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Browsing 12 posts in critical thinking.

Gum disease doesn’t cause heart disease

Contrary to what you hear from a LOT of dental marketing, heart disease isn’t caused by gum disease. It’s technically correct that gum disease and heart disease are correlated or “linked,” but there is currently no evidence that gum disease causes heart disease. Or stroke. Or other health problems.

Here’s the thing…a lot of these diseases have similar risk factors. For instance, if you are a smoker you are at greater risk for heart attack and stroke as well as gum disease (as wegum-diseasell as countless other health problems). So the correlation between these maladies may have more to do with similar risk factors than the actual expression of the disease.

I’m not saying that treating gum disease is unimportant. It absolutely is important and worthwhile! Treating gum disease early and thoroughly (which includes teaching patients how to maintain their gums and teeth at home) could help patients avoid pain, infection, tooth loss and expensive dental work in the future. A few years ago I compared gum disease to one of my favorite comic book characters:

“So imagine this calculus on the surface of the roots of your tooth like a bunch of tiny slivers. Your innate immune system recognizes it as a bad guy, but cannot remove it. This makes the innate immune system mad. Kind of like when Bruce Banner gets mad. And the madder your innate immune system gets, the stronger the reaction it creates to try and remove this invader. It starts dumping the toxic chemicals it uses to kill bad bacteria and other bugs into the tissues supporting your teeth! These chemicals, along with toxins from the biofilm itself, start to break down the tissues that support your teeth. It’s kind of like you have an angry Hulk smashing around in your gum tissues, but he’s not able to get rid of the bad guys. And this makes him really angry! So instead, he starts attacking YOU!”

Essentially, gum disease is a combination of bacterial build up in your mouth and your immune system creating inflammation that breaks down the tissues supporting your teeth. Localized inflammation around the structures of the teeth causes the problem. Can this localized inflammation cause inflammation in the rest of your body?

The best answer at this point is, “maybe.” Ongoing research could indicate a more direct causative effect in the future. But for now, it’s not there. Even the American Heart Association agrees. The best way to prevent heart disease still continue to be:

  • quit smoking (and if you don’t smoke, don’t start!)
  • maintain a healthy weight
  • control your blood pressure
  • stay active

For the moment, treating gum disease isn’t on their list.

There are some dental professionals that try and use this “connection” between gum disease and “whole body health” as a scare tactic in order to promote treatment. Some even want to teach this technique to other dentists to help “fatten the bottom line” for dentists. Which is just perfect, right? As if dentists need something else to wreck our reputation as a profession.

Again, I want to stress to patients that treating gum disease is worthwhile in its own right. We’re interested in your overall health as well…that’s why we screen blood pressure and do a thorough medical history. But treating your dental needs is worthwhile without the baggage of unscientific claims and scare tactics.

Did this make you feel anxious? Do you feel holistic? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

 

Choose dental health. It’s much cheaper.

I recently had a patient cancel her appointment at the last minute. This happens sometimes. It’s frustrating for a dentist or hygienist when we’ve set time aside for a patient and they don’t come. Usually there’s a good reason. In this case, no reason was given.

As I sometimes do…I took it personally. Why did this person choose not to have the treatment done that we discussed? What could I have done better?

This particular patient has been coming to our office for years. She is someone you might describe as “skeptical” of dental treatment. I suspect she had some bad dental experiences before I even came into the picture. She’s at least mildly phobic of dental treatment, too. However, I think she’s probably one of those people that believe that when I come in the room that I’m simply looking for work to do, probably to line my pockets.

-Do I really need this crown--It’s a difficult spot for a dentist. Often times we’re both the internist that diagnoses the problem and the surgeon that fixes it. Patient see this as a conflict of interest. The guy who is telling me that I have cavities is also the guy who benefits from them being fixed. I completely understand this. I take my role as a doctor very seriously and I put my patient’s needs first. But can you blame a patient for being skeptical of a doctor’s motivations?

