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Julie M. Gillis, DDS, PC Blog

Individualized Dental Care Should Be the Norm!

February 9, 2018

Individualized oral health care – Individualized dental care. 

The way it should be!

Our office believes in individualized dental care for optimal health. 

Dental care should be individualized to the patient.  What works for you is not necessarily what works for other patients.  Every patient deserved individualized oral health care. 

Take something as simple as the notion that every person needs to brush twice daily and floss once per day.  While this may be nice in terms of warding off bad breath, it does not really apply to all people when they want their teeth and gums to be as healthy as possible.   I see patients who really do brush and floss based on these guidelines and they still have issues with gum disease, tooth decay,  and periodontal disease!  So, there is more to this story.  Achieving oral health should be the goal of our oral hygiene procedures.  Well health and nice breath!

Treating people as individuals is not a new concept but it is one that I don’t think gets applied often enough.  This is, of course, true in medicine as well as dentistry.  Two patients with the same presenting symptoms and tests cannot necessarily be treated equally and achieve the same results.

Probably not the best way to have individualized oral health care!

 

My son in law, Jeremiah Joyce, wrote this piece recently published in the Mayo Clinic’s KER blog. It looks at the risks and benefits of adopting guideline-driven care.

This from Jeremiah, “Minimally disruptive medicine (MDM) is one of the aims of the KER unit (http://www.mayo.edu/research/labs/knowledge-evaluation-research-unit/overview) here at Mayo and they are doing some cool personalized medicine research dealing with not just disease but what individual patients themselves bring to the table.”

 

Is Evidence Based Medicine (EBM) the way to best treat patients?  Does this apply to dental patients?  I think it does!

Jeremiah is a third-year student at the Mayo Clinic School of Medicine.  Mr. Joyce responded to a writing prompt meant to develop his thoughts about the role of a primary care physician. The prompt: “The ideas behind MDM or contextualized care ask us to respect the needs and circumstances of the patient before us as we construct our care plans. But that puts us in a weird spot, yes? Because just as MDM is this decade’s push, last decade’s push was evidence-based medicine: the idea that, through science, we can find a ‘best’ way to handle a problem, a ‘best’ treatment. It becomes our job to apply the evidence with less and less spin to it, if we dedicate ourselves to EBM purity.” 

With that in mind, what is your opinion of the Minnesota Community Measures’ “D5” criteria (http://mncm.org/reports-and-websites/the-d5/)? What are the risks and benefits of adopting guideline-driven care? Do the D5 measures reflect a friendly contextualization of care?” 

Mr. Joyce’s response follows:

The Mayo motto “the needs of the patient come first” uses the singular noun; the patient is an individual. In practicing evidence based medicine, however, I think we often make the mistake of using population-based recommendations for individuals. There is an interesting precedent for the idea that a “one size fits all” model fits no one perfectly. In his book The End of Average, Todd Rose describes a U.S. Air Force study of pilot average body measurements, designed to tailor a cockpit that fit the average pilot. Out of over 4,000 pilots measured to determine the perfect dimensions, not a single one was within the average range in all of the 10 primary dimensions (Rose, 2016). This article is a fascinating physical example of a truth that undoubtedly applies to medical recommendations as well. 

In practicing medicine, we should focus on tailoring the recommendations to fit the patient, rather than forcing the patient to fit the recommendation. We are all aware of the benefits of D5 recommendations on the long-term health of populations, but we also know some patients have ASA-induced asthma and others have statin-induced myositis. Still others haven’t been able to quit smoking despite their best intentions. We as future providers risk losing a therapeutic alliance with patients if we push too far or too hard. Someone with a recent diagnosis of diabetes may quickly be overwhelmed if we add on all the D5 as soon as their A1c is at 7.1%. As Rose describes in his book, the Air Force’s solution to their cockpit dilemma was increasing flexibility in the design, allowing pilots to adjust their planes. This approach resulted in a dramatic decrease in casualties. We may see the same effect when we work with patients to achieve the greatest benefit to their health. Across a panel of patients, we would be much more satisfied with a population of half-treated and gradually improving diabetics than we would be with losing many patients to follow-up due to frustration and disappointment with a rigid healthcare system.

(Rose, 2016) “When U.S. air force discovered the flaw of averages.” https://www.thestar.com/news/insight/2016/01/16/when-us-air-force-discovered-the-flaw-of-averages.htmlhttps://www.thestar.com/news/insight/2016/01/16/when-us-air-force-discovered-the-flaw-of-averages.html 

Jess, Jeremiah and Tigris

I love the part in the title above that states, ‘the flaw of averages’!  This ties right in to the need for individualized dental care.

So what do dentists need to address if we want our patients to have optimal oral health?  In my practice, we do a complete oral health assessment for every patient and tailor our recommendations based on our findings.  If someone shows no signs of gingivitis, trauma, or periodontal disease then their current regimen of oral hygiene is adequate from an oral health standpoint.  If we see signs of disease then we determine what changes can be made to improve their oral health.  Then we continue to monitor for signs and symptoms of disease to see if modifications need to be made.

