Connecting with Dr. Risbrudt, DDS

Money pit mouth:  Every year, it’s the same story:  You maximize your insurance immediately, and there’s not enough money left in the flex plan to fix the difference.  You think:  “What’s the use??  My mouth is just turning into a money pit!”  

Hold on!  There IS a way out!!  Most dental disease is VERY preventable!  Did you know that??  Want to find out more?? 

Most practices are so busy “drilling, filling, and billing” that there is no time to establish a working relationship that includes prevention at the heart of it.  (And we DON”T mean having the “Hygiene Nazi” telling you how you’re screwing up!!) 

Think about it:  Short of pain, swelling and bleeding, most dental services are elective, right?  Once disease is under control, however, now quality long-lasting  restorative work can be done at a pace that’s affordable, AND without going backwards in the meantime!!  The key is your personal confidence that the disease is contained and under your personal control.  First though, you need that assurance.  How would you feel about an office with a collaborative atmosphere, so you can work through the problem areas together and identify what needs to be done to rectify problem areas?  

Having done that, now, you can begin to prioritize and perform  restorative dentistry that will last, and not have to be done over.  Make sense??  Quality is the constant, time is the variable!!  Wow, what a concept!!

If you’re NOT preventing disease, you ARE preventing health!!  Want to know how??  It gets real personal:  Are you fed up with ongoing dental expenses?  What are you prepared to do, habit-wise to control them??  There AIN’t no magic bullet, but it CAN be done, and the research is all there to prove it!  (some of it, and I am NOT making this up, was done in the 1940′s!!)  

I can give you some general guidelines on this blog, but real prevention requires a hands-on tour of your particular conditions and how to manage them.  These areas need to be addressed and collaborated upon:  Homecare routines; homecare devices; nutrition; and a personal commitment.  There is nothing a dentist can do that will overcome what a patient will NOT do!  Something to think about!!

Any Money Pit Mouths out there??  Let’s hear your stories!! 

THR

So, now that we have identified what TMD is, what causes it, or what predisposes a person to manifest symptoms??  (You’ll have to forgive me if I get a bit passionate about this–I’ve spent a professional lifetime studying occlusion!)

Occlusion is not extensively studied in dental schools, but I have come to understand that occlusion, or the science of understanding how teeth, muscles and jawjoints all work in concert, is virtually the foundation of most significant dental problems.  That is, short of swilling sodas all day.  If you’re sipping sodas all day, you can brush after every sip and go right on having cavities.  (It’s the law!! 8^)  We’ll leave that whole “Money Pit Mouth” subject to another day.  But I digress…………

It may be well to talk about signs vs. symptoms at this point.  Signs, just like signs on the road, indicate something is about to come up, like “curves ahead”, “reduce speed”, etc.  You get my drift.  Ignoring signs often leads to untoward consequences. 

With dental conditions where TMD may be a factor, these are some of the signs:  Worn, chipped, or “short” teeth; (some wear is expected but if it’s “age-inappropriate” it’s a concern); nose and chin coming closer together, (“short” lower face) and creases deepening at the corners of the mouth; “notching” or “ditching ” at the necks of the teeth; receding gums; cracked teeth; broken fillings; crowns coming off; and unexplained isolated bone loss around individual  teeth.

Symptoms are the events or feelings you are actually experiencing, like:  pops, clicks or grinding “sandy” sounds in the jaw joints; difficulty with big bites, like a Hero sandwich; limited range of motion, like difficulty looking over your shoulder in traffic without turning your whole body; ear problems such as recurrent earaches, ringing, buzzing or stuffiness; head, neck, shoulder and back pain or stiffness, and snoring and sleep apnea.

Since much of this is not typically covered in the curriculum in dental schools, many dentists are unsure of what to do, if anything,  regarding these observations.  In fact, these subtleties may not even be in their stream of consciousness as significant signs.  I find in my work with teaching dentists, that there is a lot of confusion about occlusion, so they just get frustrated and tend to downplay it in their practice.  “There’s so much controversy and difference of opinion on this, that I just don’t want to get involved.”  It was precisely this kind of reasoning that led me to get involved!  I took my first course on occlusion in 1973.  The week before I took it, no one in my practice had an occlusal problem.  The Monday after I came back to work, I was amazed at what I saw.  Once a mind is exposed to a new idea, it never returns to its original shape!   

That’s about enough for this post.  Anyone out there suffering with any of this?  Been to your ENT doctor and he can’t find anything wrong with your ears??  Been to your chiropractor and the pain just keeps recurring?  Repeated massages don’t seem to help?  Maybe it’s time to dig deeper!!

Dr. R.

