I had just finished discussing the oral health of a patient who was new to my practice when she asked me “why hasn’t anyone ever shown me or discussed things like this with me before?”  She proceeded to tell me of all the wonderful Dentists she’s seen, people who she respected and liked.   She was amazed at the level of detail, the photographs, the analysis and the time I took to discuss all of it with her. Her comment took me a little off guard and after she left I started thinking of WHY I do things that many other dentist don’t.

I won’t even discuss the issue of Insurance and why it is ruining health care by promoting “sick care” and devaluing Doctors’ time and communication time. That’s a whole other blog!

Have you heard of the 80/20 rule? It’s applicable in many areas and I think it applies to Dentistry as well. 80% of people have fairly routine dental issues like decay and gum disease.  20% however, have more complex issues such as bite issues and systemic interactions. Because of my training and teaching experience, I see these issues when others may not.   Most Dentists treat everyone like the 80% because that’s how they’re taught in Dental School. I look at everyone like the 20% first, and if they’re lucky to be in the 80%, great for them and it makes my job of helping them stay healthy, easier.

Is the 80/20 rule WRONG?

But I’m seeing a lot more people with bite and systemic issues than I ever have. Could the 80/20 rule be wrong? Could it be that most Dentists just aren’t seeing these problems? I think that’s certainly possible because in my Practice, more than 50% of people have some form of complex issues.   It’s up to you to make sure you find someone who looks for ALL the problems.

For example, sensitive teeth are a common problem and complaint. I know it’s common because every toothpaste manufacturer produces a “sensitive” version. They do it because it sells and it sells because it fills a need. So why are people’s teeth sensitive? The toothpastes work but they treat the symptom and not the cause.

What’s the cause of sensitive teeth?

The 2 most common, non-decay causes are stress and acid erosion.

Stress such as from clenching and grinding can cause teeth to become sensitive. Stress can also cause gums to recede, exposing root surfaces with are porous and can transmit signals to the tooth’s nerve.

What causes clenching and grinding? That can be very complicated.

It could be sinus issues. That’s right, those allergies and sinus problems you may have can be contributing to your clenching/grinding. How?  Your body wants to equalize the pressures in your sinus and one way of doing it is by pushing up on the sinuses as by clenching.

It can also be airway problems, like those that contribute to snoring and sleep apnea. If you snore, you might also be experiencing some level of sleep apnea. This is a very serious issue as it effects your whole body, depriving it of enough oxygenation.

WOW, it’s complicated isn’t it? Does your dentist have the training to see if these things are going on in your mouth? Does he see the 20% or just the 80%?

I don’t know about you but I want someone who sees close to 100%

Michael

I want to congratulate all the Doctors who made it into New York Magazine’s Best Doctors issue. In fact, it was great to see one of our friends’ children, Dr. Scott Moerdler pictured on the main page of the article.

I’d like to particularly congratulate the 30 patients of mine who made it onto the list. I feel extremely fortunate to have so many Best Doctors as friends.

The article made me think again about what is truly “The Best”.  Is there really such a thing? I think not in the absolute. Choosing a healthcare provider is extremely complex and I know many great physicians who are not on this list.

I really believe that it depends on your personal needs, your specific goals and wants. Do you need someone with a dynamic personality and fantastic bedside manner? Do you need someone warm and fuzzy or are you content with expertise and results?

Do you have a non-routine problem?  Are you in need of a ‘super-specialist’? Are you one of the “challenging” cases that Lisa Sanders, M.D. writes about in her weekly The New York Times Magazine article that I love to read?

When I personally refer to another Doctor, I consider many issues and perhaps you should as well.

1. Does the Doctor have specific expertise in the area in which the patient needs?
2. Is the Doctor readily accessible?
3. Does the Doctor’s personality mesh with the patients’?
4. Is the Doctor communicative with the patient and me?
5. Is the Doctor’s office efficient?
6. Does the Doctor have emergency coverage?
7. Does the Doctor use the latest technology to help diagnose, treat and communicate?
8. Does the Doctor have a passion for what they do?
9. Does the Doctor demand excellence from himself or herself as well as those around them?
10. Is the Doctor’s office a reflection of their care, skill and passion?

Please excuse me, as I did not list financial considerations as a criterion for choosing a Doctor. While that is a personal decision, I believe that I’d rather sacrifice other things than my health.  Many of us have the latest smart phones and cable TV.   We take vacations and drive cars that aren’t necessarily the least expensive on the road. In short, we make value judgments all the time about how to spend our money.

There’s a saying that says: A healthy man has many worries; an unhealthy person has only ONE!

Yesterday I went to a New York State Dental Foundation luncheon.   There, I heard the honoree, Dr. Charles Bertolami, dean of NYU’s Dental School talk about the challenges posed from “Junk Science”.  I couldn’t agree more.

