by Trish Walraven

Rubber dams, meet silicone simplicity! Awkward assistants, take your cheek retraction and spit-sucking attempts elsewhere. You have both been banned from the operatories where isolation mouthpieces rule supreme.

First brought to market in 2005, Isolite™ Systems originated the idea of combining dryfield illumination and isolation in a patented product called the Isolite, which costs about $1700 per operatory to set up. Whoa, steeeeep. The tubing and LED Smart Stick sure isn’t their loss leader, now, is it? Then you still have to buy a $2.50 mouthpiece for each patient because they’re not sterilizable. All of it together is still easier and less expensive than your assistant.

But what if you want to keep your assistant, even though she kicks you under the chair all those times you say something stupid to a patient or start getting all OCD over a procedure? You’ve already ditched your overhead lamp for loupe-mounted headlights, so maybe you don’t even need the Lite part of the Isolite.

About a year ago, Isolite™ Systems indroduced a non-illuminating version called the IsoDry that runs a little less than half the cost of the original product. Both systems come with extra tubing. Tooobing. Makes me want to laze down the Guadalupe River with a six-pack in a styrofoam cooler. Don’t we have enough tubes and hoses to twist around each other already?

This brings us to the essence, the soul, the very magic of what makes the Isolite System the game-changer that it has become. It’s all about the mouthpiece. This transparent, comfortable, easy-to-insert soft piece of silicone not only attaches to high-speed suction to create a dry field, it replaces bite blocks, throat packs, cotton rolls, drying angles, and everything else that you used to cram in your patient’s mouth to create a perfect restorative environment.

But in order to use the mouthpiece, the rule is, you have to buy an Isolite or an Isodry. You can’t just stick it onto your high-speed suction and use it solo.

Or can you?

Mark Frias, RDH, can hook you up to go commando. Literally. He’s invented a hook-up mod for the Isolite mouthpieces that must have been driven by the frustration of trying to keep a squirmy six year old’s teeth dry for sealants with traditional isolation. You can see the differences between his design and the original Isolite on the left. It’s not sleek and sexy, but from a cost perspective this little adapter is a no-brainer. Mark calls it the Kona Adapter. Why? Is he an Ironman Triathlete from Hawaii? Actually, I think he named it after his dog.

Whatever the case, the ingenuity here is striking at a great moment. Mark is having difficulty keeping Kona Adapters in stock if that’s any indication of its demand.

For those who are concerned about taking business away from Isolite, Mark suggests purchasing a single system for one of your operatories and fitting the rest with Kona Adapters. This will give you the privilege of being an official Isolite customer so that you can be assured that you aren’t buying mouthpieces on the down low.

And everyone really wins here. Isolite could give the system away like Gillette gave away razor handles to sell you the blades for the rest of your life, or use the printer model: sell the hardware cheaply to lock you into high-priced ink refills. It’s not like Isolite Systems is exactly losing money on the mouthpieces. With this new adapter, Isolite can now make money from the dental practices that may have not been able to justify a whole-office use of their product.

So slippery-gripped assistants everywhere: Ding! You are now free to move about the office. Your hands have finally been relieved without a significant lightening of your employers’ bank accounts.

by Trish Walraven

The Dramatization:

At first it was small. The outbreak began in Florida’s Tampa Bay Area as local hospitals noticed an influx of patients with complaints of turquoise discolorations of their lips and aversion to simple carbohydrates. Once case histories were correlated it was noticed that all those who were affected had either recently received an inoculation of a mutant version of Streptococcus mutans at their dentist’s office or had been in close contact with someone who had.

Initially the culprit was thought to be excessive consumption of blue raspberry slushies, but by the time the CDC discovered that an organism was responsible for these symptoms and that it was bacterial in origin and highly contagious the disease had spread far beyond Florida and had affected millions throughout the US and abroad.

