Many people believe that since they aren’t experiencing dental symptoms – like tooth pain or bleeding gums – then all must be well.
Unfortunately, a sizable number of dental problems, including cavities and periodontal disease (bone loss around your teeth), just don’t produce obvious symptoms in their early stages. At least not symptoms that tend to be obvious to patients.
In fact, by the time people the average person experiences pain, his dental issue is typically pretty far along. And all too often, by then, the problem can also be quite expensive to handle.
It might amaze you to discover the types of problems your average dentist encounters every week, many of which you would expect to be painful, but they just aren’t. They can still result in tooth loss though.
Pretty much anyone who has ever worked in a dental office for any length of time will tell you this is so. And they will tell you that you can inform some people that they have a problem, but unless it is “real” to them, they just won’t do anything about it.
They may come back a few years later (or maybe sooner) – usually with an emergency – desperately wanting to save the tooth that you told them about earlier. Of course, by now, it may be too late. And very often they will have forgotten it was ever discussed at all, because it was never a realistic problem for them to begin with.
Human nature can be funny that way.
So, keeping that in mind, it’s generally a good idea to get checked out by a dentist. Regularly.
The best news you can hear is that everything looks great.
But sometimes getting a confirmation that you don’t have cavities or gum disease is not the only reason to get a dental exam. Over the years, I have detected cancer (not just oral cancer) – as well as a host of other non-dental problems – that might have been overlooked had the patient not scheduled an exam. Obviously, we refer patients to an appropriate specialist for treatment when we discover medical problems outside the scope of dental practice.
Other benefits of getting a dental exam: I can recall many patients who told me that what they thought were unrelated health problems simply resolved when their oral problems were gotten under control. These have included digestive problems, low energy problems, elevated blood cell counts, hypertension, and more.
Over the years, some people have told me they don’t want to get a dental exam because they don’t want to discover they have any problems. I guess that works.
Just maybe not too well.
Your overall health is connected to your oral health. Take a look at this infographic. Then think it over. . . .
First of all, what the heck is vitamin P? First discovered around 1936, the term is hardly used anymore – except maybe euphemistically for Prozac (fluoxetine) – which you definitely don’t need, unless you like playing Russian roulette with your health. Prozac is widely regarded as one of the most dangerous drugs on the market. More about that some other time, perhaps.
But, real Vitamin P is better known today as a plant classification called flavonoids or bioflavonoids.
[Because of my interest in natural health, I subscribe to a number of health-related newsletters. One of them (and I recommend this newsletter to anyone interested in sensible health and nutrition) recently reminded me of a subject I have already written about on a number of occasions. Namely, the importance of controlling inflammation, actions one can take to do so, and the nutrients that can assist with this problem. The newsletter I’m referencing here is called Health Alert, by Dr. Bruce West. Much of what follows in this posting comes from that source. If you are interested in subscribing, their number is 831-372-2103. I receive no financial benefit by recommending them. It’s just good information.]
Nevertheless, here’s why real vitamin P is important to your health, and yes, even more specifically – to your dental health:
The cells that line your blood vessels are truly amazing in terms of all the functions they provide. Their end-result have a great deal to do with how you heal. But they can’t do their job without the adequate nutrition that they need. And the prime nutrient required by these cells is vitamin P. Originally, vitamin P was named for an extract of paprika. Today, we know it better as bioflavonoids.
But if you are deficient in vitamin P, you are likely suffering from sub-clinical scurvy.
At one time, scurvy was considered deadly. Today, it is looked upon as an old disease that has been pretty much eradicated. But the less deadly version – sub-clinical scurvy – can be found in much of the American population. It’s even possible you may have it.
And while you probably won’t die quickly from scurvy as people did centuries ago, your odds of dying from damage to your blood vessels and the resulting strokes and/or heart attacks are significantly increased. If you notice your toothbrush looks a little pink when you brush, or if you have outright bleeding gums, or possibly blood stains on your skin as a result of leaking blood (Schamberg disease), or you have been diagnosed with coronary artery disease, blood clots, plaque, stroke, heart attack, deep vein thrombosis, peripheral artery disease, and most other circulatory problems – you are suffering from sub-clinical scurvy and you need vitamin P.
