Archives for November 2012

What the heck is numbing jelly?

“Numbing Jelly” or Dental Topical Anesthesia.

I often ask my patients what they hate the most about a trip to the dentist, and a solid majority always says one thing: The Shot.  There are other things that patients do not like, and I even compiled an abridged list of things patients have told me they dread:

  • The sound of the dental drill.
  • The feeling of “too many things” in their mouth.
  • Being tilted back too far.
  • The thought of a “hole” being drilled into a body part.
  • The “suction thingy” (a.k.a. saliva ejector or spit sucker).
  • The spray of the water.
  • The taste of metal instruments.
  • Two individuals (dentist and assistant) staring into their mouth
  • And literally hundreds of other things…

All of these things are reasons why patients avoid the dentist.  However, based on my experience as a dentist, these items all pale in comparison to the administration of local anesthetic.  Local anesthetic is necessary for all types of dental procedures, including fillings, crowns, root canals, implants, etc.  It doesn’t matter whether you’re in Orange, CT where I practice or thousands of miles away, patients hate the shot!

Dentist and Needles | Topical anesthetic| West Hartford Family DentistryNot surprisingly, dentists and dental supply manufacturers have been identifying and developing techniques over the years to eliminate the pain and fear associated with the local anesthesia injection.  Perhaps the biggest and most significant development was the introduction of narrow diameter disposable needles.  Prior to the 1950s, the needles used were much larger in order for them to be able to stand up to multiple sterilization cycles. I’ve had many older patients who experienced dental procedures back in the 1940s who described these as “horse needles.” Now we use much narrower disposable needles.  I will cover the history of dental needles in a future blog post.  But regardless, a needle is still a needle!

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Gatorade Versus Red Bull

Is Red Bull four times worse for your teeth than Gatorade?

Nearly every day, I get questions from patients in practice about the effects of diet on dental caries (a.k.a teeth cavities).  I can’t think of an instance in all my years as a dentist when a patient was not aware of the relationship between sugar intake and tooth decay.  Nearly all patients are aware of the harmful effects of regular soda on their teeth.  Many patients ask me if diet soda is better than regular soda (it is only marginally better and still very destructive – that will be addressed in another blog post).  But very few patients have ever asked me about sports drinks and energy drinks and the effects on their teeth.

Sports drinks like Gatorade cause tooth decay requiring fillings from the dentistSports drinks became first commercially available in the late 1960s after the University of Florida’s athletic teams achieved improved performance after consuming a beverage with high concentrations of carbohydrates and electrolytes.  The electrolytes include potassium, sodium, and others lost during rigorous physical exercise.  Not surprisingly, sports drinks such as Gatorade include large amounts of sugar designed to fuel the athlete.

Energy drinks like Red Bull cause tooth decay requiring fillings from the dentistEnergy drinks came to the United States in the late 1990s but did not become popular until approximately 10 years later when large marketing campaigns were launched around these beverages.  Energy drinks contain significant quantities of caffeine in addition to sugar.  They are being marketed not just for athletic performance but also for other uses including weight loss, stamina, and concentration.  Energy drinks are frequently associated with the “toxic jock identity” in adolescent males.  Like sports drinks, they are very acidic.

Like it or not, sports and energy drinks are very popular in the United States.  One study showed that 30% – 50% of adolescents and young adults in the U.S. consume energy drinks regularly.  Marketing for the various brands such as Gatorade, Red Bull, 5-Hour Energy, Powerade, and others ensure that the names are becoming nearly ubiquitous. Just recently, Red Bull sponsored Felix Baumgartner’s free fall record as chronicled in this article.  I routinely see patients in this age demographic consuming energy drinks.  I suspect many readers of this blog consume these drinks as well.

So what does all of this mean with respect to dental care, teeth and cavities? The short answer is that both sports and energy drinks have destructive effects similar to sugary soda (Coca Cola, Pepsi, Mountain Dew, etc.).  This is because of the high sugar content in the drinks as well as the acidity.  Acidic foods and drinks dissolve the protective enamel coating on all teeth, weakening them and making them susceptible to decay.  Sugars are used by specific bacteria (S. Mutans, as seen in this recent blog post) as food.  When these specific bacteria consume the sugar, they produce acids that cause cavities.

