Wednesday, November 4, 2015

Axe dental visit anxiety

There are a variety of things that cause anxiety in life and here is our top 10
  1. When your phone is at 1% and you can’t find a charger anywhere in sight. Darn it should of bought that car charger...
  2. When you’re in a circle and everyone is saying something about themselves and you're last trying to listen to what every one else is saying while trying to think of something cool yourself and can’t figure out what to say that would really make you sound cool
  3. Trying to find a new job. Resumes, phone interviews, real interviews, waiting for voicemails… need I say more
  4. Public restrooms, for those times you wish you could just be sitting in the comfort of your own throne
  5. Walking out of a building at the same time as someone else and you're both headed in the same direction; unsure as to whether you should walk at the same pace, directly behind the person or slightly in front or walk across to the other side of the street. Behold the awkwardness
  6. To emoji or not not to emoji. How friendly do I want to make this text, what message am I sending, is this too casual for a business message … lol :)
  7. Not knowing what someone is talking about but feeling like you need to pretend you’ve been listening the entire time because you just gone too far in the conversation and it would be rude to divulge your complete lack of interest
  8. Thinking you lost your wallet. I have to get a new drivers license, call my credit card company, get new debit cards! Where’s my wallet… oops there it is
  9. Seeing someone in a public place who you really don’t want to talk to but you’re not totally sure that they haven’t seen you and you’re not sure if you can escape without being noticed
  10. Sitting on the couch thinking about all the things you need to do but really you don’t want to get up to do any of them… but really you should…. but it’s so comfortable here
Guess what we left off this top 10 list, a visit to the dentist! Yes a visit can now be more comfortable then ever with a painless computer controlled anaesthetic delivery system, a super special topical anaesthetic, a non clinical environment and for those people who are really anxious oral sedation to calm the nerves.

After doing hundreds of successful sedation cases we continue to hear the same things over and over again. Why didn’t I do this sooner? I love the fact I don’t have to remember everything. Can't I do this for all my appointments?

Really a visit shouldn’t have to be a stressful experience and working together with your dentist to come up with an effective plan to manage anxiety is the most helpful bit of advice I can give. As far as figuring out what to do when you walk out of the elevator the same time as someone else, you’re on your own.

Thursday, September 10, 2015

Medications and Dosages for Mouth or Toothache Pain

Many people when they first have a toothache go to the medication cabinet and will usually decide between Tylenol (Acetominophen) or Advil (Ibuprofen).  Most believe they are interchangeable but because of their different modes of action, the truth is somewhere in between. These medications are both effective but your particular ailment is what will determine which will work better for your ache or pain.

The exact mechanism of how Acetominophen actually works is still a bit of a mystery. It is believed that Acetaminophen is a prostaglandin/COX inhibitor that results in a by-product that reduces fever and activates special serotonin pathways to produce a general feeling of analgesia.

While Acetaminophen shares the fever reducing and analgesic properties of other COX inhibitors such as Aspirin and non-steroidal anti-inflammatory drugs (NSAIDs), the one thing it does not exhibit is a significant anti-inflammatory property.

This is where Ibuprofen comes in. Ibuprofen is NSAID that is used to relieve pain, reduce fever and also reduce inflammation. Like Acetaminophen it is also a COX inhibitor that reduces the amount of prostaglandins but it’s mode of action is different.

Prior to 2013 it was suggested that Ibuprofen was the drug of choice with respect to tooth pain. While this is true with respect to mild and mild to moderate tooth pain recent studies have shown the moderate to severe and severe pain are much more effectively treated with the combinatorial therapy of Acetominophen and Ibuprofen together. The chart below depicts a definitive protocol for the administration of these two pain medications to treat toothache pain and/or oral discomfort.
This is our recommendation at our clinic and I have found it is successful in 99.9% of cases. One alternative therapy is Oxycodone but because of the addictive attributes of this opioid it is reserved for severe cases. Ultimately the pain must heal or be treated to address the source of the pain to avoid the need for continuous pain management.

It is important to state that Acetominophen is toxic to the liver at high dosages and Ibuprofen can cause GI bleeds in high dosages which is why one should not exceed the recommended daily maximums and consult with your healthcare professional for specific recommendations.  Also it's important to remember that Advil and Tylenol are just trade names and generic medications can be substituted in their stead.

Wednesday, August 5, 2015

The Story Behind Orthodontic Retainers

Why are retainers required after orthodontic treatment?

