Chronic Pain, Marijuana, and the Dentist

On the front of the Journal of the American Dental Association this month was the dentist’s role and prevention of prescription opioid abuse.  I read the article, understood a dental professional’s need to recognize abuse and try to prescribe enough medicine for the pain associated with the procedure and not in excess. But little did I know that I would have be face-to-face with an issue of a non-prescription drug just a day later!

I saw a patient last week that I hadn’t seen in over a year. As I became reacquainted with his teeth - we discussed any changes in health status and medications. He first apologized to me about his teeth and reminded me that he lives with chronic pain with generalized neuropathies, arthritis, and spinal problems and it’s hard for him to get out and about, let alone brush his teeth or floss. As we reviewed his medical history and medication list – there were many strong prescription drugs and he also confessed to self-medication with marijuana to help him with the pain. He had a high medical IQ and was well versed on THC and it’s mechanisms of blocking pain. But then he shocked me. He asked me my personal opinion on medical marijuana and he wanted ME to approve and support the possibility of creating a synthesized THC inhaler so he wouldn’t have to smoke. What struck me the most, even after his dental appointment was finished and the work day was completed was that a patient had asked me my direct and professional opinion on marijuana, or marijuana alternative in this case. This had never happened to me before. WHY ASK ME – his dentist? Because I’m a dental health professional and I'm a part of taking care of his overall health.

Ironically the same evening I was watching the news and surfing the television channels and Dr. Oz was discussing medical marijuana and what marijuana does in blocking the pain nerve receptors. He was also debating its legalization with a panel of speakers, including Montel Williams (diagnosed with multiple sclerosis), an oncologist who has prescribed medical marijuana for the past 30 years to his cancer patients, and a representative of the FDA. I was amazed. There were SO many people in the audience with such heartfelt and strong feelings on this issue - and what a spectrum of feelings about access & legalization.

Marijuana in the past for me hasn’t been presented as a medical issue, especially in high school or college, it was more a peer pressure or addiction issue or socialization issue.  But now as I have gotten older, and my background in health and neurobiology, and access to realize how many severe conditions & polypharmacy people today deal with in prescription drugs (and the expense) just to stay out of pain - it really has opened my eyes. Additionally knowing the abuse of non-prescription drugs, being a dental practitioner in California and knowing that here medical marijuana is legal (as well as 14 other states) and also because here a PATIENT was stating he needed it to function and not feel such severe pain -  it is truly an issue of quality of life.

I was reminded of this class after watching this presentation, we took as part of our dental school curriculum after listening to this discussion. The class was about dental conditions and chronic pain - and one discussion was about a condition called trigeminal neuralgia (nerve pain). Our professor brought in a patient whose quality of life was dramatically changed – previously engaged, previously happy and employed with her whole life ahead of her, changed by pain and an unknown way to cure it or change it. Would prescription drugs help her or could something like THC? Would the quality of her life be changed?

I am still thinking of what my position is – on prescription & non-prescription drugs. I prescribe medicine for patients after I perform dental surgery. As dental professionals we recognize that there is abuse, many times it is not difficult to tell – but I think I need to be aware of those people that have to suffer with chronic pain and a deterioration of the quality of life. Because daily life is hard enough WITHOUT chronic pain.

image courtesy of: legalmichiganmarijuana.com

The Dental Loupe Light World is my oyster – but which one should I choose???

The light bulb recently went out on my wonderful yet antiquated dental loupe light on Friday - and it was like - for a moment - all the light went out in the dental world. I know...I exaggerate - but loupes are the special glasses many health professionals use with the magnification lenses attached or built in. They are wonderful and allow me to have better posture, and most importantly, they help me SEE!!! There is an attachment that you can place on these loupes, a little light that makes us look like that terrible bottom dweller fish in the movie Finding Nemo, and this helps us see even more – and once you have it, let’s just say that you don’t want to go back.  And so was created my dilemma. 

As a background, I bought the light for my loupes over 2 years ago. I carry it its own special aluminum case with so much care that it must have been like i was carrying the huge diamond in the movie Snatch. It is the kind of light where I have the light attached to my loupes, and attached to that is a long LONG wire, and then I plug the wire into an attached wall unit. I have had many of an almost whiplash moment when jumping from room to room. The long chord has almost tripped me, and it is very heavy – nowadays where you have much lighter, battery operated-fit-in-your-pocket LED light sources. So I have drooled over many a lighter light sources for some time, but being a newer graduate, financially every little bit helps that you don’t have to spend. And so is it in many facets of life. SO it is the mentality of: I have one already, why do I need another, even though I WANT one badly?? BUT you can imagine my despair when I heard the light make it’s initial noise and then heard the familiar flicker, and then…darkness.

