This blog entry continues my review of the book Cure Tooth Decay by Ramiel Nagel. In the last review I covered some of the topics raised in Chapter 1 and today I complete my review of Chapter 1. And as in the previous review, I will be writing this on the premise you have read, or are reading the book along with me. I will continue to focus on pointing out both areas where I disagree with the author as well as areas I do agree with the author.
If you have any questions about anything written here, feel free to contact my office or post your questions on the My Family Dentist facebook page.
Chapter 1: continued
1. This chapter makes reference to damage to teeth from high speed drills: I have seen various reports on this and based on my experiences, I have to agree. High speed drills have the potential to overheat and crack teeth. This is why I only use electric drills that have the power to do the job at much slower speeds (~200,000 rpms or less compared to over 350,000 rpms of many air turbine drills). This is also one of the main reasons electric drills (handpieces) are becoming the recommended standard in dentistry.
To provide a comparison, I have done a fair bit of wood working. Anyone who has done the same will likely have experienced what happens when a dull blade is used at high speeds when cutting wood. In addition to cutting, the blade produces heat and will actually burn the wood as it cuts. Air turbine handpieces do much the same with their high speeds. Unfortunately, the high speed with an air turbine is required as they do not have the cutting power to keep spinning under pressure. Electric handpieces have the power (torque) necessary to keep spinning under pressure at much lower speeds. Thus, less heat buildup and less trauma to the tooth.
2. The author references “extension for prevention” in a very negative light. I personally believe in this ideology, but not as stated by the author. To me, extension for prevention is essential for restoration longevity and is a concept used around the world in all aspects of construction and engineering. For my application in dentistry, this refers to extending beyond decayed tooth structure to remove severely weakened tooth structure that is not sustainable and would not hold up as long as the restoration, or would compromise the integrity of the restoration. Further, this involves extending beyond fine grooves or weak tooth structure to find a solid transition between restoration and tooth, and to ensure adequate retention to withstand function. If this is not done, restorations fail prematurely, which results in even further tooth structure removal and damage than what would have been done by proper use of the principles of “extension for prevention”.
3. The author makes several references to various filling material options, and in response, I refer you to my pages on mercury filling removal and filling material options. Additionally, studies demonstrating immune system reaction need to factor in material placement (was it done correctly), restoration location, types of material (newer materials used correctly are a lot safer than they ever used to be), as well as health of the individual. This enters into very complex territory as each person and dentist is different, and the number of materials to choose from are countless.
4. Drill Fill Bill model: The references made here by the author definitely have merit and there are several reasons for this. Before stating those reasons, I would like to mention that there are many good dentists out there that do not follow this model and endeavor to not only treat, but to educate their patients. And many of my patients have commented as to how different my office is than previous offices they have been to, and this is a primary reason (we do not follow the drill fill bill model).
– Yes, there are many dentists who either go into dentistry strictly for the money, or who have been corrupted by greed and the ease of making money when they put their own pocket book first, rather than putting the patient first and focusing on their needs. In many cases, this has the potential to change as patients ask questions and challenge their dentists to explain the existing condition, treatment options, and risks of no treatment. The more engaged the patient is in their own treatment, the easier it is for a dentist to provide ethical treatment, and the easier it is for a patient to spot a dentist who is focusing on the money alone.
– Another challenge that perpetuates this model is rising costs in the dental field combined with lack of adequate compensation for dentists and their team when the focus is on prevention. For example, many people will rather get another filling that is paid for by their insurance rather than spend a couple appointments learning how to prevent the cavities and billed a similar fee that their insurance does not cover (insurance pays for repair, not prevention and many people often choose based on coverage rather than what is best). If a dentist was going to charge you $150-300 an hour for counseling on preventive dentistry, would you be willing to pay for it?
Now you may be saying to yourself, does the dentist and his team really know enough about prevention to justify paying them those fees. To which I respond, if people where demanding dental offices provide accurate information that is practical and works, wouldn’t more dental offices make sure they had the knowledge and resources to pass on? Good old supply and demand.
– Another challenge dentists face is a sense of “what’s the point”. A dentist can spend hours with a patient coaching and guiding them and have no success as the patient does not want to change from the destructive habits (we all have bad habits that we are resistant to change as we are pulled in many different directions). Dentists and Hygienists have a hard enough time getting people to brush and floss, let alone change their diet. And so, following the “crawl before you can walk” ideology, the dental team will often start with the basics like, floss your teeth, don’t drink pop, etc. And if the patient refuses, prevention stops there. With enough patients like this in a dental practice, who are resistant to prevention, the office will easily fall into the drill fill and bill model. This will then taint the approach taken with all patients, especially if patients do not ask questions and challenge the dental team.
At My Family Dentist, a key focus and part of our mission statement is education and maintenance. I personally receive no joy in restoring a mouth to health, only to have it fall apart over the next year due to neglect. That is why we focus not only on restoring, but also maintaining, and truth be told, the vast majority of our success is based on the patient being willing and able to do their part in living a healthy lifestyle.
Well that raps up Chapter 1. Stay tuned next month for my feedback on Chapter 2.