Some common medical conditions and dental problems. Part 1: Diabetes

In the blogs so far, I have written a lot about the complex nature of dental diseases and the many different factors which can cause or be associated with these diseases. Some of these factors are intrinsic and come from ‘inside’ us- our overall health, our genetic make up, our age…while others are extrinsic and environmental- our stress levels, our habits (oral hygiene habits, smoking, illicit drug use), our diet…

This article series summarizes some ways in which medical conditions affect our dental health.

You must be aware, though, that just because you may have one of these conditions you don’t necessarily have to suffer from poor oral health, but you are definitely at a much higher risk of developing dental problems and must take your preventative dental care seriously.

Periodontal disease is a chronic inflammatory condition of the periodontal tissues (gums, ligaments, bone, which support our teeth). It usually begins with a reversible inflammation of the gums (gingivitis). In susceptible individuals, the bacteria spread to below the gums, where they cause gum pocketing (gums loosen up around the necks of teeth and create small pockets where bacteria can settle). Bacteria in the gum pockets mutate into nastier types than their cousins on the surface and can then cause more severe damage to the deeper tissues, such as ligament and bone around the tooth, causing the tooth to loosen or even creating abscesses around otherwise healthy teeth. Severe periodontal disease leads to tooth loss and also subsequently affects any implant replacement of lost teeth.

It has been well documented that periodontal disease is one of the most common complications of Type II Diabetes (diabetes). Patients with diabetes are more likely to suffer from periodontal disease, their periodontal disease advances much faster and they also suffer from much more severe forms of periodontal disease than non-diabetics. Both these diseases are very common and they also seem to affect the same age group (35-65).

Type II Diabetes is a disease with a very high incidence: statistics show that more than 7 per cent of US population have diabetes, while it also affects 4% of Australians and 12.8% of Indigenous Australians. It accounts for 90% of all diabetes cases and is primarily caused by obesity.

Type II Diabetes is a result of high blood glucose levels due to insulin resistance  (insensitivity) and one of the triggers of such resistance is chronic disease.

We used to think of periodontal disease as a localized infection and inflammation of the gums and supporting structures around our teeth. However, this disease also has some more far-reaching consequences to our health. People who suffer from severe periodontal disease show increased levels of chemicals in their blood which regulate inflammation elsewhere in the body. Diabetics also have inflammatory messengers elevated in their blood, which is makes them insensitive to insulin.

When periodontal disease and diabetes come together, the presence of these messengers is so high that it makes it very difficult to control diabetes and makes the sufferer even more insensitive to insulin.

While the relationship between periodontal disease and diabetes is not a causative one (we can’t say that periodontal disease causes diabetes or vice versa), the presence of periodontal disease in a diabetic makes this person more sick. This is also true in the opposite direction: diabetes makes periodontal disease more aggressive.

What can you do to protect your teeth and your health?

If you suffer from diabetes, you MUST find a good dentist and a hygienist and establish a strong relationship with them. Be serious about your preventative dental care and commit to 3-4 monthly cleaning of your teeth and gums (three to four times per year). Most healthy people can get away with 6 monthly preventative visits, but your medical status makes you much more vulnerable to aggressive, destructive periodontal disease which can develop very quickly if your diabetes becomes poorly controlled or your hygiene habits change.

It has been proven that poorly controlled diabetes improves after non-surgical periodontal treatment (the sort of treatment your hygienist, dentist or periodontist can provide for your routinely).

By increasing the frequency of your preventative care visits and professional cleans, you are not only protecting your teeth and gums, you are also improving your overall health!

If you are unsure whether you may suffer from diabetes, please visit your medical GP as soon as possible. If you are a sufferer, visit http://www.diabetesaustralia.com.au for most up to date information and support.

If you need to talk to a dentist regarding your oral health, which may have been affected by your diabetes, call The Dentist at 70 Pitt Street on (02) 92326367 or email us on info@thedentist.net.au.

Wisdom teeth: should they stay or should they go?

Wisdom teeth are probably the most misunderstood teeth in dentistry. People associate any mention of wisdom teeth with pain, surgical procedures, swollen faces and all sorts of horror stories.  I have had clients ‘warn’ me at their first visit that they “do not want to hear about their wisdom teeth”, which every dentist they’ve seen before me has advised they should have removed.

People either assume that pain-free is problem-free, therefore their wisdom teeth should be left alone, or that all wisdom teeth should come out.  Both opinions are wrong, most of the time.