Vitamin P feeds the lining cells of your blood vessels – called endothelial cells – and can restore your health after they have been suffering from a vitamin P deficiency. That makes vitamin P a natural anti-stroke, anti-clot, and anti-heart attack nutrient. It will help regenerate your endothelial cells to heal your blood vessels properly. It will even help to keep your blood flowing better (by making them less stick and sludgy) without the many side effects of poisonous blood thinners.
As a dentist, I know that vitamin P is also helpful in your fight against gum disease and tooth loss. More teeth are lost (worldwide) due to periodontal disease (bone loss around the teeth) than to any other factor. Vitamin P deficiency has a lot to do with this. But it doesn’t end there. Because of its direct effects on collagen, vitamin P can also help you with ulcerative colitis, frostbite, arthritis, varicose veins, hemorrhoids, and more. It is even protective against radiation damage.
But, by far, its main benefit is to the linings of your blood vessels. And when it comes to your gums that’s crucial.
All kinds of products claim to be able to heal your blood vessels. Frankly, most of them don’t work. If you truly want to heal your blood vessels, then the most effective source of vitamin P, by far, is the juice of deep green buckwheat leaves harvested at the time of their peak nutritional content. Possibly, the most powerful bioflavonoid in buckwheat juice is called rutin. Now, most of us aren’t going to start an organic garden to grow buckwheat — that we then harvest at the optimal time — and then make juice from the leaves. And, fortunately, we don’t have to.
One company – Standard Process – does that all for us. They make the supplement Cyruta-Plus in a tablet that contains all the life force, nutrients, and bioflavonoids of the juice itself. If you have gum problems, or any of the other problems listed above, 2-4 tablets of Cyruta-Plus 3x daily, would be a good place to start. Give it one to two months to help repair the damage already caused by what has probably been a long-term deficiency.
If you are not easily convinced and need additional proof (other than observing the results for yourself), you can ask your doctor to have your CRP (C-reactive protein) level checked. Most people with blood vessel inflammation will have an elevated CRP in their blood. If this is you, this is an inflammation marker, and your chance of having a heart attack or stroke becomes significantly higher.
You might be tempted to try one of the advertised “super-potent, artery scrubbing” anti-oxidants which are advertised, like reservatrol or ascorbic acid. Go ahead and try it. Then have your doctor order a new CRP blood test. After that treatment fails, try Cyruta-Plus (9 – 12 daily for 30 days) and get one more blood test. See what happens. Chances are you will be both shocked, and happy.
Not only will you have helped your gums and teeth, but you will have lowered your risk of heart attack and stroke, you will have helped your joints by improving arthritis, your gut will enjoy better digestion, your skin will thank you, as will your legs. Plus, the potential for living longer is not a bad result either.
Common sense. Does it seem to you that this has become a rare commodity nowadays? Possibly, then, it is really uncommon sense that we should be talking about.
The latest example of an affront to logic – at least for me – lies in the latest media challenge to oral health. This morning various news agencies including The New York Times, suggested that maybe flossing is really overrated. Apparently, “officials” have never researched the effectiveness of regular flossing.
Now, millions of people are likely to jump on this as a justification for not flossing. But, in reality, the new media sensation is probably not going to change very much at the end of the day. Why? Because I can confidently tell you – based on more than 25-years of personal experience – most people don’t floss anyway. About all this latest “research” will promote is the possibility that some people will feel just a little less guilty about what others with any sense (common or uncommon) already understand is a pretty good idea.
But, it makes for good press. Doesn’t it?
Just for the sake of argument, let’s assume that flossing doesn’t remove plaque. Heck. Some people fail to remove plaque with a toothbrush. That doesn’t mean either fails to benefit the patient, if done properly. I can think of several reasons why flossing helps, though:
Passing floss between the teeth sweeps out the contact point between them – meaning the points where they touch. That’s a source of about 30% of all tooth decay. Your toothbrush typically doesn’t reach those areas, unless you have gaps between your teeth. Floss does reach those areas.
Flossing stimulates blood flow in the gums. One of the body’s first-line mechanisms of defense is to increase blood flow to an affected area. You are effectively helping your body do this in a controlled manner by flossing.
