We’re always on the lookout for the latest in dentistry, and this newish entry to the world of burgeoning oral health products caught our eye. Developed by an orthodontist, it is a patented disclosing toothpaste (Plaque HD) which is designed to help patients with braces to brush better.
One of the greatest challenges when it comes to braces (especially the traditional metal ones) is brushing. Food and plaque tends to build up very easily, causing significant gingivitis to the point where the gums can grow over the braces and cover one’s teeth completely. This can also lead to extremely significant cavities, the cost of repair approaching the cost of the braces themselves. We’re talking thousands of dollars. Gulp!
But how does one know that you are doing an adequate job? For our younger patients who don’t brush well, we give out disclosing tablets (there are also mouth rinses). These tablets, which are chewed after an initial round of brushing, get incorporated into plaque that hasn’t been brushed off, turning these areas pink. Hence, one can actually see the areas that are being missed, and can go back and brush the pink off. Aside from a great educational tool, it is great fun for the kids to see their teeth turn pink.
Plaque HD incorporates this disclosing agent in their fluoride cavity preventing toothpaste. Instead of pink, it turns teeth green in areas that haven’t been brushed well (ie. plaque is accumulating) and serves as a visual cue for patients to go back and brush in those areas. The benefit of this toothpaste is that it’s a one step process – simply brush, look for green areas and then brush again until removed.
This is a fabulous idea that is a long time coming. It’s applications are not limited only to patients with braces but can be used by anybody who brushes poorly. It is a vast improvement from the traditional disclosing tablet route which is more labor intensive, messy and takes more time. The toothpaste retails for $21 (direct to consumer) which may seem like a lot, but keep in mind that even one small white composite filling costs significantly more. Think of the toothpaste as an investment for not only a beautiful smile, but a healthy one. We think this is a win-win for all.
So the super geeky, jet propulsion lab, MIT wanna be, engineering side of my personality (isn’t there an engineer in all of us?) was fascinated by this video produced by google engineer Ben Krasnow, which in illuminating, exhaustive detail shows the effects of brushing on the bristles of a toothbrush. Google is famous for it’s search engine, but a little known fact is that Google engineers are encouraged to spend 20% of their time to work on things that personally interest them (and which may have an application for Google). Apparently, engineer Krasnow has a fascination with microscopes and toothbrushes. And so do the 280,000 who have viewed the video.
It is common knowledge that one should change a toothbrush every 3 months. Ben’s project showed that after 3 months when viewed through a scanning electronic microscope, the bristles on the end of your toothbrush are worn smooth. In order for brushing to be effective, the tips of the bristles need to be ‘microscopically’ rough which not only aids in abrading away plaque but increases the surface area of the bristle contacting the tooth.
Ben also scans toothpaste, specifically looking at the coarse grains of di-calcium phosphate di-hydrate which is in toothpaste, and which acts as an abrasion agent to aid in the cleaning of teeth. Think baking soda or sand. These grains are 20 microns in diameter, similar to 600 grit sandpaper which is actually surprisingly coarse. He does reveal that in a pinch, one can use toothpaste to clean dirty car headlamps.
The video which is over 8 minutes in length is a nerdy scientist’s dream and is appropriate for anybody who enjoys watching detailed explanations of how things work. It is full of words like zoom ratio, vacuum desiccation, aspect ratios and silver vaporization. I give it a strong 2 thumbs up.
If you need a good excuse to change your toothbrush after 3 months, I highly recommend this video!
As pediatric dentists, we are referred patients who are unable to tolerate procedures at their family dentist. Patients come to us for a variety of reasons – chief among them are anxiety, apprehension, inability to comprehend, fear of the ‘needle’, combativeness, shyness and stubbornness. With the vast majority of patients simple behavior management which involves a lot of talking on our part, and clear, child-friendly explanation of procedures enables us to transform a previously uncooperative patient into one who comes to the practice with a smile!
Patients on the autism spectrum experience all of the behavioral issues previously discussed and more. Autism Spectrum Disorder is an extremely complex disorder of brain development. Symptoms vary in severity but are characterized by difficulties in social interaction, communication and repetitive disorders. Autism can be associated with intellectual disabilities, difficulties in motor coordination, and sensory disorders.
The key to treating our patients with autism is understanding, patience and parental involvement. Parents help guide our understanding of their child’s ability to tolerate treatment and are invaluable in discussing tactics that may be effective in gaining their child’s trust. Mostly, it’s about understanding that one needs to be flexible in determining what qualifies as a successful visit. For some of our patients, the ability to sit in a chair for a short period of time may be enough for a first visit. On the second visit, introducing them to the high speed suction or other tools that we use in dentistry may be the next step to gaining their trust. Usually, what is needed is patience and the willingness to spend multiple visits to achieve what may typically be done in one visit.
Other things that we do that have been successful in the past include:
- Treating patients in the operatory alone – less noise and distraction is essential and gives the patients the chance to acclimate to their environment
- Having the same dentist/hygienist see the patient every time. This eliminates the chance of there being any surprises for the patient
- Doing procedures in smaller chunks ie. only clean the teeth in 10 second increments, taking only one x-ray, doing only one filling
- Discussing with parents beforehand what the plan for the day is
- Placing a heavy lead apron over the top of the patient which can be soothing for some patients
- Use of a picture chart with images that patient can point at to communicate
- Instead of using a loud handpiece for cleaning teeth, brush with a toothbrush only. Loud noises can be quite disturbing
- Having the parent bring an iPad/tablet with the patient’s favorite music, movie or show playing
This list is by no means exhaustive nor do these techniques work with every patient. But these techniques can help.