Junk Science takes the form of information, mainly disseminated via the popular media and the Internet about health care.  Claims about efficacy, results and benefits as well as negative reports of allergies, adverse reactions and negative outcomes can make sensational headlines.

People often look at the HEADLINES and not at the whole story.  Our attention spans have shrunk along with the increase in information being thrown at us.

Even articles in well-respected, peer-reviewed journals such as the New England Journal of Medicine, JAMA or JADA can be faulty.  We’re human and make errors.   Statistics can be misinterpreted and faulty conclusions drawn.  It happens more that you’d like to know.

I’ve seen this personally, many times.   In the 80’s there were articles published about a new solvent that could dissolve-away decay.  WOW, no more drilling?  GK-101 was eventually marketed as a system called Caridex.  It was a dismal failure because the system couldn’t truly distinguish between decay and healthy tooth.  It was based on faulty, “Junk Science”.

How does one make sense of it all?

It’s hard.   That’s what I see as one of my main responsibilities as a Doctor.  I read incessantly and always take courses on the web and at conferences.  In fact, even I have a hard time keeping pace with all the information.  I love trying.  All good Doctors do.

People ask why I don’t do certain procedures.  I answer that being a Generalist is the hardest thing in healthcare.  It’s nearly impossible to read all the journals and keep up on the latest in all specialties.   It’s why I have relationships with some of the best specialists is the World.   They share the same passion I do about keeping up with the science.

Trust.   It all comes down to it.   You have to trust the right people to sift through the science and data and distill out what is most relevant to YOU.

I was coming home from San Diego where I attended the American Academy of Pediatric Dentistry annual conference.  I didn’t go to learn, rather I went to recruit Pediatric Dentists to work at the DVI, free children’s clinic in Jerusalem.

I couldn’t resist, so I did attend one lecture.  It was about how to minimize radiation to patients.  Believe it or not, most Dentists are (or should be) concerned about minimizing “life-time” radiation.  the lecturer spoke about digital vs. film and protection such as Thyroid collars.  It was a confirmation of everything we currently do in our office.

Fast forward to the Airport.  We enter the security line and my wife, Laurie is asked to go through a “back-scatter, X-ray detector.  I was not.  Wisely, Laurie refused.  She knows that the effect of radiation is cumulative and one never knows when they’ll need to have diagnostic radiation, so minimizing it, is always a smart thing.

Unlike our previous such encounters with the TSA, a pleasant woman came forth to do a body search on Laurie.  She cordially asked why she chose not to go through the scanner.  After all, she said, “It’s a safe x-ray”.  In fact, we observed a pregnant woman go through several people in front of us, before we could stop her as we have previously done.

Safe X-rays?  Who’s kidding whom?  There’s no such thing.  The thought of people, like those in the TSA, utilizing dangerous equipment without the appropriate knowledge is scary, to say the least.

When an employee is hired in my office, in order to emphasize the impact of radiation such as X-rays, I use the following analogy.  Taking an x-ray is just like using a scalpel.  The only difference is that with a scalpel you see the cut immediately because of the blood and with an x-ray, the cut is made with radiation and you won’t see the damage for years.  Ionizing radiation, of which x-rays is an example are dangerous.  We’re exposed to them all the time.  Our sun produces them, so do our microwaves.  You can’t avoid them…but you can avoid them in the airport and at the Dentist office.  So, please be careful.  Ask questions.  Make sure you know all the facts and if a technician or a TSA agent can’t answer your questions… JUST SAY NO.
Michael

I’ve been fortunate to know many people who appear in the media.   I’ve been proud to know these people on an intimate basis and call them both patient and friend.   Indeed, I feel blessed to have been given the opportunity to interact with such interesting people. On the front page of Saturday’s New York Times, a former patient Dr. Robert Spitzer was featured.

Bob and Janet had to move away as a result of his battle with Parkinson’s disease, as the article mentions.  Bob, mentioned in Wikipedia as “the most influential Psychiatrist of the 20th century,” recanted a position he took on homosexuality, that some “highly motivated” individuals could undergo therapy to change their sexual orientation.  The healthcare community has obviously moved beyond such an archaic notion and never attempted to “change” a person’s sexual orientation.  I give Bob a lot of credit.   It takes a big man to admit that he was wrong and doing so on the front page of the Times takes a lot of courage.   Bravo Robert.

Many of my patients are well-known psychiatrists.   I’ve joked that when they come in, we should switch positions and I should lie down and they sit.  This week, I spoke to one who is on the current DSM V team, just as Robert Spitzer headed the DSM III panel.  DSM is the “Bible” that is used by the health care industry to categorize and define mental illness.  It helps clarify a very difficult area of medicine and is constantly evolving.