So after that initial shock, I thought, no problem. I would simply ask for help in ordering another lightbulb that I would pay back thinking it wouldn’t be more than a $100 or so, and it cost over $500!!! AGH!!! I could buy another entire LIGHT for just a little more.  I have learned watching all of my employers order supplies, and balance supply budgets, and I know that supplies (aka: overhead) are an amazing but necessary expense.

But I feel I need this particular overhead to see better, to do the best job I can. But, I read Product reviews, and I have gone to conventions but still I don’t know which one is best!! 

Now the dental loupe light world is my oyster.  SO…at the end of that story…I guess the news is that I am now in the market for a new loupe light.  Until then I’m at the mercy of the angle I have the patient chair at, the ability for the patient to open (hopefully it is like the dental reach commercial - 180 degrees), the strength of the dental chair light, and the amount of sun shining on the dental chair (please pray for me to let it be sunny for the next few weeks). HELP!!

image courtesy of: traderscity.com

My Place in this World…of Dentistry….What is it?

Michael Smith said in his famous (albeit a little cheesy) 90’s hit “I’m looking for a reason, roaming through the night to find my place in this world” and I feel like that person (not on the beach with a piano and a faux-hawk) but one that is trying to find my place in this career world of dentistry. Today I am going to share a personal worry/frustration I have been trying to deal with as a “newer” graduate. I graduated in 2007 – seems like a good amount of time but in reality it isn’t – just five years – and they have flown by. But while I was at work today I realized that ever since I graduated I have been trying to figure out just WHAT MY NICHE IS in this huge and all-encompassing world of dentistry!!!

I am a General Dentist – that is my title. But within that title encompasses ALL the facets of dentistry – a smorgasbord – a buffet of choices!!!! It’s like the equivalent to an internist regarding medicine. There are many people (a lot of my own friends) that have gone on to further study – specialized in an area of dentistry they love. But if you asked me when I graduated what area of dentistry I wanted to practice it is almost like someone asking you in high school what you want to be when you grow up. You just don’t know! And after five years, it makes me a little worried that I still don’t have a definite answer. 

What do you mean that I don’t know what my niche is? Get with the program and PICK already right??? Well – like most general dentists I see patients and do whatever they need me to do – a crown, a bridge, children’s treatment, fillings, emergency treatment, and implant crown, anything... But, there isn’t one particular arena that I have delved in – “a vision that I can call my own.” An area that I have thrown myself into – something that motivates me so that I feel that I can contribute to the profession. As a few further examples - one of my bosses has embraced the CEREC machine (a device that we can put in your mouth and it can take a picture of your tooth, send that picture to a computer, and it can mill your crown for you right then and there). Another one of my employers has embraced the general dentist scope of Invisalign (non-traditional clear braces/aligners) and everything that it entails. Another of my friends has embraced dental implants, their placement & restoration.

While one part of me feels that those who decided to specialize are VERY lucky – and those general dentists who know what forte in dentistry they want to hone in on, another part of me feels that I LIKE being a general dentist. Is that bad? I know it isn't BAD, but is it bad motivation-wise for me? Possibly! I’m able to do all facets of dentistry and if it is beyond my scope or I need advice, I can go to the specialists and ask them for their opinions.

Am I alone in my frustration? Am I alone in my concerns?  I know that there is a lot of time to decide and that I shouldn’t be so hard on myself to hurry and decide an area I will delve myself into. I know there is just so much to dentistry, so much information, so MUCH to KNOW!  If you ask me what I am most passionate about - I am a huge advocate of public health, community service, care to the underserved/homeless & drug rehabilitation population, and the care of children. But I cannot say I am an expert in those arenas- but they truly interest me. Least there is a start right?

I guess my ultimate fear is, like everyone who loves their career and wants to be remembered or have a career legacy, that when my career in dentistry is said and done (hopefully many many moons and years from now)that I don’t want to be like the figure of speech “jack of all trades, master of none.” I know that I don’t have to figure it out NOW, but I know just as surely that I am anxious to decide.  I guess I will have to continue on like everyone else, follow my heart, and in time and with patience, I’ll figure it out...my place in this world.

image courtesy of: redbubble.com

Today's Media & the Humanization/Humorization of Dentistry

Have you seen the ads & previews for the movie "Horrible Bosses"– with Jennifer Aniston who plays a very HOT but sex-crazy dentist but who sexually harasses her staff & patients? And do you remember the dentist played by Ed Helms in the movie “The Hangover” where he pulled out his own tooth? Or have you seen the movie “The Dentist” and “The Dentist II” – both of which are basically about dentists that go crazy and are psycho killers??? Or Matthew Perry’s character as a dentist who helps in assassinations with Bruce Willis in the Whole Nine (and then Ten) Yards? And when is the last time you saw a fun Twitter or Facebook message from your dentist or hygienist??

