Return of A Dental Perspective & Life’s Paradigm Shift

by drjennygst Posted on December 22, 2011

Yes, I am alive!!! I must first apologize to my readers that I have not posted in quite some time, but when you hear why – trust me the reason is a good one. When you hear the saying “life changes in the blink of an eye” – the saying really hits the target for me.

So for the big news and unveiling of why I have been missing in action… I am writing to you now – with not only a dental perspective, but also a PREGNANT-in-my-second-trimester female working woman perspective! AGH!! Now isn’t THAT a mouthful, or should I say in this case, stomach-full? But, I’ve been working full time and been dealing with morning/evening sickness, nausea and fatigue and unfortunately my writing at night had to take a back burner to the need for survival and sleep. But I’m BACK! Hopefully I’m forgiven!

Now at 16 weeks the bursts of energy have returned and the precarious first trimester is over and I feel reborn!!! As you can imagine, my family, my husband, and I are extremely excited. My husband and I are just tickled that we get the honor of bringing another person into the world to join our family and we are adjusting and embracing this next adventure. Of course this entire process is like navigating the unknown – I look down and there is this little bump there and it is just so surprising. When I’m working I think as I get bigger how am I going to see?! And of course I am nervous about birth, large epidural needles, being a good mom and balancing everything – taking care of a little one, paying a mortgage, paying school loans, while still continuing a professional and successful career. I thought the balancing act was difficult before, but I guess I’m testing the balancing act even more.

There was something that we learned when we were in school called a “paradigm shift” – defined as a “radical change in underlying beliefs or theory.”  The last paradigm shift I had was more of a professional one – making decisions to work in different dental settings instead of staying in one office. Now, the shift is a personal one involving the care and addressing all the needs of a helpless baby who is depending on me to feed, clothe, bathe, burp, change…everything!!! There are some days when I feel like I don’t even get to comb my hair the way I want and get to work – now put a little darling human in the mix whose diaper needs to be changed and who knows what will happen!!!?!?! I read an article that says you change a diaper 4015 times in a year!! Can anyone say CLOTH diapers?

There are so many things that I wish I could try – cloth diapers, sign language for the baby, spending hours and hours with the baby just looking at the little angel face. But then I also want my career not to stagnate and I don’t want to forget dentistry. So in light of these conflicting emotions I have come to realize what so many of my female friends have told me. This adventure of parenthood is the greatest one I’ll ever endeavor. But I CAN have both – be a mom and also continue to be myself and continue my professional career – but I need to figure out how I’m going to accomplish that out on my own. I know each woman is different and each working woman makes the decisions for her and her family to make things work. Unfortunately no manual comes out with the placenta that tells us how to take care of the little baby – but my type A personality hopefully will serve me well and my not having any shame in asking questions and asking for help.

So now I return, writing for two – to bring you another perspective from the dental chair.

image from: logodesignworks.com

Posted in Health, Humor & Laughter, Personal Experience, Women's perspective | 1,088 Comments

Candy Buyback – Sign up your office and get involved in your community’s health

by drjennygst Posted on October 5, 2011

It is October already…yes…already!!! And that means the glorious changing of leave colors, the warm cozy sweaters come out of the closet, and of course…Halloween. With Halloween comes, the crazy fun costumes, the fun friend and family parties, the food, and of course…the TRICK or TREATERS and…inevitably what follows is: the candy.

For parents this time is fun, and possibly expensive with too many sweets, and not enough brushing. For kids, this is the time when it’s ok to have a huge pile of candy and your parents even help dress you up to get it!!! But from a dentist standpoint – and I love candy like everyone else (Kit Kats and Red Vines are two of my weaknesses) we want to also be leaders in our community and promote the oral health of children, families, and patients. And so today I found that there is something we can do not only for our local community children but also for our veterans.

I work with the Veterans at the VA dental clinic once a week and I finished my residency there also – making the VA and veterans very important for me. Additionally, as a member of the private sector of dentistry and as I have said in previous posts, the local businesses and local community and oral health are also very important to me.

Today I found a program called: Operation gratitude in conjunction with Halloween candy buyback and it is fantastic!! I don’t know why I haven’t heard about it before, but it serves both things that are important to me: the local community and veterans. So YAY!!! Today on the NPR I heard that there is a proposal to move all the troops out of Afghanistan by 2014 but the speaker stated that is likely not going to happen. And not only in Afghanistan there are men and women that are fighting for our freedom and freedoms we enjoy today!

So what is Halloween Candy Buyback and how does it work?

