Thursday, December 18, 2014

Latex allergies a reason to be Latex free

Natural latex rubber is a product that has been synthesized from the sap of a rubber tree. Rubber tree sap, or natural rubber latex, is a cloudy white liquid composed primarily of cis – 1,4polyisoprene, a benign organic polymer that confers most of the elasticity and strength of latex. It can be used to synthesize a variety of a products like pacifiers, erasers, make-up, diapers, medical and over the counter gloves, balloons, dental dams, first aid tape, bandages. The number of items that can be made with latex is extensive and because of that the number of people with latex sensitivities is on the rise as well.

Who suffers from latex allergy?

The major use and exposure to natural latex is from gloves used in medical and dental procedures. People at most risk of having and developing a latex allergy are those who have other allergies (such as hay fever) and those who use latex gloves in their regular occupations. This includes nurses, physicians, dentists, doctors and hygienists. Children with certain medical conditions (such as spina difida) that result in frequent exposure to natural latex are also commonly latex allergic.

What are the symptoms of a latex allergy?

A reaction commonly begins with a rash and can follow with symptoms like itchy swollen eyes, runny nose and sneezing. With more severe reactions a person may experience shortness of breathing, wheezing and tightness of the chest.

As with any type of allergy increased exposure can actually increase the allergic response so if your symptoms are mild it is still best to avoid contact.

Can a latex allergy be life threatening?

While the likelihood is rare it is possible to experience a serious reaction known as anaphylactic shock. It can happen within minutes to exposure and is characterized by hives, breathing difficulties and low blood pressure. If not treated with an adrenaline injection it can be fatal.

Treatment of Latex Allergies


More mild reactions often no treatment is necessary but as a precaution a dosage of Benadryl can be taken to minimize reactions.

For more severe reactions an injection of epinephrine (adrenalin) will be required. The most common form of self-administration is an EpiPen that administers a 0.3mg dosage within seconds.


At our office we keep two preloaded syringes in case of any anaphylactic reaction since after 15 minutes symptoms can resurface and may require a second dosage.

A commonly unknown fact is that there is a different dosage for children between 33 to 66 pounds. For this reason the same manufacturer as the EpiPen has created the EpiPen Jr.


For our office we have abstained from purchasing any natural latex products so that we can virtually eliminate the chance of any person with a history of latex allergy having a reaction while also eliminating the chance of someone having a new latex allergy reaction.

As more and more health professionals have inadvertent medical soliloquys from latex exposures hopefully it will become the norm that latex-free products will be provided for medical personnel and this very preventable reaction can be prevented in the healthcare industry.

Wednesday, November 26, 2014

Inadequate Dental Care for Preschoolers in Canada



An interesting article came out from the Canadian Institute of Health Research regarding preschoolers and inadequate dental care.  The study ran from September 2011 to January 2013 and found that less than 1% of children received adequate dental care as recommended by 12 months of age.

It’s a common misconception that baby teeth are not important to the development of permanent teeth but important to know that's entirely false. Infected baby teeth can cause malformation and discoloration of permanent teeth; not to mention significant pain for the child.

Oral hygiene when younger is incredibly important in creating the bacterial biofilm that adult teeth will be introduced to. Once you have a specific mix of cavity producing bacteria established in the oral environment it can be extremely challenging to change it over time.

The Canadian Dental Association recommends that a child come see the dentist at around age 1 but statistically the Journal of Pediatrics shows less than 2% of kids have seen a dentist by 24 months.

Are we going to do treatment on a 2 year old? No but we can notice if there are the start of cavities that are beginning to develop and where it can be important for parents to focus their brushing habits.

I have had 3 year olds that have been neglected, left to suck on baby bottles all night, that we have had to send for treatment at BC Children’s hospital for treatment under general anaesthesia to address cavities. Don’t think just because your child never complains of pain that everything is OK. It’s important to have a trained professional look and assess.

In situations where there is pain dental health complications can be significant:
  1. Difficulty eating
  2. Poor nutrition
  3. Poor growth
  4. Difficulty sleeping
  5. Behavioral difficulties
The most common surgical procedure performed in hospitals is extracting teeth in preschoolers. If these cavities can be caught earlier then these teeth could be saved.

It’s also important that pediatricians and family doctors provide counseling and do preliminary screening on all preschoolers to assess a childs risk of dental disease. If there are any potential problems spotted then a child can be sent to a dentist for an immediate evaluation.


Tuesday, November 11, 2014

50 Shades of Floss

More commonly known is that you should brush your teeth twice a day, less commonly known is that you really should be flossing a minimum once a day but ideally 2-3 times a day. I know… I know… who has time for that! It’s the same problem we all have when health gurus tell us we should exercise 4-5 times a week: it's hard to fit in all the things we need to do in the course of week much less a day. I don’t pretend that at this moment you’ll read this and take it as an affirmation to make a unilateral change to your morning and bedtime routine but I hope it will open your mind to the possibility that this simple act could reduce years of possible hardship and keep your teeth young and healthy for your entire life.