There have been no reports of mortality, save the demise of the soft drink and candy industries. Sugar consumption has plummeted as more of the population becomes infected by this new strain of bacteria which was originally created to cure the problem of dental decay. Because persons who are affected display a noticeable change in their appearance, blue lips have become a strong signal of exclusion due to the fear surrounding this epidemic. However, as more evidence points to the positive outcomes of having been infected, the “blue look” is currently trendy in the larger cities. Blue-lipped patrons that had been banned from public venues such as restaurants and arena events are slowly trickling in, thanks to the assurances from the World Health Organization that this current situation has actually caused more good than harm. The long-term effects will be felt by dentists, who, in the next 30 years, will see an attrition of their necessity as caries becomes extinct, and possibly within the cosmetics industry with a shift in lip color preferences.

The Reality

Um, Yay? It’s been like, since the early 70′s that everyone’s been asking for a caries vaccine. And wouldn’t you know it? A company in the United States is already so ON this. Oragenics first initiated their first Phase 1 Clinical trials in 2005 but were halted by the FDA because of the fear of something happening like the above scenario. Think I’m kidding? Okay, maybe I was being sensational. But there can be genuine risks when you fiddle with a few genes, and the FDA seemed to be mainly concerned with the lack of a plan to eradicate attenuated strains in the test subjects’ children. AHHHHH!

It starts to get interesting when you look at the solution that Oragenics came up with to begin their second Phase 1 testing announced last week: The trial subjects will be inoculated with a strain of S. mutans that cannot survive without the amino acid D-alanine, which is not found in a normal human diet. This means that the subjects will have to feed their germs daily with a mouthwash to keep them from dying.

Are you excited yet? Well, you’d better hold those horses back for a while. A long while. It’s going to take a bunch of time and a lot more money to get this to the market.

The inoculation is designed to be a painless 5-minute treatment with a cotton-tipped swab to deliver the suspension of Oragenics’ patented bacterial strain into a patient’s mouth during routine dental visits. But this one won’t die without feeding. It will live forever.

And what is it supposed to do once it goes viral? Err… bacterial? Oragenics calls this treatment SMaRT Replacement Therapy™ and it promises to:

• Offer lifelong protection against tooth decay caused by S. mutans

• Eliminate the creation of lactic acid by oral bacteria

• Dramatically reduce the ability of S. mutans to cause tooth decay

• Be genetically stable

• Grow at a rate similar to non-genetically-altered S. mutans

• Aggressively displace the native, decay-causing strains of S. mutans and preemptive colonization of its niche

• Not cause any acute or chronic adverse side effects

I think it’s a foregone conclusion that this sort of genetic manipulation is probably the only way we’ll and break caries’ hold on humanity and the loss of teeth caused by decay. We can’t just kill all the bugs in our gut – all the Jamie Lee Curtis Activia commercials have given us TMI about probiotics lately – so it makes sense that this same premise is true in our mouths.

And the raspberry slushie is still your best bet for getting blue lips. Sorry, Oragenics will probably not be helping you there.

by Trish Walraven

Stanky Moufs, Stanky Moufs, I want to rid the world of Stanky Moufs. When a patient sits down in a chair with a freshly-stanked cigarette mouf, that smell hangs in the operatory longer than their jacket.

Is the American Lung Association with me? NO! Maybe it’s because they’re still getting a part of that $206 billion settlement from Big Tobacco back in 1998. Can’t put their sugar daddy out of bidness.

Well then, is the government with me? Not really. The government wants to tax those stanky moufs for recreational nicotine use, and they want to regulate the patches, gums, and lozenges being sold as medical devices designed for smoking cessation.

How many smoking patients do you have that don’t want to quit? They’re not supposed to admit to you that they really love smoking, now. Especially not to you. But more and more of them are coming into my practice, breaths a-bloomin’, tissues pinkin’, and when I ask them if they quit smoking, they don’t say yes. They say that they’ve switched to e-cigarettes.

RRRrrrRRT ( that record scratch stop noise that’s used too much in media but I can’t help myself). WHAT THE?  WHAT IS AN E-CIGARETTE?