When I examine a patient I’m looking to see what level of dental health the patient has. And when I see a problem, I’m obliged to tell them about it. I have found what I believe is the most effective way to do this. I do all of my recall exams with a dental operating microscope. This microscope magnifies what I can see and has a very bright light that allows me to see parts of the mouth that don’t get lit up very often. I’ve attached an HD camera to the microscope with a monitor mounted over the patient to allow them to see exactly what I’m seeing…as I see it. I feel like this is a great solution to the problem of showing the patient what I see instead of me just describing it. I like it more than still photos because I can show it to them “live” as I’m describing it.

blog post scopeBack to my patient that chose not to come in today. I definitely examined her with the microscope and I definitely showed her what I was seeing. I recommended to some treatment because I saw some problems. I try and do this dispassionately. I try not to “sell” a patient on treatment by showing them what I’m seeing. I try to help the patient choose dental health by showing them what I’m seeing and describing what we can do to correct dental problems.

I have a suspicion that this patient still thinks what I’m describing isn’t a real problem. Like many dental problems, what I’m describing probably doesn’t hurt. Most cavities don’t hurt. Gum disease almost never hurts. Even broken teeth often aren’t painful. If you use pain as the threshold for dental treatment, you’re probably going to end up choosing the most expensive way to fix the problem or worse, sometimes the problem can’t be fixed leading to the loss of a tooth. A small cavity left untreated almost always becomes a bigger cavity, so what may have been easy to fix with a filling could end up needing a crown or even a root canal. This sounds like a scare tactic used by a dentist. Ask any dentist and they’ll explain that they see it. All. The. Time.

So I’m going to suggest that you listen to your dentist’s recommendation. The choice to treat is always yours. But almost always, the sooner you treat a problem, the less expensive and potentially painful the fix is.

Did this make you feel skeptical? Are you feeling put under the microscope? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

 

 

“Did you take your premedication?”

I hear these words almost every day. Someone on my amazing and responsible team is either reminding a patient to take their premedication or asking them at the appointment if they did remember. They’ve gotten really good at it because we’ve been doing it as long as I’ve been a dentist. Dentists have been acting as if dental procedures are inherently risky for developing heart problems or artificial joint infections in certain patient populations. It’s time to set the record straight.

Virus infectionInfective endocarditis is a scary sounding condition. It happens when bacteria get into the bloodstream and end up infecting the lining of the heart, a heart valve or even a blood vessel. It’s a very uncommon infection. People who have certain heart conditions are clearly at greater risk than the rest of the population. But the one thing everyone seems to know is that dental treatment is almost always the cause. We know this because the mouth is full of bacteria, and dentists and hygienists cause bleeding with their treatment. So bacteria is definitely going to enter the bloodstream if you have dental treatment and if you are at greater risk for infective endocarditis, you better look out.

So what have we done for dental patients with these heart conditions? We preventively treat them with antibiotics. A LOT of antibiotics. We used to give them doses of antibiotics days before and after dental treatment. But then later we dropped the dosage down to an hour before and several hours after. And now, we just give it an hour before.

But it’s O.K. Because we have solid evidence that our intervention prevents infective endocarditis at these levels, so it is worth doing, right? Well. Not really. The American Heart Association has continued to change its guidelines for premedication to the point where we only rarely premedicate patients with certain very serious heart conditions. For instance, we premedicate people who have had a previous case of infective endocarditis. Also folks with prosthetic heart valves and a few other rare congenital heart problems.

One of the more bizarre aspects of our tendency to premedicate our patients is the assumption that dental procedures in particular cause a great risk of bacteria entering the bloodstream. If you’ve ever bitten your tongue, flossed a little too hard or bitten down on a Dorito in the wrong way and caused a wound in your mouth, you’ve had an “event” that cause bacteria to enter the bloodstream. But you don’t see us lobbying Frito Lay to start lacing their corn chips with amoxicillin! The evidence for dental procedures causing infective endocarditis has always been a little thin. Patients treated for endocarditis (yes, thank goodness it’s very treatable) are always asked if they’ve had recent dental treatment. Some patients may have, so it was assumed that the dental treatment caused the infection. What I really want to know is if cardiologists are screening for nacho chips or beef jerky.