So where to start – lets have a multiple choice game (Yes I’m tricking you into getting interested in flossing by associating it with a game – you got me)

1. What percentage of your tooth surfaces are cleansed by brushing?
   (a) 60%
   (b) 70%
   (c) 80%
   (d) 90%
   (e) 97%

2. Flossing cleans how many surfaces of a tooth?
   (a) 1
   (b) 2
   (c) 3
   (d) 4
   (e) 5

3. Which type of floss is better?
   (a) Nylon
   (b) Teflon
   (c) Same

4. A person with wide spaces between their teeth should use:
   (a) Floss that look like a flat wide piece of tape
   (b) Thin floss that looks like a small string
   (c) A shoelace

5. How long of a piece of floss should you use?
   (a) 4-7 inches
   (b) 8-11 inches
   (c) 15-18 inches
   (d) 22-25 inches

The Answers:

1. (a) Brushing takes care of removing 60% of the plaque on your teeth. Flossing takes care of the other 40% and this plaque can't be removed by any amount of brushing or rinsing with mouthwash.

2. (b) A tooth has 5 surfaces – One top, two sides, one front and one back. If you don’t floss it’s like washing your car on the top front and back and just leaving the sides. Doesn’t seem to make sense to do that so that’s why we always stress flossing because it literally doesn’t make sense not to.

3. (c) Nylon and Teflon are two different products that will accomplish the same task.

4. (a) Large spaces are generally associated with recession and root exposure. The flat tape will work better to gently remove plaque on those areas without traumatizing the gums. If your teeth are close and tight then use a thin floss.  There is also Gore-Tex floss that will pass through the tightest of contacts.

5. (c) Using a piece of floss, 15-18 inches long, slide it between the teeth and wrap it around each individual tooth in a C-shape and gently polish in an up and down motion. If you haven’t flossed regularly don’t worry if your gums bleed, that’s normal. If it’s persistent after a few days it could be a sign of periodontal disease.


If you lack the manual dexterity to floss then try soft wooden plaque removers, which look similar to tooth picks, or a two-pronged plastic floss holder. Both allow you to floss with just one hand.

Tuesday, October 28, 2014

Can running ruin your teeth?


Pile on top the fact that running can be hard on your knees a new study shows runners may suffer from higher risks of tooth erosion and cavities. 

In the Scandinavian Journal of Medicine & Science in Sports a team of German dental researchers found higher rates of cavities and erosion in triathletes than non-athletes.  In addition researchers found the more a triathlete worked out the more likely they would get a cavity vs. an athlete not training as hard. 

Being in this profession for over a decade I can definitely say this is quite common problem for all types of athletes.  Combine the decreased salivation from working out (saliva has many antimicrobial properties) with the consumption of sugary, high energy drinks the resulting environment for cavity causing bugs is ideal.

A remedy for this condition? 
  • Stay hydrated
  • Drink water before, during and after workouts
  • If you’re a distance runner, consider increasing your salt intake which allows your body to retain water
  • If you choose to drink a sports drink like Gatorade try not to sip on it for your entire workout.  Drink the juice at one time to replenish your electrolytes without constantly exposing your teeth to the acid and sugar

Monday, October 20, 2014

Ebola transmission and how our dental office prevents the spread of all infectious diseases

The College of Dental Surgeons of BC recently released a Health advisory update regarding the Ebola virus and how it may influence dental treatment. What they have asked is for us to identify patients whom:
  • Have travelled to any West African country: Liberia, Guinea, Sierra Leone, Nigeria (Lagos), or the Democratic Republic of Congo AND
  • Are experiencing fever or other symptoms related to Ebola (e.g. headache, weakness, muscle pain, or hemorrhage)?
And if a patient answers yes to both questions then they should isolate themselves and phone their local emergency department.
As I was reading it two thoughts came into my head. The first being was that I’m sure if a person was hemorrhaging and had been to one of those countries I suspect they would call the hospital before booking a dental appointment.

The second was what is the exact mode of transmission. I already know everything we do for infection control but I think it is a mystery to some as to what’s involved in sterilization and infection control in a properly operating dental office.

First I'll go through the facts for Ebola and then I'll let you know our sterilization protocols.

When listening on the news you will always hear the journalist reference that a bodily fluid must be transferred for Ebola transmission. But HIV is another virus that requires bodily fluid transfer – is Ebola easier or more difficult to contract than the former?

You cannot get Ebola through air, water or food transfer, or casual contact. You can get it from:
  1. Touching the blood or body fluids of someone who has died or is sick with Ebola
  2. Touching contaminated objects like syringes
  3. Touching infected animals, or their blood, or eating their meat
So with regards to the first point, what is considered “touching”?

