Old wives’ tales

Dec. 1, 2005
Our perception of truth is often based on tradition. There is no research verifying any therapeutic benefit to the removal of supragingival stain and plaque, yet we promote a prophy as a necessary preventive procedure.

Our perception of truth is often based on tradition. There is no research verifying any therapeutic benefit to the removal of supragingival stain and plaque, yet we promote a prophy as a necessary preventive procedure.

“When I was pregnant the baby leached most of the calcium out of my teeth and that’s why I have cavities.” Hygienists have heard this more than we care to admit. We educate, inform, and insist, yet the old wives’ tales won’t go away. While some dental myths are regional, others like this one are heard everywhere. Since my efforts to defeat the myths have been less than successful, I decided to enjoy them. Most of us probably have some tales to share. The following are a few of my favorites.

Early in my hygiene career a woman brought her young son to our practice to have a “bad tooth” removed. She stated that the tooth was too stubborn to come out on its own and all her at-home efforts were unsuccessful. After an examination, the dentist explained that the tooth was indeed badly decayed. But, before he removed it, an X-ray would be needed to make sure there was a permanent tooth in position to erupt into the space that would be left. The mother declined the added expense and stated that all would be well because all of the men in her family were born with three sets of teeth. Even if the tooth to be extracted was not the “original baby tooth,” another tooth would “grow in once it realized there was space.”

I watched a red faced dentist try to keep from laughing and explain that perhaps not all men in her family carried the trait, and it would be best to check before removing the tooth. He even offered the X-ray at no charge. The mother still refused, stating that mothers know their children best, and showed irritation that the dentist would question her request for an extraction. The mood in the entire office turned when the dentist went from amused to annoyed. He took a good 10 minutes to explain the science and logic of his recommendation, but the mother would have none of it. The dentist even offered to restore the tooth for free and leave it in place until a replacement tooth erupted. Still the mother declined.

After a few deep breaths, the dentist explained the risks and benefits and had the mother sign a consent form. He said that orthodontic treatment might be necessary in the future if no permanent tooth was present. The mother smiled at her victory, and left the room while the tooth was extracted. I asked the dentist later what he would do if presented with this dilemma again and he said simply, “That can’t happen twice in one lifetime.”

I remember a tale about a man who swore the reason he had peg laterals on his maxillary arch was because a rat bit his mother while she was pregnant with him. In the story the laterals were referred to as rodent teeth. Multiple versions of this story have been circulated. One patient told me he read the story in a newspaper while visiting Austria, while an acquaintance of mine actually grew up next door to the rat bite victim in the United States. Since I haven’t seen the story authenticated by any of the tabloid newspapers, I still doubt its validity.

Most of us have heard patients talk about their third molar extractions and swear the dentist was kneeling on their chest. The image is funny, but I have yet to find an oral surgeon who will admit to such a stance. I am still looking for a good picture of a molar with roots that wrap around the jawbone. According to extraction horror stories, these molars are often the culprits behind the “foot in the chest” technique.

It is still occasionally necessary to tell a patient to swallow the aspirin to relieve a toothache instead of placing the aspirin directly on the offending tooth. And I bet that almost every clinician has heard a patient complain that the last hygienist was overzealous and scraped off too much enamel. My own grandmother blamed her sensitivity on too many “scrapings.” While I try to educate my patients and convince them otherwise, there’s no way I would have argued with Grandma.

Standing in a line recently, I heard a new twist on an old dental legend. The gentleman behind me was explaining his recent gum surgery to a friend. The details of his genetic disorder that caused the enamel to fall off the lower half of each tooth caught my attention. He took great care to explain the procedure used to cover the stricken areas of his teeth with tissue taken from the roof of his mouth. While I was thinking connective tissue grafting and chuckling to myself, his friend pointed out, “Everyone gets long in the tooth at our age,” combining one myth with another.

A favorite dental myth is the tooth fairy. It would be interesting to discover the origins of this flying pixy whose sole purpose is to retrieve exfoliated teeth. While my own kids never bought into the idea of a tooth stealing fairy, they did accept the theory that a child should be paid for the miraculous feat of removing a loose tooth. The mythical creature was easily replaced by grandparents willing to exchange dollars for teeth.

Most of the dental fables we hear are harmless and entertaining stories. They provide a source of amusement and an opportunity to remind ourselves that we are a science based profession not swayed by folk tales. As educated professionals, we operate on fact alone. Or do we?

Sugar Bugs are one dental myth that will probably last throughout time. Some well-meaning clinicians still teach home care based on the theory that bacteria “eat holes” in the teeth. Young children across the nation scurry to the bathroom after meals in an attempt to scrub all the bugs off their teeth. Definitely a habit we want to promote, but it is not necessary to give scary and false information.

Our perception of truth is often based on tradition. There is no research verifying any therapeutic benefit to the removal of supragingival stain and plaque, yet we promote a prophy as a necessary preventive procedure. Like most dental hygienists, I recommend a six-month recall for patients with healthy tissue and low caries risk. While we have many good arguments for such a recommendation, there is seemingly no solid scientific research to support this approach. Similarly, some offices still use a two-part rinse for topical fluoride treatment. Yet a quick search of PubMed brings up research from as far back as 1990 stating that this method is ineffective and not recommended.

Ceasing to recommend routine examinations and prophies for healthy patients is not my intention. Perhaps it is more reasonable to propose a slight change in priorities, to make such appointments truly preventive. We need to remind ourselves that a prophy is essentially cosmetic. While home-care instructions, fluoride treatments and sealants can prevent staining, plaque build-up and decay, more preventive measures can be taken by educating patients about the mouth-body connection, taking blood pressure, and thoroughly reviewing the health history.

It is our responsibility to debunk harmful dental myths. On the other hand, there is no harm in enjoying some of the entertaining stories.

Lory Laughter, RDH, BS, practices in Napa and Sonoma, California, in both general and periodontal offices. She is a partner of Dental IQ, a team committed to arranging quality continuing education opportunities for Northern California. Through her involvement with Dental Hygienists against Heart Disease and other organizations, she hopes to bring a total health concept to the dental practice. You may contact Lory at: [email protected].