOVE snow...maybe not this much, but why complain? Mother nature's wrath is certainly out of our control. Who doesn't want teeth that are as white as snow?! Well, me, for one.  The natural hue of enamel is a mix of yellow, gray, blue and even red. Like skin tone, artificially going too far can look unattractive and unnatural.  Over whitening can also damage your teeth.  We all remember the mother who was arrested for allegedly allowing her toddler into a tanning booth? Or how about plastic surgery obsessed celebrities who end up looking like bizarre duck-like aliens?

 

White hot...but a bit overdone.
www.nbcnews.com

 

 Having said that, whitening, when done correctly, can look fabulous.  After all, your smile is one of the first things people notice when meeting you.

 

Hands down, the two most talked about topics from people I meet are 1.) whitening and 2.) Invisalign. (We'll save Invisalign for a later post...)

 

First off, notice that "whitening" and "bleaching" mean two different things in the tooth world. It's a bit confusing for the average patient, I understand.

 

Whitening Agents:

These products only affect stains embedded in the enamel or superficial pellicle of a tooth. They DO NOT alter the base color a tooth.

 

Bleaching Agents:

These products not only dissolve surface stains, but they also penetrate the tooth, affecting the base color via powerful oxidizers like carbamide peroxide and hydrogen peroxide. 

 

Imagine that your teeth have pores like your skin.  After a facial, the debris and bacteria in the pores are eradicated. The result is smooth, bright, and healthy skin.  Temporarily, the oils in your skin have been eliminated.  This may be a bad thing .  But your skin will re-generate the natural oil layer throughout the course of the day.  The same goes for teeth.  The pellicle is your jelly-like microscopic layer that protects teeth from acid attacks.  It replenishes itself after being removed by brushing or whitening.

 

 Extrinsic stains occur on the surface of teeth, usually from heavy staining food and plaque.  These stains can easily be removed by over the counter products and a professional cleaning. Intrinsic stains are tougher - you may need a special internal bleach treatment if it is a root canal tooth. If your staining is from exposure to antibiotics at a young age, often, this requires rigorous bleaching, or most often, a crown or veneer.

 

**People should know that we do not actually use bleach, otherwise known as sodium hypochlorite, in the whitening products. We use it in root canal disinfection, albeit, at a very diluted concentration and with proper isolation. 

 

Let's play Jeopardy in reverse:

www.buzznet.com

 

 

1. "How does bleaching actually work?"

The two  main active ingredients are hydrogen peroxide (HP) and carbamide peroxide (CP). HP is three times stronger than CP.  So be wary of comparing outright percentages with professional products and over the counter products.

 

For example, in testing, Crest White Strips are 6% HP.  But I'm not so sure I would call it a true bleaching agent.  They tend to get most of their whitening effects from disruption of the enamel pellicle -- all that "stuff" layered on your enamel.  We don't want to go eradicating the pellicle though. It protects teeth from daily exposures to acid.  So all of this acidic action by the strips makes your mouth more acidic, and all of that acid slowly wears down enamel - which can't be replaced! Eventually, the enamel can weaken or cavitate.  This is the birth of a cavity.

 

Bleaching causes a short term weakening of the enamel, unless you use a professional product that has supplemental ingredients that actually strengthen the enamel while oxidizing. One such product is the professional Opalescence gel.  We use this product as our "go to" take home gel at the office.

 So all in all, the strips aren't bad.  In fact, they may be the most convenient way to whiten at home.  They certainly are not as effective as professional products, but they are safe for at home use of a non-dental professional when used as instructed. 

 

A lot of times I see patients with an old silver filling (amalgam) that can cause the entire tooth to be gray in appearance.  I mean, imagine the appearance of skin around an old tattoo? The ink bleeds and becomes embedded in adjacent pores, etc.  The only way to really alleviate the discoloration is to do a crown.  If the amalgam filling is only several years old, like my husband's was, we can replace it with a white filling and the tooth looks white again.

 

2. "How often should I bleach?"

It depends.  I know. NOT the answer you wanted, right? It's recommended that after a 14 day cycle of Crest White Strips, you take a two month break.  The company that produces Opalescence won't give me a recommendation for duration of treatment for their products.  Generally speaking, after patients reach their goal, we have them back off for several months until their recall exam.

 

Your diet, exposure to tobacco and hygiene all affect how often you bleach as well.

