How Hard Is It To Get Into Dental School?

How competitive is it to get into dental school?  I have addressed this in my book in some detail, but want to add this interesting chart (I hope you can see it-click it to enlarge slightly):

This is a long term view of the popularity of dental school.  The red line is the number of applications, the blue line is the number of positions available.  In the year 2010, there were 12,202 applications for 5089 slots.  There are times where applications fell and other times where the number of applications rose.

You can see the overall trend that there are more applications per opening now than in the recent past.  So, is this a more competitive environment?  Yes.  However, this is data can be somewhat misleading if you are to conclude one has no chance.  Decisions on entrance are made one student at a time.  If all the additional applicants in recent years have a less attractive resume than you, then it does not matter as much whether there are more applicants or not.  Still, usually these are top notch applicants.  In fact, I have some data that indicates the "quality" of the applicant pool in increasing.

The striking thing to me is the greater desire of students to select dentistry as a career and the rather limited number of slots in dental schools to meet that demand.  That, "bulge" in the blue line in the 1976-1983 time frame produced a large number, some would say a glut or oversupply, of dentists that are still practicing today.  They will be retiring over the next 10 years.

I have talked to many a physician, and have seen medicine become a less attractive field than it might have been in previous years.  Also, in times of economic downturn, the stability of a profession like dentistry becomes more attractive--and more competitive.

More info can be obtained in my new book:

Dental School: Preparation, Survival and Success available on Amazon.

Dental School-My New Book Is Now Available!

My new book, "Dental School: Preparation, Survival and Success" is now available.

Many times on this blog, people have asked questions about the dental school experience.  They have asked, "How do I get into dental school?"or, "What courses should I take?"  I have compiled answers to these and many more questions into my new book.  It is now listed on Amazon.

Have you ever wanted to become a Dentist or Orthodontist?  This book covers not only how to get in, but what dental school is really like, how to excel, and how to succeed the difficult years of study. Postgraduate residency in specialties like Orthodontics, Oral Surgery and Pediatric Dentistry are covered in addition to business aspects of the profession and options after graduation including setting up a practice and employment opportunities.  I have also included a section on The Internet, Dentistry and Social Media.

If you or anyone you know is considering dental or medical school, or you just want to find out what it takes to become a dentist, this book will provide lots of answers.  I have included data on tuition and financial costs, the DAT, in addition to personal experiences and advice.  Some highlights:

-Is dentistry right for you?

-How to get admitted into dental school

-What courses to take in high school and college

-Tuition and financial options

-The dental school curriculum

-How to overcome the challenges of dental school

-Specialization and postgraduate education

-Business and employment opportunities

-A special section on Dentistry, the Internet, and Social Media

The foreword is written by Dr, Nido Qubein, the president of High Point University.

Please purchase the book and write a great review!  Here is the link to the Amazon listing:

"Dental School: Preparation, Survival and Success"

(click to enlarge)

Dental School - My new book is now available

My new book, "Dental School: Preparation, Survival and Success" is now available.

Many times on this blog, people have asked questions about the dental school experience.  They have asked, "How do I get into dental school?"or, "What courses should I take?"  I have compiled answers to these and many more questions into my new book.

Have you ever wanted to become a Dentist or Orthodontist?  This book covers not only how to get in, but what dental school is really like, how to excel, and how to succeed the difficult years of study. Postgraduate residency in specialties like Orthodontics, Oral Surgery and Pediatric Dentistry are covered in addition to business aspects of the profession and options after graduation including setting up a practice and employment opportunities.  I have also included a section on The Internet, Dentistry and Social Media.

More details on my post here:

Dental School Book

The Future of Dentistry: Technology

How will technology affect dentistry?  Well, technology is already playing in increasingly important role in this age old profession.  Here are the major developments I foresee:

1.  Diagnostic technology such as digital radiography (x-rays) will continue to become more common. Digital Panoramic and intra-oral x-ray machines will completely replace chemical films and developing.  Computerized image management software will be able to store, display and enhance digital images.  3-D imaging will become more common.  Instead of several intra-oral films, panoramic and cephalometric x-rays, yucky impressions for models and photographs, there may only be the need for one imaging machine or technology which can do all of the above.  Computerized diagnostic software will be able to detect and identify decay and other anomalies and pathology

2.  There will be continuing development of information technologies for the business and record keeping end of dentistry.  As in most health businesses, physicians offices, hospitals, etc., there will be even further incentives for electronic medical records (EMC), computers in the dental office for scheduling, management of financial and patient records, and insurance claim filing.  Ipads, flat screen TVs, and digital entertainment will become more common.