A number of the bacteria under your gums are anaerobic bacteria. That means they don’t grow in room air. So what is a person introducing into the gum pocket when they pull back their gums by flossing? Could it be . . . air? Is it possible that the oxygen in the air could kill some of those bacteria as well?
Think about it.
If we can set aside this newly created question of doubt for just a moment, I would propose that you ask yourself the following question:
“Have I ever flossed consistently?”
By this, I mean every day, and it would have to have included doing so for at least two weeks.
This question is particularly directed to someone if they ever had a gum problem like gingivitis or periodontal disease. Sure, one needs to get rid of tartar and control bacteria as well, but for patients that make the effort to floss (and with only a few qualifications that I can think of), it is almost a sure bet that their gums got better as a result of the daily exercise. First of all, the gums probably bled less afterward. Not in the beginning – to be sure – but after about two weeks of flossing every day, we typically see positive change. Breath improves too. An overall sense of well-being is not out of the question either.
When it comes to flossing sporadically, I agree. It doesn’t help much. It’s kind of like exercising once or twice a month. And let’s face it, that’s where most of the population lives when it comes to flossing — once in a blue moon. Is regular exercise effective, though? What does your common sense tell you?
Why would I hold on to this idea in the face of “new evidence”? Well, I have seen flossing help too many times to just call it a coincidence. Hard core scientists might say “Oh, well, that’s just anecdotal evidence. It doesn’t stand up to real scientific scrutiny.” OK. Then survey practicing dentists. Let’s see if I’m the only one with that observation and experience. I doubt it.
I’m not saying flossing is the only thing you need to do to have healthy gums. It isn’t. Diet and good nutrition are paramount. A healthy immune system doesn’t hurt either. But for Pete’s sake, flossing is cheap, really not all that hard to do once you have practiced it for a while, and it can end up saving you a lot of money in the long run. With health care costs being what they are, I can’t think of too many actions a person can take that bear as much fruit and keep money in their pockets.
But, if the media has just succeeded in making you feel better about not flossing, then OK. Bully for them. (Heaven knows, they do a top notch job spending most of their time getting people to feel less than great.)
And, I suppose there are other ways to handle tooth loss – which, by the way, happens a lot more from gum disease than tooth decay.
I have little doubt that some patients who visit a dentist and are told they have decay, but don’t experience any symptoms, are convinced that someone is trying to pull the wool over their eyes. There are probably several reasons for this. Possibly, they had been to some unscrupulous person in the past who suggested they had a problem, when they really didn’t.
I can see how that might create skepticism. I mean, it’s conceivable that sort of thing could happen.
But even if that were the case, I sincerely don’t believe it represents the behavior of a majority of dentists. Most of the dentists I know genuinely care about what they do and the people they treat. So maybe these skeptics are just people who don’t trust anyone. I don’t know.
The reality, though, is that these patients will eventually be in for a big surprise when the you-know-what hits the fan. Or – and let’s keep this a family column — when the decay hits the nerve.
But that could take a while.
And I believe that could be where some of the problem lies. A patient tries to use this to their advantage — they want to buy some time. After all, it’s not really being a “problem” for them in that they don’t perceive anything as being different. When the problem eventually does occur, I usually hear: “I never thought it would happen to me.”
A doctor detecting treatable decay usually recommends that the patient handle it at their earliest opportunity.
Why? Well, the patient can catch the problem when it is small, when it is less likely to cause post-operative discomfort, and when it will generally cost them a lot less.
But, first, let’s back up a little and explain why it’s possible to have a cavity – several in fact – and have absolutely no symptoms.
Most decay starts on the outer surface of the tooth called the enamel. It’s roughly 97% mineral in consistency and does not contain nerves. That means it has no feeling. Practically zero. Your dentist could DRILL on that part of the tooth and most of the time you won’t feel it.
Notice that in the earlier paragraph I mentioned “treatable” decay. Well, when would decay not be treatable right away? I can’t speak for other dentists, but I typically won’t treat decay when it is confined to the enamel. Why? It has the potential to re-mineralize. In other words, it has the capacity to fix itself – that is, if you don’t continue to do the things that led to the cavity in the first place. Usually, this is related to your diet, but it can be affected by hormones, or even medications.
