Silver Fillings (Amalgam)

I don't want a silver filling! I hear this from time to time in the office. What are silver fillings (amalgam fillings)? They are sometimes called amalgam because they have a few different things in them amalgamated together to form something new.

Just so you know we do not do amalgam silver fillings anymore in our office and have not for many years. This mainly was a factor of the improvement in the strength and durability of white fillings and patient demand. We have found that the ability of the stonger newer composite white fillings that bond to the tooth (strengthening it) and the cosmetic benefits make it a very desirable restorative material.

Amalgam consists of a powder of ground up mainly silver and copper and some other metals mixed with a little drop of mercury. You shake it all together (amalgamate). After a few seconds of "trituration" the thing is kind of maleable and putty like. It is placed into the cavity preperation and initially hardens in a few minutes. It is very important to note that there is basically no murcury coming out of a silver filling once it is amalgamated. They are quite safe as determined by extensive scientific clinical studies-(See links below.)
Silver fillings were very common in the past and were the standard of care, and still are, because they hold up quite well to biting forces. If a dentist is still doing silver fillings, that is still an acceptable method of treatment. There are a few drawbacks to "silver" fillings: 1. They do not bond to the tooth, they basically just fill the cavity. 2. They are silver so there is a cosmetic concern. Now, how many people are looking at your back teeth trying to see in there? If you know them that well, it probably does not matter what your teeth look like. Still, we are all concerned with appearance and want the most cosmetic solution available.

See the ADA sites here for more scientific reviewed studies on this sometimes controversial subject:
ADA site on dental filling options
ADA Summary of safety of Amalgam study April 19th issue JADA 2006

Halloween

We just finished the APDA fifth annual Pumpkin decorating contest. Patients voted these two pumpkins the winners:

Then, the entire office dressed up for the kids. Yes, a typical day in a pediatric dentistry office. You never know what you might see.

By the way, "Buy back Halloween Candy" programs from dentists IMOP are basically a well intentioned gimmick. Let the kids have their candy!-just brush afterwards and avoid the really hard candies.

My Blogworld Experience

Las Vegas! The Blogworld annual convention brought together bloggers from around the world to the sun drenched desert city. Blogworld for the first time had a medblogger tract of lectures and panels discussing medical professionals and blogging. I met the famous Dr. Anonymous, a podcaster who moderated the panels and Nurse Kim of Emergiblog, The life and times of an ER Nurse.

In addition to inspirational keynotes and technical tips, we also had a little fun too. Imagine if you will "The Bank" nightclub at the Bellagio hotel in Las Vegas full of bloggers. Most people were staring down at their phones texting and twittering away as the music played-no one dancing. The DJ actually said: "please put down your iphones and dance!" Yes, they/we eventually did dance and have a great time while twittering it all to the outside world. Bloggers are a pretty good group of people eager to share their love of blogging. I did get to meet a few famous folks including "Dr. Greene" of ER and Goose from Revenge of the Nerds (aka Anthony Edwards), and the infamous "Chad Vader" (Darth Vader's brother who is a day shift manager at a small town grocery store).

Why Do Doctors Have Such Bad Handwriting?

Why do doctors have such bad handwriting? Many people think most docs have atrocious handwriting. Why? Did they always have this condition? Do they teach it in medical and dental school? Being a dentist, I think I know the answer. Firstly doctors do not have bad handwriting, they just choose to write badly. This is not a conscious decision to confuse people, but an unintentional consequence of viewing other things as more important or urgent in the moment. These are the same people who have developed fine motor skills for precise surgical procedures. They CAN move a pen and write well.

Why? From personal experience, I have three writing styles. One is artistic and legible, the second is legible but occasionally a little more messy, and finally I have the doctor chicken scratch. Why do I "choose" to write messily? Like I mentioned above, we may be in a time crunch, usually not rushed, but mentally, writing takes on less importance than other things going on at the time. Even if we are not in a hurry, we immediately place the importance of a legible signature, etc. below that of a patient's time, the patient waiting in the next room and the much more important (to us at the time) of putting all our energy into diagnosis and treatment concerns.

