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The other day, the New York Times featured an article entitled "Radiation Worries for Children in Dentist's Chairs". The article mainly centers around the increasing use of Cone Beam CT Scans by dentists, including oral surgeons and orthodontists, to aid in the diagnosis and treatment of a variety of common dental problems in children such as malocclusion and impacted teeth. The main issue is that these children are being exposed to much higher doses of radiation as compared to those children who are being evaluated with more traditional diagnostic tools such as conventional panoramic and periapical dental Xrays (both digital and film), photographs, and study casts of the dentition.

The article states that many experts in dental radiation have raised alarms about what they see as their indiscriminate use. They worry that with few guidelines or regulations, well-meaning orthodontists and other specialists are turning to a new technology they do not fully understand, putting patients at risk, particularly younger ones. Some orthodontists now use Cone Beam CT scans to screen all patients, even though a number of dental groups in this country and in Europe have questioned whether the benefit of routine use justifies the added risk. The ADA has already responded and advises that dentists follow the ALARA principle (As Low As is Reasonably Achievable) to determine which diagnostic tools are best for each particular case.

There is no question that Cone Beam CT scans can help dentists and surgeons deal with complex cases involving dental implants, TMJ disorders, jawbone pathology, and other serious dental and medical problems. As a periodontist who has been placing dental implants for over 23 years, we have been using CT scans since the early 1990s to aid in diagnosis and treatment planning for complicated cases. The technology is an extremely valuable tool which helps us to provide our patients with a safe, predictable surgical outcome. But the vast majority of our smaller cases do not require the use of this technology, especially when we have extracted the teeth and repaired the bone with bone graft and guided bone regeneration procedures. These cases may be evaluated by more conventional means outlined above.

With the increasing prevalence of in-office CBCT scanners, usually at a cost of around $140,000, I sometimes wonder if they are being overused by some clinicians just to help pay for the cost of the machines. I would like to believe that this technology would only be used when absolutely necessary to justify the extra radiation exposure, but I have seen instances with patients referred for second opinions where conventional dental Xrays would have been adequate for proper diagnosis and treatment. On the other hand, I completely understand the concept that dentists and surgeons would like to have the best and most complete information available to them prior to treating their patients. In this litigious society, implant surgeons have oftentimes been told that utilizing CT scans in the diagnostic phase is actually the standard of care. So, therein lies a "Catch 22". In the end, we must rely on the judgment, skill and expertise of the treating dentist and surgeon to determine how best to evaluate cases. But, patients do need to be informed of the risks and benefits, especially when concerning children.

Do you think the NY Times article is valid? What are your experiences? Your comments are appreciated.

Cary Feuerman, DMD

Periodontal Associates

In the past I have written about the dangers of misinterpreting information from research articles or news sources, with even the Discovery Channels’ own author blowing things out of proportion. A recent example is from Dr. Joseph Mercola, a physician turned internet health guru.

In Dr. Mercola's opening paragraph he says this: “A new study in the Journal of the American Dental Association finds once again that, contrary to what most people have been told, fluoride is actually bad for teeth.”

Fortunately there is a link to the article listed in PubMed, which says something completely different: “Results suggest that prevalence of mild dental fluorosis could be reduced by avoiding ingestion of large quantities of fluoride from reconstituted powdered concentrate infant formula and fluoridated dentifrice.”

What that article is actually saying is that if you are using too much fluoridated water for your infants formula, or if your toddler is squeezing the tube of toothpaste down their throat like its cupcake icing, it will cause fluorosis.

So what is fluorosis? It’s a condition of the teeth which is caused by an increased amount of fluorapetite. This fluorapetite comes from ingested fluoride (not rinsing), and can cause white or brown stains on teeth. The condition is esthetic only, with these teeth having a greater ability to resist decay. While these stains are undesirable, saying something is “bad for teeth” implies that the teeth are being damaged insome way, as in the case with soda drinks or sucking on lemons. In thedental field, it is important to balance the difference betweenesthetics and health. I would never tell a patient with coffee stains onhis teeth that coffee is “bad” for him.