Why not mention home care first? Isn’t that important too? Of course it is. It just may not be the most important factor.
Another time a dentist might not treat a cavity could relate to the age of the patient. For a much older patient, there are times when the pain or infection are not likely to come up before the patient passes. Of course, your dentist doesn’t have a crystal ball on that point. (Well, probably not.) But, it wouldn’t make sense to recommend treatment in the majority of those cases.
And this takes us back to the nature of a cavity. They often take a long time to get bigger. (But not always…. Again, no crystal ball here.) The reason has to do with the hardness of the enamel itself. Enamel, for you trivia lovers, is the hardest substance in your body. It’s harder than bone, and that property, along with the lack of sensation, can be problematic.
Here’s why: a cavity is often quite small on the outside of the tooth. It’s actually difficult for decay to work its way through that hard enamel. Most of the time it burrows a narrow channel down to the dentin (only a couple of millimeters away) and then it really starts to spread. Because dentin is softer than enamel, it’s just easier for it to spread more quickly there. By the way, this additional, and deeper, decay – very often still doesn’t hurt – as long as it is far enough away from the nerve.
Meanwhile, your enamel is, for the most part, continuing to hold its form. That stuff is hard. But things are generally hollowing out on the inside of the tooth now — out of sight and out of mind — as the decay continues to spread. Painlessly.
Eventually, your tooth can become very much like an eggshell.
Then one fine day you bite on something, and the hard enamel that was still doing its job holding the form of the tooth caves into the hole below. It just got too thin.
Now, at this point, does the skeptic understand that he got a cavity? Sure. Some of them finally get it. But for others –no! It’s more like: “Hey that blowhard dentist was obviously wrong because he talked about me having cavities years ago, and look – I did fine until now. In fact, I probably just lost a filling! Jeez, this hole just came out of nowhere. It’s probably the fault of some earlier dentist.” (Um, Mr. Skeptic never got the filling though. Remember?)
“Hey doc, how much is this going to cost me? $2,400?!!! (For a root canal, buildup and crown.) Are you insane? Just pull it.”
Now you are going to be missing a tooth, and may lose even more teeth as a result. Yet, when the doc first mentioned it, that cavity was only going to cost $150. How can it suddenly become sixteen times more expensive?!
“Rip-off artist. Seems you can’t trust anyone. . . .”
This is a reprint of a column I recently wrote for our office newsletter. While it is only mailed to existing patients, it contains sentiments I wanted to share more broadly. Hopefully, it will help you consider a few things about your dental health and maybe even save you some trouble down the road. While this was directed to the patients in my practice, if you aren’t a patient of mine and haven’t seen your dentist in a while, please reach out to him at your earliest opportunity. Read on and I think you’ll understand why. At least I hope so.
You can save your teeth. How do I know this? After more than 25 years in practice, you get to see a few things.
The two main reasons people give for not taking care of their teeth are time and money. Typically, people will swear they have neither.
I believe that they believe it.
But, here’s the funny thing: when the emergency happens (and it will given enough neglect) most of these same people find the time and the money to handle their problem. Sometimes, it even costs more than it would have to prevent the problem to begin with.
So, what’s that about?
It’s actually pretty simple. One patient summed it up concisely: “I never thought it would happen to me.” You see, I know that most people — deep down — really understand that neglecting their dental health can lead to trouble. But a couple of other things come into play.
First, is this classic error: “If I don’t have dental pain, then everything must be OK.” Here is why that’s just not true. Cavities usually start on tooth enamel. Tooth enamel — being about 97% mineral and not containing any nerves — doesn’t feel pain. Trust me on this. Once you actually do feel pain, it’s bad.
Second, the number one cause of tooth loss (worldwide) isn’t even cavities. It’s periodontal disease. More than half of American’s have it and most don’t have any clue that they do.
Sometimes the first symptom they notice is that their teeth are getting loose.
