Dental Phobia: Conquering Fear of the Dentist

(Photo: Emir Memedovski/BigStockPhoto.com)

The newest Dental Smarts site made its debut a few days ago: Dental Phobia.
Anyone who is avoiding dental visits because of dental fear might want to take a look. My observation over the years I've been practicing dentistry is that people with real phobias (be they fear of flying, spiders, snakes, etc.) is probably good at visualizing the feared event or thing in all its vivid detail. For instance, those afraid to fly start to visualize the crash, the burning plane, passengers trying to escape, the pilot's message. And those who have dental phobias, similarly 'see' the needle, the drill, and imagine everything in penetrating detail.

In any case, the new site discusses causes of, and various treatments of, dental fear and phobia. It also discusses how important finding the right dentist can be and gives some novel ways to find the best one (in skill and personality) in a geographical area.

Modern Oral Surgery Looks Good: The Tibetan Tooth Extracting Forceps

This item was purchased by me for US $250 in 2000. I was in Tibet that summer when a friend / Tibet art, archeology and thogchag expert told me he had seen this amazing dental instrument for sale in the Barkor Market. Of course, I responded immediately by dragging him to the seller's stall. My friend translated as the seller explained that the object was a forceps used for extracting teeth. Being a dentist by profession, I was compelled to purchase the thing, and after a long bargaining session that lasted many days, it was mine!

Having extracted many teeth in my tenure as a general dentist, I wondered: How in God's name did they get a tooth out with this thing? It was about 12 inches long and made of heavy base metal with a bit of gold decoration. Two parts to the jaw (shaped as a Lion when held in approximation) must grip the tooth and a sleeve tightens the jaws together. I guess having somehow grasping the tooth, the "extractor" torques it.

Of course, the only way a tooth could be removed by this thing in toto is if that tooth had severe periodontal disease, complete with a lot of bone loss around the tooth. This could not work for a healthy tooth anchored in bone.

Now, suppose a tooth were filled with soft decay and abscessed. This thing could just crush the whole crown of the tooth, allowing trapped pus to escape. This would be a life-saving drainage technique.

Before penicillin was discovered in the 40's, dying from a tooth infection was not rare. Today it still happens, more so in medically under-served parts of the world. Penicillin (we use amoxicillin now) and well-designed extraction forceps (hopefully along with local anesthetic) have saved many lives. Perhaps this thing was a life-saver too. I suspect I will donate it to a dental museum.

In any case, the thing is unusual. Now, when extracting a molar, I delight in the beautifully designed contra-angled stainless steel instruments in my drawer. (In fact I have at least 25 of them, one shaped for every tooth in the mouth, plus elevators to dig and pry, and Ronguer forceps to nibble away bone.)

(I have a web site about extraction of wisdom teeth and one about toothache and dental pain in case anyone landed on this page hoping to get that kind of information.)

Do I Really Need This Dental Work?

My Dental web sites have finally gotten a new look. I chose dental office green.

Dental Smarts' sites, Tooth Lightening, Root Canal, Impacted Wisdom Tooth, Dental Caps, Abscessed Tooth, Tooth Implant, Gum Disease, Canker Sores, Electric Toothbrush, Dental Decay, Dental Plans, and Dental Pain (Formerly entitled Toothache) are, at least for the time being, finished.

As far as web design, the sites are incredibly primitive. But the text is straight talk from a dentist with more than a few years of practical experience. I'm not selling anything in my text ( and I don't choose the ads that appear so I don't endorse those). And I don't sell dental work in the office either. Selling dental work - That brings me to the title of the web site I am constrained to create next: "Do I Really Need a Crown?," and "Do I Really Need this Dental Work?" Yes, I already have the URLS (I am in the domain business, after all): DoIReallyNeedThisCrown.com and DoIReallyNeedThisDentalWork.com.

No Doubt about it! In the current dental treatment climate in the US, these will be frequently visited sites. A seven word Internet web address? Absolutely. That's exactly what hundreds of people who just received dental treatment plans are, and will be, typing into the search bar. Stay tuned...

