Why Can’t I Get My Teeth Cleaned?

By Dr. John Paul, FDA Editor

I hear this question every so often, and I can sympathize with you. I’d like to give you a quick answer that would solve your concern, but there just isn’t one. Health care is a complicated subject.

Without seeing you, I can’t offer specific answers to your questions because every patient has individual conditions and needs. If I can tell you a story about two seemingly similar patients, maybe you can find some answers about yourself.

Jane is 30 years old, has always been fairly healthy, never had many cavities and has no immediate concerns about her teeth. She got a new job with dental benefits and decided now was the time to see a dentist. She scheduled an appointment with an office that seemed popular on social media and local advertising. The staff seemed pleasant and the office was clean. She saw the dentist for a few minutes — he looked at some records on the computer, took a quick look in her mouth, said something to the assistant and left. Mostly Jane talked with staff members who told her about how she would need to start with “deep cleanings,” and they talked about how she could make plans to pay for the treatment. Jane made an appointment for the deep cleanings, but canceled it because she was unsure about the treatment.

She scheduled with my office for a second opinion. We had her X-rays sent from the other office and I performed a thorough evaluation that lasted 20 minutes. We discussed the health of the bone and the gums holding her teeth in her jaw as well as the teeth themselves. There were a few fillings that were OK, no decay and her teeth did not need any other fillings. Her gums bled a little and there was stuff between her teeth because Jane was not the best flosser. The probing depths were all 3mm or less and the bone level was proper in the X-rays. All this was explained to Jane so she knew what a dentist was looking for and what the results might mean. Jane’s diagnosis was gingivitis, with a low risk of caries. The appropriate treatment was dental prophylaxis, which some people refer to as a “regular cleaning,” but is really a maintenance visit to help healthy people stay healthy. I didn’t have complete records from her previous dentist, and I am left to assume I disagreed with their initial diagnosis and treatment plan.

Bill’s also 30 years old, never had a cavity in his entire life, but he was concerned about his bad breath and wanted to get his teeth cleaned to take care of it. I spoke with Bill about how we would review his mouth and teeth. We examined his entire mouth, took X-rays and used these results to form a diagnosis. While Bill had no cavities, the space between his teeth and gums measured at least 6mm and bled at every site. On X-ray, the bone loss at each tooth was significant and most of his teeth were loose. His diagnosis was advanced periodontitis. I referred Bill to a specialist, though he did not go. A year later, Bill came back to my office and without treatment, the disease had advanced. We ended up pulling 28 teeth that had never had a cavity because the bone was too diseased to hold them in his mouth.

From the outside, both patients appeared to be about the same — successful young people without much history at the dentist and no serious concerns. They represent two extremes of what I see in my practice, but I see someone who could be Jane and someone who could be Bill nearly every month.


When choosing a dentist, you may want to call or visit more than one dentist to find the right match for you, as dentists and practices often have different styles to fit patients’ distinctive needs and personalities. Ask trusted friends and family for recommendations or visit floridadental.org/public/find-a-dentist to find a Florida Dental Association member dentist near you.

Providing Dental Care for the Patient with Autism

By H. Barry Waldman, DDS, MPH, PHD; Steven P. Perlman, DDS, MSCD, DHL (HON); and, Karen A. Raposa, RDH, MBA

Autism spectrum disorders (ASDs) are a group of developmental disorders defined by a significant impairment in social interaction and communication and the presence of unusual behaviors and interests. Many individuals with ASDs have atypical ways of learning, paying attention or reacting to different sensations and stimuli. The assessment and learning abilities of youngsters and adults with ASDs can vary from gifted to severely challenged. ASDs begin before the age of 3 and last throughout a person’s life. It occurs in all racial, ethnic and socioeconomic groups.

The Centers for Disease Control and Prevention (CDC) estimated in 2018 that one in 37 boys and one in 51 girls have some form of autism. It is unclear if the increase is due to changes in how one identifies people with ASDs or whether it is an increase in prevalence.

General Symptoms

People with ASDs differ greatly in the way they act and their capabilities.

Social skills: They have limited or no interaction with other people, might not make eye contact and just want to be alone. They may have difficulty understanding other people’s feelings or talking about their own feelings. Children might not like to be held or cuddled. They may not know how to talk, play or relate to other people.

Speech, language and communication: About 40% of ASD children do not talk at all. Others repeat words or questions directed to them, rather than responding. They may not understand gestures. Some can speak well, but have a hard time listening to others.

Repeated behaviors and routines: Individuals with ASDs may repeat actions. They may want to maintain routines and have trouble with changes. Children with ASDs may have significant delays in language, social and cognitive skills, but may be great at solving puzzles or computer problems.

Causes and Treatment

It is suspected that there are numerous causes for ASDs due to complex interactions of genetic and environmental factors. Studies of twins have shown that in identical twins, there is about a 75% rate of both twins having autism, while in fraternal twins this occurs about 3% of the time. The cause of ASDs in most people is unknown, however, it tends to occur more frequently than expected among individuals who have other particular medical conditions, including Fragile X syndrome, tuberous sclerosis, congenital rubella syndrome and untreated phenylketonuria.

