Anxiety

I love being a dentist.  I love the opportunities my profession provides me to help people look better, be healthier, and get out of pain.  I get to work with good people.  I rarely have to sit at a desk in front of a computer.   I get to work with my hands in field that incorporates art, science, business, interpersonal relationships, and a variety of other studies.  No two days are alike and I never feel bored.  The hours are good and I feel well compensated for all of the time, effort, schooling, and debt I’ve put into being a dentist.  There’s just one problem:  people are scared to death of me and avoid me like they avoid public speaking or the bird flu. 

                In the tradition of my favorite late night talk show host, I’d like to present  . . .

The Top 10 Reasons People are Scared of Coming to the Dentist:

10. Pop Culture.  Television and movies have not been kind to dentists.  If you are familiar with this, this, or this, I bet these scenes cross your mind every time you cross the threshold of a dental office.  Pop culture hates me and is out to make me look like a barbarian.

9.   Past Memories.  Kids today don’t know how easy they have it.  Ask any Baby Boomer about their childhood dental office and they’ll tell you horror stories of ungloved hands, gigantic drills, stern and uncaring personalities, scary hospital environments, and abundant tears.  Even though today’s dental scene is significantly more kind and inviting, old memories, especially bad ones, die hard. 

8.  Smells and Sounds.  My wife remarks nearly every day when I come home to hug her “go change, you smell like a dental office.”  Although I’ve grown almost completely desensitized to that antiseptic/fluoride/dead tooth smell, I definitely remember it distinctly from the days when I came to the office solely as a patient.  Additionally, who can hear the high pitched whine of a dental handpiece and feel completely at ease (besides dentists, of course)?  It’s been determined through several studies that sounds and smells, trigger memories better than other senses, so if any of those memories are unpleasant, they can be a real deterrent to visiting the dentist. 

7.  The Flossing Lecture.  Dental visits can be stressful and embarrassing enough without hygienists and dentists piling on with their lectures on hygiene.  When I was in high school, I left a Provo dentist for this very reason.  I still have bad memories of his doom and gloom outlook toward my teeth (which were always pretty good, by the way) and his apparent desire to appear smart in front of me.  The traditional authority model of “I’m the doctor and you’re just a patient; do what I say” is not pleasant to endure.

6.  The Time Requirement.  Almost everyone will agree that regular checkups and visits for treatment are important, but why must it be so inconvenient to schedule?  Most dental offices are only open during normal business hours—basically when you are at work or school.  Vacation time is sometimes hard to take for fun things, let alone for something you really don’t enjoy doing.  Then there’s the issue of waiting; how frustrating is it when you call hoping for an appointment next week and all that’s available is a slot two months away? 

5.  The Cost of Dental Care.  Spending time on something you’d rather not do is one thing, but even more frustrating to some is spending money on an unpleasant experience.  Dentistry, like any type of health care, is not cheap.

4.   The Value of Dental Care.  Cost and value are different concepts.  Yes dental treatment can be expensive, but to anyone who values good health, aesthetics, and the ability to eat a steak, it is a great value.  Many do not place such a premium on dental care, or simply do not value it at all.   I learned this lesson early while in dental school in Louisville, Kentucky when patients in their 20’s asked me to pull all their teeth because “my dad had dentures, my grandpa had dentures, and I just want to get rid of these teeth so I can get my dentures”.  Unfortunately, some patients only come around when they are in severe pain; one by one, teeth are pulled and dentures are the ultimate result.  In most of these cases, valuation of dental health is the issue. 

3.  The Uphill Battle.  “Another cavity!  I just had three at my last checkup six months ago.  I promise I’ve been brushing and flossing.”  Unfortunately some individuals seem to be very susceptible to dental decay in spite of modest preventive efforts.  Most of these individuals need almost perfect hygiene and diet modification to stay cavity-free but, unfortunately, many are not willing to put forth that kind of effort (or don’t understand what is needed).  Hygiene habits are hard to break and the result can seem like an unwinnable fight. 