“Wisdom teeth” is a common term for third molar teeth. These third molars are the last of our adult teeth to erupt, usually between 16 and 18 , which is probably why we call them “wisdom” teeth. Due to human evolution and the nature of our modern diet, it is becoming very common for people not to have all their wisdom teeth form or erupt. When they do erupt, they very rarely ‘fit’ in the jaw and often are positioned at an angle or become ‘stuck’ (impacted) under soft tissue or bone.

NOT ALL WISDOM TEETH HAVE TO GO!

If they erupt relatively quickly and painlessly and settle into a position similar to the surrounding teeth, wisdom teeth are treated just like any other tooth.

BUT…MOST PEOPLE ARE NOT SO LUCKY

In most people, one or more of the following complications of wisdom teeth eruption take place:

• Wisdom teeth erupt slowly and become completely or partially stuck below soft tissue

This ‘flap of gum’ (operculum) traps food and bacteria and becomes inflamed and infected, leading to frequent painful episodes.

• Wisdom teeth erupt only half way and settle lower than the surrounding teeth.

This allows more food to be trapped around them, making it difficult to floss the area and leading to tooth decay and gum disease around the wisdom tooth and the tooth next door.

• Wisdom teeth erupt at an angle before getting ‘stuck’ against the tooth next door.

This leads to bacteria being trapped on the surface of the wisdom teeth and between the wisdom teeth and the teeth next to them. Decay and gum disease can develop as the area is impossible to clean.

• Top wisdom teeth can ‘over-erupt’ into the space below them if the lower wisdom tooth is not there or hasn’t erupted properly.

This can be traumatic to the soft tissue in the lower jaw and create ulcers or can leave the top wisdom tooth vulnerable to plaque as it is difficult to clean.

SO, HOW DO WE KNOW WHEN THEY STAY AND WHEN THEY GO?

This OPG radiograph allows us to assess wisdom teeth before removal

When deciding when to remove wisdom teeth, we look at a few factors:

1. Do these teeth cause pain and trauma, which may prevent patients from carrying out their daily tasks?
2. Are these teeth decayed and are they difficult to access for restoration (filling) to be done?
3. Do these teeth pose a risk to the surrounding teeth?
4. Do these teeth create weaknesses in the jaw, possibly putting patients at risk of jaw fractures in case of any trauma?
5. Are these teeth safe to remove and is the benefit of having them out greater than the risk of removing them?

If the answers to these questions are “yes”, we then recommend that one or all of the wisdom teeth are removed.

There are various ways wisdom teeth can be removed:

• by routine extraction procedure, under local anaesthetic, by a general dentist
• by minor surgical intervention, under local anaesthetic, by a general dentist
• by minor surgical intervention, under local anaesthetic or sedation, by an oral and maxillofacial surgeon
• during a day-stay procedure in hospital, under general anaesthetic, by an oral and maxillofacial surgeon.

HOW WILL I RECOVER?

Recovery time from wisdom teeth removal varies as much as the reasons behind their removal and the way they were removed. Everyone responds differently to the procedure. Most people handle it really well, suffer no complications and have no need for time off work.

Postoperative pain is common for up to 3 days and is best treated with antiinflammatories (eg. Ibuprofen).

You should expect longer recovery time for more complicated procedures and allow yourself between 24 and 72 hours for full recovery.

Remember: if they need to be removed, the longer you leave wisdom teeth untreated and avoid extraction, the more likely you are to suffer from complications before and after their removal.

For a more thorough assessment, make sure you see your dentist or call The Dentist at 70 Pitt Street on (02) 92326367, email: info@thedentist.net.au.

Online Dental Check Up

We all know we can do most things online. These days I opt for online shopping, online socializing, online information gathering, online bill payment….Well, now you can even have a dental check up online! You must be thinking I have lost my mind…

As I discussed in my articles so far, dental diseases are largely lifestyle diseases, much like obesity, type II diabetes, some forms of heart disease. As such, to know or at least suspect there may be something wrong with your current condition, you don’t just need to see a dentist, you need to check your diet, hygiene, lifestyle, medication. This online check up tool, devised by The Dentist at 70 Pitt Street, exclusively available on our website, enables you to do just that. It is a self-assessment tool which reports back to you where your risk of disease may be. Of course, you will still need to see your dentist to detect surface changes on your teeth and gums and check for oral cancer changes, but at least you will know what to expect when you do go to see them.