Bird Flu Masks in the Dental Office and Mercury in Fillings. Yes, again...

Not to worry: DentalDecay.com is almost ready for it's grand debut. Amalgam and Mercury issues (non-issues) are close behind. For the present, I can tell you what I will say about that in a sentence or two: Amalgam is still the restoration of choice in BIG back fillings. The mercury scare is just that, a scare, and white filling disappoint in many ways over the years, although they are often the best choice in esthetic situations. I make more money doing a white filling and my patient's are happy when they leave. So what's the problem? Well, the problem is that they don't last, don't hold the bite as they wear away (look, they are composite resin, resin being a fancy term for plastic) and they do seem more likely to kill teeth (yes, it is in the literature, necessitating more root canals and consequently more crowns). Composite/white fillings are called, in some circles, "The Root Canal Specialist's Best Friend."
If you get informed and consent, and still want white, go for it. But don't do it without informing yourself about the different players and who wants you (and me) to use what and why. Get it?

Okay, I am still thinking about avian flu. Here is a copy of the letter I just wrote to the American Dental Association:

My letter to the American Dental Association regarding Avian Influenza:
Dear Government Section of the American Dental Association:

I have been following the avian flu events for some time and it does seem that almost every expert trained in infectious disease and virology acknowledges that we could be in for a difficult time.
I am in general practice and teach Law and Ethics at Penn. I have withstood the Hiv infection challenge, but influenza, as you know, presents many more challenges in a dental office. I have two specific questions:

1. Is the ADA doing anything to help ensure that dental offices are included in Health Care Workers so that we will share in whatever antivirals are available?
2. Would the ADA consider asking the Banking Committee, Federal Reserve, to order a forbearance for Dentists' mortgages, equipment loans, etc., so that we may keep our offices open to the extent this is possible?

Thanks for considering these issue that will be extremely important to your members.

Best wishes,
Lynne Heckert, DDS, JD February 8, 2006
My ‘blog: Http://dentalsmarts.blogspot.com "

I expect an answer because the ADA usually is quite helpful.

With all the crazy things in the news these days, I myself wonder why I concentrate on Bird Flu. Truthfully, I see a real threat to our economy, way of life, health, political situation. On one of the non-dental sites I pen, here is my latest entry:

"February 8, 2006 Avian Flu Update: Still, there is no vaccine an individual can get. There have been some advances and test vaccines and lots of controversy about whether a vaccine will work in people, especially due to the many different strains of bird flu and the flu virus’ ability to change quickly. The usual seasonal flu vaccine may or may not help, but if it does its benefit will be very small against Avian Flu.
There are reports that Sanofi Pasteur has delivered Avian Flu antigen which may be useful in making a vaccine to the Department of Defense. There are a few university based trials of vaccines in humans. There is much progress in faster production of flu vaccines in general. But, there seem to be no vaccine possibilities in the near future. Individuals should be aware that they need to plan, read up and give the situation serious consideration now.

There are some “experts” making the speaking circuits who are not infectious disease experts at all. Their messages is that this threat is overblown. I don’t believe that for one minute. I wish I did.

Today, Bird Flu was found in Africa in poultry, for the first time. No doubt it has been there for a while. It is also in Iraq (We know who else is also there), all over Asia and the Middle East. It has changed in a way that makes it more comfortable in mammalian tissue and it has been able to spread human to human in close situations. It has not yet been able to spread easily among humans but if and when it does, there will be very little time to accommodate to large economic and societal changes. If you do one thing, it should be to buy Dr. Gratt Woodson’s book and take it seriously."

The site is about masks, surgical masks, procedure masks, etc. Face masks are of interest to me as a dentist. I know what mask I need for blood and saliva splatter (HIV and hepatitis) and I know I have to spend another fifty cents to get a mask that filters smallpox (God forbid.) Spores are big and bacteria are medium sized and viruses range from small to nano.