2.  Pain.  If you’ve ever had a painful emergency situation, you’re well aware that a dentist can be your best friend, but for anyone else, going to the dentist = pain.  In spite of using very effective anesthetics, some teeth can be “hot” (resistant to numbing medicine) and what is enough anesthetic to tranquilize one individual might be the equivalent of a throat lozenge for another.  Even though we strive to avoid it, there is sometimes pain involved in dental care.  And to be perfectly honest, it’s probably not even the pain that’s the worst part, it’s the anticipation of pain. 

1.  The Needle.  By far the scariest instrument in a dentist’s arsenal (yes, even more than “the iron hook”) is the dental syringe.  The needle has probably warded off more dental treatment than all the above items combined.  And what do dentists call it?  “Just a little pinch.”  What follows the needle is probably even better.  Who doesn’t love that nice numb feeling that persists hours after treatment is complete? 

                From my perspective as a dental patient I can identify and agree with most of the items on this list.  I fully understand that coming to see a dentist isn’t your favorite thing in the world.  There is some fear and anxiety involved.  Fortunately, most people are able to deal with the small or moderate amount of anxiety that comes with the experience, but for those with a true dental phobia or strong aversion to one or more items on my list, the experience can be truly horrifying.  At Barry Family Dental, we strive to make each patient comfortable and minimize the discomfort and anxiety you may feel.  In spite of how dentistry was in the past or how it is viewed in cinema and television, an experience at our office is much more comfortable than you may think it would be.  Compassion, understanding, and kindness are ideals that we strive to live each day, with each patient that comes through our door.  With iPods and headphones, free nitrous oxide (laughing gas to help patients relax), and use of the latest dental technologies and techniques, we attempt to minimize the sounds, smells, and discomfort of dental treatment and make your visit as quick and relaxing as possible.  We are providers with most dental insurances and offer various payment options to help our patients obtain treatment.  Although we are busy, we have extended business hours (open until 6:00 on some days and open almost every Saturday) to help accommodate your schedule and will always make time if you are need urgent care.  We hope you value dental treatment and will do our best to answer questions and provide education in a non-condescending manner where it is needed.  If you or someone you know is apprehensive about dental treatment, we’d love to help.  Dentists really aren’t as bad as you think we are.

Nicolas K. Young, DMD

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Dry Mouth

Saliva is your friend  

That slimy wet watery substance found in your mouth is actually one of your best friends.  Saliva is very important for many different reasons.  It plays a necessary and vital role when eating and chewing.  We don’t recognize how important it is until you lose part of it and find your tongue sticking to the top of your mouth.  Think back on those times when you have a really intense situation or your adrenaline kicks in and you can’t pull your tongue off the roof of your mouth.  It can be really annoying and hard to talk or eat anything. 

Saliva also helps in keeping the teeth healthy and strong.  It washes away food and debris from the teeth and gums.  Some of the minerals found in your saliva can actually help fight cavities by replacing those that are lost when a cavity first develops.  Some people have a condition where they are always like this.  It is called xerostomia, or dry mouth.  This condition is not a disease but a symptom caused by a myriad of different reasons.

What causes dry mouth?

            In the majority of cases xerostomia, dry mouth, is a side effect of using some types of medications.  These medications include antihistamines, diuretics, blood pressure meds, muscle relaxants and painkillers just to name a few.  Up to 400 different medications have this side effect.  When taking a new medication it is important to look at the list of side effects to see if this condition is listed. 

            Other causes of xerostomia are head and neck cancer, head and neck radiation therapy, stress, Sjodgren Syndrome, endocrine disorders, Parkinson’s disease, diabetes, stroke and AIDS.  Dry mouth can also be the cause of some hormonal changes during pregnancy and   menopause. 

What are the symptoms?

            Here is a list of some of the symptoms of xerostomia.  Read down this list and see if you have one or more of these:

-          a sticky, dry feeling in the mouth or throat

-          limited saliva that seems thick or stringy

-          a burning sensation in the mouth

-          trouble in chewing, swallowing, or speaking

-          an altered sense of taste

-          a rough dry tongue

-          cracked lips, sores or split skin at the corners of the mouth

-          an infection in the mouth

-          increased plaque (a thin film of bacteria), tooth decay and gum disease

-          bad breath

Dealing with dry mouth, JADA, Vol. 136, May 2005, pg 703

Treatment for Xerostomia.

