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On The Hubris Of Tooth Doctors


  02:31:33 am, by Nimble   , 2303 words  
Categories: Thoughts, People, Science

On The Hubris Of Tooth Doctors

Okay, it's a rant, I admit. Despite many a dentist I've met that's nice, there are some I've met and some observations I've made that have, over the years, painted a picture of arrogance and mythology amongst dentists and orthodontists that I find irksome. I'll pepper this with a few anecdotes - I'm sure you may have your own.

The state of the art in dentistry has moved forward incredibly. Root canal technology is amazing, cosmetic dentistry has moved forward by leaps and bounds. There are better braces out there.

That all said, some of the fundamentals seem to be lagging. There is still a pervasive belief out there that there are two panacaeas to everything in dentistry: fluoride and flossing. Fluoride for adults seems to be just fine. Fluoride changes the hydroxyapatite in tooth enamel into fluoroapatite, which isn't nearly as acid-soluble, but which is somewhat more brittle. In children, however, it can cause tooth pitting, especially in communities that already fluoridate their water.

In Dena's town where she grew up, Strathmore, there was water fluoridation in place. Both she and her father developed this pitting. When there were fluoride treatments come to town, despite an explicit note excusing her from this, adults were constantly trying to push her into the fluoride line.

Flossing is the other one that seems to have an amazing myth of being a cure-all. Actually, no, it's the other way around. Anything wrong with your mouth can be explained by "not flossing enough". "Do you floss?" "You're not flossing enough" By poking your gums directly with sharp implements and having them bleed, your dentist may hope to convince you of this fact. Strangely, the amount your gums bleed depends less on the amount you floss than which dentist you have.

If you are one of these poor unfortunates, try an experiment. Actually floss. Lots. Religiously. Then go back to your next dentist appointment. "Did you floss?" "Yes" "Are you sure?" "Yes"... and have them poke around in your mouth, muttering to themselves under their breath that you must be lying. I've never had a dentist who could tell the difference between flossing lots and flossing hardly at all. I'm sure they would insist they could.

I breathe through my mouth at night as opposed to my nose. I don't know if this is because I have no more adenoids or not, but very few dentists have been aware of the extra irritation this can cause. The "usual" accusations come from the others.

Being empirical and all that, resorting to stock phrases and beliefs annoys me.

Then there's the evil calculus. Not math, although that calculus is also evil, but the term for tartar or mineralization or whatever have you. The stuff they pick off your teeth. If this stuff is so deadly, then why not show us how to take care of it ourselves? Dental picks are not that expensive - you even see them in hobby stores. Tartar-control toothpaste does a not-very-good-job at keeping it away between appointments. Personally, I would need a mere small amount of instruction. Currently, I look at my teeth and can't tell what's calculus and what's not. How about disclosure tablets, but for calculus instead of plaque?

I will now throw in a couple of anecdotes of woe for your viewing pleasure.

I've had one root canal so far. It was well done, but I chafe that it was necessary in the first place. I have deep cavities in my back molars. Is it from not brushing or flossing? Well, indirectly, and not for lack of wanting to. Those teeth were the anchor points for my braces. The braces that were supposed to be on for a year and a half, according to the orthodontist. But, like meetings, you are suckered in to believing this timescale, and when the deadline swoops by with no end in sight, you feel trapped. I'm sure my teeth are even straighter due to the extra time. However, that extra time made for cavities, severe ones on the molars, and minor ones on every single other major anchor point in my mouth. Considering how much extra I'm sure the extra time and appointments cost my parents, and the outcome, I consider that negligent. I am assured that he's a high-up professional now. That's small comfort.

A more recent tale concerns what can happen when an old dentist retires and a new one takes over. The new partner was extremely skilled, loved to do complex procedures. Loves to do complex dentistry.

I can hardly believe, though, I've ever seen such naked greed.

No, seriously. Hear me out. I grind my teeth (I'll come back to that in a moment), so my teeth surfaces are fairly worn down and flat. One slight upside to that is that I can finally close my mouth - I've suffered from a gummy smile most of my younger life. Now it's just fine.

First, he started in with the offers of what he could do for me. We could grind this down, put veneers on them, extend them, and you'd have excellent looking full-size teeth. Fair enough, but no thank you.

Then, over time, he started laying into me over this. "Your surfaces are worn," he'd say, "it makes you look really old. Do you want to look really old?" and so on. That and, "you know, if you're worried about how much it costs, we can provide you with really good credit/payment plans/loans". Jesus, does this guy have a crack habit he's trying to pay for?

The last straw was when I checked the scheduled appointments they had for me. They're supposed to run everything by me. They usually do. However, I saw that I was pencilled in for another expensive root canal... without even having had it mentioned to me, much less approved.

That was the last time I ever showed up there. A pity, too, because the staff is extremely nice. The dentist is, too, quite frankly, but I'd rather have niceness and the feeling that I'm not just a vein of cash to be mined.

So, I'm a bit bitter.

The field isn't totally like that. I do miss my old dentist, Rebryna. She was going off into some dental research, from the sounds of it. I wonder if she ever did. There was a question I told her to find out for me if she ever got the chance: does it make a difference whether you brush your teeth with hot water or with cold water?

One last thing: tooth grinding. I want it solved. The technical term is bruxism or bruxing. There's no accepted cause. There's no accepted cure. Just get a piece of plastic in your mouth and that's it. Are we really no further ahead with this than we were twenty years ago?

