Tag 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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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?


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?


Or drink through someone else’s teeth?


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.


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


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!


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


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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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:


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All Dental X-rays Are NOT Created Equal

“Information overload” isn’t a new concept or phenomenon, but it is a more common one in our hyper-connected world.

As the world moves into a new era of globalization, an increasing number of people are connecting to the Internet to conduct their own research and are given the ability to produce as well as consume the data accessed on an increasing number of websites….This flow has created a new life where we are now in danger of becoming dependent on this method of access to information. Therefore we see an information overload from the access to so much information, almost instantaneously, without knowing the validity of the content and the risk of misinformation.

Another consequence is greater competition for attention. It’s one reason why we see the kinds of headlines we do – sometimes promising practical, helpful content to come, but more often striving to shock, surprise or otherwise arouse curiosity. More than ever, it’s important that we read beyond them and really grasp what’s being said.

Consider, for instance, this post on Dr. Mercola’s site yesterday:

Now, if you were to just read the headline and first bit of content, you couldn’t be faulted for thinking that dental x-rays are horrible, dangerous and something to avoid at all costs. But that’s not what the article actually says. The risk suggested by the research discussed involved only routine and conventional x-rays. It also has significant limitations, which Dr. Mercola points out. And his ultimate recommendation?

My personal recommendation is to find a dentist that uses digital X-ray equipment that does not use film but a sensor to capture the image. This type of equipment typically generates 90 percent less radiation and is far safer. The dentist I see uses this type of X-ray equipment.

It’s the type of equipment I use, as well (as do many other dentists, conventional and holistic alike). For x-rays remain an important diagnostic tool, not something that should be “routine.” Taking digital x-rays – and then, only when needed – keeps risk as low as possible. (Another benefit to digital imaging: You don’t need to have all those chemicals – a potential source of toxic exposure – to process the film. No chemicals, no fumes to permeate the office environment!)

And truth be told, most biological dentists use digital imaging for the exact same reasons. It’s safe and lets us see below the surface so we can correctly diagnose your dental situation. It helps us provide you with the best biological dental care, fixing any problems early – and biocompatibly.

That level of care and safety is one thing that should be routine. X-rays? No, and especially if they’re conventional film.

More about why x-rays matter

More on information overload in the digital age

Image by a440, via Flickr

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Filed under Biological Dentistry, Dentistry

How to Save Money on Dental Care

What keeps people from getting the dental care they need? Fear is a major factor. Another is concern with cost.

According to a new Consumer Reports reader survey on oral health, 43% delayed care due to financial concerns. But the survey also found that those who delayed dental treatment were also less satisfied with the care they got. The why is simple:

Because not going to your dental appointments may lead to more extensive and more costly dental treatment in the long run.

Whether money is tight or you’re a committed saver, the best way to minimize dental costs is the same: Take a proactive, preventive approach. This means

  • Brushing after meals, flossing daily and regularly using a proxy brush, perio-aid or oral irrigator to clean the necks of teeth and at the gumline.
  • Eating a varied, balanced diet based on whole foods, low in sugars and refined carbs.
  • Regularly exercising.
  • Getting enough quality sleep and rest.
  • Managing stress and maintaining a balanced lifestyle.
  • Seeing your dentist every 6 months for a cleaning and exam.

Any money you spend pursuing the above is nothing compared with the cost of dental surgery and restorations!

Funny. You know the entertainment discount books full of coupons? We don’t usually think twice about buying things like those, justifying the cost by thinking of the money we’ll save. Sure, there’s more fun potential there, and a quicker payoff to the investment. It takes years for our lifestyle choices to catch up with us, but when they do…! Of course, writes one dentist,

It is easy to rationalize buying something you want like shoes, a car, diamond ring, etc. On the other hand, it is even easier to rationalize not doing something like dieting or going to the dentist, right? I mean who wants to have someone stick their hand in your mouth, poke around it, mumble a few things and then tell you the bad news?

The catch: It doesn’t have to be bad news.

The challenge: Start backing up our words with action. Most everyone agrees that good dental hygiene is important, yet according to the CR survey, only 1/3 of readers brush and floss as much as they should. Changing that behavior alone would do much to cut down on dental bills.