The American Heart Association continued to evaluate the evidence for taking a large dose of antibiotics prior to dental treatment Prescriptionand found little to no proof that the antibiotics prevented infective endocarditis. For that I say “three cheers for the AHA!” Many dentists and patients don’t think much about the megadose of antibiotics that their patients were routinely taking prior to routine dental treatments. What many don’t consider is that a hypersensitivity (allergic) reaction to antibiotics can happen at any time. Just because you aren’t allergic to amoxicillin now doesn’t mean you’ll alway s tolerate it. In fact, the more often you have to take it, the more chances you have to develop hypersensitivity to it. What I’m saying is even though taking antibiotics is common place for most people, there is still a risk involved. In fact, the AHA weighed the risk of taking a prophylactic dose of antibiotics agains the risk of developing infective endocarditis and determined that the risk was only worthwhile in a very select number of patients.

The AHA did what so many doctors, dentists and patients are unwilling or unable to do. They evaluated the evidence and changed their recommendations! Here at Mead Family Dental we follow the 2007 AHA guidelines for the very few patients that require premedication for a heart condition. A few patients who have been premedicating for a long time, find the change disconcerting. They assume that what they’ve been doing all along was correct and that the new recommendations are putting them at risk. However, most of these patients are tickled at the idea of not dealing with this premedication regimen.

A more complicated and less well defined problem is the risk of infection of artificial joints. I will tackle this problem the sequel to this post: “My surgeon told me to premedicate for life.”

Did you find this post heartwarming? Did it raise your heart rate a little? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

You’re pulling my oil: 3 reasons to skip oil pulling

Coconut oil for alternative therapy If you spend any time on Facebook, you’ve probably seen articles on oil pulling. The “ancient” practice involves swishing coconut or sesame oil in your mouth and through your teeth to increase your oral health. Not only is it claimed to be better than conventional oral hygiene, but many also claim numerous other benefits.

“…oil pulling is usually recommended for treating mouth-based conditions such as halitosis, gingivitis or oral plaque, it actually benefits the entire body. Long-term oil pulling has, for instance, also been linked to healthier hair, clearer skin, whiter teeth, elimination of parasites, improved body odor and the easing of joint pains. It is, in short, a full-body cleanse, and anyone with $5 to spare on good-quality oil can reap its benefits.”

So, should you use this technique for better health? Here are three reasons you should skip oil pulling.

  • It doesn’t do what they claim it does: One of my pet peeves is when alternative medicine proponents claim that a certain treatment can detoxify the body. If a treatment is meant to remove toxins, I think it’s important to specify what toxins are being removed. This is where much alternative medicine loses credibility. They convince otherwise healthy people that the environment around them is slowly poisoning them with toxins, but they don’t specify what toxins. In most cases, they don’t even use the term toxin correctly. A toxin is “…is a poisonous substance produced within living cells or organisms;[1][2] synthetic substances created by artificial processes are thus excluded.” Simply stated, a toxin is a biologically produced poison. Sometimes they’ll mention “heavy metals” or “chemicals.” Typically they insinuate that modern industry and technology is to blame for these toxins in our environment, but rarely do they get more specific than that. Motor oilBut let’s be honest, if you really needed toxins removed from your body wouldn’t you want to know exactly what toxins you have, how they got there and how a doctor is going to get them out? Rinsing your mouth with oil doesn’t remove toxins. At the most, the swishing action might mechanically remove some dental plaque. There is  some research that is suggestive that oil pulling can  have an effect on bad breath and  bacteria that cause tooth decay. However, the research is done on extremely small sample sizes with questionable experimental design. If there is an effect, it is likely from the mechanical effect of swishing the oil. Other liquids would likely have a similar effect. If coconut oil or sesame oil are good, wouldn’t a nice 5w30 motor oil be even better?
  • If it did work, it takes too long: Almost all of the proponents of oil pulling suggest 20 minutes of swishing oil around the mouth is required for the benefit. They’re actually quite specific about the 20 minutes…no more or no less. I don’t know about you, but 20 minutes is a long time to add to my normal routine. Brushing shouldn’t take more than 2 minutes. If you’re going to floss, there’s another two. If you choose to pass on oil pulling, I just saved you 16 minutes per day! And proper brushing and flossing is clearly more effective at cleaning your teeth and gums than swishing oil around. It’s true that I don’t make any claims of detoxifying your body with regular brushing and flossing, but oil pulling doesn’t really do that anyhow. No harm, no foul.
  • It isn’t risk free: Maybe you still aren’t convinced. You’re thinking, “sure, brushing and flossing is better and I might not be detoxifying my body, but what harm can it do?” There’s this thing called lipoid pneumonia. It’s a special kind of pneumonia that only occurs when someone inhales small amounts of aerosolized oil. Kind of like when you’re swishing coconut oil around in your mouth for 20 minutes at a time. Am I saying that oil pulling will give you lipoid pneumonia? Yes. Yes I am. O.K., I’m not really. I’m just saying that there is a risk of side effects that many alternative medicine proponents fail to mention.

