Tuesday, June 19, 2012

We Need a Better Diet, Not More Dentists

     
       I've been in the process of writing a paper highlighting my beliefs of the state of our nation's oral health for a few months now.  It started when I was learning about the big push for mid-level providers in the state of Kansas.  And now, PBS will be airing an episode of Frontline titled "Dollars and Dentists" on June 26th.  While I'm all for informing the masses on true state of things, I get pretty annoyed when these pieces point the finger at the "rich and greedy" dentists and not at the real causes; lack of hygiene and high consumption of sugar (and other crap foods).
       The sad fact is that 90% of what I do is totally preventable in the first place.  Sure, there is the occasional trauma (sports, car accidents, etc) and genetic anomalies (the actual incidence of "soft teeth" is a pretty darn rare condition known as enamelo/dentinogenesis imperfecta, and unless you were born with your teeth being brown, blue, or see-through that are easily worn from day 1, you don't have it).  All of these special-interest groups, media outlets, and politicians rant and rave about "access to care".  I don't disagree that there is a great need for care.  Where we disagree on is that they like to blame dentists, where I put the blame on diet.  I don't see cardiologists getting blamed for the rampant heart and cardiovascular disease in our nation, but for some reason dentists get blamed for oral disease.
       I would LOVE if I never had to do another filling a day in my life.  Will that ever happen?  Not likely.  But maybe this paper will help people understand how cavities work, and what they can do to prevent them. So without further ado....


This Country Needs a Better Diet, Not More Dentists

Make no mistake; dental caries (aka cavities) is a disease.  It is a degenerative disease of the teeth caused by bacteria. The 2000 Surgeon General’s report on “Oral Health in America” identified tooth decay as the most common chronic disease of children in the U.S. Dental caries is most prevalent in lower income households.  When folks read this, they usually throw their hands in the air and blame it as an “access to care” issue. Because of these reports, there has been a push by lobbyists and politicians (both state and federal alike) for a “mid-level provider” to increase this “access to care”.  The purpose of this article is to shed some light on the issue, to advise where attention should really be given, and to give some suggestions on where to go from here.
First, a short science lesson is in order.  We’ll call it “Cavity-ology 101”.  The first lesson is a simple formula on which we’ll expand:
Teeth + Bacteria + Sugar +Time= Cavities
The mouth contains a wide variety of bacteria, but only a few specific types of bacteria have been found to cause cavities.  It’s because of these select strands of bacteria that we have thousands upon thousands of kids with tooth decay.  But how do these bacteria, which I like to call “bugs” due to better imagery, cause cavities exactly?  Well, bacteria are constantly creating a layer, or biofilm, on your teeth.  This biofilm becomes a sticky, creamy-colored mass most commonly known as plaque.  In other words, that fuzzy stuff that collects on our teeth is a network of millions of bugs lining an assault.  Their means of attack is by the production of acid.  And the fuel source for these bugs to pump out acid is none other than sugar.
The harmful bacteria in our mouths convert sugars into acids through a process called fermentation.  If allowed to sit on the teeth, these acids can cause the teeth to lose their strength by robbing them of minerals through a process cleverly called demineralization.  With enough demineralization over time, the tooth “disintegrates” and is left with a hole, or cavity.  The scientific study of how sugars can affect the progression of cavities is called cariogenictiy.  Without getting too jargon logged, let’s keep it simple.  Different types of sugars are worse than others (i.e. table sugar is worse than sugar from fruit), but given enough time, most of these common sugars (sucrose, glucose, lactose and fructose) can cause cavities. So it doesn’t matter if the sugar is from candy, pop, bread, milk, potato chips, juice, fruit, etc; they all will lead to cavities given enough time.  
The next step on the road to cavities is time.  How often teeth are exposed to sugar and acid plays a big role in the formation of cavities.  After meals, snacks, or anytime you put fermentable sugar in your mouth, bacteria produce acid.  Each exposure can dissolve your teeth for up to 2 hours.  To help get this point across, let’s use an example.  Jack and Jill don’t brush their teeth all day.  Jill eats 3 times throughout the day: Breakfast, Lunch, and Dinner.  Each one of these meals has a good amount of carbohydrate (sugar) content.  This means that her teeth can be subject to acid attack for six hours in just that day alone.  Now to make things worse, here comes Jack.  Jack eats the same meals as Jill, but also has some potato chips for a mid-morning snack, and has a can of Coke a couple hours after lunch. This means his teeth could be left dissolving for 10 hours (5 meals x 2 hours of acid)! And I won’t even go into what would happen if Jack were to nurse his Coke all day long.
There are other factors that can lead to cavities.  These can include the quality of mineral content in your saliva, tobacco use, and rare developmental disorders of tooth formation.  But for the vast majority of the population, cavities are the result from the combination of bacteria, sugar, and time.  So where do we go from here?  Well, the answer is painfully simple.  Cut down on sugar and brush and floss more. 