I know that I want to be treated as in individual and I believe our patients do too.

Yours for better dental health,

Julie Gillis DDS

Caring For and Enhancing Your Smile

 

 

Dentists, Referrals, and Specials!

February 5, 2018

Filed under: Our Dental Office - What makes us unique — Tags: , — Dr Gillis @ 3:19 am

Your Referrals Matter

All dentists and especially good dentists always need referrals to keep their practice healthy.  Unlike doctors who tend to max out on the number of patients they can manage, good dentists tend to get their patients healthy and the patient then just needs to maintain their dental health with regular examinations and cleanings.

Woot, woot! It’s a win-Win Special referral program!

This Spring our office is offering a New rewards program to help us grow!

One of the things that our patients do – something that makes us feel great and confirms that you think we’re doing a great job – is referring friends, family, and colleagues.  In fact, our number one source of referrals is from our existing satisfied patients.

As a thank you and incentive to spread the word about our practice, we have started a new reward program this spring.  When a referred adult patient completes his or her first appointment, you will receive a $25 gift card of your choice and the new patient will receive a $50 credit towards their dental care.  

We’re always happy to accept new patients, but friends and family of existing patients are very special.  Please make sure that your friends or family let us know when they call that they’ve been referred by you and want to take advantage of this spring special!

Professional Cleanings and Exams – Are They Necessary?

December 21, 2017

Is this mouth healthy? You cannot tell just by looking.

Professional Cleanings and Exams – Are They Necessary?

An alternate title for this might be, “Isn’t it pretty obvious if I have a problem with my teeth or my mouth?  Why not wait I am concerned to have a professional cleaning and exam?”

Your dentist and dental hygienist can determine why the gums look different are positioned differently on the two upper centrals.  This is one of many benefits of a professional exam and cleaning!

Your dentist will be able to tell you if the dark area below this crown is okay to leave as is.

Is the mouth above healthy? Are their conditions that can’t be seen or felt?  Would you be surprised if I told you that there is a problem with the right front tooth? The gums are uneven and slightly red here for a reason and it will take a professional exam and cleaning and an x-ray to determine the reason!

Look closer at the lower left.  Is there a reason the tooth is so black here?  It doesn’t hurt.  These photos are only to help make you realize that you can’t often see what is going on in your own mouth and it is good to have a thorough examination and Professional cleaning as often as necessary to keep you healthy.  Our office knows that there is no substitute for an excellent quality professional cleaning and exam!

This patient thinks they are healthy. Thinks gums are healthy. Are they?

Professional cleanings and exams are a necessary part of your overall health care.  In our office when you are scheduled for these services, we are also evaluating your mouth for signs of oral cancer and other diseases.  We evaluate your jaw joint, your bite, the muscles that make chewing possible and we compare our findings to what was occurring at your previous visits.  And, of course, we check the health of your teeth and gums.

This patient feels their mouth is healthy.  They floss often (see the lines where floss went through the tartar between the teeth?).  They were unaware of bleeding gums and gum disease.  This inflammation could progress to irreversible bone loss between the teeth.  So, even though it is painless, only a dental professional and a thorough professional cleaning and exam can treat this infection.

Even severe gum disease like the photo shown above will be not be painful.   The patient may be unaware of this condition which is easily treated with professional dental care.

If you would like to save money and have the healthiest mouth possible, it is necessary to do these things:

  • Brush and floss your teeth (or do something that is as good as brushing and flossing)
  • Eat and drink a healthy diet
  • Visit your dentist and dental hygienist regularly

Problems with your teeth and gums are often not easily visible even by a dentist.  Decay (rotting) of the teeth may occur on any tooth surface susceptible to decay and may be below the gums or between the teeth where an x-ray is needed to evaluate for decay.  Tooth decay is painless until the decay progresses close enough to the tooth nerve to cause damage.  Think $$$ and possible loss of your tooth!  Gum disease and periodontal disease is also painless.  We see many people with these diseases that say their gums never bleed and we see bleeding with a gentle puff of air blown on the gums.  It is very easy to miss the signs and symptoms of mouth diseases like cancer, decay, gum disease and periodontal disease!

Our office cares about your health.  Please ask us about any concerns you might have!

Yours for better dental health, Julie Gillis DDS AAACD

Restoring Smiles/Restoring Health

Laser Cavity Detection – Better Even Than Your Mom’s Dentist!

December 14, 2017

Laser Cavity Detection – Better Even Than Your Mom’s Dentist!

The cavity detecting wand is about the same size as a pen!

Some cavities are obvious some are not, but in all cases, it is best to find cavities when they are small and easily treated.  Laser cavity detection may not have been around for your Mom’s dentist, but it is here now!  Cavities, as most people know, are soft or rotten parts of your teeth that require professional treatment so that they do not continue to grow.