As an aside, in the past there was a certain shorthand used for prescriptions that would mean, say three teaspoons that would be just a squiggle that the pharmacist would understand. These days it is still important the pharmacist and other health care professionals understand orders, prescriptions and notes. Thank goodness for the development of paperless solutions and computers. Oh, and spell check too!

Dental Curing Lights

What is that blue light you are shining in my child's mouth? Dentists are very gadget oriented. We love the newest gizmos some of which are valuable to our clinical practice and some which are not. One of the advances in modern dentistry is the advent of light cured composite restorative materials (in other words-white fillings). The filling material starts out like a putty like substance you place and contour into the cavity preperation. You shine this blue looking curing light onto the material. This causes a polymerization reaction and makes the material get as hard as a rock (harder really) in just a few seconds.


The light is not an ultraviolet light or a laser. Originally, they were a really bright projector bulbs with a loud cooling fan, cords and everything. Now the newer ones are wireless LED's which do not produce much heat. The light travels down a fiberoptic glass bundle to the tooth. (That's the curved rod looking thing). I think most of the cost of the things is making the fiber-optics. They also have reduced the curing times by adjusting the frequency of the light to match the chemical in the material that initiates the reaction-roughly 470nm. Curing times used to be about 40 seconds. The most recent one claims a 5 second cure. That seems a little too short for me, but we will see. They make the thing beep every 10 seconds or so as a timer, so you might hear a mysterious "beep" noise while in the dental office. For all this fancy technology, I tell the kids it's a flashlight, (which it pretty much is).

Oh, this is a short funny video showing the "flat (dead) battery" feature. Of course, I always dress in a tux in the office:



There are some other cool videos out there for different companies version of these lights, especially if you go deeper into their websites. Ivoclar has a Ivoclar James Bond Theme Video-A License to Cure

Light frequency distribution chart courtesy ADA Professional Products Review Vol. 4 Issue 4 2009.

Blogworld

Off to Blogworld next week...

I'm traveling to Las Vegas to attend the largest convention for bloggers in the, well, blog-world. More updates to follow.

An Interview

Here is the text of an an Interview I recently did with Dr. Torunn Birkeland that you might find interesting:

Dr Dean Brandon is a Pediatric Dentist who runs a dental practice in Huntsville, Alabama. He is also one of the most popular dental bloggers online. Visit his blog Pediatric Dentistry- a blog dedicated to Pediatric Dentistry and Orthodontics.

We give you this interview, to start off a series of interviews to present some insight into dentistry - with interviews of dentists, dental bloggers and others within the dental field.

1. Dr Brandon, you have one of the most extensive online blogs about dentistry and your speciality, pediatric dentistry, in particular. When and how did the interest for dental health and kids first start out for you ?

Early on in college I knew wanted to be involved in medicine and/or dentistry. The science and biology of it all fascinated me. Even before entering dental school, I knew I wanted to work with children either as an orthodontist or pediatric dentist.

2. You've been online for four years now with your blog and you have a wonderful way of combining your obvious passion for dentistry with easy to read, interesting topics that everyone can relate to. Why did you start blogging ? You've also been teaching at the University of Alabama. Do you think blogging and teaching ("bringing the message across in an understandable way") has helped you in your communication with patients as well?

I started the blog in 2006 when blogging was in it's infancy. I noticed how an obscure small profession could communicate through blogging. Not only as a marketing tool, but to educate. A blog is a conversation, not a lecture. The experience of dealing with patients (and parents) every day helps me with the way I write the blog.

The wording I use in talking with patients is the one I try to use in the blog, just as if I were talking right to them face to face. A technical boring academic dissertation on a topic would not communicate what you need to say---not in the office, and not in a blog. I do not do much "teaching" at the school anymore as our private practice takes all of my time these days.

3. You just moved to a new office in Madison, Alabama. How is a normal day in your office and what do you enjoy the most about your job? What do you find most challenging ?

As far as what we do pretty much every day, see my most recent post on that. I love the variety. Most jobs/professions are basically the same thing over and over again day after day. There is some of that, but it seems every moment there is some new intellectually challenging situation.