I can’t tell you how many times a new patient has come in and told me, my front tooth just fell out. (Naturally, it was loose for a while, but that’s the thing — they expected that maybe it would get better or, if they didn’t think about it, they could just ride things out a little while longer — or … they just didn’t think it would happen to them.)
One panicked lady absolutely had to leave the office with all her problems handled that day. After all, she couldn’t let people see her with missing front teeth. It didn’t matter that she let it go for years.
It doesn’t work that way. But you can take care of your teeth. Ask us for help. That’s why we’re here.
I haven’t written anything to the blog for some time now. Like so many people I know, I have been busy with other projects. Every now and then, though, something will come up and I find I tell myself, “I need to write about that”. Recently, an exchange with a patient prompted me to write on the subject of how much time a patient might expect from a crown or a bridge.
What I found interesting was this patient’s viewpoint about something that was happening with her relative. It seems that this relative was experiencing a problem that required she/he have a crown re-made. My patient, made an off-hand comment to me along the lines that her relative’s dentist might not have been so great because the crown was having to be redone.
I’m thinking: Oh, it must have just been placed recently.
She’s thinking: After about twenty years.
Granted. My patient has not (yet) had to replace any of her dental work and she has been with me nearly twenty-five years.
But here’s the thing: as a dentist when I hear that a crown lasted twenty years, I think – “Sounds like that dentist did a pretty good job.” It seemed to me, my patient had an entirely different impression.
I asked her: “Did you realize that the average life for a crown or bridge is only between 5 and 15 years?” My patient seemed a little alarmed by that, but acknowledged she did not realize it.
There are so many factors that can go into how long a crown or bridge may last, that this can be really difficult to predict. The five- to fifteen-year figure often cited by dentists is based upon university studies and insurance company estimates of how frequently they need to be replaced. Most insurance companies will pay for a new crown after five years, although, a number of them have recently extended that replacement date to 7 or even 8 years.
In all fairness, sometimes crowns can fail due to manufacturing errors. But the reality is that this is very seldom the case. More often it is the patient that fails the crown.
How so? There are two main reasons: decay under a poorly maintained crown and tooth clenching and grinding.
But here are a few other ways a crown can break –
Removing bottle caps
Cracking crab claws
Holding roofing nails
Tearing open cellophane packages
Inappropriate use can cause porcelain that is veneered onto a metal base to break off. Using common sense is important.
Provided a crown is manufactured to high standards, after choosing the right material for you, and having it fitted correctly to your bite it has the potential to last a lifetime.
Home care has something to do with it too.
In my twenty-five years of practice, I have seen this repeatedly. For me, two cases have illustrated it best:
Earlier in my career, I had a patient who needed a lot of dental work. He already had quite a bit done, but much of it was pretty old and, frankly, it didn’t look very good. It’s actually uncommon for me to see work that I believe wasn’t done carefully, but if any situation fit that bill, this was it. His crowns fit like “socks on a goose.” I don’t know where he had it done and, at this point, it really isn’t the moral of this story. The important thing is that this work was, apparently, what he could afford at the time. What amazed me was that these crowns were still functioning after more than twenty years. There was no reason they should have. They fit that badly. So, why were they working? This patient’s home care was excellent. He brushed and flossed after every meal. He knew that getting new dental work was going to be costly for him, so Mr. Flosser he made sure that what he had lasted him. I was impressed.
Not too many years thereafter, I saw a different patient for a new patient exam. This man had bridgework from ear to ear. Honestly, it looked great. Pretty much everything about his crown and bridge work was technically correct. The bite was good, they were esthetic, and when I took his diagnostic x-rays, I noticed that the critical areas fit perfectly. Someone obviously took a great deal of care to make sure that they delivered a great product to this patient. I would have gone to that dentist.
But another thing that I observed when I reviewed the films was that there was decay all over the place. So much, in fact, that the only way to correct it would have been to remove the bridges, clean out the decay and replace everything.
The likelihood that his dentist would have left behind that much decay is nearly zero. No one who took that much care into crafting his work would have allowed it. But the real reason I know that is this: during the course of my exam, I observed that this patient has so much plaque and garbage in his mouth, I doubt he ever brushed his teeth. It looked like he had just finished eating cottage cheese before he came in. The plaque was that heavy.