People hear about a comprehensive approach to dentistry and immediately assume it’s expensive. In our view, it’s more expensive NOT to be comprehensive!! For instance, if being thorough in the beginning saves you the cost of just one implant and the crown that goes on top of it, the savings more than offsets the investment in a thorough examination and evaluation. By about a factor of six!  

What if a person was able to intercept things that were headed in a negative direction that could be costly later?  Kinda like if you were able to know a day in advance that your hard drive was about to crash, would you just let it crash, or would you do something about it before it did? Replacing a hard drive is an investment alright, but nothing compared to having to retrieve any unsaved date on a crashed disc.  Or, let’s say you were going to build your dream house.  Would you just start putting lumber in the air, or would you give it a lot of thought?  Or, your dream vacation.  Just take off and see what develops??  I don’t think so!!

Back to health:  If you had a way to diagnose a tumor before it became obvious and symptomatic, how would you feel about that?   Okay, you’re thinking: “what kind of dentist can even recognize that kind of stuff??  What kind of dentist can help you intervene before you just start slinging money at one dental crisis after another?  All they’re interested in is maxing out my insurance until the next calendar year!”  We get that.  We hear stories of patients just slinging money at one dental crisis after another until they throw up their hands and say: “My mouth is turning into a money pit!” If only the developing problem could have been identified (diagnosed)  in it’s earliest stages.

Being an astute diagnostician takes time, effort, experience  and a TON of postgraduate education.  Why would a guy spend that kind of time and money pursuing the care, skill and judgment that it takes to become accomplished and astute?  With me, it’s a values thing–I can’t help myself.  I feel every single person who presents themselves for my care deserves the best I know how to do it.  Every year I re-define what that looks like for me, and it had better be a cut above last year.  Just because!!

Let me relate a couple of stories about being “astute.”  Webster defines “astute” as “keen in discernment.”  Several years ago, I did one of those full body scans, and something showed up on one of my lungs.  The physician who read the scan at least reassured me:  “It’s NOT cancer, but what is it?”  There then was the resultant referral to a pulmonologist who ordered several tests, including an MRI, etc.  He came to the same conclusion:  “Well, it’s NOT cancer, but I don’t know what it is.”  Not long after this all happened, I was visiting with my wise old endocrinologist.  I related the story to him, and he smiled and asked:  “Ever have pleurisy?”  Man, did I ever when I was in high school!  I can still remember having a special pad made for my ribs when I was playing football, as it was so painful!!  “Well”, he said, “that’s a scar from the pleurisy!”  That’s what I mean by astute!!

Here’s another classic:  An M.D. friend had been practicing in rural Oregon for a number of years when he decided to go back to school and get a Masters in Family Practice.  During his residency, each of the interns was presented with patients who had challenging conditions to test the interns diagnostic capabilities.  Most of the interns were very young, fresh out of medical school, while my friend had some wisdom, maturity and experience going for him.  One patient had a particularly vexing diagnosis, and it really caused the assigned intern a real challenge.  Finally, after an exhaustive battery of tests and much time spent in the biomedical literature, the proud intern was ready to announce his findings to the rest of the group.  My friend walked in the room with the group, sniffed the air a couple of times, and thought out loud: “Diphtheria!”  The intern in charge almost had a breakdown on the spot for this wise, astute physician had made a diagnosis without a single test or examination, but by the particular odor of diphtheria.   Wisdom, maturity, experience–that’s what it takes to become astute.  Do you think my friend was a pretty cost-effective  and astute physician in his little community?  Wouldn’t you feel comfortable in his presence?   Quiet confidence–that’s what evolves out of this process of “paying the price” in terms of hours and course work to become astute.

We’re offering a no-charge visit to any of you who think you or a loved one has a developing bite problem that needs attention. We believe that mouths need NOT become money pits!!

Remember that scene in the movie “The Rookie” starring Dennis Quaid as the high school baseball coach who starts on a Cinderella trip back to the major leagues?  When he gets close to being called up to “The Show” (The major leagues) he quips to the hot young rookie who is on his way up as well:  “Isn’t this great?  We get to play baseball today!!”  That’s the way I feel when I come to work:  “I get to help people by doing dentistry today!”   Everyone I see today will be unique!  Everyone I see today will be impacted by their dental condition in a different way, so I get to hear their stories!  I get to help out in whatever way I can consistent with each person’s circumstances, temperament and objectives.  How lucky can a guy get?  What a blast!!  Never a dull moment!

I also get to work with some of the finest professionals I know on planet Earth:  My team!  Our relationship as professionals has grown to be very special because we have shared wonderful moments with people who have reclaimed a lost portion of their health in ways that I never dreamed possible when I graduated from dental school.

If you our a loved one is struggling to make sense of your dental condition, trying to avoid “Money Pit Mouth syndrome,” please consider our office.  We’re hear to listen and to help!!

