NPR and Dan Ariely on Dentistry

First off, let me say that I have been an NPR supporter (yes, including financial support) for many years, so please do not misunderstand my post and think I am bashing NPR itself.  HOWEVER………I have an axe to grind with Mr. Robert Siegel of All Things Considered, the evening news program that used to be one of my favorite programs for the drive home from work. And it all has to do with the particular intervew with Professor Dan Ariely, of Duke’s Fuqua School of Business in Durham, NC, about dentistry, which was aired on Tuesday, October 5th.  Please take a moment to read the transcript:

Copyright © 2010 National Public Radio®. For personal, noncommercial use only. See Terms of Use. For other uses, prior permission required.

ROBERT SIEGEL, host:

Dan Ariely conducts experiments, too. He’s a professor of psychology and behavioral economics at Duke, where he does research into our predictably irrational behavior. And he comes on the program from time to time to share his research.

Today, Dan Ariely on irrationality at the dentist’s office.

Professor DAN ARIELY (Behavioral Economist, Duke University): So, you know, you go to a dentist and the dentist x-ray your teeth and they try to find cavities. And one of the questions you can ask is, how good are dentists, right?

SIEGEL: Mm-hmm.

Prof. ARIELY: So imagine, you came to a dentist, you got your x-ray and then we took your x-ray and we also gave it to another dentist.

SIEGEL: Right.

Prof. ARIELY: And we asked both dentists to find cavities. And the question is, what would be the match? How many cavities will they find, both people would find in the same teeth?

SIEGEL: And I’d really hope it would be somewhere up around 95-plus percent.

Prof. ARIELY: That’s right. It turns out what Delta Dental tells us is that the probability of this happening is about 50 percent.

SIEGEL: Fifty percent?

Prof. ARIELY: Fifty percent, right. It’s really, really low. It’s amazingly low. Now, these are not cavities that the dentist finds by poking in and kind of actually measuring one. It’s from x-ray. Now, why is it so low? It’s not that one dentist find cavities and one doesn’t, they both find cavities, just find them in different teeth.

(Soundbite of laughter)

Prof. ARIELY: And here is what happens. Imagine you’re a dentist and you see a patient, and you really want to find a cavity because you get paid more if you find cavities and you can fix them. And the patient is already on the chair. He’s already prepped. You might give them the treatment right now, really good marginal income for you. How is this motivation to find cavities will influence your ability?

Now, you look at an x-ray, which is a little fuzzy and unclear and there are shadows and all kinds of things are happening. What happens is this unclarity, thus the x-ray helps in some sense the dentist to interpret noise as signals and find cavities where there aren’t really.

SIEGEL: And fill them?

Prof. ARIELY: And fill them, and drill them, expand them. I don’t think they ever tell their patients, hey, I thought it was a cavity but turns out it was just a mistake.

(Soundbite of laughter)

Prof. ARIELY: But they do fill them.

SIEGEL: You’re describing a very private relationship between patient and dentist.

Prof. ARIELY: Yes.

SIEGEL: You’re telling us we should, on average, expect our dentist to be getting it wrong on the x-rays, but that’s not how people feel about their dentists, right?

Prof. ARIELY: That’s right. And the dentists actually have a tremendous loyalty. People are really loyal to their dentist, much more than other medical profession. And I think one of the reasons we go back to cognitive dissonance. Cognitive dissonance is the idea that when people do something painful, they become more committed to the goal. If we have a fraternity and we haze people in a more difficult way, they become more loyal to the fraternity.

SIEGEL: You have dentistry as a hazing experience right now.

Prof. ARIELY: That’s right. And I think the same thing happen with dentists. Dentistry is basically the unpleasant experience. They poke in your mouth. It’s uncomfortable. It’s painful. It’s unpleasant. You have to keep your mouth open. And I think all of this pain actually causes cognitive dissonance and cause higher loyalty to your dentist. Because who wants to go through this pain and say, I’m not sure if I did it for the right reason. I’m not sure this is the right guy.

(Soundbite of laughter)

Prof. ARIELY: You basically want to convince yourself that you’re doing it for the right reason.