The dentist or dental clinic goes to the website: http://www.halloweencandybuyback.com/ and you sign up your office address. You can also find out more information there about this program. Then dentists and clinics and offices will then “buy” back kids Halloween candy on a certain day – maybe on Halloween, maybe the day before or after – whatever and whenever you decide.

You don’t have to “buy” back the candy through monetary means – You can “buy” back the candy through different ways: coupons to a local store, coupons for a muffin, or you can buy back the candy for “$1″. Another example the site gave is that you can set up a “prize” for a drawing or special prize from the office or community or restaurant (free toothbrush, free dinner, free cleaning, etc).

The dentist will then send the candy to Military support groups (such as Operation Gratitude) and then they will send candy to the US Military overseas in christmas packages or goody bags.

So, you ask, we are promoting oral health of our local community and sending candy and giving our troops cavities? Well, in looking at the grander scale and grand picture – in many of those remote areas or stressful situations, having a sweet, or a candy bar or a small chocolate goody from home is not going to give our men and women overseas cavities. It can give a small joy to them, and I know that I didn’t get my cavity from the last Kit-Kat bar that I indulged in. We are trying to bring them a small joy amidst difficult situations. In addition Operation Gratitude stated on the website that they are trying to put together kits including a toothbrush and floss and toothpaste with the candy as well so that lovely candy sweet won’t stay on their teeth for very long – even if they wanted it to linger!

The flyers and posters about Operation gratitude and for more information you can email: opgrat@gmail.com. As long as you are sending all the collected candy and letters to Operation Gratitude, the site states that you can use the operation gratitude name, logos and photos and flyers and other materials as part of you promoting this event.

SO take a look and see if this is something you want to do! Support our local children and oral health of our community and give a small joy to our troops abroad. This is a responsible yet fun, and creative way to help especially in this time of economic uncertainty. Health, laughter, happiness, family and giving to others are the things that are going to keep us going even when things get rough.

image from: livelighter.org

Posted in Current Issues/Events, Health, Humor & Laughter, Personal Experience, Public Health | Tagged , , , , , , , , , | 1,030 Comments

Practitioners might have to pay 33% more for the DEA license????

by drjennygst Posted on September 29, 2011

I was reading the ADA Advocacy publication the other day and it mentioned that on August 10th of this year The Drug Enforcement Administration recently proposed to increase of 33% for EVERYONE (all practitioners – physicians, physicians’ assistants, nurse practitioners, pharmacists and…dentists). The fee would be raised to $732 under this increase request (an increase of over $150). The license would be valid for three years. Apparently the new calculation is to cover increased costs of diversion control (diversion control being those that monitor for abuse of drug privileges and compliance with current standards and protocols.

Isn’t that crazy? That those of us who are prescribing medicine to help people and are not benefiting at all financially by writing the prescriptions that people NEED are suddenly going to have the price raised by over 1/3? And that the programs are to help monitor regulation and ABUSE of prescription writing and medications? Don’t you feel that drug companies that are pushing for us to prescribe their products should help to take care of some of the cost of this? Why should small businesses or practitioners that are prescribing and helping the public have to pay for the cost of monitoring drugs that we don’t even see? Why should the financial burden be place on us? I prescribe mostly antibiotics, some pain medication, some antifungal medications and chlorhexidine (antibiotic mouthrinse for periodontal disease maintenance. Sometimes I prescribe an anti-anxiety medicine to help patients be relaxed before their dental appointment, but that is VERY rarely. Abuse of writing medications is not even in my consideration. It is my dental license on the line – I’m not going to jeopardize that…for anyone.

But do NOT FEAR – it isn’t just me that thinks that it is ridiculous! Recently in the American Dental Association stated that the “proposed fee increase is an unfair burden on dentists who are prescribing the controlled substances. You can read the ADA stance here: http://www.ada.org/news/6244.aspx

At least the ADA and other responsible legislative bodies are voicing their concerns and requesting that this fee increase not be done. If someone doesn’t say something, I’m sure they would increase the fee ten fold if they could, not just the 33%. I would pay this fee with less opposition if I knew it was going towards the patients, or a fund that patients need to help those who can’t afford it. But I do not think that I should have to pay because the drug companies need regulation or people who abuse drug prescription tablets are not responsible. I need to help people and help my patients and need my drug license to prescribe it. But I do NOT need to pay for company fees for monitoring.

Ok, I know….I’ll get off my legislation & political soapbox now. I’ll keep you updated on anything new regarding this!!!