The End... for now

I have a lot more to write about the subject, and the paper is far from over.  But the here is a launching pad if you want to know how to protect your teeth for life-long service.  As always, if you have any questions whatsoever, feel free to ask. 

Down with Tooth Decay!

Monday, February 6, 2012

7 Habits of Highly Effective People (1&2)

7 Habits of Highly Effective People

As some of you might know, I'm a bit of a self-help junkie.  I started this journey a couple of years ago to overcome a sense of apathy that had slowly growing in my life.  Since starting on this track of self improvement, my quality of life has increased significantly.  And now I'm constantly devouring books and audio CD's with the goal of self-satisfaction.  Of all the books that I've read so far, the book 7 Habits of Highly Effective People is one of the best.  Below is a review and summary of the book.  It is meant to be educational, but not a replacement for the original work.  I have read the book all the way through for an overall understanding of the material.  I'm now on my 2nd time through for application.  I welcome you to start on this journey as well. 

Stephen Covey’s 7 Habits of Highly Effective People was the epitome of self-help books just over a decade ago.  Even though you might not have heard of it, it has shown to be the real deal. 
The overall philosophy of the book is based on a maturity continuum which travels from Dependence (you) to independence (I) to interdependence (we). Habits 1, 2, and 3 deal with self mastery and private victories and assist in the transformation from dependent to independent. Habits 4, 5, and 6 build teamwork, cooperation and communication. These include Public Victories and transfer from the independent to the interdependent.

Habit 1: Be Proactive

There are 3 accepted theories of determinism (a theory or doctrine that acts of the will, occurrences in nature, or social or psychological phenomena are causally determined by preceding events or natural laws) to explain the nature of man.

1) Genetic determinism: it’s inherited in your genes (i.e. Of course you have a temper, you're Irish)
2) Psychic determinism: learned early from your parents (think the teachings of Freud)
3) Environmental: this includes everything else.  Your boss, coworkers, spouse, kids, the economy, national debt, personal debt, etc

However, between stimulus and response, man has the freedom to choose. You are responsible, or better, response-able.  There are multiple ways of choosing your response including self awareness, imagination, conscience, and independent will.

Reactive vs Proactive
Reactive people are affected by their environment, the weather (sad on a rainy day), how others treat them. Reactive people are driven by feelings, by circumstances, by conditions, by their environment…
Proactive people are still influenced by external stimuli but their response to it is a value based choice or response.
A quote that Covey used that I love is: Eleanor Roosevelt: “No one can hurt you without your consent”

Self Awareness
Circle of Concern: where do we focus our time and energy (both physical and mental)? i.e. our health, finances, children, work, national debt, etc.
Circle of Influence: these are the concerns we have control over either directly (problems involving our own behavior) or indirectly (problems involving the behavior of others).
Any time we think the problem is “out there”, that thought is the problem. We empower what is out there to control us. This paradigm approach is from the outside-in, example “that much change before I can…” The proactive approach is to generate change from the inside out. (Personal note:  This is one of the hardest changes for me personally)

Habit 2: Begin with the End in Mind
To begin with the end in mind means to start with a clear understanding of your destination. It means know where you are going so that you can better understand where you are now and so that the steps you take are always in the right direction.
In the book, Covey asks you to imagine your own funeral.  What would the people there say about you and how you lived your life?

