Category Archives: Dentistry

Smart & Safe Dental X-Rays

digital_radsAbout a year ago, researchers established a possible link between routine dental x-rays and cancer (intracranial meningioma in particular) – more reason why, as we mentioned, x-rays in our office are never “routine.”

Since then, there have been more studies – and ongoing debate about what the research means for dentists. The latest is a paper in the Annals of Oncology, which ultimately gives a more nuanced view. While the relation between brain tumors and x-ray frequency persists, a key difference was found.

According to the study authors, “multivariable unconditional logistic regression analysis showed that the risk of BBT [benign brain tumor] increases as the frequency of received dental diagnostic x-ray increases.” However, they found no significant association between malignant brain tumors and dental diagnostic x-ray exposure.

The study abstract is available here.

For a long time, ADA recommendations were just for a full mouth series of x-rays for first time patients, then bitewings at intervals ranging from every 6 months to every 3 years, depending on the patient’s age and risk of decay or gum disease. Late last year, however, they updated their guidelines, saying that

dental X-rays help dentists evaluate and diagnose oral diseases and conditions, but the ADA recommends that dentists weigh the benefits of taking dental X-rays against the possible risk of exposing patients to the radiation from X-rays, the effects of which can accumulate from multiple sources over time.

And we think that’s as it should be: patient health and safety first. It’s why our office practices mercury-free, mercury-safe dentistry. It’s why we insist on using only biocompatible materials. And it’s why we use digital imaging, which lowers radiation exposure by as much as 90% while offering superior quality, and only take them when needed for an accurate diagnosis.

For x-rays remain an important diagnostic tool, letting us see what the naked eye cannot – inside the tooth and gums – so problems can be identified (or ruled out) and a plan of action made to solve them efficiently and safely.

Image via Medgadget

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Like Mercury, BPA Deemed Warning-Worthy

There was good news from Geneva recently: 140 countries have now agreed to the global mercury treaty, several years in the making. Once ratified by 50 nations, it will become legally-binding. Its main goal is to reduce mercury emissions, and to that end, it includes steps toward a phase-out of dental amalgam.

Similarly good news came from Sacramento this week: the state Environmental Protection Agency, Cal/EPA, announced their intent to declare BPA a reproductive hazard. This means it would become subject to Prop. 65 requirements – the same rules that require dental offices to display warnings about the presence of mercury in amalgam.

prop65_warnPublic comments will be accepted for the usual 30 days before BPA can be officially added to the Prop. 65 list. (Want to submit your own? Details here.)

No, it’s not a ban, but it is a step in the right direction – just as the mercury treaty is a step in the right direction. Yes, the treaty could be stronger. Still, it’s the broadest acknowledgement yet of the hazards posed by “silver” fillings and does require some action.

Of course, many dentists, biological and conventional alike, have already stopped filling teeth with amalgam, opting for composite instead – the stuff used for sealants and “white” or “tooth-colored” fillings. Unfortunately, some brands of composite contain BPA. So now you sometimes hear mercury’s defenders say that since BPA is a toxin, too, what does it matter? Why not just keep placing amalgam?

Yes, BPA is a toxin – a known endocrine disruptor that’s been linked to conditions like cancer, heart disease, kidney disease, diabetes and erectile dysfunction. Its ability to alter reproductive hormones endangers fetuses and infants, and a leading cause of the recent spike in cases of early onset puberty, especially for girls.

But with respect to dental products, there’s a catch. In the words of my colleague Dr. Gary Verigin,

…while all amalgam fillings contain mercury, not all composites contain BPA

Indeed, we – and you – have options. The new generation nontoxic alternatives, as we mentioned before, are

strong and durable, less prone to fail and certainly more aesthetic. Placing composite is also a less invasive procedure than placing amalgam, letting you retain more natural tooth structure.

More natural structure means a stronger tooth, as well.

We also have the help of compatibility testing. Through blood serum, electrodermal screening and other methods, we can identify materials best suited for any particular patient – meaning, also, the healthiest.

Always, the health of the patient comes first.

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Filed under Biological Dentistry, Dentistry, Mercury

Sleep Apnea? Help May Be as Close as Your Dentist’s Office!

awake_not_awakeGetting a good night’s rest is often the difference between having a good day or a bad day. It’s also a key component of health. Yet there are many things that prevent healthy sleep, and over recent years, one of the most common physical factors that’s emerged is sleep apnea.

This sleep disorder is marked by abnormal pauses in breathing, which can last anywhere from several seconds to whole minutes. Sometimes it happens due to faulty signaling between the brain and muscles that control breathing – a fairly rare condition called central sleep apnea (CSA).

Much more common is obstructive sleep apnea (OSA), which occurs when the airway is partially blocked by either the soft tissues lining it or even the tongue falling back as one’s muscles relax. (The sound of snoring is made by the force of air against those obstructions as you try to keep breathing.) The recent increase in OSA rates is largely due to two factors: the obesity epidemic (more tissue that could block the airway) and an aging population (we lose muscle tone in our later years).

