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It’s Always an Inside Job

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“Janet! I’m glad to see you. The receptionist told me that you called. This isn’t your usual six- month dental check up time, is it? What seems to be the matter?”

“Dr. Kaplan. I have a pain in my tooth.” Janet craned her head around as the dentist approached the dental chair where she was reclining. “I didn’t want to do like I did the last time and come too late. I don’t want novacaine and I don’t want my tooth drilled if I can help it.”

“Good for you. I’m glad you came in right away,” Dr. Kaplan said as he selected a dental pick from the instrument tray. “Open wide and let’s take a look.”

Janet held her mouth open while Dr. Kaplan looked at her upper and lower teeth, occasionally pressing down or scraping slightly with the dental pick. When he relaxed for a moment, she spoke.

“I didn’t tell you which tooth.”

“I didn’t ask. I wanted to see for myself.” Dr. Kaplan smiled. “It’s that upper 1st molar on the right, isn’t it?”

 “But how can you tell which tooth it is? What are you looking for?”

“ A hole. Or more likely, since you came in right away, a soft, brown spot – down in a crevasse or hiding between your teeth. Those are harder to see.”

“A brown spot? You mean a stain? I don’t drink coffee.”

Dr. Kaplan smiled. “No, not a stain. A place where the calcium and phosphorus is being leached out of the dental enamel. It makes a soft spot which sometimes turns brown.” He turned and reached for another instrument. “But you came in plenty of time. Do you floss?”

“Yes, several times a week.”

“Good. That keeps the plaque down.”

“Plaque? Like I get in my arteries.”

Dr. Kaplan laughed. “No, It’s an accumulation of bacteria on your teeth, usually around the base of each tooth where it’s hard to clean. If it’s not brushed off, it hardens into calculus – that crusty stuff on teeth. But yours don’t have any,” he said, pointing to her mouth. “The bacteria hide there and use the acids in your mouth to break down the enamel on the top and sides of your tooth.”

“What acid? I haven’t been eating anything acid, have I?” Janet didn’t understand.

“This is where you come in, my dear.” Dr. Kaplan looked serious as he pointed at her. “It’s not that kind of acid. It’s the acid made when sweets get in your mouth and coat your teeth – for extended periods of time. The bacteria break down those sweets into acids and use them to eat away at your teeth.”

“Mercy! How can I prevent that?”

“Brush your teeth – and floss. And eat foods rich in calcium – green veggies, for instance. Fortified low fat dairy is good but it also contains sugars – so it’s a two-edged sword.” Dr. Kaplan was counting on his fingers. “Oh, yeah. That brushing – use a fluoride toothpaste. Fluoride helps lock in the calcium into the enamel, makes it harder to leach out. And – see your dentist – that’s me,” he said with a grin. “I can treat your teeth with fluoride and sometimes sealants, in case you are the kind of person who gets small cracks in the enamel. And one more thing.”

Janet looked perplexed. Dr. Kaplan seemed so serious.

“Give your teeth a rest. No snacks, not constant eating. Take a mouth break. Give your saliva a chance to neutralize the acid in your mouth – especially since most snack foods are sweets that become acid.” Dr. Kaplan was preparing a soft paste of something. “I can help you with the outside of your teeth – with fluoride treatments and sealants and cleaning. But I can’t help you with the inside.”

 “The inside? You mean inside my teeth?” Janet asked.

“Yes, the inside,” he said. “The same sweets that coat the outside of your teeth, cause inflammation of the small arteries and tubules that feed the inside of your teeth. That’s how the calcium and phosphorus get to the inside of your teeth to replace that which gets leached away. When those arteries and tubules clog up, the nutrients – the calcium and phosphorus can’t get in. And the tooth can become soft – inside out. That I can’t help you with. ” Dr. Kaplan held a little tooth mold in his hand. “The food choices are up to you. I know you want to take good care of your teeth. Make good choices.” He held up the mold. “Okay, now. Open wide.”

Author

Max Wayne Hammonds was born Aug 3, 1943, in northeastern Indiana, in the county hospital in Wabash. He attended high school and college in his home town of North Manchester and attended Indiana University Medical School in Indianapolis. Following an internship in South Bend, IN and a year of flight medicine in the Air Force, he took a residency in anesthesiology at Wilford Hall Medical Center at Lackland Air Force Base in San Antonio, TX.