3.  Laboratory technology, which I have often viewed as remaining in the dark ages using proven but old techniques, will transition to CAD/CAM (Computer Aided Design/Computer Aided Manufacture).  This may manifest as in office or laboratory fabrication of crowns and other prostheses by computerized milling machines and digital printers.  Intra-oral cameras will advance to be able to easily take virtual impressions of teeth and transmit the information for production.

If you are in doubt about the impact of robotics in medicine and dentistry, check out how wearable robotics developed by the military are helping paralyzed individuals walk:

                 click photo for link: Wearable Robots help Paralyzed warriors walk again

4.  Currently lasers are used for soft tissue surgery and some hard tissue preparation.  A little further into the future, there may be new devices to more efficiently and simply prepare (drill) teeth for fillings, crowns and other things with more precision and less effort.  Orthodontics will reduce treatment time and accomplish previously difficult tooth movements using new techniques.  Perhaps even stimulation of bone remodeling to speed up tooth movement.

5.  Diagnosis of at-risk patients, targeting medications to particular problems will become more sophisticated.  The use of DNA techniques in diagnosis and treatment will continue to advance.  A caries vaccine?  -They have been talking about that one for 20 years so I do not anticipate an effective vaccine in the near term.  Techniques to replace teeth with laboratory grown teeth for a patient's own DNA or tissues may become a reality.  Advances in oral surgery including nanotechnology in the targeting of cancer cells will enable less traumatic and more successful treatment of these debilitating and often fatal diseases.

6.  Newer techniques of anesthesia and the development of new medications will make dental care even more pleasant and comfortable.  Safer and more effective sedative agents and/or advanced anesthesia techniques will enable any surgical procedure to be completed more easily for the patient and the doctor.

What might all this mean for the practicing dentist?  Well, you cannot say that just because a great technique exists that it will be incorporated into daily routine practice.  There are so many other things to be factored into the equation.  Financial issues and/or insurance may or may not pay enough to make these technologies feasible.  Patients may not be willing to cover the increased cost to use a $100,000 machine to do just a few minor procedures.  I do know many of these technological advances will make dentistry more efficient.  There may be a need for fewer laboratory technicians, but the ones remaining will be skilled in these new techniques.  There may even be a reduced need for as many dentists as each dentist becomes able to accomplish more treatment.

St. Elsewhere

While in my residency, I did an anesthesia rotation at Charity Hospital in New Orleans.  As Pediatric Dentistry residents, we spent every day for a month providing anesthesia for all kinds of surgical cases.  Later on, we did a rotation at Children's Hospital.  During these rotations, with often minimal supervision, we started IVs, calculated and administered medications, intubated the patients and provided whatever was needed to keep the patient asleep and alive during surgery.

Video:

It could be stressful, as we were no as familiar with the OR as the medical residents.  Moreover, Charity was a unique place.  It was built like Fort Knox with 24 operating rooms on the 12th floor.  It was an old building and had an eerie St. Elsewhere atmosphere.  In fact, it seemed every time I entered the building, I'd hear the theme song from that TV show.  We didn't get too much help from anyone there and kind of had to fend for ourselves, scrounging up supplies.  If you didn't have an IV setup or a pulse oximeter, you'd just "steal" one from an adjacent unoccupied operating room before someone was the wiser.  We also sat in on anesthesia resident meetings.  Some of the surgeries were interesting to watch.  Of course, we were actually quite busy keeping the patient monitored.  There were orthopedic cases and a few jaw reconstructions, sometimes abdominal surgeries, but mostly minor stuff.

Every now and then they brought in patients from the local prisons for treatment.  One day one of them escaped and somehow in the ensuing melee, was chased outside, where the police promptly shot him.  They brought him right back in the hospital to get patched up and go back to jail.  That was a typical day at Charity.  Of course Charity became even more infamous during hurricane Katrina.  I was so glad to finish with the rotation, but was thankful to have had the experience.  I learned a lot about sedation and anesthesia.

3D Orthodontic Scanner

Here is a new device we at APDA have just acquired for our practice.  It is a 3-D scanner.  What it does, is scan a dental impression and create a digital or virtual model of teeth.  It can also scan plaster models so you can dispose of the plaster cast and have a record in three dimensions of the patient's mouth.  These models are used in diagnosis and for instructional purposes.  Diagnosis is the most important part of any orthodontic (braces) case.