Posted in Business Side, Current Issues/Events, Health, Personal Experience, Public Health | Tagged , , , , , , , | 987 Comments

Laugh of the day & funny sayings

by drjennygst Posted on September 27, 2011

In light of yesterday’s more serious post and my concern about education and high costs, I needed to laugh today. I also find that many people have strong opinions about education and taxes – and I like to have those discussions because it makes people continue to question and not just accept things as they are. Changes and controversy are very good…But, we all need a little humor in our lives or else everything will become too much and the concerns can overwhelm us. Laughter is the best medicine!!!

So – today’s post is a little fun images and sayings that I thought brought some humor to the day…

I was going through some fun dental sites and came upon this post by www.dangerousminds.net – a post from 2010 had shared a youtube link with composer/musician Frank Zappa being known as a “dental floss tycoon” and that he even helped to work the the ADA (American Dental Association) to make a record about the importance of flossing!!! Interesting isn’t it?  You can see the link below: http://www.dangerousminds.net/comments/frank_zappas_psas_for_the_american_dental_association

It might seem silly at the time but it can demonstrate how professional organizations can involve public figures to help influence patients and people of that particular time! (who would that be today?)

If this picture doesn’t get you to floss, I don’t know what will!

image from: vitaminwatercanada.ca

 

When we as dentists request that you get an electric toothbrush, this is not what we meant:

image from: wastetimepost.com

Smiling and cuteness will get you a LONG way…

And lastly, this saying is really cute, and our hygienist had me write it out for a patient of ours today as a motivation piece to put up when he is brushing and flossing:

saying and image from: tidymom.net

We all have to laugh and enjoy life with a little sense of humor, even when issues at hand are serious. Or else we won’t stop and smell the roses. :) ENJOY!!!

Posted in Health, Humor & Laughter, Personal Experience | 1,390 Comments

Petition to ask for help for new health professionals: a small step to help the symptom of escalating education prices

by drjennygst Posted on September 27, 2011

This morning I was driving to work and on the radio they were talking about President Obama’s program called “We the People” (https://wwws.whitehouse.gov/petitions ) where people are able to create or join petitions on issues that are important to us to make a difference in public policy! I had never heard of this program and was VERY excited about it! While the radio DJs talked about the program and their current event story, I was thinking about how this program might be helpful in the dental and medical professions. I think this is a fantastic way for the public to be involved in policies, public health, and issues that are important to us. It is really an innovative way and privilege to be able to present issues to our administration in such a direct manner.

So I made a personal petition asking that new health professionals (medical, dental, optometry, osteopathic medicine, allopathic medicine, nursing, hygiene, etc) be able have our school loan interest be tax deductible OR that fix low interest rates be made available to us: https://wwws.whitehouse.gov/petitions#!/petition/allow-new-health-professionals-1st-8-10-years-deduct-federal-education-loan-interest-or-give-low/yzH8bHf1

Now, I know that the saying is – that there are 2 things certain in life: death and taxes. And this petition is NOT about evading or not paying taxes. I understand that my tax dollars are very important to our federal, state, and local communities. Taxes help with public education, teachers, the public schools, public transportation, safety of our society by policemen, firemen, etc. I also am well aware that it is the banks that allowed me to fund my post-graduate education. And I pay my taxes, EARLY, without fail. And as it is for everyone, paying taxes are difficult but I do it. BUT what I am trying to address is of course – the bigger picture regarding the issue of the HIGH PRICE of education (public and private) and its continued escalation that needs to be addressed. But I am enough of a realist to know that higher education prices are very unlikely to be changed or altered anytime soon. I understand that schools need funds for research, for supplies, for teachers, the future children’s educations, and the ability to give those educations.

So instead, what this petition addresses is a small yet significant symptom of higher education costs – addressing the needs of recent graduates to allow for tax deductible student loan interest when paying taxes. This petition is asking for help for NEW HEALTH PROFESSIONALS (in the first 8-10 years) who are trying to become established in their professions, help the community, become the experts society needs, and eventually the teachers of future professionals.

There are many things I am passionate about – the importance of family, the importance of literacy, education, health, and dentistry. As a new dentist (new dentists are considered to be practicing for 10 years) I have been struggling with many issues. I know that I am not the only one – because I have spoken to many of my fellow classmates and we are all struggling with similar issues. Additionally, there is a New Dentist Magazine (http://www.thenewdentist.net/) devoted solely to new dentists to help us as we navigate through our initial stages in the world of dentistry.

Why did I place this issue on a petition? Why should the general public CARE about helping health professionals when there exists the assumption that every health professional is very wealthy?

