Featured – Page 5

Why your fingers shouldn’t be in the picture

March 15, 2013 By Trish Walraven 7 Comments

“Just this once; it’s okay.”

Does that sound like your practice? You know, you have a gaggy, bouncy kid who’s just about to tongue-thrust their way out of having those radiographs taken, but here comes Amazing Assistant to help you get a diagnostically acceptable image. SCORE!

The problem is that this never happens “just once.” I’ve seen the same person holding sensors in patients’ mouths dozens of times, and that’s when it becomes a problem. Yes, radiation is safer now that we’ve dialed it down and collimators make sure that there’s nothing scattering beyond the focused beam, but that doesn’t mean that we should be flippant about limiting exposure to our patients and most importantly, ourselves.

My best friend from high school could tell you not to hold those films in people’s mouths, too. She was a dental technician in the Navy and also worked for years in pediatric dental offices and orthodontics as an assistant, calming nervous children, helping them to have good dental experiences, and when she was exposing radiographs, sometimes she admits that she would make it easier on everyone if she would stay with the child while the x-rays were beaming through her hand.

She doesn’t have to tell you not to hold the films, though. She can just show you why you shouldn’t:

This is her right hand. Several years ago when she was doing laundry her finger caught on the dryer and “snapped.” This is important, sort of like when your patient tells you exactly what they were eating when their tooth broke – don’t you pay that the most attention of all? Because it was the darn dryer that was the problem….(!) Let’s be serious, though. Like you, her doctor really didn’t care what broke her finger, he wanted to know why it broke.

Turns out that she had developed a giant cell tumor in the first (proximal) phalange of her ring finger that had eaten everything except a small sliver of bone and that was what had snapped. These are very, very rare in small bones like those found in our fingers; most osteoclastomas happen in the larger bones like femurs and such. Hmmm.

Even though the tumor was benign, because of the damage done, the possibility of regrowth and other factors, the decision was made for my friend to have her ring finger amputated. I would have had her flip you the bird for effect but she no longer has a middle finger either…! (think about it…!)

So she was fortunate enough to stay in dentistry as a patient care coordinator for a few more years as she recovered but is now working towards her master’s degree for speech pathology. While she doesn’t seem totally convinced that excessive radiation exposure caused her to lose her finger, she doesn’t count it out for even a second.

And neither do I.

Losing a finger may be anecdotal evidence about the dangers of radiation, but it’s enough for me to feel like enforcing what we already know to be true.

Please share this story with those you care about, even if it makes you feel like the Radiation Nazi.

A plea to use DMG Icon infiltrant

February 22, 2013 By Trish Walraven 9 Comments

Don’t you think that this is the WORST part of orthodontia? You take off the brackets and voila! Straight teeth… with fugly white squares where acid beat the $#!† out your patients’ anteriors. And NOW you have to go drill on their teeth, destroying what you so carefully tried to perfect.

Once you’re here there’s no use in blaming the patient; it’s not like they’re going to get the brackets put back on to cover the white spots and then get more decalcification there. Yes, you should help them with their lifestyle choices (less energy drinks and voluntary mouth breathing, please) but at this point you have to do something to make them look better.

As a hygienist I’ve been totally itching for about the last four years to get the go-ahead to use a relatively new product called an infiltrant. There’s only one, it’s made by DMG and it’s called Icon. This infiltrant is placed on the tooth where it seeps into smooth-surface lesions that haven’t fully cavitated (although if you ask me the ones in the “Before” picture above look way gnarled out) and pretty much does a little remineralization voodoo.

I’d hoped that it would be classified as a sealant because Yay! I can do sealants. There’s no drilling done, right? There’s nothing taken away, right? There is, however, some irreversible improvement made to the tooth though and that (plus a significant etch time) means that when the CDT recognized that an infiltrant needed a code, where did that boom fall? Smack dab into Composite Land as a D2990. I know. The wording says “placement of an infiltrating resin restoration for strengthening, stabilizing and/or limiting progression of the lesion” and that SCREAMS prevention. Alas there’s the other word. Restoration.

Dangit.

Another problem is that this stuff is very expensive. See what it costs here for the mini kit for a maximum of six lesions?

That’s at best, $27 per tooth just for the kit (not including your other overhead or minusing the limited-time Amex card!). The suggested cost to a patient should be somewhere between your one surface composite fee and a sealant fee, and conservatively it takes at least 20 minutes of intense doctor time to place an infiltrant on a single tooth. Composites don’t cost that much or take that long to place so you know what that means, right? THE FEASIBILITY OF ICON SUCKS.

I really hope I’m wrong, but to most doctors, what’s a few millimeters of drilled-away tooth structure? Minimally invasive dentistry is for anal retentive freak dentists anyway. And every hygienist who has ever had a passion for preserving tooth structure, including me.

So yeah, this is bad news for Icon and for DMG, really. Sure, they got a CDT code this year but it’s not like anyone is going to use it. There’s like one dentist in a 5o mile radius that’s even ordered it around here. I know this because you can look on the DMG patient portal here and find a dentist that offers Icon in your area.

I have a challenge then. Actually two challenges – one for dentists, and the other for those who want to see this service added to the hygienist’s scope of practice in every state.

