patient questions – Beyond the Bite

An Early Bite with Dr. John Paul: “Doc, Just Give Me a Reline”

by Florida Dental AssociationMay 31, 2017May 31, 2017Leave a comment

By Dr. John Paul, FDA Editor

If you are a dentist, and you practice in Florida, you are more than likely to have a patient walk into your office and ask to have their dentures relined. Many are convinced that this is a simple procedure handled entirely by a technician, and the dentist is just a toll collector on their highway to better eating and speaking. “I’m paying you good money, just put the stuff in my teeth so I can be happy.”

I focus on the “make me happy” part. I want you to have comfortable, functional dentures that allow you to speak and eat with confidence. You know they “don’t fit.” I want to know why you aren’t comfortable. That requires an examination and evaluation. I will definitely want to look at your mouth and touch the parts that support your dentures. I may want to take an X-ray to determine the quality of your bones.

More often than you might guess, the patient’s dentures fit their jaws fine, but do not stay in under function. The teeth don’t mesh together properly and that is why they seem “loose.” No need for a reline, just adjust the bite. There are times when the bones have changed shape and the denture no longer fits. That’s when we take an X-ray to determine if the bones are healthy but a different shape, or if the reason for the change is disease in the bones, like cancer. We need the X-ray to make that diagnosis, and the treatment plan may be something much different than “just a reline.”

Without a proper examination, evaluation and treatment plan, it isn’t possible to provide appropriate treatment. What makes for a proper examination and evaluation is specific to each patient and is something you should discuss with your dentist. I can’t make my diagnosis based solely on information provided over the internet, and you shouldn’t rely only on what you read on the internet to make your decision.

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 Won’t You Give Me an Antibiotic?”

by Florida Dental AssociationAugust 30, 2016May 31, 2017Leave a comment

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 Florida Dental AssociationAugust 16, 2016May 31, 2017Leave a comment

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 Florida Dental AssociationJuly 26, 2016May 31, 2017Leave a comment

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.