You really couldn’t make it up!

Ok, the patient realised that that was crazy advice, and most people these days would know it too. But, as a dentist, a small proportion of my income comes from repair work done to restore mouths damaged, not by silliness, but by attempts to eat a healthy diet!

I am writing this today because I have had several patients come in this month with problems related to this effect, probably because January is traditionally the time when the excesses of the Festive Season are put behind us and we set out to get fit and slim for a summer in skimpy clothes.

Of course, it makes sense to reduce the amount of sausages, bacon, ham, and other processed meats and fats in our diet, and to increase the amount of green veg, nuts, and fruit that we eat. However, there is a worm in that apple! The trouble is that fruit, packed with vitamins and trace minerals that it is, is also loaded up with sugar and acid. And sugar and acid are bad for your teeth.

I have as a patient a lady, who, thirty years ago, decided that PLJ (Pure Lemon Juice) must be very good for you and drank it from morning to night. A glass or two of PLJ  each day would do you nothing but good – but continuous exposure of your teeth to citric acid can have only one outcome. She arrived at my Practice in some agony, with almost no enamel left on her back teeth, which all had to be crowned in short order.

The trouble is that, out of green veg, nuts, and fruit, most people find the fruit nicest to eat. The other trouble is that your mouth cannot distinguish between sugar and acid from sweets, and sugar and acid from fruit. Once or twice a day – good. Every hour – bad!

Another source of real trouble is dried fruit. This is often bundled with nuts as a healthy snack or between-meals nibble. The drying of the fruit concentrates the sugars and acids, while reducing the overall bulk, so you can eat more dried fruit than natural. Concentrating the sugars makes them stickier, and the condensed fibre gives the sticky mass bulk and resistance to being washed away. So the dried fruit residue in your mouth sticks to your teeth and is is slow to dissolve – it just goes on holding the acids and sugars right against your teeth. And yes, I have had to repair a mass of holes caused by this.

I have told the tale elsewhere in this blog about the lady who assumed that sugar-free meant “safe for teeth”, and drank Pepsi Max continuously. The continuous acid exposure did more damage than she could afford to put right.

Let’s be relaxed for a minute here – it is blindingly obvious what the solution is. Think about what you are eating. Sugar? Acid? Then not continuously and not too often.

Above all – avoid fads!

DD-P

Cleaning and sterilisation may sound boring, but nothing - absolutely nothing – is more important to you. Get real, and take responsibility – your health and survival might depend on it.

I find that patients are very prone to take best practice entirely on trust. That is fine if you have been with the Practice a long time and have established that trust. With a practice or dentist that you do not know, common sense insists that you should be very careful to be sure that the highest standards of cleaning and sterilisation are being routinely adhered to.

Why? Because poor cleaning and sterilisation of instruments could cause you or your family to be infected with microbes collected during their use on another patient.  Some disease-causing microbes such as the AIDS virus are delicate and unlikely to survive any cleaning. Some, such as the hepatitis viruses, are seriously tough, and it is they that the up-to-date cleaning and sterilisation regimes are designed to kill. Again, this is not a trivial point. Hepatitis can kill you, and usually leaves any survivors with permanent ill-health and a shortened lifespan.

That is why it is so important that the highest standards are maintained. This post is to help you to know what those standards are and how to check if they are in place. It is about sterilisation of the instruments and other bits and pieces that your dentist uses on more than one patient. Of course, the ideal would be never to use anything on more than one patient but the reality is that only the Howard Hughes and Bill Gates of this world would be able to  afford dentistry if the kit was ditched after each patient use.

Those things that are regarded as being single patient use are all disposables, including suction tubes, injection needles and anaesthetic cartridges, bibs, drapes, scalpel blades, and any instrument that is used inside a root canal. This last is not observed by every endodontic (root-canal therapy) practitioner and that fact is winked at by some  lecturers in the subject.  My personal opinion is that there is no reason for the rule from a sterilisation point of view, but it does mean that every patient gets brand new equipment used on them and that the metal of the instruments has not been disturbed by the high temperatures of sterilisation. Personal experience shows that obeying the rule and using new instruments for every patient leads to fewer problems of instrument breakage, which can compromise the clinical result, and that is definitely worth having. For that reason, if you ever need root-canal work, check that the dentist is scrapping instruments after use and will be using new ones for you. If you are not convinced, time to go elsewhere.