            There are some things that you can do if you are experiences a dry mouth.  In some cases if it is a side effect of medication you can ask you doctor if there is another type of medication that you can take that doesn’t cause dry mouth.  In most cases the medications are too important to switch or stop.  In that case there are some saliva replacement options available.  Alcohol free mouth rinses, such as Biotene, are available over the counter and some by prescription.  Taking frequent sips of water or using sugar free candy or gum can increase the secretion of saliva.  Most important is the need of proper oral hygiene.  Tooth decay can run rampant in a mouth that is dry.  Brushing and flossing after every meal and more frequent dental cleanings can help to keep your teeth cavity free. 

            If you are experiencing any of these conditions please make an appointment and let us help.  We want your mouth and teeth to be healthy and cavity free.

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Removable Implants

Do You or Someone You Know Have Problems With a Denture or Partial Denture?

Dentures and Partial Dentures can be difficult to get used to.  If you or a loved one has ever had, or has, a denture or partial denture you probably know what I mean.  They tend to fall out of your mouth easily, food can easily become trapped under the appliance, and if the partial denture is attached to your teeth it can cause decay on the teeth or cause them to become loose.

And those are just the functional problems.

Often a partial denture will have metal wires or clasps that are visible when you’re speaking or eating causing embarrassment, or even worse, changing social habits and altering self-confidence.

 Overall, dentures and partial dentures can be unsightly and uncomfortable.  Fortunately, with dental implants, many of these difficulties can be, and have been, overcome.

Dental Implants Can Help

After a dental implant is placed in the jaw in the correct position and after it has healed for an appropriate amount of time it can be attached to either a denture or to a partial denture.  When a removable appliance is attached to a dental implant if offers several advantages:

1. Because the implant is fixed in the bone the partial or the denture that is attached to it becomes much less mobile and stays in the mouth much more easily;

2. If the implant is attached to a partial denture less stress will be transferred to the existing teeth thus extending their life expectancy;

3. If the implant is attached to a partial denture we can often get rid of the unsightly metal wires and clasps that often accompany partial dentures.

In short, placing an implant under a partial denture or a full denture can be one of the most cost effective ways to replace missing teeth.  The appliance is much more stable in the mouth and kind to the adjacent teeth.

Come See If We Can Help!

If you are or someone you know is suffering from a loose denture or ill-fitting partial denture please come see if dental implants are the right option for you.  We have seen them improve the fit and comfort of many peoples’ full dentures and partials and we’re hopeful they can do the same for you.

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Sensitivity vs. Toothache

Even if you are the “perfect” dental patient who flosses thirty times daily, carries a toothbrush in your pocket at all times, and devoutly obeys every word spoken by your hygienist, chances are good that at some point in your life you will experience discomfort or even pain because of a tooth. Other than routine cleanings and checkups or scheduled treatment, tooth pain is probably the most common reason dental appointments are scheduled. When you go to the dentist with tooth pain, one of two conditions will usually be found: tooth sensitivity or a “true” toothache. The purpose of this post is to help you understand each and give some helpful advice if/when you experience either.

Sensitivity

To understand tooth sensitivity, one must know something of tooth anatomy. Teeth are composed of three basic layers. The outermost is a hard, protective covering called enamel which covers an intermediate layer of dentin. Within the dentin is the pulp, a gelatinous core composed of nerves and blood vessels. The middle dentin layer is not as hard as enamel and is filled with millions of small channels or pores that are filled with fluid and a microscopically small nerve branch that comes from the inner pulp layer. Tooth sensitivity occurs when the dentin layer becomes exposed. Usually this happens when the enamel layer is worn away by overly-aggressive brushing, acid erosion, tooth clenching and grinding, etc. Root surfaces, which are lack enamel, can also become uncovered and exposed through gum disease and gum recession. Temperature changes, pH changes (sweet, sour foods), drying of the tooth, and mechanical touch each cause the fluid to move within the tiny dentinal pores or channels, which in turn tugs at the small nerve contained within and the result is a pain signal to your brain.

