Good dental care is an often-expressed concern of a large proportion of Free People's Clinic pa tien ts. On and off for the three years the Clinic has been in operation we have tried to develop relationships with dentists with varying degrees of success. We were just about to open a Free People's Dental Clinic when the Washington St. Community Center burned down. Now we are pleased to announce that a dentist, Dr. Wes Schultz has joined the Free Clinic staff. Wes is very interested in preventative dentistry, things that people can do for themselves to keep their teeth and gums happy and healthy. FPC: When are you working at the Free Ciinic, and what kinds of things are you doing there? Wes: I'm working every Tuesday night from 7 pm until the last patiënt is seen. Basically, I do brief oral exams on any patiënt who wants to be examined, let them know briefly what their dental needs are, and give them some suggestions for better oral hygiëne. FPC: Are there any referral arrangements for patients who need further dental work? Wes: Yes, some patients will be referred to private dentists where they can often pay over time. Most people will be referred to the Dental Emergency Ciinic because of its low cost. The Emergency Ciinic is a small facet of the overall Dental School operation. It's basically a three unit set-up where three students are assigned each day to cover emergency care on a walk-in basis. They treat anyone who is in pain, usually the same day, on a first come first served basis. It's on the first floor of the Dental School. The Dental Emergency Ciinic gives the cheapest care around. It costs between $3-10 to have a cavity filled; it's $5-10 for an extraction. And the care is excellent. I wouldn't have any qualms about receiving care there myself. FPC: What kinds of preventative things can people do for themselves? Wes: Preventative dentistry has only recently come into its own. In the past, dentistry has been mostly patch work. You'd go to a dentist as a child, and continue throughout your life, until, by the time you were 30, you'd have a mouth full of fillings, and by the time you were 50, you'd have dentures. So dentistry used to be a kind of supervised neglect. For instance, 25 million people in the U.S. today wear dentures, and well over half the people over 50 years old have dentures which is pretty astonishing, really. In the last 5-10 years, the approach has changed from repairing the mouth to trying to prevent the disease. Basically the diseases of the mouth are those that relate to the teeth and the soft tissue, the gums. There's plaque, which is a soft material made up of bacteria and bacterial producís. Plaque sticks to the teeth, and is largely responsible for tooth decay and gum diseases. If you can control the plaque, you can prevent alot of dental disease. To remove plaque requires no more than a tooth brush properly used, and dental floss. The problem is that most people think a toothbrush is a magie wand: you wave it around your mouth a few times, and your teeth are clean. So alot of people brush their teeth and still get cavities. The key is in using a toothbrush properly, and supplementing it with dental floss. Floss is a string-like material which cleans in between the teeth. Over 80% of tooth decay occurs between teeth. Toothbrush bristles can't get in there. They only hit the broad, flat areas. Dental floss is necessary because it disrupts the plaque between teeth. Another factor in decay prevention is diet. Keep sweets to a minimum. Keep frequent eating to a minimum. The more often you eat, the more often the bacteria can feed, consequently, the more chance they have of growing and doing damage. As far as tooth brushing method goes, there are many methods. It is not so much the method used but the roughness of the brushing which is most important. The more thoroughly you brush, the more plaque will be disrupted and removed, the less trouble you'll have. FPC: How should people brush, how often? Wes: That depends on the condition of your mouth. Most people have some degree of inflamed gums due to plaque getting in there and irritating them. The bacteria cause an acid condition to exist which reddens the gums, and may cause bleeding when brushing andor flossing. After some good care, the inflammation will subside, and the bleeding should stop. But, assuming that most people have at least some inflammation, I'd recommend using a soft, multi-tufted toothbrush, held at a slight angle to the teeth, and moved throughout the mouth in a series of small, circular strokes. Very small circles, almost like a vibration. All over: the cheek side, the biting surfaces, and the tongue side. Plaque forms in about 24 hours, and therefore only needs to be removed theoretically once a day. But most people don't get all of it, so I'd recommend that people brush a few times a day. But you can brush too often. Toothpastes are abrasive, and teeth can be worn down by too much brushing. You shouldn't brush more often than four times a day, though, again, frequency is no substitute for thoroughness. FPC: What about dental floss method? Wes: There is a correct way to use dental floss, and it should be a painless method. Sometimes, when people t first start using dental floss the gums will bleed due to the plaque being in there or hurt a little. But that should go away after a while. You shouldn't saw between your teeth with floss. Use a gentle action. All you're trying to do is disrupt the plaque that's formed. I'd say it should take three minutes to brush your teeth properly, and a couple minutes to floss. There are two kinds of floss: waxed and unwaxed. They're similar in effectiveness. The waxed floss doesn't string apart as much as the unwaxed, so it's a bit less hassle, but some people feel the unwaxed does a better job. There's not that much difference. The important thing is to use it. If you don't use dental floss, you may lose your teeth because of gum disease. After age 35, very few teeth are lost due to decay. Plaque can irrítate the gums to the point