CLICK HERE TO TRY OUR ‘ONLINE CHECK UP’ TOOL

So, try it out, share it with friends and remember to arrange an appointment to get a professional opinion, too. Let us know if this tool was valuable for you! Email us on: info@thedentist.net.au

My braces are off, but Acceledent is here!

I am proud to announce that I recently completed my orthodontic treatment. As a child, I didn’t have the option of fixed braces and due to the nature of my malocclusion (teeth misalignment) the removable appliance (plate) treatment I had was not enough to make my teeth straight. Luckily, as an adult and a dental professional, I knew just the right person to turn to when I decided that I wanted to ‘take the plunge’ and get my teeth straightened.

As a dentist, I see a lot of clients who choose to have their teeth straightened because they are conscious of their appearance or they may have had braces in the past, but their teeth reverted back to their old position. I also see a few clients per year who are at risk of periodontal disease as they are unable to clean their crowded teeth properly and recommend straightening their teeth to lower this risk and enable them to look after their teeth better. Lastly, there are a small number of my clients who need braces for much more serious reasons than just aesthetics or future maintenance. Some of these people have seriously impaired function, speech and even severe wear of their teeth as a consequence of poor alignment. Over the long term, they develop muscle and joint dysfunction and the years of restorative treatment aimed at masking the wear and the appearance of their teeth eventually catch up with them and the teeth become severely compromised.

I have always had crowded teeth: my dad, my sister, my brother and I all had almost identical arrangement of our teeth and same bite. My appearance never bothered me and I survived the teenage years relatively unscathed. Plus, it was kind of cute when the whole family were all posing for photos together (I know, you are picturing something from the Awkward Family Photos gallery, but I’m sure it wasn’t that bad). However, over the past few years, I felt like a bit of a fraud, recommending orthodontic treatment to clients and having less than ideal teeth arrangement, like a hairdresser with bad hair!

In December 2010, I finally decided to see my good friend Dr Andrew Pitsis (http://ajpitsis.com.au/) and see what he had to say about my orthodontic problem.

Dr Pitsis and his staff were absolutely amazing. They are truly a customer-centered orthodontic practice, who understand the needs and concerns of an adult client. They guided me through the whole diagnosis with utmost respect and care and explained all the options.

We decided that the best treatment for my malocclusion were fixed braces. At first, I expected the stainless steel train tracks (think: Ugly Betty), but when Dr Pitsis pulled out a demonstration model of clear ceramic brackets, white coloured wires and clear silicone modules, I had no doubt that this braces business was going to be a lot less obvious than I ever imagined.

The braces went on a couple of weeks later and although it took a while to get used to the feel of having something glued to your teeth day and night, people hardly noticed them. I had to point out to my clients that I was wearing braces, even they could not tell.

In April this year, I finally had my braces removed, the thinnest little wire retainers bonded to the inside of my top and bottom front teeth and my perfectly straight teeth are now on proud display!

18 months flew by for me. Even though it initially sounded like the treatment time was really long, I was never truly concerned about the time it would take, I was more concerned with the end result and really wanted it to be perfect. However, a lot of my clients do feel that the length of treatment is an issue for them, be it for the number of orthodontist visits they need, the feeling of brackets permanently attached to their teeth or the frustration with slow progress. For them, I have some fantastic news.

Last time I saw Dr Pitsis, he showed me this great little gadget that is taking the world of braces by storm. It is called ACCELEDENT and it is proven to reduce treatment time by 30-50%. Through vibration, Acceledent stimulates faster bone remodelling and speeds up movement of teeth, plus it feels great on those ‘freshly pressed together’ teeth.

He also showed me the new generation of clear brackets, even smaller and thinner than the ones I had…I am jealous!

So, if you have ever thought about having your teeth straightened, see Dr Pitsis. This truly is a very exciting time for orthodontics and the new technology seems to be improving treatment duration, comfort and aesthetics to the point where none of these three ‘concerns’ should be a concern to you any more! Wear them with pride!