To your health!

Dr. R.

Before we get too deep into this subject of TMD, it would seem appropriate to have a philosophical discussion about different practice models.  There seems to be two distinct dental camps these days:  Disease-centered vs. Health-centered.

Disease-centered dentistry is designed to diagnose, treat, and cure disease wherever it is found.  Its overall objective is to stamp out oral disease for the benefit of mankind.  Disease-centered dentistry is essentially something someone does to someone else, either through active therapy or through education of the patient.  The doctor and staff are in charge.  the patient is the passive or active recipient of the service.

Health-centered dentistry, on the other hand, is largely a behavioral science in which the locus of control is transferred from the dentist and the staff to the only person who can achieve a higher level of wellness–the client.  The client is empowered to become an active participant in achieving a preferred future.  As the client assumes greater responsibility for his/her destiny, he/she becomes more of an active client than a passive patient.  The doctor and staff members function more as consultants than as therapists.  The health-centered practice is in the decision-making business, since each client is seeking to make important decisions on his/her behalf.

Does this resonate?  It seems to me that rapid advances in technology have virtually eliminated the idea of health-centered practice by circumventing the patient’s latent sense of responsibility.  Am I being a pollyanna to think that many people in their heart of hearts would rather be “collaborated with” than “done to” regarding their dental health?  Or, their health in general??

Something to think about!!

Comments???

The answer is YES!!!  Everyone has TMJs.  Temporo Mandibular Joints.  They’re located just in front of the ear on each side of the head.  Feel them–open your teeth slightly and place your fingers right in front of the ear hole and wiggle your lower jaw around.  You’ll feel them active beneath the ball of your finger.  They support the mandible (lower jaw) on the skull.   No other joints quite like them in the whole body.  Not only do they rotate, but they also translate down and forward. Anatomists call them a ginglymo-arthroidal joints due to their ability to rotate AND translate.

Right!  Okay, so I’m being a bit facetious about “TMJ.” The real question is:  Got TMD? TemporoMandibular Dysfunction!!  Now, we’ve got something to talk about!!  Some sources say that “TMD” stands for “Too Much Disagreement!”  The reason for that anacronym is there seems to be controversy out there between various camps about the nature of TMD.  The undergraduate curriculums in dental schools don’t spend much time on occlusion(How teeth fit and function) because, quite frankly, the students have their hands full just learning the basics of treating tooth decay and gum disease. That’s pretty sad, because often TMD springs from the teeth and muscles being out of harmony (malocclusion) and indirectly contributes to gum disease and tooth decay, and the average dentist feels rather overwhelmed trying to make sense of occlusion and TMJ.  But I digress…..

TMD has to do with dysfunction of upper quadrant musculature, (Head, neck, shoulders, upper back, etc.), TMJs and the bony parts of the mandible or lower jaw.  What kind of dysfunction?  Headaches, neckaches, ear pain or chronic stuffiness, pops and clicks in the joint proper, grinding noises in the joints when chewing, upper neck, back and shoulder pain, even pain between the shoulder blades.  Sometimes even the range of motion can be affected, like difficulty looking both ways over your shoulder before leaving a traffic signal, for instance. (As Dave Barry used to say:  “I am NOT making this up!”)

So—Got TMD??  What should you do?  One thing’s for sure, if there is pain on a regular basis around these areas, taking Aleve, Motrin, or Advil is NOT a long-term solution that’s in your best interests.  These remedies are for occasional discomfort.  You don’t have an ibuprofen deficiency!  It might be a good idea to seek someone out who knows something about TMD.   I’d suggest interviewing a dentist who claims to know something about TMD.  In my own case, it took me about ten years to “get it in my tissues”, so to speak, with literally hundreds of postgraduate hours.  It’s a fascinating field, but there is a lot to know, and there’s always more to know!!

In Got TMJ, Part II we’ll talk more about this condition.

To your health!!  Dr. R.

This will be a place for a long series of pieces that will hopefully help you make sense of your dental conditions and give you options to consider that promote predictability, longevity, comfort and esthetics.

It may be helpful to know where I’m coming from, both personally and professionally, in order to evaluate where the value is for you, the dental consumer:

I have had several significant mentors in my life, each building on the other. They collectively helped me to identify and embrace what really matters most in terms of professional and personal fulfillment and happiness. One of the major themes of all their collective works with me revolved around providing superior personal service to people presenting for care. Providing that kind of service with an eye to becoming better with each successive year is what keeps me and my team going year in and year out. “Service before reward.” “The magic of giving–nothing but your best!” “There is no pride in doing slipshod work–only in doing one’s best!” “Never treat a stranger!” This will probably date me a bit, but I remember a little limerick we used in school years ago: “Good, better best; never let it rest; until the good is better, and the better best!”  The concept is simple, really:  I feel that if your God-given teeth without any disease represents perfection, my job is to faithfully emulate that perfection to the best of my ability.  Since the philosophy of this practice is devoted to the concept of maximum dental longevity, I have dedicated my life’s work to have my patients retain their teeth for a lifetime in a state of health function and acceptable appearance.  This demands thoroughness and dedication to excellence. Because you deserve it!!