“Begin with the end in mind” is based on the principle that al things are created twice. There’s a mental of first creation and a physical or second creation to all things. There is an idea before there is an action.

Covey then goes on to describe the difference between Management and Leadership. Fundamentally, Management asks: How can I best accomplish certain things? Leadership asks: What do I want to accomplish? Management is doing things right, leadership is doing the right things. 

A Personal Mission Statement
The most effective way to build a personal mission statement is to begin with the end in mind. Focus on what you want to be (character) and do (contribution and achievements) and on the values upon which being and doing are based. A strong sense of values and conviction cannot be emphasized enough. Begin at the very center of your Circle of Influence. Different people have different paradigms for the source of their center, i.e. spouse, family, work, pleasure, money, self, but perhaps the center should be based upon principles instead?  
Covey quotes Viktor Frankl: "Ultimately, man should not ask what the meaning of his life is, but rather must recognize that it is he who is asked. In a word, each man is questioned by life; and he can only answer to life by answering for his own life; to life he can only respond by being responsible."

So there you have habits 1 & 2.  I will be focusing on these two habits for this month, until I feel comfortable enough with these principles to proceed.  If you have any questions, do not hesitate to ask.  I can only hope that you decide to start a similar journey.  And remember that this is not a quick-fix, but rather a life-long lesson of self mastery.  

To be continued!

Wednesday, October 5, 2011

My Plans for Eureka

       Hello everyone!  I have been getting a lot of questions about my plans for my office at 801 N. Main, Eureka.  I figured I would write this post to hopefully clear up some confusion and answer some questions.

       About 6 weeks ago I purchased the vacant dental office in Eureka.  Most of you know which one it is.  The... well... dated white building on north main (next to Casey's).  I bought this building because the bank was being pressured to liquidate the contents, and I thought that it would have been a terrible shame for the community to lose that location for a dental office.  

       Now to give a little insight to where I'm at right now professionally, and what my future plans are.  I am currently working full time at Flint Hills Community Health Center in Emporia.  I am also associating in my spare time at Burlington Dental Center with Dr. Larry Hargreaves in (you guessed it) Burlington.  So between my 40-60 hour workweeks, my spare time is quite scarce as you can probably imagine.  I am blessed to have wonderful staff and facilities at both of these locations.  

      You might be wondering what this means for Eureka?  Well, as a young doctor, I have a hefty amount of debt from student loans alone (~$250K).  By working at a Federally Qualified Health Center (FQHC) like Flint Hills, I am eligible for student loan repayment.  I have taken this loan repayment, and by doing so, I have obligated myself to 2 years at a health clinic or Health Professional Shortage Area (HPSA).  Eureka does qualify as a HPSA, but since I will be opening my own private practice, there are much more regulations that I have to go through in order for the Eureka site to qualify.  

      To summarize, it looks like it will be a while until I'm down in Eureka.  If I remain in Emporia until the end of my loan repayment contract, I wouldn't be down in Eureka until September of 2013.   I am looking into what it would take for Eureka to become an approved site sooner.  But when dealing with the government, it's safer to shoot long when estimating time schedules.  

     The good news is that I do own the building, which is a major stepping stone.   Over the next several months I will be traveling down there making plans for the building and updating it.  I want to offer the area something that they might not be used to.  And what I mean by that is new technologies and amenities of a more modern office.   Down the line I would love to build a new office on that lot, as the current office doesn't have the best layout, flow, or space for expansion.  It is, however, a great starting point to offering the area high quality care with the convenience of being local.  

     I urge folks NOT to hold off on getting care until I'm down there.  Often times in dentistry, and many other areas of life for that matter, more conservative and less expensive treatment is available when a problem is found early enough.  Car maintenance isn't too expensive until you drive 25,000 miles without changing the oil and ignoring the knocking sound coming from under the hood.  