Fortunately, tooth sensitivity is rarely a serious condition and treatment, which focuses on relieving symptoms, is often quick and relatively inexpensive. All forms of sensitivity treatment are designed to seal the dentin pores, or block the small tooth nerves within from sending pain signals. Toothpastes containing high concentrations of fluoride or potassium nitrate may be prescribed, or commercially available pastes such as Sensodyne (which also contains potassium nitrate and fluoride, but at lower concentrations than prescription pastes) may be recommended. In more severe cases, small fillings to cover the exposed dentin or night guards to prevent grinding and clenching during sleep may be advised.

Toothache

True toothaches arise from many different conditions, among the causes of which are the following: shallow tooth decay (not to the nerve), deep tooth decay (that has penetrated the pulp of a tooth), trauma, cracked teeth, severe grinding and clenching, necrotic or dead teeth (which may have an abscess), and gum infection or disease. One common theme is present in treatment for each: the source of the pain needs to be dealt with; treating symptoms (as is the case with sensitivity) is not enough. Damaged tooth nerves and tooth infrastructures will not repair themselves, and bacterial infection left unchecked, will destroy a tooth (or jawbone). These problems often start small, but over time get larger, more dangerous, and more costly to treat. Fortunately, most painful teeth can be treated with fillings, crowns, and root canals, but if treatment is delayed, a tooth may be rendered non-restorable and extraction may be the only alternative (potentially leading to tooth replacement with dentures, partials dentures, bridges, or implants).

It must also be noted that many conditions can mimic a “true” toothache, among which are teporomandibular joint disorder, wisdom tooth impaction, sinus infection, trigeminal neuralgia, atypical facial pain, heart attack, and tumors. Obviously, some of these conditions are very serious and should receive immediate treatment.

“My tooth hurts; what should I do?”

Ask yourself the following questions in order to determine the next step:   What hurts? Discomfort from cold things, sweets, and sour things may indicate either sensitivity or a “true” toothache. Discomfort from biting usually means something more serious, like an abscess or cracked tooth.

•       Where on the tooth hurts? Discomfort on the tooth surface right by the gums usually indicates sensitivity, whereas discomfort between teeth or in other areas indicates something more serious.

•       How long does it hurt? Discomfort to cold things that doesn’t go away quickly often indicates irreversible nerve damage.

•       Does it hurt when you try to sleep? Teeth needing immediate treatment tend to get more painful when your body relaxes; fewer stimuli are being sent to the brain and so pain signals are harder to ignore. Sensitivity issues rarely hurt at night.

•      Can you see anything wrong in the mirror? Gum recession is very common in sensitive teeth. If you see any noticeable holes, cracks, discoloration, gum swellings, or sores, something more serious is likely to blame.

•       How bad does it hurt? Intense pain requires urgent treatment. Don’t be fooled by minor pain though; dental problems can start small and snowball into a very painful situation.

The purpose of the information in this post is not to cause worry or fear, but to inform. Too often we see problems left untreated for months and even years—sometimes with very costly and significant consequences. If you are experiencing discomfort in your teeth, we’d like to help you resolve your problem and improve your quality of life. If you believe you have sensitivity issues, and don’t have cause to suspect a “true” toothache from the above questions, buy a tube of Sensodyne toothpaste over the counter from any grocery store or pharmacy and try it for two to three weeks. If the problem persists, it is something that you should get checked. Few things can be as bothersome and painful as as a toothache, but please don’t hesitate to schedule an appointment if you see signs of more serious problems. As with most problems, dental or non-dental, early detection and treatment are critical.

Nicolas K. Young, DMD

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Osteoporosis Medications

When visiting the dentist, every six months, you might notice certain questions that are consistently asked. One of these questions involves a group of medications called bisphosphonates. This group of medication is used in treating osteoporosis, or decreased density of bone tissue. These are very effective in helping to prolong the strength of weight bearing bones in the legs and hips. Osteoporosis makes these bones more likely to break. Breaking a bone is bad business and can have lasting effects. But breaking the bone of an osteoporotic spine or hip is more serious and can be life threatening. So, these medications are really important.