Oil pulling is just the latest in a long line of natural cures being offered by proponents of alternative medicine. Medicine and dentistry can be scary. Searching the internet for information about health makes sense. However, the internet has no filters for information. In many cases, bad and incorrect information is easier to find than accurate information about health. Remember what Jimmy Wales, the founder of Wikipedia, once said:

“We are still in the very beginnings of the internet. Let’s use it wisely.”

Critical thinking techniques are vital to finding health information on the internet. The best bet is to have a relationship to a trusted dentist and physician. Ask them questions! Answering your health concerns is what they should do best!

Did you find this post oily? Perhaps a bit swishy? This dentist in Saginaw, MI would love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a Saginaw dentist, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

It CAN happen to you!

I’m currently reading a book called The Cure for Everything by Tim Caulfield. He brought a concept to my attention called “the information deficit model.” According to Wikipedia, the information deficit model:

“…is the idea that public uncertainty and skepticism towards modern science…is caused primarily by a lack of sufficient knowledge about…relevant subjects. The second aspect relates to the idea that by providing the adequate information to overcome this lack of knowledge, also known as a ‘knowledge deficit’, the general public opinion will change and decide that the information provided on the environment and science as a whole is reliable and accurate.”

In a nutshell, the information deficit model claims that a specific problem is caused by lack of information or knowledge and if we can present more information or the right information or present it in the right way, people will understand and see the problem differently.

According to the information deficit model, we should be able to solve tough scientific problems with great educational campaigns. Let’s take obesity as an example. Our country has an increasing problem with obesity. But with increasing education about eating right and increasing exercise, we should be able to solve the problem, right? Mmmm…not so much.

Here’s the deal. The information deficit model works in a perfect world. If every human being made choices from a completely rational point of view, we could solve our problems by educating the public alone. We humans aren’t so great at that. In fact, we humans have physical and emotional drives that are just plain illogical. I can decide that I’m going to eat only healthy vegetables in small quantities when I’m having a good day, but it’s tough to turn down a donut when it’s sitting in front of me. 

Furthermore, humans have an amazing capacity to justify our choices simply by believing “it won’t happen to me.” Everyone knows that smoking greatly increases the risk of lung cancer. Our government along with private interest groups have spent millions of dollars to educate people about the health risks of smoking. We all know that it’s terrible for our health. So why doesn’t everyone stop? Because just knowing something isn’t enough.

Most of what I talk about on this website pertains to preventing tooth decay. I’ve written posts on how to take care of your teeth, avoiding pop, using xylitol to prevent tooth decay, etc. I’m interested in educating the public about causes of tooth decay and how to prevent it. I won’t stop writing about it, either. But I understand that it’s not going to make a dent in how much tooth decay people get. It’s just too easy for an individual to think, “yeah, drinking pop can cause cavities, but it won’t happen to me…” Sometimes it just has to become a problem before the message gets from a person’s head to their heart. Having an abscessed tooth has been known to make a chronic pop drinker a convert to water!

