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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

 

 

Periodontal Disease and Treatment

April 8, 2014

Periodontal Disease and Treatment

Periodontal disease is the loss of the supporting structures of the teeth namely gums and bone.  Treatment can take many forms depending on the severity of the disease, the location of the periodontal disease and variables between patients based on comfort goals and finances.  In our office, we believe it is important that your periodontal disease is explained to you and that you have the opportunity to ask questions and select the best treatment for you!

Advanced periodontal disease and gum disease.

Periodontal disease and gum disease.

 

Advanced periodontal disease and gum disease after treatment.

Periodontal disease and gum disease after treatment.

You can benefit from periodontal disease treatment!  The tissue can heal completely but bone loss that has already occurred (periodontal disease, by definition, includes bone loss) may never return. So the earlier treatment begins, the better.

  • This will help you maintain the affected teeth as long as possible.
  • Treatment will assist in the control of bad breath
  • Periodontal disease treatment may well reduce the risk of some systemic diseases

Periodontal disease is an infectious ongoing disease that must be well maintained with adequate home care (That’s right – you are an important part in the success of periodontal disease treatment!) and regularly scheduled re-care visits.

Periodontal disease and gum disease.

Periodontal disease and gum disease.

Periodontal disease and gum disease following treatment - bone loss remains but gums have healed.

Periodontal disease and gum disease following treatment – bone loss remains but gums have healed.

This information shared with you by Julie Gillis, DDS PC .  We feel that your dental health is the top priority, and if we can make your smile more attractive while improving your health that is wonderful! Dr. Gillis practices restorative and cosmetic dentistry including porcelain veneers, tooth whitening, implants, crowns, bridges and periodontal care.  I feel our dental hygienists are the very best in the valley! Our office website is www.juliegillisds.com.  For further information, please contact us at (970) 242-3635.

Yours for better health,

Julie Gillis, DDS,

“Restoring Smiles – Restoring Health”

What is Tartar and Why Should I Care?

December 17, 2012

What Is Tartar and Why Should I Care?

Gross tartar deposits, blunted tissue, periodontal disease

Please see the tartar on the following photos:

Heavy deposits of tartar behind lower front teeth.

The real problem with tartar lies in the fact that once tartar forms, it is very difficult or impossible to remove with a toothbrush and floss. We compare the formation of tartar on your teeth to the formation of calcium deposits on your faucets or the formation of barnacles on a ships
hull.

Moderate tartar deposits - moderate gum inflammation

Because tartar is bound to your teeth so strongly, careful removal of tartar requires the assistance of a dental professional – your dentist or dental hygienist will do this for you.  Tartar makes the teeth rough and creates places for even more bacteria and food to accumulate leading to gun disease, periodontal disease, decay, bad breath, and more tartar!  It is a vicious cycle.  Other common names for tartar are calculus and crud!

The accumulation of tartar requires three things:

1)    The presence of an organized film of bacteria – and yes, new bacteria are always there ready and willing to take the place of bacteria that have been removed by brushing and flossing!  As soon as you brush and floss, more bacteria begin to accumulate on your teeth and gums as well as in the crevice between the teeth and gums where the bacteria are hard to reach but can usually be removed with careful dental flossing.
2)    The presence of food and minerals for the bacteria.  These things are almost always present in anyone’s mouth.
3)    The presence of teeth!
We used the term, ‘organized film of bacteria’ above.  This is very important because part of what you are doing when you brush and floss your teeth is simply stirring up the bacteria that are present.  Bringing the worst bacteria out from under your gums and into the oxygenated openness of your mouth limits tartar formation and limits colonies of bacteria to form which can then lead to gum disease and periodontal disease.