The problem is that the language Dr. Mercola uses is inflammatory, inciting fear commensurate with the rest of the article.

So what about his other claims, such as “Fluoride (no amount noted) causes bone fractures”? On a brief search of the PubMed database, I found an article saying that there is no conclusive evidence for the long term effects of water fluoridation on the human skeleton.It’s hard to tell what is true and what is speculation… or what issensationalism.

Fluoride seems to be one of the most controversial topics in America, and I’m sure that my thoughts here will prompt a few comments. But remember, just because it is on the internet doesn’t always mean it is true. It’s important to keep in mind the source. PubMed is agreat start with thousands of peer-reviewed articles. The point is todig in, figure this out, do the homework, and formulate a solidconclusion that will benefit my patients and my family. I welcome anyevidence you the reader might have to get to the real bottom of thistopic.

RC Health Services LLC, based out of Houston, Texas, has now expanded to offer classes throughout the United States. RC Health Services is in high demand nation wide due to its large network of AHA instructors is every city in America. Our courses are conducted in a comfortable, no stress classroom or private setting. Covering the United States and the Caribbean, we are an American Heart Association training site that provides courses to large organizations such as: Nursing Agencies, Outpatient Surgical Centers, Physician Groups, Private Practices, Endoscopy centers, Conferences, Corporations, and Private Facilities.
Courses offered for the medical professional includes Basic Life Support for Health Care Provider (BLS), Advanced Cardiac Life Support (ACLS), Pediatric Advanced Life Support (PALS). There are also courses such as Airway Management, Acute Stroke, Learn Rhythm Adult, Learn Rhythm Pediatric, and Learn STEMI. As a leading provider of both online and traditional courses RC Health Services strives to meets all our clients needs.

Nationwide Corporate CPR/AED and First Aid Training. High profile clients such as Shell Oil, Air Liquide, and ATI Enterprises illustrate the experience and professionalism that has been the hallmark of this AHA training site. Maintaining OSHA compliance is made easy with RC Health Services with our corporate data base management system. We assure our clients that their employees are kept compliant on all their American Heart Association course requirements. Classes include Heart Saver CPR and AED, Heart Saver First Aid, and Blood B Pathogens. All of our courses are offered in both online and traditional settings.

Dental implants traditionally have a very high success rate. The majority of studies that have been done indicate long-term success rates well over 95%. However, there are many factors that can compromise the success rates of dental implants. These can be divided into three categories: general health concerns, local factors and maintenance issues. It is important to consult with your dentist or dental professional prior to having implants placed to determine whether you are a goodcandidate. Most implant failures can be eliminated through proper caseselection.

1. General health concerns that may impact an implant’s success include such factors as smoking, certain drugs, osteoporosis, history of radiation treatment, or a compromised immune system.
2. Local factors that could impact implants include bone quality, bone quantity, and initial stability of the implant at the time of placement. Bite-related concerns depend upon the amount of stress that the patient will be placing on the implants. When evaluating a dental implant patient, your dentist has to evaluate whether you clench or grind your teeth.This will impact both the potential short and long-term success ofimplants.
3. Finally there are maintenance issues, while implants are wonderful high-technology replacements for teeth, they need routine maintenance. This includes daily cleaning and continued professional management. Without ongoing professional care,implants just like any other technically sophisticated device aresusceptible to breakdown.

I believe that one should have confidence that dental implants are an excellent choice to replace missing teeth, but feel free to consult with your dental professional about your unique case requirements — how many implants you need, your medications, your medical history, and local findings such as bonequality and quantity. If you are properly evaluated by a qualifieddental professional and determined to be a good candidate, there is noreason why you cannot have extremely high success rates as do mostpatients.

For more information contact Dr. Todd Welch with West Tennessee Periodontics and Dental Implants at www.wtnperio.com or you can leave a comment in the section below. You can also view my blog post “What are Dental Implants?”. Thanks for reading !!

