Pediatric Dentistry

Animal Dentistry

2008-05-13T16:51:00.001-07:00

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.

Open Wide!------------->

Dentistry on the Wild Side:

Interesting links:
Veterinary Dentistry Practice
Another good link

Aphthous Ulcers (Canker Sores)

2008-04-22T17:53:00.000-07:00

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.

Our New Madison Office

2007-12-31T09:15:00.000-08:00

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!

Local Anesthesia in Pediatric Dentistry

2007-11-22T20:58:00.000-08:00

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

2007-10-31T19:52:00.001-07:00

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

2007-10-02T18:00:00.000-07:00

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

2007-09-01T00:20:00.000-07:00

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:

Designer Travel Toothbrush

2007-07-07T13:42:00.001-07:00

I was watching the Home and Garden Network the other day. Now, that channel is not my usual fare, but I'm doing some remodeling around the house, and they have some cool programs on there for that kind of thing. For some reason while showing bathroom fixtures, faucets, sinks and the like, they showed this travel toothbrush. You evidently place toothpaste in there and it comes out through the brush bristles when you need it. I thought I'd never see a travel toothbrush go upscale. Well, if it promotes better oral hygiene, then I'm fine with that! Hey, you have to be on the cutting edge of style even in dentistry.

Cephalometric Measurements in Orthodontics

2007-07-04T08:25:00.000-07:00

Cephalometric measurements help determine proper diagnosis in orthodontic patients. A "Ceph" is a lateral x-ray of the head. Measurements are made of specific landmarks. Various analysis of the angles and distances help determine variation from known norms and changes over time due to growth and treatment. The cephalometric radiograph is used with other diagnostic information such as plaster dental models, panoramic and frontal radiographs, photographs and a thourough clinical examination. All these are used in diagnosis and treatment planning in orthodontics.

Here is a video from Dolphin Imaging showing their particular software. In the past, we used to trace and measure all these by hand. Now we use Dolphin in our office. I have some gripes with Dolphin as we also use it as our database for all our orthodontic and intraoral x-rays. It's been quirky lately and as with all computer software, needs tech support from time to time. I may post more on that later. Still, it's a pretty neat system.

Click here or on the photo to view a video from Dolphin Imaging:

The 10 million dollar smile

2007-06-01T14:50:00.000-07:00

America Ferrera, the actress that plays "Ugly Betty" has her smile insured with Lloyds of London:

Ugly Betty's Smile Insured for 10 Million Dollars

Alabama Dental Hygiene Program

2007-06-01T14:40:00.000-07:00

We just returned from our mandatory course for the doctor sponsors of students enrolled in the Alabama Dental Hygiene Program. This unique program enables students to obtain the necessary education and training to become dental hygienists. Alabama is the only state with this type program. It is administered by the Alabama Board of Dental Examiners and requires the student attend intense weeks of study in a university setting. Then the student returns for clinical training and experience in the office under the direction of the sponsoring dentist. They must complete additional hours of didactic study by returning to Birmingham over many long weekends throughout the year. There are several university based programs in Alabama as well, but this program is particularly valuable to students wishing to stay employed while receiving their education. It's also great for the dentists because you don't loose a good employee.

You have to be a full time assistant for one year before entering the hygiene program. There are also didactic tests along the way in anatomy, pathology, etc. The courses are more difficult than many anticipate. In fact, many students do not complete the program due to poor academic performance. However, if a student passes the program, they become eligible to take the Alabama Board Exam for licensure. They said us doctors could come down and attend classes with the hygiene students if we wanted to. Umm, I'm not so sure about that...

Details of the program can be found here: ADHP Information

Extra Wisdom Teeth (fourth molars)

2007-05-04T08:57:00.000-07:00

Most people have about four "wisdom teeth". These are also known as "third molars", one in each quadrant. They are way in the back where there is usually not enough room. Often, but not always, they need to be removed because of limited space, angled eruption, impaction, or they just can't erupt properly. Sometimes there are no wisdom teeth at all; they just didn't form. There also may be one, two or three of them.

Every now and then there is a patient with extra wisdom teeth. Often these are called "fourth molars". Here is a panoramic x-ray showing the developing fourth molars. If there is not enough room for wisdom teeth (third molars), there for sure won't be enough room for any extras.