SIEGEL: Every visit to the dentist is an episode in the Stockholm Syndrome here, is what you’re describing. You studied these dental insurance records and you looked at what happens over time as our relationship with the dentist grows over many years, and you find it affects the kinds of decisions the dentist and the patient make, the choices.

Prof. ARIELY: That’s right. So you can imagine that at some point in your dental treatment, you have a choice between things that have the same possible outcome, but one of them is more expensive to you and better financially for the dentist. Which one would you choose and how the duration of relationship be affecting that?

And it turns out that the more time people have seen the same dentist, the more likely the decision is going to go in favor of the dentist. People are going to go for the treatment that is more expensive but has the same outcome. More out of pocket for them, more money for the doctor. So in this case, loyalty actually creates more benefit for the dentists.

SIEGEL: More expensive filling material, for example.

Prof. ARIELY: That’s right. That’s right.

SIEGEL: Well, Dan Ariely, thanks for talking with us again.

Prof. ARIELY: My pleasure.

SIEGEL: Dan Ariely, professor of psychology in behavioral economics at Duke University. His book is “The Upside of Irrationality,” and he talks with us about our rational and irrational decisions from time to time on ALL THINGS CONSIDERED.

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NPR transcripts are created on a rush deadline by a contractor for NPR, and accuracy and availability may vary. This text may not be in its final form and may be updated or revised in the future. Please be aware that the authoritative record of NPR’s programming is the audio.

Now…….as you can imagine, this has created quite an uproar among dentists, and especially among those of my colleagues and I who have long considered NPR to be a source of (mostly) unbiased and reliable news, as Professor Ariely, whose field in Behavioral Psychology, in 1 fell swoop, condemns all dentists as money-hungry, greedy, unethical, and incompetent!

Of course, there are several problems with this interview that I would like to address:

• As far as we can tell, Professor Ariely has absolutely NO background in dentistry, nor has anyone been able to learn where he learned to read and evaluate x-rays.
• No one has yet been able to find any published research by Professor Ariely on this topic, so we really don’t know where he’s pulling this stuff out of, except probably his a**.  😦
• Please read the quote below, from Delta Dental’s Director of Public Relations (posted on another blog), especially the underlined text (my emphasis).  So……if Delta Dental did not provide the alleged research, where did Professor Ariely get it?

We’re normally fans of Dr. Ariely’s work, but he should not have made reference to Delta Dental when stating that 50 percent of the time dentists will interpret x-rays differently. Delta Dental has no data that could lead to any such conclusion. Delta Dental processes 84 million claims a year for 54 million customers, so obviously we’re interested in making sure those claims are accurate. That’s why we employ dentists throughout the country to review claims for accuracy. Still, we understand that conclusions made in the medical arts, like other arts, are prone to some degree of subjectivity and interpretation. Assuming otherwise would just be irrational.

Thanks,
Chris Pyle
Director of Public Relations
Delta Dental Plans Association

• No one can seem to find any published research on how dentistry can be related to the Stockholm Syndrome, either.
  
• Professor Ariely made no mention of any research that he evaluated as to whether or not the alleged research, allegedly from Delta Dental.  Hmmmmm, kind of one-sided.
• Professor Ariely has a new book out that he wants to sell lots of copies of……….hmmmmm, no conflict of interest there, right?

So, according to Professor Ariely, all of our Patient Reviews are just because they were somehow pressured into it?  And all of their problems were made up by me so I could make money?  Wow, who knew!  I thought it was because my team and I do our best to make our patients comfortable, take care of their problems at a time and pace that is comfortable for them?  And the lady I referred to another dentist today, because I know he can do better dentures than I can……what in the world was I thinking, doing the right thing for her like that?

Ah well………can you tell I’m fired up?  Let me just say in closing: I love dentistry and I love taking care of people.  That’s why I invest so much time and money in improving myself and my skills every year, as well as in making sure we have leading technologies and techniques to make appointments faster, more comfortable, and just better.  No matter what some Duke Professor says.

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Six-Month Braces if you have Gum Disease? YES!