It’s time for a gut check. Do you have habits that you know are harming your health in some way but maybe you’re having a hard time believing the consequences can happen to you? I know I do. I’ve been taking a good hard look at them. It’s not pretty and it’s not very fun. But I owe it to myself and my family to make some changes and I’m trying.

How about you?

Did you find this post preachy? Whiny? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

Gum disease and heart disease, dental x-rays and brain tumors…what’s the link?

I have this on my wall. No, really.

Two weeks ago the dental community was in an uproar. Morning news shows were making claims that “dental x-rays cause brain tumors” and “dental x-rays are linked to brain tumors.” What made dentists so mad? For one thing, dentists are an easy target. Many people have had bad experiences with dentists, many people are afraid of shots and a lot of folks associate toothaches with dentists. Dentists have baggage, and this news story didn’t help. So we’re kind of touchy.

There are a couple problems with the Yale research that these news stories were based on. First, the methods used in the study were questionable. But even if the results had been accurate, the news media took “x is related to y” to mean “x causes y.” This is a conclusion that the data do not support. There’s a lot more work that would need to be done before that conclusion would be fair. Just because red cars are twice as likely to be in accidents as blue cars, you cannot assume that the color of the car is what’s causing all the accidents!

Humans are kind of funny that way. Our brains love to “assign a cause.” We like to take two things that are proven to be related in some way and jump to a conclusion. Usually the conclusion we jump to is: “one thing is caused by another.” Dentists do it, too.

A recent statement from the American Heart Association has taken the dental world by storm over the last few days. Apparently the assumption that many dentists made about periodontal disease causing heart disease was firmly clarified by the AHA:

“The message sent out by some in health care professions that heart attack and stroke are directly linked to gum disease can distort the facts, alarm patients and perhaps shift the focus on prevention away from well-known risk factors for these diseases.”

Boom. That seems very clear to me. The statement continues:

“Although periodontal interventions result in a reduction in systemic inflammation and endothelial dysfunction in short-term studies, there is no evidence that they prevent ASVD [“atherosclerotic vascular disease” aka heart disease] or modify its outcomes.”

From what I can tell, the American Heart Association is saying “don’t use heart disease as a scare tactic about gum disease.” I think that’s fair. I’ve noticed for years that some dentists have played a little fast and loose with the relationship between gum disease and heart disease. The truth of the matter is that gum disease and heart disease share quite a few risk factors: smoking, age and diabetes to name a few. Gum disease is worth treating in its own right. Potential tooth loss, pain and bad breath are pretty compelling reasons to keep your gums healthy. It’s just that dentists were getting comfortable lumping potential systemic problems in with the other problems gum disease presents as a selling point to the treatment. This is intellectually lazy and we need to re-evaluate it.

Perfect

The moral of the story is this: “is linked to” does not mean “is caused by.” Even when your brain really wants to take that leap, you need to take a step back and really look at the relationship between whatever variables are connected.

Did you find this post interesting? Thought provoking? Tedious? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

 

how much radiation is too much?

I recently wrote about some new research that connected dental x-rays to a common brain tumor called a meningioma. Unfortunately, the news media took the “connection” from the research and made some pretty sensational claims. It made a lot of dentists pretty mad and it made a lot of patients pretty nervous.

Today I got a suggestion from a Facebook friend:

“Al, I’ve seen the phrase ‘levels of radiation that are so small as to be insignificant’ used a fair bit in the last few years. Particularly in relation to the Japanese disaster and the observation of levels of radiation around the world due to it…I think it would be instructive to have hard numbers to compare to background and other common sources that are considered safe.”

I agree. I’ve been explaining how safe x-rays are to patients for so long, I’ve kind of forgotten about the actual amounts of radiation that we expose them to. So let’s talk a little bit about radiation.

Electromagnetic radiation like visible light and x-rays travels in waves. And I have a cool graphic of it.