The future of education is why the general public should care. The future of health and medicine is also why people should care. Education prices are at an amazing yet necessary price – the inflation and fees growing even MORE quickly and exponentially than mortgage prices. Wonder if the cost of education becomes so high that people are asking for over half a million dollars for loans? We are NOT far off. Can the government loan that much? Can the government afford to loan that much for each student? Will students who would be wonderful medical and dental and health professionals be turned away because they can’t afford the education? And instead those who are independently wealthy or have a million grants be the only ones able to achieve higher education? Are the potential of amazing children and people in the future going to be crushed because education (even college education) be unattainable due to finances?

The petition is a small step to help new health professionals and PROMOTE education. As we are economically addressing the mortgage crises, we are also in an education crisis affecting college students to new health professionals. Health professionals spend their entire professional lives helping others. Given the current economic status – there is no guarantee that jobs are available. There are also many fees that allow a person to even practice: licensing fees, malpractice insurance, disability insurance, drug licenses. How can most of us pay our significant education loans, have a family, and have a home? Student loans, in the eyes of the banks, are considered to be “GOOD DEBT” but to the student or new professionals, DEBT is DEBT. And for RESPONSIBLE citizens, you do not run away from debt. Years ago, education prices were not as they are now & these things might have been less of an issue. But this petition would be a huge step in the right direction for students who have pursued higher education, given sweat and tears to their professional careers, but are held hostage by high interest loan rates and high education prices. Students work hard their entire student careers – many to achieve higher education, advanced degrees that they hope will help them to provide for their families, in addition to having their own professional goals.

So PLEASE VOTE: https://wwws.whitehouse.gov/petitions#!/petition/allow-new-health-professionals-1st-8-10-years-deduct-federal-education-loan-interest-or-give-low/yzH8bHf1

If don’t want to vote to help new professionals, then vote to help the future of higher education – for your children, and your grandchildren. It isn’t much, but it is the best I know how to do, for now. I am doing dentistry – what I love, and pray that I hope the rest will follow, but I think we need help- in any form – so we can continue to love it.

image courtesy of: http://www.student-loans-guides.com

Posted in Current Issues/Events, Health, Personal Experience, Public Health | Tagged , , , , , , , , , , , , , , | 1,136 Comments

Free Dental Services: CDA Cares May 18-19, 2012 – Volunteer if you can!

by drjennygst Posted on September 25, 2011

Today I was reading an update article in our monthly news magazine from our California Dental Association (http://www.cda.org/) and there was one story that caught my eye that I want to share with you about a new event called CDA Cares

As I continue through my journey through dentistry I am learning more and more about legislation and public health issues, policies, and budgets. I truly feel that as the economy continues to fluctuate, and dental benefits, and budgets follow, the need and demand for education, public health and public service will continue to increase. With the loss of Denti-cal for under-served adults and the loss of many prevention programs for children, the need for ways to provide Californians oral care is great. And as dental professionals, with a program like CDA cares, it gives me hope that we are on the right track to meeting those needs.

On May 18 -May 19, 2012 in Modesto,  CDA and Mission of Mercy with a team of dental volunteers will put together an event that they hope will help thousands of under-served Californians with their dental needs.. .Hopefully one of MANY events that will provide FREE DENTAL SERVICES. According to the article most of the supplies will be donated or almost donated by many national dental manufacturers to make the event possible!! What I admired most was the emphasis on education & educating patients about oral health and options for continuation of dental care even after the two day event is over.

I was really excited to read about this event where the article states they hope to help over 1,000 people per day. There are many events like this all over (if you have heard of RAM – they had a health event at the Oakland, CA Coliseum April 2011 – hence the video). I have seen many and helped in many dental events – but after an event is over, we have helped these patients but we don’t know when they’ll be able to be taken care of again. Like fish in the sea, they are tossed back to fend for themselves, waiting for the next free event or being seen only on an emergency basis. I greatly admire and support this emphasis on education and helping patients find resources that will allow continued dental care is a HUGE step in the right direction. I help drug rehabilitation and homeless veterans, and volunteer at Give Kids a Smile day, I have helped in churches and soup kitchens. Giving to the community and underserved is something very important for me. And to have this kind of event, on such a large scale – as most Mission of Mercy events can be is very exciting in the dental world.

What I love about dentistry, and health professionals in general, is that generally we want to give and help others and educate them to take better care of themselves. Everyone wants to be successful in their life – but what are your measurements of success? Being good to your own family and cultivating and taking care of patients in your practice is a wonderful ability and measure of success. But also giving back, volunteering, being kind to others, helping to makethe lives of others better are successful things in my book.