In some instances there have been reports of a condition called Bisphosphonate-associated Osteonecrosis (BON) of the jaw. This condition is seen in patients taking this type of medication. It is not very common but can be very serious. In almost all cases it is seen in patients taking this medication through an IV, while being treated for cancer. A very small percentage of cases were seen in patients taking the medication by mouth.

Here is a list of medications that are bisphosphonates: alendronate, ibandronate, risendronate and zoledronic acid. If you have had any history of taking any of these medications please inform your dentists. Dental procedures that involve any type of trauma to the bone can result in an increased risk of developing this condition. These include tooth extractions and any type of bone contouring. All other dental procedures are benign relating to this condition.

This definition of BON is taken from the Journal of the American Dental Association, volume 140, page 812.

BON is diagnosed in a patient who:

-has an area of exposed bone that persists for more than eight weeks;

-has no history of receiving radiation therapy to the head or neck;

-is taking, or has taken, a bisphosphonate.

For more information please see the link below.

http://www.ada.org/sections/scienceAndResearch/pdfs/patient_84.pdf

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Dental Implants

So, You Need a Dental Implant . . . .

“We will need to take out this tooth.”

Few statements said in our office, or probably any other, are as shocking or seemingly life altering to our patients than this one. We have had grown men and women break down in tears after hearing this proclamation.

Especially if that tooth happens to be a front tooth.

On the other hand, there are very few things that we do that compare to the positive life change that a permanent tooth replacement offers.

Dental implants have become a very popular and predictable way to replace one or more missing teeth. When done correctly they are a relatively simple, painless way to replace teeth. Their use has ballooned over the years into multiple areas. My goal with this post is to address how they can be used to replace teeth with a fixed restoration (i.e. a crown or a bridge) and the advantages of doing so.

When a crown or a bridge is placed on an implant it offers several advantages to other tooth replacement options:

1. Appearance - Because an implant is placed in the bone, the crown that is placed on the implant appears to be growing out of the gums just like a natural tooth. This contributes to a natural look and, consequently, confidence in the appearance of one’s smile.

2. Hygiene - As opposed to other tooth replacement options implant hygiene and maintenance is very simple. Just brush and floss around the implant like you would around a natural tooth.

3. Preservation of Facial Structures - When an implant is placed and properly maintained, the hard and soft tissues around it are stimulated and maintained for the life of the implant. Without an implant these tissues generally melt away over time causing unaesthetic boney contours in the front of the mouth and decreased bone support.

4. Function - When a tooth is missing from someone's mouth one or more things can result:

๏ Supraeruption – This is when a tooth has no other tooth to bite against and it continues to grow until it meets something (the opposing gums? Another tooth?) to stop its growth. This can cause both an unsightly tooth smile line (crooked teeth) &/or problems with biting patterns leading to excessive tooth wear and potential TMJ problems. An implant will hold the opposing teeth in place so this doesn't happen ;

๏ Tipping -- The teeth in front of or behind the empty site can tip forward or backward into the empty site. Along with crooked teeth this can cause problems with biting patterns and the gums. An implant will hold adjacent teeth upright and help avoid these problems ;

๏ Improper Chewing & Digestion – Missing teeth compromise your ability to chew food well, to digest it, and consequently your overall nutritional health. An implant functions just like a natural tooth and restores effective chewing.

Once an implant is placed in the bone and the bone has fused to the implant a crown is fastened to the implant. The implant essentially becomes the “root” of the new tooth.

Please see the Patient Education Pamphlet from Zimmer Dental linked below for more helpful explanations and pictures.

If you have any of those empty spaces in your mouth, or need to have a tooth removed, and would like to consider having one or more implant(s) placed to replace it/them please know that we are very familiar with implants and have been working with them for more than ten years. We would be happy to help guide you through the entire implant process. Please give us a call to set-up an implant consultation to see if implants are right for you.

We hope to see you soon!

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