Patients with periodontal (gum) disease often end up being very embarrassed about their smiles, because as the disease progresses and more bone is lost, the teeth start drifting.  It’s not uncommon to see the teeth flared out with a lot of spaces between them, or the bottom front teeth really crowded as the teeth shifted with the bone being lost.

Very often, these cases are the kind that would respond very well with our 6MonthSmiles Clear Adult Braces, but there’s a little problem……if you try to move teeth with braces while there is active gum infection going on, you will only make the situation worse, with the result being even more bone loss, more gum recession, and eventually even looser teeth than before you started.  While it might seem like your smile is improving during the process, once the braces came off, and the support they provided was gone, you’d suddenly realize you were closer than ever to losing your teeth entirely.  So it’s not uncommon that people simply become resigned to not only having gum disease, bad breath, etc., but to living with a smile that embarrasses them.

Now There is a Way!

As one of only 4 dental offices in the city of Charlotte (along with 1 in Salisbury and 1 in Fort Mill, SC) with the Periolase MVP-7 dental laser, with which we perform Laser Periodontal Therapy^(TM), a patented procedure that treats gum disease more effectively and more comfortably than any other procedure currently available, we can actually regenerate bone and healthy gum attachment.  And THAT is why it allows us to offer patients a way to not only save their teeth from gum disease and dentures, but also to give them a smile to be proud of once again.  Why is that exactly?  Because – in the absence of active gum infection – moving teeth with braces actually stimulates bone growth!  When you combine the major reduction in infection and inflammation with the healing effects of the laser, AND you add the bone stimulation of tooth movement and alignment through braces, it’s like a double benefit.

In the case of crowded teeth, improving alignment also makes it easier to brush and floss, too, and this is still an important part of maintaining healthy gums and teeth over the long term.

Over the next 6-10 months, be on the lookout here for some truly dramatic smile transformations for patients by combining 6MonthSmiles and LANAP.

If you are unhappy with your smile and are worried about losing your teeth and being forced into dentures, call us at 704-364-7069 or Request an Appointment Online.  This is a great time of year to plan for LANAP, because we can divide the treatment into 2 halves (right side then left or vice versa, starting with the worse side) in December and January, which will allow you to use 2 years of dental insurance benefits and reduce your out-of-pocket expense.  If you don’t have insurance, you’ll love our Quality Dental Plan, a terrific dental discount plan that we offer in the Charlotte area, that gives you a 20% discount on all treatment ; if you want monthly payments to fit the cost into your budget, we also offer CareCredit Interest-Free Dental Payment Plans.  Our goal is to make it affordable for you to get the treatment you need, so you can have the smile you want!

Frequently Asked Questions about 6MonthSmiles (fast, invisible, adult braces)

The Most Commonly Asked Questions at a Six-Month Braces Consultation

These questions really aren’t surprising, and you’ve probably wondered about them already yourself if you’re considering this remarkable cosmetic dental option, so here are your answers:

1) Can you REALLY move my teeth that fast?

Yes, we really can.  I know it seems hard to believe, because most everyone thinks that you have to wear braces for 18 months to 3 years to get everything right.  You can take a look at this Smile Gallery to see a whole bunch of people who’ve had their front teeth straightened in 6 months or less.

2) HOW do you move teeth that fast?

It’s quite simple, really, and it’s not magic or rocket science.  Basically, since we’re really doing cosmetic braces, this is an alternative to porcelain veneers.  That means we are just concentrating on straightening the front teeth, NOT trying to correct major bite problems. Answer these 3 questions and you’ll know if you’re a good candidate for 6MonthSmiles:

• Do you have any jaw or muscle pain, or a history of headaches?
• Do you have any difficulty chewing or biting normally, or is your bite really “off” in the back teeth?
• Do you have some spaces in the front teeth you’d like closed or crowded front teeth you want straightened?

If you answered NO the first 2 questions but YES to the last question, then you are probably a good candidate for 6MonthSmiles!

3) WHEN CAN WE START!?