Antibiotics and dentistry

The Sydney Morning Herald recently published an article about overuse of antibiotics in Australia and stated that “Prescribing Service data showed Australians’ antibiotics use was above the OECD average, with 40 per cent of people taking them in the past 12 months.” (Read more: http://www.smh.com.au/national/health/why-antibiotics-can-be-health-risk-20120419-1xa34.html#ixzz1soqupIc4)

As I am sitting here, half way through a course of antibiotics prescribed to me by my GP for a suspected chest infection, nine months pregnant, still struggling to breathe and battling an excruciating cough (six weeks and counting), lack of sleep and all the pre-baby drama, I begin to ponder the importance of this article.

I am a very conscientious patient and medicine consumer. I avoid pharmaceuticals unless absolutely necessary and follow my doctor’s advice on the dosage, frequency and duration of any needed treatment. So far, through my pregnancy I have avoided taking any medication for a painful wisdom tooth infection, upper respiratory tract infection which left me bed-bound all through Christmas, a gastro-intestinal infection and this persistent six week cough which feels like it’s bringing the birth of my baby closer by the minute:) I know, you don’t need all the gory detail of my ailments over the past nine months, but with a preschooler/”germ factory” in the family, this is by no means unusual. To be honest, throughout those illnesses, my GP never recommended antibiotics as the infections were viral. As a health professional, I understand that antibiotics do not eliminate viruses. However, this most recent bout of illness prompted my GP to prescribe a course of ‘pregnancy-safe’ antibiotics. I am taking them, but my cough is not getting better- once again, probably a legacy of the viral component of my illness (and sometimes, bacteria and viruses can strike together).

I am boggled by the statistics of prescribed antibiotics use in Australia. I feel that a lot of it is not the public’s fault, but also the fault of their health professionals, who may find the use of antibiotics as the quickest way to ‘treat’ their patients. I know that this can also be tempting in a dental emergency, where dentists or medical GPs may not be able to accurately diagnose or haven’t got enough time to treat the affected tooth or gums. There is also a level of mis-information amongst the health professionals regarding the most appropriate treatment of dental problems and it is always best to see a dentist when your teeth or gums give you grief. Dentists are equipped to intervene and begin appropriate treatment without medication, whereas your medical GP will only have medication at their disposal until you get to see the dentist.

As a dentist, my prescription pad lasts me almost two years. In dentistry, antibiotics are pretty much useless, the best painkiller is an over-the counter anti-inflammatory and the ‘cure’ for infections and pain is intervention (this can be an intervention by the dentist to ‘fix’ the tooth or clean the gums, or by the patient, to eliminate potential causes of pain)!

When do dentists still use antibiotics?

• Acute, painful teeth or gum infections which cause considerable swelling of the nearby area and sometimes fever - it is important to note the difference between these types of infections and just painful abscesses, localised to one tooth only and not causing any other, systemic, signs and symptoms.
• Intravenous antibiotics are used in cases where tooth or gum infections have been allowed to progress untreated and have caused facial cellulitis- swelling of the face, neck, eye area, sometimes even obstructing the airways and not allowing the sufferer to swallow- this type of antibiotic treatment requires an immediate referral to the emergency department and a hospital admission for up to 7 days!
• Acute, painful infections and swelling of the tissues around an impacted wisdom tooth, often accompanied by a constant discharge of pus from the area - while ‘wisdom teeth infections’ are self-limiting and usually die down within 7-14 days, they can actually be very severely debilitating, they can cause a mild fever, severe pain may be associated with them and they impair normal jaw function (eating, speaking, even moderate pressure on the area). In these most severe cases, a specific type of antibiotic is used for quickest results.
• Post-operative secondary infections following teeth extractions or other surgical procedures- these procedures do not automatically put you at risk of an infection, but in a small number of patients, altered healing due to internal or environmental factors, can lead to an infection of the vulnerable site. In this case, topical treatment of the site with antibacterials (iodine, eugenol, chlorhexidine) may need to be combined with systemic treatment with oral antibiotics, depending on the severity of the infection.
• Prophylactic antibiotic treatment for prevention of endocarditis infections - a small percentage of our population are at risk of bacterial endocarditis, which may be caused by a transient contamination of one’s blood stream with bacteria living on teeth and gums. There is a very small chance of this happening during some invasive dental treatment (deep scaling of teeth and gums, some local anaesthetic injections, surgical procedures and teeth extractions). The jury is out on whether antibiotic prophylaxis is as necessary as we once thought and whether the risk of contracting bacterial endocarditis exceeds the potential risk of antibiotics (allergic reactions, antibiotic tolerance). Usually, patients who are required to receive this sort of antibiotic treatment are well aware of their risk and have been advised to do so by their specialist Cardiologist or Orthopaedic surgeons.