More information will come on how you can help. If you are not in California, PLEASE look out for programs such as these. A WONDERFUL resource I found is: Free Dental Work http://freedentalwork.org. But if you can help for this dental event – as a dental assistant, as a hygienist, as a dentist, or technician – PLEASE mark your calendars and VOLUNTEER!!! I know I’m going to try and help!!! I am SO EXCITED about this!!!

image courtesy of: blog.sfgate.com

Posted in Current Issues/Events, Health, Public Health | Tagged , , , , , , , , , , | 1,145 Comments

Pradaxa: Anti-Coagulants & Dentistry

by drjennygst Posted on September 22, 2011

Yesterday I had the pleasure of working on a very nice patient who also happened to be a physician! I was doing his examination & we started chatting and reviewing his medical history. He stated that he recently had been to Africa and unfortunately had become very sick and experienced: paroxysmal atrial fibrillation (abnormal rhythm of the heart) and was placed on a drug called: Pradaxa (generic name: dabigatran)

I learned two lessons today: 1) I was reminded how important it is for a medical history to be updated at each dental appointment, and 2) I met my first patient who was using Pradaxa (a new anticoagulant drug).

Now, I know that I am over-simplifying but if you have abnormal rhythm of the heart, the heart doesn’t send blood out to your lungs and your organs efficiently and there are all kinds of problems that result from that – the most important being the increased risk of stroke (the 3rd leading cause of death & leading cause of disability – information courtesy of: Dr. Pullen – you can see his information here: http://drpullen.com/pradaxa)

But what I REALLY want to talk about from a dental standpoint is the medication treatment after being diagnosed with atrial fibrillation – which has always been an anticoagulant: either coumadin (aka: warfarin), IV administered HEPARIN, or ASPIRIN. But this patient was placed on PRADAXA.Why do I care as a dentist about anticoagulation drugs (such as warfarin/coumadin and now, Pradaxa)?

The reasons are many: to understand your comprehensive medical history, to expect more bleeding when a cleaning is performed, but MOST importantly because if I need to perform surgery or an extraction of a tooth, I need you to STOP bleeding after. If you can’t clot because your blood is too thin, the extraction site is like an open wound that just keeps bleeding and can, if not caught, can lead to mortality. And that is DEFINITELY not something anyone wants.

I have seen Pradaxa commercials on television but I didn’t know much about it. So of course, I looked up history and information of the drug. I am not a medical physician but here are a few things that I found:

-it was developed by the pharmaceutical company Boehringer Ingelheim.

- it was FDA approved October 2010 and approved to be put into effect February 2011 (so a relatively new drug – out less than a year)

- usually dosed to a patient at 150mg two times a day

- upon taking Pradaxa it is effective within a few hours of taking it vs. coumadin/warfarin where the dosage is a little tricky and you have to go in for tests all the time before you can get the dosage correct

- it supposedly has “fewer drug interactions” than warfarin

- as it is a new drug it is more costly & the long-term side effects are still not yet determined

Either way, from a dental standpoint it is important for me to be aware of this drug and put it on my “anti-coagulant radar” so that if I can be aware of any potential complications & plan your dental treatment accordingly. I am excited to hear that there is an easier alternative to coumadin – that can save lives and help in the prevention of stroke & further medical complications!

If I find out more I will let you know and keep you updated!! And if you see your dentist, please update him or her on your new medications. It could save your life!!!

image courtesy of: noprescriptioneeded.com

Posted in Current Issues/Events, Dental Product, Health, Personal Experience | 1,426 Comments

A “HOT” tooth – a not so hot experience

by drjennygst Posted on September 21, 2011

I’m sorry that today I have to share an experience that is NOT the most positive – but I CAN state that I learned MANY positive lessons today that I will share with you.

I have heard from many people that dental pain is on a pain scale all to its own. I hope and pray that I never have to experience it. You hear of people getting cuts and bruises, and spraining or breaking their ankle from sports injuries, even hip and knee replacements – which to me sound VERY painful. But it is my experience that there are people that would rather experience a broken ankle, or replace a hip joint, rather than experience dental pain. And today I vicariously lived through one of my patients who today was experiencing what we in the dental world non-scientifically term a “hot tooth“. You ask: What is a “hot tooth”? Please read on…

You can find me, almost every Tuesday s at the VA Dental Clinic (veteran’s affairs dental clinic) seeing patients and taking care of the homeless and drug rehabilitation patients. And today was no different and I was going through my day without significant incident. But then, this afternoon I took an emergency walk-in patient. As I passed the waiting room I could see a young man – his shoulders slouched, his head in his hands – very obviously uncomfortable. We brought him back and even before he sat down in the chair immediately he began moaning and said he was in SEVERE pain and had been off and on the past 3 weeks! Just as immediately he mentioned that he was a heroin addict – had been a user for many years and experienced a lot but NEVER in his life had he experienced this kind of pain.