•If you’re a dentist and you love saving teeth, JUST DO THIS. Charge what you must, you’re not going to get rich, but you will have the warm fuzzy feeling that you’re doing the right thing by preserving tooth structure. We all know composites and amalgams eventually fail around their margins. There are no margins with an infiltration, just a lovely, arrested half-moon where an incipient lesion never progressed if you follow up with radiographs two decades from now (I may be exaggerating, but maybe not!). Go here, learn more, buy some.

•Those of you who are frustrated with dental hygienists wanting to become these mid-level providers that are supposed to help in low-access areas but will probably just come take your job away from you (I keed! I keed!) please support the use of infiltrants by hygienists. You will still need to diagnose that the treatment is needed but the service should be able to be delegated because of the very nature of the care being provided and the labor intensity needed for this smaller ROI.

As a realist, I don’t see squat happening as a result of this challenge. What can one blogger do? I have these silly dream glasses, when I put them on and see the future, well, there are no more cavities, on anyone, except arrested ones, and all the dentists are happy because all they have to do is play on the computer and nod their head every so often while their hygienists prevent all dental infirmities for ever and ever. Then I take them off again, and I see white spot lesions on teeth.

And I say…..dangit.

Thanks to Dental Products Report and The Catapult Group for this review of ICON from DMG America: http://www.dentalproductsreport.com/dental/article/review-catapult-group-delves-details-icon-dmg-america

Patients can keep on smoking?

January 24, 2011 By Trish Walraven 6 Comments

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.

UPDATED 2/21/19: The CDC has an infographic with a few surprising current statistics about e-cig usage. You can view it here:

https://www.cdc.gov/tobacco/basic_information/e-cigarettes/pdfs/Electronic-Cigarettes-Infographic-p.pdf

Worst Tasting Top Ten

August 30, 2010 By Trish Walraven 8 Comments

The next time your patient makes a yuck face at you with the accusation that the stuff that just hit their tongue has the most awful flavor EVER, you need to be sure and come back to this blog to share your experience so that your offending dental material can be rated accordingly.

For now, you’ll have to settle for this Top Ten, which was created by someone who is so meticulous about isolation that they never (!) get complaints about the taste of the following products:

The Top Ten Worst-Tasting Dental Materials

10. Air polishing powder

Some people like the taste of baking soda, which is why this is at the high end of the list. Others, you’d think that you’d hit them with the entire Pacific Ocean with the way they wretch from the spray. Young Dental has one of the better products in this category. And most patients actually do prefer it to the grit of pumice prophy paste if an operator is good at managing an air polisher.

9. Impregum Penta impression material

Fortunately the second generation flavor is much better than the first. But what is with the aftertaste? It’s not like you can use a rubber dam when taking a full mouth impression.

8. Vizilite rinse

Sour flavors seem to go over worse than salty ones. And because this cancer-screening pre-rinse is essentially vinegar, you may get a dirty look right before you start checking for the dirty bombs that are cancer cells.

7. Jeltrate Plus

Yum. Unflavored alginate with a splash of antimicrobial quaternary ammonium compounds to give it a little bit of awkward je ne sais quoi.

6. Compounded tricaine topicals

This is like benzocaine on steroids. Because it is not available in a commercial formulation, you’ll have to have a pharmacy compound the gel for you. John Hollis Pharmacy whips up a pretty mean cocktail of lidocaine, prilocaine and tetracaine at a decent price. It tastes pretty bad, but when patients rave about your painless injections afterwards, you’ll want a tube of it in every operatory.

5. Parkell Mucohard relining material

Not only does it taste foul, it gets bonus points for heating up while it’s curing in your patient’s mouth. This PDF from Parkell even cautions against leaving the patient alone for fear of spontaneous combustion.

4. Septocaine

Even a few drops of the local anesthetic inadvertently dripped onto the back of the tongue will make your patient want to chew through the stainless steel of your syringe. Be careful or else you will be switching back to lidocaine.

3. Viscostat hemostasis gel

Great for getting a lot of bleeding under control. Unless that bleeding is on the tongue. Then, not so great. Ultradent has addressed this notoriety by bathing their latest Viscostat with mint flavor ribbons. But I’m sure you can still taste the caustic astringency that would make bleeding to death not seem so bad.

2. The goo under a loose crown that you just removed

Can we all gross out at this one for a moment? And hahahahaha, they can’t blame this flavor on you. Which brings us to:

1. RelyX Unicem cement

Stag-nasty payback for that loose crown you just had to smell. RelyX gives you the ultimate in sourness and bitterness that lasts and lasts (but so does the bond).

_____________________________________

Why more dental product manufacturers don’t try to mask the noxious flavors inherent in their materials is a question that can’t be easily answered with chemistry or economics. If you’re not one to wait on this development, let your patients choose the flavor of their next crown seat or impression tray instead by carefully slipping them a few drops of one of these flavoring agents that are especially created for that purpose.

Pearson Dental Supply Flavorings

Practicon Flavorings for Alginates

Dental A to Z Flavor Set

jazidental Flavor Drops

American Dental Supply Flavor Kit

And when you ask your patient how everything tasted, they can honestly tell you it was just peachy. Or grapey, their choice.

Now it’s your turn. Which materials taste the worst to your patients? Leave a comment below to cast your vote.

I got a potty mouth

July 21, 2008 By Trish Walraven 4 Comments

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.

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