We constantly are moving from room to room, patient to patient. Each child that walks in the door is different. We love our new office. It helps that both offices are fairly new and basically the same layout. I made a short tour video so our patients would be able to see the new office even before their appointment. My kids helped me film the thing and it took some time to put it all together, but it was a great fun.

4. This is a common question : as an experienced pediatric dentist, how do you deal with kids that are afraid of/concerned about going to the dentist and if you were to give parents some advice on how to approach this, what would your top tips be ?

There are many posts on this subject in the blog. I have a lot on those topics there. Most of the time it's a combination of things. Diagnosing the child's general way of dealing with things, as children are sometimes very different. Some are naturally head-strong, some are always nervous and some are go with the flow. If we do things in a certain order, in a certain way, saying the right things, things generally go quite well. Sometimes we do need pharmacologic modalities (medications or even general anesthesia) to get complicated treatment accomplished, but generally, most things are not difficult.
So, as a parent, let the pediatric dentist do his thing. Do not relate your bad experiences or use scary words. It all comes down to two basic things. One, children are not little adults-you do not treat them as you would an adult. Kids are just kids-and you cannot really reason with the unreasonable (especially two year olds).

Secondly, the secret is: kids are not really difficult at all, its the parents that demand the most attention and cause the most stress. They bring strong personalities, expectations, past experiences and anxieties. They can be almost over-loving sometimes.It often helps if the parent lets their child be somewhat independent. If we have a child as a patient at a very young age and they come often and have minimal interference from parental anxieties, they will be great patients.

5. One last question : we also try to give some tips on dental insurance and dental plans at this site. There is a debate around the need for dental insurance vs. just discount dental plans. Do you have any particular personal views on this ?

I have mixed views on dental insurance. In general it is good for people with lots of treatment needs. It allows people to get work done that might not be financially possible otherwise. At the same time, as a general principle, insurance should only be for catastrophic situations-death, cancer, a major car accident, the rare but potentially financially devastating situation. Dentistry is more routine and would best be handled without insurance.
People often forget that an employer chooses to give them dental insurance in leu of a higher paycheck. Sometimes, I think it would be better for an employee to have the higher paycheck and use that money to deal with dental expenses. Remember, an insurance company is a middleman between you and your doctor, that can be a problem. Also, it is usually the employer that bought the policy and is the customer of the insurance company, not the employee.

Still, if it is offered anyways by the employer, I think it is can be a good thing, so long as the patient understands the limitations of their specific policy. It is very sad to me when a patient decides not to have recommended treatment done because their insurance policy "does not pay for that." There is always a concern with finances, but I think we as a practice have failed to communicate the real need for the treatment if that happens. No dental insurance policy pays for everything.

Link here to see original interview posting:
Original Interview post on Dr. Birkeland's blog

A Typical Day in Pediatric Dentistry-Part 2

What does a Pediatric Dentist do? I mean, what do we actually do on a daily basis?

In Part One on this, I described without too many specifics, the flow of a normal day. Here are some more specific cases I seem to see almost every day:

1. Teeth coming in behind baby teeth. Every day, I mean every day, a child (or several children) presents with this.

2. Chipped or Fractured Teeth-Usually after a long weekend kids show up with small or large fractures of their teeth. Some we just smooth and some need a composite buildup to restore.

3. Premed or Sedation Cases. These are usually the longer operative cases of the day. These are children who need conscious sedation for the longer or more complicated work they require-this can be anywhere from one tooth to multiple quadrants of dentistry: white fillings, stainless steel crowns, Pulpotomies, extractions, Space Maintainers.

4. Routine operative dentistry-one or two fillings, one crown, a couple of extractions for orthodontic reasons, etc. on more cooperative patients.

5. Occasionally the tooth ache, Ulcer, or other odd things that need a dentist's eye.

6. Orthodontic adjustments-not too many for me as we have a couple orthodontists that handle most cases. Still, I have a few Crossbite corrections etc.