I’ve been privileged to know many psychiatrists who have worked on the DSM teams.   I can categorically tell you that they are wonderful, well-meaning individuals who are seeking to perform a service to society by making mental illness more defined.  In fact, all the Health Care Professionals I know share this; A desire to HELP humanity, not just themselves.  That’s really what sets us apart.  If we wanted to just help ourselves, we’d have chosen a different path, not healthcare.

Realization and acknowledgement that health professionals want to help and truly care for their patients is a source of the trust the public gives to healthcare practitioners.   When that trust is misplaced, it is a blow to each of us.  The reason I wrote What The Tooth Fairy Didn’t Tell You is to help you “trust” the correct dentist.  We are each human, subjected to pressures and circumstances to which we have to adapt and respond.   Some respond better than others.  Your job is to find the right team for your needs and to monitor your results.   It’s a continuous process that is aided by knowledge.

I will continue to help you by discussing topics of importance in Dentistry so you can ‘trust’ the care and advice you’re given by your oral health providers.

So…keep tuning in and ask questions!

At issue in the latest 2 BILLION DOLLAR snafu was something called “risk management,” or how large corporations and even government police themselves and protect themselves, their clients and citizens from unfair and possible hurtful practices.

Jamie Dimon’s a smart man.   He’s known to be one of Banking’s Top Risk Managers.  Why didn’t he or other big companies control their risks better?

Perhaps they can’t.   Perhaps it’s inherent with growth.  Perhaps the mantra shouldn’t be “Too Big To Fail” but “Too Big is Destined To Fail”!!  Is that what happened to Countrywide, Lehman Brothers, to The Roman Empire?   Will it happen to the USA?

These are scary thoughts and beyond the scope of this blog.   What lesson can we learn regarding your health and particularly your oral health?

NO ONE CARES MORE ABOUT YOU…THAN YOU!

Ultimately, you have to be responsible, which is why reading my book is so important if you’re going to find a new dentist.   You have to take responsibility for educating yourself and finding a caring, compassionate and skillful healthcare provider.

All Dentists Are Not Created Equal

From 30 years in academia and 35 years in practice, I’ve met many dentists.   I can categorically tell you that all, myself included, have various levels of expertise, natural talent, communication skills, motivation and compassion.  Most, go into the profession because the want a one-on-one opportunity to help people.

Most Dentists want to help people.

So, if that’s true what gets in the way?  Often, it’s money.  We’re a capitalist society.   It’s part of the culture of our Country.   In the US of A, if you work hard you can succeed.   We believe that we’re rewarded for our efforts.

Insurance Companies are trying to change that.  

Insurance companies, big bureaucracies, try to make healthcare a commodity, like milk, sugar and oil.   Similar procedures are equally compensated.  Similar levels of expertise are equally compensated.  And worst of all, different results are rewarded equally.  It’s the only way they can control the “risk”.

Insurance companies have a mission.   It’s to make money.   Let me repeat that.   Insurance Companies just like Banks are in the business of making profits.  They have shareholders to whom they are responsible.   Their executives’ compensation is calculated based on these profits.  This is a huge issue, one that I will address at another time.

Insurance Companies are NOT the agency to act in your best interest.  If you get sick…they lose money.   Yet, their strategy isn’t to help you prevent disease, it’s to control payments to Doctors.   Does that make sense?   Not to me.

What Does This All Mean For You?  Who should you TRUST?
Let’s look at Mary.   She (not her real name) came to me because she was told she needed a huge amount of costly and perhaps even painful treatment.   She had been going to the same Dentist for 8 years and the same office for over 20.   Suddenly, she was told that she needed all this “work”.

Mary did the smart thing.   She went for a second opinion.

What I told Mary after taking a scan (that her previous dentist never took) is that she’s in terrible shape.   She has gum disease that will result in the loss of 3 or 4 teeth that will need to be replaced.   The amount of money she will have to spend to re-build her mouth and get it into health is nearly 7-8 times what her previous dentist quoted.   More important, the treatment recommended by the previous dentist wouldn’t solve her problems.

Where did Mary go wrong?

She chose poorly.  She put trust in the wrong person.   That trust was misplaced and caused her to ignore the sign she had that something was amiss.  She could have read the signs better if she were educated about oral health.

Some of the signs that something’s wrong:
Bleeding gums are not normal.

1. Discomfort while chewing is not normal.
2. Uncomfortable hygiene visits are not normal.
3. Getting food caught between your teeth is not normal.
4. Bad taste and odors are not normal

Mary had some of these signs, yet she ignored them because she trusted her Dentist.

What can YOU learn from this?

1. Educate yourself about yourself.
2. Ask questions.
3. Tell your healthcare provider about ALL your symptoms and other healthcare issues including ALL medications, supplements and diet changes.
4. Find a healthcare advocate that will help you do a RISK ASSESSMENT.

