Archive for August, 2012

The Truth about Fluoride – Debunking the Myths

Monday, August 27th, 2012

By Dr. Weston Heringer, Jr.

Fluoride is natures cavity fighter with small amount present in all water sources such as lakes, rivers and wells. Communities fluoridate their water supply as a cost-effective public health measure to help prevent tooth decay and cavities in both children and adults. According to the best available scientific evidence, water fluoridation is safe and effective. Thousands of studies and more than 65 years of experience tells us that water fluoridation is effective in preventing tooth decay and is safe for children and adults. Even with all the science, there are still a lot of misconceptions about community water fluoridation so let’s talk through them.

 

1. Fluorosis. Fluorosis can occur before teeth erupt from the gums if teeth are exposed to too much fluoride. The vast majority of fluorosis is very minor, barely detectable white spots on the teeth, that does not affect how they function or a person’s overall health. There are studies that suggest that fluoride occurs more frequently in African American children, however more research is needed on the topic. Fluoridation is implemented because dental decay is widespread, the burden of which falls unfairly  among some  population groups.  The National Dental Association, representing African American dentists, and the Hispanic Dental Association both endorse community water fluoridation as safe and beneficial.

2. IQ. According to the best available scientific evidence, there is no association between fluoridation and brain development or lower IQ. The studies often cited are from China, India, and Mexico where environmental conditions are significantly different than those in Oregon. The vast majority of these studies have never been published in peer-reviewed journals and the quality of these studies does not stand up to scientific scrutiny.

3. Osteosarcoma. In 2011, a team of researchers from Harvard University, the Medical College of Georgia and the National Cancer Institute published a study that analyzed hundreds of bone samples from nine hospitals over an 8 year period from patients with osteosarcoma and a control group to measure fluoride in levels in the bone. Considered the most extensive study to date, the results indicated NO CONNECTION between fluoride levels and osteosarcoma. All the other organizations and agencies that have looked at this issue – including the FDA, National Cancer Institute, California EPA Office of Environmental  Health Hazard Assessment – have concluded the same thing.

4. Infant Formula. Although we encourage all parents and caregivers to talk to their dentist of physicians about their child fluoride intake, community water fluoridation has been proven to be safe for children, including babies. Babies who are fed powdered or liquid concentrate infant formula mixed with optimally fluoridated water might develop mild enamel fluorosis, which is a cosmetic condition and has no effect on how they function.

 

Water that has been fortified with fluoride is similar to fortifying salt with iodine, milk with vitamin D and orange juice with vitamin C. Community water fluoridation saves more than it costs. Studies show that community water fluoridation prevent at least 25 percent of tooth decay.

Want more information on fluoride? You can find extensive information in Fluoridation Facts, the ADA’s comprehensive publication with facts from over 350 scientific references.

 

Dr. Heringer is a retired pediatric dentist and has served on 19 overseas dental trips. He operated a private practice in Salem for 30 years with a satelite office in Lincoln City for 26 years. For the last two years of his career he was the full time dentists on the Tooth Taxi, a mobile dental van providing free care to children in Oregon. Dr. Heringer is a past president of the Oregon Dental Association and is a board member of the Dental Foundation of Oregon.

Does Botox Have a Role in Dentistry? Yes!

Wednesday, August 22nd, 2012

By Dr. James Catt

Does Botox have a role in dentistry?  This was what I was determined to discover when I registered for my first introductory Botox course.  The course was instructed by Dr. Warren Roberts from the Pacific Training Institute for Facial Esthetics (PTIFA) in Vancouver B. C. .  I was drawn here because of its recognition by both ADG PACE and ADA CERP as well as this being the most thoroughprogram that I could find. I was in search of answers, not a diluted course that spoon fed material and handedout a flowchart of “how to’s”.  I needed both a didactic and clinical perspective in order to arrive at a sound judgment on the practicality and safety of the possible utilization of Botox in my practice if Oregon were to allow dental professionals access to this therapy.  PTIFA fulfilled this requirement for me.

Admittedly, prior to attending the training I had some pre-existing bias on two levels.  Apprehension of the drug’s effects and unwanted clinical outcomes made up the bulk of my bias.  In addition, understanding the psyche of the patients who seek this type of therapy also added to my unease.  The latter was less of an issue since I learned multipleclose acquaintances evidently received Botox therapyregularly provided by individuals who at first glance appeared to have fewer head and neck anatomy credentials then I.Also, all of these acquaintances seemed like normal people and their outcomes were as expected.  In reality, it was only due to my close relationship with them and their voluntary divulging of this informationthat I had any idea they had received treatment at all.  So the question lingers; how does Botox apply to dentistry?