Plaster casts or models are the nemesis of Orthodontists.  There are rumors of Orthodontists being killed because the hundreds and hundreds of orthodontic plaster models they store in their attics collapsed on them from the immense weight.

This new robotic device scans the impressions (you know the yucky stuff they put in your mouth to make in imprint of your teeth when you get braces).  Usually, plaster is poured into these impressions to make a model of the teeth which aids in diagnosis of the orthodontic case.  The scanner uses a laser light to scan the impression in different orientations.  Then a digital image is produced on the computer replication what the plaster model would look like.

So, no more plaster models!   Here is the digital result that can be rotated and displayed for the orthodontist and the patient to view.  Maybe someday we can do away with the yucky impression altogether. (they are actually working on that with 3d x-ray machines.  One x-ray gets the panoramic, cephalometric, and models with just one image).

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Our New Website

Ok, finally we have our new website up and running.  Check it out!  I am sure we will be editing the text and adding features and videos as time goes on, but here we are!

http://www.alabamapediatricdentists.com

Pediatric Dentist or Pedodontist?

Pedodontist is a word that was used for some time to describe the specialty of dentistry devoted to the treatment of children.  "Pedia-"or "Pedo" means child or children; "-dontist" denotes one who studies teeth.  The old word was found to be confusing.  Some people thought it meant foot doctor or something.  The modern accepted term these days is Pediatric Dentist or Pediatric Dentistry.  The term was changed a few years ago, but you will still hear the older term.  Pediatric Dentistry is an age-defined specialty that provides both primary and comprehensive preventive and therapeutic oral health care for infants and children through adolescence, including those with special health care needs.

I came across google "ngrams" search engine.  This searches millions of books published over the years and finds certain terms or phrases.  See if you can see when one term fell out of favor and the other is now accepted.


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Practice Management Consultants

Do dentists need consultants to advise them on practice business issues?  Well, in my opinion, sometimes yes, sometimes not so much.

There are a myriad of dental practice consultants.  Some are individuals, some are larger firms that advise dental practices on scheduling, marketing, compensation, staffing, customer service, phone skills, billing and other financial and people issues.  Do dentists need to master these issues? Most definitely yes!  Dentists, especially those in solo practice, (which is most dentists) are prone to try to do everything themselves.  In my experience practices can improve if they establish appropriate systems or ways of doing things that are appropriate for their particular situation.  Consultants can help, especially in young practices or those more established practices who are having problems and that have never done a systematic analysis of what they are doing well and what they are doing not so well.  They need good systems.

Over the years, our practice has had many consultants come in and give advice.  We have developed, established, and refined systems. Of course, we still need to adapt and look at new ways of doing things.  Even good systems can become ineffective over time.  Newer staff do not remember the reasons certain methods of doing things were originally established.  Management gets distracted with other issues and lets good systems wilt.  New issues arise.  A good consultant will adapt any analysis and advice to each practice.  Still, I have found that there is a certain point where most advisors simply cannot offer any new or effective ideas.  They tend to charge a lot of money to come in and tell you what you already know.

Good practices, especially well managed larger group practices like ours, have already tried and refined 95% of what is out there.  We have management that is able to analyze data and focus on what works for us.  At this time, there are simply not that many multi-specialty Pediatric Dentistry / Orthodontic practices out there, so consultants do not have a good database to develop useful ideas.  Sometimes I think we could teach them a thing or two.

One time, we specifically asked a well known consultant not to cover certain basic topics we had already addressed, but to focus on certain new concerns we had.  They proceeded to do what they evidently did with all practices, spending an entire day covering the stuff we told them not to waste our time with.  We fired them the next day.  Cookie cutter approaches are not appropriate for most situations.  So, with few exceptions,  practices like ours do not benefit as much from dental practice management consultants.  There is simply a point of diminishing returns.  We can direct our resources, time and combined expertise to determine what works best for us.  Yes, we still need outside advice on financial, technical and legal issues, but for the most part, there seems not much value for unique practices like ours with the management consulting industry as it stands today.  Again, many practices do need advice.  I am not dissing the consulting industry, but a business needs to do what is right and prudent for them.  Sometimes dental practices can benefit from expensive practice management consultants, sometimes not so much.

