Using a tooth to help the blind

I know this sounds weird, but there is a surgical procedure that uses a tooth implanted in the eye to help some types of blindness. It's called..

Osteo-Odonto-KeratoProsthesis

OOKP:

Osteo=Bone

Odonto=Tooth

Kerato=In this case corneal tissue of the eye

Prothesis=artificial replacement of a body part

Here are a few links:

Opthalmology Report-OOKP in Detail

Here is a CNN Report on this:

Chidren Grinding Their Teeth

"My child grinds their teeth at night, what should I do?" I get this question all the time. In adults it is often called Bruxism.  It seems most preschoolers grind their teeth (at least according to their parents).  I also see it a lot of this with babies trying out their new teeth.  Bottom line, it is usually not a big concern for baby teeth.

Teeth grinding in children seems to be very common.  Sometimes, continued grinding (usually at night), can cause abnormal wear of the teeth, sometimes it does not. 
When it does, I usually see flattening of the baby teeth almost if you had placed them on a sander. Sometimes it can look like back teeth in the photo here sort of like a bowl shape.  Sometimes there are associated factors that might aggrivate the situation like esophegeal reflux causing erosion of the enamel.

What to do? Well, even though it sounds awful and eventually can look funny, there is not much you can do. More importantly, usually there is really no need to do anything. As the enamel wears away the teeth flatten out, the dentin (inside more yellow layer) wears away even faster, sometimes leading to funny looking teeth like in the photo. It does not hurt as the pulp "scars" back out of the way about as fast as the kid grinds away the tooth structure. By the time you would see real problems due to lost tooth struture, the teeth naturally fall out. Very few cases I have ever seen where we needed any kind of restorative treatment or extraction.

What about a night guard? I might consider such a thing in adults who are grinding and doing damage to permanent teeth, that is more of a concern, but in kids-no. You would have to remake the thing so often due to growth and the kid would never wear it. Plus, like I stated, there is no real benefit.

"But the noise is driving me crazy!"  First, get your pediatric dentist to take a look to make sure what is going on.  If everything is ok, the grinding will likely reduce and most of the time go away by the time the permanent molars settle in around 7 or 8 years of age.  Oh, a good set of earplugs for the parents does not hurt. 

A Typical Day in Pediatric Dentistry-Part 1

This is the first of a two part series on a Typical Day in Pediatric Dentistry. What is the framework of a typical day for a Pediatric Dentist? Well, usually quite busy. Most Pediatric Dentist's services are in great demand. So, here is a typical day:
Get to the office early, usually 7:10 or so. I look over the charts especially the morning conscious sedation patients. If needed, fill out forms and mix the drugs, as they usually need to be administered first thing. We have a morning meeting at 7:30 with all the staff to review new patients and announcements. The first patients begin their appointments at 7:40---we're off to the races!

Most of my morning consists of doing operative dentistry (fillings, crowns, etc.) and spending a large amount of time checking hygiene patients discussing treatment, etc. We see our sedation patients in the am, usually preschoolers. In fact most of the morning is younger patients. It is usually a long busy morning--it can be a noisy morning too. Sometimes we get behind if a young child demands more attention. Hey, kids are unpredictable. It may take 10 minutes to do a filling, or an hour. It often depends on the patient. In addition, nearly every day we have patients with emergencies.

We break for lunch at 1:00 (if we are finished with the morning patients). Back to work at 2:00. It's nice to have a mental break from the fast paced, sometimes stressful mornings we have. That long morning is worth it to have a short three hour afternoon. We are often spent from the morning and see the teens and older more cooperative patients in the afternoon. Usually this is a high demand time for orthodontic patients. We end the day at 5:00. I usually do not leave the office till 5:30 if everything is on track.

On Fridays we see our hospital patients, doing treatment under general anesthesia. Pretty intense work too but a change of pace from the normal workaday routine. Most Pediatric Dentists like doing OR cases. Now having said all this, we do take some Fridays off and the occasional vacation. I don't know too many of us that can go too long without a day off.
Is that it? Well mostly, but if you are an owner, you have after hours meetings in the evenings or on the weekends. Not to mention having to come in on the weekend for an emergency. No rest for the weary.

