Common is not normal

….or Do giraffes get tooth decay?…Part 2

There was something troubling me when I asked myself this interesting question. We seem, as a community, as a species, as humanity, to have come to accept certain disease processes as acceptable, OK, and just a normal part of life. In fact, we seem to be very blasé about these problems, shrugging them off as something that can be “fixed”.

Have we come to call our health problems, (and indeed societal problems) normal because they affect a lot of people?

The low incidence of dental disease in wild animals, show us that what we call normal, is not necessarily normal.

Have we come to confuse the term “common”, with the term “normal”?

Here is an example: I see a number of pregnant women as patients, who assure me that their bleeding gums are normal.  The assurance comes from pregnancy guide books…the ones that tell you how to eat and sleep, etc during pregnancy.  It is hard to bring  these women to the understanding that this is not the case, after all, the fact was written about with much authority. But it is simply not true; bleeding gums are common in pregnancy…but bleeding gums are always a sign that something is out of balance and needs attention. Not normal.

Pregnancy tends to magnify the intensity of health problems we already have. This means is that if something is healthy, it will stay so, if something is not healthy, it will tend to deteriorate, or symptoms will increase.  In simple terms, pregnancy does not cause gingivitis, but it will increase the intensity of it. Many woman have some degree of gum swelling and bleeding prior to pregnancy. Their gums will bleed more during the course of pregnancy, because the bacteria that cause the swelling and bleeding absolutely love the surges of hormones that are a natural part of pregnancy.

It is common for women to experience this problem….but understand that to call it normal…to normalise it, is a an error.

When we call something “normal”, it is easy to dismiss and ignore. I know of women who had aggressive, destructive gum disease, but under the illusion that the bleeding was “normal”, did not seek appropriate professional care. In the process, damage was done to their gums.

Another example: Tooth decay has become so common that we have come to accept it as normal.  Parents don’t get disturbed about the fact their children have dental cavities, but they do get disturbed about the cost of treatment. So many children have decay, that the problem has become normalised. (Just read this article if you need evidence that what I  am saying is true http://www.guardian.co.uk/news/datablog/2013/may/31/childrens-dental-health-statistics).

Stainless steel crowns have become very common in children in primary school.
Common, not normal.

Common and normal are not the same, and never should we allow them to become confused.

Something can become common (for example high levels of alcohol related violence) but that does not make it normal, natural, or acceptable. And surely if tooth disease is a normal, or natural process of life, it will affect all species equally.

Clearly, this is not the case.

Everyday, I have conversations with the people I see in my work that go something like this:

“You have two areas of decay…one here (pointing at the X-ray), the other one here….both need to be filled.

or

“Do you see the redness around your gums here (indicating an area of inflamed gum tissue), and do you see how easily it bleeds when I touch it lightly? [we go on to discuss the nature and extent of the problem, and the treatment required].

The problem is that when we regard these issues as normal, our relationship to them is off key.  In my experience, we get upset by the diagnosis of medical and dental problems, but mainly because they are:

  • inconvenient to treat, and take too much time in a busy schedule
  • expensive
  • provoke fear about discomfort / dentists / dental procedures /medical procedures

….…and not because these problems are an indication that something we have been choosing to do or not do is hurting our bodies.

Wild animals (such as giraffes…I chose them because they are so ridiculously cute) are a wonderful point of reflection for us.  They have no oral hygiene aids, no water fluoridation policies, no public health campaigns, and no books on pregnancy, yet they also do not have the disease problems that we humans have, at an increasing rate.

Does the question “do giraffes get tooth decay?” now make sense?

And does the question “if giraffes don’t get tooth decay or gum disease, why do we?” take this a little deeper to heart?

That supermarket and pharmacy aisle of oral hygiene aids is desperately needed. We need the brushes, pastes, creams, gels, flosses and brushes. Without them, we would collapse into a morass of disease. Already busy dentists would be stretched beyond capacity to cope.