Electromagnetic radiation, or EMR, is any form of energy that travels in a wave. Visible light, radio waves, microwaves and x-rays are all forms of EMR that are common to us. The different types of EMR are characterized by their wavelength and frequency. Longer wavelength radiation like radio waves and have a lower frequency and are considered “low energy.” The shorter the wavelength the higher the frequency of the energy and generally these are “higher energy.” Very high energy like x-rays and gamma rays that can cause an electron to break away from an atom are considered ionizing radiation. These are the kinds of radiation that can cause health problems. Too much ionizing radiation can cause damage to the DNA in a person’s cells, which can lead to tumor formation and even cancer. The high energy state of x-rays is also what makes them so useful for seeing structures inside the body. Visible light is stopped by the skin and soft tissues around your bones and teeth, but x-rays can penetrate through them to show us things that we cannot see with visible light alone.

Harm from radiation sources is “dose dependent,” which means that more is worse. So in order to maintain safe levels of radiation in the dental office we need to know what kind of dose that we’re giving. The dose of radiation is measured in millirems or mrem. You can actually calculate common radiation doses using this chart from the American Nuclear Society.

So what is a “safe” level of radiation dosage? According to the American Nuclear Society the average level of radiation per person in the United States is 620 mrem/year. The safe allowable dose for people that are exposed to radiation in their work (nuclear plant workers, radiology technicians) is 5000 mrem/year.

Here are some examples of radiation dosages for different common exposures:

  • 1 bitewing or PA dental x-ray: 0.5 mrem
  • 2 hours in a jet plane: 1 mrem
  • 1 panoramic dental x-ray: ~3 mrem
  • living in a stone, adobe or concrete house (instead of wood frame): 7 mrem/year
  • a full mouth set of dental x-rays: 9 mrem
  • chest x-ray: 10 mrem
  • 1 pack of cigarettes each day: 36 mrem/year
  • chest CT scan: 700 mrem
  • whole body CT scan: 1000 mrem

These numbers reflect conventional film x-rays. Many dentists use digital x-ray technology which needs significantly less radiation to make x-ray images. In some cases the amount of radiation needed is 80% less than conventional film radiography, which would yield even lower radiation doses.

How much is too much?

Even though dental x-rays have an incredibly low dose of radiation, it makes sense to limit the amount of radiation as much as possible. Patients with a proven track record of low decay rate are an example of a type of patient that may not need diagnostic x-rays each year. Other diagnostic methods like high magnification with intense lighting, evaluating saliva flow and dietary evaluation can help determine a patient’s risk for new decay. For patients who have experienced cavities recently or new patients that don’t have a track record with their dentist, taking dental x-rays on a regular basis is necessary diagnostic tool.

So what’s a patient to do? How do you know if an x-ray is necessary? You need to ask your dentist. And if you don’t feel like your dentist is hearing you, perhaps you need to find another. Having a relationship with a dentist whose opinion you trust is a great way to know that you’ve found a good balance between too many x-rays and not enough information to prevent dental problems.

Did you find this post helpful? Zealous? Wonderful? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

 

Can dental x-rays cause brain tumors?

Can this cause brain tumors?

A new study attempting to correlate dental x-rays in the past to an uncommon benign brain tumor was published today. And the headlines are scary! A cursory Google search of todays news yields these headlines:

  • “Are Dental X-rays Causing Brain Tumors?” (reported by KGO-AM)
  • “American Cancer Society study links dental x-rays to tumor” (reported by ABC Action News)
  • “Dental x-rays linked to common brain tumor” (reported by Reuters)
  • Early Dental X-rays Linked to Brain Tumors” (reported byABC News)

You get the picture. If you read the headlines and listen to the superficial news story you could walk away with the message that “dental x-rays cause cancer” or more likely “dental x-rays = bad” and “avoid dental x-rays.”

I am a dentist. I use digital x-rays to help me diagnose dental problems all day long. I really don’t want to think that all these x-rays I’ve taken over the years are causing horrible things to happen to my patients. I think it’s worth taking a good hard look at how the research was done and what it really says.

