Most of life experience has pressed upon me the awareness that it is day to day habit that shapes a person’s life. How so? For close to thirty years, I have been working as a dentist for people struggling with psychiatric and addictions problems. The key link between these disorders and the health of the teeth is the fact that there can be long periods over which the motivation for daily brushing disappears.

Now cleaning our teeth is a routine task that most people take for granted; a single instance of brushing requires only a modest amount of willpower to execute.  But just think about why you do it. With due respect, my guess is that you, my reader aren’t motivated to clean your teeth to prevent pain or disease. You will probably feel no discomfort if you fail to clean your teeth… probably not for months.  Most of us learned to brush in order to please our parents or caregivers. After a while the habit became internalized.

Amidst the disruption of a major psychotic episode or a depressive illness, or an addiction, the delicate systems of internal rewards, routines, and self-care are interrupted for weeks or months on end. And whereas one may bathe or shave some time later with no residual effect, tooth decay or loss of supporting bone leave their permanent mark on the teeth. That is why the condition of the teeth, and the history of their treatment are like an archaeological record of ups and downs of a person’s life– recording periods of emotional disruption severe enough to suspend oral self-care for several weeks or months on end.

Once a person feels better, he usually wants to chew better, feel better, or look better.  If  one is attached to our hospital and on the road to recovery, he is sent to see me or one of my colleagues. You would think that the biggest challenge is to restore a devastated mouth to full esthetic function on a shoestring budget—but it isn’t. The greatest challenge is in fact to help the person find the motivation to begin and maintain the habit of daily brushing after the evening meal. (I never say before bed anymore because most people are too tired by then and can’t muster the willpower required.) Without the cleaning and the decision to abstain from the daily sipping of sugar in any form (tea, coffee, soft drinks), all restorative dentistry is completely futile. Over thirty years, there is no fact that has been branded itself into my professional psyche more deeply that that.

So perhaps you, my reader can understand why I attach so much weight to the importance of small daily decisions.  Daily choices, once rewarded and reinforced, have a way of becoming daily habits until they become ways of life that completely determine how we look, feel, and function.  Once ingrained, the best efforts of well intentioned care providers can do little to alter the course if the early decision was poorly made.  This is for me a rich theme to mine and it touches on my other areas of interest: relationships, spirituality, education, and counseling,–which I would like to explore in subsequent posts.