See tartar and defective restorations

Some of the tartar in your mouth can be seen easily by looking closely in a mirror.  Don’t be tempted to scrapethe tartar off yourself though. You may accidently scrape away some of the surface of your teeth along with the tartar deposits which can permanently make the teeth weak!  The most damaging tartar is the tartar that forms below the gums where it can be seen on x-rays and felt by a skilled dental professional.
If you would like to see images of your teeth and see the tartar that is being evaluated or treated, please ask us!  Our office would be happy to explain in as much detail as you would like what is going on in your mouth.  Conversely, if you would just like to enjoy peaceful or rocking music while you are being treated and remain oblivious to the nuts and bolts of the procedures we would be happy to do this as well.  Once you make an informed decision about your dental care we will strive to treat you as comfortably as possible!  Our office is located in Grand Junction,
Colorado.  Our office phone number is (970) 242-3635.  Please visit us on Facebook (see Julie M Gillis DDS PC) or call us if you have any questions or concerns.

Restoring Smiles/Restoring Health

Julie Gillis DDS

If Your Teeth Could Talk… The Mouth’s Clues Part 1

February 28, 2012



Gross Periodontal Disease

 

 

Periodontal health much improved!

 

Please see the photographs here:  Is this you? 

This is a before and after of the same patient.  The treatment consisted of oral hygiene instruction, periodontal debridement, laser assisted periodontal therapy, and improved brushing and flossing by the patient. The time elapsed bnetween these photographs is a few months.  It doesn’t take long to get healthy and you will achieve a lifetime of benefits!

Look closely at your own gums – about 90% of the population has some amount of gingivitis – do your gums look pink?  Are they inflamed?  Do they bleed when you brush or floss? (They shouldn’t! Not at all!)  

From the Wall Street Journal/ Health Journal December 27th 2011

If Your Teeth Could Talk …

The Mouth Offers Clues to Disorders and Disease; Dentists Could Play Larger Role in Patient Care

  • By MELINDA BECK

 The eyes may be the window to the soul, but the mouth provides an even better view of the body as a whole.

Some of the earliest signs of diabetes, cancer, pregnancy, immune disorders, hormone imbalances and drug issues show up in the gums, teeth and tongue—sometimes long before a patient knows anything is wrong.

WSJ ‘Personal Journal’ Senior Editor Melinda Beck explains that one’s teeth and gums hold a lot of details about the body’s overall health. Also, don’t be fooled by a bright set of pearly whites. Tom Gannam/AP Images for Crest and Oral-B

There’s also growing evidence that oral health problems, particularly gum disease, can harm a patient’s general health as well, raising the risk of diabetes, heart disease, stroke, pneumonia and pregnancy complications.

“We have lots of data showing a direct correlation between inflammation in the mouth and inflammation in the body,” says Anthony Iacopino, director of the International Centre for Oral-Systemic Health, which opened at the University of Manitoba Faculty of Dentistry in Canada in 2008. Recent studies also show that treating gum disease improves circulation, reduces inflammation and can even reduce the need for insulin in people with diabetes.

Such findings are fueling a push for dentists to play a greater role in patients’ overall health. Some 20 million Americans—including 6% of children and 9% of adults—saw a dentist but not a doctor in 2008, according to a study in the American Journal of Public Health this month.

“It’s an opportunity to tell a patient, ‘You know, I’m concerned. I think you really need to see a primary care provider,’ so you are moving in the direction of better health,” says the study’s lead researcher Shiela Strauss, co-director of statistics and data management for New York University’s Colleges of Nursing and Dentistry.

George Kivowitz, a restorative dentist with offices in Manhattan and Newtown, Pa., says he has spotted seven cases of cancer in 32 years of practice, as well as cases of bulimia, due to the telltale erosion of enamel on the back of the upper front teeth, and methamphetamine addiction. “We call it ‘meth mouth,’ ” he says. “The outer surface of teeth just rot in a way that’s like nothing else.”

Some of the most distinctive problems come from uncontrolled diabetes, Dr. Kivowitz adds. “The gum tissue has a glistening, shiny look where it meets the teeth. It bleeds easily and pulls away from the bone—and it’s all throughout the mouth.”

An estimated six million Americans have diabetes but don’t know it—and several studies suggest that dentists could help alert them. A 2009 study from New York University found that 93% of people who have periodontal disease are at risk for diabetes, according to the criteria established by American Diabetes Association.