 

If you do ZOOM in office, we send you home with custom trays and six at home gel applications.  I have only ever had one patient go home and decide to whiten right after ZOOM.  Once you do ZOOM, you really shouldn't repeat the treatment for at least several years, based on my experiences.  You may "touch up" with your at home gel and trays in the months following ZOOM.

 

3. "I haven't been to the dentist for a few years.  I may or may not have cavities, and my gums bleed.  But I'm just going to whiten anyway."

OK.  Sounds good. you can also get in your car and drive blind folded.  Imagine having an open wound on the surface of your skin, but insisting on tanning or waxing first.  Sometimes beauty is pain, right? NO!  If you have untreated decay, active gum disease (gingivitis), or an abscess, these powerful oxidizers will painfully remind you why you should have gone to the dentist first.  They could also inflame the nerve of a tooth causing a root canal down the road.  Additionally, how can you fully whiten teeth that are bathed in calculus or plaque? At least the bacteria will look glamorously Hollywood white...

 

**As a side note, I saw an advertisement for whitening at a tanning salon.  As a general rule of thumb, I don't allow anyone who doesn't possess a license of some sort the ability to apply hydrogen peroxide to my body - namely, my teeth and hair. But "it's your funeral" as Dwight from The Office always used to say.

 

www.fanpop.com

 

4. "Dentists just want to monopolize the whitening market, and that's why they push more expensive professional products."

I do a fair amount of whitening consults and ZOOM treatments at the office, but it is actually a very low production procedure if you consider chair time (an hour and a half) and purchasing the kits from Phillips Sonicare.  We sell pre-formed whitening trays from Opalescence called Tres White, which rivals the Crest white Strips.  In my opinion, they are better because of fitting more intimately to the teeth versus the strips. I don't have a problem with Crest White Strips - I have used some myself actually. And if Shakira endorses your product, then I'm SOLD.  But if you want the in between spaces and around the gum line whitened well enough, then a custom tray and a stronger bleaching agent is the way to go.  If you have gray or blue hues in your teeth, you will need a more aggressive treatment like ZOOM.

 

If you don't feel like sitting at home, whitening your teeth for 6 hours a night for a week or so, ZOOM is the way to go.

 

If you don't want to spend hundreds of dollars trying out all the other products, just do ZOOM.

 

Finally, when is the last time you thought to yourself, "Hey I am SO happy I bought that one-size-fits-all article of clothing or pair of shoes?" Never. These trays are pre-formed for the "average sized mouth."  One-size-fits-all really means no-size-fits-any.  If you have a small mouth like I do, invest in custom bleach trays.

 

My sales rep for ZOOM stated that you can get the results you want with at home products just as well as if you did a ZOOM treatment.  Research supports this, as well.  So you will cross the finish line using either product, but the length of treatment will differ.  For example, my husband and I did ZOOM before our wedding in January 2012.  I haven't whitened since.  I love black coffee and dark chocolate - which I have almost everyday.  It was aggressive, and I had definite post-operative tooth sensitivity.  This is the most common (and most annoying) side effect. Every patient I have treated in the office has been 100% asymptomatic after 24 hours (approximately 20 cases).  I used the UV light treatment in 2012, but our office has since purchased the LED light, which is safer and less aggressive, yielding equal results in my opinion. It also allows me to customize the intensity for each patient. 

 

Why use the light? It has been shown, through research, to accelerate the process of bleaching.  There are several other "knock-off" brands that you can utilize for accelerated in-office whitening.  ZOOM is the number one patient requested in-office whitening for a reason.  It works!

 

As a caveat:

I take issue with the whitening kiosks at malls or tanning beds, though.  These companies get around the law by having you apply the whitening material yourself. The laws on whitening vary state by state, similarly to Botox and dermal filler procedures. Would you go to a salon and paint hydrogen peroxide on your hair yourself... hoping for the best? These places may not adhere to the strict guidelines of the CDC, and you may suffer a soft tissue burn or irreversible damage to teeth. The employees aren't subject to any rigorous testing and licensing by the state. I worry about the level of safety and precaution given to these patients.  Anyone can hide behind a 30,000 word "signed consent," but really, come on?  Just like anything, you can overdo it.  Too much whitening damages teeth. But how can one's safety be properly assessed without a proper and complete dental exam?