Halloween can present a very scary time of year for any parent concerned about their child's oral health, since your kids will probably come home with that big haul of candy from trick or treating. But should you let them immediately gorge themselves on the candy and get it out of their system? Temple University pediatric dentist Mark Helpin thinks that might not be such a bad idea. "The frequency of eating candy, and other refined carbohydrates, and their stickiness, are big factors in creating the risk of caries (cavities)," he said.

Eating carbohydrates can change the pH balance of the mouth, making it more acidic, which can increase the risk of cavities. Each time candy is eaten, the acid environment in the mouth can take up to an hour to dissipate.

"If I eat a piece of candy now, the pH in my mouth will become acidic, and it will take 30-60 minutes for it to become normal," said Helpin. "If I eat 2 or 3 pieces of candy when I eat that first one, my mouth stays acid the same length of time that it would if I ate just that single piece. It's still 30-60 minutes. If I keep eating candy throughout the day, there is acid in my mouth for a much longer period of time. The longer teeth are in an acid environment, the greater the risk they will become decayed."

Helpin, the acting chair of pediatric dentistry at Temple's Maurice H. Kornberg School of Dentistry, says that there are a number of ways parents can minimize this risk while still letting their children enjoy the holiday. "Parents can let kids eat a bunch [of candy] now and a bunch later. But don't let them have one piece now, then an hour later let them have another piece," he said, adding that candy can also be dispensed as a dessert or snack.

Meals are a good time at which to have treats as dessert because the production of saliva increases, which helps to wash away acidity in the mouth. Helpin also recommends that parents have their children brush their teeth after eating candy, or if that's not possible, tell their children to rinse their mouth with water three or four times after eating, which will help reduce acidity in the mouth.

Helpin warns that substituting small bags of chips or pretzels for candy doesn't solve the cavity problem, either. "Chips and pretzels are also carbohydrates and they also will create an acid environment that can create cavities," he says. "These treats and snacks get stuck on your teeth, and that's the stickiness factor," he said.

When trick-or-treaters come to his door, Helpin likes to give out sugar-free candies, and avoids the sticky, gummy candies, which stick to the teeth promote cavities because they allow bacteria "to feed" for a longer time. Ultimately, "it's not realistic to think you can tell your child you can't have candy, cookies, cakes, or other treats," says Helpin. "Those are the things most people enjoy -- and we want our kids to enjoy life."

Source: Science Daily

Conscious Sedation Consulting has announced the launch of a comprehensive online dental sedation course.

This online continuing education course is for the non-anesthesiologists and non-anesthetist dental providers who are involved in or are considering the administration of sedation or the monitoring and or recovery of sedated patients.

The company is offering a free online 1 hour sedation module entitled "A Culture of Safety" for anyone who wishes to participate. Seven other modules are available for subscribers. A subscription allows access to the database for a period of 2 years. This course is comprised of lectures, video and power point combinations and examinations. It allows users to participate in the online learning experience from anywhere at any time and at their own pace. Course has been developed and is presented by John Hexem MD PhD a board certified anesthesiologists with over 25 years of clinical experience.

The course is a total of more than 9 hours of continuing education, each module is about 1 hour in length and after each module has been viewed, a 10 question examination will be available, at the completion of all modules and examinations, participants will be able to print a verification form, stating they have received 9 hours of CE on the administration of sedation.

Course topics include; A Culture of Safety, Assessment, Sedation, Pain & Phobia, Monitoring & Management, Adverse Events, Pharmacology, Recovery & Discharge.
Courses will also be available for institutional licensing as a mechanism to credential staff on sedation administration.

Courses are available on the company's website at www.SedationConsulting.com

Conscious Sedation Consulting LLC is an ADA CERP Recognized Provider.
ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.

For more information on this or other services this company provides, inquires can be directed to:

Conscious Sedation Consulting
5988 Mid Rivers Mall Drive
Saint Charles, MO 63304
888-581-4448

I'm not a dentist, but there seems to be a lot of bad stuff brewing in people's mouths!

