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62 – Practice Principle Number Two

Hi there. You are listening to the Perio Patient Podcast, a podcast for my patients and anyone else who cares to listen. My name is Dr. Ben Young, and I am a periodontist in private practice in San Antonio, Texas. This is podcast Episode 62 and I have entitled it “Practice Principle Number Two.”
Welcome if this is your first time listening. Otherwise, welcome back.

Before I get to the main topic of this podcast which is obviously a continuation from last time – let me talk about flossing for just a second because I find that no one else really talks on this subject much at all.
Also, apparently it is controversial — that is to say – some, even experts, claim that it is over-hyped, unnecessary or, even possibly worse — harmful.
Why I find this interesting is because flossing is one of the cheapest preventive activities anyone can do.

Compare it to taking vitamins for example. What are you spending for supplements? Then look at a small plastic floss container usually holding 40 meters of floss. If you use the 18 recommended inches per use (I probably use about 12 inches) then you will get 87 uses out of one box. That’s just shy of three months.

Anyway, it’s pennies a day.

To me, the real problem with flossing is the fact that we don’t describe it adequately enough in order to separate out when it’s useful and when it isn’t. Also we don’t describe how to use it clearly enough to avoid a major problem – the fact that most people do not use it correctly. So, once again, for just a moment, let’s review. You can get all of this from my little book – with pictures in the middle that show how to hold it most effectively – or from an earlier podcast on the subject. When is flossing useful? When you have two teeth next to each other and touching. Big spaces make flossing more difficult. The contact between teeth enables you to slide the floss under the contact – being careful not to snap down and injure the gums. Once the floss is in the right position the contact keeps the floss between the teeth – then it is a matter of understanding that the purpose of the floss is to scrape the
sides of the two teeth – up and down. The plaque – that bacteria that can cause tooth decay or bone loss – depending on you personal resistance to different types of organisms as well as your dietary habits – whether or not you use a lot of sugar, for example – is dislodged and floats away. Your saliva has some antibodies that keep it from reattaching and it is destroyed by your stomach acids.

Flossing is a matter of frequency, not intensity. What I mean is that if you do it every day – and you don’t miss doing it – then it will prevent bacteria from colonizing enough to begin to work against you.

If you have an active disease – whether it is tooth decay or periodontal disease – even gingivitis – then flossing is not curative. In fact, flossing inflamed tissues can further injure them and then the body not only has to deal with the affects of bacteria and the body’s inflammatory response causing damage – but also the injury you are inflicting as well.

Flossing alone is not enough to prevent disease forever. That is why you need to see dentists and dental hygienists at intervals that makes sense in your particular case. Damaged teeth and mouths need a greater frequency of observations and intervention – to clean in areas flossing and brushing never are able to reach.

If you cannot get flossing between teeth because of fillings, then these need to be checked. If your fillings cut the floss, this needs to be evaluated. If the contact between teeth is open, then it may be helpful to have a dentist close this contact to make flossing easier and to keep food from lodging to easily between these particular teeth. This is not to say that we don’t all get food – like corn-on-the-cob between our teeth – but if you have a problem area – you know exactly what I mean.

Finally, how to hold the floss. The floss is wrapped a few times around the middle fingers of both hands between the two knuckles. This leaves your first fingers and thumbs to manipulate the floss. If you have trouble with this, floss holders are an option but I find that flossing with my hands is easier than working with holders – this is because over just a little bit of time – the process become simple.

What kind of floss should you use? Whatever you like is my answer.

If you have a complicated mouth with bridge work and dental implants, one you might try is called Super Floss by Oral-B. This also works well for people in braces. It enables you to thread the floss under bridges and it also has a foam element that cleans around dental implants well. That’s it about flossing.
Now last time I began by describing the loss of a dental implant – that it was a huge disappointment – especially for the patient – but also for me. And this led to me wanting to talk with you about how patients and medical and dental providers work best together. Essentially, I believe we work best together when we communicate clearly – I titled it “Clear Communication” – that was my first practice principle. And now I’m ready to talk about my second practice principle.

To do this, let me first describe it’s opposite. Routine, whatever the routine is, can make inter-personal interactions almost mechanical. We are all pressured by schedules. Not only do I have to work with the individual who is before me at the moment, but I am also aware that there are likely others who are either waiting to see me – because I am running behind – or will soon be expecting to see me – because every appointment has a limited amount of time allotted for it. And if someone is the last person of the day, it doesn’t mean I can forgo the discipline of maintaining the appointment time as best as I can, but it means that others – like my employees as well as others in my life have expectations involving me, as well. The problem is sometimes our limitations in time can result in people becoming short with one another – we don’t have unlimited time and we – let me just say I – (make my comments personal to me here) – I can become grumpy and short with people – all because things are going on in my mind that are building up and I – for whatever reason – at the moment – think are unfair to me.

So, what counters this natural tendency to play the victim in my own life? How can I not fume at every stop light or slow driver who happens to be in front of me? On the one hand, I can scold myself – tell myself to shape up and be nicer. But I have two problems with this approach. First, I think it lowers my mood – which I frankly don’t want to do if I can help it, and second, it doesn’t work.

Instead of just getting down on myself, my approach is to practice respect.
What do I mean? I mean I practice respecting everyone – not just those who are nice to me, who are in positions of authority compared with me – but with everyone – even children. I’m not talking about being
nice or even kind – things that involve my personality and mood. Of course I want to be nice and kind – but if I don’t feel like doing or being either, my fallback is – I will respect.

People deserve respect for being people and no other reason. This means taking them seriously. But there is more to this than just respecting others. I also, want to respect myself. If I respect you and I respect me, then my interactions will be serious, clear and respectful. If I have fun with someone, it will not be at their expense. Do I always achieve this? Of course not, but when I don’t, by practicing respect, my path becomes clear. I know I need to apologize. Overtime, by practicing respect, I find that people are able to trust me more – because I try not to operate on any superficial level of manipulation.

So now, let’s go back to the schedule. When I respect people, I find myself quicker to letting people know when I am running behind. I give people options to reschedule – because if I am in the middle of an important procedure – I will strive to continue to do it to the best of my ability without cutting corners.

Later, after the dust settles, I and my team can discuss how we might do it better in the future.

Respect is a discipline. This means it is not conditional. If someone disrespects me – or I feel I am being disrespected – it does not give me license to disrespect back – because to do so is to violate myself and my own principles. Again, am I always successful? Absolutely not, but I find, over time, with a lot of work, I can improve in this area.

Finally, in order to help anyone else who listens to me here and thinks for a second that mastering the ability to respect others as a principle is easy, I want you to know that I am a strong and practicing believer in twelve step programs like Alcoholics Anonymous and Al-Anon. This is a huge topic all to itself – but one of its most important elements to me is that it gives me opportunities to learn from and work with others who are striving to recover from failures in their own lives. Within this context, much of what I and my good friends struggle with can be shared confidentially (thus the word Anonymous in the title) and through this process we are all able to go back into life and manage things at a much healthier level.

Next time we will get into my final practice principle.

This has been the Perio Patient Podcast and I am still Dr. Ben Young. If you like this podcast, feel free to like and share. Also, if you have questions, don’t hesitate to drop me a line. Thanks for listening. Let’s talk again soon. Bye for now.