X-rays and Brain Tumors

There has been a great deal of controversy about a recent scientific study that associates dental x-rays with meningioma, a common brain tumor. Understandably, this has raised questions from some of you about the safety of x-rays in general and dental x-rays in particular.

Meningioma is the most common brain tumor and occurs in about 15 out of every 10,000 people. It is a benign tumor, which means that it is not cancerous. The study found that people who had dental x-rays were slightly more likely to have meningiomas than those who did not. While there are some questions about the validity of the technique used to determine the patients’ x-ray exposure, (the researchers relied on the patients’ memory to guess at how many x-rays they had) the results of this study generally agree with similar ones done in the past and simply confirm what we have known for years – any kind of x-rays are to be used with caution. In other words, this is not big news.

To put this in perspective, the average American gets about 700 times more ionizing radiation from the environment and from medical procedures than from dental x-rays. Radiation is in sunlight, in the air, given off by building materials, and in cosmic rays from space. Unless you wear a lead suit, including a helmet, there is really no way to escape radiation exposure. But even given the fact that radiation is everywhere and that dental x-rays contribute only a minimal amount to the overall dose, it still makes sense to minimize exposure wherever possible.

So what changes do we plan to make based on the new study? Other than spending more time discussing the issue, we do not plan to do anything different. That is because we are already doing everything we can to minimize radiation exposure. We follow the principle known as ALARA: As Low As Reasonably Achievable. That means we take the minimum number of x-rays to diagnose and treat a patient safely. For example, we determine the frequency with which diagnostic bite-wing x-rays are taken (the ones we take at your recall appointment) by the conditions in your own mouth, not by a set of general guidelines.   Every time an x-ray is taken in our office, you are covered with a lead shield that incorporates a thyroid collar. For over ten years we have been taking only digital x-rays, which produce a significantly lower dose of radiation than conventional ones. In fact, the author of the study admits that the past exposure levels on which the study is based were much higher than they are today. In addition, our modern x-ray equipment is registered and tested by the State of Delaware. Given all these precautions, we believe that the risk of NOT taking appropriate x-rays far exceeds the risk of taking them.

Some patients ask, “Why take x-rays if nothing is bothering me?”

The main reason x-rays are used at all is that they find disease at an early stage – before it starts to hurt. We find tooth decay, gum disease, early abscesses, cysts, impacted or missing teeth and tumors, among other things. Early treatment of these problems is easier, cheaper, less painful and often prevents tooth loss. X-rays are one of the big reasons why most of our patients in their seventies, eighties and nineties still have their own teeth.

Some say, “I don’t care. I’ll just take my chances without x-rays.”

That’s your choice, of course, but it does raise legal and ethical problems for us. Taking appropriate x-rays is the Standard of Care and failure to do so is malpractice. We understand and respect your beliefs, but if you really want ongoing care without x-rays, we can’t be your dentist. Some of our patients have even offered to sign a waiver absolving us of responsibility if we don’t take x-rays. Unfortunately, that won’t work either. We are not allowed, nor do we want, to do negligent dentistry, even if the patient asks for it. The only option for a patient who insists on having treatment without x-rays is to find a dentist who is willing to take the risk – and good dentists won’t.

This study doesn’t really tell us anything new about dental x-rays. Our goal is to do our best to keep your teeth and gums healthy and attractive. As always, we are happy to discuss your concerns.

A Whole New Meaning for Thanksgiving

Once in a while, something happens that causes me to see the world through new eyes. It's usually a surprise event that makes me realize that the life I take for granted is not guaranteed and that major shifts can take place at a moment's notice. Such an event happened to my wife, Chris, and me on Thanksgiving Day. The turkey was in the oven and all was ready for our guests to arrive. She went out at about 2:30 pm to feed our horses before putting the final touches on the meal. After I while, I realized that she had been gone for an inordinately long time. I went to look for her and found her lying in the field. One of the horses had spooked and run over her. She was conscious but could not move and was in extreme pain. A 911 call summoned an ambulance and we took a trip to Christiana Hospital. It was determined that she had broken her hip. Early the next morning she had a total hip replacement. As I write this, it is just a month after surgery and fortunately she is doing very well. A full recovery is expected.

I learned several things from this experience. First, life is fragile and everything that we take for granted can change at a moment's notice. A broken hip is no fun, but she will mend. Had the horse hit her at a different angle, the result could have been much more severe and life-changing. Second, our current medical system takes a lot of heat from politicians and pundits but in our experience the care that is available is remarkable. Everyone, beginning with the EMS technicians and ending with the post-operative therapy staff, was skilled, caring and patient-centered. I am very glad that the accident happened here, rather than in some far-off, third world country. I shudder to think what might have happened if it had occurred in the African bush rather than at home.