     Well that's it for now folks.  I hope this helps clear the air and answers some questions you might have had. Take care and God bless!


Now.....


  
... Later?

Tuesday, July 19, 2011

"I Brush My Teeth With Sugar!"

*NOTE: I did not write this article.  This is simply a copy of the article "I Brush My Teeth With Sugar" by Chris Kammer, DDS in the June 2011 issue of DentalTown magazine.  I found it quite interesting, and thought you might too.  It has encouraged me to learn more about the sugar substitute, Xylitol.  Also, this article was written for dentists, so some of the technical jargon might be a little hefty*



Yes, I really do brush my teeth with sugar! That might sound like the craziest thing you have ever heard. In much the same way that there are good fats like flax seed oil, and bad fats like trans fats, not all sugars are bad for your teeth. In fact the sugar that I brush my teeth with is a secret weapon to wipe out oral disease-causing bacteria. This sugar is xylitol and it is poised to replace fluoride as the greatest scientific discovery for healthier mouths. Furthermore, xylitol is safe and has been used by diabetics for decades. Xylitol has none of the controversy that surrounds fluoride and it comes in a variety of usable forms that make it very easy, delicious and economical to use.

There's a battle going on in our mouths and xylitol can help us all win and easily give us healthier mouths. While oral disease continues its rampage against teeth and gums, as a profession we should be doing much more on the front end of this problem to prevent it.

The "Miracle Drug" is Here Now
For many populations worldwide, the levels of dental caries have reached epidemic proportions. Even in the U.S., childhood tooth decay is on the rise. I have heard some patients of mine claim that they are victims to this disease that caused their mouthful of cavities because they were born with the misfortune of having "soft teeth." Many people believe that cavities and gum disease are inevitable. Sadly these people are probably waiting for a future miracle drug that will kill the bugs that are behind all of these problems. However the closest thing we have to a "miracle drug" is already here and it's not a drug – it's xylitol, a naturally occurring substance that is as sweet as candy and disarms the bad cavity-causing bacteria in your mouth. With consistent use of xylitol, the nasty oral bacteria are rendered virtually harmless. Studies have shown that five to 10 grams of xylitol a day can reduce the acid-producing bacteria by as much as 95 percent after six months. Pure xylitol looks and tastes like regular white table sugar and it is used to sweeten a variety of candies and chewing gum, in addition to toothpastes and mouth rinses.

We all know that sucrose (white table sugar) serves as food for the harmful bacteria in our mouths, resulting in acid production that destroys tooth structure. Xylitol is a different kind of sugar known as a polyol. It occurs naturally in many fruits and vegetables and is produced in the human body as well. Side by side in a sugar bowl you can't really tell them apart and they both taste deliciously sweet, however, xylitol has a much different effect on the bad bacteria in our mouths, preventing it from adhering to the tooth surfaces. Also, since the bacteria can't metabolize xylitol, they can't create the acid by-product that is created when bacteria eats up regular sugar. The xylitol-fed bacteria starve and die off! Regular use of xylitol has been shown to not only reduce tooth decay but also facilitate the remineralization of teeth.

We Need Xylitol Now
Dental caries affects the populations in every country. The National Center for Health Statistics reports that in the U.S. by the time kids are age 17, almost 80 percent have experienced tooth decay. In Finland it is practically the opposite where 80 percent of high school graduates have no caries. What is the difference? Finland schools regularly distribute xylitol to the students. Need more proof? Dr. Peter Allen, head of the Ministry of Health in Belize, reports that in his country's landmark study, xylitol reduced caries by more than 50 percent with results continuing to show that same reduction even five years after the study (and xylitol usage) was completed. It appears that xylitol usage has a very long-lasting effect.

Knowing that a child's major oral infection source is his or her mother, studies in Finland showed that maternal use of xylitol can prevent the colonization of the Strep Mutans in the dentition of the child. This leads to caries prevention in the child. Additionally, Professor Brian A. Burt, editor-in-chief of Community Dentistry & Oral Epidemiology, stated that "the evidence is strong enough to support the regular use of xylitol-sweetened gum as a way to prevent caries, and it can be promoted as a public health preventive measure."

