Yesterday I had a 92 year old woman in my chair. She has been a patient of mine for about 12 years, and we have had a great relationship. She has always been so nice and gracious to us.She is having some health problems. Her main problem appears to be her eyes; she has macular degeneration, and can't see very well. They have told her to stop driving (even though she made it to the office driving herself, probably hitting four cars in our parking lot). She is moving about 3 hours away to live with her daughter, and told us this would be her last appointment.
Before she left, everyone hugged her and told her how much we appreciated her and how much we like her. She then thanked us for taking such good care of her teeth, and that was it. It seemed like I was at her funeral but she was still alive. It was hard.
This makes life seem so short. Our mortality is so right in front of us in times like these. And as my 42nd birthday is a mere 4 days away (if you are looking to send me birthday cards with gift cards in them, you can get my office address off our website. I am not saying I am expecting that, but it would be real nice), I can't help but think of my life. It is going so fast.
I want a remote so I can press the pause button. I love my life RIGHT NOW. I don't want my kids to become teenagers (I heard their heads spin around). I love when David (16 months old) hears my voice and stops what he is doing and comes running.
I love coaching my kids and driving them to school/practice/church/whatever.
But hugging Mrs. Jones yesterday means it is all going to end, and 40 more years seems too short. I know heaven is supposed to be so much better than this and I know that Jesus is sitting up there laughing at my simple mind. But what I know is this and I like this, and to be totally honest, leaving here kind of scares me (but that is a whole other blog). I was told once that life is like a roll of toilet paper: it starts off really slow but at the end it goes really fast. I agree.
Sorry about that. On to today's topic.
I have a friend that is also a patient. Well, he was a patient first but we got along so well that it led to families coming over for BBQs and such. He has been to my birthdays and such, so you know, a good friend.
He has always had issues with his teeth. The first thing we did for him was about 6 fillings, a couple of crowns, and an implant. And he is in his MID-30s. "Okay," I said to him, "I don't know where you have come from, but we now have a clean slate." We gave him a thorough oral hygiene protocol: brushing, flossing, rinsing with chlorhexidine. He has jumped on board with the whole thing.
Let me back up and tell you that people come in all the time with what they call "soft teeth." And every time they say that, I am thinking this is total bulls@#*. "Soft teeth" is a term (to me) that means "I don't take care of my teeth and I eat whatever the hell I want, I drink whatever the hell I want and then go to the dentist and try to blame my teeth." People think they take care of their teeth but they don't.
I know you hear, "I usually floss all the time, but I haven't in a couple weeks because I ran out."
"I usually floss, but my gums started bleeding so I stopped."
"I brush all the time. Should I be brushing in the morning, too?"
You have sugar-coated candy with an energy drink shooter for breakfast. For lunch, it is a bologna sandwich with some kids' cereal in there (to make it crunchy, like The Breakfast Club) and wash it down with an alcoholic energy drink. Then for dinner it's bread, bread, and more bread, and oh a gallon of soda. They you let it sit in there and fall asleep on the couch and forget to brush before bed. Well, this isn't "soft teeth."
Back to my friend. He has stuck with the plan we gave him and things are not that much better. His gums are still not beautifully pink like people on this routine usually are. So when he comes in for an exam and we tell him things don't look that good, he kind of gets dejected. You know the face that says, "This sucks, I work and work and I do everything you tell me to do and it still is not that good."
I sit him up and tell him that it is what it is. You have something going on that is beyond everyone's control. I think you are one of two people in my practice that I tell, "Do the best you can, but you are going to get decay. It is always going to be a battle and if you didn't do the regime that we gave you it would be a lot worse. You are going to do everything you can, but you are still going to get cavities."
I will be as conservative as I can, but don't get mad at me when I tell you it is time to fill a cavity. I tell him that I don't know why it is happening, but we will continue to communicate and try new things as they come out.
Do you have patients like this? We do rinses, we do fluoride trays, high-concentration toothpaste. Nothing seems to work. They claim they have cut out the soda and are strictly water. What else can I say to them?
I just read an article in this month's AGD impact about Proactive Prevention and I learned about a lot new things I might start trying.
Have you heard of these Salese™ lozenges? Me neither.
How about pilocarpine lollipops? GlyLic™ lollipops? Arginine mouthwash? Anyone doing a saliva analysis? Do you have your patients brush with baking soda - straight?
These are all new to me, but what the heck? I am going to try it. I just don't want to be writing a blog 25 years from now telling you about that I just finished putting in 12 implants for my friend.
How is it with you? Am I the only one that feels helpless to these kind of patients?
Have anyone with "soft teeth?" What are you doing about it?
Have a great Wednesday. See you in a couple of days.
john
12 comments:
Agree - my patient told that to me yesterday -- that he had 17 teeth extracted 30 years ago because he had "soft teeth."
How about xylitol lollipops or adding Ice Cubes gum (5 or 6 pieces per day?) I've got one of these too...no idea! I have a patient who is a dental student and she mentioned that they are learning about celiac disease and its relation to dental decay. I only graduated 10 yrs ago but heard none of this when in school. there is some research on the topic. Try googling it! Good luck. Let me know if you have any suggestions for me to try!
Did you try GC MI Paste Plus?
Diet!!! and or Dry mouth. Both are a losing battle. I have gone back to using glass ionomer in surfaces that don't show.
i would also try xylitol! keep us posted.
I am not a dentist...just the mother of beautiful 23 year old daughter who wore braces for 2 years and has gorgeous teeth and smile. She is so proud of that, and she takes great care of her teeth. A year ago, we had 3 cavities filled...one year later, she calls and tells me she has 7 more cavities. What in the world. She cried and begged me not to even tell anyone else that she has them because she is so embarrassed and doesn't want anyone to think that she doesn't take care of her teeth. What next? Is there a way to offset this track she seems to be on?