Ebola is transferred through direct contact of the eyes, nose, mouth, broken skin (a cut or abrasion) – the “fluid” would have to directly touch one of these areas.

What bodily “fluids” spread Ebola?

The virus can be contracted through an infected person’s saliva, mucous, vomit, feces, sweat, urine, breast milk or semen.

Can you get Ebola through a sneeze or a cough?

Yes. A person who is symptomatic would have to sneeze directly on the person and then the mucous or saliva would have to contact the eyes, nose, mouth or broken area of the skin for an individual to be at risk. Sneezing and coughing are obviously not indicative that you have Ebola but they are symptoms.

Can you get Ebola from kissing or intercourse?

Yes if the individual is symptomatic.

Can you get Ebola from shaking hands?

Yes if the persons hand is contaminated with fluids but this is a lower risk.

How long before you start showing symptoms?

The incubation period can be from 2 to 21 days from exposure with most individuals showing symptoms between 8-10 days.

What are the symptoms of Ebola (EVD)?

Ebola is a virus that can result in fevers of 101.6F/38.6C or above, headaches, joint and muscle aches, weakness diarrhea, vomiting, stomach pain, lack of appetite, abnormal bleeding and possible red eyes, hiccups, sore throat, chest and rash are all symptoms.

As you can see because of the ease that this disease is transmitted in contrast to HIV the reason why it has become a major concern world wide.

What precautions do we use to combat the transmission of every known pathogen in the world?

(i) Every patient has there own personal set of individually wrapped and sterilized instruments. This is not a requirement with respect to Canadian and US guidelines but if it was me this is what I would want which is why we’ve chosen to do this.

(ii) Every caregiver uses a new set of gloves and mask between patients. Even when moving out the room in between procedures the gloves are mandated by us to be removed and left in the room.

(iii) Instruments are washed in a machine called a Hydrim. Again this is not required by the Canadian or American Dental Association but we feel it’s much more effective than using the alternative: a cold sterilizing ultrasonic solution where multiple patients instruments are placed in a giant tub throughout the course of the day. The Hydrim washer will remove 99.9% of protein. You cannot sterilize if you can’t remove loose debris.

(iv) The instruments are then packaged and wrapped and sealed with sterilized indicator tape or packages and run through a sterilizer. If the sterilization process fails at any point the tape will not change color.

(v) We also conduct weekly spore tests as a double check the whole process is working correctly.

(vi) The rooms are wiped down with a bactericidal, sporicidal and tuberculocidal soak that will eliminate any residual bacteria, spores or viruses on any counter surfaces.

The last place you should get an infection from is the dental office which is why we incorporate all these important safeguards into treatment.

Wednesday, October 8, 2014

Lipstick Danger?


A 2013 study in the Environmental Health Perspective magazine conducted an experiment with 32 different lip products on women in Oakland, California and found that there were high levels of lead and 8 other heavy metals in women’s lip products. 

Lead was detected in 75% of these products over the acceptable daily intake (ADI) levels while greater than 20% of products had higher than acceptable levels of aluminum, cadmium, chromium (a suspected carcinogen) and manganese (associated with nervous system damage).

Researchers are questioning what happens as these metals are ingested over the long term. In the US, the FDA won’t release information on which brands have the most lead and still has no standard for lead percentages in lipstick. After conducting their own study in 2009 the FDA looked at 20 different lipsticks and found that all 20 contained trace amounts of lead.

Since there is no acceptably safe amount of lead for children and pregnant women this does pose a legitimate health concern.

What are the potential side effects of lead consumption:
  • Learning and language deficets
  • Behavioural problems associated with a lower IQ
  • Reduced school performance
  • Increased aggression
  • Impaired brain development following cross-placental transfer in pregnant women

The FDA found the average level of lead in lipstick was 1.07ppm – more than 10 times higher than its own standard for lead in candy – but disputes this as a health risk since candy is ingested.


But some metals are undoubtedly absorbed through the oral mucosa and some people do swallow lipstick, that's one reason it is so often reapplied. Currently the FDA believes this is not a risk to the general public but does concede that further testing is warranted.

It’s recommended that small children don’t play with lipstick and it should be treated as something dangerous because we’re potentially talking about a relatively large level of metal going into a small body.

There is no evidence that lead in lipstick causes cancer and it is banned in Canada as an ingredient that can be added to cosmetics but lead can still be found in trace quantities in these products. Health Canada is creating guidelines to set limits on these impurities.

Are there lipstick alternatives, a simple Google search will provide you with options but the jury is up in the air as to whether there is a certifiable risk associated with trace amounts in the vast majority of other lip products. Ultimately it will be up to you the consumer to decide whether you are willing to accept the risk.


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Friday, October 3, 2014

How do your teeth stack up versus a T. Rex

The following blog relates to a question posed by an inquisitive patient about teeth and dinosaurs. She was quite dumbfounded that I didn’t know the answer to how many teeth a Tyrannosaurus Rex had and as a dentist I felt it my obligation to remedy this situation to be prepared the next time I'm stumped by an 8 year old.