  • studying “past exposure”: The newly published study deals with past exposure of x-rays. Current standards for film x-rays use much less radiation than past standards. Digital x-rays use much, much less than current film x-rays. So any findings of this research only deals with your exposure in much earlier life. Technology  has essentially solved the problem of higher exposure to dental x-rays already.

    Do you remember?

  • using patient’s memories: The new study is a case control study. Case controls are useful, but are one of the weaker forms of medical evidence out there. The study compared two groups. One group was composed of patients who have already been diagnosed with a meningioma and the other group of patients did not have the condition*. The researchers asked the patients in the study to remember how often and what kind of dental x-rays they had in the past. So the data for the study was dependent on what the patients remembered. Can you tell me what kind of x-rays you had in 1995? Can you tell me whether a panoramic x-ray was taken instead of a full mouth set of x-rays? I’m not critical of the study being done nor of the researchers. That is how case control studies are done. I’m much more critical of how the media is portraying this evidence.
  • type of tumor: A meningioma is a “benign”/rarely cancerous tumor. It is the most common brain tumor. Meningiomas are tumors that occur in the membranes lining the brain and spinal cord. They can range in severity from occult (the patient didn’t know that they had the tumor) to life threatening. Common complications are seizures, localized neurological problems (muscle spasms) and they can cause increased intracranial pressure. Depending on their location they can “crowd out” vital structures of the head and neck. More severe meningiomas often require surgery, and sometimes radiation therapy. The cause of this type of tumor is not well understood, although there is evidence that genetics plays a part. The current study was done in an effort to understand potential causes. I don’t mean to downplay the seriousness of a meningioma. Since I originally wrote this blog post I have heard from many survivors of meningioma and they assured me that I definitely had downplayed their severity, and for that assumption, I apologize. The most severe type can be debilitating and even life threatening. Luckily, the majority are not this serious. The bottom line…dental x-rays don’t cause cancer, they don’t cause brain tumors and this research doesn’t claim that they do.
  • “is linked to”: The media loves to make the connection that “A is linked to B.” It makes great headlines. But it almost never means what the media portrays it to mean. “Is linked to” is not the same as “is caused by.” “Is linked to” or “is correlated with” only means that there is a relationship between the two factors. The new research shows that there is a relationship, but it’s not reasonable to assume that one causes the other, yet. More research will be done that may help us refine our understanding of these relationships, but until then…don’t assume!

So, should you have a talk with your dentist about x-rays? Absolutely! Should you avoid them at all costs? No. Not at all. The amount of radiation used with digital x-rays is so small as to be considered insignificant. The amount of radiation from dental x-rays is surprisingly low relative to some other common exposures…you might be surprised! Treatment or lack of treatment should be based on the amount of risk that the treatment can cause. A frank discussion with your dentist should help you understand that modern dental x-rays, particularly digital x-rays, are a very low risk diagnostic tool that offer great preventive benefit.

Did you find this post helpful? Silly? Scandalous? I’d love to hear about it! You can share any Mead Family Dental post with a “Like” on Facebook, a “+1″ on Google+ or you can even “Tweet” it with Twitter! All you need to do is hover over the heart shaped button next to the title of the post. Or you can leave a comment by clicking on the balloon shaped icon next to the title.

If you’re looking for a dentist in Saginaw, we’re always happy to accept new patients! You can request an appointment online or call the office at (989) 799-9133. And, as always, you can email me at alan@meadfamilydental.com. I always answer my own emails!

 

*  Actually, the group was assumed to not have a meningioma…the researchers took the patient’s self reporting of no meningioma as the same as “no disease.” Since often the condition displays no symptoms, this isn’t a good way to choose a control group.

 

 

What’s the diagnosis?

25_house_lg Here's how it's supposed to work.  The patient comes in with a problem.  The dentist (that's me) looks at the patient, evaluates the x-ray, examines the tooth or teeth in question and tells the patient in no uncertain terms "you need a filling," "you need a root canal," or "this tooth can't be saved."  The doctor knows and tells the patient what they should do, right?