And yes, CSA and OSA can happen together – a condition called complex sleep apnea, although there appears to be some debate on the matter.

But so long as you start breathing again, what’s the big deal, right?

Quite a big deal, actually, and far beyond the exhaustion some people suffer without proper rest, which raises risk of automobile accidents and workplace injuries. Research has linked sleep apnea to a host of other health problems, including heart disease, diabetes and high blood pressure. A study published just last year in the Journal of Periodontal Research showed a relationship between OSA and gum disease. Another – published in the American Journal of Respiratory and Critical Care Medicine – found that those with severe sleep apnea are four times more likely to die of cancer than those without the condition.

Yet one of the challenges is that most who suffer from sleep apnea don’t know it until someone points it out – a family member, roommate, spouse, partner. Or they complain of chronic tiredness to a doctor who may consider sleep apnea as a cause if multiple risk factors are present. Or they suspect it may be a problem and take one of the many online tests available to get a better idea of their risk.

It used to be that use of a CPAP device was the only real option for dealing with sleep apnea – a machine that uses mild air pressure to help keep the airway open. (“CPAP” stands for “continuous positive airflow pressure.”) This is what Rosie O’Donnell used to deal with her condition, as she discussed on The View with sleep specialist Dr. Michael Breus. One look at the device and you can probably imagine why so many people who might benefit quit using it – or never start.

cpap

While CPAP may still be the best option for severe cases of apnea, there’s an ever-widening range of treatment options for those with mild to moderate conditions, including oral appliance therapy that a dentist can provide.

Like some of the splints provided for help with nighttime bruxing (clenching and grinding), dental devices for apnea often look like sports mouthpieces on a serious fitness kick. Yet they’re light and extremely comfortable, custom fit for each patient needing help with their sleep disordered breathing. Those we’ve treated in our office have expressed great relief once they’ve begun their therapy. Many are amazed at just how improved their sleep is – how much more rested they feel upon waking, how much more energetic through the day.

If you decide to give oral appliance therapy a try, it’s vital that you get one fitted by a qualified dentist. Yes, there are some over-the-counter devices now available to help with apnea and other sleep problems, but as a 2008 study published in the American Journal of Respiratory and Critical Care Medicine showed, they’re not especially effective and “cannot be recommended as a therapeutic option.”

Learn More

Waking image by Vluzinier, via Wikimedia Commons;
CPAP image courtesy of Barbara J. Greene (used with permission)

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More Twisted Gifts for the Dental Minded

When dental-themed gifts go wrong, they go wrong in a special kind of way.

Sometimes, it’s the concept. Would you really want a drill-wielding dentist full of wine?

dentist_wine
 

And flossing is hard enough for some folks. Are you really going to want to do it with a piece of floss pulled out of something’s mouth?

otto
 

Or drink through someone else’s teeth?

teethmug01
 

On the other hand, if you ever get the urge to open bottles with your mouth, using someone else’s teeth is a much better choice.

dent_opener
 

Those wanting something a little more upscale could go for some toothy fashions:

fashion
 

Or be both extravagant and practical by giving the full line of Margaret Josefin toothpastes from Japan, one flavor for every tooth, including such favorites as Tropical Pine, Curry, Pumpkin Pudding and Monkey Banana!

monkeybanana
 

But if you’re going to give someone a cavity or bad breath, you’re safest sticking with this kind:

plush_bugs
 

Last year’s catalog

Happy holidays from all of us
at Dr. Erwin’s office!

Regular posts will resume on Friday, January 4.

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What’s Bite Got to Do with It?

“Bruxism” is the dental term for the habitual, involuntary clenching and grinding of teeth, often during sleep. It’s also pretty common.

Physical and psychological stress are often the main culprits, but a variety of other factors have been suggested, too, including sleep disorders, SSRIs and other drugs, even parasitic infection. Many have thought bruxism can result when a person’s teeth don’t come together (occlude) properly – an attempt to self-correct the problem, even if it means wearing down the teeth for a more comfortable bite.

But according to a meta-analysis published earlier this year in the Journal of Oral Rehabilitation, the bite may actually have little to do with it. Having reviewed 46 relevant published papers, the authors say they found “no evidence whatsoever for a causal relationship between bruxism and the bite.”

Instead, there is a growing awareness of other factors (viz. psychosocial and behavioural ones) being important in the aetiology of bruxism.

What’s more, malocclusion (“bad bite”) may not even play a “mediating” role between the grinding and the damage it does.

Even though most dentists agree that bruxism may have several adverse effects on the masticatory system, for none of these purported adverse effects, evidence for a mediating role of occlusion and articulation has been found to date.

Of course, malocclusion and bruxing can and do occur together. It’s just that there may not be a causal relationship between them.

For the individual who grinds, though, that may make little difference. What they know is how it affects them – the headaches; the face, neck and shoulder pain; the damaged teeth; the receding gums and tooth sensitivity; and so on. Usually, it’s the pain that leads people to seek help.