It’s not just that the same lifestyle habits contribute to both gum disease and high blood sugar; the two conditions exacerbate each other, experts say. Inflammation from infected gums makes it more difficult for people with diabetes to control their blood-sugar level, and high blood sugar accelerates tooth decay and gum disease, creating more inflammation.

In our office, we like to tell people that gums are just like skin, and it is not healthy to have skin with open sores, ulcerations, areas that bleed, or any infections.  Healthy skin and healthy gums protect our bodies from the bacteria all around us that cause diseases.  Open sores and infected gums allow bacteria to enter our bloodstreams and cause further problems.  

Our biggest problem is that gum disease doesn’t really hurt like infections elsewhere, so people tend to think it is normal for their gums to bleed when they brush, floss, or eat certain foods.  Our office will thoroughly evaluate your gum tissues for any signs of infection or inflammation and show you what should be done to eliminate this for a healthier mouth and a healthier body!

This information shared with you by Julie Gillis, DDS PC.  Our office is located  in Grand Junction, Colorado.  We feel that your dental health is the top priority. and if we can make your smile more attractive while improving your health that is wonderful! Dr. Gillis practices restorative and cosmetic dentistry including porcelain veneers, tooth whitening, implants, crowns, bridges and periodontal care.  Our office website is www.juliegillisds.com.  For further information, please contact us at (970) 242-3635.

Yours for better health,

 Julie Gillis, DDS, “Restoring Smiles, Restoring Health”

Laser Assisted Periodontal Therapy

January 3, 2012

Laser Assisted Periodontal Therapy

As described to patients by my treatment assistant, Regina

Moderate to Advanced Periodontal Disease

 

Everyone has spaces between the gums and the teeth where bacteria and food accumulate.  Bacteria under the gums in patients with periodontal disease and gum disease or gingivitis cause inflammation which leads to deepening of the pockets in the gum tissue around the teeth.  Normal healthy pockets range from 1-3mm in depth.  You can keep these pockets clean by routine brushing and flossing.  When the pockets get deeper than 3mm, it is impossible to clean them – even if you are great at brushing and flossing!

As a result, the harmful bacteria living at the bottom of the unreachable pocket cause gum disease, gingivitis, and periodontal disease or loss of the supporting bone around the teeth.  Without treatment the teeth will lose enough support to become loose and will eventually be lost.

After removing tarter (calcified deposits), stain and debris by scaling, polishing, and sometimes ultrasonic cleaning devices, a laser is used to selectively remove diseased or infected tissues lining the pockets around your teeth.  The laser kills the bacteria that cause gum disease and periodontal disease. This promotes healing of your gums around your teeth.The laser can also increase circulation and collagen formation at the bottom of your periodontal pockets.  This specialized treatment is usually performed multiple times over a period of a few weeks.

Laser in use around healthy tissue

 

The dentist and hygienist will evaluate the results of treatment and determine what type of maintenance schedule is best for you so that you can keep the remaining teeth for a lifetime.

Heavy Tartar, Gingival Recession & Periodontal Disease

 

After removing the tarter, a laser is used to selectively remove diseased or infected tissues lining the pockets around your teeth.  The laser kills the bacteria that cause gum disease. This promotes healing of your gums around your teeth.
Please contact our office if you have any questions about periodontal diseasegum disease, orgingivitis.  We would be glad to help!

This information shared with you by Julie Gillis, DDS PC.  Our office is located  in Grand Junction, Colorado.  We feel that your dental health is the top priority. and if we can make your smile more attractive while improving your health that is wonderful! Dr. Gillis practices restorative and cosmetic dentistry including porcelain veneers, tooth whitening, implants, crowns, bridges and periodontal care.  Our office website is www.juliegillisds.com.  For further information, please contact us at (970) 242-3635.

Yours for better health,

 Julie Gillis, DDS, “Restoring Smiles, Restoring Health”

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