 

It's unethical to, according to the ADA, whiten a patient who has active or untreated gum disease or cavities.  How would a teenager working a part time job at the mall on the weekend supposed to know this? What if you are pregnant, lactating, take photosensitive drugs or have other medical issues?

 

If this sounds like I still want to simply monopolize the whitening market, then you got me.

 

5. "I have sensitive teeth. Can I still whiten?"

Sure. So do I, but I used a professional grade anti-sensitivity tooth paste before doing so and it really helped.  An important de-sensitizer is potassium nitrate.  It's found in Sensodyne and other anti-sensitivity products but in weaker concentrations versus the prescription kind.  You may have other issues like abfraction lesions (notched out roots) or cracked teeth that will need to be selectively isolated during ZOOM.  Again, not something that I want a non-professional trying to do. If you have extensive sensitivity problems, ZOOM should be avoided.   I'd recommend a product like Opalescence take home gel - which has some de-sensitizers built into it. If you try out the weakest percentage and you still can't stand it, then STOP. You shouldn't go through enormous pain to whiten.  Look at other options after discussing your concerns with your dentist.

 

6. "How much does it cost? Does insurance cover it?"

Unfortunately, dental "insurance" does not cover this cosmetic, elective procedure. It's similar to wondering why health insurance doesn't cover elective Botox or dermal filler procedures.  It would be FABULOUS, but hard to justify why it's of equal importance to other active disease processes.  (We will discuss why dental insurance really isn't insurance on another post.)

 

You get what you pay for.  The most aggressive and effective whitening treatment we offer is ZOOM.  The HP content is 25% to 38%. It's by no mistake that it's the most expensive.  But it works.  Depending on the case, it will run you several hundred dollars.  You also get 6 at home treatments and custom trays with ZOOM.

 

The next step down is the at home Opalescence gel with custom trays.  We offer 10%, 15% and 35% CP formulations.  This will run about $150 less than the ZOOM treatment.  Great results as well.  You just need to be compliant.  The next product is TresWhite.  You get 10 pre-loaded, pre-formed trays.  You only have to wear them for 15-30 minutes a day.  We offer 15% HP strength.

 

7. "How many shades whiter will I get?"

Good question. Most dental professionals utilize the Vita Classic Shade guide to record crown shades and whitening shades. I'm not sure which shade guide the evaluators use for Crest White Strips, but to "guarantee" so many shades lighter, is tough.  Depending on the shade scale, you could claim that the whitening spans far more than what I would claim based upon the Vita scale.  There are A,B,C and D ranges for tooth shade.  We even utilize Bleach shades for those people who go "off the scale."

 

If you are a A or B range before whitening, you will lighten up very nicely.  These are the people with yellowing from extrinsic staining.  The only exception would be those who have lost enamel due to erosion or abrasion.  If you have lost enamel, you have lost the ability to whiten effectively.

 

If you are a C or D range, you will not whiten easily. These people have deeper gray or even dark red undertones. It would be reasonable to expect to get to a C1 if you start out as a C3, for example.  Some patients actually jump up to a bleach shade.  If this is you, you really need to try ZOOM or a rigorous whitening program, minus any extreme sensitivity issues.

 

I'd be remiss without mentioning dark staining food and tobacco products.  The more you use these items, the more you will have to update your whitening. Avoid them while you are whitening.  It's like clogging up your pores with sweat and oil right after a facial. The teeth become very "porous" after whitening, so don't clog them up with stains and impurities right away!

 

So let it snow, let it snow.  Go ahead and whiten and lighten. Just be careful with whatever product you use to brighten.

 

Jacquline R. Owens, DMD, MBE

Welcome to the Tooth Truth!

Hello and welcome to my inaugural blog! As a general dentist and a mom, I have wanted to start a blog for a long time, and now I feel that I have a small window of perspective to do so. You may notice that this is an extremely BORING blog page.  This is intentional.  Content is king - no fancy videos or distracting (and annoying) pop ups. I'm a simple person - I will try to heed my own advice of KISS - "Keep It Simple Stupid."

 I want this to be a non-biased opinion page from a dental professional with no corporate ties or high paid lobbyists breathing down my back. You deserve that.  You all work hard for your money and want to know what's what when it comes to your mouth.  I am also not going to preach from high atop a tower of academia with studies that feel irrelevant to the bread and butter of dentistry today.