Abbreviations and Acronyms in Pediatric Dentistry and Orthodontics

You may hear some shorthand or slang terms around a dental office. Hopefully, you will not hear anything like I heard once like this conversation a staff member had with a patient.  "Your O-H is pretty good but we are sending you over to Ortho to get some Records and see if you need any e-x-tees.  I don't see you in TPL, so I'll check Dolphin to see if your Pan is in there."  What?

Abbreviations and acronyms are very common in today's society.  The military tends to bring it to an art form.  In the dental office, doctors and staff often forget that patients are not in the office five days a week and do not use the shorthand language understood by staff.

Here is a list of a few common abbreviations, acronyms and slang heard in some dental offices:

E-X-T: Short for dental extraction or removal of teeth
ORTHO: Orthodontics or braces
PAN: Short for a Panoramic Radiograph (x-ray)
I-R-M: Intermediate Restorative Material (a temporary or sedative filling)
PEDO: Short for Pediatric Dentistry
Computer system terms peculiar to each software such as TPL (the list of that day's patients)
FILTEC or DYRACT: Particular brands of composite (white filling) material.
O-H: Oral Hygiene (status of brushing and flossing)

This is not to mention the confusing array of dental nomenclature and terminology that is a normal part of dentistry like condensers, plastic instruments, ball burnishers, spreaders, burs and forceps.  There is also a whole collection of terms we use in Pediatric Dentistry to help children understand what is going on.  See my post on Pediatric Language on that subject.  Hopefully your experience in our office will be one of friendly communication that is actually understood.

Indirect Pulp Cap

What is an Indirect Pulp Cap? For that matter, what is a direct pulp cap? I was asked this in the comment section of a few other posts, so I though I ought to clarify.

An indirect pulp cap, if done properly, and in the right cases, can help avoid the need for a root canal in severely decayed teeth.

An Indirect pulp cap is where, in a permanent tooth, most of the decay is removed. As a dentist, you find that the decay is extensive and very close to the pulp (nerve) of the tooth. In fact, it may be likely that if you did remove all of the decay, the pulp would be exposed by the infected decay thus resulting in the need for a root canal. So, in order to avoid a root canal, the last little bit of decay is left in there and a sedative temporary filling is placed, usually IRM. After a few months, the temporary filling is removed and the remaining decay is removed and the tooth restored. How does that work? In teeth that have no signs or symptoms of pulpal necrosis or abscess, and that seem to have a good blood supply (ie, the younger the patient, the more likely it will work), by removing the bulk of the nasty decay and sealing off the remaining decay from its nutrient source (the mouth), the pulp has a chance to repair itself and what I call, "scar away" from the decayed area. Once this secondary dentin layer is in place, the remaining decay can be removed without pulp exposure. It doesn't always work, as many teeth are too far along and cannot recover, but sometimes it is worth a try.

A direct pulp cap is where there is an actual exposure of the pulp and a medicament like Calcium hydroxide or Mineral Trioxide Aggregate (MTA) is placed to stimulate the secondary dentin formation. A direct pulp cap is usually done with small mechanical or traumatic exposures with no evident decay in the area.

What is a Root Canal?

What is a Root Canal? Sounds bad doesn’t it? Well, where a pulpotomy is the removal of the pulp tissue in the upper chamber of the tooth, a pulpECTOMY (root canal) is the complete removal of all pulpal tissue including down to the end of the roots. Root canals are often needed if a front tooth is traumatized or even knocked out. Yes, we can often save a knocked out permanent tooth, but it may take a root canal to do it. Often severely decayed teeth simply “give up the ghost” and die. All that dead stuff in there, well, the body cannot get to it to naturally clean it up.

We dentists do root canals or pulpectomies if the tooth is dead. There is a slight difference in how we approach permanent teeth as opposed to baby teeth. With permanent teeth, pulpectomies are often used to “save” a dead or abscessed tooth. You have to get the dead tissue out. You can get it out with a pulpectomy or you can take the tooth out all together. Well, if it’s my tooth, I would rather save a needed permanent tooth if at all possible with a pulpectomy. Some permanent teeth have up to four canals; that can be very complicated and expensive. By the way, I often refer patients (usually teenagers) to the Endodontist for permanent tooth root canals. They do that kind of stuff all day long, are experts, and have all the tools right at hand. Root canals are very useful at saving permanent teeth.