So, everything that your dentist is re-using, patient to patient, has to be sterilised. Let’s look at what is required. First of all, used instruments are “dirty”, and their movement through the practice must not be allowed to contaminate anything “clean”. So the instruments are moved from the treatment room where they were used to the cleaning and sterilisation area in trays used only for that purpose. In the sterilisation area they are hand-washed under running water in a sink kept for that purpose,and rinsed in a second sink. They should then be re-washed in a “washer/disinfector”. This is like a dishwasher, but uses much hotter water and should clean both the outside of all the instruments and the inside of any hollow equipment. From here the equipment should transferred to a vacuum autoclave (steriliser). The vacuum bit is important because it allows the superheated steam that does the sterilising to penetrate into the hollow parts which can harbour germs. Solid instruments can be sterilised in a non-vacuum autoclave,but a vacuum autoclave is essential for equipment such as drills that have internal hollows and passages.

When instruments emerge from the autoclave they are truly clean and sterile. Obviously it is important to keep them so before they are used on you! So they need to be covered to prevent re-contamination (we keep ours in sealed disposable bags), and kept away from any dust in the treatment room.

Right. This is what should  be done. Check out the page on cleaning and sterilisation in our website to see what the equipment we use looks like. Click here. This follows the guidelines laid down. Nothing less than this will do for your health and that of your family. Do not just ask! Demand to see the sterilisation facilities before submitting to any treatment and if you are not sure, do not risk it.

It will take patients demanding to see, and being critical, and walking away, to bring any practice that is falling short to get its act together. You would be crazy to be shy or reticent where your health is concerned.

And you’re not crazy, are you?

Go to it!

A patient who had been a member of my Practice for about 27 years, wrote a letter to my hygienist, Leah, telling her that she really appreciated Leah’s care and professionalism over the years, but that she had left the Practice and joined another locally, essentially because she did not like me. She said that she had had small piece break off a back tooth and I had smoothed it but she wanted it filled and she couldn’t afford our fee for a filling, and she wanted a crown but could not afford the fee for the crown.

She had gone to another practice and was over the moon with them – they were so proactive and forward thinking! The had taken an X ray and shown her, on the Xray, decay that we had missed! She had not had an Xray with us for two and a half years! As a result she had had nine fillings done and she was very pleased. Apparently, she could afford nine fillings.

OK. If you have been following this blog, you should already have started to look askance at this. For a start, she says that she has been with us for 27 years. That is a fair length of time. If she did not trust me why had she stayed so long? Could it be because throughout that time her mouth has been stable and well? Change practices by all means if you feel that you will benefit by it, but if you have a symptom-free mouth, with a 27 year history of health, why in the name of all that is Holy would you believe someone you have just met when they tell you that you need nine fillings? Because they “showed” you the decay on an X ray? Great if you have a degree and some useful experience in dentistry, but I could have shown her nine places on her last X ray with me and told her that they were decay – but they would not have been.

And this brings us to the point of this post.

I am occasionally asked by a new patient and stranger to my Practice to give a second opinion on work that another dentist has suggested.As you might expect, where the other dentist has said that teeth have to come out, and they are flapping in the breeze, it is simply a matter of telling the patient that their regular guy has got it right. A friend asked for second opinion on a tooth that he had been told need to be removed. On examination I found that the tooth had split and extraction was the only option.

What really gets difficult is where the work suggested is unnecessary. A teenage patient of mine was told that she needed two fillings. She does not. The patient mentioned above cheerfully accepted nine fillings which were almost certainly not necessary.

The thing is, of course, how is the patient to know which dentist is “Right”.

If dentist A says that you need a lot of fillings, and you haven’t needed them before, and for a long time, then it is time to get suspicious and, if at a second opinion dentist B  says that you do not need them, then change dentists and keep your teeth in one piece, because dentist B is gaining nothing and A might be making money unethically.

So much so clear. But if dentist A says that you need denture and B says that bridges would be better, how do you decide. Here, the situation is reversed. The dentist advising the bridges is going to take more money off you than the dentist advising a denture, but in many cases, the bridges might be by far the better option for you. But not in all cases. If the denture man has explained and shown you that your teeth are too poorly supported by bone to accept the loading of bridgework, then the bridge man is trying to rip you off.

So, what do you do?

