There are times when I need to get my message across in a different way for people to understand. So here are 9 of my favourite analogies relating to all things motoring…
1. Old teeth are like old cars!
Some old cars may not look great, being a bit tattered, torn and scratched but are still drivable and do the job!
I urge many of my mature patients to hang on to their teeth as long as possible. They often ask to have some perfectly sound teeth removed and provide dentures just because they do not look like they did when they were in their 20s.
The fact that they are in the mouth, still functioning and are relatively comfortable, is enough for the majority of patients. They may not look perfect but could be perfectly functional. Just like an old car, it will still get you from A to B but may not look as fancy as a new one!
I always encourage my patients to keep and maintain what they have rather than substituting them for a completely new car which you have to learn to drive again. A bit like switching from an auto to a manual!
2. Do you want a Rolls Royce or a Ford?
Choice of restoration-Whether it is a Rolls Royce or holden they will get you to the same place. Cost is different and perhaps aesthetics and function (crowns over large restorations).
As an example, if you wish to replace a missing tooth, There are three ways to go about it.
Firstly you can have a partial denture (a false tooth which you take in and out to clean). This is cheap and easy to make (approx $400 – $1200). The motorbike if you like.
Secondly, you could have a bridge or a porcelain tooth bonded or stuck to an adjacent natural tooth. It remains in the mouth but is a little more expensive to make and maintain (approx $2000-$3000)
This is your average family sedan; comfortable and practical.
Lastly, you can fork out for the Rolls Royce of tooth replacements or the implant. Firm and perfectly functional to the point where you say it was part of you. However, it also has a Rolls Royce price tag. (Approx $5000 – $6000)!
It does not really matter which method you choose as they all get you around the block! But why the difference in cost? Well just like cars, the level of complexity in construction, clinical skills and aesthetics are not equal…
The Rolls Royce obviously takes more skill and expense to create than a motorbike! The same goes for the provision of an implant over a denture.
It just depends on the level of style or function you want and of course, how deep your pockets are!
Looking after your investment!
Whether it is your average car or an expensive Roller, is imperative to prevent rust!
Likewise, a little pride from you on the care and maintenance of your chosen restoration goes a long way to reducing the risk of decay or future problems.
These two cars were manufactured in the same year!
I would not hesitate to bet on which owner takes a little more pride in their investment and probably their teeth!
3. Decay is like rust!
Just think of the outer surface of the tooth (the enamel) as the paint and the underlying softer material (the dentine) as the metal car body.
Over a period of time, in normal usage, it does not take much to create a blemish or scratch on the surface.
This can weaken the surface and lead to the degradation of the metal underneath (rust).
Sometimes it spreads innocuously under the cover of the paint, remaining undetected for months or even years until it becomes obvious in the late stages. At this point, the surface can bubble forming a hole or cavity. We see this appear on the tooth surface as small white spots chipping away as the enamel breaks down…
If left unattended, more bacteria will grow under the surface thus creating further damage (like rust spreading under the paint). If we do not intercept at this time, the process continues, often leaving a major problem with the rust causing deep structural damage.
So you need to seek assistance and do something about these early cosmetic blemishes (on your car or teeth!) so they do not develop into more severe structural problems like abscesses or the doors falling off!
By the way, taking regular X-rays is a great technique for detecting your tooth rust before it becomes too advanced!
This is an easy fix…
But this is not!!
Keeping your car or teeth in the right conditions will go a long way to protecting your paint or enamel surface. This calls for a little maintenance…
4. Regular Check-Ups or Servicing!
Just like taking your car to a mechanic for a routine service, having a regular check-up is a great habit to get into!
At least choose a dental professional rather than a mechanic (as our tools are slightly more subtle and probably cleaner!).
We are trained specifically to pick up early signs of disease in and around the mouth as well as any breakdown of the teeth. If we notice things not quite right we can advise on the most appropriate course of action. As a rule of thumb, the earlier a problem is detected, then usually the easier the cure!
Similarly, if you take our car in for a service and tell the mechanic that there is a squeak somewhere in the front end – He can diagnose and hopefully fix it before the wheel falls off!
So how often should you service your car?
Some manufacturers recommend 10,000 kms (about 6000 miles) or every 6 months whichever is the earlier. This really depends on whether you have an old banger which often requires a lot of TLC to keep it going, or a brand new vehicle which is trying to keep its resale value and warranty! How you drive is also important. If you are a Sunday afternoon casual driver I would suggest you do not need as much servicing as a sales rep who perhaps travels interstate weekly!
Teeth are the same, some people eat carefully by not crunching harder foods, whilst others are quite reckless with their pearly whites “off-roading” with sourdough crusts, pork crackling, ice cubes and hard lollies!