Now, in baby teeth it is a little different. If a baby tooth abscesses, you usually choose to remove it rather than attempt a root canal/complete pulpectomy. Why not do a root canal to save the tooth? Well, on rare occasions we do try, but there are several reasons that we do not. First, root canals on baby teeth do not really work that well. Pulpotomies do. Full root canals are more unpredictable as far as results. Secondly, often there is not enough baby tooth root left to adequately remove and fill the canal space. You see, baby teeth roots are meant to slowly dissolve as the permanent tooth erupts. Baby teeth have anatomical differences that you don’t see as much in permanent teeth: accessory canals, unseen vascular openings, twists and turns, and great variation. Also, as far as filling up the cleaned out root canal space, well, you can’t put in the regular gutta percha material. You have to put in something that will dissolve along with the baby tooth root or at least not interfere with the normal process. Hmm, what to do? Well, 99% of the time, where we cannot do a pulpotomy (i.e. the tooth is still vital), we need to remove the abscessed baby tooth. Fortunately, removal of the tooth is 100% effective at removing the offending stuff in there. Healing will take place rapidly. Unfortunately, if you loose the baby tooth too soon you need to place a space maintainer.

Why would you even try a pulpectomy (root canal) on a baby tooth? Good question. Like I stated, most of the time if the tooth is still vital and just has lots of decay, you can do a pulpotomy. If it is abscessed, we remove the tooth. Now, there are rare times we might attempt a real baby tooth root canal. The one that comes to my mind is when you have a second baby molar (the one in the way far back) that is dead, but not to the point of bone loss and severe symptoms, and the new permanent 6year molar is just about to erupt, and there is no easy way to place a space maintainer. If there is enough root structure, and if the tooth is not mobile and causing massive infection, cleaning out the dead tissue with a root canal might just keep the tooth viable long enough for it to guide in the permanent molar. Once it is in, if the baby tooth gives trouble you can easily remove it and place a proper space maintainer, or if the new tooth is fairly close, just remove it and allow the new tooth to erupt without incident. Sometimes we will do this on front baby teeth to help save the tooth for appearances sake. Problem is, that front teeth come out earlier than the back teeth, so if the child is any older than about four and half there may be root resorption from the erupting tooth. If the child is any younger than three years old, and the issue of cooperation becomes a bigger issue.

How do you do it?

With a baby tooth pulpectomy (root canal), it get’s a little technically detailed as to what you have to do. First, you need a relatively cooperative patient. It is easier to work on a slightly wiggly child to remove a tooth than do technically more precise procedures. Second, you have to remove the bulk of the necrotic or dead tissue. That is sometimes more difficult due to the strange anatomy of baby teeth. The good news is that you usually do not need to be as precise with the cleaning and filing out process as with a permanent tooth. You try to do a thorough job, but you don’t have to spend what seems like hours filing out the root canals of the tooth. Once the tissue is removed and the canals filed out and irrigated as best you can, you place something like Zinc Oxide Eugenol paste or various other kinds of paste materials in there. It kind of sets up after a few minutes and hopefully seals it all up. Then you usually do a crown on top to seal it up and restore an obviously very decayed tooth. Then you need to observe the tooth for a few months/years, to make sure there are no further problems.

Designing A New Office Website

We are currently working on a long overdue upgrade to our APDA website. This of course, involves the input of a skilled web designer, as I don't really have the skills to program one myself. Most medical/dental offices contract with companies for a stock site. This is great for most docs who really don't have the time or resources to devote to anything more than the basics. These sites have improved over the years and most are very nice.

We decided to employ a skilled web designer and also an SEO (Search Engine Optimization) consultant as well. We want something very special as our community is very Internet savvy due to the highly technical engineering and professional jobs here in North Alabama, Madison, Decatur and Huntsville: (NASA, Army Missile Command, Biotech Hudson Alpha Institute, Boeing Delta Rocket Plant, Space Camp and all the Universities here). So far, it is quite easy for patients to find our website. This is in no small part is due to the success of this blog. Thank you readers for making this the premiere blog on the Internet for Pediatric Dentistry and Orthodontics.

So, stay tuned and I'll introduce and link to the new site as soon as it is ready.

Apollo 13, a "Successful Failure"

In 1970, Apollo 13 launched from Cape Canaveral on its way to the third moon landing. About 56 hours into the flight an oxygen tank exploded. The crew had no real idea what had happened, but they knew it was bad. They soon began to realize, the mission to the moon had transformed into a mission of survival. Through massive teamwork both on the spacecraft and here on the ground, and with clever ingenuity and courage, they returned safely to earth from the dark depths of space. The mission was termed a "Successful Failure". To this day this mission is probably the best remembered Apollo flight after the first Apollo 11 moon landing.