Cavities in Young Children Increasing

2007-05-01T16:06:00.000-07:00

Recently, the incidence of tooth decay has been rising particularly in young children! How can this be? Over the years, we have seen the beneficial effects of fluoride and increased dental care cause a reduction the incidence of caries. New studies indicate this change may be due to increased use of sugary drinks and foods in young children. There are a lot of other factors that go into causing cavities, but looking at this recent news well, I think we all need to focus again on the obvious.

What can we do? 1. reduce the frequency of sugary drinks and foods. Don't let your child use a sippy cup like a pacifier, carrying it around taking one sip every 2 minutes for an hour. Don't put children over 1 year of age to bed with a bottle filled with juice or milk. Just put water in there unless it is meal time. 2. Get your child to the dentist by one year of age. That way we can detect problems early and create good habits from the beginning. 3. Larger issues surrounding access to care need to be addressed.

ADA News Article

MSNBC Article

AAPD News Release

AAPD Tips to Prevent Decay

AAPD Annual Session, San Antonio

2007-04-26T20:30:00.000-07:00

I have been asked to speak at the American Acdemy of Pediatric Dentistry's Annual Session in San Antonio, Texas. The subject? "Blogs and Their Use in Dentisty". A more thorough report will follow in June after the meeting has ended. It's pretty fun speaking about something you know and enjoy. I am not an expert in Powerpoint, but I think I can get together something pretty entertaining and informative. Last Tuesday I made a presentation for our office staff incorporating pictures and music from the Austin Powers Movies. It was a great hit!

So, off to Texas, Yeah Baby, Yeah!

Parental Behavior in the Pediatric Dental Office

2007-04-21T09:55:00.000-07:00

Isn't it difficult to work on kids? Well, no not really. It's the parents that can cause much of the stress. We as Pediatric Dentists are trained to recognize patterns of behavior and adapt stategies to change or accomidate the behavior in order to accomplish the desired treatment. We see hundreds of kids a week. We see all developmental stages and ages. We see kids in all kinds of moods and with all kinds of personalities. The parents of these patients know their child quite well, but have also developed an interactive dynamic with their child that they often do not realize exists, and that can occasionally hamper our efforts to accomplish what we are trying to do.

An example might be a parent who has an anxious child. Why is the child anxious? Perhaps, because the mother has either said something about her own difficult experiences at the dentist, conveys unspoken anxiety or has actually used words or phrases that increase the child's reactions. See "Pedo Lingo" for more information on how we use language with children. Parents can be "overloving". They react to every sound or word the child expresses. The child who just wants a little extra attention whines a little causing the parent to say something like, "oh, my poor baby." The child has the parent wrapped around his or her little finger.

Another case frequently encountered is the parent wishing to be present during some kind of treatment. Some dentists do not allow parental prescence during treatment at all. By the way, in our office we allow parents into the treatment area. It is often necessary and desirable to communicate treatment needs, and for many children, parental presence is helpful. I like them to see what we are doing. Many times I do prefer, if I am doing an operative procedure (fillings or something like that), for the parent to be to the side or better yet, if they choose, in the reception area. This way the child's full attention is on me and not the parent. In addition, it can make the dentist distracted trying to manage the child AND the parent. Of course, little bitty children, I need the parent there to help. I like them to be present. Older kids, well, I have seen parents holding the hand of their 16 year old teenager during a simple orthodontic appointment. Seems like more and more parents want to be present than in the past. Gets a lot more crowded these days in the operatory. I'd rather have parents back than sitting worring too much in the reception area. If they are back, they can see what is going on and know it's not such a big deal.

Some parents think their presence will help calm an anxious child. Someties it does. Although we allow parents be present during treatment, we sometimes like them to be apart from the immediate discussion and communication between the dentist or assistant and the child. If the parent is hovering and interacting with the child, the communication is just not there with the dentist. It makes it much harder to communicate with the child. Example: Dentist: "Johnny, how old are you?" "He's 7 years old" (Mom answered the question not the child)(by the way, I don't mind a parent answering, this is just an illistration). Or, Dentist speaking: "Johnny, I'm going to put some sleepy juice in your mouth to help your tooth go to sleep". Mom then steps in and says, "You're ok, it's not going to hurt a bit", just squeeze my hand if it hurts." The child then is anxious. Hurts? What is going to hurt? What's going to be ok? It might not be ok??? He has already forgotten what the dentist said. Dentist: "Johnny, open your mouth, please", Johnny looks at mom who's hovering nearby. Mom says, "Johnny open your mouth" Johnny never looks at the dentist. This is going to be tough. You would be surprised how much better many children do once the parent leaves the treatment area (or at least around the corner).

