Every week I hear someone mention how dentistry is very expensive, and I don’t disagree, it certainly can be. Moreover, it can be one of the smallest investments in your healthcare budget if you’re doing the right things at home. I also hear the gamut of reasoning behind why a patient thinks their suffering from dental problems: “my parents had gum disease so I do too,” “when I was pregnant I lost all my calcium and my teeth fell apart,” “I have bad genetics,” “my grandparents were in dentures by the time they were 30 so I guess I will be too,” and “my parents never took me to the dentist so now I’m having to deal with all the problems.”
What I rarely hear is, “I know why my mouth is unhealthy; I’ve neglected to take care of it.” Don’t get me wrong, every now and again I meet someone who’s brave enough to own up to their less-than- stellar home care habits, or what I like to call “low-giene.” And if you’re one of the folks that have said or thought one of the statements I previously mentioned, most of those CAN play a FACTOR (the pregnancy one has pretty much been resoundingly refuted though). The reason I emphasize that is because sure, genetics can absolutely play a role, but it’s usually one part of the puzzle and can only really be blamed as the actual cause in extreme cases. Most people don’t realize how much control they have over their own dental fate (or maybe they don’t want to take ownership), but even someone whose whole family has had periodontal disease doesn’t have to suffer the same fate as their ancestors. If they do have similar problems, the reason is much more likely that if their parents never took care of their own teeth, they probably didn’t teach the best habits to their kids…or perhaps they never built value into having a healthy mouth. Regardless, you have the ability to trump genetics, prove your parents wrong, and have a healthy mouth for a lifetime if you commit to it.
I’m not expecting you to become a daily flosser either. Please believe I’d LOVE it if you were, but I know for a fact that most of Americans floss a couple times a month at most, and that’s usually to get the pesky piece of popcorn or steak sandwich out from between some teeth. That, or they’ve got a dental appointment in the next few days and they think flossing in the 48 hours leading up to a cleaning will fool the hygienist. It doesn’t, I promise. However, if you tried flossing about 3 times a week for 2 or 3 weeks I bet you’d fool some of us. That’s because gingivitis (puffy, tender, gums that bleed easily) is a very reversible condition. The inflammation in your gums is your body’s way of trying to fight back from all the plaque and buildup that accumulates daily. If you floss just a few times a week, that allows your body to get that inflammation under control, and you’ll find that pretty quickly it won’t hurt to floss, there won’t be blood in the sink, the floss won’t smell terrible, and it’ll actually start to feel good. Yeah, I said it, flossing can FEEL GOOD. You know how a massage feels nice to a healthy body but would hurt like crazy to a swollen limb or joint…well, the same goes for flossing on some inflamed gums. The nice part here though is that the massage that floss provides removes the offending agent (plaque) and therefore gets rid of the inflammation—you’re actually massaging your gums to health. So keep this in mind: if there is blood in the sink after flossing or brushing THAT IS NOT OK–it means there is some serious inflammation at a minimum. Would you be ok with any other part of you that bled if you just pushed on it a little? Heck no, you’d go see a doctor about it.
But often I find that a major part of the problem is that I’m having this talk with a younger portion of our patients. I don’t mean kids and teenagers, I mean 20 and 30 somethings, and there are a number of reasons for this. For one, some of us cling to a bit of the invincibility-mentality that most of us went through as teenagers. “Bleeding gums aren’t a big deal,” “I’ve never had a cavity,” “nothing hurts,” “yes I have a bite guard, but no I don’t wear it,” etc. I hear this from young people because it’s a SLOW process. Enamel is the hardest substance in our body. It’s incredibly dense, and it takes YEARS for a cavity to dissolve it (bacteria turn sugars you eat into acid and use it to burrow through the teeth). Enamel also doesn’t have feeling; if it did, every hot, cold, or hard thing would hurt our teeth. However, the next layer of tooth is called dentin, and it’s very sensitive and very soft compared to enamel. So you can have a cavity and it will not feel like anything until it’s dissolved its way through the enamel and gotten to dentin–that’s about 25% of the thickness of the tooth! And when it does make it to dentin, things really escalate–it hurts, especially with cold or sweet foods, and the speed at which the cavity grows ramps up because dentin is so soft. So when I hear, “it doesn’t hurt so I’ll wait to do anything about it until it does,” it can be very frustrating. If you fix it before it gets that far, not only is that minimally invasive to your tooth (they’re not that big, you don’t want to have any more removed than necessary) but it’s minimally invasive to your wallet. If you were told you need a filling for a couple hundred bucks, that’s a bummer. If you wait and let the cavity expand, that little $200 filling can rapidly escalate into the thousands as more and bigger procedures are needed to fix the tooth. My younger patients haven’t had to go through these major expenses yet, so they’re skeptical. What they don’t realize is they have the repercussions of decades of low-giene habits accumulating. Think about this: every tooth has the same born-on date, the same manufacturer, are made of the same material, and have been exposed to the same environment. If one tooth is sensitive or having issues, there is an excellent chance you have about 27 other teeth that may be on the brink of the same problem. If you have a $200 filling on all 28 teeth (I see this more than you’d think), that’s $5,600. Let that worsen to the point of $2,000 per tooth (I’ve absolutely seen this too) we’re talking $56,000. I don’t know about you, but as a 20 something I may have felt invincible, but my bank account didn’t (still doesn’t, actually) and $56,000 would have been unfathomable to me. THAT’s how people end up in dentures before their kids hit college age.
The same applies if you’ve been told you’re a clencher or grinder. Most of us are, especially when we have stressful episodes at work, home, whatever. If you’ve been told you need a bite guard, it’s because we can see the wear that you can’t feel yet. After decades of beating on your teeth while you’re asleep (you can bite much harder in your sleep than you can awake because your safety reflexes are turned off) they form little hairline cracks. Just like the little crack in your windshield, it’s tiny and a non-event…until it isn’t. When you hit that pothole (or almond) and that crack all of a sudden runs the length of your windshield, you have to get a new windshield. Guess what, the same is often true for your tooth. Cracks can go vertically or horizontally. Vertically, there’s no saving it and that tooth has to come out and will need to be replaced with an implant or bridge. Horizontally we can sometimes save them with crowns and root canals but the tooth is vulnerable forever. Again, these are expensive repercussions that can easily be prevented with a bite guard. Make sure you use one made by a dentist though–if they aren’t calibrated they can introduce more problems than they prevent, but that’s fodder for another blog. I know this probably sounds like I’m trying to talk myself out of a job, but I have a feeling there will always be people who are lazy about flossing, disregard the advice of their dentists, chomp on almonds, and practice the dark arts of low-giene…but you can’t say I didn’t try to warn you. And if you ever complain to me about the cost of dentistry, be ready to hear my response of, “You know what’s a much more affordable option? Floss.”
-Andrew S. Currie, DMD, MS