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.

Click the link Lighthouse Dental Centre and like us on Facebook!

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.

Click the link Lighthouse Dental Centre and like us on Facebook!