It’s incredible to me that the modern anatomic form of humans today date back only about 200,000 years. Despite what Jurassic Park may have you believe dinosaurs roamed the earth over 65-85 MILLION years ago. If you take a second to pause, as I did, and think about that number it’s absolutely amazing that we have fossils of these mammals to examine today.

Dinosaurs in general were giant mammals that had a host of pressing conerns in their lifetimes with the primary one being: to survive. The most famous dinosaur was the Tyrannosaurus Rex. The name is derived from Greek origin: Tyranno (tyrant) saurus (lizard) Rex (King) --- The tyrant king of lizards.

I visited the Field Museum in Chicago a couple of years ago and got to see an excavated T-Rex up close and being a dentist it made it all the more fascinating. In fact, Tryannosaurus Sue, as she is nicknamed in Chicago is the world’s most complete T. Rex skeleton with over 85% of the original skeleton.  It was discovered by fossil hunter Sue Hendrickson in South Dakota who in turn sold the fossil to the Field Museum for a reported $8 million dollars.


With a length span of close to 40 feet this king of the dinosaurs was a fierce predator that walked on two large powerful legs. Next to a school bus a T-Rex would be the same length and tower over it with a height of over 20 feet.

The average length of a T-Rex tooth was a bone crunching 9 inches while the average length of a human tooth is just over ¾ of an inch.  While a human tooth is more rectangular in shape, and has flat surfaces on the back molars, a T-Rex had 50-60 thick conical teeth that were meant for attacking prey and self defense.


An average human male or female adult has between 28-32 teeth present. For us teeth are meant to be chewing, grinding workhorses. Before we had blenders and conventional cooking practices, our ancient ancestors had to forage and eat what they could no matter the conditions.

Over time one can physically see how human teeth have become smaller and less robust especially looking at wisdom teeth. These teeth are anatomically smaller than other molars. Most scientists believe that as humans evolved we no longer needed these teeth to develop fully for survival.

A human jaw is appoximateg 3.5 inches in length, the length of an average T-Rex was closer to 4 feet in length. For reference, a T-rex could have ate 500 pounds (About 3 average humans) in a single bite!  While on average a human can bite down with a bite force of 175lbs a T. Rex could chomp down with an astonishing 5000lbs of pressure. Scientists have determined that a T. Rex's jaw muscles grew larger and stronger faster than any other part of its body. So as a T. Rex grew over a lifetime it became an even better predator.

When humans lose a tooth as a child we have teeth that end up replacing these lost baby teeth. On average a child has 20 such baby teeth that become replaced along with 8-12 additional teeth that form in the back. Once you have all these teeth you won’t have another one grow back. If you lose a tooth then we have to looking at placing implants, bridges or partial dentures to replace the missing tooth or teeth. The really cool thing about a T-Rex was once they lost a tooth a new one would form to replace the missing tooth. Considering that a T-rex was a carnivore and ate other animals for food this would have been a very useful adaptation.


Why did T. Rex’s have such small arms when their jaws were so big? The answer is that no one really knows. It may be that with such an evolved jaw they could get whatever they needed from just clamping down on their prey but think about eating from your plate without hands! Would be a messy proposition.

So these monsters of prehistoric history must have lived for hundreds of years because of their size and growth rate, right? Guess again. The average T. Rex lived approximately 30 years.  Since they were the top of the food chain we can only assume that attrition, disease or famine would have been the undoing of a Tyrannosaurus Rex. Researchers now know that females were larger than the males by a few thousand pounds but it’s unclear whether their life span was longer or shorter.

The land mass of North America is the largest repository for dinosaur bones in the world.  With the western portion the continent being the hotbed. While states like Dakota and Montana and the entire US continent also have the largest variety of dinosaurs in the world it’s actually Alberta, Canada that has the greatest number of species in one site. Canada’s dinosaur provincial park has over 40 species in one location.



People presume dinosaurs all lived around the same time period as one big happy family. In reality the T-Rex’s lived approximately 65-85 million years ago but dinosaurs themselves actually lived in a much larger window: 220 to 65 million years ago. For example; if you wanted to find a Stegasaurus fossil you would need to find a rock almost 150 million years old.



So how much are you going to get from the tooth fairy for a T. Rex tooth? A definite adult T. Rex tooth measuring at least 2 inches goes will net you approximately $2000 while a 2 inch juvenile T. Rex tooth will net more in the neighbourhood of $400. The average little boy or girl these days gets a mere $3.40 for a lost tooth.

Thanks for checking out the blog and hope you learned something interesting, see you back soon.

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Friday, September 19, 2014

6 things to look out for when searching for a new dentist


Location...

1) It can be useful that your dentist is close to your place of work, school or home for convenience.  But it’s more important that you find a dentist that you trust for your treatment. It’s easy to go places because of proximity but it’s more important to search for a dentist with a high standard of care.

