In the newspaper, the Reading Eagle, Dr. Reitz writes a weekly article titled "The Dentist's Chair".
Week of September 11, 2011
Dear Dr. Reitz
I recently turned 82 years old. I love to eat but the last few years it is getting more difficult to chew my wife's cooking. She said the meat is just as tender as always but my jaw gets tired before I am done with the meal. Eating steak is especially difficult. I have all my teeth and they don't hurt. I eat quite often, so my chewing muscles get plenty of exercise and they should be in excellent shape. Is my wife's cooking to blame?
Leon - from Temple
Dear Leon:
I am going to assume your wife has not changed her cooking methods at this point in her life, therefore the problem is most likely due to a change in your chewing ability. Since you are not experiencing pain, I think we can eliminate a toothache or temporomandibular joint pain from the mix of possible causes.
It's impossible to make an accurate diagnosis without a clinical exam, however it appears that your muscles of mastication are getting weaker.
We all know that exercise strengthens muscles, and it would seem logical that the skeletal muscles used for chewing are no exception. Unfortunately, even with exercise, many studies confirm that skeletal muscle mass decreases with advancing age in both men and women.
A recent study done in Japan and published February 2011 in the "Journal of Oral Rehabilitation" found chewing ability was related to handgrip strength and overall skeletal muscle mass. It appears that just as the aging process reduces skeletal muscle mass resulting in a weaker hand grip, it also reduces the muscles of mastication's ability to exert force during chewing.
The researchers found that as muscle mass diminished some patients could only chew food which was soft or pureed. Your perception of your wife's cooking getting worse may be just your decreased ability to chew slightly hard food.
Since aging has the effect of reducing skeletal muscle mass, there may not be a cure for your diminished chewing ability. If you provide this information to your wife she may be able to modify her cooking to accommodate your diminished chewing ability. This may eliminate harder foods from the menu, however there are lots of alternatives to a chewy steak and hard crust bread.
Before you blame your wife for making dinner a challenge, discuss your problem and maybe she is still young enough and willing to discover some new recipes.
Week of September 2, 2011
Dear Dr. Reitz:
I read the Federally Qualified Health Center proposed for downtown Reading was not approved by the federal government. Is there hope for a second chance for approval and is a dental clinic going to be included at such a center?
Bob - from Shillington
Dear Bob:
The Berks County Community Foundation spearheaded the effort to get a Federally Qualified Health Center (FQHC) in downtown Reading at the location currently occupied by the Reading Health Dispensary. That approval would have provided both federal and possibly some state funding for a health clinic that would primarily treat the underserved and uninsured using a sliding fee schedule adjusted based on ability to pay for individuals at 200% or below the federal poverty level.
Reading's application was one of 746 projects from all over the country seeking approval from the Health Resources and Services Administration (HRSA). The Berks County Community Foundation anticipated at least half of the proposed projects to be approved, instead HRSA only granted 67 clinics of which Reading was not included.
Nationally in 2009 there were 1,131 FQHC's and about 75% of those centers have a dental clinic. Currently Reading's proposal does not include a dental clinic, however I think including dental is an excellent idea.
A study by Drexel University School of Public Health stated that there are 35,152 residents of Reading who are on Medical Assistance and an additional 12,340 uninsured which comprise 60% of the city's population. Those statistics confirm that downtown Reading is a medically underserved area, but evidently that wasn't enough to get approved for finding as an FQHC.
Many dentists in Pennsylvania provide some free dental care for the underserved, but unfortunately it is not possible to solve this problem with charity on the part of our dentists. Operating a dental practice is expensive and there are very few dentists or staff members that are wealthy enough to work free for very long.
Poverty is a societal problem and its toll on individuals must be resolved with everyone's help. An FQHC is funded with federal dollars obtained from everyone's income taxes.
Hospital emergency rooms are crowded with uninsured people using them for their basic medical needs. Currently hospital emergency rooms are mandated to provide free service to patients without insurance, but in reality hospitals are charging higher fees to patients with insurance to cover the cost of the uninsured.
The Berks County Community Foundation has not given up on the idea of a medical FQHC in Reading and I believe the plan should include a dental component. The burden of providing basic dental services to the underserved and uninsured should not be solely on the shoulders of dentists but society as a whole.
Dear Dr. Reitz:
My husband and I were discussing the observation that we both prefer to use the right side of our mouth for chewing. We thought that our dominant chewing side would be the same as our dominant hand but my husband is right handed and I am left handed. We are both in our early forties and have all of our teeth. Does everyone have a favorite side in their mouth for chewing and, if so, why?
Mariana from Reading
Dear Mariana:
It is commonly believed that many people have a preferred side in their mouth for chewing. As you and your husband have noticed, chewing side preference has not been found to be related to an individual's dominant hand side.
It is believed that everyone is born with a genetic predisposition to be either right or left handed. A chewing side preference appears to be something some people subconsciously decide at some point later in their life.
The process of chewing is almost automatic requiring very little concentration on your part. So there must be a factor that influences a person's decision to pick a preferred side for chewing.
A study published in 2011 in the Journal of Oral Rehabilitation indicates the factor may be pain. Before I get to that, I need to explain how things work when chewing.
When food is placed in the mouth the tongue usually places it on either the left or right side for chewing. The right and left temporomandibular joints (TMJ) both guide and support the mandible when chewing. Studies have found that the TMJ on the opposite side from where the food is placed receives the majority of the stress. So when food is chewed on the right the TMJ on the left is under the most stress and vice versa.
The 2011 Journal of Oral Rehabilitation study found that, even in the absence of pain, 37% of the population has a problem with at least one of their temporomandibular joints. The problem is often just a disc that is slightly out of place. Additionally, they found people subconsciously chewed food on the same side as the problem joint, which is logical since the TMJ force is less on that side when chewing. This was especially true when they masticated hard food.
It is likely that both you and your husband have one TMJ side that is more stable than the other. Although you are not experiencing pain, it is likely more pleasant for your TMJ when you chew on the side with the weaker joint making that your favorite chewing side.
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