Well, influenza is "nano" or, in scientific terms, teeny weeny. So an N-95 mask (or higher, at at least a buck a piece) is needed. Also needed is a new framework to think about the way we dentists work (if we do work in a pandemic). Goggles, coats, antivirals, anticeptics, Chlorox, Lysol, gloves, more Chorox, but more than that. What is really needed is a "method" that is based on what is known about the flu. The idea is that, once the virus is on the outside of your mask, goggles, whatever, they have to go right in that red bag with no touching the outside, with handwashing right away. No leaving the mask hanging from your ear anymore. No plopping it on your desk. No re-using masks. Flu viruses can live for a week at least on surfaces (HIV dies quickly on cold instruments and when out of it's element). This virus likes the cold and does not mind cold water. It sits there on door knobs and where ever it landed, waiting to get into your mouth, eyes, nose. It probably is spread in other ways as well. I hope it never does acquire the ability to be spread easily among humans (like the normal flu we get each year) but if it does, I know I'll want a mask, or a few hundred, at least. Actually, when I do the math for my whole staff, better order a thousand today.

Now, here is a question: Does the world have enough masks? Very good question. Easy answer: Of course not! A few of my sites are about masks and the ads that show up on it are for masks. Lots of visitors. My more useful sites are Flu Mask and N-95Mask . I wonder if one could take off the mask, place it on a surface, Lysol the heck out of it and then let it dry? I know the correct answer is "no." Hypo number two: There ARE no more masks in the box? Humm.....

Living Dangerously With Tooth Decay: Six Rules For Dental Risk Takers

February has always been Dental Health month. I just learned it is now also Pet's Dental Health Month. Yesterday I had my photo taken working on Mrs. T's Tall Teeth (Yes, they learn their alphabet now with blow up dolls and, well, we already know who "T" is). So, with my first grade teacher patient in the office, I started to think: What does a kid need to know about dental health? And here is the short answer: plaque, boring old plaque.
"Plaque" is the word that sends every dental patient into a vague stupor in which they just stare at the far wall and then fall asleep. I know what they are thinking: "Oh, here it comes again, bacterial plaque, floss; now she's going to get out the pictures of cavities and red sick gums, da da...."
So, this year, in honor of Dental Health month, I have decided to take the contrarian view. I am now putting together the last pieces of www.dentaldecay.com and I am thinking of including an essay addressing the need that some people seem to have to live dangerously dentally. It will be called something like "How to Be Sure You Will Use All Your Dental Benefits." My hygienists helped me with the list at lunch yesterday. Here it is:
1. Always go to bed with food in your mouth. Gumdrops are best;
2. Start carrying Altoids or Life Savers in your purse or pocket and pop one in your mouth at regular intervals (Don't bother with the sugarless ones);
3. Do not invest in an electric toothbrush (They are just a gimmick);
4. Forget floss altogether (it justs gets stuck);
5.Tell your dentist you want to skip x-rays - again (If no one knows those between teeth cavities are there, what's the problem);
6. Don't make a dental appointment until a tooth caves in or you are up all night with a throbbing ache. Wait for a weekend if possible to call the dentist.

But, seriously, honestly, I am going to tell you the absolute truth here: Plaque matters. It is filled with squiggling live bacteria. Those bacterial colonies secrete acid that dissolves the helpless tooth away. It also is an infection and your gums and arteries (that's another whole blog topic) don't like it and react with inflammation (think pus and bleeding). Plaque harbors decay and gum disease-causing bacteria and it's really gotta go. That's my Dental Health message and it's the best I can do. Happy Dental Health month!

Bird Flu and Dentistry / A Personalized Home Disaster Dental Kit?

