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Facts & Myths about TMD, TMJ, & Orofacial Pain

In dentistry as in medicine, you'll find doctors on every side of contentious issues: is the mercury in amalgam dental fillings safe or not?  (Yes, the science is clear that it’s safe).  Is fluoride beneficial or dangerous? (Again, the science is solidly on the side of safety and efficacy).  While dentists argue about which bonding agent or porcelain is best, one topic is almost guaranteed to cause huge fights: Occlusion and TMJ/TMD, if they're connected or not, and even their basic definitions.  If our profession can't even agree, it’s no wonder that the public knows so little of what causes TMD, what can be done to treat it by dentists, when one should be evaluated or treated by other medical specialists, what medications help and which don’t.  Hopefully this article can help clear up some of the myths & misinformation. This article was co-written with Dr. Rich Hirschinger, an Orofacial Pain Specialist in California, and was first published in April 2017 in Massage & Fitness Magazine Winter 2017 edition. “My Last Dentist Told Me I Have TMJ” Whenever I hear this comment, I have to chuckle, because I sure hope they do!  After all, “TMJ” simply means Temporomandibular Joint and refers to the joint where the uppermost part (the condyle) of your lower jaw (mandible) moves against the temporal bone at base of your skull.  After all, you don’t go to the knee specialist and say, “I have knee.” What people really mean is that they have one or more signs and/or symptoms that fall under the broad term of Temporomandibular Disorders, or TMD.  For most people, they think of these kinds of conditions: They clench or grind their teeth. They have pain in their [...]

Why is Oil Pulling a Waste of Time?

It simply astounds me how blindly people accept "natural" remedies without any proof except personal testimonials, all while they proclaim that "real science" has been co-opted by greedy individuals and companies. The current fad of "Oil Pulling" is certainly one of the biggest examples of snake oil holistic mumbo-jumbo quackery to grace the surface of our planet.  Why?  Because it's JUNK, people!  And if there's one thing that really ticks me off, it's JUNK MEDICINE and JUNK SCIENCE. Coconut Oil is Just Fat, People! That's it.  Right there.  That's the reason that oil pulling can not "heal" or reverse cavities, why it can't whiten your teeth, and why it can't cure gum disease.  Because IT'S JUST FAT! When analysed, here's what's in coconut oil: Got that?  It's mostly saturated fats with a little bit of unsaturated fats and a little bit of other stuff.  If you look at the link above, there's also a comparison with other types of oils, and the only one with a higher saturated fat content is cottonseed oil. Now, would someone who believes that coconut oil is a miracle solution for the mouth tell me how all that miracle stuff is done by FAT?  Because fat does not kill bacteria.  It doesn't harden enamel.  It doesn't get down under the gums and get rid of tartar (calculus).  So please...explain how it "cures" cavities or gum disease.  I'm waiting, but I won't hold my breath. Claims of "Toxins" Being "Pulled Out" There is no known process by which fats "pull" so-called toxins out of your body, but that's the claim that gets made.  So why can't people explain how that's supposed to happen?  I mean, if you're going to make that [...]

2016: A Charlotte Dentist’s Year in Review

Wow, I just realized that it's April and that I never published this post about how amazing 2016 was for our Charlotte dental office!  Because it really was a great year in so many ways, and all because we have so many awesome patients. A Terrific Team For our patients who've been with us more than 5-6 years, you probably remember that there used to be frequent changes in our employees.  I admit, it is very difficult to be a good employer and to hire the right people.  But one of the wonderful things about 2016 was that we closed the year with almost all of the same great team members since the beginning of 2015, as both Rose and Charlene joined us early that year.   Megan has been our full-time hygienist for nearly 4 years, while Amber has been our part-time hygienist for 4 years and is moving closer to being full-time as her schedule fills up more consistently. Fara and I are also deeply grateful to each of them for all their hard work. The one new face in our office is Patty, who joins Fara at the front desk.  We'll be adding more information about her soon, but she's an Ohio native who moved the Charlotte in 2015 with her husband to be close to family and for the better weather.  She has more than 35 years of experience in all parts of the dental office except being a hygienist, from assisting her previous doctors to managing their whole office. Continuing to Grow One of the biggest stories in our practice this year was the expansion, which I wrote about here, although I still need to update it with some final photos. [...]

By | 2017-06-09T20:28:14+00:00 April 23rd, 2017|ANNOUNCEMENTS|0 Comments

Do CEREC Same-Day Crowns Last a Long Time?