where the bone support to the tooth is lost, then the tooth falls out. Having healthy gums is as important in preventing tooth loss as having decay free teeth.There's no reason why, with proper care, teeth can't last a lifetime. The kind of brushing I've recommended, plus floss, plus flouride by a dentist, and drinking flouridated water should prevent 60-70% of cavities, even more. Ann Arbor does have flouridated water, by the way. FPC: Speaking of flouride, what are your feelings on "The Great American Toothpaste Battle"? Wes: There are all different kinds of toothpaste, and most of them are good. Everyone is concerned about abrasiveness. Tooth powders are much more abrasive than pastes, and usually aren't recommended except in rare instances. Flouridated toothpastes are better in that they have been clinically proven to reduce the amount of decay. Crest and Colgate are recommended by the American Dental Association. FPC: What about the million-and-one other cosmetic brands? Wes: Teeth cannot be whitened by toothpaste. The color of teeth comes not from the outer layer you brush, but from the layer under that one. Teeth can be polished, and brightened, but they can't be whitened. There's no such thing as a whitener. They're cleansers. All you can do is clean your teeth. FPC: What about chewing gum and using mouthwash? Wes: Chewing gum right after a meal, for a very short time, might help remove food debris and clean your teeth. But to chew gum for any length of time is bad. Most gums are sugared, and sugar just feeds the plaque-producing bacteria in your mouth. Dentyne, which claims to remove trapped food particles is, to my knowledge, no better than any other sugared gum. They're all pretty much the same except for the sugarless gums. And some of the sugarless gums aren't all they claim to be, either. But, in general, if people want to chew gum, they should chew a sugarless brand. Mouthwashes have little value. Even though they might claim to destroy 99% of the bacteria in your moufh, there are so many bacteria in your mouth. 99% of a billion still leaves ten million which will multiply in a short time to the level they were before. Mouthwash will make your breath smell fresher for a few minutes, but it really has no other value. FPC: What about wisdom teeth? I have sort of semi-impacted wisdom teeth. One dentist told me to have them out right away. Theguy I'm seeing now, says wait until there's cause. Wes: There is a difference of opinión on this point. The thing is those teeth may give you trouble when you don't haveaccessto a dentist. Therefore manydentists recommend that wisdom teeth be extracted to prevent later problems. Wisdom teeth areuseless. Food isn't chewed that far back in the mouth. They're very difficult to keep clean. And it's hard to fill cavities in them. So, for several reasons, wisdom teeth are routinely extracted. The extraction is cheap at the Dental Scoool. But, it depends on the individual case, too. FPC: What are root canals? Wes: Root canals are often a treatment used instead of extraction. They're a way of saving the tooth. When decay has gotten into the dental pulp - pulp being soft, inner, living part of the tooth -- the tooth can be opened. the dead pulp removed, and the tooth sealed, and saved. The only other alternative is to extract the tooth, which is not a minor thing. Teeth are there for a purpose, and it's a good idea to save them if you can. Root canals are cheap at the Dental School or the Dental Emergency Clinic. I think it's about SI 1 .00. FPC: What kinds of "first aid" can be used for everyday dental crises like fillings coming out, teeth being knocked out...? sy continued on page 16 Prcventative Dentistry continued from page 7 Wes: Fillings come out for a number of reasons: improper original placement, foods eaten, a blow to the tooth, or decay undermining a filling. The tooth should be kept warm, with a piece of cotton guaze, something to prevent air and cold fluids from contacting it. Then gt to a dentist as soon as possible. You can take aspirin for the pain, just don't let it dissolve in your mouth. Use this same procedure if a tooth chips or breaks. If a tooth gets knocked out entirely and is whole, it should be kept moist and taken as soon as possible to a dentist. Often it can be put back in and sa ved. For people who play contact sports, wear a mouth guard. They're available at sporting goods stores, ready made, or you can get one custom fitted at a dentist. But any type of guard is better than nothing. FPC: Is there any special way children's teeth should be cared for? Is thumb sucking bad? Wes: Children's teeth are a particular problem in that children don't care to brush their teeth. But baby teeth will decay. Baby teeth basically hold space in the dental arch for permanent teeth. The loss of a baby tooth too early might lose this space, and the permanent tooth may come in crooked. Consequently, baby teeth should be cared for. Most children enjoy thumb sucking, and it isn't detrimental to the development of baby teeth, though they may become slightly displaced by it. Usually kids stop sucking their thumbs at the appropriate level of maturation, and if there has been any displacement of the teeth they usually correct themselves and the permanent teetl come in okay. But, in some cases of prolonged thumb sucking, the child may wind up needing some orthodonic treatment. FPC: What is the availability of dental care in Ann Arbor? Wes: Believe it or not, Ann Arbor has the highest concentration of dentists per capita of any city in the country. The ratio of patients to dentists here is around 700-1 . In the country as a whole it's more like 2000-1 . But that can be a little misleading becausea lotiof those dentists are affiliated with or on the faculty of the Dental School We have one of the largest and best equipped Dental Schools in the country. There are dentists available. Many have evening hours. They're listed in the Yellow Pages. And if peoplewant some screening, they can come to the Free Clinic on Tuesday nights.