As a result of all this, Thanksgiving has taken on a new meaning for me. I am approaching the new year with gratitude. I'm grateful for what we have in this country. Grateful that the accident was no worse. Grateful that we have first-rate care available to us. Grateful that, despite the administrative and funding mess that plagues our medical system, the people that provide care are able to put patients first. Grateful to be alive and healthy.

I'm not big on New Years resolutions, but I think this year I'll resolve to live in the present and appreciate what I have.

Dry Mouth

Patients with dry mouth, also known as xerostomia, are becoming more and more common, mainly due to the increasing number of people who are on multiple medications. It's a big deal because it is uncomfortable and because it can lead to rampant tooth decay. There is nothing more frustrating than to see a patient who has had healthy teeth foe many years suddenly begin to develop decay problems. In extreme cases, it can actually lead to the loss of teeth. The information below is from a handout we are designing for patients who have this problem.

Dry mouth occurs when normal saliva flow is interrupted for some reason. It most often occurs as a side effect of taking medications but also happens after chemotherapy or radiation treatment to the head and neck for cancer. There are also certain autoimmune diseases that result in dry mouth.

Xerostomia is an uncomfortable and potentially dangerous condition. Saliva acts as a lubricant, so without it the membranes in your mouth can become dry and cracked making eating and swallowing uncomfortable. Saliva also acts as a buffer, counteracting the acid produced by decay-causing bacteria. When your mouth is acid, decay can occur very quickly, even if you have not had cavities for many years.

There is no predictable cure for dry mouth. The best we can hope for is to manage it in such a way as to keep you comfortable and prevent decay. Some things you can do right away to begin the process are:

·         Carry a water bottle and take frequent sips to keep your mouth moist.

·         Use a humidifier when you sleep.

·         Minimize your intake of caffeine and alcohol.

·         Avoid mouthwashes containing alcohol. (Listerine Zero and Smart Mouth are alcohol free.)

·         Avoid sweet, sticky, spicy or acid foods.

·         AVOID CANDIES OR GUM CONTAINING SUGAR, LEMON OR CINNAMON !!!!!

·                             Avoid toothpaste containing SLS. (sodium lauryl sulfate)

             
              Non-Prescription Products 
                      Biotene Products (Available at  pharmacies and online www.biotene.com)

o    Oral Balance Gel

o    Mouth Spray

o    Liquid

o    Oral Rinse

·         OraMoist Disks (Available at Rite Aid or google “Oramoist disks”)

·         Xylitol gum and mints (Spry brand available at Harvest Market in Hockessin, the Vitamin Shoppe on Kirkwood Highway and online at xlear.com Other varieties at epicdental.com,)

·         Xylimelts (Avaliable at the office or online at orahealth.com)

·                             Boost Spray (Avaliable at the office)

·                             Carifree Treatment Kit (Available at the office)

         Prescriptions

·         Numoisyn Liquid and Lozenges

Comitting Suicide One Soda at a Time

As a dentist, I am on a permanent crusade against sugar because of its negative effect on teeth, but I’m beginning to think that tooth decay is the least of your worries if you are a big soda consumer. Here are some disturbing facts from a recent article in Bottom Line Personal.

The American Heart Association says that the safe upper limit for sugar consumption (above what is naturally present in foods) is six teaspoons for women and nine for men. Simple enough. But a 12 ounce can of cola contains 10 teaspoons of sugar. So do bottled iced teas and sports drinks. Even real fruit juices like orange, grape or apple contain about 10 teaspoons of sugar per 12 ounce glass. (It’s true that fruit sugar occurs naturally, but it creates the same disruption of body chemistry as added white sugar.)

So how many servings of these drinks do you consume in a year? If you are an average American, it’s 600 cans of soda and 125 12-ounce servings of juice. When you do the math, that’s about 7300 teaspoonfuls of sugar. American Heart Association guidelines are about 2000 teaspoons for women and 3000 for men. 

Without getting into the gory details, in addition to tooth decay, excess sugar consumption is associated with calcium depletion (as in osteoporosis), diabetes, autoimmune diseases, high blood pressure, pancreatic cancer, gout and asthma, just to name a few. These are all chronic diseases, meaning that they gradually diminish our quality of life. Said another way, we are killing ourselves a little bit at a time.

So what can you do? Switch to diet soda? I’m afraid not. In a study of 2500 people, those who drank diet soda daily were 61% more likely to have a heart attack or stroke than those who didn’t. On top of that, it’s hard to quit soft drinks because there are actual withdrawal symptoms, like headaches and cravings. Here are some strategies for quitting – switch from soda to fruit juice and water it down – about 25% juice and 75% water. If you like fizzy drinks, mix soda water with fruit juice or iced tea, about 50% of each. You can also add lemon slices or a little pureed fruit to good old water. There are a few commercially available beverages that are acceptable. Look for brands like Metromint or Hint. Be careful of so-called health drinks like Vitamin Water, however. Reading the label may reveal high sugar levels even though the name implies otherwise.