This philosophy is part and parcel of why I look forward to each day’s work.  I get to apply my knowledge with patients. If you’ve perused my website, you’ve probably come across the charge that one of my most significant mentors, Dr. L.D. Pankey, posed to me 30 years ago: “Sooner or later, Tom, you’ll have to decide if you want to have superficial relationships with a lot of people, or life-changing relationships with a few!” Once I understood the meaning of his admonition, it changed my personal and professional life forever. I slowed down, something I had been yearning for in my heart of hearts for as long as I could remember, and started spending time with people coming in to my practice in a whole new way, relationally.  The result? There are many friends (patients) in this practice who have been coming for over 25 years and counting. What a blessing!!  It just doesn’t get much better than that!!

Here’s a quote from John Wooden, one of my heroes: “It’s the little details that are vital. Little things make big things happen.”

And, in the same vein: “Trifles make perfection, and perfection is no trifle!”–Michelangelo

I encourage you to visit our website:  www.drrisbrudt.com to get the whole picture at your leisure.  Now that you know a little about me, in the weeks ahead we’ll visit many areas of dental and holistic health that I trust will be of value to you as a dental consumer.

Have a great week!!   Dr. R.

A Word about my dental philosophy…….. What is my dental philosophy, anyway? It’s what I believe, what I do, who I do it for, and how I do it. No easy task to spell it out in 150 words or less, but I’ll try.

As a dentist, I have come to believe when I replace or repair God-made teeth that have failed in our imperfect world I’d best provide nothing but my best, because it’s a distant second to Perfection. I also feel I should provide the best because, quite simply, you deserve it!

That being said, I get no satisfaction in pressuring people to make dental health care decisions for treatment. Two conditions MUST be satisfied: 1. A complete understanding of existing conditions and all options for treatment, and 2. A method of affording these options that are completely understood. I don’t want you to spend too much, but I’m just as concerned if you spend too little!

I, along with my dental team, call our practice a “health-centered” dental practice because it means you, the patient, have the locus of control over what goes on in your mouth. That means we’ll be a team, you and I, working together to provide a preferred dental future as defined by you, personally. Treatment will need to be “appropriate” for your particular and unique circumstances, temperament, and objectives. Quality is the constant; time is the variable. Health-centered also implies a high degree of personal accountability on your part for caring for your dental investment, and we love participating in your discovery of methods to prevent future dental breakdown.

We want our services to be comprehensive, individualized and personalized, addressing the uniqueness of each person who presents themselves for care.

What’s the process? Early in our relationship, as is comfortable for you, we like to engage in the process of what we call a comprehensive evaluation. During this appointment, both you and I will learn about the unique conditions present and active in the oral environment. The oral environment as we define it also includes the surrounding structures of bone, muscles and jaw joints which have a direct effect on conditions I observe in the mouth itself. Nobody likes surprises, least of all you as a patient, so we’ll seek to uncover both short-term and long-term concerns together. We also make it a point to celebrate those things that are right and healthy in your mouth!!

Services: The services on which I direct my energies have evolved over 40+ years in practice. We are mainly an adult (18 and over) restorative and preventive practice. One caveat: Since I see a lot of TMJ/TMD problems in my adult population, I get great satisfaction from rendering early orthodontic opinions to help you select an orthodontist for your children, of all ages, which will prevent head and neck problems and develop beautiful smiles and faces in the future! I don’t want to minimize the fact we do a lot of traditional “general dentistry” too. We recognize that there are many people who function at a level that only requires simply good, solid maintenance–type care.)

I focus my post-graduate learning in the following areas: Esthetic, cosmetic, and restorative (beyond just reparative) dentistry, TMJ/TMD issues, occlusion (how teeth fit and function) implants, snoring and sleep apnea, comprehensive complex restorative problems to include implants and periodontal issues (surrounding structures of the teeth) , minor orthodontics (Invisalign), preventive dentistry, general dentistry, nutrition and health.

Restorative dentistry vs. reparative has to do with longevity. Sometimes reparative is appropriate until disease is brought under control. Once disease processes are being managed, the future begins to look more certain for both doctor and patient alike. There is nothing that brings me more satisfaction than to see disease processes brought under control, in our patient’s mouths, through the joint effort of the patient and my entire dental team. I’m passionate about “Practicing on Purpose!”