Unfortunately; the best way to really know who is good it to look at dental work every day. Everytime I look at a filling, a crown or orthodontic treatment I’m trained to judge it by the highest standard. But how can someone with no dental experience judge how good their dentist is?

Things to look out for:


Experience

2) The more times one spends practicing his or her craft the more skilled he or she will be. Like anything it takes time to become proficient with your hand skills as a dentist but it's just as important to become proficient with your biggest asset, your brain. What works in each clinical situation is the key to a successful outcome.

Try to find out whether your clinician is involved in continuing education.  The dental field is continuously evolving and effective new therapies are developed all the time.

Up to date Equipment

3) Just like a automobile you can get around in a 1970 chevy to get from point A to B but a newer model will have the latest in technological advancements in safety, engineering and cleanliness. It was a natural evolution that as research continued to improve that dental equipment was going to vastly improve as well. The bacteria that cause cavities haven’t changed but our tools to treat the disease have improved tremendously.

Listening Skills

4) In the 80’s going to the dentist or medical office meant sit down, don’t talk and I’ll tell you what you need. That’s no longer an acceptable way to practice dentistry. The reason for the huge shift in focus is that what a patient tells you can be integral in what your selected course of treatment may be.

Dentistry for many years was reactionary, you have a problem so now we’ll fix it. A major change in thinking has now moved to dentistry towards a preventative model. How can things be addressed so you don’t have future gum problems, cavities, enamel wear or arthritic joint concerns.


Word of Mouth

5) What do people say? The best reference is often a first hand account. Approximately 90% of our patient’s find us because they were referred by a friend, colleague or web review.

Trust

6) It’s important to remember that you have choice in deciding who you will enlist to take care of your oral health. You have to feel comfortable with that person as you will be seeing them for potentially the next 10, 20 to 30 years.

It’s amazing the number of people that come in and tell me how they disliked their old dentist but it took them years to leave the office! Just remember you can make the final decision with respect who you want to build your health relationship with and once you find the right place you'll know.




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Tuesday, September 9, 2014

Musical Instruments and a Childs Brain Development

You may have heard that studying and playing music can be beneficial to brain development. But how many parents have tried to put their son or daughter in a music class only too see the early days of excitement wane after a few weeks after the homework and long practice sessions curb the initial enthusiasm.

An interesting study by Dr’s Erika Skoe and Nina Kraus posted in the Journal of Neuroscience shed new light on how music and brain development are linked.

“… results suggest that a limited period of music lessons (~3 years) during childhood fundamentally alters the nervous system such that neural changes persist in adulthood after auditory training has ceased (~7 years later).”

This means that even if your child stops playing an instrument the benefits from the initial experience can fundamentally change their brainstem activity into adulthood.

Most studies look at the exceptional music composers and how their brains are different to the general population but the conclusions from this paper were unique because it showed the how the benefits of music can apply to all children.


In another study from the Journal of Neuroscience from Jan 2013 by Dr's Steel, Bailey, Zatorre and Penhune researchers found that white matter changes in the brain before the age of 7 from playing music generated a scaffold that stayed with children throughout their lifetime.

The moral of the story - have your kids play musical instruments and start them early.  Even if they don't stay with it the benefits for future development are tremendous!





Friday, September 5, 2014

Oral Cancer - Part 2: Treatment and Dental Care

Because cancer treatment can affect the oral tissues it’s important to know about the various side effects and how these conditions can be managed. Often preexisting conditions can complicate treatment and will require an organized and systematic approach to therapy.

Oral complications from radiation to the neck and head areas can compromise quality of life and sometimes can be so debilitating that treatment is postponed, moderated at lower doses or even cancelled all together.

There are some things that can be accomplished prior to chemotherapy that will help to increase the success and comfort level of treatment but first it’s important to understand how chemotherapy and radiation work.

Chemotherapy works by stopping or slowing the growth of cancer cells which grow and divide quickly. But it also affects the other cells of the human body that divide quickly: blood producing cells, hair cells, cells of the mucous membranes of the mouth area and of the digestive system. These can have short term effects like hair loss, anemia, nausea, vomiting, diarrhea and infections in the mouth. The severity of chemotherapy will vary individual to individual and sometimes can be less severe. The most important thing to realize is that hair, mucous membranes, and blood production will all repair themselves after treatment. The adverse effects of chemotherapy can present themselves later on, particularly for younger people. Because sperm and eggs can be damaged from treatment it’s important to practice oral contraceptive use.


Radiation therapy will work in two ways
  • It will stop or slow the growth of a tumour
  • It will shrink the size of the tumour, reduce some symptoms and relieve pain.

Doctors want to provide the right amount of radiation while protecting the healthy cells around the area so the size of the beam and the strength is determined on a case by case basis.