Although there is no known cure for ASDs, early and intensive education can help children develop and learn new skills. The goal of these efforts is to help the child to talk, interact, plan, learn and care for his/her needs. While some medications can relieve some of the symptoms, structured teaching of skills (often called behavioral intervention) is currently the most effective treatment.

Associated Oral Conditions

The complex neuro/developmental disabilities compound and exacerbate the all too frequent oral health disorders in the general child and adult populations, including: poor oral hygiene, increased risk for caries, generalized periodontal problems, oral-facial pain, xerostomia, poor nutrition and poor diet.

Dental Services in a Private Practice

The actual technical aspects of care are similar to the delivery of services for the general population of patients. Modifications in practitioner-patient-staff-parent or guardian interactions, however, may be necessary. Providing dental care and ensuring follow-up home care for individuals with ASDs will vary by patient age, type and level of the particular disorder, as well as an appreciation of family/living arrangements. An underlying understanding of patients with ASDs will facilitate the actual provision of care.

  • Not all patients with ASDs are alike.
  • They may be hypo- or hypersensitive to sight, sounds and smells.
  • Nonverbal patients may carry out self-abusive behavioral acts as their only means of expression for pain.
  • You may need to attempt different modalities of behavioral guidance.
  • Additional time may be necessary.
  • Schedule appointments in line with behavioral medication.
  • Keep wait times to a minimum to help reduce anxiety.
  • With proper consent, medical immobilization/protective stabilization may be a necessary behavioral guidance technique.
  • Use simple verbal and nonverbal communication.
  • Use adequate pain control for both restorative and surgical procedures

H. Barry Waldman, DDS, MPH, PhD, SUNY Distinguished Teaching Professor, Department of General Dentistry, Stony Brook University, NY.

Steven P. Perlman, DDS, MScD, DHL (Hon), Global Clinical Director, Special Olympics, Special Smiles; Clinical Professor of Pediatric Dentistry, Boston University Goldman School of Dental Medicine.

Karen A. Raposa, RDH, MBA, Published Author and International Speaker, Clinical Education Manager, Hu-Friedy Mfg. Co., Raynham, Massachusetts

Reprinted from Today’s FDA, Jan/Feb 2020. Visit floridadental.org/publications to view Today’s FDA archives.

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.

12 Tips to Engage with Your Patients and Respond to Reviews Online

From your social media platforms to your online reviews, it’s important to keep a pulse on what your patients are saying and engage in positive dialogue. Proactively engaging with patients on your online platforms helps you keep your practice top of mind, highlight services and products, and get feedback from your patients. The following are best practices for engaging on your online platforms:

1. Check your social media platforms at least once a day and aim to respond to messages and questions within 12 hours. This shows your audiences that they are valued and ensures you are handling any issues quickly.

2. “Like” and respond to positive comments — even a simple “Thank you!” or “You’re welcome!” The commenter will appreciate it, and it keeps positive comments at the top of the thread.

3. Ensure that all posts and responses are on-brand, professional and respectful.

4. Hide or remove comments with inappropriate language, threats, HIPAA compromises (such as photos where individuals’ faces are shared without consent) or negative mentions of a specific doctor. Consider including these community guidelines in your “About” section.

Now, you might be wondering what to do when a patient or follower shares a negative review, comment or complaint. You may be tempted to delete the post, respond tersely or even fire back. But remember that the rest of the online community is “watching” your actions. It’s critical to show professionalism and respect and to take the time to think through the question and best response. While you can’t control every comment or review, your response may help prevent further negative feedback. The following are tips to keep in mind for negative reviews:

5. Identify sensitive questions or comments and determine the best course of response. This could include patient complaints and questions on cost, billing or office policies. A good practice is to take the conversation in private via direct message.

6. Decide whether it is worth it to respond on a case-by-case basis. In some cases, it may be best not to respond, depending on the content of the review, the volume of reviews for your practice, etc.

7. If you respond, do so in broad “all patient” terms and office policies versus getting into a direct dispute.

8. Do not get into an online debate over the incident that prompted the negative review. Doing so can look defensive or confrontational.

9. Invite the negative reviewer to contact you directly to discuss the issue further.

10. Make sure that any response represents you as a compassionate, concerned and understanding professional.

11. Consider this example response: “Our office strives to provide the best service to all patients. We would like to learn more about what happened and hope you will contact us as soon as possible.”

12. Negative reviews should not be removed, unless they include profanities or statements of hate, reference a specific provider or violate any privacy policies.

Consumers don’t expect businesses to have 100%, five-star reviews. Engaging with positive online comments and reviews, while thoughtfully handling any negative feedback, will help your practice strengthen your relationships, reputation and service to your patients.


Reprinted from Today’s FDA, Sept/Oct 2020. Visit floridadental.org/publications to view Today’s FDA archives.