I have one more observation. Unless you have been living in a cave, you know that health care costs are one of the biggest economic challenges we face as a nation. The folks we have put in Washington don’t seem to have the slightest idea how to deal with it. What do you suppose the long-term economic benefit of reduced sugar consumption might be? Have you heard anyone in Washington talk about it in a serious manner? Neither have I.

Lifestyle Choices and Heart Disease

For over 25 years I have been a participant in the Healthcare Professionals Follow-Up Study (HPFS) sponsored by the Harvard School of Public Health. It is the world's largest, detailed long-term study of men's health. I fill out periodic, detailed questionnaires about my diet, exercise patterns, medical issues that develop and medications. The study has access to my medical records and occasionally even takes blood samples.What they seek to learn is the effect that dietary and lifestyle choices have on disease. 

In their recent newsletter, they reported on cardiovascular disease (CVD). While we all know the risk factors for CVD, I was astonished at what a large difference lifestyle makes. For example, men with a body mass index of 30 or higher (categorically obese) have more than DOUBLE the risk of skinny guys.

They also analyzed "low-risk lifestyle" choices which include prudent diet, regular exercise, weight management, moderate alcohol consumption and not smoking. Men who achieved all five of these factors had a whopping 87% lower risk for CVD than those who achieved none of the factors. Even men who were taking medications for high cholesterol or high blood pressure showed lower disease incidence if they maintained a low-risk lifestyle in addition to the medications.

I was pretty much blown away by these numbers. We all know that low risk behavior makes us healthier but I had no idea that the magnitude of the effect was so great. I guess I'll keep eating salads and working out at the Y.

VELscope and Oral Cancer

We have been using the VELscope in our oral cancer screenings for several weeks now. It's basically a high-tech, filtered, blue LED light that makes abnormal soft tissues in the mouth look different from normal tissue even before it changes enough to be seen with the naked eye. It's quick and painless and has met with overwhelmingly positive response from our patients. The idea is that the earlier we can find a problem, the better the chance of successful treatment.

Obviously, we can see more with the VELscope that we can without it. But using it has made me realize just how much we cannot see, no matter how carefully we look. We can't see down into the throat and in most cases, we can't really see the tonsils. Unfortunately,  these are areas where oral cancer is occurring more frequently in younger people. In a way, the VELscope is a metaphor for what happens in dentistry (and medicine, for that matter) every day. No matter how hard we try, it's impossible to find everything. High-tech stuff helps, but it is not a magic bullet. And we can't overcome the damage that occurs from harmful everyday habits. Treatments like filling a cavity or surgically removing a cancerous lesion are never as good as preventing the problem in the first place. I'm glad to have the VELscope, but I would be even happier if I didn't need it. Wouldn't it be great if no one smoked, or ate refined carbohydrates, or engaged in behaviors that encourage the spread of Human Papilloma Virus (HPV), a leading cause of oral cancer in young people? The VELscope is a cool thing to have and makes a big impression with many patients. Prevention, on the other hand, is not very dramatic but it is, by far, the best tool we have. 

Necessity is the Mother of Invention

On March 29, fresh from a trip to Viet Nam, I made a post about the difficulty of crossing the street in a small country with a lot of busy people and 25 million motor scooters. There's a lot more to the motor scooter story, however. If a motor scooter is your only means of transportation and an important part of your livelihood, you can use it for things that would never occur to those of us who have the luxury of having minivans and SUV's. In Viet Nam, the lowly motor scooter is family transportation, a commercial vehicle and a beast of burden among many other things, I saw scooters carrying dozens of live baby ducks, every conceivable fruit and vegetable, chickens, a side of beef, hundreds of eggs, hay and straw, flowers, stacks of cardboard for recycling, twenty foot long bamboo poles, giant bales of stuffing for furniture and the furniture itself. As long as the kids are little, it's no problem at all for a family of four to go on an outing with the sleeping baby wedged between Dad, who is driving, and Mom on the passenger seat while big brother sits in front of Dad. All kinds of things are sold from scooters. I saw basket vendors, brooms and brushes, pizza, a toy store and lots of mobile bakeries. I watched two guys weaving their way through traffic while carrying a full length mirror. But the most amazing thing of all is in one of the attached photos. Our guide in Hanoi, Huy, needed a new refrigerator. Rather than pay extra to have it delivered in a truck, he recruited one of his buddies who balanced it on the back of his scooter and made the delivery without incident.