The problem is that these amazing products are not keeping up with the way we are eating, living and treating ourselves on a daily basis. The problems are so common, that they have merged and morphed into something we call normal, so much so that we don’t even regard them as a great indication that we are not living in balance with our bodies…

…like wild animals do.

Actually, the problems are now so common, that we share them with our pets and zoo animals.

We need to be very careful about the language we use. I am not talking here about correct spelling, perfect syntax and impressive grammar.

I mean truth in language.

There is a power in the words we use, so when we think and say “normal” that means something specific and that affects our understanding and our concommitant behaviour.

More and more people are experiencing diabetes, heart disease, arthritis, depression and anxiety. And what about obesity? Are we now perceiving these conditions as normal? So much so that it is normal for a person to take 3 or 4 different medications? To make airline seats larger to accommodate larger people? I see people everyday, who can barely make it up our surgery staircase. They take a cocktail of medications, and yet they tell me they are healthy.  Everything is normal. Apparently, it is now normal, and healthy to have high blood pressure, diabetes and gum disease….well everyone else has them too!

Let’s take it further…what about aggression on our roads, racist “jokes” and attitudes, carelessly expressed anger, disconnected and disinterested people? Are these ways of being morphing into something we call normal, and simply have to cope with everyday? Why do we accept dull eyed, aimless teenagers, hooked into their electronic devices as normal? Especially at a time of life when physical vitality is running high? Is it now normal for a working mother to completely stressed out, and angry all the time, breaking her teeth from the held jaw tension?

The blurring of “common” with “normal” has allowed us to be increasingly irresponsible in our treatment of ourselves and naturally extend that to others.

Is it not time to put a stop to this blurred way of thinking, and regain the clarity and precision of understanding that will make us stop and call into the question the very abnormal things we call “normal”?

Tooth decay in a clean mouth

At work, I observe people with good oral hygiene, who are getting  tooth decay, and sometimes at an alarming rate.  It is upsetting and frustrating to take care of your teeth, yet be diagnosed with the problem that the care was meant to prevent.  When such a diagnosis is made, the next question is often “what toothpaste should I be using?” I can understand exactly why this question would be asked. We have been trained to apply greater solutions, materials and techniques to all of our problems. Perhaps a stronger tooth paste will do the trick? Some people throw their hands up in despair, and claim they “give up”, feeling that they are doing all they can and it still isn’t working. Again, I understand. To work hard and get disappointing results can make us feel it is all too much and pointless to try.

…but what if we were to observe the problem of tooth decay in a clean mouth from a different perspective?

There is great value in stepping back from a problem. It allows us to take in a bigger perspective, one that focusses less on the solution and more on the completeness of the many choices we make on a daily basis that may contribute to the problem.

What if there is something else we are doing that is feeding the decay problem?

What if that something else was related to our diet?

What if we are eating such an abundance sugar and carbohydrate that our good oral hygiene simply cannot keep up with the harm being done?

What if we took the food we eat into equal consideration with the care we give ourselves with the brush and floss?

Many of the companies that produce oral hygiene products and chewing gum have fed the idea that we can eat our cake and prevent decay too. The dental profession has supported this approach, making prevention about cleaning and fluoride, but not paying adequate attention to diet.  Without the support of toothpaste, brushes, floss, gum and professional dental care we would be in an even bigger mess where tooth decay is concerned.  But have we taken this message too far, and put all of our attention on the products that save us, and no focus on the way we treat our teeth the rest of the time?  Have we assumed that we can eat just as we choose, and the oral hygiene products, the tooth brush and floss will save us?

There is a prevailing belief that we can choose to do something that will balance off a previous choice.  The diet industry has done a great job of convincing us that we can eat that chocolate cake, as long as we skimp on food for the rest of the day, work a little harder at the gym, or run a little bit further. I know people who love to party on the weekend…lots of alcohol, big meals and late nights. During the week, they drink vegetable juice and fast.  We have become expert managers, trading our “good” choices against “bad” ones, but how does the body feel about this oscillation from one extremity to another? Are we really fooling anyone?  And more importantly, are we really fooling our bodies?