Is there decay in this tooth? The laser cavity detection says YES! Your Mom’s dentist and dental x-rays alone would have said no.

The stained areas in the tooth shown here may look like obvious cavities.  They were not soft to pressure.  This is and a very good situation to test with laser cavity detection.  There was no decay! We note the readings obtained with the laser.   We can then compare these readings when you return for other visits and we test the area again.

Testing your teeth with a laser is painless.  We scan the laser over your tooth and see a digital readout of any changes in the density of the tooth below the surface.  Our laser also gives an audible tone that starts when there is a significant density change and increases when the change becomes more significant.  There is a low level where it is okay to continue to “watch” for further changes over time, and a level where the appropriate treatment is to remove the decay.

Laser cavity detection: the laser is small, painless, and easy to use!

When your dentist or dental hygienist checks your teeth for cavities or decay, this usually begins with evaluating your x-rays and looking for areas of decalcification or weakened areas in your tooth.  Your dentist (and your Mom’s dentist)  will look for areas that are different in color from the adjacent teeth.  It should be noted here that cavities do not always change the color of the tooth.  Black or dark areas on your teeth may just be stains!  Your dentist will press on your teeth to check for areas that are soft.  These methods for checking for decay were also used by your Mom’s dentist.  Now we can detect a cavity even earlier with a cavity detecting laser.   Laser Cavity Detection did not even exist several years ago!

We know that cavities can start anywhere on the surface of a tooth.  The most likely place for cavities to start is in the grooves on the tops of teeth, below the areas where two teeth contact, or beside crowns and fillings.  The process of decay may penetrate the softer inner layers of the tooth leaving the surface intact.  So, pressing on the tooth doesn’t always tell you if there is decay below.  In our office, we use a laser like the one shown above to check your tooth for changes in the density of the tooth that would indicate decay below the surface.

The cavity detecting laser noted decay below the intact surface of this tooth. It is easy to see once uncovered and can be treated early!

The  laser cavity detection was used on this tooth and the decay was treated while the cavity was still small.  If decay had been left in the tooth until the surface had become soft, much more of the tooth would have been destroyed and weakened and the treatment would have been at a much greater cost to you!

This might look like decay. Time to test this tooth with a cavity detecting laser. Yea! No decay. We can retest this tooth later to compare the readings.

 

The laser cavity detection is here now!

We believe in embracing new technology when it is to the benefit of our patients and has been texted to be safe and accurate.  We do this because that is the kind of treatment we would want for ourselves or for anyone we care about!

 

With early cavity detection, we may be able to treat your cavities with the use of a special carrier like the one shown here that delivers medications and seals the tooth without drilling on it!

Treatment of early decay without drilling on the tooth!

Our office wants to make sure to stay up to date on technology that benefits you.  The laser cavity detection is just one of the ways that we do this!

Yours for better dental health,

Julie Gillis DDS, AAACD

Restoring Teeth/Restoring Smiles

 

Dental Crowns Do Not Bleach

December 1, 2017

Filed under: All Porcelain Crowns,Tooth Whitening or Tooth Bleaching — Tags: , — Dr Gillis @ 7:00 am

Before you bleach your teeth, you should find out if you have any dental crowns or restorations (fillings) in your mouth that may look odd or unmatched after your tooth bleaching is complete.  The reason for this is (insert sparkly boom here!)

Dental crowns do not bleach!

If you want to bleach your teeth and you have crowns on your front teeth, you may need to replace those crowns if you want them to match your newly bleached teeth.  In our office we will tell you what to expect from tooth bleaching and let you know the likelihood that you will also want to replace fillings or crowns for the ideal final result.  We think it is very important that you are aware of this before you start the bleaching process!

Dental crowns do not bleach!

In some cases you may find that the crowns seem to get whiter.  How could this happen?  If, for example, your  crowns are somewhat translucent so that your natural tooth color can show through, they may seem to get brighter as your teeth get brighter.  If you have all-porcelain and slightly translucent veneers the tooth may bleach and the brighter color will show through and make your veneers seem brighter as well.  If your crown or crowns have any metal below the porcelain  or if they are made from an opaque porcelain, they will not bleach.  This is not a problem if you know in advance what to expect with bleaching.

Very successful bleaching result in our office! Our patient is excited to replace the crown that got darker and darker looking as the teeth brightened.

KoR can be very successful for bleaching hard to bleach teeth. But, your crowns do not bleach!

Our patient had tried several types of bleaching systems and none seemed to work for her until she tried KoR bleaching in our office.  Our office has had some amazing success with this bleaching system on our patients that do not whiten with other systems.  We let her know that as her teeth became whiter, her crown would look darker and she would probably want to replace it.  She had already wanted to replace this crown due to the visible margins and the fact that it had never looked “real”.  Please look again in the future to see our final results after replacing the crown!

Which color would you rather have? Maybe someday dental crowns will bleach!

Yours for better dental health

. . . . . and maybe for dental beauty as well!

Julie Gillis DDS

Restoring Smiles/Restoring Health

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