This is, of course, the most fun question.  It’s amazing how many times patients will want to start RIGHT NOW.  As in, before they’ve even left the Complimentary Consultation appointment.  And most of the time, we can accommodate.  Getting started is literally as easy as getting molds of your teeth, a complete set of photos, and a panoramic x-ray (this one goes around your head and records your entire jaws, joints, etc. to make sure there are no complicating factors).  We send the info to our 6 Month Smiles lab, which makes custom trays that let us put pretty much all the brackets on at once, just a couple of weeks later.  It’s much easier and faster this way, I promise.  And off we go!

Periodontal disease and Erectile Dysfunction? Seems crazy, but just maybe connected!

Wow – this one even surprised me!  Check out this summary of a recent study from the Journal of Sexual Medicine:

Erectile dysfunction might be associated with chronic periodontal disease: two ends of the cardiovascular spectrum.

Zadik Y, Bechor R, Galor S, Justo D, Heruti RJ.

Center for Health Promotion and Preventive Medicine, Medical Corps, Israel Defense Forces, Zrifin, Israel. yzadik@gmail.com

INTRODUCTION: Both chronic periodontal disease (CPD) and erectile dysfunction (ED) are associated with cardiovascular disease and its risk factors, including smoking and diabetes mellitus. However, the association between ED and CPD has never been studied. AIM: To study the association between ED and CPD. MAIN OUTCOME MEASURES. Prevalence of ED, prevalence of CPD, ED severity. METHODS: The study population consisted of 305 men who filled the Sexual Health Inventory for Men (SHIM) questionnaire in order to detect ED and assess its severity, and underwent a pair of standardized posterior dental bitewing radiographs in order to detect CPD. SHIM questionnaire scores 21 or less represented ED. Alveolar bone loss of >or=6 mm represented CPD. RESULTS: The mean age of included men was 39.5 +/- 6.7 years. Overall, 70 (22.9%) men had ED and 13 (4.3%) had CPD. CPD was significantly more prevalent among men with mild ED (P = 0.004) and moderate to severe ED (P = 0.007) in comparison to men without ED. CONCLUSIONS: ED might be associated with CPD. These preliminary findings are consistent with theories that associate these conditions with systemic inflammation, endothelial dysfunction, and atherosclerosis.

Ohhhhh, and I apparently forgot to mention (Oops! 😉 ): if periodontal disease is something you need treated, and you want the absolute best treatment currently available, please request a Consultation/Exam with us by either of the following ways:

Call 704-364-7069,

OR

Request an Appointment Online

Further Information on LANAP Treatment for Gum Disease in Charlotte

OK – so I’m just going to be adding a LOT of information about periodontal (gum) disease and how the Periolase MVP-7 laser treats it so well; in addition, I’ll finally be getting around to adding more information on the significant health effects that gum disease can have, including:

• Increased risk of heart attack
• Increased risk of stroke
• Risk of worsening diabetes
• Increased risk of pre-term births
• Increased risk of low-birth-weight babies

Just so you know I’m not making this stuff up 🙂  , here are a few videos by national news programs that will help fill in the gaps:

And in case you missed Whoopi Goldberg talking about her gum disease on “The View,” don’t miss it again!

Laser dentistry in Charlotte

Despite the solid research and years of terrific results that accompany the PerioLase MVP-7 dental laser in treating moderate-to-severe periodontal (gum) disease, it is amazing to me how slowly it is still catching on.  I’m heading to Cerritos, CA on Wed., August 12th to attend the 3 days of Boot Camp, otherwise known as 3 days of a bunch of dentist geeks who really love providing the best care to their patients sitting around and talking laser physics.  🙂  LOL  Yes, I’m one of those dentist nerds – we’ll even be talking about lasers, gum disease, etc. over dinner and drinks, late into the evening.  But still…….once I receive my laser, I will be one of only 4 dentists in Charlotte – one of only 7 dentists in all of western North Carolina – and one of only 19 dentists in ALL of North Carolina to have this remarkable laser.