Is tooth decay showing us that all of our choices come into play, and when we ignore the complete understanding of that, problems occur?

Our modern diet is heavily biased towards sugar and carbohydrate. This has become worse with the emphasis on low fat eating. Low fat foods are high in sugars. There is an assumption that “natural” sugars are OK, and only processed ones are not.  Most of the abundant, and readily available snack foods are high in sugar. Even flavoured potato crisps get their “yum” factor from sugar.  Commercially prepared meals, breakfast cereals and sauces make life convenient, but at a high price when sugar content is factored in. When we take this into account, the picture of decay in a clean mouth, as presented in the beginning, makes sense.

It is time to put food choices back into our consideration when it comes to caring for our dental health.

 There is no question that good oral hygiene is essential, but it is not the only ingredient.
Let us chart a sensible and practical way forward.  We can do this when we take into account how much sugar is in our diet, and steadily work towards reducing it. Then our mouths can be truly clean and healthy.

 

Flossing….and life

The six monthly check up and clean is something many of us are familiar with. It is an opportunity to check in, get a sense of how the teeth, gums and whole of the mouth are going. Potential problems can be captured before they develop into something more serious.  Oral hygiene techniques can be reviewed, and refined if needed.

I love to use this re-connection time to ask people how they are going with their flossing and /or use of interdental brushes.  The question is not a test, or a trap designed to “catch people out”. It is important to know if we are flossing or using the brushes consistently.

Here are the reasons why:

  • If we are, and there is inflammation of the gums, then there is something wrong with the technique, or we are using the wrong sized brush. This is important to discover and correct. There is nothing worse than doing something consistently that is not actually working. Let’s discover it and address it, so that the care we bring our body is true.  It can be uncomfortable to discover we are “getting it wrong”. Doesn’t this expose how much we have been trained to always be right, rather than see the opportunity to learn more deeply? To bring more care?
  • If we are not, then it is a great opportunity to explore why. It can help uncover rhythms that we get into that don’t support the care of our body. It can help us explore the living relationship we have with our body.

The responses/reactions when we don’t floss are revealing in themselves.

Embarrassment is common. Often people say “I was really good for 2 weeks after I saw you….then I lost interest/ got lazy/ got too busy.”

My favourite one is “Oh , I kept thinking about you, and how I would get in trouble when I saw you again (really!!??), but I just didn’t get around to it.” I’m touched to be in people’s thoughts every night….but  wouldn’t it be simpler just to floss?

One common comment I hear is “I’m lazy.” Full-stop.

Lazy?

Possibly.

But there may be more to it than that, and the “more” can be very revealing if we are willing to go there and explore it.

The “more” often exposes the relationship we have with ourselves and our own body.

When we say “lazy” and defend it, it creates a barrier to further exploration of this relationship. This is a relationship that is worth exploring, without the usual self-criticism and self-blame.

Are we lazy? Or do we not deeply value ourselves, and hence feel inspired to bring this deep level of self care?

Do we make everything else more important than ourselves and our body?

Do we allow ourselves to get so worn out by life, so tired, that the last thing we want to do at night is dedicate more time to our own care?

Are we lazy, or have we not allowed ourselves to feel that we place our attention, energy, and care everywhere else except here; our own body?

Here is another common response: “I’m too busy”. Full-stop.

This is tough one to address, because so often it is quite honest. Modern life has become overwhelming in the demands and expectations that we live under. Time has become an enemy for many of us, ticking against us and the too-many things that need to be done.

Yet the body, in its simplicity, and honesty, has a need for a certain level of care.  The body does not punish us, or “pay us back” when we don’t care for it; there is a very simple cause and effect relationship to understand. Plaque grows, irrespective of how full our lives are. Gums get inflamed when there is plaque. We may be busy, pressed by outer needs and requirements, but there is an effect on our body when we don’t include it in the overall plan of how we live, and what we perceive as important in life.