7. AND--of course the many hygiene examinations we do throughout the day. Hospital Cases on Fridays.

What I do not see on a regular basis is something like that that I saw the other day. A "routine" examination of new patient. Yes, one or two cavities, but an evident large swelling in the mandible the size of a golf ball. X-rays, discussions with the other docs in the practice, and finally a referral to an oral surgeon for followup and likely surgical removal of an obvious tumor. Yes, we do see things like that and need to be prepared and educated to make the right decision. That kind of case makes the whole day much more interesting and rewarding.

Upgrading the Blog Layout

I am switching from old "classic" Blogger" to "new" Blogger. The look will change slightly, but hopefully the links will all transfer appropriately. All this is supposed to make it easier to add links, customize etc, but I am not sure. Change is often good. I hope to continually upgrade the blog. I even updated my photo!

Fluoride Varnish

Remember when your dentist put that sour gel stuff in a giant foam tray put a straw suction tip in your outh and let you sit like that for 5 minutes? That flouride treatment was to help prevent tooth decay. Now there are some better options than that aweful gel. Fluoride Varnish is the most elegant version of office applied Fluoride.

Now there are a hundred different kinds of fluoride and many ways to apply fluoride. There is the fluoride in the drinking water, which you might drink every day which has been statistically proven to prevent tooth decay in large academic studies. That concentration is about one part per million of fluoride ion (ppm). The oral rinses you get in the grocery store are about 200 ppm. Toothpaste has about 1000 ppm. Once you get into those kinds of ranges you really don't want to swallow large amounts of fluoride. That's why we do not recommend regular toothpaste for very young children (under two) and we ask older children and adults to rinse and spit after brushing. The kinds of fluoride we apply in the office are much higher concentrations, usually of a version called APF or Acidualted Phosphate Fluoride (the sour stuff) or sodium fluoride. There has always been a concern for children that you don't want them to swallow too much fluoride during an in office delivery-those concentrations can be around 22,600 ppm! Foam systems were developed and we use that from time to time as you can get the fluoride on the teeth more easily without such a large total dosage.
Now there is an even better way-especially for children-Fluoride Varnish. It's sort of a thick liquid you paint on the teeth coating a concentrated dose of fluoride right up against the teeth, but in total dosage it is quite small. Better yet, long after the patient has left the office, it bathes the teeth in fluoride. It lasts for a few hours or until the patient brushes. It actually tastes pretty good, kind of like bananas I think. The first version thay had was called Duraphat. It was good, but was yellow colored and although very good, it always bothered patients to leave the dental office with goopy yellow looking teeth even if it was just for a few hours. Now they have improved the color. It's a sort of clear/white colored material. It is painted on and once it gets wet, it hardens up a little. Pretty cool, huh.

ADA on Fluoride Varnishes

The CDC on Fluoride
AAPD on Fluoride

More info and video:
Vanish brand varnish from 3M
CDC on fluoride products

NASA, Apollo & 40 years

40 years ago, I was in Florida for the launch of Apollo 11 in 1969. Even though I was a kid, I remember it with great clarity as a most awesome experience. I also remember watching on a black and white tv the images of man's first steps on the Moon. Over the years I have followed many NASA programs. We have done much in 40 years, but I am somewhat disappointed that the country could have done so much more by this time--we simply did not have the will to do so.

If you ever get a chance to see a launch in person, it is an experience you will never forget. I have seen a shuttle launch and several of the Apollo launches. The Apollo was much more graceful off the pad and even louder than the shuttle, making the ground shake and the reverberations drumming on your chest were unbelievable even at over 3 miles away. Let me tell you, people wept with tears of joy, relief, awe and pride.

The Apollo mission was one of exploration and adventure. The Shuttle program, while very useful, was simply transpotation to low earth orbit where some experiments could be conducted and some technologies developed. Will we send men to Mars? Will we fund any further NASA missions other than the occasional unmanned pod? Will we continue to receive the spinnoff benefits of an advanced space program? The shuttle will "retire" in about a year. It will be some time before such a launch will shake the ground again.

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. Part 2 here 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!"

Student dentist sees mother and young three year old child--Student: "How you doin sport?" Child says, "I ain't no spoat you fool!" Mom then says: "Oh, don't pay no mind to him, he's got an electron loost inside of his head."

"That Sucks, that really sucks a lot"--child referring to the dental suction.

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 previous 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.