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trends, innovations, and quirks of dentistry

Why your fingers shouldn’t be in the picture

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handinmouth

“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:

KKBWhand2

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.
 
DBSmile1
 
 
Please share this story with those you care about, even if it makes you feel like the Radiation Nazi.

Open, sesame!

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I wish they would have named it “Strangle Me Elmo.” Because that’s how I feel about that particular character.

Sesame Street was my babysitter growing up, especially since the show and I are practically the same age. So when the news comes that Sesame Workshop is launching an educational oral health initiative geared towards two year olds and up, I get it. They’re about modeling good habits with jingles and images that kids will remember when it’s their time to “do what they saw on TV.”

This is especially helpful for the kids from low-income families, because parents may not realize that their own belief systems about primary teeth can prevent children from getting appropriate care. When a kid sees Elmo brushing his teeth and eating healthy “crunch” foods, studies show that they’re very likely to have positive changes in their own nutrition and hygiene habits, and so even if they’re not going to the dentist, they just might have healthier teeth.

Elmo’s annoying voice was not part of my childhood, so I don’t “connect” with him. But I would, oh, I SO would connect with him, if someone wanted to put him in my hygiene chair and let me spin a prophy cup at his fur.

 

 

Learn more about Sesame Workshop and their “Healthy Mouth, Healthy Me” series here, and you also may enjoy reading this interview with Dr. James Crall, Sesame Workshop advisor and professor of pediatric dentistry and public health & community dentistry at UCLA.

Suction supermod

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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.


Release the (S.) mutants

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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.

 

 

 

 


Patients can keep on smoking?

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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. 

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