Now I can stop with the bulging vein in my forehead :)

Share your tales of woe, or quite frankly of awesome dentists or even orthodontists (they exist)


# Be glad you're not a grinder like Dale -- he tends to get through the plastic protector within a month. Literally chews through it in his sleep. As for me, despite having spent most of my youth in places where fluoride was in toothpaste, not water, my teeth are in pretty good shape. The most fiddling any one did in there was to remove my wisdom teeth in my teens. As a contra-example, my niece in Richmond BC where they don't fluoridate the water, already has fillings despite having a mother who mandates brushing and not eating a lot of sweet foods. Go figure. I reckon it's all luck of the draw with a few contributing factors.

Comment by Adam [Visitor] — 08/10/05 @ 13:32

# Disclaimer: I do not work for Oral-B. :p

Ritchie, if you don't have one already, get yourself a good electric toothbrush. You'll probably have to spend at least $75, but the results are well worth it. Before I got mine (this one: http://www.oralb.com/products/product.asp?tid=products&sub=power&cid=power&pid=3d ), I usually had to endure a lot of heavy scaling when I went in for checkups and cleaning. Now, the dental hygienist tends to say things like "Your teeth are so clean!" and "Well, there really isn't all that much to remove here." At my most recent appointment, the hygienist even insisted that the gum recession at one spot in my mouth had actually reversed itself a bit. I'm not complaining. :)

Now if I could just stop my wisdom teeth from decaying. Unfortunately, since they're so far back there, it's difficult to clean them thoroughly. Root fillings are NOT fun, especially at the very back of the jaw. :(

Comment by Lorelei [Visitor] — 08/11/05 @ 17:04

# It's long been the aim of my dentist to have my wisdom teeth out, and at my last visit the hygienist found "something going on" in one of them. Looks like the dentist will finally get his wish. Unfortunately, after having a look at the xray, nobody in the office wanted to handle it. I had a look, and there's a nice large nerve curving next to the root of the tooth. Looks like it's surgery for me...oy. I'm told that it's for the best, dentists being better with a pair of pliers and dental surgeons for handling tricky teeth. Maybe I'll get the other one out at the same time...

They're big fans of flossing and electric toothbrushes at my dentist too.

Comment by ElTwo [Visitor] — 08/13/05 @ 00:20

# The wisdom teeth on both sides have erupted and the one in question is largely made up of metal since I haven't always been diligent. It sounds like something's gotten started again underneath the filling and it's the dentist's opinion that going after it with another filling wouldn't leave much tooth left. Then they had a look at the xray and got spooked. :)

The other one seems to be fine so far. Of course, they want to get rid of that one too, since "it's so far back that it's bound to develop a cavity" and have to be dealt with.

Comment by ElTwo [Visitor] — 08/18/05 @ 23:33

#Adam - poor Dale; I have bruxing but certainly not to that extent. It bugs me a bit that after all this time, the only advice they can give on the subject is "use plastic" or "pay a dentist a small fortune to put ceramic caps on all your teeth", or "relax and listen to soft music to relieve the stress before you go to sleep". I'm with you on the luck of the draw plus-a-bit.

Lorelei - I may do that again, though I must say that when I had one, many years ago in electric toothbrush and WaterPik (remember those?) form, it didn't seem to make much of a difference. Ultrasonic scalers have been around for quite a few years, and I haven't found anything that compares them negatively with hand-scaling yet - most of the clinical I've come across rate them as good for cleaning, better for rinsing, but with a risk of bacterial sprayage. I don't know if they make a home version, but it doesn't seem like there's any good excuse for dentists to do the gum-poke-until-you-bleed these days.

Lowell - Is there anything actually, actually wrong with your wisdom teeth? Are they crowding out the other teeth in your mouth? Is there an infection going on? Wisdom teeth and root canals are things that (according to pre-dentistry coworker) dentists love to work on, practice and, of course, charge for. If the wisdom tooth is causing you no problems (I only ever had one erupt, and there hasn't been a single problem with it), then tell them to f___ the hell off. Wisdom teeth are not problems in and of themselves. That would be like going for voluntary appendix surgery without appendicitis, with more pain and about as much recovery time.

I was tootling around on the 'net, and found an interesting web page on a site that is otherwise (IMO) sucky, all about mouth chemistry. It's a very cool read for even the lightest of chemistry geeks :)

Comment by nimble [Member] — 08/17/05 @ 11:35

# That preventive removal sounds idiotic. I mean, it's not "might as well kill your cat now - it'll be dead in two years" kind of idiotic, but it sure feels the same. Unless it's got a cavity NOW, the chances of it suddenly deciding to miss its partner teeth and commit suicide don't seem all that big. I've left dentists over attitudes like that.

The ideal dentists these days seem to be the ones that have some of the latest equipment, but not all of it (one wonders where they get the money otherwise), that are fairly old but not crotchety, and who don't think that you have less interest in your own well-being than they do.

I'll have to start looking again. My last dentist I liked had a waiting list to get on with them. Just like contractors, that often means that they're worth it ;)

Comment by nimble [Member] — 12/23/05 @ 19:15

# That's been my argument every time they bring it up. Unless it has to come out, I'm not interested.

Judging from the newsletter they just sent me, my dentist is halfway out the door into retirement fairly soon here.

Comment by ElTwo [Visitor] — 12/24/05 @ 22:51

# Good to hear :) Gads, where else can you get away with "preventive surgery"?

Does your dentist have any succession plans? At my old dentist's, they brought in a more junior replacement a considerable while before retirement happened.

Comment by nimble [Member] — 01/01/06 @ 12:26

# They're shuffling in the new generation, but I haven't been introduced to them yet. I mostly go just for cleanings, and there isn't usually much interaction with the dentist. Unless, of course, I've been negligent in my dental habits. :)

Comment by ElTwo [Visitor] — 01/03/06 @ 05:12

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