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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“Gluten-Free” Doesn’t Have to Mean “Low Fiber”

Commenting on last month’s post about whole grains, a reader raised an issue that’s often overlooked: How to get enough fiber when eating gluten-free. “I’ve been looking for more fiber in foods,” she wrote, “and find that often, but not always, whole grain labeled foods have more of it.” Gluten-free choices, she added, “typically have little fiber in them.”

And that’s true – but only insofar as you think of grains as your main source of fiber. Gluten and fiber, however, do not go hand in hand.

Unlike gluten – a protein composite – fiber isn’t a nutrient. It’s the part of edible plants that we can’t digest (“roughage”), yet it affects how nutrients are absorbed and the composition of gut flora. Most known for promoting regular bowel movements (keeping a person “regular”), it’s also been shown to lower cholesterol, normalize blood glucose and insulin levels, and reduce risk of some cancers.

Only some edible plants contain gluten, but all contain fiber. This leaves you with an incredibly diverse selection of foods!

Colorful vegetables and fruitsRather than looking for gluten-free grain-based products, look to fresh vegetables and fruits, as well as legumes (beans, peas), nuts and seeds.

Eating a wide variety of these foods can ensure a healthy fiber intake (a minimum of 25 grams daily is generally recommended). Some, of course, deliver more fiber than others. One serving of white beans, for instance, gives you almost a whole day’s worth: 19 grams! Individual vegetables and fruits can range from 2 or 3 grams per serving to more than 10. Mix a variety together with salad greens, and again, you’ve met a good part of the recommended daily intake.

You can learn much more about these gluten-free, high-fiber foods here.

When you have any kind of food sensitivity that makes you define your diet by what you can’t have, it can be all too easy to overlook the wealth of things you can. Focusing more on the latter, you may find yourself depending less on finding analogs to replace foods you miss – gluten-free bread or pasta, for instance – and enjoying the adventure of discovering new foods you like and that deliver the nutrition you need.

Image by 365 Dias que Acalmaram o Mundo, via Flickr

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Trees, Green Spaces & Your Health

treesHave you ever wondered why it can feel so good to be among the fresh air and greenery of the great outdoors? According to a new study, there seems to be a distinctive link between trees and human health. And a small beetle showed the way.

Inadvertently brought to North America from its native Asia around the turn of the century, the emerald ash borer has devastated the ash tree population of the upper Midwest in particular. All 22 species of ash are vulnerable to it, and it almost always ends up killing the trees. More than 100 million have thus far.

How might this loss affect us? Researchers looked at data from 15 states across a 17 year span, including several years before the borer was introduced. What they found was an increase in human deaths from cardiovascular and lower-tract respiratory diseases. The greater the tree loss, the greater the increase in mortality. Said lead author Geoffrey Donovan,

“There’s a natural tendency to see our findings and conclude that, surely, the higher mortality rates are because of some confounding variable, like income or education, and not the loss of trees…. But we saw the same pattern repeated over and over in counties with very different demographic makeups.”

The findings were published in the American Journal of Preventive Medicine.

And they follow numerous other studies that likewise demonstrated a strong relationship between nature and human health. Among the earlier research mentioned in The Atlantic’s coverage of the new study: a 2010 paper that

looked at the presence of parks and forests in the vicinity of people’s homes and their ability to act as a “buffer” against stress. [Its authors found] that the presence of “green space” was more closely related to physical – in terms of minor complaints and perceived general health – than mental well-being.

Other research has shown that obesity is less of a problem for children in greener neighborhoods, and those diagnosed with ADD/ADHD show marked symptom improvement after spending time in natural settings. College students with dorms that look out on nature tend to score higher on attention tests. Girls who live in homes with greener views show enhanced concentration and self-discipline, academic improvement and more thoughtful decision-making.

Here are some of the other health benefits that have been shown to come with the (green) territory:

  • Increased physical fitness
  • Lower stress and anxiety
  • Improvements in blood pressure and muscle tension
  • UV protection
  • Relief from eye strain
  • Less aggravation of allergies (due to tree-filtered air)
  • Faster healing and recovery rates

Of course, trees are great for the health of our environment, as well. (Let canopy.org count the ways…)

Environmental health. Our health. A virtuous circle.

Maybe that new ash tree study is just the kind of wake-up call we need to accept the connectedness of all life. The call to environmental stewardship is not just a noble one. It’s a call we must answer for the sake of our own health and well-being.

Image © Dane Jessie

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Persistent Pathogens : Dedicated Defense

These are our children. We’d do anything for them, right?

kids

Helping them grow up with healthy smiles takes a little wrangling with microbes, though. Consider the results of a study published in last December’s Journal of Oral Microbiology:

The Oregon Health & Science University School of Dentistry have determined that certain genetic strains of bacteria are dominant in children one year after treatment for microbial-caused plaque and tooth decay, and six new previously undetected minor strains were identified.

Some of these, they found, are resistant to xylitol, well-known for its ability to prevent cavities.