Oral complications that are common to both chemotherapy and radiation:

  • Infection: These can include bacterial, fungal and viral infections resulting from xerostomia (dry mouth), myelosuppression and damage to the mucosa.
  • Xerostomia and salivary gland dysfunction: Dryness can effect chewing, speaking and swallowing. Saliva can cleansing and anti-microbial properties and if it’s effect is diminished the number of dental caries can increase rapidly for those succeptible.
  • Taste Alteration: The changes in taste can cause food to be anywhere from tasteless to unpleasant
  • Nutritional Compromise: Because of the difficulty eating food, loss of taste the quality of nutrition can become compromised
  • Oral mucositis: Inflammation, tissue sloughing and increased sensitivity
  • Abnormal dental development: If younger than the age of 9 then this becomes a major concern in jaw bone development and tooth development.
  • Radiation caries: cavities that result because of changes in either the quantity or quality of saliva
  • Trismus and tissue fibrosis: When the muscles of the masticatory system restrict the normal ability to open the mouth.
  • Osteonecrosis: Blood vessel compromise and necrosis of the bone

Proper planning and preventative measures will increase the likelihood that a patient will complete their treatment and decrease the severity of oral complications while minimizing pain.

The role of Pretreatment dental care:
  • Identify and treat existing infections, both periodontal and tooth related. Including a cleaning and treating tooth decay.
  • Remove teeth that have excessive bone loss associated with deep pockets around the gums to prevent future related bone necrosis from tooth removal at least 2 weeks prior to treatment.
  • Conduct a prosthodontic evaluation of any removable appliances and make sure they are well fitting to prevent “tissue burn” from the prosthesis rubbing aggressively. Ideally the prosthesis should not be worn at all.
  • Remove orthodontic bands and brackets
  • Supplemental fluoride using custom made trays and a daily 10 minute application of 1.1% neutral fluoride gel.
  • Obviously the cessation of alcohol and tobacco products will reduce the chance or current and future complications
  • Use an extrasoft toothbrush and avoid brushing aggressively
  • Avoid mouthwashes containing alcohol
  • Avoid candy and gum unless they are sugar free
  • The use of an appliance, like the therabite, will help to prevent the stiffening of jaw muscles
  • Avoid spicy foods
  • Sip water frequently
  • Suck ice chips or sugar-free candy
  • Use a saliva substitute rinse or spray if needed

Friday, August 22, 2014

Oral Cancer - Part 1

Sigmund Freud, Babe Ruth, Roger Ebert, Sammy Davis Jr. all impacted the world with their career defining legacies and will always be remembered for their contributions in their respective fields but they all share one common trait: they were all victims of oral cancer.

Within the US and Canada 1 person dies from oral cancer every hour of every day. Incidence rates are almost twice as high for men vs woman. According to the American Cancer Society incidence rates showed that death rates have been slightly decreasing over the past 3 decades but the number of HPV related oropharynx cancers is on the rise. Currently the WHO estimates that over 450,000 new cases of oral cancer are diagnosed every year. While historically the majority of people are over the age of 40 when diagnosed the number of young people diagnosed with oral cancer is on the rise.

Signs and Symptoms:
  • A sore in the throat or mouth area that does not heal and bleeds easily
  • A persistent red or white patch or a lump or thickening in the mouth, throat, ear, neck or coughing up blood
  • Difficulty chewing, swallowing, or moving the tongue or jaw often indicates a more advanced state

Risk Factors:
  • All forms of smoked or smokeless tobacco products
  • Alcohol
  • A strong correlation exists between the combined use of alcohol and tobacco and a higher susceptibility to oral cancer.  For individuals who smoke and drink heavily studies have shown more than a 30-fold increase in risk 
  • HPV infections are commonly associated with the tonsils or base of the tongue and are believed to be transmitted through sexual contact

Early Detection:
  • Cancer can affect any part of the oral cavity and dentists are often the first line of defense in detecting premalignant abnormalities 
  • Treatment will be less invasive if a cancer can be found in stages 1 or 2 of development
  • A yearly visual cancer screening is essential to catching this disease early
  • A biopsy is the gold standard for confirming a cancer diagnosis

Treatment:
  • This may involve surgery, chemotherapy or radiation individually or as a combined therapy
  • Cetuximab (Erbitux) is a epidermal growth factor receptor (EGFR) drug that has been used successfully in the treatment of head and neck squamous cell carcinomas
  • A multidisciplinary approach involving the efforts of surgeons, radiation oncologists, chemotherapy oncologists, dental practitioners, nutritionists, and rehabilitation and restorative speech specialists will have the highest success rate for therapy

Survival Rates:
  • For combined stages 1-4 approximately 84% of people diagnosed survive 1 year after diagnosis
  • The 5 year survival is 62%
  • The 10 year survival is 52%


In our next BLOG I’ll go over the dental professionals role in cancer treatment

Thursday, August 7, 2014

How to Utilize the Healing Properties of Tea Following a Tooth Extraction

Everyone has had a tooth taken out at one point or another.  Remember when your were a child and you kept wiggling that tooth like their was no tomorrow!  As you grow older it’s possible to lose a tooth for a variety of reasons:

Tooth Decay – Bacteria can metabolize sugar and cause cavities that become so large that a tooth can become sensitive.  If these cavities get into what’s called the nerve pulp tissue of the tooth this can result in a root canal.  If a tooth still cannot be saved following a root canal then the only option would be a tooth extraction.