I tried to remain calm – assured him that we would help him the best we could today and ordered an xray to be taken so we could see the problem. With just one look at the xray I knew the source of his pain was that one of his lower right molars had a HUGE cavity that had deteriorated to the nerve and had spread down below the bone. In short – we couldn’t save the tooth and it would have to be extracted.

Now before presenting the options to the patient, I’d like to say that ALL the options would include giving him antibiotics and pain medication BUT in terms of actual treatment to get him out of pain today were: 1) administer local anesthetic to get the area numb and give him a little relief from the throbbing pain and give him a few days for the tooth to calm down and the bacteria to start to be flushed away 2) get him numb and do what is called a “pulpotomy” which is the first start to a root canal and relieve the pressure, still anticipating that the tooth would need to be removed, and 3) get him numb and extract the tooth.

But options 2 and 3 would be very difficult in this case and like MANY dental cases, this patient brought with him a little more complication.

WHY you ask? Why don’t we just get him numb and get the tooth out?? Because there are many things to consider:

1) FIRST and MOST IMPORTANTLY this tooth is causing this patient SEVERE pain (on a scale of 1-10, 10 being the worst, this patient scaled his pain as 10) – meaning it is termed in the dental world as a “hot tooth“. What do we mean by hot? Unfortunately it does not mean that it is attractive or sexy, but that it means that the bacteria have infiltrated the nerve so severely that it is causing a raging painful infection. When bacteria infiltrate and agitate the nerve so much, the environment changes to an ACIDIC pH environment. The ability for local anesthetic to work in an acidic environment is VERY difficult. The nerve fibers don’t absorb the local anesthetic the same as if there were no infection – and therefore – the patient does NOT get numb as quickly, and sometimes doesn’t get FULLY numb (which is why you hear people saying that they could feel everything) – and we DO NOT want that.

2) this patient has a history and current history of drug use and abuse. Most of these patients have a VERY high pain threshold and because of the recreational drugs (and sometimes even prescribed pain medication) many times these patients take MUCH longer to be affected by local anesthetic. Many times, the illness of recreational drug use prevents dental anesthesia to be as effective and the metabolism of anesthetics is different.

3) this patient exhibited dental phobia and was in severe pain – rationale and reasoning went out the window. Getting himself out of pain was his main objective. And when your sole objective is to get out of pain you are NOT making rational decisions, nor are you in control of your hands and motions.  Dental phobia, drug use, swearing and pain do NOT a great patient make. I understand completely that being in pain is not something ANY person would smile about – I’m just stating that if a person is normally afraid of the dentist WITHOUT an infection – imagine what they feel WITH an infection.

4) Lastly from a personal safety perspective – this patient was very strong, muscular, MUCH BIGGER than me, and had a history of drug abuse. While I’m quite strong, me standing next to this man, I could see myself swashed like a bug. Generally speaking (and I recognize that this is not always true) it is common to see many recreational drug abusers with many types of infectious diseases – some so severe as HIV and Hepatitis B and C (causing irreversible life changes and quality of life issues). Knowing that I would have to give an injection to a patient who was in severe pain with a sharp needle, inside his mouth, was NOT something I was jumping up and down to do. I COULD do it, but I didn’t feel a 100% safe. And neither did my assistant. And listening to myself and safety is a top priority for me and for the future of my family. No matter the job – it is not worth the risk of doing a procedure if I don’t feel safe.

So what did I do!?!

I did what any responsible clinician would do. I asked for help. Thankfully working at the VA I am surrounded by more experienced dentists that I can turn to for help. I asked one of my mentors, a staff dentist, to come in and help me. He agreed that antibiotics and pain medication were required. And agreed that the tooth was NOT saveable. But what he was able to do that I was not was that he was able to get the patient numb by giving him A LOT Of local anesthetic – to get the patient comfortable for a few hours until the antibiotics and the pain medication could enter his system and start fighting his infection.And he was going to see him tomorrow to get the tooth out. Because antibiotics and pain medication will only get a person so far, and then there is a possibility of the tooth getting reinfected again. He left, as happy as he could be in this situation, and MOST IMPORTANTLY: OUT OF PAIN.