Here are CR‘s tips for dealing with the cost factor:

  • Shop around and bargain. Look up typical insurance paid rates in your area at FairHealthConsumer.org and HealthCareBlueBook.com, then ask providers to accept that amount, or less, as a cash payment. [Of the two, the first seems better – more specific, targeted and accessible to the layperson.]
  • Consider Free and low-cost clinics and health centers. Some community health centers offer dental care with fees based on the ability to pay. Consumers should call their local health department to find one nearby. But they should expect to encounter waiting lists in some locations.
  • Look into dental and dental-hygienist schools. Consumers who are willing to be treated by supervised students can avail themselves of schools that offer free or discontinued care to the public. A list of schools is available at http://www.ada.org/267.aspx.
  • Investigate dental discount plans. For an annual membership fee of around $50 to $100, one can get access to a network of dentists who have agreed to discounted rates. But Consumer Reports recommends that consumers watch out for pricey add-ons and extra procedures they don’t need.

One caveat: Most low-cost clinics and dental schools are not holistically focused. Things like mercury amalgam fillings, root canals and insufficient cleaning of the socket after tooth extraction can have long term health effects that vastly outweigh the short term bargain of low-cost care. As my colleague Dr. Gary Verigin writes,

In short, “cheaper now” usually means “more expensive later.” In the best case, you wind up replacing work sooner and more often. In the worst case, cutting corners causes more extensive and expensive problems down the road.

The smart consumer looks at the big picture.

Or as a small plaque hanging in our office has it, “Beware of bargains in parachutes, brain surgery and dental care.”

Consider: If you needed surgery on any other living organ – and each of your teeth is a vital organ, just as your heart, lungs, liver, kidneys and such are – would you opt for the cheapest surgeon or the most qualified surgeon whose services fit within your budget?

So also keep in mind that some dental offices will work with you to develop a payment plan for costly procedures. It’s worth asking about when you first call. There are also options such as CareCredit for financing over time.

But again – and as ever – your best bet is to make your oral (and physical) health a priority and minimize the risk of pricey problems arising in the first place.

Image by Danielle Moler, via Flickr


Filed under Dental Health, Dentistry

Painful Tooth? Why Pointing at It Isn’t Enough for a Dentist to Help You

For most Americans – 80%, according to a 2009 survey by the American Association of Endodontists – going to the dentist is a scary thing. Over half say it keeps them from seeing getting dental care, despite the fact that regular visits for exams and cleanings help them avoid the things they fear: pain and procedures like root canals.

But tell that to a person who’s just heard their best friend describe a bad dental experience or read one of the strange and/or horrific dental stories that crop up in the news from time to time – even as these stories can just as much be a source of motivation to take good care of your teeth and gums, and reduce the chance you’ll need extensive, intensive (and expensive!) treatment down the road.

And they can cast light on important concepts. For instance, consider this story that made the news a couple weeks ago:

A dentist who pulled the wrong tooth from a patient had it retrieved from a medical waste bin and replanted it two hours later.

Kim Green, who was in agony from a root canal infection, did not know that her healthy tooth had lain among bloodied tissues, saliva wipes and needles used on other patients.

Dentist Justin George sewed it back in, left her rotten one in place and suggested she take painkillers until another appointment was arranged.

According to the Mail, Mrs. Green eventually went to the hospital. A surgeon removed both teeth and then reported the Dr. George to the General Dental Council. Mrs. Green alleges that the dentist didn’t consult her x-rays before pulling the tooth: “Instead, he relied on her pointing to the throbbing tooth.”

Problem: As research published last year in the journal Pain demonstrated, when a tooth hurts, our brains have a really hard time figuring out exactly which one it is.

In the study, researchers led by Clemens Forster of the University of Erlangen-Nuremberg in Germany analyzed brain activity in healthy — and brave — volunteers as they experienced tooth pain. The researchers delivered short electrical pulses to either the upper left canine tooth (the pointy one) or the lower left canine tooth in the subjects. These bursts of electrical stimulation produced a painful sensation similar to that felt when biting into an ice cube, Forster says, and were tuned such that the subject always rated the pain to be about 60 percent, with 100 percent being the worst pain imaginable.

To see how the brain responds to pain emanating from different teeth, the researchers used fMRI to monitor changes in activity when the upper tooth or the lower tooth was zapped. “At the beginning, we expected a good difference, but that was not the case,” Forster says.

Many brain regions responded to top and bottom tooth pain — carried by signals from two distinct branches of a fiber called the trigeminal nerve — in the same way. The V2 branch carries pain signals from the upper jaw, and the V3 branch carries pain signals from the lower jaw.

* * *

Because the same regions were active in both toothaches, the brain — and the person — couldn’t tell where the pain was coming from. “Dentists should be aware that patients aren’t always able to locate the pain,” Forster says. “There are physiological and anatomical reasons for that.”