I Gurgled it. Gurgling is kind of like Googling except that you ask your patient an open-ended question while they’ve got a little spit in the back of their throat that they really don’t have but they think they do and they want you to suck it out before they answer the question.

Best answer I got: “Well, everyone in our office either got a supply of E-Cigarettes if they would quit using regular cigarettes, or $200 to use on themselves if they weren’t smokers.” An employer has gone out of their way to get tobacco out of the bodies of their workforce. This sounded BIG.

That’s when the internet got much more handy than Gurgling. Here’s a great description of an E-Cigarette from AlterNet:

The e-cigarette was invented in China in 2004. It’s a cigarette-shaped tube that contains a rechargeable battery, a mini-vaporizer, a small reservoir, sensors and, in most cases, a light on the tip. The sensor notes when you take a drag on the tube and turns on the vaporizer, which more-or-less instantaneously turns the substances in the reservoir into a stream of visible water vapor that mimics the taste and feel of tobacco smoke. The tip glows like the end of a lit cigarette with each drag. It’s infused with the taste of tobacco – or tobacco combined with other flavors for those who are into that sort of thing – and nicotine, in various doses (including none at all). The refill cartridges – which look like the butt of the cigarette–give you about the same number of drags as a pack of cigarettes, but cost around $3 each – a bit more than half the national average and a third of what a pack of smokes go for in places like New York City.

The next question everyone asks is “Is it safer?” (I must stop with the Marathon Man references…this is only my second offense, sorry!). But really. Are e-cigs safer than tobacco? I for one am totally convinced that they will kill you much, much slower than tobacco, and far slower than water (if you’re drowning in it, of course). It’s the combustion that creates the majority of carcinogens found in cigarettes, which is why no real smoke is safe. The vapor ingredients in an e-cigarette – propylene glycol or glycerin – are Generally Recognized As Safe (GRAS) by the Food and Drug Administration. The problem arises when you don’t know what else is being added to the cartridges. Like Cialis. No joke. You can get some Cialis to smoke in an e-cigarette here. What about a dangerous, banned weight loss drug? They’ve got that too.

These extreme additives are all the excuse that e-cigarette opponents need to try to get them banned in the United States. That’s why no one will touch this issue, especially with the FDA coming down hard on new tobacco products in March. The federal courts are leaving it alone for now, but arising is a vast current of e-cigarette fanboys. They call themselves Vapers, and their recreation? Vaping.

What do you prefer? Stank Mouf or vape mouth? If your patients are committed to their cigarettes, it might not be such a bad idea to turn them on to something that may do less harm than their current habit.

I don’t know about you, but my ops are smelling better already. 

By Trish Walraven

2011 is the year for inspirations to move us towards actions, so it only seemed right today to share a few things with the DentalBuzz audience.

My subscriptions to various RSS feeds is getting rather long, especially the dental blogs, and it’s just not fair for me to keep them all to myself! You’ll notice that there’s a new Bloglist to help you get all of the news and insights that concern you as a dental professional. Some other resources that I use are DentalTown and Dr. Bicuspid, but if you also enjoy following individual voices then you simply must browse through all of the great blogs that I’ve evaluated here at DentalBuzz. Also, please me know if there are some that you read that I haven’t listed.

You may have already noticed the other change. It’s the voice here. The impersonal nature of third person sometimes causes me to feel disengaged from the audience, and as much as humor is less risky from that perspective (especially when bravery is involved because it can be DIFFICULT to pull off!) it also makes it harder to stay inspired. So hi, audience. One of my favorite kinds of humor is that which is Andy Kaufman-esque so it’s okay if you laugh uncomfortably at my poor comedic attempts.

