I Need a Hero

By Dr. John Paul, FDA Editor

I was wearing a long face and being generally disgruntled by all the goings on in this great country when I walked into the room with one of my favorite patients and longtime advisors, Ima Mae Gruntbuns, a great American. Not being one to let me rest on my laurels or rain on any parade she is enjoying, she questioned my lack of enthusiasm for being alive one more day. I complained that people just seem to being sliding back into the slime. Folks I know and like are being nasty to one another. Others think they can run amok, spouting hate and destroying things that don’t belong to them. When one side behaves badly, the other side tries to top them and then the “news” tells you about the worst of us every hour on the hour in gory detail with plenty of video from every angle.

Mrs. Gruntbuns pulled me up short. She said, “Son, you are looking in the wrong place for inspiration. Just because you get elected or you are famous or someone points a camera your way, doesn’t make you a leader or a hero. All those pictures on your Marvel comics scrub top are fiction.”

That was a little disheartening because my wife thinks I look like Thor now that I wear a beard, but Mrs. Gruntbuns wasn’t slowing down.

“Turn off the TV and put down the phone. Last April when no one knew who had or who might die from the coronavirus, who opened his office and removed that fish bone stuck between Mr. Gruntbuns’ teeth?” she continued.

I replied, “Well, I did Mrs. Gruntbuns, but he’s a friend and I was just doing what I know how to do with the tools I have on hand …”

“Yes, Doc — but you did it. You came in and got him out of pain. He carries that bone around in his wallet and he’s still telling people about it.

“Who grabs people’s tongues with a piece of cotton, pulls it out past their nose and stares at that hangy-down thing and whatever else is in the back of our mouths to make sure we don’t have cancer, or at least catch it early so we can cure it?”

“Well, we dentists do, Mrs. Gruntbuns, but it’s just what we were taught to do in school and it’s the right thing to do,” I responded.

She went on. “Have you counted up the lives you’ve saved, the suffering you prevented? There is a hero or two in every dental office. Every once in a while, an ‘Atta-girl/boy’ and a pat on the back goes a long way, but you don’t need the satellite truck and the pretty newsreader to verify what you do. Just keep doing it for all of us regular folks who may not be famous either but deserve your best effort every day.”

It’s hard to argue with someone who is so right.


Reprinted from Today’s FDA, Jan/Feb 2021. Visit floridadental.org/publications to view Today’s FDA archives.

An Early Bite with Dr. John Paul: “Why Won’t You Give Me an Antibiotic?”

By Dr. John Paul, FDA Editor

Have any of you heard this today?

“Doc, I’m calling you at home after hours because I’ve got this toothache again. This time it’s been hurting about a month and it’s just killing me. You’ve got to call me in an antibiotic.”

Here’s my answer:

“Mrs. Gruntbuns, back when Mr. Fleming found penicillin, antibiotics seemed like magic. You give people a pill and their problems went away. While that was the net effect, what really happened was the drug killed enough of the infection that your body could heal itself. The drugs were so new that they wiped out every bacteria they came in contact with. It’s important to remember over time that changes. The more often bacteria contacts a drug that does not completely wipe them out, the more they develop resistance to the drug until that drug becomes harmless to the bacteria.

“We’ve talked about this before. That antibiotic I gave you last time was to help you get by until you got a real treatment. Once a tooth is infected enough that you have symptoms, there is no way for your body to heal it after a little help from a drug. You’ll need a real treatment like a root canal or an extraction to remove the source of the infection before you can heal. The more times you get a drug without the real treatment, the more the bugs get a chance to become resistant.

“Tomorrow morning I can get you an appointment with an endodontist or an oral surgeon. Which would you prefer?”

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: “Why Do I Have to Take Antibiotics Before My Dental Appointment?”

By Dr. John Paul, FDA Editor

How many of your patients complain when you prescribe their prophylactic antibiotics? In my practice, it’s all of them. No one complains about the drugs they think will make them feel better, but when they perceive no problem, they want no cure.

“It’s four big old horse pills that make me gag, I can never remember them and I read that it’s bad to take too many antibiotics. Why do I have to take them every time I come to the dentist?”

“Mrs. Gruntbuns, you’re right, it’s bad to take medicines you don’t need and it is four large pills. If it’s just the pills and remembering, we can get you a liquid (but it costs more and won’t last on the shelf) and we can call to remind you. If you need the medicine though, it might just be the difference between life and death, or at least between a relatively comfortable life and misery.

“Not as many people need or are prescribed an antibiotic before dental care today as when I started practice. Science has shown us some situations aren’t a risk while others remain. If you are likely to get an infection in your heart or on an artificial piece of equipment, then you should have an antibiotic before we do any procedure that may cause bleeding and let germs enter your blood stream.

“Remember, you have that artificial valve in your heart — that’s a place where bacteria can land and live, and since the artificial valve doesn’t have a blood supply, giving you antibiotics to kill the bugs that start living there is no easy matter. It won’t just be a couple of pills, but days in the hospital. I like you too much to risk you going to the hospital just because you had your teeth cleaned.”

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: “Are Amalgam Fillings Safe?”

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.