One important component to having your orthodontic treatment completed successfully for years to come is wearing your retainers. Your teeth following treatment have been pushed and guided to a new normal position following tooth movement. The entire process is an equilibrium between bone resorption and bone apposition and because of the fluidity of this process teeth are exceptionally prone to relapsing into their prior positions unless they are stabilised right away.

How long should someone wear retainers?

The first weeks following having your braces or Invisalign removed are critical in preventing tooth relapse. At the very minimum it’s recommended that you wear retainers full time for 6 months and then they can be worn at night for a minimum of 2 years. Sometimes we will bond a lower lingual bar retainer in behind the lower front teeth. With these you sometimes will not need to worry about using a lower removable retainer but we also recommend that they stay in place for a minimum of 5 years. If there is considerable risk of the back teeth moving we will also make a removable retainer to go over top on the lingual bar.

What do our retainers look like?

As mentioned above sometimes we will bond a small lingual wire in behind the teeth, this is called a fixed retainer.

Most other times we will use removable retainers. These are clear plastic trays that fit directly over your teeth. The advantage of these retainers is that they are easy to take in and out and allow you to floss normally. The disadvantage is that they can be easily misplaced and forgotten to be worn. The selection of retainers is individually based on clinical experience and projected patient compliance. 

How do I store and/or clean my retainers?

For removable retainers what we do is make you a set of 4 retainers that are worn for 6 months each. When not wearing the retainers it’s best to place them in the storage box that we provide so they don’t get lost, i.e. the dog eats them! The retainers can be cleansed using your toothbrush, toothpaste is not recommended.

For the lingual bar retainer we will provide you with a floss threader that you can use to actually get underneath the wire to floss between your teeth. Even so this wire is often a food trap so it’s quite common to get a little more build up in this area that needs to be removed professionally during your hygiene appointment.

How long does it take to take to get used to retainers?

For bonded retainers it only takes a day or two to get used to. For removable retainers they are very similar to Invisalign aligners so it will take no time at all to get used to them. If you had traditional wire braces then it can take a couple of days to get used to the extra saliva that Invisalign retainers cause. This excess saliva usually subsides after the 2-day period and the subsequent minor slurring of speech also subsides.

Can I ever stop using retainers?

Bone has the capacity to change anytime over your lifetime. That’s why if you break a bone it can heal over time.

Even up to the age of 50 your face matures and can cause crowding of lower teeth regardless if you have had your wisdom teeth removed, extractions of teeth or previous orthodontic treatment for crowded teeth. For this reason it is suggested that you wear retainers indefinitely following orthodontic treatment.

If you want your teeth to stay in perfect alignment as an adult you’ll need to wear retainers for the rest of your life. It may seem like it’s asking a lot but really it’s a simple way to make sure your smile lasts a lifetime!

Wednesday, June 10, 2015

Dental Tooth Erosion

Dental Erosion: The chemical dissolution of tooth structure by acidic forces without the aid of microorganisms. A fancy way of saying your teeth get soft, thin and weak if the acidic levels in your mouth become too high.  The picture below is from a recent 19 year old patient who plays sports and drinks Gatorade constantly; as you can see there is a white powder look to the teeth and many pitted yellow areas.  These pitted areas are actually areas where the enamel is completely gone and has exposed the soft inner portion of the tooth.  Unfortunately situations like this are all too common and can be prevented if caught early.

There are two main types of erosion:
  • Intrinsic – This is erosion caused by acid from the human body. Including acid reflux, anorexia or bulimia. The acid produced by the stomach is designed to break down food so it is generally 10-15X more acidic than a can of Coke
  • Extrinsic – Erosion caused by environmental factors like fruit drinks, lemons, carbonated drinks, sports drinks

The chart below is a chart of common drinks and their associated pH values. 
 Tooth structure will begin to erode at any pH below 5.5 and remember because pH is
measured on a logarithmic scale a drop of just 1 unit is actually equivalent to 10X more acid!

A recent study looked at a comparative breakdown of not just the acidity of a soft drink but also the acid content known as titratable acidity (TA). Taking it to the next level this study showed that even though a particular drink may have not have a lower pH level than another it could result in a significant amount of more tooth erosion. The higher the TA value the longer it will take the healthy bacteria in your mouth to go back to a neutral pH.  Had a red bull lately?

It’s likely that the high concentration of glucose and sucralose in Red Bull is responsible for the high levels of enamel dissolution found in this study.

