Dental X-Rays

A few weeks ago The New York Times published an article titled "Radiation Worries for Children in Dentists' Chairs".  Here's the link:

http://www.nytimes.com/2010/11/23/us/23scan.html

It focuses mainly on the radiation dose from a specific type of imaging device called a Cone Beam Ct Scanner or CBCT and it's potential abuse, but the title and content seem to blur the line between this technology and traditional dental x-rays.  The issue of dental and medical ionizing radiation can be confusing, and there's a lot of passionate and conflicting advice on the internet.  It's difficult to find reliable, unbiased, information on the topic.  I've found useful information at the Health Physics Society website:

http://www.hps.org/publicinformation/ate/cat5.html

The HPS is an independent nonprofit scientific organization devoted to radiation safety.  They're not affiliated with any government or industrial organization or private entity.



As parents, it's our duty to safeguard our children and make sound decisions for them.  It's unreasonable to expect every parent to be an expert on ionizing radiation.  So rather than getting into a technical discussion about radiation, I think it's more valuable to give you the following advice:

1.  Make sure your dentist knows about and practices the ALARA Principle.  ALARA stands for  "As Low As Reasonably Achievable".  ALARA means taking every reasonable effort to minimize the exposure to ionizing radiation.  For example, by reducing exposure times, utilizing shielding, utilizing proper technique, etc...

2.  Understand that dental x-rays should not be taken the same way for every patient.  If your dentist can't articulate to you the reason they are taking a particular x-ray...don't take it.  I don't take an x-ray unless either: 1. the risk of an undiagnosed dental disease outweighs the risk of the x-ray or 2. the x-ray is likely to have clinical implications...meaning that the results will affect treatment.  Children with poor hygiene, a history of trauma, or dental decay will typically require more x-rays than those with good hygiene, no trauma, and no decay.

I hope this helps!

Happy Holidays!

- Dr. Jeremy

Electric vs. Manual Toothbrush, Which is better?

This question comes up often in the office.  The simple answer is:

The one you use most often! 

There seems to be some debate as to whether powered toothbrushes actually clean better than manual brushes.  Virtually everyone agrees, however, that regardless of the type of brush you use, if you brush regularly and properly you will have healthier teeth and gums.

There are advantages and disadvantages to both types of brushes.  Electric brushes can sometimes be better for people with poor manual dexterity and/or motor deficits.  Kids with poor technique could conceivably benefit from the additional motion and 2 minute timers found in many electric brushes.  Manual brushes are less expensive and more portable.  They also don't require an outside power source.  I've found some kids don't like the added stimulation of the electric brushes, while others enjoy the novelty.  Some electric brushes have lights or music that guide kids to brush for a specified amount of time.

Regardless of which type of brush you chose for your kids, make sure that it has a small enough head for their mouth size, and soft bristles.

The take home message is...find a brush that your kids like and make sure they use it!  We'll help you, and them, make sure they're using it right.

- Dr. Jeremy

Cleaning Baby's New Teeth

It's important to begin cleaning our baby's teeth as soon as they come into the mouth.  When Audrey got her first teeth, I found these Spiffies Baby Tooth Wipes to be very handy.  I incorporated them into our bedtime routine.  After she finished her bottle, I would wipe her teeth with these while reading to her.  She really likes them! 

Wiping the teeth with the spiffies helps remove plaque and they're flavored with Xylitol, a naturally occurring sweetener that helps fight the bacteria that causes tooth decay.  Now that she is getting older (she's 14 months now) I'm using a small soft brush, but in a pinch, I'll still use these occasionally.

What's the deal with Fluoride?...Part 3

How should I be giving my child fluoride?

Here in New York City our municipal water is fluoridated, so your child is getting some fluoride if they drink tap water and/or if you cook with it.  In many areas, such as Nassau and Suffolk Counties here in New York and in some areas with well water, there is no fluoride in the water.  The American Academy of Pediatrics and American Academy of Pediatric Dentistry recommend that children in these non-fluoridated areas receive a daily fluoride supplement in the form of a vitamin.  This is a very safe and well established way to prevent tooth decay, and your health care provider can recommend the appropriated dosages for your child which are typically divided into three age groups:  6 months to 3 years, 3 years to 6 years, and 6 years to about 16 years.

It's also recommended that everyone brush twice daily with a fluoridated toothpaste.  For children under the age of two, a thin smear should be used.  For those between ages 2 and 5, a small green pea-sized amount should be used.  Your child will still benefit from using these small amounts, while reducing their risk of developing fluorosis.

You dentist may also recommend an in-office topical fluoride application depending on your home fluoride status, your child's dental hygiene and dental caries risk.  These typically take the form of a tray delivered foam or gel or a brush applied varnish.

I think the take home message for these related posts is that, when used properly, fluoride is an excellent tool for the prevention of tooth decay.  Actual fluoride poisoning is extremely rare and the benefits of using fluoride, as recommended, greatly outweigh the risks.

Best,

Dr. Jeremy

What's the deal with Fluoride?...Part 2

So what exactly is the downside of fluoride?

