My patient Linda is 54 years old. She ran the compliance department for a regional hospital system for eleven years. She is meticulous, methodical, and not prone to catastrophizing.
When Linda tells you something is bad, it's bad.
She came in for what she thought would be a routine cleaning about two years ago.
She sat down in the chair and I could tell immediately something was different. She looked tired in a way that went beyond a bad night's sleep. She had her hands clasped too tightly in her lap.
Before I could even say good morning, she said: "Just tell me the truth, Dr. Carter. How bad is it?"
It was bad.
In eighteen months — eighteen months during which she had not missed a single cleaning, had brushed twice a day without fail, had been faithfully rinsing with the Biotene her previous dentist had recommended — she had developed four new cavities.
Her enamel had measurably thinned along her back molars. Her gum pockets had deepened on both sides of her lower jaw.
"I don't understand," she said. "I do everything right. I've always done everything right."
She had started perimenopause fourteen months earlier.
I knew that was the answer. But knowing the answer and having a real solution for her were two completely different things.
And as she sat there in my chair, blinking back something that looked like it might become tears, I realized that the professional advice I had been trained to give — drink more water, try Biotene, come back in three months — was not going to be enough.
It had never been enough.
"I wake up in the middle of the night with my mouth so dry I can taste it," she told me.
"I have water on the nightstand. I drink it. It helps for maybe a minute. Then it's back. By morning my mouth feels like something died in it. I've tried everything. My doctor said it's normal. My last dentist said try Biotene. I've been using Biotene for a year and I'm sitting here with four new cavities."
She paused.
"I'm so tired of being told to drink more water."
That night, I sat at my desk for three hours and didn't leave until I had asked myself the question I should have been asking twenty-two years ago:
Why does this keep getting worse — even when people do everything we tell them to do?
"I watched a patient who had done everything correctly for two decades watch her oral health collapse in eighteen months. She didn't have a hygiene problem. She had a biology problem. And nobody in dentistry had built anything for it."
— Dr. Michael Carter, DDS