Concerned Mom!
Debra,
Your concern for your daughter is admirable.
I have a couple things I thought of as soon as I read your comment.
First, that age is probably the highest amount of caries age for me at my practice.
For their whole life they are under the close watch of their folks. Then they go off to college and they start drinking Mountain Dew by the 2 liter. They get introduced to beer and sometimes have too many and "forget" to brush their teeth.
From personal experience, I did not have my first cavity until I was 21 (and I got nine).
I did the Mountain Dew and beer X2.
Even if your daughter is not in college you are probably loosening the reins a bit and a lot of times the oral hygiene starts to lag a bit.
Now, it sounds like she might be taking care of her teeth so I started thinking my second thought.
It might be the dentist. Now I am not throwing this guy/gal under the bus. But to go from no cavities to 10 cavities in a year....Red Flag.
Now if you like this guy and trust him that is another story but if I were you I would get another opinion.
I just did a filling on a woman we came to me for a second opinion that her dentist told her to remove it and get an implant. I did a $250 filling. He wanted to do $3800 worth of work that would take 6 months to a year.
But lets say it is all legit and she really does have 10 cavities in a year (he/she should have seen this coming and let you know that things were not looking so good and that if the oral hygiene doesn't turn around we are looking at a lot of cavities)
then she does need to take a real hard look at what she is putting in her mouth and how she is cleaning her teeth.
We need to look at the amount of sugar she is ingesting (that is drinks as well as food) and she needs to be meticulous about her home care. That is brushing (the full two minutes) 2 times a day, flossing, and rinsing.
Hope that helps.
john
"Soft teeth" may be used as an excuse by a lot of people, but I'm surprised you haven't heard of Amelogenesis Impecfecta or Dentinogenesis Imperfecta, where the enamel is thin or abnormally formed leading to discolored, weaker, easily damaged teeth. I'm not a dentist, but even I know about it after just a little research. Imho, you shouldn't dismiss someone's concerns so quickly. Isn't it easy enough for you, a dental professional, to determine whether or not the person has poorly formed enamel (vs enamel they wore away with poor dental hygiene)?
My dad was told he had "soft teeth" when he was a preteen. His dentist upped the flouride treatments while his teeth got worse, cracking, crumbling, cavity after cavity. When he joined the army as an adult, his remaining teeth were removed and replaced with dentures. My questions to him had been "Why didn't your parents take you to the dentist more often?" and "Why did they let you eat so many sweets?" He told me they did take him for regular cleanings and for multiple other visits from preteen to teen years. He said he ate less sugar than his siblings or his friends, never drank soda, and he brushed his teeth regularly, even more so when he started noticing the discoloration, but nothing worked.
He didn't pass on any "soft teeth" genes to us, but he did pass on his dental hygiene habits. As kids, refined sugar was a rarely given dessert, and we always brushed after. Bedtime brushings were always met by an inspection from our dad; he didn't want to take any chances. I didn't have my first cavity until I was an adult and no longer following the established routine. (Sadly I did, as a child, have crowded teeth with a small mouth so I was no stranger to that needle. Many teeth were removed before giving me braces, but all of the teeth were healthy.) I can't say what testing was done on my dad as a kid, but whether or not my dad actually had the genetic condition of "soft teeth," it does exist.
Danielle,
I appreciate your comments, I really do.
I appreciate you going on the internet and trying to find out more about teeth. I appreciate you reading my blog.
Telling a dentists about Dentinogenesis Imperfecta is like telling a cook about pots and pans.
I know about DI and AI. And I don't think I was dismissive. In fact if I can remember this blog I was talking about one of my friends who I know is taking very good care of his teeth. In this case I have a feeling it is a bacteria flora issue.
I know teeth. I know diseases of teeth and I know when someone is not taking care of good teeth and I know when someone is taking care of "soft teeth".
Talk to you later ,
j
I'll approach this from a different angle. I'm 46 and have had 2 fillings in my entire life. Although for the past 10 years I've gone to the dentist 1-2 times per year, this was not the case throughouit my teens and twenties. My longest period without seeing a dentist was nealy 8 years. My diet is full of sugar, I never floss, and brushing is only once per day before I go to bed. I do have some receding gums but my teeth are fine. On the other hand, my wife has a very heathy diet, brushes twice per day, flosses every day and has a mouthful of fillings. She is diligent about seeing the dentist twice per year and has done so her whole life. Now our daughter who is six with the same habits as my wife has already had 2 surface fillings and needs 2 fillings in her brand new molars. We all go to the same dentist. Call it "soft teeth" or whatever but lack of care is not the reason for my wife and daughter's issues.
I just wanted to leave my personal story about my soft teeth. When I was 18 months old I suffered 3rd degree burns on 75% of my body. As you can imagine I was pumped full of antibiotics so I could survive. My dentist as a child recognized I was excessively prone to cavities. When my adult teeth started to grow in spotted yellow and brown, his suspicions were confirmed. My enamel was weak as a result of massive antibiotic use when my teeth were still developing. now, I had the same dentist from infancy until I was 18. Unfortunately, due to insurance issues, I had to go without care for 3 years. My new dentist, unfortunately thought like you did, and he mistook my soft teeth as a lack of hygiene. I was insulted. I take care of my mouth. If I didn't I wouldn't have any teeth left. Unfortunately through all the decay, and filling on top of filling finally resulted in 4 root canals. At this point, after getting so much crap about how I'm not taking care of my teeth from every dentist I've seen...I'm just going to say screw it and save up for implants.
Thanks for your story. All us dentist need to hear it.
I just saw another patient today that just can't stop getting cavities. She does a pretty good job at home.
I just don't know what to do.
I introduced her to xylitol and told her to chew gum all the time.
john
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