In short, the education that I received allayed my misgivings concerning Botox.  Let me repeat that.  The educationallayed my misgivings concerning the safety and utilization of Botox.  I’ve since taken an additional 16 hours of continuing education from PTIFA (totaling  32 hours) which focused on specific dental applications and hands on exercises.  There is absolutely no question in my mind that this treatment can provide dental advantages.  The next question would pertain to who specifically should be providing the therapy for dental applications.

In making my assessment and attempting to answer this question, I began to systematically review what my particular “job” as a dentist currently entails.  My “job”, as I would describe it, may be quite different then my dental colleague’s “job” who practices next door if he were to describe his own duties.  We are both D.M.D.’s, obtained our degrees from the same dental school and we are both required to meet the same standard of care.  However, he may state that his “job”entails extensive endodontic and pediatric treatment.  Theoretically, in these cases, I may state that my “job” is to schedule these patients with a great specialist.  My colleague has taken additional training and provides a high level of care in these cases that I don’t necessarily feel comfortable becoming involved in.  The converse may also be true.  After dental school I chose to pursue a greater level of understanding of occlusion.  I began a four year post graduate path that ultimately provided a competence in treating complex occlusion cases.  Coincidently, often times, this therapy helps with head and neck pain.  My colleague may not report this as one of his “job” objectives.  We are both working within our scope but our focuses differ.  I believe that it is well established that while working within our scope the discretion of what services we provide is based on our education.  Likewise, one practioner’s voluntary dispassion for a type of dental procedure does not, nor should it ever, preclude other practioners from focusing on this said procedure as long as it’s within the scope of dentistry.   Which dental professionals should be allowed to administer Botox for dental purposes?  The answer is the dental professionals who have taken advanced Botox training for dental purposes.   Dental purposes include, but are not limited to, muscle/frenum pulls leading to gingival recession and other periodontal concerns, bruxism and hypertrophic facial muscles, excessive gingival display, and muscle related TMD symptoms.

Some may say that the general dentist should stick with treating teeth and gums.  Some may say that facial musculature isn’t something that the general dentist should involve themselves with.   At this point I am going to use my own training as an example of how the general dentists in our state, who have had the proper advanced training, currently involve themselves with facial musculature every day.   The application of Botox by the general dentist is not an expansion of scope.  On the contrary, Botox is simply a potentially powerful new tool in our armamentarium of treatment options.    The question at hand is,which dental professionals can use Botox in a comprehensive manor and safely maximize the benefits of this therapy?By no means is this example to imply a specialty on my part.  Like many of my dental colleagues, this is simply one aspect of my “job” as I’ve defined it through advanced education and is what I’ve chosen to study and implement in my practice.

 All of us dentits have seen severely worn dentitions.  We as dental professionals know that severe dental attrition is only one sign of a systemic problem.

After ruling out other biological etiologies such as medications, eating disorders and gastric problems, it is inherent that we address the facial musculature system which attaches to and controls the grossly worn hard tissues.  It is impossible to predictably treat the teeth alone since the hard tissues and the soft tissues are reliant on one another.  Without superfluous explanation since the methods vary, the facial muscles need to be relaxed, the jaw joint needs to be passively stabilized, a diagnosis made and treatment options proposed.Botox therapy could often times be useful atmany of these junctures.After consent is given, irreversible procedures are performed on the hard tissues.  The treatment objective is to provide therapy which will lead to permanent stabilization of the occlusion and therefore provide a state of musculature stability which coincides with this new stable occlusion.    As I mentioned earlier, the consequence of this treatment is often times a reduction in myofacial pain.  Below are several photos of one of my own cases.  These photos document the muscular changes that occur when advance occlusal therapy is performed.   There is no refuting that there are permanent changes to this individual’s facial musculature.  This is an irreversible and, might I say, quite an invasive procedure.  However, the results are predictable and successful due to advanced education.  This treatment falls within today’s scope of practice for our state’s general dentists.  Not all dentists perform this type of invasive, advanced, irreversible procedures whichaffect the hard AND soft muscular tissues.  This is a voluntary choice made through the practitioner’s involvement in advanced education.  Botox therapy, even though reversible, should have similar educational requirements.

 Before and After Occlusal Therapy and Muscle Stabilization

So, should a general dental professional be allowed to provide Botox Therapy?  The answer is a resounding, YES!  The caveat being, the general dental professional should be required to meet a standard of competency based on educational requirements.  It is obvious that there are well trained general dentist who treat facial musculature every day and we do this with irreversible procedures.  Botox therapy can be used as an adjunct to such treatment as well as others. Not only is Botox proven safe to use in the right circumstances, it is completely reversible.  The real question is, who better to provide dental Botox to our patients?  Logic requires that the treating doctor has the knowledge of the masticatory system, complex occlusion, head and neck anatomy, as well as possesses the dexterity for specific injection techniques.  Certainly this treatment option isn’t for every dental practitioner, but let’s not withhold this from those general dentists who have the ability, desire, and education to serve their deserving patients.