Here are a few tips to follow to follow to decrease/manage dental erosion:
  • Wait at least a half hour before brushing your teeth after eating or drinking acidic things. Reason being that the acidity actually does temporarily soften your teeth and the abrasives in toothpaste can remove a small amount of enamel if you don't allow time for your saliva to remineralize the teeth.
  • Rinse with water after contact with acidic drinks or food
  • Drink through a straw 
  • Use fluoridated toothpaste/mouthrinses at home. Therabreath is an excellent mouthrinse because it actually has a basic pH where as most are acidic
  • Get a professionally applied fluoride varnish on the teeth

Wednesday, May 13, 2015

When to Remove Your Wisdom Teeth

It used to be the common belief that one had to have their wisdom teeth removed somewhere between the age of 18-22. Today that’s no longer the case as more and more evidence has shown the risk of complications should make practitioners take pause before arbitrarily removing wisdom teeth.

There are a few reasons that I may suggest removing wisdom teeth:
  • Gum disease leading to obvious signs of infection and pain associated with the tooth
  • If one wisdom tooth is removed and the opposing tooth is erupted it has the chance of hypereruption causing infections later down the road
  • The teeth are impacted and damaging the tooth they are impacted against and/or possibly pushing teeth together causing crowding. 
  • Cysts or tumours have developed around the wisdom tooth
  • There is extensive tooth decay
  • There is not enough room for the tooth or teeth to come in
Erupting wisdom teeth don’t always come in straight, they can grow at various angles and sometimes even horizontally either completely covered by the gums or partially covered. These impactions can sometimes undo the effects of braces, bridges, crowns, partial dentures and other types of dental work.

If a wisdom tooth partially emerges through the gums a passageway is created that harbours the bacteria that cause gum disease and oral infections.

For some people it’s possible to extract wisdom teeth using just local anaesthesia which numbs the teeth so no pain is felt during extraction but pressure will be felt. If the tooth is infected, close to a nerve or the patient is really nervous then an alternate possibility is to see an oral surgeon so the teeth can be extracted under IV sedation.

In rare circumstances it also becomes a possibility that you may need to have your wisdom teeth removed under general anaesthesia but this has become less and less prevalent over time.

Hopefully when you have your wisdom teeth out there are no complications but that really depends on your health and your potential risk factors. One of the most common complications that can arise from having your wisdom teeth taken out is dry socket which is caused by a blood clot not forming in the extraction site. This quite often can be extremely painful and while there is no defining characteristic that will automatically lead to a dry socket your risk can be increased by smoking, diabetes or a previous occurrence of dry socket.

It’s best to see your dentist on a regular basis so he can follow your care and best suggest the course of action regarding removing or keeping your wisdom teeth.

Saturday, March 21, 2015

Dental Waterline Asepsis

Potable water in the United States and Canada has a health standard of less than 500cfu (colony forming units)/ml to be considered safe for drinking. Believe it or not the water that is expelled from non-treated dental lines can be upwards of 1 MILLION cfu/ml!

Why is that dental units can have such a high incidence of bacteria that they would surpass the bacterial load in your toilet? The water lines in your house have large diameters of ½ inch to 1 inch. Dental water lines on the other hand have lumens that are measured in the millimeters. These small diameters are exceptionally great breeding grounds for all sorts of bacteria.

In 1995 the American Dental association put out a release encouraging the industry and researchers to improve water unit output to less than 200 cfu/ml. This is a similar standard in Dialyslate, one of the fluids used in dialysis.

Subsequent to this one of the major changes with newer dental offices units has been the introduction of a bottled water system. Prior to this dental offices received their water from city water lines and the only way to “sterilize” the water was to introduce an iodine filter into the line prior to it entering the dental unit.  The problem with this method is that it often has the undesirable side effect of making the water taste like diluted iodine…. mmmm…. not so great.

Some offices have no protocols in place to sterilize the water and up until recently their was no direct causal evidence that these extremely high bacterial loads posed a tangible health risk. But in 2012, a report in the Lancet, chronicled an 82 year old woman who passed away after developing Legionaires disease – a respiratory illness associated with exposure to L. pneumophilia. The inception of the disease was linked back to her dental office because she had only left her house twice in over a month and both times was to visit her dental office. The report drew worldwide attention and was picked by ABC news and other agencies. Despite immediate treatment with antibiotics the woman developed immediate and irreversible septic shock and died within two days.

This story should have been a shock to all dental offices and forced nationwide change in waterline maintenance. Unfortunately; change takes time and as a profession we are still waiting on mandated changes to infection control with respect to water treatment.

In an effort to be proactive at our clinic we have chosen to protect our patients the best way possible by introducing a daily and monthly waterline treatment developed by the German company Hu-Friedy.  Ultimately this was a win-win for us as we get to make sure our water is as pure as it can be and it tastes great too!