Well, as a member of the dental profession, I get SOOOOOO excited when I find out that a character is playing a dentist. It just tickles me!  BUT - then I'm just as equally disappointed sometimes after I see what the character portrays!!! Publicity is publicity (bad or good right)?? NO!!! Another reason why I started this blog is that I noticed that dentistry is seldom portrayed in a positive light in social media (TV, movies, etc). And why should it- because it isn’t the most enjoyable experience for everyone and it isn’t really REALLY funny. But it CAN be.  If you meet most dentists, we are pretty AWESOME people (am I bias??? hmmm)... But truly I think we are generally VERY pleasant –personal, we smile and make jokes often. We are GREAT listeners and we have (for the most part) excellent chair-side manners. We volunteer often, and we enjoying giving back to our community. (Be honest now, I’m sure you laugh JUST A LITTLE BIT in the chair – you just don’t remember it because right after we make you open your mouth and we look around and you can’t get a word in edgewise…and that isn’t fun…for anyone.) And there are always references to a terrible situation and joke that “oh THAT is just about as fun as going to the dentist” – meaning it is more like torture.  

Now - I haven’t seen “Horrible Bosses” yet, and I REALLY enjoyed the dentist character in “the Hangover.” You’ve never heard anyone laugh out loud so hard as me than in the Hangover scene when he is pulling out his own tooth (I even read in a magazine that he really has a dental implant which is why the scene looks so REAL – because I was trying to figure out how they did that!!!) I LOVE sarcasm and humor – I thrive on it.

But I recently went on Twitter and Facebook and when I looked up dentistry there were either important yet long articles with no pictures (or if they had pictures it was of bleeding gums or the most extreme gross teeth you can imagine). And while there were some great blogs and posts and topics of interest especially to all those in the dental field, a lot of posts were from vendors trying to sell their products, etc.  They didn’t appeal to the public!

So I truly feel that we need to humanize and HUMORIZE dentistry – make it relatable and funny while still putting the profession in a positive light. I’m not asking the television or movie industries to make dentists the smart-yet-somewhat-boring-goodie-to-shoes but maybe it is the DENTIST that saves the day! Or we can be like the hilarious & sarcastic yet smart OB-GYN who delivers the baby for Hugh Grant in the movie 9 months! We are the unsung heroes in identification in such tragedies at 9/11, and we are the unsung heroes when you are having an emergency. Why can’t we have our own television series like Grey’s Anatomy or The Practice where all the characters are amazingly good looking, and they are all dentists, and the characters solve mysteries in dental diagnostics?!?!? I’d watch it!!!

I know I’m not going to be able to change the precedent of media negativity towards the profession, but I’m DARN well going to try….at least here is my contribution…..

So CHEERS to the HUMORIZATION and the HUMANIZATION of dentistry!   

Image courtesy of: today.msnbc.msn.com

Do you let insurance dictate how many times you go to the gym? It shouldn’t be so with your dentist!

I’m not writing this entry to lecture. But I do want to make a point, a comparison. There is an emphasis these days on the importance of health and taking care of YOU and the health of your families. Exercise at least 30 minutes a day they tell you. And MANY people spend a lot of time (and finances) on fitness – yearly gym membership, gym clothes, energy and protein drinks, yoga wear, yoga mats…as you know - the list continues. The industry survives & health professionals hope, so do you. 

But this emphasis on health issue does NOT seem to be included when it comes to dentistry! There are many people who faithfully come to the dentist – it is part of their routine and a priority in their life. But there are equally as many, for those lucky enough to even HAVE dental insurance, the feeling that “I am going to do what I’m able to do within the guidelines of my insurance policy.”

I was working on a patient the other day and after treatment was complete I told them that their treatment was all done (yay!) AND that we would like to see them every three or four months (ideally three months if they could manage it). There was a blank stare, uncomfortable silence, and then a look at me like I was nuts. Then they asked “does my insurance cover it? Because I think they only cover two a year.” 

This is a response that I have come to expect – almost like a common pleasantry that people exchange. But if your gym told you that they would cover you only a few times per year, would that keep you from going? Perhaps it would deter some, but most would still just go! And if your gym said that you only get two classes each month that they would cover and then the rest must be covered by you would that keep you from going? NO! More likely than not, you’d still pay to go! So WHY NOT this mentality for dentistry? 

Before I was a dentist I worked in a dental office for two years answering phones, setting schedules, presenting treatment, AND reviewing insurance. I KNOW that there are some terrible and restricting insurance policies –with waiting times, calendar years that start in the middle of a weird month half way into the year, and maximums that seem to disappear as soon as you became eligible to use. And I know that dentistry is not inexpensive, and that if severe treatment must be performed then it can cost an arm and a leg, or teeth in this matter. 