So this brings us to the big question, which is:

Energy drinks vs. Sports drinks: which are worse for your teeth?

Energy drinks are on average four times worse for your teeth than Sports drinks. This is based on a research paper by the Academy of General Dentistry. I won’t go into the fine details of how the researchers reached their conclusion.  But on average, energy drinks require four times the amount of “dilution” from saliva to get your mouth back to normal. Or stated another way, your oral cavity has to work four times harder and longer to neutralize the teeth destroying effects of an energy drink than it does for a sports drink!

Tips on reducing teeth cavities from Sports and Energy Drinks:

  • Minimize your consumption of them.
  • Do not brush your teeth directly after consuming one as your brushing action will wear away the weakened enamel.
  • Attempt to either rinse your mouth out with water or drink milk directly after.  The milk will help to neutralize the acidic effects of the drink.
  • Do not sip one throughout the day.  You will be bathing your teeth in a constant supply of acid and sugar. If you are going to drink sports and energy drinks it is best to drink them more rapidly.  However, consumption of highly-caffeinated energy drinks quickly can lead to very high blood levels of caffeine with possible fatal side effects.  Just another reason to avoid them!
So which is the worst energy drink?  The answer is Rockstar which is almost five times worse for your teeth than Propel Grape, a popular Sports Drink.

Like it or not, sports and energy drinks are here to stay.  Whether you are a dentist in Orange, CT like me or work in another health profession or are a frequent consumer of these beverages, you should be aware of the risks to not only your teeth but also your overall health.  With proper knowledge, you can consume them sensibly and safely.


Tooth Tattoo

Small Sensor May Help Dentists Assess Dental and Overall Health.

As a dentist in Orange, Connecticut, one of the things I enjoy most is watching and following all the exciting research developments in the dental field. It is amazing the creativity and ingenuity that goes in to developing these innovations.  The research spans all areas, from better local anesthetic delivery systems, stronger crowns, new surgical techniques, more esthetic restorative materials, etc.  Some products are still many years away from market release.  Other dental innovations are “cool” but will never be feasible as commercial products.  Some products are ready to be released and placed into the hands of dentists today!

To stay abreast of these dental developments, I subscribe to different email lists and participate in various online forums about dentistry.  I do this so that I can incorporate newer technologies into my daily practice.  I came across the following article just a couple of days ago. The article describes a device that can attach to a tooth and provide information about the types of bacteria present in the mouth.

Tooth Tatoo Diagram

Tooth Tatoo – The Sensor (A) attached to the tooth (B) binds with bacteria (D) and sends radio signals (C). Image courtesy of Manu Manoor/Nature Communications.

Researchers at Tufts University have developed this technology.  In the prototype, there is a sensor with a width less than a piece of paper that attaches to a tooth.  Outside the mouth there is a receiver that continuously “pings” the sensor providing it with power as well as allowing the sensor to send data back to the receiver.  The sensor will send back different types of data based upon the presence or lack of bacteria as well as the types of bacteria that are adhering to the sensor.

Strep Mutuans, the cocci bacteria found on teeth that cause cavities or dental decay

Strep Mutans – the bacteria responsible for cavities

Dental caries (also known as dental decay or dental cavities) are caused by specific bacteria, aided or hindered by certain dietary habits.  Periodontal disease (which includes periodontitis and gingivitis) is caused by specific bacteria as well and is affected by numerous other factors (smoking, certain systemic diseases, etc).  The presence/absence as well as the amount of these different types of bacteria are directly linked to the current disease process as well as the future possibility of disease.  So a device such as this would be beneficial in diagnosing both current and future cases of cavities and periodontal disease.

Dr. Gerard Kugel from Tufts University School of Dental Medicine mentions in the article examples of how this technology could be used in an everyday dental practice.  If a patient is experiencing a spike in bacterial loads associated with dental caries, the patient could be given a prescription for high strength fluoride and be instructed to chew xylitol gum multiple times throughout the day.  Or if the sensor is detecting a surge in one of the 3 main bacterial species associated with periodontitis, the patient could be notified and be recommended to have a cleaning soon or to start on a mouth rinse containing chlorhexidine.

