What you should expect from your Dentist.

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What you should expect from your Dentist.

Any service profession requires an ability to listen, diagnose, propose a plan of action, and implement that plan.  The sticky part comes between the proposition of a plan of attack and the implementation, because unless the client understands the ins and outs of the plan (the good the bad and the ugly) the plan is, at best, a one sided undertaking by the professional that happens to satisfy the client, and at worst, an unmitigated disaster for the client with the blame falling squarely on the professional.  “Informed consent” is what inhabits that space between planning and action and it is probably the most important part of any professional relationship, and really it encompases all of the communication between the “problemed” and “problem-solver” and it can be all too easy for either side to abdicate her/his responsibility.

 

 

When I started my career, informed consent seemed to be simply part of your risk management strategy, a check box that needed to be completed in order to mitigate any liability in a treatment plan.  While communication was always of paramount importance to me (I felt empathy for my patients and wanted to make sure that their needs were met in the most caring and compassionate way possible), what it took me a while to understand is that all of that is part of informed consent.  All of it.  My primary job is to make my knowledge accessible to a patient, to be a resource for them to ultimately make the decision as to which course of action is right for them at that moment in their life.  I need to give them an accurate picture of what I can and cannot do and what the expected outcomes of various treatment modalities are, including any risks.  Only then can a patient place some kind of value on the service being offered and weigh that against the cost (in time, emotional energy, and money) of the plan.  I need to be as precise and honest as possible in my assessment and as clear as possible in my communication.  And the patient needs to engage in the process actively.

 

So what does this look like?  Well we first need to get to know you, and that process starts with our initial contact with you.  We obviously need to get the basics (name, contact info, primary reason for calling or emailing), but we also hope to start to get a deeper picture of who you are and what you hope we can help you with.  When you arrive for your first visit, the forms you fill out (or filled out after printing from our website) continue to enrich our understanding of who you are and what your needs are.  Next we collect a lot of data through examination but also extensive conversation.  Through this process we attempt to keep the communication open in both directions.  In a sense we are trying to give you access to our expertise so that you can better understand the state of your health and understand how we might work together to realize optimal health.  Once we have a roadmap we can work out the details of treatment sequence, finances, and scheduling.

 

For some, the preceding paragraph may seem to be missing an acknowledgement of the fear and anxiety that accompany dental experiences for many.  In my experience, however, alleviating fear and anxiety is best accomplished through the very steps outlined above.  Do people like pain?  Of course not, but that is not what I’ve found to be the root of their dental phobia.  The unknown, the lack of control combined with the possibility of pain is really the driving force.  When we take the time to develop a relationship with a patient and address their dental problems as a team, we can (sometimes with the help of adjunctive treatments like nitrous oxide and/or antianxiety medication) overcome that fear.  Once trust is developed a patient (and dentist) can relax, which leads to more comfortable visits.  This partnership is the key to successful treatment outcomes as well and it is really what informed consent is all about.  You should not settle for less.

 

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Diet, Guilt and Teeth:  A Dentist's Take on What to Eat

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Diet, Guilt and Teeth: A Dentist's Take on What to Eat

I will distil this blog post down to its essence:  Everything in moderation.  Seems like such a let down to start the first post with such an overused idiom, but I have come to realize that nutrition really is the foundation on which one’s health (or lack thereof) is built.  So this where I start a list of “good” and “bad” foods (concentrating on sugars and other fermentable carbohydrates, as this is a dental office website) end of story, right?  Not really.  I am not interested in telling anyone what to eat or not eat; to do so would be presumptuous, especially in this context, where my audience will likely consist of many people whom I have yet to meet.  I would rather present information, admittedly influenced by my own experiences both professionally and personally as well as study and observation.  To that end, I will put a disclaimer here that this post should not be used as a diet plan, nor should it take the place of an exam and conversation with a dentist or nutritionist, but you already knew that.

 

 

Conversations about diet seem to revolve around what one should and shouldn’t eat.  “I’ve been bad” is a refrain I’ve caught myself saying a thousand times, and I think I’m not alone.  But Is there such a thing as a “bad” food?  Well, there clearly are a number of foods that have very high caloric density (i.e. they pack a large amount of calories into a small package).  So let’s get this out of the way:  Yes, sugary foods give fuel to the bacteria in plaque, which release lactic acid as a byproduct of metabolism of that sugar, lowering the pH in the mouth and leading to the demineralization of the teeth; i.e. sugar + plaque = acid, which dissolves your teeth leaving decay.  And this is not limited to simple sugars; any carbohydrate source, especially ones that are easily broken down by salivary enzymes (e.g. crackers and cereal) will increase acid levels in your mouth.  *Sorry.  No more biochemistry...I promise*

 

 

What I just described is simply a mechanism; it does not indicate that sugary foods are inherently bad, only that they are easy energy sources for plaque bacteria.  Sugars and carbohydrates are also a great easy source of energy for your body; at 3:50 PM, when you feel like you may collapse, you are going to grab something with sugar in it.  It’s quick energy for your body to process.  The problem comes in when we consider that our food production system has gotten really good a refining sugar and making it cheap and most people don’t have a very strong “off” switch when it comes to sweets because we’re hardwired to crave them.  Before industrialized food, sugar was hard to come by; you basically had to find a beehive, or wait for a tree to produce ripe fruit.  Or maybe you were smart and realized that you could concentrate the sugars in sap by boiling or evaporating the water out, but that still required a lot of time and energy to get to the concentrated sugar.  When you found sugar, you ate sugar, because you didn’t know when you would get it again.  Well, this lack of an “off” switch works against us when we have access to essentially unlimited quantities of carbs and this is where the “bad” comes in.  Your body (teeth to toes) can handle sweets and starchy snacks in moderation, but in excess, well...

 

 

Why don’t I just call those foods “bad” then?  Because we’re all going to eat these foods, and for myself I know that I am much more likely to eat more of something than is probably healthy for me when I attach guilt to the eating of it.  “Well I’ve already eaten a handful of M&Ms, I might as well eat the rest of the bag.  I’ll do ‘better’ tomorrow.”  The hitch is that tomorrow I’ll probably eat something “bad” as well, and the cycle of eating too much will continue, and, focusing back in on the mouth for a second, that frequency of carbohydrate exposure is what really sets the teeth up for decay.  So eat your cookies and cakes and visit “that” table at the office party.  Just try not to visit it twice (or a couple of more times that afternoon).  Enjoy your sweets and snacks; don’t feel guilty about them, but remember:  Everything in moderation.

 

 

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