Dentistry for Children, P.C. Blog

X-Rays, Flying and Colorado

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“I don’t want my child to have any x-rays!”

“I think my child is getting too many x-rays and I’m worried about radiation”

These are just a few of the comments that we hear on a daily basis at our practice. Parents are extremely concerned about the amount of radiation that their child is being exposed to, and instead of running from these important questions , our practice welcomes them and we spend a lot of time discussing their concerns.

digital-dental-x-ray-of-human-jawParents, like most individuals, have heard about the dangers of excessive exposure to radiation.  They have most certainly heard about the high levels of exposure when taking a chest x-ray, CAT scan, or MRI.  They have probably also heard that radiation exposure accumulates over a lifetime; hence, the more one is exposed, the greater the amount of lifetime accumulation.

The simplest explanation I usually give parents is that the amount of radiation a bite-wing x-rays  emits is extremely , extremely low – about 10 times less than that of a chest x-ray and 1000x less than a CT scan.  One of the more important things to consider is that  for we are also all exposed to radiation from natural sources all the time.  The average person in the U.S. receives an effective dose of 3 mSv (millisieverts is the scientific unit for radiation dose) from naturally occurring radioactive materials and cosmic radiation.

Radiation Type                                          Radiation Amount

Daily background radiation                     0.008 mSv

Single Digital Bitewing                              0.005 mSv

Digital Panorex                                             0.01 mSv

Cross Country Flight                                   0.03 mSv

Chest X-ray                                                    0.1 mSv

Chest CT                                                          7 mSv

Head CT                                                           2 mSv

To put things in perspective, a single typical dental x-ray is less than a day of usual background radiation, and a panoramic x-ray is 3 times less than flying a plane cross country. One chest CT is the equivalent of 1400 dental x-rays.  In fact, if one lived in higher altitudes such as in Colorado, you areSamolet-13 exposed to 50% (1.5 mSv) more background radiation than those of us at sea level (that’s the equivalent of 300 dental x-rays for those of you keeping count). Click here  for more information.

The takeaway from this data and the multitude of studies done on x-ray safety is one should not worry about the amount of exposure one gets from dental x-rays.  As shown, the amount of exposure is low, and the estimated additional risk of developing cancer as a result is negligible.

All things in life are about considering the cost:benefit ratio. The cost of not taking a dental x-ray is the inability to diagnose disease (dental caries) Lemieux-Dental-Decayand allowing it to progress to a point where one is put at risk of pain, localized and systemic infection, and extensive treatment which could have been avoided.  The cost of taking an x-ray is…..well, as we have seen, is less than a day outside. One should note that people who live in Colorado get 50% more background radiation than those of us in Boston, are deemed some of the healthiest people in the United States, with cancer rates not being any higher.

Certainly, if you do have concerns about the need to take x-rays, I would encourage you to speak with us.  There is a recommended schedule for taking x-rays – the key word here is recommended. There are certainly reasonable cases to be made for not taking x-rays routinely (ie. low caries risk, exfoliating baby teeth) which should be made on a case to case basis.

The “magic” liquid that makes cavities go away

What if you, as a parent who has a very young child with a cavity, is told that instead of a 30 minute long appointment consisting of the dreaded shot, drilling, and no small amount of drama, that we could very simply, in less than a minute paint a magic substance on your child’s cavity, and voila, cavity is taken care?

Well, what if we told you that such a substance has been used in Japan for the past 80 years, can apparently basically ‘freeze’ cavities in place eliminating the need for placing a filling, and that the cost of such treatment is fairly low.  Sounds good doesn’t it?

That magic substance is Silver Diamine Fluoride (SDF).  It is a colorless liquid consisting of 24-28% silver and 5% fluoride. The FDA recently approved this for use as a cavity varnish placed on enamel to reduce tooth sensitivity.  Though it hasn’t been technically approved for use in the treatment of cavities, some dentists have started using SDF ‘off-label’ (which is allowed) for management of the aforementioned cavities.

As we alluded to in the introduction, the dentist simply dries the tooth with the cavity, swabs a small amount of the SDF liquid on the tooth, allows it to dry (1-2 minutes), and you’re done – the cavity is arrested (which means it kills the bacteria causing the cavity, hardens dentin, and promotes re-mineralization or hardening of the surrounding enamel).

Of course, as with any treatment option, there are some downsides to this treatment.  The most significant is that any tooth treated with SDF will turn black in color.  To be completely fair, only the cavity turns black, but when we say black, we mean BLACK. Not a slight discoloration, or graying. Black.

It also requires multiple applications for complete success, cannot be used in individuals who have silver allergies, can cause irritation to gum tissue, and has a slight metallic taste when first applied.

While SDF has been used for decades in not only Japan, but also Brazil, Peru, Australia, Thailand and a slew of other Asian countries, studies looking at its efficacy, and safety in the U.S. are limited. To date, there have only been 14 reputable studies on SDF; 7 of which have been completed, 5 that are recruiting, and 2 that have not yet begun recruiting.

Despite it’s drawbacks, there is probably a place for SDF in dentistry.  Patients who are unable to tolerate extensive or any dental treatment such as the very young, very old, and/or medically compromised seem like candidates who would benefit from this very non invasive treatment.  However, it needs to be understood, that this is not a cure for cavities – it is simply managing a disease process until such time that more definitive treatment (ie. filling, crown) can be completed. Furthermore, more research need to be done around issues of effectiveness, long term safety and treatment protocols.

For patients for whom it is indicated, Dentistry For Children now provides Silver Diamine Fluoride treatment.

 

 

Don’t brush your teeth after eating oranges?

Dentists are fond of reminding our patients of the importance of brushing on a regular basis, at least twice a day. A completely unscientific, random polling of the staff here at Dentistry For Children reveals that most of us brush immediately after waking up, and immediately before going to sleep. However, some of us brush after each meal, and that includes lunch.

 

Group of oranges

 

This got us to wondering if there is ever a bad time to brush your teeth?

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Why Sealants Matter

Dental sealant infograph

I happened across a great article  in the New York Times (readers of this blog may have come to the realization that I’m an avid reader of this publication) that sang the praises of the dental sealant.  It still comes as a shock to me to  hear of members of my own profession who still don’t place sealants on a routine basis.  At our practice, most of our patients have sealants placed; the rare instances when we elect not to place them are for patients with extremely shallow grooves,  easily cleaned teeth and a history of no cavities.  Otherwise, we are HUGE believers in the value of sealants.

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Habit/Crib Appliances

The Merriam Webster dictionary defines the tongue as “the soft, movable part in the mouth that is used for tasting and eating food and in human beings for speaking”.  While this is true, what the definition leaves out is the fact that the tongue is made up mostly of muscle.  This explains why it is so effective in moving food through the oral cavity, and why when one receives lidocaine (‘novocaine’) during a dental procedure, your tongue feels like it’s paralyzed.

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