Servicing is designed to keep your car running in the best possible condition. Likewise, we want to advise you regularly on how to optimise your chewing apparatus!
Most dentists, I hazard a guess, would recommend 6 monthly check-ups. I have no idea why the world population needs to be checked at the same intervals. But hey, if Government funded treatments and insurance companies say so, then who are we to suggest otherwise! Well, to be honest, these institutions should not dictate the dental needs of the individual (Ooh that sounds political!).
So don’t be alarmed if a dentist advises your personal check-ups at different intervals depending on your own individual needs. I often suggest to patients, especially if they are high risk or have high maintenance dentition, that 3-4 monthly check-ups are valid to keep them going or keep an eye on certain conditions. Others can get away with seeing their dentist every 12 months if they have little or no sign of disease and maintain their mouth in a healthy state. So the timing of check-ups is arbitrary.
What if you don’t go?
Please keep in mind that if your dentist shows you a cavity on an X-ray and advises you to have a filling, make sure you get it done! Or at least get a second opinion from another dentist.
Here are two cases of mine – The first is a gentleman whom I advised to have a couple of small, easy-to-place fillings.
He did not return for 12 months and complained of pain!
The second is a four-year-old whose parents were advised 6 months prior, to have one of his baby teeth filled.
Again, they waited until he was in pain from an abscess!
This tooth will not come out naturally until about 10 years of age. It is unlikely that it will now survive another 6 years! As you can see, things can get out of hand very quickly, especially with children’s teeth!
So what do we do at your dental service?
Some of the things we look out for are not only that the teeth are in good shape but also that the gums are healthy. Ulceration, sore spots, red or white patches on the soft tissues and lips can indicate more serious conditions such as cancer, especially in smokers. The more times that you have a well-trained eye looking over these structures, the more likely it is that abnormal conditions are picked up early.
If we notice early signs or issues, we can advise on preventative treatments rather than leave it and turn up three years later for a call out by the automobile repair service!
Each check-up may include a clean of the teeth and perhaps every few years there is a full service, where small radiographs (X-rays) are taken to check for rust under your dental paintwork!
I suggest for adults with a stable dentition having your teeth and mouth checked at least once a year. Children every 6 months (more frequent if they have a high decay rate) and those with no teeth, but full dentures, every two to three years (yes you can still develop soft tissue disease with no teeth).
5. The Tyre Blow-out!
I do see a few patients return to the surgery having only just had a recent check-up perhaps weeks previously. Usually, it is due to a fractured tooth, broken filling or acute swelling (abscess). Most see the funny side of having to put up with my dad jokes again but others appear miffed that I did not see this coming! The only way I can explain it is that if you just went for a car service and a fortnight later your tyre suffered a blowout, then really do you blame the mechanic! Accidents happen. All I can do is be here to help repair the issue. Regular checks can minimise the issues by advising if the tyres look worn but neither mechanics or ourselves have that crystal ball.
A mechanic would probably tell you to change this tyre! Before this happens…
Likewise, I would probably advise you restore this filling before the ‘arrowed’ areas break down!
Resulting in something like this….Oops too late!
Listen to the dentist who may say things like ‘be careful with what you are eating’ and ‘chew softly’ or ‘you have heavily filled teeth’ prone to chipping or fracturing. They are telling you for a reason, as they may have seen a weakened part of a tooth. So think twice about having the pork crackling or that one minty you do not usually have! Remember if your dentist does advise having a “cap” or “crown’ on a particular tooth, he or she may have the “tyre blow-out” scenario in mind! So don’t be afraid to have a frank discussion with them as to why they think a tooth may need such treatment.
6. Wash the Side Doors!
Traditionally, we tell kids to go “brush their teeth”! What would make a refreshing change, is if we now ask them (preferably show them) to brush their gums as well? After all, the gums are the foundations upon which our teeth depend for proper functioning and are just as important to look after.
Most kids share the habit of brushing only the top surface of the teeth rather than the sides and gums. We see this daily in practice. I am constantly reminding them to brush the whole of the tooth rather than just the grooves on top so I get them to imagine they are washing a car!
They know full well that all the sides of the car need cleaning otherwise it would not look right! So I often get them to think of washing a car as they brush their own teeth. This encourages them to remember to not only wash the roof but also the side doors!
This is my son, Harry trying to wash the old banger. It was full of rust, so he could not have done a good job cleaning the doors! I shouldn’t complain, it was cheap labour after all!
7. To Repair Or Refill?
When the unfortunate chip or break does occur then don’t be afraid to ask the dentist for options.
If your car gets a little prang, the mechanic may ask if you wish to just repair the offending dent rather than a total body respray over areas of the car which do not need attention. This would keep time off the road and costs to a minimum.