One of the joys of pediatric dentistry is seeing our patients grow up before our very eyes. Treating patients on the autism spectrum is no different. The only difference is that it may take a little longer to gain their trust. But the reward is always a High Five and a smile.
Click here for a New York Times article on children with autism and dentistry
Take a walk down the aisle of any supermarket or pharmacy and you will be shocked by the number of toothbrushes available. From different shapes, sizes, bristle type (soft, extra soft, medium), brand names, store brand, electric or manual, what’s a consumer to do? Well, to further add to one’s toothbrush confusion, one now has the choice of purchasing an eco-friendly, recyclable and compost friendly, design chic toothbrush.
If one considers that you should be changing your toothbrush every 3 months, that is a lot of toothbrushes in one’s lifetime (rule of thumb is if the bristles on your toothbrush are no longer standing upright, it’s time to change your toothbrush; furthermore, waiting to get a new free toothbrush from your dentist at your regular 6 month check-up should not be the only way you obtain a new toothbrush). Imagine throwing away 500 toothbrushes over your lifetime, multiply that by the global population, and that is a lot of trash.
This new toothbrush made by the folks from a small Portland based company called Goodwell aims to solve this problem by creating a toothbrush that is biodegradable. The handle is made from harvested renewable bamboo, and the bristles are made from binchotan. Binchotan is made in the Kishu region of Japan.. It is a charcoal activated by burning oak branches at extremely high temperatures for several days and then rapidly cooling them. This charcoal is incorporated into biodegradable bristles. Aside from being environmentally friendly, proponents of this product state that it prevents bad breath, deodorizes and removes plaque. Supposedly, this activated charcoal also gives off negative ions and prevents bacterial growth within the brush. However, this has not been independently verified or studied.
Clearly, this is a toothbrush designed with those who care greatly about both the environment and chic design. Priced at $14.99 for a 3 pack, it is reasonably priced considering it is not manufactured by one of the ‘big boy’ companies that have the advantage of scale and distribution. There is also a subscription based model which will ensure that one never runs out of toothbrushes.
It will be interesting to see if this model of direct to consumer sale will be successful in the long run or if the Crests and Colgates of the World will jump in once they see there is a market for internet distribution of toothbrushes. They may even determine that an eco-friendly toothbrush makes sense. In a way, they are lucky to have the benefit of waiting to see if this small crowd sourced company achieves some measure of profitability before spending any money of there own. Best of luck to Goodwell for trying to shake things up in the toothbrush world.
Oops….Sorry about our earlier email blast which sent out a post of ours that we’re working on but which is still decidedly under construction. To make up for that, hopefully, these pictures of us celebrating Back To The Future Day (October 21st, 2015) will allow us to go back in time, and take back our email (or at the very least show you that pediatric dentists know how to have fun).
Trending on the internet now is an article from ‘Mom News Daily’ headlined “Children are 800% Worse When Their Mothers Are In The Room.”
The study coming to us from the University of Washington Department of Psychology found that “…children as young as eight months-old could be playing happily but upon seeing their mother enter a room were 99.9% more likely to begin crying, release their bowels, and need her immediate attention.” The research goes on to say that if children are under the age of 10, the percentage of children who behave poorly doubles to 1,600%. Furthermore, the study also “…found that despite using the same disciplinary methods, 100% of the children were more responsive to instructions spoken at a normal voice level if the came from someone other than their mother.” (Click here for article)
Those are huge numbers and prove what most pediatric dentists have known for decades – children behave differently when their parents are around. Now I’m not one that believes that every child behaves poorly when their parents are around, and there are times when parental presence can be helpful for an anxious child. However, there are just as many times when children who have had a hard time calming down with mom or dad, in the room, suddenly do extraordinarily well when his/her parents leave. Giving children an opportunity to have a successful appointment without tears or anxiety, and without the need for their parents to help them, is a win-win for all.
So finally – I thought – here is a scientific research paper (we’re all about evidence based dentistry here) which we could show to parents (especially mothers) and explain that research suggests that it best that they not be in the operatory with their child. Without parental presence, their child would behave, listen and have an appointment without tears, drama or anxiety.
Well, here’s the problem. The research paper is a sham. Fake. Bogus. Not real.
I must admit, I was so intrigued by this article that I decided to read the actual scientific paper. Turns out there is no Dr. K.P. Leibowitz at the University of Washington. I also discovered that the Mom News Daily website churns out other noteworthy studies such as “Researchers announce anti-whining vaccine”, “Democratic and Republican Parents Unite On Need For 12-hour Toddler Sleep Aid” and “Toddlers Who Wake Up Before 5.30am Are Smarter Than Their Peers.” In other words, the website is a site for Mommy satire, similar to The Onion which also features satirical news articles made to seem real.
The fascinating thing about this article, and proof that nobody reads anything but the headlines these days, is that the article got a lot of play on a number of other mommy websites and it seems that most of the people posting the article actually believe it to be legitimate and real. And to show that pediatric dentists aren’t above being duped, a number of my dentist friends who are on Facebook, posted links to this ‘research’ and got a lot of comments celebrating the fact that science has proved what pediatric dentists know – that children behave better when parents are not in the room with them.
If only it were true.