New statistics indicate that the prevalence of periodontal disease in the United States may be significantly higher than originally estimated.

This is according to research published in the Journal of Dental Research from the Centers for Disease Control and Prevention (CDC) and the American Academy of Periodontology (AAP) which suggests that the prevalence of periodontal disease may have been underestimated by as much as 50 per cent...Yikes!

You can read the full details here:

http://bit.ly/dCBAyn

Will this change the way you do anything in your practice? Patient communications, patient education literature, info on your web site?

I'm curious and hope this post will spark a lively discussion.

Dental Bill

For some people it's a living nightmare for others its a visit once every month, you guessed it the dentist! It does't take much effort to dodge going to the dentist all it takes is the usual 2 brushes a day, 1
in the morning and another at night and cut out the sugar intake but we all know it isn't as easy as that! I hold my hands up there is many times I forget to brush my teeth at
night due to just wanting to crawl into my bed and get my head on the pillow. If your working you will know that dentist bills aren't exactly
on the cheap side and that gets me thinking is it maybe better to sort
out a dental insurance plan?

Modern dentistry has eliminated much of the "ouch!" from getting a shot of dental local anesthetic. Now a new discovery may replace the dental needle used to give local anesthetic in the dentist's chair for many procedures.Scientists are reporting evidence that a common local anesthetic, when administered to the nose as nose drops or a nasal spray, travels through the main nerve in the face and collects in high concentrations in the teeth, jaw, and structures of the mouth.

The discovery could lead to a new generation of nasal drug delivery systems for noninvasive treatment for dental pain, migraine, and other conditions, the scientists suggest in American Chemical Society's bi-monthly journal Molecular Pharmaceutics. The article is scheduled for the journal's May-June issue.

William H. Frey II, Ph.D., and colleagues note that drugs administered to the nose travel along nerves and go directly to the brain. One of those nerves is the trigeminal nerve, which brings feelings to the face, nose and mouth. Until now, however, scientistsnever checked to see whether intranasal drugs passing along that nervemight reach the teeth, gums and other areas of the face and mouth toreduce pain sensations in the face and mouth.

Neil Johnson, working in the labs of Frey and Leah R. Hanson, Ph.D., at Regions Hospital in St. Paul, Minn., found that lidocaine or Xylocaine, sprayed into the noses of laboratory rats, quickly traveled down the trigeminal nerveand collected in their teeth, jaws, and mouths at levels 20 timeshigher than in the blood or brain. The approach could provide a moreeffective and targeted method for treating dental pain and dental anxiety, trigeminal neuralgia (severe facial pain), migraine, and other conditions, the scientists say.

Furthermore, these scientists discovered an improved future location to administer anesthetic, the maxillary sinus. The maxillary sinus is a golfball-sized space located underneath each cheek where drug can be sprayed. Delivery into this confined space may be the next generation approach beyond a nasal spray in providing amore rapid and focused delivery of dental anesthetic.

Sept. 16, 2010 Woburn, MA – Virtual Dental Solutions announced that its free dental webinar for the month of Sept. will take place on the 16th. This month’s online dental meeting is titled “Ask the Consultant: An Interactive Event” and is sponsored by Banc of America Practice Solutions. Nancy Blumenthal-Kagan, founder of Summit Dental Partners, a practice management consulting company working with dentists and dental practices throughout New England, which will take place from 7-8 PM EST / 4-5 PM PST.

This online dental meeting will cover:

• Philosophies that successful practices share
• Systems for success
• Concerns all offices share
  • Staff issues
  • Administrative systems
  • Patient retention
  • Practice management software integration
• Where to turn for answers – Participants may submit questions when signing up for the webinar,prior to the webinar or simply raise their hands during this last segment.

e-DDS, a one-stop dental solutions company, has been conducting free dental webinars for the past several months in its endeavor to create a direct platform for interaction between dental industry experts and practitioners. With the tips and tools given in these online dental meetings, dental practitioners can manage their practices more efficiently.