Thursday, March 5, 2015

Drinking Water and the Role of Fluoride and Fluorosis

What is Fluoride?

Fluoride is a natural occurring element in the earth’s crust that is found in soil, fresh water, sea water, plants, foods and many professional dental products. Fluoride is helpful in preventing tooth decay by recrystallizing demineralized tooth enamel.

What is Fluorosis?

Your permanent teeth start forming in your upper and lower jaws starting from the age of 2 to 3 years old. Outside of your wisdom teeth the rest of the crowns of your teeth (the white part that you can see) are done forming by the ages of 8 to 9.

If during this developmental time period you consume too much fluoride the extra fluoride can disrupt the formation of the enamel.  If someone has too much fluoride the changes can range some white spots that are barely noticeable to staining and pitting in more severe cases. Dental fluorosis occurs in children consume too much fluoride from any source.

Only children up to the age of 8-9 are succeptible to the effects of fluorosis. The duration, dosage and frequency with which the fluoride is ingested all play a role in fluorosis. 

Fluoride actually works BOTH while the teeth are developing and every day after the teeth have emerged from the gums. 

What are the common sources of fluoride?
  • Toothpaste if it’s swallowed by young children
  • Fluoridated drinking water
  • Beverages and food processed with fluoridated water
  • Dietary prescription supplements
  • Professional products (mouthrinses, gels, etc.)
Fluorosis is the reason we advise that adults supervise young children under the age of 6 while they brush so they don’t inadvertently swallow fluoride.

If the fluoride in the water is above 0.7mg/ml it is not recommended that fluoride drops or tablets be used.

What are the benefits of Flouride that is added to the drinking water?

Extensive research over the last 50 years by the World Health Organization shows that Fluoride is a low cost, effective way to decrease the rate of tooth decay in children up to 35% ultimately reducing the number of potentially missing teeth in adults. Adding too much can cause fluorosis but having the right amount can be of tremendous benefit.

Within British Columbia how much of the water is fluoridated?

Over 96% of the communities in BC, including the lower mainland, are NOT fluoridated.

The only communities that still DO fluoridate their water are:
  • Cranbrook
  • Fort St John
  • Prince George
  • Price Rupert
  • Sparwood
  • Terrace

So despite the Canadian Dental Association, Canadian Medical Association, Canadian Public Health Association, Canadian Pediatric Society and the World Health Organization all recommending fluoridating water, BC is overwhelmingly against this practice. Why?

Unfounded reports of birth defects, cancer and other syndomes have unfortunately skewed public opinion in much the same way that erroneous reports of vaccinations causing Downs syndrome or ethylmercury in Thimerosal have caused people to elect not to vaccinate their children with potentially life saving medicines.

The likelihood that communities will change back to fluoridation is slim because of anti-Fluoride groups that have been fanatical about it’s eradication from the water supply.  Unfortunately; fear can sometimes win over scientific truths.

Even though the bacterial flora in your mouth play a key role in determining susceptibility to cavities I would suggest at the minimum you have a Fluoride toothpaste, rather than an all natural variety, and of course maintain a low sugar diet as much as possible. Otherwise you might need to see the dentist more often than you like!

Sunday, February 1, 2015

The key to effective leadership in business

Understand the environment in which you operate

Don’t expect that you can walk into any situation and that your presence alone will be enough to solve issues within a business.  Whether it’s personnel, or the methods in which the business is run, it’s important to really know the people within the business.  I harken back to a key piece of advice a business professional once told me: understanding the human psyche is the most valuable part of business leadership.   How someone reacting or performing can almost always relate back to their past experiences.

Take this scenario:  You had a great day at work, you feel like everything is going your way and feel like everyone around should be feeling as good as you do.  On your way back from work you stop at the grocery store.  You’re in such a great mood and while you’re at the till you say hello to the cashier with a big smile and to your surprise you get a fake smile back with a very curt “Hey”.  As you patiently wait for your groceries to be rung through the cashier points out you forgot to write the scan number on one of your bulk items and with a hint of distaste reminds you that you need to pay more attention.   Now as you wait for her to finish, with your own hint of annoyance starting to build, the cashier forgets to take scan your points card so you politely remind her that you need it to be scanned.  For your trouble she shoots you the “are you serious” look before she scans and gives your card back without so much as a thank you or a smile. 

Now look back at this scenario, what are the first thoughts that may come back to your mind:
-       Why would someone hire this person to represent their business?
-       Should I talk to the manager to give my two cents?
-       I have no idea why this person would be in a people industry

But now suppose I told you the night before she had her mom go into the hospital and was dealing with a life threatening ailment. Would your opinion change? 