APDA Carnival-Madison Office

New Madison Office Tour!

Is there a higher caries risk from lost sealants?

If a child has preventive sealants placed, but then the sealant is totally or partially lost, is that tooth more susceptible to dental caries? I get this question from time to time. I am pleased to say that the answer I have been giving is backed up by a review of several scientific studies. Teeth with fully or partially lost sealants were not at a higher risk of developing caries than were teeth that had never been sealed.

Hey, kids chew ice and other things that may cause a sealant to chip or wear off. Most sealants are supposed to last from 5 -7 years if you take care of them. Sometimes they do not last 5-7 months on some kids. Still it is reassuring that there is not a higher risk.

Of course, there are studies that show teeth sealed have a lower incidence of caries-that's why we recommend them.

Journal of the American Dental Association, Vol 140, No. 4pp. 415-423, 2009.

The Funny Things Kid's Say

Just a quick post today. I may add more to this later on, but it always strikes me the funny things kids say at the dentist. Of course, they say funny stuff all the time. I am just blessed to hear it more often than most because I see so many children every day.



Yesterday, in our office, a child recovering from a sedative medication looked at her mother and said: "Mommy, you have three eyes".

Also, yesterday a child said (with pride): "I broke my brother's arm. Yea, we fight real bad. I broke his arm."

Other things overheard: "My lip is fuzzy", "Is this real life"?

The little films we use to take intraoral x-rays are called "Bitewings" because basically you bite on them. Well, a long time ago a young girl heard something different: "Bat wings? you aren't going to put bat wings in MY mouth!"

Patient looking over to the doctor (not me)--said: "You ugly"

Thank you for letting me look at your teeth--patient says "you're Not welcome"

This is sooo funny, (but I worry about this kid and whether he was ready to leave the office)-still funny:



More to come....

Why Does Dentistry Cost So Much?

How much does a filling cost? How much to "pull" a tooth? These are important questions. However, because the cost of everything medical related is rising faster than the general rate of inflation, you need to ask yourself what are you getting for your money. This is not a product oriented business. You can't go online and get it a cheaper. Dentistry is part of the service industry. It is important to provide good compassionate care for these children.

What if I told you I could give you a filling for $10? What a great "deal"! So, I hand you the material we use for fillings (costs about $10 for that little blob of filling material). Are you happy? Now, wait a minute. Most of the cost of a dental procedure is not the materials (although that can be high enough sometimes). What you are paying for is Time and Expertise.

In order for a dentist to provide a service, he must stock the materials, buy the instruments to put in the filling and do the surgery, buy fancy dental chairs and equipment, hire skilled assistants and front office staff, and buy copiers and all the other stuff most businesses require to operate. In addition he must pay large insurance premiums, and buy very expensive x-ray machines. Then you obviously want someone qualified to do surgery. This is not your car, it's you; (or your child).

Expertise--Dental school takes four years after college, plus a few more years of specialty residency if needed. Most dentists are in debt up to their eyeballs when they enter the workforce. They have invested in the training and education to become proficient. He has become an expert. That's the guy you want working on your tooth.

Time--Have you ever noticed how little time the medical doctor spends with you? The nurses and office personnel do a lot and the M.D. is in and out in two minutes. Why? Time is money. The market demands less reimbursement, so the patient gets what he pays for. Although sometimes visits are short, dentists spend way more time with their patients especially during a filling or surgical procedure than do physicians.

Also, in the last decade insurance companies have influenced the market so much that a dentist often writes off much of the work he does. One often overlooked aspect of dentistry is the charity work done for free. I'm not making excuses or trying to make is all a bed of roses. If a dentist's fees are too low, he will eventually go out of business. Dentistry is a business and it is expensive. But all things considered, it's a bargain.You may just keep those teeth the rest of your life.

So, next time you wonder why it is so much. Remember: Time and Expertise.

Here is an interesting link:
Why Is Dentistry So Expensive?

New Office Construction Update

Check out the Construction Progress of our new office in Madison!