LANAP – the most effective, most comfortable treatment for periodontal (gum) disease available

The procedure is called LANAP, or “Laser Assisted New Attachment Protocol.”  What it means in practical terms is that, following treatment with the protocol (which is extremely strict, which is why Millenium Dental, the manufacturer, does not even allow a doctor to have the laser until after the initial 3 days of training), your gums will actually REATTACH to your teeth, and oftentimes the bone will actually grow back!  Yes, you read that correctly, this laser and protocol can actually stimulate your body to REGENERATE LOST BONE SUPPORT FOR YOUR TEETH! No other laser has ever been shown to have this capability.

But what else can the PerioLase dental laser do?

Laser Root Canal Treatment: the laser can be used during a root canal procedure to help disinfect the inside of the tooth, which may increase the success rate of the procedure, and minimize post-treatment flare-ups.

Laser Removal of Excess Gum Tissue: Especially during extended orthodontic treatment, it is not uncommon for the gums to overgrow and get big and puffy.  With the application of some Ambesol-like gel to numb up the gums, the PerioLase can easily remove this excess gum tissue with barely any discomfort.

Release a “tongue-tie”: if your tongue is “tied” to the bottom of your mouth too tightly by the connecting tissue, it can make it more difficult to talk.  This tissue can be “trimmed” or released with a laser-incision that then requires no stitches.

There will be other uses, but these will be some of the primary ones.  I’ll let you know more once I get back from the training!

Before & After Pictures of Another One-Visit Porcelain Crown with CEREC

Interestingly, this porcelain crown was done on the same patient as the last gold onlay that I posted.  So why a porcelain crown on this tooth instead of gold?  Simple — this one is more visible in his smile, and he wasn’t interested in having “bling” in his smile.  LOL  Given that strength and durability of his porcelain crown is also very important, as is obvious by his choice of gold for his second molar on the other side, we did use what is currently the strongest porcelain crown available today, whether made by a lab or with our CEREC, and it is called Emax.  This ceramic is incredibly strong, far superior to the old Porcelain-Fused-to-Gold (PFM) crowns that have been used for decades.  And, of course, we did it in a single appointment.

A CEREC Emax porcelain crown to replace a broken silver filling

Just to review the advantages of CEREC 3D CAD/CAM Porcelain Crowns, and why we’re proud to offer them at our Southpark Charlotte NC dental office:

1. Just 1 Appointment
2. No temporary (provisional) crown
3. No worries about the temporary crown falling off
4. Incredibly strong
5. Very natural-looking and blend in beautifully
6. LESS sensitivity afterward because the tooth is immediately bonded and sealed

If you need a crown and are looking for the convenience and excellent result we can provide with our CEREC 1-visit crowns, call us or visit our website:

704-364-7069

Family & Cosmetic Dentistry in Charlotte NC

Headache relief for 10yo boy with the NTI

I really, truly love treating patients for migraines and chronic headaches, and this was a case that was even more satisfying than usual, because my patient was only 10 years old when we made his NTI. He was in for a 6-month exam and cleaning today, and in talking with both him and his mother, we found that he was faithfully wearing his NTI and having 100% relief! Here’s what his Mom wrote to us in thanking us for helping her son, even though the other doctors he’d seen said there was nothing wrong with him:

==============================================
“Hassan began suffering from frequent headaches last year. It took a while to pinpoint the source of these headaches until Hassan visited Dr. Payet’s office for a routine cleaning. During the exam, jDr. Payet asked Hassan if he had headaches in the morning and how often. This was a key question that eventually led to the discovery that Hassan would need a NTI to assist in aiding him with the necessary buffer to relieve the pressure of him clenching his teeth @ night. The clenching was the direct cause of his headaches.

I’m happy to say that Hassan has been 100% pain free since he received his nightguard!

We cannot thank Dr. Payet enough for the major role he played in correcting a major issue for Hassan.”

Laura F.
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Does dentistry last forever?

This is a question I’m frequently asked, especially when a patient is considering a significant investment of time and money into some form of cosmetic dentistry, such as:

• Porcelain veneers
• Bonding (tooth-colored fillings)
• Porcelain crowns and bridges
• Teeth whitening
• Even Six-Month Braces

It’s a very understandable question, and the simple answer to the question, “How long will my dental work last, Dr. Payet?” is “It depends.”