Well, my point here is that a second opinion does not always help you and may simply deepen your confusion. What you need to do is to find a dentist that you trust. One who takes the time to explain things to you, using a minimum of jargon and simple plain English. Who repeats the explanation using different words and approach if you do not immediately understand. One who never suggests that you cannot understand because it is too difficult for you, and that you must accept his advice and superior knowledge.

It may be that some otherwise unknown aspects of your case may need to be explained to you so that you can understand the final decision that the knowledge leads to, but what is being told to you should make logical sense to you. Use the same tools that you use when you make any purchase in an area outside your field of expertise (just as your dentist does when he goes to buy a television or a computer); look at the logic of what is being explained to you and keep a wary eye on “upselling” (leading you into a purchase of greater complexity or cost than you want and need). Does your gut feeling tell you that the person advising you is genuine or do you have a bad feeling about it? Does the person advising you have a good reputation? Is he new to the area and/or likely to leave soon? Does the information offered make sense with what has previously been told to you?

As you can see, much of the above requires some level of mutual trust between you and your dentist, something that will seldom be present with the unknown Practitioner called upon for a second opinion.

But, in particular, avoid the illogical behaviour of my ex-patient. If you haven’t needed treatment for a long time, ok, there are reasons why you might suddenly develop cavities, but you would need to be thoroughly convinced by simple, logical explanations that gelled with you, before accepting having that sort of invasive and damaging treatment.

Never be afraid to say “No.”, and to walk away.

It is a great pleasure to me that I have patients of my Practice who have been with me for most of the thirty-seven years that I have been practising. Many have become friends and enjoy their visits to see us. We keep up with their news and they follow the staff’s lives and children’s development, even in one case to the extent of knitting baby clothes for one of our nurses’ first child. So it is always sad when a valued client has to leave the practice for any reason, and of course, people do have to move from time to time. I am often asked by people moving away if I can recommend them a good Practice to go to at their destination.

If they have had dental implants with us, I always call the implant company to find out if they have a user of their system in the area my client is moving to, but otherwise all I can do is to offer advice of what to look for in their new Practice, to help them to make a good choice. If you have to move to another area, it is after all, an important decision for you and your family, and one that may have to be made at a much busier than usual time.

So, I thought that it might be useful to some people if I wrote down and expanded the advice, and it will be found in a static page of the same title in this blog. I know that many people, some of them dentists, will accuse me of raising people’s expectations too high, but this is very much the point. Practices that do not offer good service, particularly in the seriously important areas such as sterilisation and customer care, ought not to gain custom, and those Practices that take the time, effort, and cost of providing the service ought to find that discerning people are seeking them out.

Right, down off the soapbox; as always I hope that you find it helpful and interesting, even if you do not need the info right now.

Hope to see you again soon,

DD-P

It claims that those who have their teeth professionally cleaned at least once a year cut their risk of a heart attack by nearly a quarter, and are 13% less likely to suffer stroke.

A further finding in a separate study claimed that those people with fewer than twenty-one teeth were two-thirds more likely to have a heart attack than those with more.

This isn’t new, of course. It was suggested some years ago that gum disease was a linked and causative factor for heart disease, the mechanism appearing to be the bacterial toxins from the diseased gum,and their effect on heart and other blood vessel linings in the long-term.

I have seen it claimed that the supposed link of smoking to heart disease may not be due to a direct causative link of nicotine or tars to heart blood vessel damage, but the fact that smoking in the absence of adequate oral hygiene encourages gum disease and makes it worse. Certainly my experience has shown a very direct link between smoking and advanced gum disease. The theory states that smoking creates and worsens gum disease, and the gum disease damages the heart and blood vessels.

I do not know if anyone is researching the effect of smoking on gum disease – my opinion is based on observation over time. It is known that nicotine has an effect of reducing capillary growth in the repair of wounds, and it appears, from observation, that this might be one of the reasons why smoking advances gum disease, since the body’s efforts to effect repairs to the damaged gums would be hampered by such an effect, and that would speed up the loss of bone around the affected tooth.