Dealing with stress, as tenuous as it can be, is a very trainable attribute.  Not everyone grows up or has been taught the same coping mechanisms and as the leader of any organization your ability to understand where your team members are psychologically can be invaluable to the continued success of your business.  The absolute worst thing you can do is to ignore the problem and wait until it goes away.  Every day and every moment can be a reflection of your business and with you being the leader it’s a reflection of your leadership ability: fairly or unfairly. 
Why do the best hotels in the world consistently have positive reviews.  It’s not because they have the softest pillows or the best locations.  It is because of training, communication, detailed job descriptions , accountability, performance reviews, standards of care and the constant ambition to excel.  These are not just buzz words, they are roadmaps to success.

If you have not read it an excellent book to pick up is "Mastery" by George Leonard.   Using his personal experiences learning the martial art Aikido, combined with Zen philosophy, the author shares his life changing lessons and how he used them to gain a high level of success and personal achievement in every aspect of his life. 

Constant growth will always be its own reward and will lead you on a path to lifelong happiness.

Thursday, January 1, 2015

The Truth About Dental X-rays: How much radiation are they really?

Digital X-rays are the new standard for dental imaging. As little as 10 years ago it was still relatively common for dentists to have dark rooms and develop X-rays in developing solution. Oh how times have changed, what used to take 10-15 minutes to process now takes a matter of seconds. This technique uses a digital sensor rather than an X-ray film and stores the digital image on a server hard drive.

The biggest advantage of these digital sensors is the fact that radiation exposure can be reduced from 70-90% of the already low dose of a dental X-ray.

There is a perception out there that the radiation you get from dental X-rays is “bad.”  I’m here to tell you that really isn’t the case and the information I can gleam from an X-ray is easily worth the scant amount of exposure it requires.

Let’s address the two most obvious questions people have:

(i)            “if the radiation is not bad then why the lead apron and
(ii)          why does the staff leave the room?”

The answers are why not and because we do it all day.

With an X-ray we use something called a collimator that focuses the X-rays, unlike medical X-rays that irradiate a large portion of the body, a collimator reduces radiation scatter dramatically.  To minimize exposure even more we use the lead apron to prevent exposure to the thyroid and upper torso area because why expose areas we don’t need to.  That’s really the only reason we use a lead shield.

The staff leaves the room when taking X-rays because they do that procedure all day long for hundreds of days a year.  While one X-ray session is insignificant; subjecting someone to X-ray exposure thousands of times a year makes no sense. 

It’s hard to get a sense of “how much” radiation a X-ray really is without comparing it to something else.  Whenever we look at X-rays we measure them on a scale called millisieverts (mSv)

From a typical set of 4 bitewings (4 X-Rays) you can expect a 0.005mSv exposure.

Look below and you’ll see how minimal dental X-rays really are compared to other types of X-rays, CT scans and even regular background radiation from all of our daily lives:

Avg. natural background radiation per year – 3.10 (620X bitewings)
Avg. natural accumulated exposure per person – 6.2 (1240X bitewings)

YES: You would have to get 1,240 sets of 4 X-rays OR 4,920 individual exposures to be exposed to the same radiation you are exposed to being on earth every year!

Airline 7hr flight – 0.02 (4X bitewings)

Chest X-ray - 0.10 (20X bitewings)
Lower GI Tract X-ray– 4.060 (812X bitewings)
Pelvis X-rays – 0.600  (120X bitewings)

Brain CT – 2.0 (400X bitewings)
Abdomen CT – 8.0 (1600X bitewings)
Chest, Abdomen, Pelvis CT – 21.0 (4200X bitewings)
Coronary Angiogram – 7.0 (1400X bitewings)

Along with the minimal radiation exposure the true benefits of digital vs conventional X-rays are numerous.  We are able to change contrast, exposure and clarity to enhance dental images.  We can enlarge and measure X-rays to improve diagnoses and treatment planning. 

For example: Take a look at this photo, the patient was complaining of sensitivity but couldn’t see anything on his teeth that could be causing the problem.

Now look at what we can see on the X-ray: All those little black areas in the red circles are cavities that have eroded the enamel and are progressing towards the vascular nerve bundles inside the teeth.

Without having X-rays it would have been impossible to diagnose the patients issues correctly and it's the reason why we ask for regular maintenance films at periodic dental visits.  It's important that we diagnose and repair these type of cavities before you have to go through root canals, extractions and the pain that can result from prolonging appropriate care.