I learned a LOT from this situation. There was the part of me was very disappointed that I could not do that myself – that my reservations and concerns based on my past experiences with “hot teeth” and knowing his medical history prevented me from going in and just giving him an injection to get him out of pain. BUT, I learned that listening to myself regarding saftey is not a weakness. I learned that asking for help is the responsible thing to do when I need it. I learned that I felt safer that who came to my aid in this situation was a STRONG CALM MALE (not necessarily that it has to be male but a dentist with a lot of dental experience) due to my concerns of SAFETY. And I learned that while I knew what the best plan of action was when a patient is experiencing a “hot tooth” that I shouldn’t second guess myself about what to do. Next time I feel that I will know exactly what to do the next time a “hot tooth” and I cross paths…

Hopefully it will not be anytime soon.

image courtesy of: clipart.com

Posted in Health, Personal Experience, Women's perspective | Tagged , , , , , , , , , | 1,981 Comments

Deep Sea Diving & Dentistry- Connected??

by drjennygst Posted on September 19, 2011

This past weekend my brother told me of this diver earlier in July who was almost swallowed by the whale shark seen above. Immediately I googled the story and saw this CRAZY picture you see here – http://newsinabox.net/1721/whale-shark-photographed-when-almost-swallowed-a-man.html

Just as immediately, the dentist in me began to think of diving and related this story to MY work experience with diving. Who would have thought that dentistry and deep sea diving would be connected? While NO ONE in the world would want to be that young diver in the picture above – I learned this past week firsthand how divers and dentistry can be connected…

The other day I had a very nice patient come to our office with pain in his upper left jaw. He saw the hygienist for a cleaning and then I was asked to come in and evaluate the area and see what was happening. Even before seeing the patient my immediate assumption after hearing from the hygienist that he had a jaw problem was that he possibly had an infection, possibly had tension in his jaw due to trauma, or what was at the top of my list: that he had been clenching and grinding creating jaw pain. Nowadays I am more and more aware of wear on people’s teeth from clenching and grinding ESPECIALLY in today’s economy with no economic relief in sight and the need for a guard to help protect their teeth.

When I went in to check, it was not as I had suspected. He was healthy as a clam, no medications, and missing his upper left teeth – no clenching and grinding there! Then out of the blue he mentioned that he deep sea dived two weeks ago and he started noticing it getting worse after that. After he said that, it was as if a LIGHT BULB had gone on. AHA!!!!! Why?

Because deep sea diving = pretty extreme pressure changes! You’ve seen the movie The Abyss? Diving Pressure – yes! Human deep sea bottom dwellers – NO! As the diagnosis light bulb grew brighter in my head he said he remembered that when he had his tooth removed over four years ago that there had been a large hole in his sinus because the roots were very long and went right into his sinus cavity! Everything had healed but they had told him that he had a huge hole there after the extraction and they had packed it well and checked on him a few times after.

I had found my answer: his deep sea diving (and probably his flight home) had caused such extreme pressure changes that it had not allowed a complete equilibration of pressure in his sinuses. This increased pressure led to sinus inflammation and increased pressure in his gums! This even probably irritated the extraction site where there had once been a hole!

Now, for you (and for us dentists) it is GREAT to note that most of these communications will heal just fine on their own as long as the dentist/surgeon treats it appropriately (I will share more on this at another time). So why have pain NOW – years later after his extraction?

Perhaps he dove too deep and didn’t let everything equilibrate as slowly as he could. Perhaps he has allergies which cause inflammation of the sinus cavity – and that combined with the deep sea pressure and then the abrupt change in altitude with flying – all in combination irritated his sinuses. As you can see, while there is no ONE reason for this – there are MANY things to consider.

To help answer this: as a background – when you have teeth extracted in the upper left or upper right, towards your premolars and first molars sometimes the roots of those teeth can be VERY close, touching, or even EMBEDDED in your sinus cavity covered by a very VERY thin membrane. If this membrane is pierced or torn it exposes the sinus air cavities – allowing food, smoke, bacteria etc. a passage into your sinuses and drain into your nose and nasal passages leading to nasal inflammation, pain, and infection. NO ONE wants dinner from last night affecting their breathing. Yuck.

If this communication occurs it is called in the dental world: an oral-antral communication (aka: OAC)  – a serious word that basically means a connection between your mouth and sinus cavity and it must be treated accordingly If it isn’t treated  then an “oral-antral FISTULA” can be formed – a “tunnel” that is a PERMANENT link between the sinus and your mouth! If this occurs unfortunately the only option is surgery to close this link.

As I had said, most of these OAC’s heal just fine on their own. BUT like a scar on your skin, this area is weakened. So when you do various activities that involve changes in pressure or altitude (like flying or in this case deep sea diving AND flying), the sinuses CAN be affected! It is possible that he was only having pain on the left side of his jaw because that is the only area where his sinus had been perforated – weakening that area. Additionally if you have infection or sinusitis (inflammation) from sinus infections, this pressure can sometimes cause pain.

