Modern medicine and dentistry are educationally, clinically and financially driven by the concept of providing sick care to patients while dentistry is focused on repairing and replacing teeth.
The economics of these approaches is unsustainable. Science has provided us with more
effective treatments for acute and chronic diseases and dental technology has provided the
dental profession with more efficient ways to replace teeth. Preventing disease in both professions has become an orphan in a world of sick care options.
Current media advertisements fill the airways, promoting the concept of replacing all one’s teeth in a day with titanium roots and manmade crowns and unfortunately, influencing the viewpoints and treatment provided by dentists. As medicine should focus on providing patients with a long health span, Dentistry 3.0 should be committed to preserving the natural teeth for a lifetime. The Mayo Clinic has observed that patients presenting with a healthy, intact natural dentition live on average 10 years longer.
Let’s first discuss the issues that lead to dental disease and ultimately tooth loss. There are ten horsemen of the dental apocalypse.
1) Your Genetic Vulnerability to Dental Decay and Periodontal Disease
If your parents or siblings suffer from dental issues, you are more vulnerable. Knowing
this should guide your dentist, as well as yourself, in seeking preventive dental
procedures as early as possible and as frequently as necessary. Just as knowing that
your family has a history of breast cancer and the Bracha gene can prevent death from
ovarian cancer, knowing the risk of dental disease can make an enormous difference in
the care you seek and receive.
2) Understanding The Cause of Dental Disease
The oral cavity is populated by hundreds of different bacterial species. A dozen or so
survive by growing on your teeth, between your teeth and below the gum line. Within 12
hours of your teeth being thoroughly cleaned, these bacteria begin to re-form. The
outcome of your future dental issues will depend upon your genetics, your general health
and most importantly, how effective you are at disrupting the bacteria before they’re
capable of causing damage to the teeth or the bone around the teeth. The accumulation
of bacteria does not depend upon what you eat. However, sugar rich foods can increase
your rate of decay if there are bacteria present at the time of ingestion.
3) Effective Oral Hygiene is not Intuitive
All of you reading this brush your teeth, as do all the patients who’ve come to me for
dental treatment. It is not the toothbrush or the other devices you are using. Ultimately
it is how effective and completely you remove the bacteria between your teeth and at the
gum line every 12 hours.
Having utilized and observed all types of toothbrushes, both electric and manual, the key
is keeping the toothbrush at the gum line where the bacteria begin to form and using, in
my experience, a water irrigator between your teeth which has been found to be the
most effective way to remove the bacteria in the difficult areas where most periodontal
disease begins. That is between your teeth. However, this requires instruction,
motivation and, as I said, it is not intuitive. It is also time dependent. You need
approximately 5 minutes in the morning and 5 minutes in the evening to completely
remove the bacteria at the gum line and between your teeth.
4) Bruxism or Clenching Often Begins in Childhood
The forces generated while you sleep are more than 10 times the forces generated
during eating. These forces can cause severe wear, fracture of natural teeth or even
fracture of crowns. You and your dentist should be aware of this problem which is easy
to recognize by just examining the teeth for wear, or shiny areas. The investment in a
night guard or a mouth guard can be one of the most significant ones you will make,
saving you physical, emotional and economic stress.
5) Smoking and Vaping
The use of tobacco products, whether they be smoked or vaped, increases the rate of
periodontal disease significantly. Needless to say, it also results in the deaths of
hundreds of thousands of people a year. I have lost the greatest number of my patients
to tobacco.
6) Medication Taken for Chronic Diseases
Many medications taken for various illnesses can aggravate dental issues. Dry mouth is
a common side effect of many drugs. The dryness allows bacteria to adhere to the teeth
more readily and can increase, markedly, dental decay. Medications, especially those
taken for high blood pressure, can cause an overgrowth of the gum tissue, making it
difficult for the patient and the dentist to adequately clean your teeth, and predisposes
you to periodontal issues.
7) Diet
Foods rich in carbohydrates are directly linked to dental decay. Again, if bacteria are
present when you eat. Particularly dangerous are sucking candies for they constantly
bathe the teeth in sugar. They can melt away teeth in a year, something I’ve observed in
many patients. They can cause rampant decay.
8) Fluoride
One benefit of fluoridation has been that when individuals have less decay as children
and young adults. As a result they often will not require crowns and root canals on teeth
that have already been restored in their youth. These restorations require the removal of
much of the tooth structure. This can lead to problems such as tooth fracture or
infection. Thus preventing decay for children and young adults have benefits throughout
their lives.
Fluoride has been under attack for political reasons. However, it is one of the most
effective means of reducing decay in children and ultimately eliminating the need for
large restorations and crowns as we get older. Multiple countries and cities that have
removed the fluoride from the water supply have discovered a rapid increase in decay
among the children. Unquestionably, the level of fluoride used in the water supply is
absolutely free of any harmful effects, despite what you might read on more contentious
sites.
9) Dental Implants
Dental implants were introduced in the 1980’s following a long-term Swedish study
which demonstrated their predictability. They’ve enabled people with no teeth to be able
to chew, smile and speak normally, a great improvement over dentures. They’ve also
allowed us to replace individual teeth without involving the adjacent healthy teeth.
However, the downside has been that they’ve become a first choice go-to for dentistry
when the teeth that they are being used to replace do not have to be removed. Prior to
implants, many teeth that are today extracted, were preserved for a long period of time
with a combination of periodontal and restorative care.
There are many patients in my practice who, if appeared decades ago, would have had
all of their natural teeth removed. Thanks to periodontal care and patient education,
they still have their natural dentition.
In addition, implants are not bulletproof. They require the same maintenance as natural
teeth. They can develop periodontal disease called peri-implantitis which is much more
difficult to treat than teeth with periodontal disease.
My message is, before your dentist suggests you remove a tooth or teeth to replace with implants, carefully discuss your options.
10) The Corporatization of Dentistry
There has been a huge increase of corporations or hedge funds buying dental practices
and monetizing them. Young dentists, as I’ve mentioned before, are working in these
practices. Many of these young people have a great deal of debt and cannot afford to
purchase a practice or even start a practice of their own. Unfortunately, when there is a
corporate owner of the practice and not the name of the doctor on the door, the
incentives to provide dental care at a high level can be distorted.
The individual that owns the practice, in this case the corporation, has only one interest and that is the monetization of their original investment when they bought the practice. Sadly this often leads to unnecessary or less than ideal dental care. For much of my career this was an unknown entity. Dentists developed a reputation based upon the manner in which they treated their patients as well as the quality of the care they provided. Corporate entities are not motivated in the same fashion.
Finally in closing, the most important thing you will learn from a dental practice, from a dental hygienist is how to effectively remove bacteria on a daily basis from the gumline and between your teeth. The ten minutes you will spend, if it is effective, will have the greatest effect on the maintenance of your dental health and the preservation of your natural teeth. In addition, it will hopefully minimize the emotional, physical and financial toll that invasive dentistry often elicits. Just remember that when you pick up your water irrigator.