 

Dr. Jim Catt  practices health centered comprehensive cosmetic restorative dentistry in Medford, Oregon. He received his Bachelor of  Science from  Oregon State University and was Magna Cum Laude from Oregon Health and Sciences University with his Doctorate in Dental Medicine.  Dr. Catt is  a past president of the ODA and has served as an  Trustee for 13 years, participating on many Boards and Committees. He is a member of the International College of Dentists, American College of Dentists, and Pierre Fauchard Academy. In addition, he facilitates dental health in children through dental health awareness in Medford schools, volunteering at Jackson County Children’s Dental Clinic, and acting as the Project Lead for the Southern Oregon Mission of Mercy.

 

Dental X-Rays

Monday, August 6th, 2012

By Dr. Medhi Salari

Benefits of Dental X-rays

Dental X-rays help us detect cavities, infections, gum disease, cysts, tumors and developmental abnormalities much sooner than waiting for these problems to get large enough to become evident to the naked eye; or painful enough to become uncomfortable and noticeable to the patient.

Dentistry has led the healing professions in preventive care since the 1940’s and x-rays help us each and every day in finding and treating dental disease in its earliest and easiest to treat stages.

Patients who receive regular exams and x-rays tend to retain their teeth for life, while patients who go without exams and x-rays tend to have more extensive dental work, such as root canals and extractions.  By the time the problem has become uncomfortable or noticeable to the patient, the decay or problem has already progressed too far.

Risks of Dental X-rays

A large number of patients cite exposure to radiation as a concern in consenting to regular dental x-rays and exams.  We gathered the following information from the American Nuclear Society website to put the amount of radiation from Dental X-rays in perspective.

Source of Radiation

Estimated Exposure (mrem)

Air Travel

0.5 per HOUR

Dental Bitewings (4 films)

2

Dental Complete Series of X-rays

10

Medical Chest X-ray (1 film)

10

Natural Radiation from the ground

30 per year

Natural Cosmic Radiation in Central Oregon (elev. 3,000 – 4,000 ft.)

41 per year

Medical X-ray – Mammography

42

Medical CT Scan – Head

200

Internal Radiation from food & air

268 per year

Medical Upper GI X-rays

600

Medical CT Scan of Abdomen/Pelvis

1000

 As you can see from the table above, radiation exposure from dental x-rays is extremely low, in comparison to other forms of radiation that we are routinely and often times naturally exposed to.  We also take the added precaution of routinely covering our patients with a lead apron and Thyroid collar to further minimize the already low exposure levels.

International standards have recommended a maximum amount of radiation for humans working with or around radioactive materials at 5,000 mrem per year.  The average accumulated amount of radiation per person is approximated at 620 per year.  You can calculate your own annual radiation dose by visiting the American Nuclear Society website (www.ans.org), and clicking ‘Public Information’, ‘Resources’ and then ‘Dose Chart’.

General Recommendations & Protocol

Our goal is to take the very best care of your teeth and mouth as possible.  In order to do that, we need periodic x-rays to properly diagnose and treat conditions that might exist or arise in your mouth.

We realize that different patients and different dental conditions require different protocols.  We have always strived to minimize our patient’s x-ray exposure and at the same time reduce the costs associated with necessary x-rays.

We do not have a one-size fits all x-ray routine in our office, but have tailored our X-ray Protocol to benefit each specific patient’s dental and medical conditions.

Patients who have a higher risk of decay, multiple existing restorations or more complex treatment plans require more frequent and regular dental x-rays.

Patients who have experienced fewer cavities and restorations in their past, and have exhibited a smaller risk of dental disease, will continue to have less frequent dental x-rays recommended to them.

Our X-ray Protocol also takes into account numerous other important factors; such as pregnancy, patient’s age, list of medications and concurrent medical conditions (dry mouth, acid reflux, concurrent radiation therapy, …).

We will continue to honor the trust that our patients have placed in us, by taking the necessary steps to properly diagnose and treat their dental problems, while remaining respectful of our patient’s wishes for a protocol that caters to each patient as an individual.

With our X-ray Recommendations and Protocols, we hope to provide the right balance between our patient’s wishes for reduced exposure to radiation and the Oregon Board of Dentistry’s Standard of Care for dental practices.

Excerpts from  American Dental Association (www.ada.org) and American Nuclear Society (www.ans.org) 

 

Dr. Mehdi Salari is a 1993 graduate of the OHSU School of Dentistry.  He has been in private practice in Bend, Oregon for 19 years and along with his wife, have three kids under the age of nine.  He is a Past President of the Central Oregon Dental Society.  He has been actively involved in the Central Oregon soccer community through coaching, playing and officiating.  He also volunteers with the Central Oregon Community College Dental Assisting Program, Healthy Beginnings, Volunteers in Medicine and the Kemple Children’s Clinic Give Kids a Smile program.