Further information about this webinar can be found on http://www.e-dds.com/dental-practice-consulting.asp.

Interested attendees can register for the dental webinar on http://www.e-dds.com/form.asp.

Electronic cigarettes (e-cigarettes) pose important issues relevant to tobacco harm reduction. This post will review the facts about these products, which have been the subject of exaggerated claims by e-cigarette proponents and nicotine prohibitionists alike. Aswith most complex issues, the truth about e-cigarettes lies somewherein between.

When users draw on them, battery powered cigarettes vaporize a mixture of water, propylene glycol, nicotine and flavorings. Nicotine is one of the most intensively studied drugs in history; while it is highly addictive, it is not the primary cause of virtually any of thediseases related to smoking. In fact, long-term nicotine consumptionis about as safe as that of caffeine. Propylene glycol is approved by the FDAfor use in a large number of consumer products; it, too, is sometimesvaporized, forming artificial smoke in theatrical and otherproductions.

It is almost certain that e-cigarette use (also called vaping) is vastly safer than cigarette smoking, but this is based on limited scientific evidence. Some questions remain unanswered.

The health effects of long-term exposure of the respiratory tract to propylene glycol vapor are unknown, and unknowable. As a health professional, I am more comfortable recommending a product with a defined risk profile, where a clear risk-benefit analysis can be evaluated. That is why I have beena strong supporter of smokeless tobacco products as cigarette substitutes.I recommend these products knowing that we have 50 years ofepidemiology documenting the extremely low level of health risks.E-cigarette consumers must understand that the safety of e-cigarettescan not be guaranteed, despite the likelihood that they pose but a tinyfraction of the health risks of regular cigarettes. But given thepaucity of legitimate research, specific safety claims for e-cigarettescan not be made.

There is a lot of uncertainty with respect to the reliability of e-cigarettes, essentially all of which are imported from China. One of my colleagues ordered numerous products with the intent of performing some routine tests; many of these products did not function properlyright out of the box. According to a recent clinical study of twobrands (abstract here),“…neither of the electronic cigarettes exposed users to measurablelevels of nicotine or [carbon monoxide]…” Not inhaling carbon monoxideis a good thing, but for addicted smokers, not getting nicotine may be aproblem. Many e-cigarette users know that the devices often don’tdeliver enough nicotine to satisfy them, so they re-load cartridges witheven higher doses from commercially available concentrated solutions.Concentrated nicotine is dangerous, and this kind of experimentationis bound to lead to injuries.

The same study showed that “…both [brands] suppressed nicotine/tobacco abstinence symptom ratings.” This is impressive, because it indicates that e-cigarettes simulate the behavioral aspects of smoking and therefore may be successful in ways that no othersmoking cessation product can match.

Electronic cigarette cartridges may contain hazardous contaminants. Last year, the FDA conducted laboratory tests on a few e-cigarette cartridges. Although the tests were biased and flawed (as I discussed here), they found in one cartridge traces of diethylene glycol, a poisonous impurity found previously in propylene glycol (reported here).

Consumer products should be free of contaminants. Cartridges, as well as the hardware, should be subjected to independent quality control testing. The FDA tests underscored the need for regulatory oversight. This could be accomplished if the FDA regulatede-cigarettes as recreational tobacco products under authority from theTobacco Act. Instead, the FDA is attempting, inappropriately accordingto one federal judge, to regulate them as drug-delivery devices(discussed here).That would effectively remove them from the American market, leavinghundreds of thousands of e-cigarette users with no satisfactoryalternative to tobacco combustion.

There is no justification or scientific rationale to ban e-cigarettes. Still, anti-tobacco extremists are campaigning against them, claiming, entirely without proof, that they are a starter tobacco product for children. As with all tobacco products, they should notbe available to minors.