In the meantime, this controversial article was recently written about a product that I was hoping to bring to the table at our next office meeting. The product in question is Perio Protect®, an anti-biofilm regimen that shows great promise for non-surgical perio resolution. Is it a scam? Can a periodontist’s opinion be trusted, especially when the argument is against a product that is being touted to specifically keep patients out of a periodontist’s practice? In this case, power to the blogger perio dude. Even though it is in his best financial interest to scorn a system that relies on patient compliance at home to be effective, he gets huge points for diligent research. Ultimately, it comes down to me and the irritation that he has caused me personally. Because I’ll now have to find some other implementable product or service to present in our practice for the new year.

Also Dr. Todd, thanks for the inspiration.

Tomorrow the an FDA panel will “probe cavity fillings” (that’s really the title of this segment shown on CBS this evening):
http://www.cbsnews.com/stories/2010/12/14/eveningnews/main7150398.shtml

Once again the media is out to sensationalize the debate by conjuring up images of daily vomiting, years of sinus congestion, and children who can’t go an hour without a seizure or two. And once again, it is mercury that is the alleged culprit.

If it really were as bad as it appears for the few people that are willing to testify before the panel, don’t you think that there would be a significantly larger population of people affected by mercury poisoning?

Four years ago, a panel decided that further study was necessary to understand whether amalgams give off more vapors when being placed or removed versus the amount of mercury vapor produced with chewing and brushing.

Maybe they were on to something there! What the FDA should do is launch a study of mercury levels in the blood, urine, and body tissues of the dentists who regularly place and remove amalgams, correlating symptoms described by those afflicted with mercury toxicity with the dentists in the study. If those symptoms are consistent in the dentists who have high levels of mercury, then go from there to decide whether amalgams are truly a problem.

The ADA stands behind the science. And until it is refuted, they are doing the right thing by not wavering on their position.

UPDATE – December 20th, 2010

Last week, an advisory panel to the US Food and Drug Administration (FDA) convened a professional panel review to again look at the safety issues associated with mercury amalgam in dentistry. A group of scientists and dental and medical professionals, lead by the International Academy of Oral Medicine and Toxicology (IAOMT), had called for FDA to reconsider its July 2009 “no risk” classification of mercury fillings. The FDA panel concluded that there are no huge scientific flaws in the agency’s 2009 finding that mercury-based dental fillings are safe for adults and children aged 6 years and older. The panel, however, recommended that the FDA look at more data, including the latest data, on the possible health risks dental amalgam poses to pregnant women and their fetuses and to young children, particularly nursing infants whose mothers have these fillings. The panel also said the FDA should consider adding warnings for these groups to the material’s product instructions.
 The ADA commended the panel’s call for continued research while offering support for the FDA’s current amalgam regulation. The panel’s call for more scientific data acknowledged concerns of dental amalgam opponents who link mercury exposure to dozens of diseases ranging from autism to Alzheimer’s disease.

After all the buzz in the past two years about a new type of carpule that also starts with an “O,” you may think you’ve seen this product before. In one sense it’s similar: it must be used in conjunction with your regular anesthetic instead of as an anesthesia alternative.  What’s more exciting is that this just may change the way we prepare syringes for every single patient from now on.

Onset™ is the name of a new buffering agent created by Onpharma™ Inc. that will be available as soon as the final FDA review is complete. If you can answer yes to these questions, read on:

Do you want to eliminate the sting that can be caused by the acidity of local anesthetic? Would you like to be able to give an injection and go to work immediately? Are you interested in a product that will help you get your patients profoundly numb, even when infection is present? What about tissue necrosis? Would you like to prevent it if possible?

The idea behind the pH buffering isn’t novel, but the patented device is. Onpharma™ has created a simple system that can be used with all anesthetics and also solves the problems of shelf life and proper dosing. Product previews aren’t yet available on the internet so all images and details will be withheld here at DentalBuzz until further notice (it’s so hard to hold a secret, though!).

If your curiosity is now piqued, make sure to click over to the Onpharma™ website and sign up so that the company can let you know when you can purchase Onset™.

Just don’t expect it to be rapid.  