My own experience was that I flossed irregularly for many years, and described myself as “lazy” and “too busy”.   I was a fully qualified dentist, with a head full of knowledge about the mechanisms of inflammation, the effect on the body etc, etc. I was not “lazy”.  I just saw my body as an object to get things done. As long as it was functional, that was enough. I did not understand, or feel that harmony and true health were possible. I was “busy”, but that busy-ness incorporated everything other than me. I understood from my head, that the inflammation in my gums was damaging my body, but the things on the “to-do” list were more important.

Calling myself “lazy” and “busy” were my excuses, but they came with a load of self-denigration, and stopped me feeling more deeply that I just did not value myself, or my body or true health.

That completely, and forever changed when I started to appreciate that my body was delicate, and responded beautifully to consistent self-care. I discovered, quite by accident, that it feels beautiful floss and use the little interdental brushes everyday. The mouth feels light and fresh and clear.

I can assure you, I did not learn that at University.

The body keeps bringing us the understanding of consistency and rhythm, and how this plays out in self-care and in life. I flossed yesterday, I floss today, I will floss tomorrow. There is no end-point  and there is never “enough” because the body lives in cycles. It brings us back to the same point, all the time. The loveliness I felt flossing yesterday, I will feel again today. I have the opportunity, if I choose, to bring deeper care, and dedication, Can I make it more gentle?  Can I bring the same quality of attention to the back teeth as I bring to the front?

I can choose not to floss too.

If that is my choice, great, but am I willing to explore what that shows me about my relationship with myself, my body, and life?

Do giraffes get tooth decay?

…..and what about gum disease?

Humans certainly get both.  If my workload is any indication, we get a lot of them and at an increasing rate.

To answer my question, I faced the choice of going on safari in Africa…tempting but not likely to please my boss…or referring to The Journal of Zoo Animal Medicine, Vol 10, No.3 (Sep., 1979): A literature Review of Dental Pathology and Aging by Dental Means in Nondomestic animals: PartII.  Such a heavy title seemed to guarentee sufficient dull facts to provide the answer I was seeking.

What I found was really interesting. Periodontal disease is rarely observed in wild animals, compared with those kept in captivity. This is based on the examination of wild animal skulls.  The cause is attributed to diet.

Wild primates were shown to have a lower incidence of tooth decay than their captive counterparts.  One captive elephant had significant decay, not found wild African elephants.

Captive animals were susceptible to jaw infections. These were caused by tooth nerve damage induced by chewing on cage bars.

Nothing about giraffes.

Domestic animals are certainly susceptible to decay and gum disease, necessitating regular cleans with the vet,and extractions.

So here is my next question.

What is it about us that causes dental disease in animals we capture, our pets and ourselves?

Something is seriously out of place.

What is going on with human beings that dental disease is such a common experience, and it flows on to affect our pets, and other animals we closely associate with?

We invest a huge amount of money and other resources on preventing tooth decay.

Fluoride was introduced into the Sydney water supply in 1968.  There was an initial and very promising reduction in decay that we have very effectively undone in the past few years. Childhood decay rates are increasing.

We have half an aisle of the supermarket and pharmacy dedicated to oral hygiene products…we have toothpastes full of “active” ingredients, mouth rinses, toothbrushes in a multitude of colours, sizes, textures, battery operated, electric and manual. We have floss, interdental picks and brushes in a rainbow of colours and sizes. We chew gum, and self medicate with professionally endorsed preventive mousses and gels.

We have dentists, hygienists, dental therapists and public health campaigns.

Apparently, we are the smartest, most advanced species on the planet.

As far as I am aware, wild animals don’t have access to pharmacies, and I am yet to see David Attenborourgh film a lion completing his meal with a toothpick and a piece of floss.   No wombat has booked in to enjoy my dental services

Yet we (humans) have tooth decay, and gum disease, and we share it with our pets.  Wild animals experience these conditions very, very rarely, or not at all.

It feels very worthwhile for us to stop and ponder this question…

..if giraffes don’t get tooth decay or gum disease, why do we?

Beautiful teeth

Quite a lot of my personal and professional life is dedicated to discussing “beautiful teeth”. Most of the people I spend time with have strong ideas about what beautiful teeth are.  The standard of beauty, when it comes to the mouth, seems to be even more restricted than the narrow standards of beauty we apply to the rest of the body.

