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10 Things Your Dentist By WILLIAM MAULDIN AOL: 1. "You really don't need to see me every six months."If you're like most people, you see your dentist twice a year -- just like those appointment postcards in your mailbox say you should. But where did the rule originate? In a comic book written more than 150 years ago -- English satirist George Cruikshank's The Toothache -- and the biannual checkup has been gospel ever since. But it isn't ideal for everyone. Dr. John P. Meyer: Why has it been "gospel" ever since? Because it's a good benchmark. It's a reasonable reference point for the majority of people. It is true, as the author contends, that the biannual checkup is not "ideal" for everyone, but I have never heard of a rule of thumb, an easy-to-remember bit of prevention, that was "ideal" for everyone. I've never read the satirist's work, but what was it called again? Oh yes, "The Toothache." Do we assume this to be a 'how-to' manual, or perhaps a 'how to avoid' read? After I spend my afternoon doing my part to quell the mis-assumptions generated by this article, I'll google Cruikshank's The Toothache and put his work in this site's links section. The major mis-assumption that I fear will be generated is that the average reader will mistake the biannual checkup, the process by which the dentist rules out dental pathology, with the biannual cleaning, a process by which the hygienist removes accumulated plaque and tartar. The article does NOT say you can skip out on your cleanings, but maybe, just maybe, if you're feeling lucky, you can skip your checkup with your dentist. And you know what? I agree. However, far from giving the reader a "get out of jail free" card, I wish to qualify what the author is saying. More to the point, it would be amazing if more of my patients had the "problem" of visiting the dentist "too often" at once every six months. I can't generalize for all practices (unlike this article; how do these articles-designed-to-sell-papers get away with that?), but in my 20+ years of performing dentistry, visiting "too often" is not in the top ten list of problems my patients face. The article does not distinguish between a biannual checkup with a dentist, and a visit with a hygienist to have your teeth cleaned. I would personally prefer my patients visit with the hygienist rather than with me. AOL: "A six-month checkup means everybody has the same risk for disease, and that doesn't make very much sense," says Douglas Benn, oral and maxillofacial radiologist and professor emeritus at the University of Florida. "If you look at the typical middle-class population, the majority are not at high risk for lots of decay and gum disease; they probably don't need to be seen every six months." Dr. JPM: It's true! Assuming that "everybody has the same risk for disease...doesn't make very much sense," yet that's exactly what this article does. The article assumes that everyone brushes twice a day and flosses once a day, and makes assumptions from there. I would agree that if a patient is doing their home care like they're supposed to, and they have no other predisposing dental issues, then visits to the dentist, for a checkup, could need to be made less than twice a year. I would still recommend visiting the hygienist twice a year for about 60% of my patients. About 25% of my patients need to visit the hygienist 3 or 4 times a year, because they build tartar faster than others and/or they do not brush and floss properly or regularly. Almost 10% of my patients need a gum specialist because their gum disease has progressed beyond my skill set as a general dentist (maybe because they were not visiting their hygienist twice a year?). I would estimate only 5% of my patients need to visit with the hygienist less than twice a year because their home care is proper (bordering on exemplary!) and they have no other genetic, functional or habitual predisposition to dental disease. For those few patients, I don't mind skipping the occasional checkup as well. AOL: A number of studies support Benn's view, finding no appreciable benefit from biannual visits for all patients. Still, a 2003 survey by the American Dental Association confirmed 53% of the U.S. population reported seeing a dentist within the past six months. Dr. JPM: The inevitable statistics, inevitably proving the point. Mark Twain said "There are lies, there are damn lies, and then there are statistics." Always read past the statistics. This one has got glaring omissions. "No appreciable benefit...for ALL patients (emphasis added)." That's like saying "seatbelts produce no appreciable benefits...for ALL motor vehicle passengers." And it's true! For most of the drives you take, you receive no appreciable benefit from your seatbelt. It's also true in my practice, where most patients receive good checkups if they visit the hygienist on a schedule determined by my recommendation. The article says that more than half the population saw a dentist, but if my practice is any indication, a lot of those visits were emergency visits (perhaps because they hadn't been visiting their hygienist every six months, or skipped out on the dentists' evaluation of their mouth?), or for ANY OTHER WORK other than a biannual checkup. The implication that 53% of the population had a checkup in the last six months is incendiary, prompting me to write (and write, and write). More significantly, people have a universal way of believing they were "just to the dentist", and are universally surprised when they look at the chart notes indicating their last visit was two years ago, or more. It's that same 5% who don't need biannual visits with the hygienist, in my experience, who accurately report "it was 8 months ago that I last had my teeth cleaned." Those folks are two months overdue, and are concerned about it. That ADA survey is titled "2003 Public Opinion Survey: Oral Health of the US Population." and the ADA charges for it. AOL: Have a conversation with your dentist about appointment frequency. You may be one of the lucky folks who don't need such frequent checkups. Dr. JPM: You can easily be the judge for yourself. If your teeth "feel clean" to your tongue after a visit with your hygienist but before the polish, your visit has been worthwhile. Tartar and plaque have been removed. If you feel space in between your teeth after the cleaning, which wasn't there before the cleaning, your hygienist has helped to maintain and/or improve your oral health: tartar buildup and plaque have been removed. I'm not completely disagreeing with the author on his contention that checkups may not need to be biannual, but I do mean to give some framework to the "get out of jail free" attitude of this article. People don't like going to the dentist to begin with, and if people can find an excuse (any excuse will do, especially a magazine with credibility), they will avoid the dental office like the plague. Bottom line: I am already way ahead of the article. In my practice, I feel comfortable skipping the occasional checkup after we establish a history together, and my professional judgement shows that over time, you are doing a decent job with home care, and you are regular in your visits with the hygienist, and you have no genetic, habitual or functional predispositions to dental pathology, and your dental condition is stable. I have a lot of good patients who fit that description.
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