Beyond assessing a patient for dental caries or periodontal disease, I see many other applications of this future tool.  There are many biological markers in saliva that could be monitored and tracked. For example, proteins from the HIV virus can be found in saliva.  In addition, biological markers associated with Type II Diabetes, breast cancer, Alzheimer’s Disease, Sjogren’s Syndrome, and many other diseases can be found in saliva.  A great summary of the different markers can be found here.

This development is still many years away from being commercially available and viable. However, there are many possibilities beyond what has been described in this blog post.  But perhaps the greatest finding with this research is the further solidification that the mouth is a gateway to the body and that dentists and physicians should work together closely to manage their patients’ health.

Disclosure: I completed my undergraduate studies at Tufts University and I routinely take continuing education classes at Tufts University School of Dental Medicine. But I have no connection with this product or the research in practice in Orange, CT.

Dental MythBuster #1 – Knee on My Chest?

Dental MythBuster #1 – The dentist pulled so hard he put his knee on my chest!

As a general dentist who routinely extracts all kinds of teeth, I’ve heard this story so many times that sometimes I am even inclined to believe it!  However, it is not true, at least not in the United States for the past 50 years.  I’ve heard this story everywhere I have practiced dentistry, from Buffalo, NY to my current city of Orange, CT.  The dental myth is documented on numerous areas on the internet, including here.

Funny Picture of Dentist Pulling a Tooth with Knee on Chest

Dental Myth – The dentist had to put his knee on my chest in order to pull the tooth.

When people hear this myth, the image to the left is immediately conjured up.  They envision a dentist with a rusty pair of pliers purchased at their local Home Depot, pulling hard with sweat dripping. The forces require that the dentist stabilize the patient with their knee. Variations on this myth include “legs on my chest”, “forearm on my neck” as well as my personal favorite “the dentist had two assistants hold me down to pull my tooth.”

The extraction of a tooth requires more “brains than brawn.”  It is not about brute force applied randomly nor haphazardly.  Extractions require the controlled, methodical, and timely application of forces in a variety of directions, with a pulling force being the least frequently used and least effective.  Tooth extractions use the concept of a “lever” which is a lesson most of us learned in high school physics.  A lever is a rigid object (in this case a piece of molded metal called a dental elevator) that is used with a pivot point (called a fulcrum).  The lever is placed against the tooth to be removed, and by rotating the elevator against the fulcrum, a large force is exerted against the tooth to be removed.  The force then “elevates” the tooth out of the jawbone without producing any pulling forces – and without a need for a knee to be placed on the patient’s chest!

Dental elevator extracting a tooth without need for pulling

A dental elevator being used as a lever – extraction occurs without any pulling motion.

The graphic to the left shows a dental elevator being used as a lever, with the fulcrum being the adjacent tooth.  A sideways and upwards force is generated using the instrument in this way. Note that there are no pliers here!  I (along with other dentists who extract teeth) can frequently get the tooth out with this motion only.  It requires only wrist strength and no muscles above the elbow are used.  And most importantly, it does not require the dentist to put his or her knee on the patient’s chest!

On occasion, some teeth require more than just elevation with a dental elevator to remove completely.  This can include sectioning the tooth into 2 or more pieces, cutting some of the tissue surrounding the tooth, use of dental forceps, and other techniques. The detailed descriptions of each technique are beyond the scope of this blog post. However, none of the techniques involve a pulling motion.

Steve Martin Dentist Little Shop of Horrors pulling a tooth

Steve Martin as a sadistic dentist

So the next time you hear this myth, call them out on it, as it is not true… unless their dentist is Steve Martin and they are living in the movie Little Shop of Horrors!  Or they resemble Dustin Hoffman and just recently were found acting the movie Marathon Man!

If you are in the vicinity of New Haven, CT and need your tooth removed, you can come see me. As promised, I perform all types of tooth extractions, some with IV sedation.  And I promise I won’t put my knee on your chest!

Stay tuned for another Dental MythBuster blog post in the near future!