Another battle rages over whether e-cigarettes can be used safely indoors. Some militant users object to any indoor restrictions, while prohibitionists claim that second-hand vapor is annoying and/or toxic. The latter claim is preposterous, but e-cigarette users who arecourteous and respectful toward bystanders are likely to lead longer,healthier and less stressful lives.

Actor Michael Douglas' recent revelation that he has stage IV oral cancer has highlighted the growing incidence of oral cancer, and experts say dentists can help stem the alarming increase of the disease by checking for it during routine examinations.

The actor's cancer includes a walnut-sized tumor at the base of his
tongue, and he will require radiation therapy, chemotherapy, and
surgery. Douglas says his doctors told him he has an 80% survival rate
if it hasn't spread to his lymph nodes.

While tobacco was the prime cause of oral cancer in the past, recent studies have attributed the steady increase of the disease to
the human papillomavirus (HPV). HPV are common viruses that cause
warts. There are approximately 130 versions of HPV but only nine cause
cancers, and the HPV16 version causes almost half of the oral cancers in the U.S., said Brian Hill, executive director of the Oral Cancer Foundation.

"Tobacco is no longer the only bad guy," he told DrBicuspid.com. “HPV16 is increasing in incidence as the causative etiology, and if it
continues on this trend line, it will replace tobacco as the primary
cause of oral cancers."

Dentists can play a key role in catching the disease in its early stages if they check for it during examinations. Most Americans have
never even heard of oral cancer, but it's not as rare or
uncommon as people would like to think it is. This is why an
opportunistic screening by the dental community is so important.

Hill, a nonsmoker, got the same diagnosis as Douglas in 1998 and underwent radiation therapy, chemotherapy, and surgery. Since Hill's
oral cancer had metastasized to both sides of his neck by the time it
was discovered, surgeons removed the right side of his neck to remove
the lymph nodes there. He has been cancer-free for 10 years and said
there are a lot of stage IV survivors out there.

Changing demographics

In the last decade, the demographics of oral cancer have changed dramatically, according to Hill and other experts, pointing to the sexual revolution and accompanying increase in the prevalence of oral
sex. Today almost half of those diagnosed with the disease are younger
than 50 years old -- with some as young as 20, according to Hill -- and
they are usually nonsmokers. According to the American Cancer Society,
oral cancer occurs almost as frequently as leukemia and claims more
lives than melanoma or cervical cancer. The incidence in oral cancer
patients younger than age 40 has increased nearly fivefold, with many
patients with no known risk factors, according to the ADA.

"Social and sexual behaviors have changed," Hill said. "Oral sex is more common. The virus is spreading, especially among young people because sexual contact is more common, and this virus is not only ubiquitous in our society, but the mechanism of transfer is very simple."

Until 2000, scientists were unsure if HPV caused oral cancer, Hill said, but definitive research in 2000 revealed it as a distinct etiology for the disease, and more recent studies have supported this finding.

The disease is dangerous because often there are no symptoms in the early stages that a person might notice. "It's a very insidious disease," Hill explained. He recalled that it was not until a lymph node became swollen that Hill realized something was wrong. Even then, it was not painful, he said. Typically there are no physical signs of oral cancer. But an alert dentist will notice subtle signs and symptoms of oral cancer in a simple three to five minute visual and tactile exam, Hill noted.
"There will be things he'll pick up on, and that's why we're urging that the dental community to become more involved in oral cancer screening," he said. Approximately 36,000 new cases of oral cancer are diagnosed each yearin the U.S., according to the ADA, and some 25% of those people will die of the disease. Only 57% of all diagnosed oral cancer patients will be alive five years after their diagnosis, Hill said. Approximately 100 people in the U.S. will be diagnosed with oral cancer every day, he added, and one person will die every hour from it.

And unfortunately, celebrities with cancer helps bring about much needed public awareness about the disease, said Hill, noting that, in addition to Michael Douglas, such luminaries as Sigmund Freud and Ulysses S. Grant have been among its victims.

"When somebody famous gets the disease, it finally gets the world's attention," he noted.