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

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: “I’m Gonna Pierce My Tongue!”

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.

An Early Bite with Dr. John Paul: “Can’t I Just Get This Done at the Mall?”

By Dr. John Paul, FDA Editor

When it comes to teeth whitening, how often do patients ask, “Why can’t I just get this done at the mall?” — which is patient speak for “I don’t want to pay what I think you are going to charge for results I want but can’t count on.”

Here’s what I tell them:

“Mrs. Gruntbuns, you certainly can go to that kiosk at the mall and get teeth whitening supplies there, but for the life of me I can’t imagine why you would want to. You don’t know where the person handing out the whitening supplies was last week. That lab coat they are wearing does not mean they are a dentist or even a certified assistant — there is no reason to believe they have any special training. There also is little or no regulation on the actual chemicals that will be sold to you. In Florida, there are regulations that say unless the person in the kiosk is a Florida-licensed dentist they cannot legally place anything into your mouth or shine a “special light” onto your mouth, but you as a consumer would have to report the procedure to see any enforcement.

When you come here, part of what you are getting is my training and expertise. I will advise you how likely whitening is to work for you. I can prescribe different products to suit your individual needs. My staff and I are overseen by the Florida Board of Dentistry and should we stray from the standard of care, my license and my livelihood would be in jeopardy. Besides the fact that I like you, I have a vested interest in running a clean office with the best products, the latest techniques and a well-trained staff.

I certainly won’t stop you from spending your money at the mall, but you should think about whether the rewards outweigh the possible risks, and whether there will be anything you can do if you are unhappy with the results.”

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 Are You Sending Me to a Specialist?”

By Dr. John Paul, FDA Editor

We’ve all had the patient who does most of what we suggest but never wants to leave our office. What do you say when your patient asks, “Why do I have to go to a specialist? I’m so comfortable here.”

“Mrs. Gruntbuns, I have a friend down the street who is an expert in the treatment you need. It’s all she does, and she is faster, better and cheaper than I could possibly be for you. What she can do in 45 minutes would take me three hours and two visits. For this procedure, my service isn’t the best and I want the best for you. When she’s done with your procedure, she will send you right back to me and I will take care of the other things you need.”

Maybe your patient needs more than one specialist. “Mrs. Gruntbuns, your condition is complicated and will need a team of dentists to restore your mouth the way you want it to be. We’ll work with specialists for those things because they do much better than I could, but I’ll always be the ‘general manager’ of your care. You may ask me questions anytime about the care I provide directly or the services our specialists are providing.”

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