Dental Sealants

The American Academy of Pediatric Dentistry recommends placing dental sealants on the first permanent molars (at around 6 years of age) and the second permanent molars (which come in around 12 years of age).

Why? --Well, basically there are a lot of studies that say placing sealants helps reduce the incidence of cavities. Does it mean you will never get cavities?--no, it still can happen, but sealants can reduce the kind of cavities that form in the pits and grooves of the back teeth, you know on the top of the tooth--you still can get them in between the teeth and on the smooth surfaces.

How long do they last?--Even with a well placed sealant I have seen cavities form in areas previously sealed. Sometimes the sealant wears off (chewing ice for instance), or sometimes just because someone is very prone to cavities. They say they last from 5 to 7 years if you take care of them--even adults can get sealants, but they seem to be most effective in the cavity prone years of youth. What is the material? Well, it's basically the same material as used in white fillings without as much filler/reinforcing material, it's a bis-GMA resin, With less filler the sealant can flow into the grooves better. Sometimes we use "flowable" composite which is kind of in between in it's characteristics.

How are they placed? Does it hurt?--I like to say it's like painting fingernails--you basically just paint it on the tooth--now that can be harder than you think as these teeth are in the back of the mouth. Most of the effort is keeping the area dry.

Do you put them on baby teeth?--you can, but generally no. The enamel in baby teeth is different microscopically, they don't seem to stay as well, but sometimes if there is lots of grooves there, so there may be a benefit to placing them. Another thing to think about is that in preschoolers, placing a sealant is just about as difficult as a small filling because little kids, well it's harder to place the sealants. It is often better to simply have regular checkups to catch things early. Also, like I said many cavities in baby teeth are in between the teeth which sealants do not prevent.

I'm going to try and make a video on this some day.

More Here: Dental Sealants pervious post

What do you want me to blog about?

Ok, so I have not posted as much this past year as previously. Things have been so busy around here with our growing practice and in my personal life as well (in a good way). We are spending lots of time on our new office in Madison. So, what to blog about? I get ideas all the time, but now, I am going to ask you. There are a lot of topics covered in my previous posts. All these are listed in the sidebar over there to your right. The topic you are interested in just may be there, so please take a look. If it is not, please let me know what topics you want to know more about. I will take the most popular and try to address them if I think I can be of any help and it seems interesting to me--ha! Please, blogging topics only here, not questions about your particular child's teeth or situation on this particular post, just general topics you would like more information on like sealants retainers, etc. If it pertains to Pediatric Dentistry, Orthodontics, the Dental Profession, Children, or even life in general, let me know and comment here!

Dakota Fanning on "Teeth"

I had to repost this again. It's a great video about her teeth.



Here she is again with braces off in 10th grade in 2008:

Our New Digital X-Ray Machine!

We just installed a new digital Panoramic Cepholometric X-Ray Machine in the Huntsville office. The radiographs are outstanding! We had the Planmeca film based machine which was adapted to use plates which were scanned into the computer. Now we have a new direct to digital system. These things last a long time and I suspect this will last for most of my career. We will have one like this in the Madison office when we get into the new office in April. The ceph part kind of looks like a star wars storm trooper helmet.

Our New Madison Office

We are currently building a new office in Madison Alabama. We have an office there now, but it is getting really cramped. We need more space! The land has been purchased and we are in the design phase now. The new office will be just down the street from the old one and should be ready by the end of 2008 (if we are lucky).

It will be similar to our Huntsville office seen here. So do not fear, we are making changes to continuously improve both our facility and our service. Stay tuned for updates on this great new office!

Update--July 2008
We are breaking Ground!
For those of you from other parts of the country, that's Red Alabama Dirt.

Update--November 2008
Completed brickwork and exterior. Encountered a buried data transmission line, so will need to have them move it before we pour the parking lot. Still, things progressing well! Ordering some new dental chairs from Zelco Brothers in Houston, Texas. Construction is by Fife construction here in Huntsville-they are doing a great job. By the way, Forbes magazine named Madison county Alabama the #1 place to weather the recession.