When it comes to dental crowns, patients have long loved the convenience of the CEREC CAD/CAM system, but some patients do ask if these crowns are as good as the those made by traditional dental labs. They particularly want to know how long these crowns last, because no one wants to have them redone any sooner than necessary.  With that in mind, I happened to see a patient recently who has in her mouth the longest-lasting CEREC crown that I've ever done: my Mom! Porcelain Dental Crown Materials are the Same in Lab & Office CEREC E.max bridge The simple fact is that both labs and CEREC offices use identical materials when making most porcelain crowns, onlays, and veneers.  For many years, Empress and VITA ceramics were highly used, but today the 2 most common materials are E.max and Zirconia, although there are many others available.  Even when dentists use traditional impression materials today, almost all labs still have scanners to convert the models into digital format to design and mill the crowns, bridges, or onlays.  That's why dentists with CAD/CAM systems and labs use identical materials, because we're using extremely similar methods to make them.  Because manufacturers can provide the same materials in the same sizes and shapes to both labs and dentists, it has helped keep the cost of these new methods steady.  That's why we don't charge a different fee based on doing it with CEREC or sending it to the lab. It's true that most dental offices using CEREC can only make onlays, crowns, and bridges from E.max; the oven necessary to bake and crystallize Zirconia crowns only became broadly and affordably available within the last couple years, but they [...]

By | 2017-06-09T20:28:17+00:00 April 4th, 2017|Family dentistry, Porcelain Crowns|1 Comment

Book Review: “The Death of Expertise” by Tom Nichols

If you've been reading this blog over the last few years, you'll certainly have noticed a pattern: a reliance on established, peer-reviewed science and critical thinking.  Whether the topic is GMO vs. organic vs. conventional food, cavity prevention, cancer, juicing, or flossing, I always rely on expertise, accumulated and tested knowledge, and consensus over anecdotes, one-off studies, or fringe "experts" outside the scientific consensus.  On the other hand, if you read a lot of news and social media, you know that many people actively deny, ignore, or attempt to refute experts as "elites" or part of one or more vast conspiracies covering up things like "natural cures for cancer," etc.  This trend seems to have significantly increased in recent months and years, too.  But why?  Are experts no longer needed?  Do they matter any more, or is Google all that anyone needs?  Can, and should, we still trust them?  Who is a real expert, and how do we know which are frauds?  Not easy questions, but they're important ones. Yes, Experts are Still Important Tom Nichols, the author of "The Death of Expertise: the Campaign against Established Knowledge and Why it Matters," is a Professor of National Security Affairs at the US Naval War College.  I first became aware of him when I read his article in The Federalist in Jan. 2014 by the same title, and I rediscovered him recently on Twitter in some political discussions.   While we have rather differing political views (he's conservative and I'm liberal), I respect him and even agree with him on a number of issues.  And on the issue of "do experts and expertise matter," I am 100% in agreement with him: YES, THEY MATTER.  But why do so many [...]

Without Women, Dentistry Would “Grind” to a Halt

Sorry, but I just couldn't resist the opening pun.  :-D  In celebration of International Women's Day today, though, a quick article is in order.  Kind of like the article I recently wrote, Without Immigrants, Smiles by Payet Dentistry Wouldn't Exist. Women Account for Over 90% of Dental Workers My apologies for not having done a ton of research or having links today, but this point should be fairly obvious to anyone who's been to a dental office recently.  The overwhelming majority of people in dentistry are women.  I do have a few statistics and will try to find a couple more when I have more time: Out of approximately 150,000 dental hygienists in the USA, 98% are women Out of approximately 375,ooo dental assistants in the USA, 98-99% are women Out of approximately 195,000 dentists in the USA, 30% are women Basically, that means that dentistry, as a medical service and profession, would completely stop without women.  And everyone who comes to our office knows what an amazing group of women work for us.  :-D  Seriously, there is no way that we could do what we do without these awesome women. #ADayWithoutWomen To be clear, I consider myself a feminist, by which I mean the normal definition from Merriam-Webster's Dictionary:  a person who subscribes to the theory of the political, economic, and social equality of the sexes.  And because of that, I would have loved to close our office for today and participate in the marches and protests, just as I would have liked to do for #ADayWithoutImmigrants.  If any of our employees had requested time off to participate, we would absolutely have said yes.  It's difficult, though, because we have so many patients who depend [...]

By | 2017-06-09T20:28:22+00:00 March 8th, 2017|ANNOUNCEMENTS|0 Comments

A Day Without Immigrants Would Close Smiles by Payet Dentistry

Today is Thursday, February 16th, and across the United States, many businesses are either closing or restricting hours as a sign of solidarity and a protest against the actions being taken against immigrants by our government.  They're also a protest against the rising tide of racism and white nationalism that is seen in the news regularly today.  The Charlotte Observer has published a list of local businesses that are participating in the day of protest here if you want to support them. While we here at Smiles by Payet Family Dentistry are open as usual today, I would like to add my voice to this protest for 2 very important reasons: If it weren't for one particular immigrant, my family wouldn't exist. If it weren't for that same particular immigrant, I would have gone bankrupt and closed the practice around 2008-2009 during the Recession.     Who is this particular immigrant, who is so foundational to my life and work?  It's my wife, Faranaz Payet.     Fara's (and Our) Story Fara and her daughter, Natalie, were born in Pakistan.  Fara and her twin sister, who lives in New Mexico with her family, were well-educated and both earned their MBAs at one of the top universities in Karachi.  In 2002, after working with Deutsche Bank in Southeast Asia for 11 years, Fara came to the USA on a student visa, along with Natalie, who was 7yo at the time.  Fara earned her MBA degree at the College of William & Mary, after which she was hired by Wachovia Bank and stayed in the USA on an H1B visa.  They moved to Charlotte in late summer 2004, and Fara and I met (through Match.com!) in January 2005.  I [...]