However SPECTACULAR you may think my blogs are, they are by no means a substitute for routine preventive care and a clinical evaluation by your dentist.  So please don't pit me against your existing dentist - we all have our own philosophy of care.  Based on my background and studies in biomedical ethics, I feel a passion and obligation to try and bridge the gap between you, the consumer, and your dentist. I want you to laugh, learn, and ask...and vent your frustrations if you'd like!

 First off, who am I?

I grew up in York, PA where DENTSPLY is headquartered.  For those of you who don't know, it's the international leader in professional dental materials and supplies, in my opinion.  As a side note, my sister is an account representative for DENTSPLY, Jasmine Tome.  I have no financial disclosure relationships with this company - although I wish I did since they are such a HUGE corporation.

I attended Albright College in Reading, PA where I met my husband, Mike.  We both swam for the swim team and quickly became best friends and yada, yada, yada. (Seinfeld reference...one of many to come) In my second year of college, I became interested in medicine and dentistry. I majored in Spanish and Biology. Yes, I can speak basic Spanish but I'm fortunate to have assistants who are native speakers!

After having multiple internships at York, Reading Hospitals St. Vincent's Hospital in Manhattan, I began to steer clear of medicine for reasons I won't elaborate on right now (maybe later). I am fortunate to have several health professionals in my family who elaborated on the direction of medicine in this country, and I really didn't want to completely sacrifice my personal life and well being to become an employee of a large corporation. I was accepted to several medical schools, but after some twists and turns in my life, I decided to serve others in a more specific way. 

After graduating from college in 2005, I accepted an internship at the National Institutes of Health where I performed laboratory research with international physicians in the area of Stem Cell Transplants.  It was here that I decided to apply to dental school after working in the NIH Dental Clinic, which treated high risk individuals.  I got accepted to the University of Pennsylvania School of Dental Medicine in 2006.

While in dental school, I really wanted a break from linear, didactic thinking so I applied got accepted into the Master of Bioethics program, offered through the medical school.  It was a great opportunity to meet professionals and students from law, medicine, research and social policy. I studied vaccine ethics, sociology of medicine and female reproductive technologies among other things.

In 2010, I completed a one year residency at the Lehigh Valley Health Network, Muhlenberg site.  I loved it.  I learned more clinically in one month of training than I did in three months of school.  But to be fair, we had didactic classes much more in school and limited clinical time. After asking employees and assistants which dental office they go to, they steered me to Bethlehem Smiles.  I scheduled an appointment and was asked to join by  Dr. Carlis and Parsons later that year.  The office is great, the staff is wonderful and we pride ourselves on practicing the right way, not necessarily the easiest way.

Additionally, I am a member of the ADA.  Another topic for a post in the future... 

I am on staff with Lehigh Valley Health Network as an attending dentist and a contracted employee for the pediatric program, Miles of Smiles.  Miles is an outreach mobile unit that you may learn more about here:

http://www.lvhn.org/facilities_directions/community_clinics/dental_clinic

I am a celebrity, you know?  Sort of.  Here I am, 8 months pregnant, featured in the Morning Call newspaper in 2013:

http://articles.mcall.com/2013-01-21/health/mc-pa-poor-dental-care-children-20130120_1_dental-van-dental-care-sealants

I also do school exams for Bethlehem Area School District, so I love treating kids.  However, I am NOT a pediatric dentist.  We refer special needs children or children who may need alternate forms of restraint or sedation which I choose not to do. For this, I LOVE our pediatric dentists. I grew up seeing only my family dentist, but I had minimal dental issues due in large part to good homecare, great preventive care and a lower sugar diet.  Also, my parents appropriately prepared me before going to the dentist - especially before I had a baby tooth extracted.  I digress - this will be a topic for a future post...

 I have been practicing since 2010, so as an esteemed, venerable, colleague of mine once said, "You guys are the really the best educated dentists since you are the most recently educated." Thanks for that, I appreciate!  I do not yet have gray hair, so I don't automatically earn a commanding presence when I walk into the room.  I'm also 5'2", and often wear pink scrubs, so you never have to worry that I will "scare you" into doing something you really don't want to do.

I love writing and hate public speaking.  I want you to learn, laugh and think.  Let's start the journey together...right after I give kisses to my little guy, who is trying to pull the plug on my laptop...and I don't mean my husband.