This man’s dental work was only between two and three years old. He probably paid a small fortune for it. It was that extensive.
Now, I had the unpleasant task of telling him my findings. To make a long story short, I never saw him again. Mr. Cottage Cheese probably thought I was trying to put one over on him. Nothing bothered him (yet!), and it was most likely inconceivable to him that he should have anything wrong in so short a time. And yet, it was not a promising scenario.
Today, however, an equally common cause of crown or bridge failure is tooth clenching and grinding. I have written about this epidemic elsewhere. But, if you grind or clench your teeth, things are just going to wear out a lot faster. It’s just common sense. If you had a choice of parking your car in the middle of a golf driving range or outside of the driving range, under which conditions is your car likely to end up with the better paint job?
Some people can place amazing forces on their teeth. When they do, if a tooth was in really bad shape before it was restored, the crown probably won’t survive the weak tooth. You need something of a substrate to support and retain the crown. The cement can’t be relied upon to do the entire job.
Also, to put things into perspective, the average force on a back tooth is typically around 75 pounds per square inch. When we chew, that goes up a little – maybe, to 80 or 90 pounds per square inch. Remarkably, some people have been recorded as having applied as much as 3,000 pounds per square inch on their teeth while sleeping. That can crack a virgin tooth, let alone one that has had any work done to it.
In the end, there really isn’t a simple answer as to how long a crown should last. It can vary. With all other factors being equal, I would hope for no less than seven years and consider anything beyond fifteen years “good.”
Many of my patients who are still with the practice after 25 years and that I still have the opportunity to examine, continue to have their original crown and bridge-work. But some have moved to other states, and others have passed away in their older years. Yet, much of what I can see looks pretty good. Some old crowns and bridges could use a face-lift. That usually means replacing it.
Every now and then, I wonder about those two patients I mentioned above: Mr. Flosser and Mr. Cottage Cheese.
Mr. Flosser may still be running around with those old crowns. Mr. Cottage Cheese is probably wearing dentures by now. . . .
It is not without purpose that dentists repeatedly herald the fact that your mouth tells us a great deal. Yes, it will communicate — and without words — whether you have been brushing or flossing. But it will also tell us a story of your overall health.
For centuries, even the physician began his examination of the patient with a look at the head, ears, eyes, nose and throat. He would ask you to “Say aah.”
Ever wonder why?
The specific reason is that the sound you make elevates the soft palate and allows for a clearer view of the back of the throat, but it also tests the function of the vagus and glossopharyngeal nerves. Doctors have an abbreviation they use to describe this evaluation: HEENT (head, ears, eyes, nose, throat). More recently, health professionals have been pushing for a modification to that standard evaluation, changing it to “HEENOT” instead (head, ears, eyes, nose, oral cavity, and throat).
Thus, health professionals can work together in the best interest of their patients. By performing a thorough oral exam, the dentist will often spot systemic problems and refer their patient to a physician for further evaluation. The family doctor can, in turn, evaluate oral health and alert the patient to the fact that it is time to see a dentist in order to get better.
Anyone following our blog or newsletter for any length of time has already been acquainted with the fact that what goes on in our mouths can affect the health of the rest of our bodies. Studies continue to show the links between oral and general health. By way of review – periodontal disease has been linked to complications with diabetes and pre-term labor in pregnancy. There is also a strong connection between poor oral health and rheumatoid arthritis, cardiovascular disease, strokes, and Alzheimer’s.
The fact that we perform an oral (and oral cancer) examination during your bi-annual checkups and “cleaning visits” does not excuse you from seeing your doctor for general health problems, and vice-versa. We are professionals in oral health and regular maintenance in our office helps you to stay healthy. So you want to be certain that each time your family doctor ask you to “say aah,” they then say “good job – everything looks great!”
If you have any questions about your oral health, please contact us! We love hearing from you.
Dr. Richard Walicki is a Philadelphia dentist practicing general and cosmetic dentistry. While we hope you find the information contained herein interesting and useful, this blog is for informational purposes and is not intended to diagnose any oral disease. Dental conditions should be evaluated by your dental health professional or a qualified specialist.