By | 2017-06-09T20:28:24+00:00 February 16th, 2017|ANNOUNCEMENTS|0 Comments

Does Gum Disease Cause Heart Attacks & Strokes?

I was recently reminded of claims that periodontal disease is associated with medical conditions like heart attacks, strokes, pre-term births, and diabetes.  Yes, there is an association among those conditions, that's true.  However, some dentists and hygienists try to scare patients into treatment by claiming that gum disease actually causes those conditions.  That's simply not true! One of the most recent articles touching on this touchy subject was by Dr. Chris Kammer, titled “Your Gums are a Cesspool of Infection...and Most Dentists Don’t Care!” as a blog article for the American Academy for Oral Systemic Health; an organization that he coincidentally co-founded in 2010.  The entire purpose of this organization, incidentally, is based on the idea that oral disease (primarily periodontal disease) has significant links to disease in the rest of the body. This link between the oral cavity and the rest of the body was first hypothesized and published in 1989 in two Scandinavian reports (Mattila et al in the BMJ, and Syrjanen et al in the J. Inter. Med) and studies continue to this day.  To this day, however, the results are simply not strong enough to make claims about causality. Correlation Still Doesn't Equal Causation Just as I've criticized holistic and alternative medicine and dentistry as junk, it's crucial that dentists be honest about the level of evidence for anything that we recommend - even flossing!  When we see things that seem to be connected, like gum disease seems to be connected with heart attacks and strokes, we have to ask: is it correlation (coincidental), or is it actually causal (one thing directly leads to the other).  Yes, there seems to be a strong correlation between gum disease and heart attacks and strokes, [...]

Cavities are Not Inevitable

Most people assume that certain things are inevitable as we age, including common dental problems like gum recession, gum (periodontal) disease, or cavities.  However, none of these conditions are as certain as the old adage, "the only guarantees in life are death and taxes," as proven by a gentleman who came to see us recently. 59 Years Old with No Tooth Decay or Gum Disease Richard came to see us as a new patient in early May 2016.  Before I met him, our hygienist Amber said that he had a perfectly healthy mouth, which naturally was a bit of a surprise.  It's true that you aren't guaranteed to have dental problems by 59 years old, but most people certainly do.  Upon looking in his mouth, however, I realized that Amber was correct!  He has never had a cavity, has no gum disease or gingivitis, no gum recession, and only a few crooked teeth.  His bite fits reasonably well, he has a small amount of wear showing on the chewing surfaces, and that's it.  WOW! In our office, he set a new record for making it the longest in life with such superb dental health by a long shot.  The previous best was a 43 year old man who, as far as he could remember, had only been to see a dentist 1-2 times in his whole life.  But 59 years old is a heck of alot longer than 43, that's for sure. Obviously, I couldn't tell him that he'd better come back every 6 months to stay healthy!  LOL  :-D   Since most people don't make it quite this long, if you're at all concerned about cavities, gum disease, or improving your smile, please give us a call for [...]

By | 2017-06-09T20:28:30+00:00 September 6th, 2016|Taking Care of Your Teeth|0 Comments

Smiles by Payet Dentistry is Growing!

Smiles by Payet Family Dentistry is expanding! It's been a long time coming, but it's finally here. I'll be adding photos and updates here as things progress through demolition and construction. We're Closed for Labor Day & That Week for Construction Our office will be closed from today, Friday, Sept. 2nd, and reopen with just 4 rooms operational on Monday, Sept. 12th, as construction is anticipated to last through the end of Sept. or into early October. Since we will be short 2 rooms during the time, our schedule will be more limited, but we'll do our best to ensure everyone is taken care of in a timely manner. This is Phase 1 of 3 and includes the gutting and widening of my 2 main treatment rooms. This will greatly improve comfort for our patients and increase our efficiency, making all of your appointments faster and easier (and who's going to complain about that, right? :-) ), as well as adding a new portrait/video studio. I'm so excited about once again offering Complimentary Portrait Sessions for all of our Inman Aligner, Six Month Braces, Invisalign, and Smile Makeover patients! Phases 2 and 3 of the expansion will be mostly invisible to patients, as they will give us a bigger team break room and lockers, a laundry area for scrubs, and more storage, while Phase 3 will be an expansion of our dental lab and sterilization area and a last bit of additional storage. Phases 2 and 3 won't happen for another couple of years, though. It's Been a Good Space, but Cramped So here's how this section of the office has looked for the last 6.25 years, since we moved in on March 19th, 2010. [...]

By | 2017-06-09T20:28:33+00:00 September 4th, 2016|ANNOUNCEMENTS|0 Comments