One of the most common and conservative measures for bringing relief is splint therapy, in which a special appliance is used to cushion the forces of bruxing. Since most grinding occurs during sleep, they’re often called “night guards.” Unfortunately, the mass market ones you can buy in a store are often of little help to serious bruxers. They grind right through them pretty quickly. Their fit can often be poor, as well, causing problems such as discomfort, damaged gums or increased clenching.

A custom splint provided by your dentist will fit your mouth precisely and normally last much longer.

Here’s what one of our patients had to say after just his first week of using a specific type of night guard called an NTI device:

Previously

Learn about other causes of jaw, face, head and neck pain

 

Image by Dr Parveen Chopra, via Flickr

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7 Must-See Videos on Mercury “Silver” Amalgam Fillings

Again this year, Dr. Mercola and Charlie Brown of Consumers for Dental Choice have teamed up to promote Mercury-Free Dentistry Week – an event designed to raise awareness of the toxic burden of so-called “silver” amalgam fillings on patients, dental personnel and our planet. As part of the event, Mercola.com has been adding some great new material to their already excellent mercury section. I encourage you to check it out – and to share it on Facebook, Twitter and other social media sites you regularly use.

For the sad truth is that even today, less than 25% of consumers realize that “silver” fillings are mercury fillings. But the more who do – and understand their impact on health – the more momentum we can give to all efforts in the fight for mercury-free dentistry.

You may also want to share some or all of the 7 videos I’ve embedded below. Some I’ve featured here before. Many are now standard sources of info on the amalgam problem.

Quecksilber: The Strange Story of Dental Amalgam

 

An Open Letter to Dental Deans & Professors

 

Smoking Teeth = Poison Gas

 

How Mercury Causes Brain Damage

 

Dental Amalgams Leach Mercury Vapor into Your Brain

 

Mercury: The Poison in Your Teeth

 

Safer Amalgam Removal

 

For more ways you can help get mercury out of dentistry, visit the “Take Action” page of Consumers for Dental Choice.

Resources for finding a mercury-free, mercury-safe dentist in your area:

Previously

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Why Does Poor Oral Health Remain Such a Problem?

Every so often, a new story comes out about the American struggle with oral health. Not long ago, for instance, we heard about how 20% of Americans have untreated decay and most have some history of cavity repair: 40% of children, 52% of teens and 75% of adults. Other studies say that by the age of 65, as many as 90% of adult Americans have experienced decay in their permanent teeth.

Why is it such an ongoing problem?

For one, there’s the standard American diet, which is chock full of sugars even before factoring in the sodas, juices and other sweet beverages we’ve come to drink more of. These, along with refined grains and other processed carbs, feed the pathogenic (disease-causing) microbes involved in oral disease. Sugar has other negative health effects, too, and makes us more susceptible to illnesses of all kinds.

Add to this lifestyle factors such as limited physical activity, high stress, poor and insufficient sleep, high drug use (including prescription drugs, alcohol and tobacco) and the like: all these factors similarly weaken the body’s innate self-regulating abilities. We become prone to illness – or at least suboptimal health.

Then there’s the matter of lack of knowledge about dental health and hygiene – a point made quite vividly by survey findings released by the American Dental Association last week. The headline on their press release?

Americans Score a D
on National Oral Health Quiz

The “quiz” was a series of true/false questions answered by nearly 1500 adults. Here’s what the ADA found – and the correct answers:

  • 90% think you should brush after every meal.
    Twice a day is the usual recommendation. And as mentioned, you should usually wait about a half hour after eating or drinking anything before you brush.
  • 65% think you should replace your toothbrush twice a year.
    Every three months is more like it.
  • 75% don’t know when a child should have his or her first dental visit.
    It should happen as soon as their first tooth erupts or no later than their first birthday.
  • 81% think sugar causes cavities.
    Only part true. As mentioned above, sugars feed pathogenic microbes in the mouth, but it’s the acidic waste they produce that actually damages the teeth.
  • 59% don’t know that those microbes can be passed from person to person.
    Like other infectious agents, oral bacteria can be passed along from one person to another – through things like kissing or sharing utensils.

Taking good care of your health – dental and systemic alike – means understanding how your body works. That’s why you may find your dentist or hygienist always explaining and teaching at your appointments – teaching that, unfortunately, some patients tune out for various reasons. But the teaching does matter, so we keep doing it. It’s central to our work. As I wrote before,

I can’t speak for all dentists, of course, but as a dentist, it’s important to me that you understand what we’re doing and why we’re doing it, as well as what you can do to gain and sustain more optimal oral health in general. After all, dentists are doctors, too – physicians whose specialty involves the teeth and oral cavity. You know how the word “doctor” came about? The English word comes from the Latin word docere, which means “to show, teach or cause to know.”

Teaching is part of our job.

Image by Jacob Barss-Bailey, via Flickr

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