Here's the problem.  Each of those treatment recommendations kind of jumps a step.  I shouldn't recommend treatment without first explaining the diagnosis.

Merriam-Webster gives us a few different definitions for the term diagnosis. First is: "the art or act of identifying a disease from its signs and symptoms."  This is probably the most typical way people think of diagnosis.  This is how we can tell a cavity from gum disease.  They present with different signs and symptoms.  A sign is an objective measure of condition in the mouth.  Examples of "signs" are periodontal (gum) measurements or x-rays.  These are collected by the doctor in order to form a diagnosis.  Symptoms are subjective experiences of the patient. Common symptoms of dental problems are pain, "discomfort" and pressure.  They aren't measurable in the same way that signs are but that doesn't make them any less real.  Symptoms are described by the patient and interpreted by the doctor in relation to the objective signs collected.  

Another defintion of diagnosis is: "investigation or analysis of the cause or nature of a condition, situation, or problem."  I prefer this definition because it describes an active search to get to the bottom of the problem presented.

Some dental diagnoses (plural of diagnosis) are very straightforward.  A cavity found on the x-ray and verified with magnification and lighting and recorded with an intraoral photo is dentistry's version of the slam dunk.  This is a very common finding and the likelyhood of a dentist getting it wrong is very low.  

Other conditions require us to be a bit like a detective.  Sometimes we find ourselves settling on a differential diagnosis.  The differential diagnosis is a list of the most likely things that could be causing our problem.  For instance, "the tooth needs a root canal" isn't a diagnosis.  That's a recommended treatment.  A differential diagnosis might be "the nerve of the tooth is inflamed from a deep cavity.  It may be able to heal from this trauma (reversible pulpitis) or it might be on it's way to dying (irreversible pulpitis).  There are some signs and symptoms that help us determine which way it's heading.  And sometimes, we just don't know!

Next time you're visiting your dentist or your doctor, ask them to talk about the diagnosis.  One thing I can promise, they'll be surpised that you asked.  You'll be letting them know that you're an interested patient who wants to take an active part in their care.  I promise that you won't regret asking!

Are you interested in working with a Saginaw dentist who explains the diagnosis?  Then I'm interested in having you as my patient!  Drop me an email at alan@meadfamilydental.com (I always answer my own email!) or call the office at (989) 799-9133.  We'll get you in right away and you won't believe a dental office can treat you so well!  

Saginaw dentist reads minds! Amazing psychic powers???

Psychic So I had a patient in the chair earlier today.  I got a look at his teeth and said, “you have heartburn, don’t you?  You suffer pain in your chest and throat after eating Italian food.”

He got this look on his face.  It was kind of scared but also kind of amazed.  It was as if Sylvia Browne had told him about a relative of his from beyond the grave!

The difference is, Sylvia Browne uses cheap parlor tricks and I’m for real!

What’s my secret?  Was I born with this amazing power?  Have I trained under experienced psychics?

Acid erosion facets Nope.  I’ve just seen a ton of gastric reflux patients.  They have telltale acid erosion spots. They show up most often on lower molars. Once you realize they aren’t necessarily from bruxism (a.k.a.”night time tooth grinding”) I see them a lot.  The amazing thing is that 25% or more of patients with gastric reflux don’t have any symptoms!  No heartburn, no itchy throat, no noticeable bad breath. On top of that…these erosion area on the teeth usually don’t hurt. They’re often only detectable by a dental exam. This is particularly scary because untreated gastric reflux is a leading cause of esophageal cancer, and esophageal cancer is particularly bad!

This Saginaw dentist is trying to impress you with his amazing powers.  But have no fear…there’s nothing supernatural here!

Do you have questions about your teeth?  Would you like more information about gastric reflux or other topics I’ve talked about?  Feel free to email me at alan@meadfamilydental.com (I answer my own email) or call the office at (989) 799-9133.  I’d like to be your Saginaw dentist!

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