Another area of dentistry where smoking causes  serious problems is implants. Like many dentists who place implants, I no longer accept smokers for that form of treatment. I know of an implantologist nearby who takes a different view which is that if the patient is warned of the problems before starting, then, if they accept the treatment, continue to smoke, and lose their implants, that is down to them. OK, that is his view, but I feel that since smokers are usually in denial about the obvious and well-known dangers of smoking, they are not likely to take such warning seriously. That means that, out of the two people involved, the dentist, and the patient, only one is truly aware of the potential for problems and loss of the implants that the patient has paid for, and the dentist accepted payment for.

So I think that it is time that we looked seriously at gum disease, its causes and its prevention. It is gum disease, not tooth decay, that causes the loss of most teeth, and as we have seen above, can have spin-off problems for your heart, your lifespan, and your quality of life. Click here to go to our Page on Gum Disease.

In the last post I said that I would return to the mouthwash question. A lot of people like mouthwashes, and it is easy to see why. The manufacturers take care to produce a product that makes the mouth feel good – they put in astringents like alcohol, flavourings like menthol which have a cool mouth feel, and they tell you that their product is killing germs and doing you good. Some run highly successful advertising campaigns on television (which gives you a clue about their income from the product). The consequence of this is that my patients, who are generally highly motivated individuals when it comes to their oral hygiene, are happy to spend their money and buy and use the product.

So why do I spend a lot of my time in the Practice telling my patients to stop using, and not to use, commercial mouthwashes?

To answer that question lets look at a few facts. Sadly, most people are not very good at looking after their mouth. In this country the thick end of twenty thousand dentists are busy repairing damage that should never have happened, most of it caused by the neglectful behaviour of the owner of the mouth. In other words, everyone knows that it is important to clean your teeth properly, but most people love their dentist so much that they are happy to skip this important bit of self-care, in order that their dentist should get a decent income from drilling their teeth. Such nice people! Ok, not really – such lazy, silly people.

But that is the way it is, and the mouthwash manufacturers know that such people would be happy to swish something nice-tasting around their mouth for a few seconds and think that they have done some good, rather than that sad old “two minutes brushing” nonsense. Sooo boring!!

So the product is aimed at a particular level of patient and this patient does not have a particularly well-cleaned mouth. If the manufacturer wants to be able to claim that his product improves oral hygiene, and advertising standards in this country being high, he needs to be able to show an improvement in oral hygiene as a result of using his product. Typically, this would require him to show that, in a clinical trial, there was a reduction in plaque that could be correlated with the use of the product. Since you cannot reduce plaque by swishing liquid, no matter how nice tasting, over your teeth, the manufacturer needs an ace in the hole. Or rather, an acid in the hole. Because acid will dissolve calcified or slightly calcified deposits  and produce the clinical result that he needs.

So what is the problem? Well, those calcified deposits are there because the mouth is not being properly cleaned. Yes, the mouthwash produces a measurable improvement, but it is probably from very bad to bad, rather than from good to excellent. Certainly it has improved the lazy, poor cleaner’s situation, but not by much, and probably not by enough to make a long-term difference.

Now let see what happens when a good cleaner with a clean, healthy mouth uses the mouthwash. In goes the acid, but here there are no calcified plaque deposits to remove. There is however plenty of calcium – in the teeth! Now, the weak acids used in mouthwashes are not going to strip the enamel off your teeth – but the dentine is another matter! Bathe your dentine in acid, be it mouthwash, or vinegar, or lemon juice, and the surface layer will be dissolved and your teeth will start to get sensitive.

Of course, not all commercial mouthwashes contain acid – some are designed to strengthen the teeth with fluoride, which makes them less, not more, sensitive, and some are just bland, nice tasting liquids.

My patients are, to a man (or woman), good cleaners. The last thing that they need is to wash their teeth in acid, but because they are keen, they respond to the advertising campaigns by buying and using the product – and then turn up to see me complaining of sensitivity in their teeth. So I tell them to stop using the mouthwash that they have been using, and if their symptoms are severe, and they often are, I prescribe a de-sensitising mouthwash! One that contains no acid, and delivers a high dose of fluoride.

So I guess the rule of thumb might be – if you use a commercial mouthwash and your teeth become sensitive, stop using it. If your teeth do not become sensitive, be warned, you need to see a hygienist, and spend more time brushing!