With respect to teeth, sometimes little chips or fractures of enamel occur around perfectly sound fillings. By way of example, look at this case from Clubb Dental Chapel Hill, Brisbane. There is a little chip on the top right of the tooth which would probably feel a lot larger to your tongue than it actually appears here!
There are three options as I see it, depending on the condition of the existing filling. Some dentists may suggest having an expensive crown on the tooth costing thousands of dollars, however, as I have just mentioned, just ask for the alternatives…
All dentists know that each time we remove an old filling, the tooth becomes that little bit weaker! So minimising future work on a particular tooth is our aim for the long term. In a case like this, (if there is no sign of other fractures or decay), I often just bond a little white filling material (composite) to the chipped area to seal and smooth it over. The motor equivalent of placing some body filler and touching up the paintwork. Easy, minimally invasive and the cheapest option.
In this case, the choice was taken to remove the existing filling and extend the restoration to the chipped area. Perfectly justifiable, as there may have been decay on the X-ray or the patient just wanted a better cosmetic outcome.
Either way, it looks to have been placed perfectly by the dentist and a great restoration has been achieved. This would be like removing and replacing the offending car panel.
Crowning the tooth is an option but why do a full body respray if you only dented the bonnet! I know another dentist reading this would argue that a full crown is warranted but not everyone has $1500-$2000 to spend on a tooth! There are, after all, horses for courses!
8. Do you concentrate whilst driving?
Fair chance you do, but maybe not all of the time!
When you last drove home, could you remember which cars were parked on the end of the road or what the last pedestrian you saw was wearing? Probably not, as the brain filters out superfluous information, hopefully making you concentrate on the important job of getting you home safely. OK, it might be a bloke thing as we cannot multi-task but it is important to know that many of our actions are carried out as if we were on autopilot or cruise control. As your subconscious brain knows the route (hopefully), you do not have to actively think about it. This can be a problem however when you brush your teeth…
Ideally, you should have been brushing your teeth twice daily from early childhood. If you are thirty that is 2 x 365 x 26 = 18,950 times! If you are 40 then approximately 26,000 give or take but you can work out the maths (or ‘math’ for our US friends)!
What I am getting at is that the coordination of the brush on the teeth by the brain, after a while, becomes subconscious and we do not actually THINK about what we are doing.
Most people, I would hazard a guess, think about other, far more important matters whilst brushing such as ‘how am I going to cover the zit on my nose”, or ” should I wear my hair up or down” or : I wonder if my arse looks big in this dress” or “shit, why do I have to go to work today!”
(By the way, click here for an alternative lifestyle if you don’t want to go to 9-5 work)!
When was the last time, for example, you thought ‘right, I need to brush the inside of my lower left molars then move onto the outside of my upper molars, then move onto the premolars’ etc? Probably never! It is as if we are driving on autopilot when brushing our teeth.
Whilst there is no real problem with this, an issue can arise if we do not have good brushing habits to start with and we just repeat them without thinking of what we are doing!
My little party trick…
I often have patients, of all ages, who show this lack of concentration quite clearly and dramatically. I can often guess if a patient is right or left handed, just by looking at their teeth… Most people are impressed until I tell them why!
It is as simple as looking where they are leaving their plaque (germs) on their teeth. As we are on cruise control when cleaning their teeth, we miss the same areas time and again. These areas have a larger build up of germs which cause inflammation and bleeding in this area making it easy for me to spot.
When you brush your teeth (for a right-handed person) you would tend to scrub along the left-hand side, then turn your hand to clean the right-hand side. As you turn, there is usually a couple of teeth on the right-hand corner (the canine or ‘eye tooth”) that miss out. The converse is true for the lefties among us, ie, they leave plaque on their left canines!
The whole point of telling them though is to show them that we still need to concentrate and think about what we are trying to achieve when brushing our teeth. We are creatures of habit and will tend to repeat the same actions (good or bad) with the same results! If we miss the same spot each day, the plaque accumulates and the tooth will rot or gums deteriorate.
Discussing this little trick often encourages patients to click off cruise control and concentrate, so you don’t miss anything – just like driving!
P.S. The fact that I saw them pick up the rinsing cup with their left or right hand is also a giveaway! But I don’t tell them that, as it is not as magical!
P.P.S If there is plaque covering every tooth, I can assume they are using no hands at all!
9. “Dentistry” is like…
Spare a thought for our profession…
I often think “DENTISTRY” is a bit like working on the engine of your car, at night, with a torch, upside down, in the rain, with no brakes and the car prone to moving at any time without warning, when someone is trying to close the bonnet (hood), and their friend is watching every move and chatting to you!
But we still endeavour to do a perfect job!
I hope this refreshing take on dentistry has given you a bit to think and talk about!
Please feel free to share the blog with your family and friends!