Just like a car, your teeth and gums require regular care to ensure that they are working properly.  Sure, you can go 10-20,000 miles between oil changes given how improved cars are nowadays, but do you really want to take the risk?  Same thing with teeth……….some people go for 5-10 years with no dental check-ups and are fortunate when they come in to find no problems, such as cavities or gum disease. But it’s not many people that are so lucky!

I always remember a quote from some lecturer at a dental conference years ago telling us his response whenever a patient asks the question, and it’s really the most honest, best answer that can be given, “Clearly the teeth that God gave you haven’t lasted your entire life, and since I can assure you that my work is not nearly as good as God’s, unless you die first, the work I do (no matter how excellent) will not last forever either.”

So what can cause your dental work to fail?

• Grinding your teeth — when the human jaw clenches, it can create an amazing amount of force, and over time, enough clenching will cause teeth to crack and break.
• Acidity — anything that increases the acidity in your mouth is good for the bacteria that cause cavities in particular, including Acid Reflux, Sodas, Power drinks (Monster, Red Bull, etc), Sports drinks (Gatorade, Powerade, etc).
• A very sugary diet — the bacteria that cause cavities love sugar.  High sugar content means the bacteria feed like crazy, produce acid, and the acid is what eats away the teeth to cause cavities.
• A compromised immune system — your saliva contains important antibodies that help keep the cavity-causing bacteria under control.  If your immune system is knocked back due to a disease or some medication, those antibodies will be decreased, allowing the bacteria to grow uncontrolled.
• Decreased saliva (dry-mouth syndrome) — again, due to medications or illness, the amount of saliva may be decreased.  With less saliva, there is less “washing” action of the teeth.
• Trauma — obviously.  LOL  One of my patients a few years ago fainted and fell face-first into a brick wall, shattering a front tooth.  Another ran into a pole, shattering another front tooth.  Clearly, if you are injured in such a way that your natural teeth would break, any dental work will break, too.
• Bad habits like chewing hard candy or ice regularly — hard candy and ice are just that — HARD!  Ice, in particular, is easily as hard as your enamel and as porcelain or bonding.  So if you bite down on ice frequently enough and/or hard enough, you can break your teeth and dental work.

That covers most of the major causes of dental work failing.  With regular care, use of appropriate mouthrinses and toothpastes, proper brushing and flossing, regularly scheduled check-ups and dental x-rays, using a nightguard, and being aware of diet, etc, your dental work can and should last a very long time.

But always remember — my dental work isn’t as good as the natural teeth God gave you, so my work probably won’t last forever either.  😉

Updates on Invisalign

ALIGN Technology, the company that makes Invisalign orthodontic aligners, has not yet made any indication that they will be reversing their decision on June 1st to require dentists and orthodontists to do a minimum of 10 cases each year and complete 10 hours of their Continuing Education courses each year.  The backlash among dentists and orthodontists, however, continues to get stronger, as this is a fairly blatant move by a for-profit corporation to intrude on a doctor’s autonomy and decision-making rights as to which cases are appropriate for Invisalign and which are not.  Several professional organizations, including the Academy of General Dentistry and the New York State Dental Association, are already responding with letters to ALIGN Technology’s Board of Directors and President, stating that there is simply no evidence that the so-called “proficiency requirements” have any basis in science, and unless they can come up with something to substantiate the claims the company is making, they should immediately withdraw the requirements.  If ALIGN Technology continues on this course, patients should fully expect to see an enormous drop in the availability of Invisalign as more and more dentists and orthodontists simply drop their service.

The good news is that there are alternatives to Invisalign, and they work as well or better, AND they’re even less expensive!  For some info and examples, check out our Six-Month Smiles in Charlotte!  Then you can Request a Complimentary Consultation to see how fast you can feel good about your smile again with straight, white teeth!  And if you’re concerned about cost, if you sign up for our Dental Discount Plan or choose Interest-Free Payment Plans with Care Credit, you can save some real money, too.