____________________________

Dear Santa,

This is so hard; I didn’t know who else I could write that could help me in my dilemma. My college finals are over and I recently went to oral surgeon’s office about my wisdom teeth. The plan is to have them taken out right after Christmas. The deal is, they’re not hurting. In fact, they are so buried in the bone that they aren’t even close to my other molars.

The weird thing was when I went to the oral surgeon for a consultation, he told me that when he took the wisdom teeth out, he could send all of them to a cryogenics lab where they would extract my stem cells and freeze them in case I needed them in the future to grow new nerve, cartilage, bone, a liver, or even a new heart.

I thought about it a lot, I really did, Santa. Did my research, too and realized that you’ve got some experience dealing with people who want to deep freeze everything they can touch. Here’s what I came up with:

• The company that my dentist is using is called StemSave. It costs about $700 for StemSave to process and store my wisdom teeth for the first year and $100 per year afterwards. Until I use them or die, whichever comes first. 
•  BioEden is another company that also cryopreserves teeth for future use, with methods and fees similar to StemSave’s.
• The technology for the actual preservation seems good, and wisdom teeth may have more useable adult stem cells compared to bone marrow if I get sick and need them later in life.
• As teeth age, they have fewer stem cells in them.
• There is a bit of controversy on the subject – I’m worried that stem cell banking may be more beneficial for the cryobanking investors than for the patients. There’s not really enough long-term data to suggest anything but hope on the researcher’s parts.

Then I got to thinking in the opposite direction. What if I just left my wisdom teeth in place? Doesn’t my own body work pretty good as an incubator for all those stem cells? Guaranteed to stay a steamy 98.6 degrees (or more), whether or not I make the payments each month? And the future, being so bright and all, maybe there will be a way to harvest my wisdom teeth with lasers instead, and then tease out all those precious tidbits from the insides.

Now I know you’re not a dentist yourself, Santa. But didn’t I hear that one of your elves become part of the North Pole Cavity Patrol? I’ve enclosed a copy of my X-Ray for Dr. Hermey to look at. All I want for Christmas is my four back teeth, one way or the other. Please help me decide what to do, Santa!

Signed,

Blue Christmas Girl               

Nice product presentation on the left, don’t you think?

Now what exactly are they? The latest in clear maxillary molar implants?

Wrong. You stick them in your ears. You. The dental professional.  Yes, you, the person who is losing their hearing and doesn’t mind spending about a grand to protect what’s left of your stereocilia.

Not losing your hearing? Then prove it to yourself. Take the test below in a quiet place. Naturally you need to have speakers turned up to about medium to hear all the frequencies. The higher ranges are what are known as the “mosquito” ringtones, which are outside the audible range of people over 30, and often used by the young-uns to send stealth text messages to each other.

There have been a few inconclusive studies published in the dental journals this decade about the concern that high decibel-level noise is an occupational hazard in dental practices. We thought that now would be a good time to gather a little of our own anecdotal evidence, and see how dentists’ hearing stacks up to the general population.

Play	Frequency	Age Range
	8 kHz	Everyone
	10 kHz	60 & Younger
	12 kHz	50 & Younger
	14 kHz	45 & Younger
	15 kHz	39 & Younger
	16 kHz	30 & Younger
	17 kHz	24 & Younger
	18 kHz	22 & Younger
	19 kHz	20 & Younger
	20 kHz	18 & Younger
	21 kHz	17 & Younger
	22 kHz	16 & Younger

Be sure to use your browser’s “back” button to come back to this page each time until you’ve figured out which frequency is your upper limit.

The University of New South Wales in Australia has posted this test if you’d like a more comprehensive hearing exam. And if it looks like your future may be one of geriatric deafness, you might want to give thought to the benefits of a pair of DentalEars.

Hi. I’m a very sad American Indian. I am crying because I just learned that my children have Bisphenol-A in their dental sealants. BPA is bad. It means my boys might end up with man-boobs.

This is about dental pollution, people. It may be ignored by mainstream science, but this problem is real enough to sell newspapers, magazines, and make you read online articles.