There were three crew members on Apollo 13, and I have been privileged to meet two of them. Most recently, I heard Fred Haise speak about his experience at the US Space and Rocket Center here in Huntsville. Also, several years ago I met Jim Lovell at a book signing for his book, "Lost Moon".

If you have never seen the movie, "Apollo 13" I highly recommend it. Mr. Haise did go over a few of the Hollywood alterations to the story, but mainly the movie is accurate and inspiring. Tom Hanks and Ron Howard visited the Marshall Space Flight Center and Space Camp here to get more information for the movie. Mr Hanks also sent his son through Space Camp.

Often in business or personal life, circumstances change unexpectedly. The original mission cannot be completed despite all the best laid plans. Still, experience, teamwork, flexibility and knowledge enables the fortunate and dedicated to change the plan, to adapt, innovate and succeed.

With medical and dental practices, which are businesses, things can happen. The recent economic distress has made patients cautious about committing to larger or longer term dental treatment, especially if it is seen as optional. Orthodontic practices in particular have been hurt in this recession. Innovative financial options, overhead reduction are some ways to help our patients obtain the services they need. However, you must keep the quality and customer service.

With a dedication to the patient, and good business decisions, we all can weather the storm. Adversity can bring opportunity. It can bring about needed change that otherwise would not have happened. So, when the mission abruptly changes, when the plan has changed from what you thought it would be, look on it as a opportunity. Turn adversity from failure into success.

Apollo 13 Timeline

Apollo 13 Movie

I am Available For Speaking Engagements

I am available for certain speaking engagements. Topics may include Pediatric Dentistry (obviously), Social Media and Blogging, Practice Management and Business Development, Practice Transitions, and others. I usually speak before small to medium sized groups, but the largest was about 800 people. Yes, usually there would be a fee, especially if I have to travel or take time off my regular schedule. I might consider a discount for dental schools or charitable organizations. If you are interested, contact me at our office, via Twitter, Facebook or on this blog.

What is "Customer Service"?

I attend many continuing education seminars every year, not only to learn better techniques and technology, but better ways of serving our patients, you know customer service. That can be how we answer the phone, how the staff answer questions, does the customer feel his needs were met, etc. This past weekend I heard Dr. Nido Qubein and Scott McKain; two awesome speakers. They are not dentists, but they understand the aspects of a dental practice that pertain to the person at the other end of the mirror--the patient. In Pediatric Dentistry that also includes the parents, you know the ones paying the bill.

In Pediatric Dentistry, you learn the how: how to do a filling, how to prepare a crown, how to manage anxiety and safely sedate and treat a patient. Once you are out of school, you hang up your shingle and start a dental "practice," otherwise known as a "business". There are several principles that apply to all businesses. Great service is not only providing great dental care, and not just great "customer service," but providing such an exceptional experience so that patient will never want to go anywhere else. Wouldn't you like to go to a dental practice where, when you leave, you say, "That was so awesome, I can't wait to take Johnny back again". What? You said the dentist? Well, I have to say that even though we may not achieve it 100% of the time, we really do want to provide a wonderful experience in addition to great dentistry. It's not an easy task. It's hard to be all things to all people. I mean, kids are unpredictable and we may not always be on the ball. However, most of the time we strive to hit a home run. We have had kids not want to leave our office they are having so much fun.

These speakers not only informed, but inspired me to improve on the wonderful practice we already have here at APDA. I promise we will do our very best to serve you and your family. We went into Pediatric Dentistry because we really do love these children.

No matter what business you are in, you can learn from these great speakers. If you ever have the chance to hear these guys speak (click the links on their names above), do not miss them. They know their stuff.

LED Lights for Teeth?

This is a trend I just now picked up on: LED Lights for Teeth. Evidently in Japan, there is a trend for placing lights in the mouth to produce the effect you see here. This was originally done for a promotional commercial. I wonder if it will catch on. Over time dental patients have requested gold or even jewelry on their teeth. I do not think it a good idea to place anything bonded (attached) to the teeth that is not there for a health reason. Braces are fine. These LED light devices may be ok so long as they are removable and do not cause any adverse dental effect. Hey, 3-M and other orthodontic bracket companies, how about orthodontic brackets that light up? On second thought, a leaky battery in the mouth does not sound so good. What do you think? Will patients be requesting this in the future?


