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Beyond the Bite

The Official Blog of the Florida Dental Association

Tag: early bite

An Early Bite with Dr. John Paul: “Are Amalgam Fillings Safe?”

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By Dr. John Paul, FDA Editor

It seems to come in cycles. Not quite as often as the full moon, but maybe as often as the blue moon. There’s a slow news day and dentistry rises to the top of the pile. Maybe we can run a story about the evil dentist that put poison in our fillings? Then I spend the next month explaining and easing my patients’ fears.

“Dr. Paul, I know I need a filling, but fillings scare me because they are full of mercury and will make me sicker than I am now.”

“Mrs. Gruntbuns, amalgam fillings are safe. Even though the opponents — who are few, but excessively loud — say, “No,” it’s still safe. They have been safe for 150 years. No credible scientific evidence says otherwise, and no one has been proven to be cured of their maladies by having an amalgam removed, unless their only malady was ‘I hate this black filling.’

“If amalgam fillings were truly dangerous, I would come to work in a hazmat suit and I would never let my darling children come into my office. Dentists are exposed to more amalgam fillings than any patient ever will be, and we aren’t suffering any ill effects.”
Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.

An Early Bite with Dr. John Paul: “How Safe Are Dental X-rays? Why do I Have to Get Them Every Year?”

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By Dr. John Paul, FDA Editor

Lately, I’ve had a run of patients who are reluctant to have — or are flat-out refusing — dental radiographs. I’ve let a few patients go because I believe it is beneath the standard of care to routinely practice without the aid of radiographs; although, I think they should be prescribed for each case and use the ALARA principle (As Little As Reasonably Acceptable). I try to use the refusal as the introduction to a conversation with the patient.

“Dr. Paul, I don’t want any X-rays today.”

“Mrs. Gruntbuns, why don’t you want any X-rays today?”

“They cost too much and there’s too much radiation.”

“Mrs. Gruntbuns, radiographs are important enough to me to evaluate your health that I will take them for you today at no charge. Will that change your mind?”

“No, radiation makes people sick, it gives them cancer and I don’t want any radiation.”

“Mrs. Gruntbuns, dental radiographs (X-rays) are safe when used properly. With the X-rays I take during a checkup, you get about 1/600th of the amount of radiation1 you can expect to receive just from walking around — it’s even less because you walk around outdoors in Florida. Because you take good care of your teeth, do all the things we ask you to do at home and come in as often as we ask for professional maintenance, we have prescribed radiographs for you every two years. This is the bonus you get for keeping up your oral health. You are at low risk of decay or gum disease, and unless something changes, we won’t change by taking more radiographs.”

Most patients accept the radiographs when they find out I think they are important enough to take them for free. I only offer this to a patient one time. I have released several patients (less than 10) for refusing radiographs because I believe this patient is asking me to provide care with one hand tied behind my back and one eye closed. Some days I do miracle dentistry, but I don’t have time to do tricks. I hope this patient didn’t leave my office for yours.

Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.
1The amount of radiation is based on an article in JADA, September 2011, Volume 142, Issue 9, Pg. 1101.  

An Early Bite with Dr. John Paul: Prevention and Cure

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By Dr. John Paul, FDA Editor

At least once a week a patient will ask me, “Why do I have to come in two (or three or four) times a year? I’ll just call you when something goes wrong.” There is a really good answer to this:

“Mrs. Gruntbuns, I have two basic tools in my kit: prevention and cure. When you decide to ‘just call me when something is wrong’ you are choosing to only use cure. You accept the risk that you will find the problem before it gets too painful or too expensive to fix.

“When we prescribe that you visit us two times, three times or even four times per year, it is an estimate of how often we need to see you to prevent disease. What you call a ‘cleaning’ is not about cleaning your teeth — it’s about evaluating your health, and as long as you are here, we throw in a cleaning.”


Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.

An Early Bite with Dr. John Paul: “I’m Gonna Pierce My Tongue!”

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By Dr. John Paul, FDA Editor

Having had more than my share of stitches and staples, I really can’t imagine electively poking holes in my person. You can imagine my dismay and confusion when someone comes in with a new piece of tongue jewelry or a glitter booger (that thing stuck through their nose, cheek, lip).

I’d love to get my two cents worth in before the assault takes place.

“Now, Ms. Gruntbuns, let me get this straight — you want to get your tongue pierced?

“Aren’t you the one who cringes while sitting in my chair and nearly faints when you get an injection? You do realize they are going to use a much bigger needle and you will not be numb? They will hold your tongue still with a big pair of pliers — remember your delicate gag reflex? — and then jam the needle right through. Then, they’ll put in the barbell, pat you on your head and send you home. Remember all those cavities we keep filling, and the bugs that cause them? They are gonna make a beeline for this new hole in your tongue and unless you are very lucky, you will have a swollen tongue from the injury and the infection that follows.

“If you are still set on adorning yourself with tongue jewelry, there is one more thing you must know. I have never seen a patient with tongue jewelry who doesn’t play with it. You flick it in and out against your teeth and bite on it, and eventually you break teeth, or fillings or crowns. There’s no warranty on restorations if you have tongue jewelry. There’s also no warranty if you have a glitter booger that wears out tooth surface or gum. Now would be a great time to let this fad pass you by.”

Have a question you have a tough time answering? Send it to Dr. Paul at jpaul@bot.floridadental.org.