Having said all this, a lot of us parents simply can't help trying to help our children the best we can. Hey, I understand that. So, in summary. Love and support your child, but let your child establish some independance. If you have questions, by all means you are welcome to come back with your child even for the most difficult procedures. However, let the dentist and staff use their skills and training to manage the child and the treatment. They don't need to divert their attentions onto an anxious hovering parent in addition to all the other stuff they are thinking about.

Horace Wells, Father of Surgical Anesthesia

2007-04-14T09:40:00.000-07:00

Ok this guy was ahead of his time. Dr. Horace Wells, a dentist, found that Nitrous Oxide (Laughing gas), which was used back then for fun at parties, had anesthetic properties. He felt a real need to help releive the discomfort patients felt in an age when there was no anesthesia. On December 10, 1844, he first had it administered on himself as another dentist removed a bad tooth with good results. After several favorable experiments, a former business partner and student, Dr. William Morton, encouraged him to set up a public demonstration. Dr. Wells extracted a tooth on a patient in front of prominant physicians and students. It went pretty well, but the patient moaned a little after the tooth was already out and all the physicians in the room discounted the demonstration and ridiculed Dr. Wells even though the patient reported reduced levels of pain.

Dr. Morton later on administered Ether for the first time in the same Massachusetts General Hospital ampitheater that Dr. Wells used for his demonstration. Unfortunately, Dr. Wells later on became addicted to Chloroform was sent to prison and used chloroform to block the pain of a self inflicted fatal injury.

Here is an interesting link on: Dr. Wells

The BAMA Rule

2007-04-09T20:15:00.000-07:00

The BAMA Rule, otherwise known as the "Buccal Object Rule". It's something you learn in radiology. There is only one school that calls this method of determining the location of objects on and X-Ray the BAMA rule, of course it's the University of Alabama School of Dentistry. It's much easier to remember if you think BAMA (Buccal Always Moves Away).

If you have an object on a radiograph that you really can't tell whether it is in front of or behind another object (buccal or lingual), you can take another x-ray from a different position to determine if the object moves in relation to surrounding objects. If you move the beam at an angle comming more from the right and the object seems to move away to the left, then the object in question is to the buccal. Buccal Always Moves Away (BAMA).

Here is a link to an article that explains in more detail: BAMA Rule

Dental School Tuition

2007-04-08T14:55:00.000-07:00

The mot recent survey of dental school tuition shows the average is about $21,000 per year for residents. For non-residents, the tuition rises to $32,000 per year. This data is from the ADA Survey Center 2004-05 Survey of Dental Education. I remember when I was in school there were costs other than tuition like a good bit of dental instrumentation and supplies you had to purchase. Private school programs can be quite high. The University of Pennsylavania tuition is over $48,000 per year! Most public university programs are less than the averages printed here:

Here is a link to the University of Alabama School of Dentistry web page on estimated tuition and fees.

Hollywood

2007-04-01T13:08:00.000-07:00

I just returned from a trip to Los Angeles. While there, I went to the Tonight Show with Jay Leno. On the way to the taping, I had to pull over to allow a fire engine to pass by. After driving over the mountain and into the Valley where Warner Brothers and NBC Studios are located, I saw a gigantic fire! This fire was quite close to the studio; in fact Jay mentioned it in his monologue. We were right in the middle of the action. The ash was in the air, on my car and even got a little on my jacket. Luckily no one hurt, but you can see, like many things in Hollywood, very dramatic. I like Los Angeles, but it's good to be home.

Which Toothbrush is the Best?

2007-03-17T15:00:00.000-07:00

Which Tooth Brush is the Best for Children? Well, I usually say the one your child likes to use! That is, the one he is inspired to use properly and for a long enough time to get the job done. Basically, you can do pretty well with a regular plain toothbrush. There are not really any modifications that can overcome poor brushing technique. Yes, a smaller toothbrush for smaller children so it will fit their hand well. Also, softer bristles will do just fine. When you have braces, there are a few "orthodontic" brushes with altered bristles that might help.

Having said that, studies indicate that many kids do a little better job with battery-powered toothbrushes. You know the "spin brushes". There are a lot of battery-powered toothbrushes that are suitable for children. I would advise picking one that your child likes to use. You don't have to spend a lot on the fancier ones. Now if you are an adult, the Sonicare and Braun (expensive fancy toothbrushes) do a really good job and may inspire you!