Apparently, teeth can only be beautiful when they are:

  1. White
  2. Straight
  3. No gaps

When all three points are achieved, you have “beauty”, and “perfection”.

Many dentists are feeding the image of perfection, using glossy promotional material covered in happy, shiny people, smiling, I guess, with the delight that their teeth are so lovely.  No matter what the age or the race of the model, the teeth all look the same.  Doesn’t it seem odd that the 80 year old man has the same teeth as the 20 year old woman?

Movie stars, models, television personalities all have “perfect”, “beautiful” teeth. Their teeth are either dentally enhanced, or “Photo-shopped” into the correct shape and colour. Bleaching is heavily promoted within the dental profession, as are the “no braces” orthodontic therapies.

Wherever you go, there is an ideal of dental beauty and perfection being promoted to us, so much so, that we don’t stop to question it.

The real teeth I get intimate with everyday come in a wide variety of colours and shapes.  Tooth enamel has different colours within the same mouth. The big robust canine or “eye” teeth, are always a little darker than their neighbours. This is because the density and thickness of this tooth affects the way light is reflected from it.

We are accustomed to different skin tones and hair colours. Teeth are the same, they differ in colour from person to person.  We may appreciate the pale skin of one person, and the deep, olive skin of another, yet when it comes to teeth, the standard of beauty has been deemed…..white.

Teeth age too. They change colour with time. This is partly due to the foods we eat, the beverages we drink, but there is a natural change that occurs when the nerve inside the tooth builds more dentine (the hard inner substance of the tooth).  This affects the absorption and reflection of light, and hence the colour we perceive.

So, after twenty one years of dental clinical practice, what is tooth beauty for me?

Firstly, I feel the beauty in tooth enamel, no matter what colour it happens to be. It is an exquisite substance. Crystalline in nature, it has an opalescent lustre. It is translucent in some areas, tending to more opaque in others. It is the hardest substance in the human body. It is harder than bone, yet suseptible to damage from sugar, acid, and abrasion from tooth brushes or hard grinding. It is a beautiful reflection to us of the robustness of the human body, and at the same time a delicacy that asks us to be more attentive, and more truly caring. It is formed when the teeth develop in their little buds under the gum and bone. Once that process is complete, no more can ever be made.  As dentists we have access to extraordinary materials, but they do not, and cannot replace this incredible material that we naturally grow.

Isn’t it interesting that people love and treasure crystals and stones, but don’t treasure to same degree the precious crystalline substance that they have in their own mouth.

There is beauty in the shape and arrangement of teeth. I am not talking about picture perfect model alignment here. What I am referring to is the harmonious arrangement of teeth, and the way this naturally balances out forces and loads throughout the mouth.  Each tooth is shaped perfectly for the task it performs.  The incisor teeth are delicate, yet designed for tearing food. They help us form clear speech when we make  “s”, “v” and “f” sounds.  The canines are the keystones of the tooth arch, holding and balancing the load as the jaw moves from side to side. They protect the back teeth from heavy side-ways forces.  Premolars start the food grinding process, they have enough sharpness to penetrate the food, and enough width to crush it into smaller particles. The molars are perfectly designed to carry heavy loads and grind food down into the right condition for digestion. This is beauty; the beauty of harmony in the body, expressed naturally through form.

I find overwhelming in beauty in a mouth that is lovingly cared for.  There is nothing lovelier than examining teeth that are treated beautifully by their owner.  Committed and gentle care is evident in the lustre of the tooth surfaces, and the lovely coral pink of their gums. It is beautiful to see the result of tooth brushing and flossing that is done in conscious presence, with tenderness and focus.  This beauty is something I deeply appreciate everyday, and it is not affected by the colour, nor the straightness of the teeth. My appreciation does not alter when the mouth is full of fillings or crowns, or dentures or implants.

This is the beauty of self-love, and it is a beauty that no glossy brochure, or bleaching kit can bring.