I Prefer to be Naïve

June 19, 2011

This August, I am going to be attending the World Congress of Minimally Invasive Dentistry. The WCMID is a group of dentists who are dedicated to serving the needs of their patients incorporating some of the cutting edge technology of dentistry to provide conservative and predictable dentistry. It will be my third straight year of attending and I am looking forward to another outstanding slate of courses for me to learn and share with my patients.

As I prepare to attend I am reminded of an encounter I had at the first meeting I attended in San Francisco. After finishing her presentation I had the opportunity to talk with Dr. Rella Christensen, who is one of the top researchers in the world when it comes to dentistry. In the course of our talking I let her know how I felt that organized dentistry did not do enough to promote prevention. It was my feeling that just because patients are not compliant we should still keep teaching and preaching prevention, and how glad I was to find the WCMID because this is where they are heading towards. Dr. Christensen in her response told me I was “Naïve”, that patients won’t do it just because of all the benefits it provides.

Flash forward to a few weeks ago when I read a letter from a dentist in one of my journals that I receive. The dentist tells about a conversation that he had with a cardiovascular surgeon about preventive cardiac care and the surgeon basically replied that until someone invents the ‘exercise and healthy diet’ pill he will keep cutting people open. His point was that you can’t change people..they want easy answers not lifestyle changes. Once again, the behaviors of the patients dictate their needs and the surgeon has embraced this and tends to their needs.

Personally, I spent some time with another dentist some years back. I was letting him know that I felt there was much more that could be done in his practice in regards to education and preventive dentistry just in his practice. I thought the sincerity of really caring about the patients would roll out into the local community and make it a magnet for patients who care about their health to come to for their dental care.. His response just floored me, he basically said I tell them to brush and floss once, if they don’t do it that’s what he is there for…to fill and drill

What it all boils down for me is that I know that prevention is the only way to keep ourselves as healthy as possible. There is no short cut to eating well and exercising (certainly surgery is not an acceptable shortcut). Yes, it takes time to brush and floss your teeth, but there is no shortcut to oral health either. If my choices are to be a drill and fill dentist (like the dentist I describes above) or a naïve dentist who actually hopes he can make a small difference in someone’s life…than I would rather be NAÏVE all the time.

To your health

Sometimes, the advertisers get it right!

June 12, 2011

Over the years there has been several times where I have written about the ‘brush your teeth twice a day and see a dentist twice a year’ advertising campaign back in the day for a tooth paste.  And even though there was no scientific basis for this over the years this was the accepted standard.  Today, we know that for many people, twice a year is not enough to maintain health; they need 3-4 visits a year.


But I read a great article about why the brush twice a day is actually correct.  There are the obvious benefits of home care (brush, floss and oral rinses) such as prevention, elimination of bad breath and cleaning the mouth of the food particles.  But according to Dr. Richard Nagelberg, in an article published in Dental Economics, there is more to it.  It involves a better understanding of how bacteria colonize around the teeth and gums, something we call BIOFILM FORMATION.  In the past I have blogged a lot about the biofilm in relationship to cavities. But today I talk about the biofilm and gum disease.


According to Dr. Nagelberg, the bacteria always start congregating the same way, with the earliest colonizers always being good bacteria (non-pathogenic).  These bacteria are considered important for healthy gums. This biofilm is on the gum tissue and it can be  different than the biofilm that is on tooth structure. If this biofilm is not eliminated (almost impossible to do) or at least adequately dismantled (this is where brushing come in to play) then the bad bacteria can start to colonize on top of the good bacteria.  These bad bacteria are floating around in the mouth, but they cannot harm you until they are attached to the gum tissues.


It only takes 3-12 weeks for the bad bacteria (the pathogens) to become the predominate species within the biofilm.  If you are susceptible to gum disease (genetics and an active chronic inflammatory response are a few of the factors that increase your susceptibility) then gum disease might develop.  And there are numerous studies out there to show a link between gum disease and multiple other health issues, most notably HEART DISEASE AND DIABETES. 


So brushing your teeth, at least twice a day is how we recommend that you disrupt the biofilm formation so that it starts at the base level, which is always a healthy biofilm for the mouth.


Here are some important tidbits on brushing your teeth to make sure you do it in a favorable way for your mouth, improper brushing can actually cause damage to both teeth and gum tissue.


  1.  Always use a soft tooth brush
  2. Use gentle circular strokes making sure you are angling the bristles into the gum near the neck of the tooth.
  3. Never scrub your teeth, it is like taking sandpaper to your teeth, it will abrades away tooth structure (as will medium and hard toothbrushes or even a soft one if you scrub too hard)
  4. It is now recommended that you do not brush your teeth after drinking or eating anything that is acidic (including fruit juices, sodas, Gatorade and the list goes on) for at least 30 minutes.  This acidity will allow your tooth brush to abrade away tooth structure much easier.  You need to give your mouth time to neutralize the acidity that it has been exposed to.