But while some kinds of oral flora can cause problems, we rely on others to maintain good health. Think of this: Bacteria make up more than 10 times the number of your body cells. In fact, our bodies are the host to more than 100 trillion microbes, many of which are not just beneficial but necessary.

Think of your body as an enclosed ecosystem. It is only when the ecosystem is out of balance that the populations shift and the pathogens (microbes that can make us sick) overpopulate and gain a foothold, contributing to illness.

Oral health is all about keeping the oral flora in proper balance.

Persistent or not, the mere presence of microbes doesn’t spell doom for your child’s teeth. Cavities are preventable.

Many factors can make the difference at dental check-up time. Frequent snacking and dry mouth are important to avoid. But the best route to a healthy mouth is based on good hygiene and diet.

And what makes hygiene “good”?

  • Waiting 20 to 30 minutes after eating to clean your teeth. (When you eat, oral conditions turn acidic for a while. This delay allows them to neutralize. Brushing right away can actually damage teeth and gums.)
  • Brushing with a soft-bristled brush and toothpaste containing no fluoride or sodium lauryl sulfate.
  • Flossing and using a proxy brush to clean the areas your toothbrush can’t get to.

When it comes to diet, balanced, varied and nutrient-rich is the key, with many more whole foods – including fresh produce and whole grains – than processed. There are a couple kinds of foods, though, to be careful about: sugars and fermentable carbohydrates (carbs that are digested as sugar). These are the preferred foods of decay- and disease-causing microbes, and because they tend to stick to the teeth, they give the pathogens that much more time to feed. These include

  • Soft drinks of all kinds – soda, energy drinks, sports drinks. (And no, diet drinks aren’t the solution, for their acids can still damage tooth enamel, making teeth more decay-prone. More, research now suggests they may raise risk of diabetes, as well!)
  • Fruit juice. (Fresh whole fruit is great!)
  • Candy – especially chewy candies that easily stick to and get wedged between teeth. (If sweets are desired, chocolate is most tooth-friendly.)
  • Dried fruit (the stickiness factor again).
  • French fries and Tater Tots.
  • White bread and pasta.
  • Cake, pie and cookies.

Along similar lines, if your child uses an inhaler for asthma, it can leave an acidic residue. So whenever possible, do let them brush after using their inhalers.

The more dedicated you are to practicing and instilling healthy habits like these, the better your defense against persistent decay.

More tips for helping your little ones develop good oral health habits and healthy smiles

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Bruxism? Sounds Uncomfortable – and Is

We’ve talked about bruxing before – habitual tooth grinding and clenching. It’s an unconscious act that can happen day or night, during sleep or waking hours. It sounds uncomfortable – and is, often leading to pain in the jaw, neck and shoulders. But even while awake, bruxers are usually oblivious to the noise that can sometimes put others on edge (and even keep bed partners from getting a good night’s sleep).

But why would someone brux anyway? Until fairly recently, there was a popular school of thought that poor bite alignment, known as malocclusion, was to blame. Yet while that idea has fallen into disfavor, there’s still no consensus on what makes people brux. Several triggers – including stress and medication side effects – have been identified.

tmj_painA study published last year in the Journal of Oral Rehabilitation verified what many dentists have long suspected: bruxism is related to temporomandibular disorders (TMD) and, by extension, depression. Although non-bruxers with painful TMD proved at higher risk for “moderate/severe depression and non-specific physical symptoms,” bruxers with TMJ problems were even more at risk. The authors couldn’t say that any one condition caused the others, only that they tend to occur together.

A slightly later study, published in Pain, likewise found an association between TMD and depression and anxiety, which the authors said should thus be considered risk factors for TMD pain.

Depressive symptoms are specific for joint pain whereas anxiety symptoms are specific for muscle pain, findings that deserve detailed examination.

TMJ pain and its related problems aren’t the only trouble to come from bruxing. The constant grinding can cause physical damage to your teeth, too. It can wear them down and even fracture them. (Take a look at this gallery of suffering teeth.) Obviously, this has potential for financial pain, as well – but it needn’t come to that, not if we identify and address the issue early on.

A quick visit to the dentist could be the first step to relief. We have many options for pinpointing problems and assisting in treatment. If you’re experiencing pain associated with bruxing, controlling or stopping the behavior usually alleviates the symptoms, but the associated pain can be treated independently, as well.

For most people, a combination of behavior modification and splint therapy with a night guard or other appliance does the trick. Dr. E can steer you to the one that is most comfortable and best suited for your specific needs.

Most people get used to their night guards very quickly. But don’t get too attached. Many patients find that, in time, the need for their mouthpiece disappears.

As with devices for sleep apnea, there are over-the-counter night guards available. And just as with the apnea devices, they’re rarely effective. Most who use them experience no improvement and end up going to a dentist to get a custom splint, properly fitted and suited to their problem.

A helpful hint: Just skip that extra step and talk with your dentist first. It’s your quickest way to a solution.

Image by reallyboring, via Flickr

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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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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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