Why is antibiotic overuse so dangerous:

• Every time you take an antibiotic, especially from the penicillin family as well as some other types, you are at risk of developing an allergic reaction. This risk increases with the frequency of antibiotics you take. Therefore, varying the type of antibiotics you take is important if you must take them close together.
• Bacteria build resistance to antibiotics (as well as other antibacterial agents). This may make less harmful bacteria more harmful as they would require more potent antibiotics to eradicate and in some cases, these types of antibiotics have not yet been developed. This resistance does not only build in the person, but also in the community. Bacteria in our environment can be exposed to traces of antibiotics from improper disposal of left-over drugs and even purposeful feeding of these antibiotics to livestock and poultry. Every jar of pills that leaves the controlled storage of a pharmacy becomes a potential risk to all of us.
• You may not respond to a course of antibiotics if it is given to you to soon after you have already finished a course. This may put you at risk of severe and untreatable infections.
• Use of the ‘wrong type of antibiotic’ can contribute to bacterial resistance, yet not help with your infection and pain. It is important that a professional sees you to diagnose the type of infection you have, in order to recommend the most appropriate type of antibiotics for you.

How we can all help protect our community from more problems:

• Visit your dental professional whenever you experience dental (or mouth) pain! Dental pain is usually a manifestation of some more widespread problem- it may not be very serious, but your dentist will be able to quickly help you resolve it either way.
• Follow strictly the advice of your GP or dentist regarding type, frequency and duration of your antibiotic treatment. 
• Try to relieve pain by using over the counter pain relief products, but follow dosage instructions! Antibiotics are not painkillers- even though the pain associated with a serious infection subsides after a few doses of antibiotics, this is a slower (and more dangerous) way to pain relief. When it comes to toothaches, try using an over the counter painkiller, such as a paracetamol or ibuprofen based treatment. Ibuprofen has been proven time and time again as the most effective pain reliever for dental pain, even more so than narcotics.
• Finish your course of antibiotics and discard any left-over medication! The best way to do this is to drop them off at your local pharmacist, rather than letting the medicine end up in landfill.
• DO NOT SELF-MEDICATE! Not all antibiotics are the same, you may have the wrong antibiotic in your cabinet and this can cause some serious side effects and contribute to the wider problem of resistance. Even if you suffered similar symptoms when these ‘old’ medicines were prescribed, you cannot be sure you are suffering from exactly the same condition. See someone before you take any medication!

Do not insist on being given pharmaceuticals for your condition. In dentistry, intervention is the only real ‘cure’ for painful conditions. Diagnosing some dental conditions can take time, but it is important that your symptoms are not distorted by overuse of painkillers and antibiotics, so trust your dentist and do not delay recommended treatment. 

Concerned about recent media reports regarding dental Xray exposure? Read this!

I have been living under a rock and completely missed the recent media reports which link dental xray exposure to meningioma tumours (usually benign tumours, which appear on the brain membranes). To put your mind at ease, we are publishing communication received from the Australian Dental Association, which explains a bit more about the study from Yale University, reported in the media.

Please remember that at The Dentist, we believe in Xray protocols which need to be custom-designed for each patient, depending on their risk of disease. We only take radiographs if the benefit of information we receive from them far exceeds the risk of over-exposure.

Dear Dr Nesic-Fisher 

There has recently been extensive media interest in an article from the Yale University School of Medicine from the USA proposing a relationship between dental radiographs and meningioma.

The article by Claus et al, ‘Dental X-Rays and Risk of Meningioma’, was recently published in CANCER, a peer-reviewed journal of the American Cancer Society.

The study compared patient-reported dental x-ray history of 1433 people who had been diagnosed with meningioma with a control group of 1350 individuals. It found that patients who had received frequent dental x-rays in the past had an increased risk of developing meningioma, the most commonly diagnosed tumour in the United States.
In the article, the authors acknowledge shortcomings in their study, namely:

• Today’s patients now receive lower doses of radiation than in the past. This reduction in dose is due to better equipment, faster x-ray films and increased use of digital radiography. Some of the subjects in the study received dental x-rays decades ago when radiation exposure was greater.
• As a case-controlled study, the study was prone to bias. The results relied on the individuals’ memories of having dental x-rays taken years earlier. The authors recognised that recall bias is common where patients who have experienced a disease are more likely to remember details of their medical history than those people who are the disease-free controls.