Spin Brushes (very popular):

Sonicare and Braun (they compete with each other fiercely):

I don't know what this is:

Our New APDA Web Site

2007-02-20T15:14:00.000-08:00

We have just updated our practice web site. You can check it out with the link on the sidebar or click the picture here. We still need to fine tune the new site a little, but it looks great. We did have a great web site before, but it was hard to update. The new site was develped with the help of Televox. I like the rocket logo blasting off!

Traveling Overseas for Dentistry?

2007-02-19T19:00:00.000-08:00

As odd as it sounds, there are more and more people traveling abroad for major medical treatments. Why? Well, basically to save money. There is a perceived financial savings to be had by going to India, Thailand, or Hungary for major surgery, especially for cosmetic surgery and other surgery not covered by traditional insurance. Hard to beleive, but this trend may be spreading to Dentistry. Now, I know there are many skilled dentists throughout the world. I personally know many great dentists outside the United States. Who knows what the future holds with the continuing internationalization of our world? We should be prepared for anything. It is perhaps more likely that, with the shortage of dental school faculty and dental school graduates, any shortage of dentists here would open up the doorway to more internationally trained dentist to come here to the USA. Who knows?

I have to say, however, that I do not think this trend of traveling overseas will affect Pediatric Dentistry or Orthodontics. Orthodontic treatment takes many visits over a long period of time, therefore, no cost savings. With Pediatric Dentistry, the majority of procedures are small low cost treatments, not big dollar surgeries. It is simply not worth it to travel for the treatment required. In addition, what makes our profession special is the time we take to build relationships and the personal nature of dentistry itself.

Finally, the risks people often take themselves are not the ones to which they would choose to expose their children.

Twenty Year Reunion!

2007-02-12T07:50:00.000-08:00

Last Friday, I went to Birmingham for my 20th dental school class reunion. Oh, my goodness, I can't believe it's been 20 years! I was afraid there would be just a bunch of old gray-headed dentists there, but actually everyone looked pretty good. We had about 45 people in our graduating class at UAB (University of Alabama School of Dentistry Class of 1987). Now, we're scattered all around the country with most still here in Alabama. Out of that class, there were three of us that went on to become Pediatric Dentists. Here I am with my nametag standing next to Rick Simpson, a fellow Pediatric Dentist here in Alabama and Mike O'Neil, who practices Oral Surgery in Florida. Another classmate, Mark Bronsky, was able to come down from New York City where he currently has an orthodontic practice on Park Avenue a few blocks from Bloomingdales. Maria is now practicing in Puerto Rico. I am very much impressed with the accomplishments of my fellow classmates. Some are now in faculty positions, some are serving patients every day in small towns across Alabama. Reunions are an opportunity to connect with the past and remember the first steps of your profession. A great time was had by all.

Joe, looks like you blinked.

The Bell Curve

2007-01-26T13:03:00.000-08:00

There it is, the bell curve, a statistical description of distribution. What does it mean to Pediatric Dentistry and Orthodontics? Well, in school, your grades are distributed on a bell curve. Most students are in the center, a few have the top grades, and a few are at the bottom. You don't want to be at the bottom.

More to the point, if you have a group of patients, they will react differently to the same medication, treatment modality, instructions, or situation. Some, for instance will respond very differently to the same sedative drug (this is critically important to understand when administering medications because the physiologic reaction to those medications can vary from patient to patient). Even with great oral hygiene instructions, some patients will brush their teeth quite well and others will not. Most people pay their bills on time; some do not.

Same input, different responses.

Some "curves" are shaped differently than others. They are skewed to one end or the other.

This is really important in understanding people and situations. You can't always count on one method working the same way every time. Sometimes you have to adapt and be prepared. Whatever training and experience you have, even if your treatment procedures are correct and consistent, there is always an element of uncertainty. When dealing with people it is particularly helpful if you remember the bell curve.

Anterior Crossbite

2007-01-25T18:16:00.000-08:00

An anterior crossbite involves one or more front teeth. The upper teeth are supposed to fit over (or in front of) the lower teeth. When this is reversed, there can be problems. It is usually best to correct these crossbites as soon as reasonably possible. Crossbites can be corrected with "braces" or sometimes a simple fixed or removable appliance. I like to use a fixed palatal arch with a finger spring to "push" the tooth forward from behind. Works very well.

More here on Posterior Crossbites.