Gum Disease – A tooth is surrounded by an imperceptibly thin ligament.  In turn this ligament has small projections that are uniquely called Sharpey fibres; these fibres are a connective tissue matrix that secures the tooth to the bone surrounding it.  Over time if the balance between these three structures is thrown into flux a tooth can suffer from recession.  If this recession becomes severe enough a tooth may need to be removed.




Wisdom teeth – The not so smart tooth, evolutionary theory suggests that these extra teeth are present because prehistoric humans needed to have more teeth for chewing all the raw uncooked foods they consumed. In modern times these “extra teeth” have become more of a nuisance than an essential component of the chewing system. Infections have the potential to cause serious problems as wisdom teeth develop. Shown here is a wisdom tooth that is actually resorbing the patients 2nd molar because of an impaction. If a pocket develops around the tooth a painful infection can result and there is a real danger of the infection spreading to other parts of the body.


Orthodontia - Space issues for orthodontic treatment may necessitate removal in order to create space to move teeth around or to sometimes expose an impacted tooth. This exposed tooth can then be gripped with a bracket to facilitate its movement back into a normal position.

Root fractures – While vertical fractures can be associated with tooth decay they are more commonly associated with root canaled teeth that have become weak.  They also can be the result of a bruxer who puts so much force on a tooth that a small crack propagates all the way through the tooth.  These situations can make a tooth quite sore and sensitive to eating and pressure.

Teabags
One of the complications that can result from having a tooth pulled out is excessive bleeding from the extraction site.  This is quite normal for some due to their body’s inability to form a blood clot quickly enough to stop the bleeding.  While this is not a life threatening condition it certainly can lead to increased post-operative pain.

One easy at home remedy available to control bleeding is to use teabags.  If after using moistened guaze pads for an hour, for 20 minute intervals, the bleeding doesn't stop then use this technique.  Place the moistened tea bag directly on the site for 20 minute intervals for up to an hour using slight pressure until the bleeding stops. 

So what is it about tea bags that allow it have this highly beneficial side effect? Tea contains an herbal ingredient known as tannins that are a bitter astringent plant phenol that can either shrink or bind to proteins. 

Have you ever had that dry feeling on your lips after drinking wine, a strong tea or eating an un-ripened fruit? That's actually caused by the astringency of tannins.

Tannins have also been linked to helping stop the spread of infections while providing a protective sheath for internal healing.  It is possible to use teabags for really any type of bleeding and/or infection.  Just make sure to moisten the tea bag before placing it on the wound to prevent it from inadvertently removing any portion of the healing tissue on the top of a wound.

So there you go, tea isn’t just a drink that you enjoy to bring some relaxation into your day, it’s also a great healing tool. So the next time you have an injury or a tooth taken out don’t forget to keep some teabags handy just in case!








Tuesday, July 22, 2014

When should I schedule my childs first trip to the dentist?

Kids run play, play, shout, learn, and fill our lives with joy.  We all love kids but sometimes any parent will tell you trying to remember everything is an uphill battle especially when it’s a toddler bounding around the house. 

The feeling you get when seeing their adorable smile is precious and it’s really important that we keep that smile healthy for years to come.  So how do we make sure those pearly whites stay in tip top shape!

                                                     



1)  As soon as teeth start coming in it’s important to start brushing them. Pharmacies and supermarkets will have non-fluoridated toothpaste. You can use your finger or an extra soft toothbrush to brush the teeth. The reason for the non-fluoridated toothpaste is that toddlers like to suck on anything in their mouths and we don't want them to swallow the toothpaste. When they get older they’ll be able to spit out and rinse just like grown ups. For kids under 2 use a small “smear” of toothpaste. Between the ages of 2-5 you can use a peasized amount. Usually an adult will need to help the child up until the age of 5 with brushing and flossing.

2) Make sure to plan an appointment with a dentist. The first visit is always an introductory visit and usually a ride in the chair and playing with Mr. Thirsty – our suction tip. After seeing literally thousands of kids I can’t tell you how important it is for kids to be exposed to a dental office at an early age so they begin to feel comfortable and alleviate any fears they might have as they get older. Their first visit will be as much fun as going to the amusement park or visiting their aunt since it’s a new experience for them. Remember they will look to you to see how they should feel, so don’t let any inhibitions you may have show and they will love coming to the dentist.

3) Make sure the child gets a toy from office – kids seem to like toys.