Lastly, something to consider is that after an extraction, most of us want to replace the tooth we are removing. It is important to know ahead of time, before the extraction, that the sinus cavities can expand and descend (a process called pneumatization) – sometimes descending too close to your bone and gums. This can make it very difficult to replace that tooth with an implant (or at least make the process of replacement MUCH longer and more involved than if you plan ahead of time). So PLAN AHEAD!

So what was I reminded from this experience?

1)      Never jump to conclusions before you start a diagnosis (I had thought he was clenching and grinding when in fact he didn’t even have teeth in the area he was having pain)

2)      Oral-antral communications can after an extraction and have long-term effects

3)      Sinus inflammation & changes in sinus pressure can cause pain and even mimic tooth pain

4)      Most importantly – I was reminded to ask medical history and listen when the patient tells you a background of the pain they are experiencing – such as if something happens AFTER an event. If this patient hadn’t told me that he had taken a recent trip and deep sea dived, I never would have considered that to be a connection to his pain and never been able to help him with his diagnosis

5)      Lastly, I realized that patient’s life activities affect their teeth and oral cavity in ways I hadn’t imagined. I truly would LOVE to try deep sea diving sometime, and if I do – EQUILIBRATE!!!

image courtesy of: pichaus.com

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A dentist is cleaning your teeth??? Yes it’s me!!!

by drjennygst Posted on September 15, 2011

Today I had a busy schedule – I was doing fillings, and crowns, and seating crowns, and finishing cases, while our hygienist also had a full schedule filled with exams and probings and xrays. It was a GREAT day. BUT I also had two appointments where I needed to do the works myself: the cleaning, the updated films, and the cleanings.

I’m not complaining about my day at all – but as I was performing the cleanings, each patient asked me “Aren’t you the dentist? How come you are doing my cleanings?” My answer to this question was that “Yes I am a dentist, but I enjoy doing cleanings because I get a more comprehensive picture of you and I am able to spend more time with you.” And these are very TRUE statements! But as of late I have been reflecting more and more on doing cleanings for patients and feel that, as with everything, there are pros and cons to a dentist doing cleanings.I have decided that there is a catch 22 with doing cleanings as a dentist.

Let me start with the positive because the advantages of a dentist performing your cleaning are many. When I’m doing a cleaning I am able to look around, get a sense of the patient’s home care, feel cavities, discuss their hygiene, see excessive bleeding and inflammation, see where their body language shows that they are having pain in a certain area when I work there. Little innuendos that I cannot see when I pop in with my white coat, white coat syndrome makes the eyes go blank, and are often sadly lost! I am able to obtain a “whole picture” of the patient from start to finish of the appointment instead of popping in for an exam, seeing teeth already cleaned by the hygienist and they are anxious and ready to leave. Also, if a hygienist did the cleaning, the majority of the interpersonal contact has already been done with the hygienist – all the energy and rapport has been spent with someone else. I become the mean dentist that comes in to check and give them the news – thumbs up, or worse, the bad news about any cavities. So when I am able to do the cleanings myself the TIME with the patient, the interpersonal contact and the face-to-face time I spend with them is invaluable. If they need me for an emergency in the future, they can put a face to my voice or if they have enjoyed our previous interactions, they know and trust I am helping them – certainly trust me more than if they didn’t know me at all!.

Now to the cons (the less positive) – while I enjoy cleaning teeth the fact remains that I AM a dentist and my time is more productive and better spent doing dentistry. Additionally I personally would like to be honing my dental craft and doing what I studied – crowns and fillings and bridges, and more complex cases. As an associate dentist I do a lot more cleanings than I would like – not again that I don’t like doing them, but I would PREFER to be doing something else – challenging myself as a dentist and learning something new in the process. In the end I could do a darn good cleaning for you – but what about the rest because if I never get to do dentistry, I won’t be able to learn and won’t be able to tackle the more complex cases and won’t have the experience to help a patient in need – because I’ve been busy doing cleanings.

For now, I am content in that I am able to have a happy medium where currently as an associate I get the best of both worlds – in that I am able to do cleanings and spend time with the patients, and I am still able to do the dental side of things and learn (like today). In the end I am able to embrace and enjoy and have a nice mixture of treatment in the day (hopefully I will do more treatment than cleanings in the future, but patience is my virtue!!!)

image courtesy of: funnyordie.com

Posted in Business Side, Personal Experience | Tagged , , , , , , , | 1,231 Comments