DD-P

At that time I had a new-patient consultation booked. The patient  was girl of eleven who was pleasant, pretty, bright, and socially ahead of her years. She came with her mother, who had brought her because the girl had been complaining of soreness of the gums in her upper jaw. In my Practice, it is normal for a new patient to be seen by Samantha,one of my nurses, who does the initial paperwork and logs the patient onto our computer system. She also does an excellent job of assessing patients and getting a grasp on their problems, and gives me a short briefing before I see the patient for the first time. She told me that the girl was seriously frightened of dentists and dentistry, and was close to tears at being there, and explained about her sore gums.

I called the girl and her mother into my room, invited her into the dental chair, and started the consultation. First, I asked her what she was frightened of – had she had a previous bad experience? No, her fear stemmed from the fact that she thought that seeing a dentist might well result in her having to have a filling, which she really did not want. I asked her if she knew why fillings were done, and she did. I asked if she knew what caused teeth to decay, and again she had a fair idea. I agreed with her that having to have fillings was a bad thing, and explained how we, as a Practice, helped people to avoid the need for fillings, and the importance of her having a good dental hygienist to help her. I explained that it was how often we eat sugar that matters,rather than how much is eaten, and that frequent sugar intake makes the mouth acid and leads to tooth decay. I explained that the plaque that makes the acid takes time to grow and that, by keeping it on the move and cleaning it off tooth surfaces before it had developed any mass, would help to prevent decay.

Next I talked to her about the complaint that had brought her to see me, her sore gums. A careful history revealed that the problem was probably tooth sensitivity, and I asked her if she used a mouthwash, which she did, and I explained why that can be a bad idea. By now she was relaxed and I asked if I could take look at her mouth and teeth, and she was happy to do that.

Examination revealed that she had a set of perfect teeth, free of obvious decay, and spotlessly clean. So my prescription for her treatment was that she should meet my hygienist, and demonstrate how she cleaned her mouth, and allow the hygienist to suggest any areas where she might improve. That she should stop using any commercial mouthwashes (I will explain why in my next post), and only use mouthwashes prescribed by the Practice for decay prevention and relief of sensitivity. That she should, with the hygienist’s instruction, floss every day, without fail, and that we would take some small radiographs to confirm that she had no decay hidden between her teeth.

After half an hour, most of it spent in talk, she left – and here’s the thing; on her way out she told Sharon that she liked dentistry, loved the Practice and was looking forward to coming back!

Now consider another scenario.

She arrives at the practice, and sits for a long time in a waiting room because the dentist is running late -her nerves get worse. She is taken in to see the dentist, who is rushed – he is already late and patients are being kept waiting, so he is as stressed as his young patient. He had five minutes scheduled for this appointment, but that time went half-an-hour ago, so now he wants her to sit in the chair, open her mouth and let him look. She is becoming increasingly frightened and is not keen to cooperate. He has no time to talk to her and can see nothing apparently wrong with her “sore gums”. You can see where this is going.

Does she leave happy and reassured, or with her prejudices against dentistry confirmed and more scared than before? And is this her first step on the road that young woman with the dental abscess ended up on?

Please do not think that the second scenario I painted above is exceptional or unrealistic. I lived that life for too many years. When the fee for seeing a patient is so low that you can hardly afford five minutes for the job, there is no other way this can go. Yes, a dentist can do better even under those circumstances, but the stress it creates is unsustainable. Think for a second, on how you would like it; how you would cope; and what you would do about it.

Think seriously about how you want to be treated, and the circumstances  that would lead to the kind of treatment that you really want.

Because in dentistry, as in all things, you cannot have something for nothing.

In the meantime, a simple post in response to news that a young woman has died as a result of a dental abscess, because she was too afraid of dentistry to attend for treatment. I did not see this in the papers, but the lunchtime phone-in shows were full of it a day or so ago.

Much surprise was expressed that such a thing is possible. In fact, any untreated infection can lead to death by septicaemia, commonly called blood poisoning, or by complete organ failure,which is due to cell breakdown as a result of the effects of the toxins released by bacteria.

Nor is it a new problem. Apparently, a Swedish king was exhumed and found to have died from similar causes due to multiple dental abscesses. He got them through tooth decay caused by eating too much sugar, simply because he was rich enough to afford it.

But the really sad thing about this case is that the woman died from a problem that could have been simply and painlessly resolved at any time. She died because she was terrified of dentistry.