Just For Fun-Paco the Pig

Just for Fun. I could not resist posting this. Here is a cute video my kids and me made about our favorite pig:

Paco the Pig-Olympic Edition

Animal Dentistry

I have heard about this a little, but there is really a significant business in treating dental problems of animals. Kind of surprising! Some veterinary practices are specializing in dentistry for dogs and cats and other various animals. There are two links at the bottom to some of these.

Dentistry on the Wild Side:

Open Wide!------>

Interesting links:
Veterinary Dentistry Practice
Another good link

Aphthous Ulcers (Canker Sores)

Ulcers in the mouth are quite common especially in children and young adults. Probably the most common is the Aphthous Ulcer otherwise known as a canker sore. We really don't know what causes them, but stress of various kinds can bring them on. Even if small they are quite uncomfortable. They tend to occur on the soft mucosa inside the lips or just beyond the gum tissues. There really is no cure, but they will go away on their own in about 10 to 14 days. These ulcers look like a small white spot surrounded by a red area. Any treatments are generally to reduce the discomfort. Possible over the counter treatments include baby oragel, tannic acid (Zilactin), Orabase-B ("B" for Benzocaine), Anbesol, etc.

Prescription medications my include anti-inflammatory medications such as Kenalog in orabase, or soothing mouth rinses for comfort. One I use a lot for really bad cases is a mixture of Benedryl liquid, viscous xylocaine, and maalox, all mixed together. Seems to help in some cases when there are multiple lesions. I have even seen some people use silver nitrate sticks to basically burn the lesions-hurts a lot at first but some say it helps the pain. ( I don't recommend this). As with all lesions a proper diagnosis is very important. You have to determine if it is something else. One basic guideline is, if it doesn't go away in 2 weeks, you get suspicious of other things.

Link:  Canker Sore/Mayo Clinic

  

Local Anesthesia in Pediatric Dentistry

Novocaine, that's the stuff that makes it possible to complete complex dentistry without discomfort. It's the stuff that "numbs" the tooth. Now really we don't use basic novocaine. I would guess the main drugs used these days are Lidocaine, Mepivicain, and Articaine. All these drugs are various derivatives in the same chemical family. They all do basically the same thing: make the area where we are working "numb".

It comes in little 1.8cc carpules that we put into the syringes. Yup, we still have to "squirt" the medication into the tissues, usually after placing some topical anesthetic. The numb feeling usually lasts a few hours. With kids you really worry about them biting their lip once they have left the office. I think the advent of local anesthesia is one of the the most significant advances in modern dentistry.

Blog Stats

Over time I have found it useful to monitor the traffic to this blog. I can tell how many people visit the site and what items are of interest. I am amazed at how fast the blog has grown!

By the way, many people ask questions of me. I have been generally happy to give my opinion, but have also tried to get across that I cannot give dental advice that is specific to any one patient (see disclaimer). Over the past few months I have gotten very busy and cannot devote too much time to answering questions. Therefore, I will be posting most of your comments, but will not likely be able to answer any questions.

Take a look at the growth of visits to the blog. This is amazing. I can tell you since this date the stats have gone much higher than even this:

Gemination and Fusion of teeth

Gemination is where a developing tooth splits into two separate teeth. Fusion is where two developing teeth merge into one tooth.

The appearance between the two can be similar, you just have to count the teeth to see if you have an extra one or a missing one. I see a lot of this kind of thing on the top and bottom front baby teeth. It can present a problem if they do not or cannot fall out at the right time and interfere with the eruption of the permanent teeth.

Gemination or Fusion can be total or partial. Here is an photo showing partial-gemination of a baby lateral incisor. You can see this "tooth" has two roots and two crowns but are both joined together, kind of like "siamese" teeth.

Stem Cells From Baby Teeth

There is now a company (BioEden) who has been able to isolate stem cells from baby teeth. This is a new alternative source for these non-embryonic cells. In the past, umbilical cord blood has been stored for potential use in the future treatment of disease. Because they come from baby teeth, there is no controversy as to the source of these cells.

I heard a representative for BioEden speak at the Annual Session in San Antonio. There is a good video on their web site. Also, here is a short news report on the subject: