US News and World Report came out with their annual (2016) listing of the Best Jobs in America. Notwithstanding the fact that any ranking is subjective, and easily manipulated by the criteria one uses to rank a job, but we must admit that it was rewarding to see Orthodontists and Dentists finish #1 and #2. Pediatric Dentists weren’t listed separately but I suspect we were lumped in under the ‘dentist’ category.
Either ways, dentistry is a fantastic profession (and deservedly one of the best jobs around) – we get to see our patients grow, develop relationships with them, eliminate discomfort and pain, educate, make patients feel great about their smile (and their overall well being), partner with fellow team members (assistants, hygienists, business associates) towards a common goal, while exercising a certain level of independence and freedom that has largely disappeared from other professions. What’s not to like? We think it’s a wonderful profession.
Here’s a listing of the top 10 jobs of 2016:
- Computer Systems Analyst
- Nurse Anesthetist
- Physician Assistant
- Nurse Practitioner
- (tie) Obstetrician and Gynecologist/Oral and Maxillofacial Surgeon
Oy! So your teenager wants to get a piercing. And not just a cute little earring, but a cool one that expresses her individuality, and wait a minute, she wants it in her tongue. What’s a parent to do?
It’s a well known fact that teenagers don’t think like adults – they are impulsive, narcissistic and aren’t capable of thinking about the effects of their behavior on other people (or themselves for that matter). Their frontal lobes aren’t quite developed, so since their insight is impaired, it makes perfect sense to them that getting a tongue piercing is completely normal and safe.
One should know that oral piercings (tongue, lip, and cheek), are associated with a number of adverse oral and systemic conditions. Parents should inform their teenagers of the risks of piercings which are significant. In fact, the American Dental Association opposes the practice of intraoral/perioral piercing.
Piercing related risks include:
- Infectious Disease transmission: Oral piercing has been identified as a possible factor in the transmission of hepatitis B, C, D and G.
- Infection: The mouth is filled with millions of bacteria and oral piercing creates an opportunity for these bacteria to infect the piercing site. These infections can be quite serious, leading to swelling, inflammation, cellulitis and even endocarditis.
- Nerve and blood vessel damage: The tongue has lots of blood vessels and nerves. One can puncture a nerve leading to temporary and even permanent numbing of the tongue. This damage can affect your sense of taste and ability to move your tongue.
- Injury to gums: The metal bars and caps in oral jewelry can cause gum recession and damage leading to long term sensitivity and potential bone loss.
- Tooth damage: Metal jewelry can lead to tooth fracture, abrasion, increased sensitivity, cracking of fillings and tooth wear.
- Airway obstruction: Oral piercings have many parts that can come loose, leading to inadvertent swallowing or aspiration (when foreign objects go into the lung)
- Allergic reaction: A hypersensitivity reaction — called allergic contact dermatitis to the metal (nickel) in the jewelry can occur in susceptible people.
- Compromised Dental Care: Oral piercings can prevent dentists from taking clear x-rays and not allow proper treatment to be recommended.
And while your teenager typically does not think adults know what they are talking about, it is important to inform them of the dangers associated with oral piercing. Sometimes they do hear what you are saying.
Sometimes the old is new again. Or it can take decades for an idea to come to fruition. Then again, maybe a fresh reboot on a concept that has been percolating for a long time is what’s needed to get things going.
What am I going on about?
When I was accepted into dental school, one of the things that attracted me to the school was it’s philosophy that the oral cavity is but just one part of the entire body, and in order to gain an understanding of how to manage and treat oral diseases, one needed a broader study of the entire body. Hence, the first two years of my dental school education were at the medical school, taking all of the same courses as my medical colleagues – biochemistry, gross anatomy, microbiology, genetics, immunology, patho-physiology and so on. It was fantastic and helped me broaden my understanding of medicine in general.
Dentistry does not exist in a vacuum. On a daily basis we treat patients in the dental chair with complex medical conditions, allergies and who may be on a variety of medications. As pediatric dentists, we are often referred patients with chronic diseases that necessitate coordinating care with other medical specialists. It is crucial that we develop a global medical expertise which gives us the skill set to recognize how medical conditions can impact the dental care we recommend.
The dental/medical community is still asking ourselves what role the dentist should have in diagnosing and managing medical conditions such as high blood pressure, diabetes, asthma and depression. Studies have shown that a lot of people see a dentist more often than their primary care medical doctor. If that is true, we are missing a tremendous opportunity in improving the overall health of our patients.
Fast forward 20 odd years, and the dental-medical community is still struggling to reconcile the mouth-body gap, and the role of the dentist in our patient’s overall health. A recent article “Fluoride and a Physical: Patients see Docs at the Dentist” reviews changes being implemented at the Harvard School of Dental Medicine is hoping to address this challenge. Primary Care Physicians and Nurse Practitioners are now actively involved in the clinical care of patients alongside dental students.
Hopefully this initiative will stick, be picked up by more dental schools and be transformative in the way we deliver health care. I’m hopeful that eventually this will come to be, but I’m still waiting (ergo my first paragraph of this article). Because 24 years ago I was a first year student at Harvard School of Dental Medicine and despite having this concept of holistic care ‘drilled’ into me, this idea of “putting the mouth back in the head, and putting the head back in the body” is still trying to gain traction in the broader community.
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!
There was a fascinating article that appeared last year in the Sunday New York Times discussing the impact of HIPAA on the ubiquitous happy baby pictures one oftentimes sees in Pediatrician and Obstetrician offices. We ourselves used to have a “No Cavity” wall which was replaced a number of years ago with electronic pictures that are erased on a daily basis.
HIPAA, which stands for “The Health Insurance Portability and Accountability Act” is a now, old law which governs patient privacy and ensures that one’s health information is protected. You, as the patient, probably know of it by the mountains of papers which you have to sign even before you are seen by your Doctor. I
The New York Times article discussed how the age old tradition of posting pictures of babies on a bulletin board are falling victim to offices bending over back to adhere to their interpretation of what the rules of HIPAA mandate. While there is no explicit line in HIPAA stating that ‘baby pictures sent in by parents may not be posted’, pictures are considered a protected entity, in the same way radiographs and medical charts are protected. One would think that if a parent were to post a picture of their baby on the practice’s Facebook page, or send in a picture of their baby, that there is implied consent to post the pictures in the office. It turns out that ‘implied consent’ is not adequate, and that ‘explicit consent’ needs to be obtained. Yet another form needs to be signed.
Our practice is quite mindful of the privacy rights of our patients, and prior to posting any pictures online or in the office, we have parents sign a consent form. While this may have done away with some of the spontaneous pictures we used to take, we are mindful that in this day and age of privacy concerns, that it is wise to err on the side of caution. The times are a changing!