Now, I do not believe that humans are born with a fear of the dentist. Certainly the mother who tries to reassure (!!) her child with “It won’t hurt”, which introduces the fear of pain to the child who was otherwise quite relaxed about his or her examination at the hands of the dentist, and the frightening jokes by relatives and friends before a child’s first dental treatment, all tend to instill fear where it need not be. But most serious, phobic fear of dentistry usually comes from a bad experience.

Of course, I understand that, outside the profession, it is easy to believe and to assume that the dentist who causes that trauma is an unthinking, careless, cruel bastard, and not to understand that the bastard might in fact be a normal, kindly, and well-meaning individual, loved by his or her family and friends, but stressed to a point beyond coping.

Whatever, as a patient, the trauma comes from the feeling of utter helplessness that the dental patient feels. He may not be tied down, but he is afraid to move, being sure that such a course of action would result in him hurting himself worse, on the very device that is hurting him already! And he is probably right about that! He might accept some discomfort, or even pain if he understood a need for it, but his terror is increased by a total lack of understanding of what is happening to him and why.

And that, ladies and gentlemen, is what this blog is all about. I want to get some understanding of the nitty gritty of dentistry out there, to remove the fear of the unknown and allow the frightened patient to take some control over what is happening to him in dentistry – to understand enough to guide his own ongoing treatment into the paths of prevention of problems and disease, to the sunny uplands of a clean, healthy, comfortable, and attractive mouth, maintained for him and by him by a team of people who are accepted as friends and advisers.

Its perfectly possible for you – we do it all the time – and its much more fun than dental abscesses, even when they don’t kill you.

DD-P

In reality it is possible with care to deliver a painless injection, but not necessarily every single time – there is a small element of luck in it, too. But when you consider the discomfort of a twinge during the injection process compared to what you would feel if there were no local anaesthetics, it can be difficult to see where the problem really is.

If you develop a reputation for trying not to hurt people, then you will naturally find that the delicate and the phobic seek you out, and you will have the opportunity to deal with such people and try to find a solution for them to deal with their fears. Phobia, by its nature, is an irrational level of fear compared to the reality, and many phobics are fully aware that their fear is irrational, but that does not help them to be rid of it.

Everyone is different, and I do not use a single method to help needle phobics. Ultimately, nothing can really be achieved until the patient trusts me to place an injection, to demonstrate that the process is one that they can cope with themselves. Now, this Blog was set up, as I said right at the beginning, to reduce the feeling of fear associated with dental treatment by explaining the processes and the reasons behind them, in order to reduce the unknown element, to allow an understanding of what happens and why, so that the patient can be part of the process and feel, and be, more in control of what is happening.

An awful lot of people fear dental injections, usually because they have, in the past, experienced the pain that comes from a badly or unkindly administered injection. I remember a demonstrator at King’s College Hospital, where I trained, who would give injections with  a callous and total disregard for the patient. He injected into potentially painful sites at a speed that made you think that the cartridge would burst. The patient’s reactions would have brought tears of joy to a sadist’s eyes. It is only fair to say that he was an exception. But how many new needle phobics did that guy create single-handedly? And why?? It is just as easy, and much less stressful all round, to inject with a minimum of discomfort for the patient.

Incidentally, just a little aside here, but studies done in America have shown that dentist’s blood pressure rises higher than their patient’s blood pressure during the injection process!

So, let’s look at dental injections – we know why they are done, but let’s look  at the how, and with what, and get some background knowledge. Let’s shine a light on something frightening, and start to see it for the very real blessing that it is for us.

As always, click here to go to a page about dental injections.

DD-P Dental injections

It was about as simple as such work can be – the patient did not need an anaesthetic, the cavity needed only to be cleaned and re-shaped a little, and then the filling material was placed and finished. Being a modern, state-of-the-art low-shrinkage composite material the placement involved several stages, and then some time was spent finishing the shaping and polishing of the material to give the final result.

As I say, fairly simple work for me, but the patient’s response surprised me. She was not complaining, and said that the process had been quite comfortable, but that she had not realised how much “palaver” there would be to achieve the result. So I thought about her response, and realised that to many people, more used to NHS ten-minute amalgam fillings , the modern materials must seem like a lot of fuss. I find that most patients tend to think that that everything in dentistry is the same – that an amalgam filling is as good as the material that I described above, just a nastier colour.

So I thought that a page about dental fillings might be a good idea. Click here to go to it.

DD-P dental fillings