When should I take my child to the dentist?  The first visit should be within the first 6 months of teeth coming in or between 12-18 months. 

Why so early?  Because I’ve seen kids as early as 2 years old have multiple cavities in their teeth, as soon as they come in they are susceptible to the bacteria that cause tooth decay.

What things will be looked at in the first visit?  We’ll look at the gums, the bite and check for cavities.  If the child is doing well in their appointment we may polish the teeth and apply a topical fluoride to reduce their risk of future cavities.


Why are baby teeth important?  They help kids speak clearly and chew naturally.  They are also placeholders for when permanent teeth come in.

So what do we get when we do everything right?  A happy child who seems to grow faster and faster every day...






Tuesday, July 15, 2014

Essential relaxation with essential oils and a sprinkle of Paris




Chaque fois que je sens l'odeur de pain au levain mon esprit clignote revenir à cette boulangerie à Paris whie je waitied pour lui ...

It was the summer of 2013, the cars whistled by in the 7th arrondissement of Paris, the Eiffel tower dominated the skyline like an old friend whose roots seemed to extend well below the city.

  I sat in this little pastry shop immune to the hustle and bustle all around me, loosely wrapped in my summer dress I had forgotten all my responsibilities at home as I spiritedly embraced the summer warmth that beamed all around me.

Every time I go to a bakery and I get that sudden smell of fresh baked baguettes my senses flood back to me and I can still remember sitting in that shop with my espresso, baguette and the slight breeze careening around me while I waited for him…

It’s incredible how the mind works and how it can be so profoundly influenced by smell and how that can affect the body.  Some smells serve to ignite small parts of the brain’s memory and other fragrances work subconsciously to heal and that’s truly why I enjoy using essential oils.

If you ever visited my home you would be privy to a variety of Saje essential oils. When deciding how to introduce healing scents into our office I knew they had to serve a purpose and be of benefit to our patients, if even at just that subconscious level.

Currently you’ll find a specially selected oil helping you relax when you enter, Liquid Sunshine, hinted with citrus fruits of grapefruit, orange, lime, mandarin and a highlight of bergamot.


Grapefruit – Genus: Citrus paradisi, associated with reducing stress and anxiety and a topical antiseptic
Orange - Alleviates anxiety, anger, depression and certain bodily inflammations
Lime - Antidepressant and antiarthritic
Mandarin – Along with being a common sedative, it’s action is also prominently associated with reducing stress and anxiety
Bergamot - The therapeutic properties of bergamot oil include properties as an analgesic, antidepressant, antiseptic, antibiotic and anti-spasmodic


I think it’s easy to see why we would choose this oil for the office, we’re all keenly aware that for some stress and anxiety can be associated with a dental office and we wanted to make sure that this was a place where people could relax while benefitting from treatment at the same time.

Dimple Goldsmith R.D.H, C.D.A.O.


Tuesday, July 1, 2014

An Alternative to Veneers

One of the most decidedly rewarding procedures we do at our dental clinic is the reconstruction of front teeth.  In an ideal world we have many patients that would love to have porcelain veneers.  Veneers can fix discolored teeth, close gaps, change shapes of teeth and improve the overall happiness someone has with their smile.  Studies have proven that smiles are one of the most important factors in making a great first impression.

Unfortunately; for many the cost can be prohibitive and we never get a chance to help those people who could really benefit from treatment.

One solution we have is to utilize a new technique in order to provide a great outcome for patients while still providing excellent dental care.  At less than half the cost of veneers, coverage through most major dental plans, this is finally a viable alternative.  Let’s go though a recent case study.


This patient in her early 40’s and never liked how her front teeth were crowded and shortened.  She knew that she wanted to do something with them but veneers were never really an option.


Step 1. The first step to correcting the smile was to get the teeth in the right position.  In order to do that we used the Invisalign system for 12 months.  As you can see below, even after this simple step there was a marked improvement.


Step 2. For the second part of the treatment I had my laboratory, Bon Dental Lab, create a wax up of the teeth. 


This was invaluable so we could create natural tooth profiles in a controlled environment outside the mouth.  Ben and his team are very talented and are adept at the process required to design a smile.  Whenever completing cases like this it’s important the starting point is centered and leveled which is why we use something a dental articulator to center the teeth.

Step 3. After the patient completed tooth whitening we began the systematic approach of repairing all of her front teeth.  Paramount to this approach is to make sure each tooth is made to be 100% ideal in shape and size before moving to the next one.


Below is the final result the day of the procedure.  Because of the minimal tooth reduction required for this technique, once the anesthetic came out, the patient indicated she had no sensitivity and a relaxing experience.


For my staff and myself we see every day the yin and yang for patients when making decisions related to cosmetic dentistry.  A lot of the time we find it helpful to show people photos of others that have travelled the same road before so they can see the possibilities and realize that great smile is not as out of reach as they may of thought…