Check out the article here: NewYork Times Article

If you are wondering, you cannot buy these yet. They are not commercially available.

Sugar Substitutes, Better for Your Teeth?

It is well known that lots of sugar over time can increase the chance of cavities. What about "sugar free" products? What about a diet Coke? Is that as bad as the original? Here are some of the options out there today: Saccharin, Equal, Splenda, Stevia, Susta, Xylitol, Sorbitol, Mannitol, etc. Most people use diet or sugar free products to reduce calories--to diet. Some avoid sugar due to medical conditions like diabetes. What about dental caries?

Sucrose (table sugar) is made up of two molecules, glucose and fructose:

The bacteria that contribute to cavities feed off sugars to produce tooth damaging acids. However, other carbohydrates can be just as bad, or worse. Why? Well, a cracker stuck between the teeth can break down into sugars. The fact it is there for a longer time can make the situation worse. After a sugar "attack" the ph around the teeth goes down (more acid) for about 30 minutes or so. If you can brush within that time, or even just rinse out with water, that will help. The fluoride in the toothpaste helps as well. Will switching to a sugar free product help? Well, maybe.

Xylitol:

Most of the information out there seems to be on the caloric content of these products not the cariogenic potential. More people are concerned with loosing weight than preventing cavities. The one product where there seems to be a good deal of solid research is Xylitol. It's good in small quantities. You may see this in some chewing gum. There is actually a beneficial effect of Xylitol. See my post here on that: Chewing Gum, Good or Bad? I recommend Xylitol products to my patients based on the research.

As far as all the others, well, it is my summation to say I think there is far less potential for cavity formation with sugar substitutes, but the potential is still there to a lesser degree. Just because you switch to a diet coke will not mean you'll never get a cavity. Sucrose may be the worst, but bacteria can find a way to metabolize different compounds in some way. So, if you want to loose weight or have diabetic concerns, you will definitely consider the alternatives to sucrose. The reduced cariogenic potential of the substitutes may be beneficial as well. Be aware that certain products like colas, have other ingredients, like phosphoric acid (to enhance flavor), that may also lower ph.

I will not go into a long dissertation about all the products and their chemical structures, but here is a reasonably good link for info on that: Sugar Substitutes and Artificial Sweeteners

Journal of the American Dental Association Article: Are sugar substitutes also anticariogenic?

By the way, do I let my kids have candy? Yes, sometimes, but I look for sugar free and limit the frequency (as much as a dad can), and make sure they brush and floss afterwards. Sweets are a great part of life, and are to be enjoyed.

Twitter

I just love Twitter. What is Twitter? It's a 140 character (that is letters periods, dashes, etc.), used for brief "Status Updates" or similar communications on the twitter "feed". With more dentists and patients using the internet, elements of "social media" like Facebook are becoming more pervasive, accessible and necessary. There are many dentists and dental organizations on twitter, so check them out. Here is our Practice twitter account link. You definitely need to follow this if you are one of our patients:

Alabama Pediatric Dental Associates and Orthodontics

Here is my personal twitter account. I may not always talk about Pediatric Dentistry, but you will get to know me a little better:

Matrixband

Recommendations for Fluoride in Drinking Water Changed

Fluoride in drinking water has prevented dental disease for many years since it's introduction. Research supports an ideal amount of fluoride of 1 ppm (parts per million). There seems to be continued beneficial effect in caries prevention as the level rises. At amounts above 4 ppm developing teeth can be affected by Fluorisis or spots or blotches on the teeth, This is not the same as hypoplasia, but can look the same. It's mainly an appearance concern as the teeth are quite resistant to caries at these elevated levels. The U.S. Department of Health and Human Services and the U.S. Environmental Protection Agency have decided to lower the maximun level allowed in the drinking water supplies to reduce the amount of fluorisis. They are recommending that the fluoride level in drinking water be set at 0.7 ppm, replacing the current range of 0.7 to 1.2.

I think it is a good idea as I have seen a slight rise in the amount of enamel hypoplasia and/or fluorosis over the last 20 years.
I suspect it is mainly because children get fluoride from other sources like prepackaged drinks that may have unknown fluoride levels. Also, a major factor is the amount of fluoridated toothpaste swallowed by children. I always advise very small amounts of toothpaste be used for children.

Article Links:
Wall Street Journal Article
Business Week Article
ADA commends new fluoride recommendations