And this brings us back to the matter of x-rays. While there’s growing concern about over-exposure to x-ray radiation, they remain a vital diagnostic tool. The key is in using them wisely – for instance, not “routinely” but when clinical need demands it. Digital imaging, which I’ve used for years, helps reduce risk, as well, since it requires less radiation than film does.

So why didn’t Dr. George refer to Mrs. Green’s x-ray before going ahead with the extraction?

When The Mail on Sunday spoke to Dr George at his home in Taunton he admitted responsibility but claimed there was ‘pandemonium’ at the surgery. ‘It was a really weird day,’ he said. ‘We didn’t have our regular nurse, there was pandemonium in the practice, and then the nurse left the X-ray in the machine.

‘People are all coming in with pain and I’m the only dentist in the surgery trying to see everybody, and yes, in the pandemonium, the wrong tooth was pulled out. It was an accident but everything was failing around me. I’m a new dentist. I was very stressed-out that day . . . I could hear people grumbling downstairs.

‘The nurse said the tooth was still in the surgery and so I thought she had not disposed of it. I didn’t know it was in the bin.’

You have to wonder about the role of inexperience here. It’s not hard to imagine a young dentist feeling the need to prove himself capable of working through “pandemonium” instead of acknowledging that he’s having trouble coping and it’s interfering with his work. Of course, there’s still the weird matter of how he “fixed” his mistake: calling back the patient and “sewing in” the tooth that had been fetched from medical waste, yet still doing nothing for the infected tooth.

Unsurprisingly, Dr. George has been suspended and awaits his GDC hearing.

Stories like this catch our attention precisely because they’re so off the norm and seldom jibe with our own experience. In fact, dentists provide a wide variety of methods to minimize pain. And where anxiety is an issue, we can provide things like nitrous oxide or oral conscious sedation to help you stay calm and relaxed. I make both methods available to my patients. And for those who prefer more natural sedation remedies, there are calming botanicals, homeopathics and other options we can recommend.

Learn more about dealing with dental fear.

Images by westpark, via Flickr, and Michael Ottenbruch, via Wikimedia Commons

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Straight Teeth: Not Just a Cosmetic Matter

When people think about orthodontics, they tend to think mostly in terms of the aesthetics – straightening teeth to get an attractive smile. Of course, aesthetics matter. A good looking smile can boost your confidence and influence how you’re perceived by others. But there are health factors, too.

Crooked, crowded teeth, for instance, can make home hygiene more difficult. When brushing, flossing and using cleaning tools such as proxy brushes and rubber tips are hard to do because of how the teeth sit in the mouth, at best, home cleanings may not be very thorough – if done at all. The consequence, of course, is a higher risk of cavities and gum disease (and with the latter, a higher risk of other inflammatory conditions such as heart disease, diabetes and stroke).

There are functional considerations, too. A misaligned bite – one in which the teeth don’t come together harmonically, with even pressure – can eventually lead to muscle soreness, TM joint dysfunction and pain throughout the head, face, jaw, neck and upper body. The surfaces of the teeth may wear down more quickly and irregularly, leading to the need for restorative dental work that otherwise may have been unnecessary.

In short, when needed, effective orthodontic treatment can benefit a person both physically and mentally, helping to support their total health and wellness. And although ortho is most often promoted for young patients, as their developing teeth and dental structures make teeth easier to move into proper alignment, teeth straightening can be done successfully in adults of all ages (even, in some cases, seniors).

One of the things that’s made orthodontics more attractive for adults has been the development of good alternatives to the traditional metal brackets. For instance, in cases where brackets remain the best choice, white polymer ones may be used for a more natural appearance. In other cases, “invisible” appliances can be used, so it doesn’t even look like you’re having your teeth straightened at all.

I’ve recently begun using a new “invisible” alignment system in my office, which we think is the best system yet for our patients:
ClearCorrect. The appliance features superior aesthetics, not clouding up as some other appliances do. It’s easily removable and doesn’t interfere with eating or regular cleaning habits, and its custom fit ensures good comfort. It’s the least invasive teeth straightening system I’ve seen and is appropriate for a wide range of individuals, from teens to seniors.

Placing the appliance is also much simpler and quicker than placing brackets. You can read a full description of the process here.

To learn more about ClearCorrect and the other services we offer at my Glendale, CA, office, just visit drerwin.com or give us a call at 818-246-1748. I look forward to helping you – or your child – get and maintain a healthy, attractive smile that supports your total health.

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