In public statements, the Australian Dental Association (ADA) has reassured the public that:

• X-rays are a vital diagnostic tool in dentistry and assist in providing information about a patient’s oral health such as early-stage tooth decay, periodontal disease, infections, problems in surrounding bone or some types of tumours; revealing potential problems in the teeth that simply cannot be observed by the naked eye;
• Much lower doses of radiation are used now as compared to those that would have been used by those involved in the study;
• Dentists are required to undertake regular training in the use of x-rays so as to maximise safety for patients and the dental profession maintains a high standard of radiation hygiene for patients and staff;
• Dentists are very aware of their responsibility in the appropriate use of dental x-rays depending on the clinical presentation of their patients. Therefore there is no reason to decline x-ray examination when advised by their dentist.
• US Studies have revealed that the levels of radiation to which patients are exposed with a single dental x-ray is 0.0067% of the level of exposure from a mammogram or 0.5% of the level of exposure from an aeroplane flight from the equivalent of Sydney to Perth.

If patients express concerns based on media reports of this issue, dentists should reassure the patient of the reason for the x-ray examination and the protocols that are in place to ensure that the delivered radiation dose is as low as reasonably achievable.

Patients have the right to decline the use of x-rays. If a patient does take this course of action, then the dentist should specifically warn the patient that some dental disease may remain undetected and therefore untreated until more serious symptoms present. Please ensure that a note to this effect is recorded in the patient’s record.

It is recognised, however, that the effects of ionising radiation are cumulative and so dentists must remain vigilant that x-rays are only utilised in the appropriate manner.

F. Shane Fryer
President

Making your family’s dental care more affordable! Part 5: Budget tips.

Fees at your dentist are much like the prices in your supermarket, at the hairdresser, at your local cafe. Just like you budget for your groceries, power bills, entertainment, you can also budget for your dental care. The best way to do this is to stop thinking of dental expenses as ‘unknown’, ‘unexpected’ or ‘miscellaneous’ bills, which can surprise you at any moment. Start thinking of dental care as ongoing care, which you need at regular times of the year and start budgeting for it as ‘dental maintenance’, ‘personal maintenance’ or ‘health and wellbeing’.

1. Have your short term treatment plan, your yearly preventative care plan and your long term treatment plan (and fee estimates) with you when creating your budget

2. Think of your dental care costs as weekly or monthly instalments of the total yearly fee:

YEAR 1:  Total dental care cost= Short term treatment plan total cost + yearly preventative care plan cost.

YEAR 2: Total dental care cost= Whole or part of long term treatment plan cost + yearly preventative care plan cost.

YEAR 3: Total dental care cost= Remaining part of long term treatment plan cost + yearly preventative care plan cost.

YEAR 4: Yearly preventative care plan cost.

Divide these yearly totals into monthly or weekly instalments for the year you are budgeting for

3. Add dental health insurance premiums to the dental maintenance costs above

4. Work out true, ‘out of pocket’ yearly expense for dental maintenance and then work out your tax rebate entitlement (see previous article)

5. Do the the tax rebate and health fund rebate cover any shortfall in your ‘dental maintenance’ account?

6. How much does the family spend on foods and drinks that are not tooth friendly? Can they be eliminated from the grocery bill? How much does that save? Does THIS cover the shortfall?

If you have covered the shortfall in the ‘dental maintenance’ account, CONGRATULATIONS! You are now on your way to a lifetime of healthy teeth, confident smiles and top of the range, highest quality dental care. It is only year one on your journey, but by year 4, your costs are likely to reduce to only your preventative care costs and your budget will be in surplus!

If you still cannot cover the shortfall, don’t despair. Are your finances generally in order or do you need help in other areas, too? It may be useful to visit a budget advisor or personal finance advisor and speak to them about your household budget and what you can do to make your family’s health a priority. Alternatively, you may need to have another discussion with your dentist and adjust your treatment plan to suit your actual financial position. This would give you more confidence and keep you motivated to continue with your preventative care until you are able to take on more complex and more expensive treatment.

If you want to find out more about your own dental condition, visit our website www.thedentist.net.au. We are launching a brand new website soon, where you will be able to have an ‘online check up’.

For a more detailed discussion about your treatment, financial arrangements and looking after your whole family, feel free to call (02) 92323667 and we will be happy to answer any of your questions.