What I’ve Heard About Dental Pollution

Everywhere I go I hear about how it’s not fair that the citizens of cities have no choice about the fluoride in their drinking water. Sure, it makes teeth stronger, but there’s a conspiracy of pollution! And it’s the people who are so poor that they can’t even afford cups, they have to tilt their heads sideways to drink under the sink faucet, they are the ones who get the most fluoride in their bodies.

Does fluoride save lives like chlorine does? Wait, I didn’t say that, because it’s going to sound like I am in favor of putting poisons in the water.

You dentists also are protecting the right to fix the holes in people’s mouths with evil substances. If you drill a tooth and put in a silver filling, you have to make the filling soft with toxic mercury. Why can’t you just heat up the silver and pour it in the cavity?

The high road dentists are no better, with their lady-man BPA-leaching plastic composites. I’d rather gnaw on a Nalgene bottle and take my chances with it than have an oil-slick wedged between my teeth 24/7.  The recent petroleum price increases are nothing compared to the cost in human lives.

The other thing that’s polluting our mouths is lead. There’s been lead found in ceramic/metal crowns. They say these crowns come from China. We like to blame everything on China.  But the real reason that there’s lead coming from the dental labs is because the cheap dentists have forced lab technicians to scavenge for scrap metal by secretly dumpster-diving for X-ray film packets.

My shaman tells me that all the metal he sees in people’s mouths is creating imbalance in their meridians. This pollution is caused by all the various metals sending out galvanic currents, which turns our mouths into electrolyte-driven batteries. It scares me even today when I see that trick with the guy who sticks the end of a lightbulb in his mouth and it turns on. I know he’s dying from galvanic currents just for a laugh.

One more pollutant that is caused by the well-meaning but unenlightened dentists of the world is when they leave a dead tooth in a living mouth. Would you leave a cadaver just laying around with living people? Well, this is just what is done when a dentist fills the root canal of a tooth and just leaves the dead shell of a tooth in place.

I’m no Navajo with my sand art, but I sketched out this modern flow chart to help us understand where all this pollution is leading:

The pollutants are circled in red. Only one treatment is circled in green because it doesn’t involve dental pollution.

With only two choices in life if we find that we need a dentist – a polluted mouth or the totally toothless gums of a baby – all we can do is pray to our ancestors to give us naturally strong, healthy teeth.

My life has been one of ignorance until now. I have been going to the dentist regularly, and have had various pollutants placed in my mouth. I still have all of my teeth and have no ill symptoms from the poisons. Should I be grateful, or should I be worried? Are teeth worth it, in the end?

Six Degrees Of Dental Pollution

Here are various tests that you can either do in your office or send home with patients to make sure that you aren’t polluting their mouths:

Fluoride: http://www.hach.com

Bisphenol-A: http://www.biosense.com

Mercury: http://www.heavymetalstest.com/_hgkit.php

Lead: http://www.zefon.com/store/leadcheck-swabs.html

Galvanic Currents: http://www.biomeridian.com/devices.htm

Root Canal Therapy: http://www.holisticdentist.com/articles/root-canal-treatment.html

I know that this isn’t Keep America Beautiful or any other grand public service announcement, but it’s important for dentists to understand the consequences of their actions. And sorry about the waterworks; you know how pollution is a touchy subject for me.

We finally figured out why the German guy was asking Dustin Hoffman “Is it safe?” in the movie Marathon Man. Obviously his wife was planning on having her third child and he was worried about the folk saying from his native country, “Every child costs the mother one tooth.”

Leave it to the Americans to show that these words actually hold a great deal of truth. Across the socioeconomic strata the results of data examination were consistent: women who gave birth to more children tended to lose more teeth during their lives.

So the next time a pregnant patient is worried about the baby “robbing calcium from her teeth,” dentists can acknowledge that there is a real correlation between making babies and an increase in dental disease. And then take steps with the mother-to-be to minimize the oral flora aggression that seems to rise in their mouths.

Hopefully this will mean fewer drills aimed directly through the central incisors.