Lately I have been alarmed at the avian flu situation. Hopefully, I am not one of those high strung worry worts that scours the news for oncoming disasters. Okay, believe me, I'm not. But I've always been fascinated by infectious disease, even in the dental office. Infectious disease is a puzzle and I love to watch people who know what they are doing piece things together. So, lately I log on at least once a day to http://crofsblogs.typepad.com/ (click on the Avian Flu link on the left) and I have to say that I think WHO and the mainstream news is trying to shield us from some pretty ominous facts. I think they just don't know what to do, dealing with politics and the fact that we are not prepared...
But, back to dentistry, the subject of this blog. I wonder: what if a pandemic makes its way to MY neighborhood. Will I even have a dental practice? Will my assistant stay home with her kids, my hygienist decide to bag work for a couple months, and do I even want to sit there like an idiot happily working in spit like nothing has changed? So, I went to the American Dental Association website and it had zero info that applied to these particular questions. (I know, they didn't have much time, like the rest of us.) I was referred to CDC's site and info on Health Care workers but, hey, we're not like a doc or nurse who can walk into the room donning N-95 mask, gloves, goggles, coveralls, write a few things on the chart and hightail it OUT of there. We're a little more like the ER, swimming in bodily fluids and getting up close and personal. Dentistry is, as we say in the law, sui generis.
So, first there is the issue of how we are going to pay everyone that works in the dental office with no money coming in (we aren't) and the equipment loans to pay, insurance, mortgage, and all that, if we are closed for a while. The other big one is this: When we are closed, what are my patients going to do when their face swells up with an abscess (www.abscessed-tooth.com) or when their tooth fractures and it's cutting their tongue? For this, I had an idea. What about a site addressing what a person at home can do in an emergency? "When the Dentist Office is Closed," something like that? And how much can I just tell people over the Internet?
Well, I don't practice dentistry over the Internet. First of all, I have a license to practice in one state only, and secondly, well, there isn't, as we say in the law, a doctor-patient relationship formed when someone reads info on a website. Thank God for that, since I do like to know who I'm treating. The sites are informational only, and the last time I looked the First Amendment was intact, medical information, opinions, etc. not being nearly enough to infer/confer a duty. Maybe a moral duty to be truthful and helpful, but that's as far as it goes. No legal duty but just the right to free speech. Seems we need that moral or ethical duty when we write on the internet though. Life is more than selling and so is dentistry.
So, I can tell people to go ahead and file their broken tooth with a nail file? That they should put a little kit together with amoxicillin in case of tooth abscesses, maybe talk to their dentist about their particular mouth and what they might need. Maybe some cement for that crown that keeps popping off with a little lesson in how to get it back on without a major mess? Most dentists would look at the patient like they were over the edge, but I'll bet they would be happy to help. Most of them would.
I already thought about this a bit back when I created www.n-95mask.com a site describing the different kinds of facemasks and how not all of them work for influenza, a tiny little monster that is not filtered out by just any old mask. Not all masks are created equal! In the dental office we use a good quality "procedure mask" and that works fine for our purposes: Hiv, hepatitis, blood splatter, saliva. Some viruses are bloodborne. Influenza virus is airborne (and who knows what else-borne) and that's a different story.
But Enough flu talk for now. I am about to tackle a new subject. Hum, tooth decay, amalgam vs. "white" fillings, or TMJ Dysfunction. What to do next? Life goes on...

Welcome to my Dentistry Blog! Dental Smarts

Greetings and Welcome to the Dental Smarts Blog, companion to www.DentalSmarts.com a series of web sites about dentistry. The first ten sites have been on the Internet for a month or so and it is amazing to see the number of people who log on.
The busiest one is www.impactedwisdomtooth.com. I suspect that's because the 17-19 year-olds, who actually have impacted wisdom teeth, and who are facing the oral surgeon soon, tend to use search engines first when looking for answers.
I have been a general dentist for what seems like forever and an attorney and member of the Pennsylvania Bar since 1983. I teach law and ethics, practice managemen, etc. to dental students and maintain a general dental practice.
My first love is, and has always been, dentistry, and my first obsession these days is the Internet, so the dental sites are a natural for me. Lack of talent for web design has not stopped me. No doubt, my simplistic Microsoft Publisher sites are a plus. Clean code is always good in SEO land. Now a blog? I'll try to keep the subject dental and hope that it's interesting to at least a few people. Okay, let's see how it goes!