Risk Assessment?
That’s right.   What J.P. Morgan Chase was supposed to do with their investments is just as important for your health.  A good healthcare provider will base their treatment recommendations on a thorough assessment of your health and a subsequent risk assessment.

Risk determines treatment.   Risk management determines outcome.   RISK ANALYSIS IS IMPORTANT.   RISK MANAGEMENT IS CRUCIAL.

As a Dentist, I’m charged with assessing (doing risk analysis) several potential diseases and functional issues.

1. Oral Cancer
2. Systemic interactions
3. Periodontal (gum) Disease
4. Decay
5. Bite issues
6. Digestive efficiency
7. TMJ, joint function
8. Facial Pain
9. Sleep/Snoring issues

10. Cosmetics/Esthetics

RISK MANAGEMENT is our mutual responsibility.  That’s not a cookie cutter approach.   It’s individualized.   It’s not part of an insurance-driven model.  It’s time consuming.   It’s the RIGHT THING TO DO.  Most importantly…

IT’S WHAT’S BEST FOR YOU

I became a Dentist because I want to HELP PEOPLE.  If it were money I was after, I’d have gone to business school and worked on Wall Street.  I chose a different path.  It hurts me that some in my profession don’t take the “TRUST” that people place in them seriously enough.  I’ve written letters to Organized Dentistry.  I wrote this book to help.   HELPING OTHERS is what it’s all about.

It starts by helping yourself.  Read the book!

I know its not politically correct but I’m not a politician.  Men and Women are different.   I don’t ask for directions.   I don’t like to talk on the phone.   I don’t say, “I love you” as often as my wife would like and I ignore little pains.  Guys are not as good as they should be about their own maintenance.   How many women would shave their heads so they don’t have to get a haircut?   I’ve seen plenty of guys do it.

Ignoring things is something men typically do more often that women, especially when it comes to their mouths.

Statistics bear this out.   Most dental practices have 50% more women as patients than men.

You would think that Doctors would know better.   As someone who’s known by my peers as “The Doctor’s Dentist” because of all the healthcare professionals I treat, I can tell you that’s not true.   The 70/30 rule applies to them as well.   More male physicians ignore their problems than females do.

I can’t stress enough how important it is to visit your dentist regularly.   Why?  Because there are so many problems that don’t manifest themselves until its often too late.

I’ve seen very smart people, yes, even medical Doctors come in with problems that could have been prevented or treated simply had they only come in sooner.

Dentistry has been great at preventing disease.   But, it requires people to come in and be treated.   And…the earlier the better.

Let’s talk about oral cancer.  37,000 new cases of Oral Cancer are diagnosed each year and over 5,000 people will die in the US  this year alone.   Worse is that the 5 year survival rate once it’s diagnosed is only 50%.  To put this in perspective, the survival rates of women with stage 1 and 2 breast cancer is 80-96% because early detection is the key.  We’re just not finding oral cancer early enough because early on, it doesn’t hurt and you can’t easily see it.  You can’t do a self-mouth cancer exam.

For that alone, it’s worth visiting your dentist regularly.  And, if your dentist or hygienist doesn’t do a routine cancer examination…go elsewhere.

How do you know that your dentist/hygienist is doing a cancer exam?   The easiest way is to see if they ask you to stick your tongue out and look under it.   There are other things involved but this should be the most obvious.   If your dentist/hygienist doesn’t do this routinely….seek one who will.

I don’t know a lot about cars and even what I did know years ago, has been supplanted by computers and technical enhancements.   Cars are just way more complex than they used to be.   The only thing I can really do is change a tire and I try not to do that either.   And, I’m dependent on my car.   In a way, I hate being dependent on something I don’t fully understand and can’t fix when it breaks.  So, I’m really careful about maintaining it so it doesn’t break.

In this regard, I’m just like any one of my patients.   I’m just like you.   You need your mouth and when something’s not right you probably don’t know how to fix it.  You have to rely on me (or your dentist) as I have to rely on my car mechanic.

Plus, because we now know just how important your mouth’s health is to your overall health, fixing it and keeping it in tip-top shape is more important than ever.

And…some dental problems are sneaky so you may not even know you have a problem until it’s too late.  I’ll talk about this another time.

I appreciate that ‘helpless’ feeling and empathize with my patients.   It’s one of the reasons I love showing them video pictures of their mouths.   It enables them to really see what I’m talking about.  I can’t imagine not using this technology to help my patients.

Would you go to a mechanic who doesn’t know how to use a computer when your car runs on one?

You certainly can’t call or rely on the Tooth Fairy!  If you do, or think you can…your problems lie a little north of your mouth.

What can you do?

• Find a dentist you trust.
• Educate yourself so you don’t get taken advantage of.
• Prevention, prevention, prevention.

And finally…READ THE BOOK.

And…Ask me questions.   I’m happy to help, if I can.