As with most minerals, vitamins, medications, and even water too much can be harmful.  Children with developing teeth, who ingest too much fluoride over a long period of time, will often develop a condition called fluorosis. 

Fluorosis is a disruption in the development of tooth enamel that often presents as "mottling" or small white spots or streaks in the teeth.  In most cases of fluorosis the discolorations are very subtle and easily remedied.  In rare severe cases the mottling can have a brown, pitted appearance.  This picture represents a patient with a typical form of fluorosis.

Fluoride ingested at extremely high doses can cause a serious or even lethal poisoning.  There are several hundred emergency room admissions each year for fluoride toxicity.  The vast majority of these cases occur in children under the age of 6 and usually result from the ingestion of great quantities of fluoride.  For a typical 3 year old child this would be over one half of an entire tube of toothpaste or about 10 gallons of fluoridated water in one sitting.  For a typical 9 year old child this would be about an entire tube of toothpaste or 20 gallons of fluoridated water at one time.

Next time in Part 3 - How should I be giving Fluoride to my child...

What's the deal with Fluoride?...Part 1

Over the past several years, I've been noticing more and more parents expressing concerns over fluoride use for their children.  So what's the story with fluoride, is it safe?  Do we need it?... 

To begin, it's important to understand that fluoride is a naturally occurring element.  It exists in combination with other elements as fluoride compounds and is found as a constituent of minerals in rocks and soil. When water passes through soil and over rock formations it dissolves these compounds.  This results in small amounts of soluble fluoride being present in virtually all natural water sources. 

In some areas fluoride is added to the public water. Water fluoridation involves adjusting the natural level of fluoride in the water to levels recommended for the prevention of tooth decay.  At optimal levels, there is no demonstrated difference in health effects between naturally occurring fluoride and that which is added to municipal drinking sources.  Using fluoride for the prevention and control of tooth decay has been consistently and repeatedly well established to be both safe and effective for decades.

Next Time in Part 2 - So what's the downside...

What are dental sealants and are they safe?

Dental sealants protect the grooved and pitted areas of the teeth against tooth decay.  They’re thin plastic coatings that bond to the teeth to prevent plaque and bacteria from getting into areas that are difficult to brush.  Depending on an individual's tooth anatomy these crevices may be more or less difficult to clean.  In some cases, even the best brushers won't be able to clean these areas as the toothbrush bristles may be wider than the crevices.  Typically, we seal the first permanent molars that grow into the mouth at around age 6 and also the second permanent molars that grow at around age 12.

Placing sealants requires no drilling of the teeth.  The procedure involves cleaning the tooth, applying a conditioning gel or "etch", placing the sealant which has a syrupy consistency, and curing it in place (or hardening it) with a light.  While the procedure is painless, we have to keep the tooth dry with cotton rolls, and some kids don’t like the feeling of the cotton in the mouth.  Afterwards the sealants often have a sticky or tacky feeling.  Again, some children get concerned about this, but it goes away after a day or two.

The sealants we use are tooth colored or a bit lighter than the tooth.  They can be sometimes be seen in an illuminated mirror, but not from a social distance when talking or eating.  Sealants can last 5 to 10 years, though I think 3 years is more the average.  In our office we check the sealants at every cleaning visit.  If they need replacement within the first year we do so at no cost to the patient.

While sealants are an excellent tool for cavity prevention, they don’t replace the need for a healthy diet and proper oral hygiene.  In fact, sealants can’t prevent cavities in the front teeth or in between the back teeth.  Sometimes we may recommend sealing baby teeth.  This isn’t done routinely, but only when we see a baby tooth that looks like it’s developing the beginnings of a cavity.  This would only be done if the tooth wasn’t going to be falling out soon and we wanted to avoid doing a full filling.  In this case we may remove a very superficial layer of the affected tooth enamel.  This sensation involves lots of vibration, but it doesn’t hurt.

Being a recent father, I’m always paying close attention to what my baby is exposed to.  One of the most prevalent, and highly publicized, chemicals that I try to avoid is bisphenol-A or BPA.  BPA is found in many plastic products, including a few brands of sealant.  In our office, we use a brand of sealant (Ultraseal, by Ultradent) that doesn’t contain BPA.  Instead it uses a much more stable Bis-GMA (see referenced link below for more info).  That being said, no sealant (or any other dental restoration for that matter) is “natural”.  They best way to maintain a healthy, chemical free mouth is still by eating well and having excellent oral hygiene.  This is also why, in our office, we don’t seal teeth in every patient.  We do so on a case by case basis only after a thorough examination and consultation.

For more information on the sealant we use see this link:

http://blogs.ultradent.com/fischer/2008/04/bisphenola_in_dental_sealants_1.php

The American Academy of Pediatric Dentistry has this to say:

http://www.aapd.org/publications/brochures/sealants.asp

And the CDC:

http://www.cdc.gov/ORALHEALTH/publications/factsheets/sealants_faq.htm

As always, I’m happy to answer any questions here or you can reach me below at:

http://gramercykidsdental.com