Dr. Catherine Hayes from the Harvard School of Dental Medicine Department of Oral Health Policy and Epidemiology published a review of the evidence in the Journal of Dental Education and she felt so strongly about the positive effects of xylitol's strong caries protective effect, she stated, "it would be unethical to deprive subjects of its potential benefits." Yet how many dental health professionals are educating their patients about the benefits of xylitol and delivering it to them in the office? Sadly very few.

A Candy Store
Your dental office's front counter should look like a candy store. Your office should display a variety of products that are sweetened with xylitol for all of your patients to see and purchase. This will also create great discussions between your patients and office team about the power of xylitol. You will be amazed at all of the delicious treats that are 100 percent sweetened with xylitol. You will find boxed chocolates, caramels, taffy, lollipops, hard candies, flavored mints and chewing gum. Have a plentiful supply of them on hand in your office and every patient will walk out the door with some. Don't let your patients be fooled by general marketplace products like Trident chewing gum for example, which proclaim on the package that it contains xylitol but actually contains only traces of the ingredient.

Go with products that clearly say how many grams of xylitol are in each serving. Products geared toward the serious "sweetened 100 percent with xylitol" user usually have a total of one gram of xylitol in two individual pieces of gum or mints. Here are three leading Web sites to learn about xylitol's benefits and where to buy products:

www.zellies.com is from Dr. Ellie Phillips. She wrote the book Kiss Your Dentist Goodbye about xylitol's benefits.

www.xlear.com is from the makers of Spry xylitol products. They are one of the larger distributors of xylitol products.

www.drjohns.com is a company founded by a dentist and his wife who is a hygienist. They have a huge variety of unique xylitol chocolates and candies.

All of the above companies will also sell you granular xylitol for around $8 per pound. That might be the most economical way to get your xylitol. A quarter teaspoon of granular xylitol is one gram. The healthy benefits of xylitol are maximized by getting one to two grams of xylitol during five separate exposures throughout the day. "Strive for five!" (exposures) is the xylitol battle cry. I keep a quarter teaspoon measure in the granular xylitol container, scoop it and place it directly in my mouth. The delicious sweetness has a cooling effect and it dissolves almost instantly and stimulates plenty of saliva. I swish it around for a minute or two and then brush my teeth before I spit it out. You don't have to swallow the xylitol, it just needs to be in your oral environment to be effective.

The Xylitol Buzz Is Beginning!
Why isn't xylitol being enthusiastically promoted by every dentist and hygienist? Could it be that we haven't noticed the xylitol message because we are so wrapped up in fixing the disease damage? Hard to imagine most people having teeth without decay, isn't it? A new mindset is springing up among progressively conservative dental professionals to mount a pre-emptive strike that includes using xylitol as a protective agent to seriously disarm the bacteria involved in the destruction of teeth and the disease in gums. These dentists have formed an organization called the American Academy for Oral Systemic Health (www.aaosh.com) and I am honored to be their president. In order for dentists, hygienists and other health professionals to be in this group they must demonstrate their knowledge of how the health of the mouth impacts the health of the body and they must know and understand the role of xylitol among many other important oral systemic issues. These dentists are currently recommending a daily xylitol regimen to most of their patients. As changes like this begin to occur in our profession, we are on our way to a healthier nation.

What's up Doc?

Hey everyone!  I'm just chiming in to let people know what's going on with my professional plans.  Every week I get asked, "when are you going to set up shop in Eureka".  I just wanted to let everyone know that I am indeed working on getting an office started there.  However, this can be a long process.  Also, I am waiting to find out if I'm getting loan repayment through the National Health Service Corps.  The cost of dental school is through the roof, and many students are graduating with student loan debts of $250,000 or more.  I am no exception.  So if I do get awarded some loan repayment, I will be tied to the clinic here in Emporia for 2 more years.  I will let you know when the situation updates.  Thank you!