But please remember that, we (and of course I am not speaking for all dentists just as I can’t speak for all patients) are trying to help you make dental treatment decisions that are going to be the best for you in the future. Regardless of cost we will tell you the most ideal option that we think is the best for you and your situation and then present you with the next best option and so on. YOU have the power to make your decisions for yourself. Your mouth. Your body. Your health. Your finances. And YOU always have the right to say no and go by insurance. But PLEASE do not let insurance policies dictate what you can and cannot do. We buy insurance policies to help us, and we have them to help us, but they should not be dictating your treatment choices. Only you can do that.

So we don’t have a set price for membership like the gym – say an average of $24.99 per month. But we are a part of your lifetime membership to good health and prevention. Because without teeth, how can we smile, how can we eat, how can we enjoy life, how can we chew? It is a quality of life issue….and we want what is BEST for you. So please try to remember to INCLUDE us in your life's health plan and not just because your insurance policy reminds you we are here!!

image courtesy of: about-face.org.

You're pulling my leg....er...tongue

Have you gone to the dentist lately and we ask you to stick your tongue out at us? You, being a wonderful and polite person haven’t done that since grade school! You ask – you’re pulling my leg…you’re kidding right?!! Well – no actually – we ARE pulling your tongue! And for good reason! We aren’t asking you to relive your sand box days, we are checking your tongue for any changes – changes in color, changes in texture, trauma – or in the worst case scenario, and most importantly, oral cancer.

I wanted to share with today’s blog that there is a new FDA requirement that a picture of oral cancer (lesion on the lip) be placed on cigarette packaging. So keep your eye out. This is with the intention and hope of education, and hopefully determent for people today to NOT smoke.  Will this be a big enough deterrent to smoking!??!  It is DEFINITELY one more step in the right direction but it is your health professionals and specifically dentists that are often the ones to spot oral cancer because we ARE looking in the mouth and there is your tongue - right in the middle. How we can miss it???

Cancer ANYTHING is scary to everyone. But oral cancer – while smoking makes you at HIGHER risk, there ARE cases where people who don’t smoke and they are diagnosed with it! We have all seen those commercials where a woman is smoking from the hole in her neck. That ALONE freaks me out enough not to smoke.  But everyone KNOWS that smoking is bad FOR them…BUT the tobacco industry continues. ..less prevalent than it was before thankfully. But I see a lot of people who smoke even though they know they shouldn’t. 

We as dentists and those in the health profession KNOW that it is hard to quit and know that there IS a high rate of relapse – we are FIGHTING ADDICTION.  And trust me – we KNOW that life is stressful and we are not trying to add to it. (there are a lot of smokers in my class of over 270 sadly to say). We know it helps keep people slim and keep from eating (why you would want this I don’t know – food is GOOD). But we are, trying to help fight, for you.

Is this picture on cigarette boxes going to be effective enough to stop people from getting a pack of smokes? It is yet to be seen.  I HOPE so!

But please – don’t be shy with your dentist. There are a lot of free oral cancer screening days - you can ask your dentist! But...please.. Let us pull your tongue! 

Special thanks for this photo: emywinchester.wordpress.com

Yes, I am your dentist and Yes, I am a girl

I have been blogging for a while personally, but never as a dentist. I thought I'd start this particular blog because I want to share a different dental perspective- daily issues I as a dentist (and we as dental ladies in the dental field) have to deal with -  life balance, leadership, public health and oral health care issues, and of course patient care...and MORE! I am a little frustrated that all that is advertised out there is that we all hate the dentist and we had a terrible experience when we had our wisdom teeth pulled.  I wanted to share the dental field in a different light - humorous while at the same time talking about serious and real issues (a formidable task - but I'm going to try)

I work very hard (five sometimes 6 days a week) I'm a girl, I'm married, and I'm a dentist and I want to have a family and yet I have to stay up to date on dental issues that help me help you, while still having a life- and I'm trying to balance it all. And who isn't? I see so many female dentists, dental professionals, out there who are successful and accomplished and balance it all. I aspire to be them - I graduated in 2007 (so I'm considered a relatively NEW dentist - but 5 years goes fast!) and did residency and yet everyday while I'm practicing there is constant learning to be done - we will never know it all, as much as want to say we will. When I have something I need to research, or a task I need to learn, then I retain it better, I become a strong advocate of it - So while I'm learning, I'm going to share. With you.

For many many years women have been fighting for their rights to hold their own in the workforce, and I have been so fortunate as to benefit from this. My class at NYU was over half women (GO LADIES!!!!). So I want to hep you know that YES, there are a LOT of women in the dental field that help it be successful and help with your dental care. Dentists CAN be girls, dentists can be pretty, funny, empathetic while at the same time intelligent and competent. The face of dentistry is changing - the person behind the mask can be a girl, a woman. And so "a Dental Perspective " begins...