The New York Times is always a good read. Recently, in honor of April Fools Day, it ran a series that highlighted common misconceptions and sought to debunk some of these common myths. Check out misconception #5.
The misconceptions (in no particular order) are:
- Exercise builds strong bones
- In an asteroid belt, spaceships have to dodge a fusillade of oncoming rocks
- The universe started somewhere
- Spree killers must be mentally ill
- Baby teeth don’t matter
- Climate change is not real because there is snow in my yard
- Migranes are psychological manifestations of women’s inability to manage stress and emotions
I certainly can’t claim to be an expert on osteoporosis, the mysteries of space, psychosis, the environment or migranes, so I’m in no position to rebut or support any of these common myths. But it is fair to say that I know a few things about Baby teeth. And yes, they do matter!
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.
Woo Hoo!
Here’s a listing of the top 10 jobs of 2016:
- Orthodontist
- Dentist
- Computer Systems Analyst
- Nurse Anesthetist
- Physician Assistant
- Nurse Practitioner
- Psychiatrist
- Pediatrician
- Anesthesiologist
- (tie) Obstetrician and Gynecologist/Oral and Maxillofacial Surgeon
Turns out people don’t read anymore. Despite the incredible quantity of articles, links, news reports, texts, emails, online op-ed pieces, listicles, facebook posts and blogging, sociologists have found that most of us don’t read beyond the headline (hence the success of the 140 character tweet).
In fact, if you have made it this far reading this blog, congratulations, you’re in the minority of people who read these days (I wouldn’t expect anything less from our blog readers!).
It seems that we prefer looking at pictures versus reading words. It’s been shown that blog posts with pictures get more hits, and the top apps used by teenagers and young adults is not Facebook or Twitter (involves more reading than these millennials prefer) but are Snapchat and Instagram. These two apps are photo based and provide instant gratification and an endorphin rush for those who receive hundreds of likes.
So in the interest of being au courant and in tune with our patients and young parents, we recently launched an Instagram page for our practice. We are still trying to figure out how best to keep connected with our dental family, but this is yet another step for us into this new (or not so new) world of social media.
Oh….and in case you missed it, click here to check out our instagram page. And ‘heart’ us. And ‘follow’ us. We promise – you won’t be easily bored!
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!
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).
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.
One of the clearest examples of the power of the tongue is in individuals who have enlarged tongues, hyper-active tongues or a condition known as tongue thrust. Over time, as the tongue pushes on the teeth (mostly the front teeth), the teeth are displaced, and are gradually moved forward and tipped out, resulting in a malocculsion known as an ‘open bite’. If the tongue thrust habit persists, the open bite can become quite significant, making it a challenge to correct even with braces.
When we identify a patient with a tongue thrust, we typically recommend placement of a habit appliance. This appliance, called a crib appliance, affectionately described as a ‘hockey mask’ by our patients, is cemented onto a patient’s back molars. The ‘crib’ portion of the appliance is made up of a smooth cage like attachment which prevents the tongue from pushing directly against the palate and the backsides of the upper front teeth,thereby eliminating the undesired pressure contributing to the open bite. And since the lips are a muscle in and of themselves, over time, lip and cheek pressure can reduce the open bite, and improve a patient’s bite.
The crib appliance is typically kept in the mouth for a year to break the tongue thrust habit. After an initial short period of adjustment to the appliance, most patients adapt easily, and have no problems whatsoever with eating and speech. And despite it’s cage-like appearance, most patients are not put off by it’s look.
In some cases where patients are also sucking their thumb, spurs are added to the appliance which act as a deterrent for thumb placement.
While the crib appliance is effective in stopping the tongue thrust habit, oftentimes one will need full braces to close the bite and improve one’s smile completely. However, if left untreated for too long, even braces may not correct one’s bite completely. Hence, early intervention is recommended.
A rite of passage for every dental student is when you are assigned and given a mannequin head, complete with a fake mouth (and fake teeth), on which you can practice one’s tooth preparations for fillings and crowns. These heads are your first patients, and dental schools are wise in thinking that a complete novice should practice using a high speed drill on fake teeth before moving on to the real deal. Practice does make better (note I’m not saying perfect), and it was of great help to me to be able to practice (and mess up) on fake teeth (without saliva, tongue, cheek and scared human being trying to talk) before ‘graduating’ to the clinic floor and seeing live humans.
That being said, the mannequin’s we used back when I attended dental school (gulp – over 2 decades ago) were fairly primitive. Adequate but nothing fancy. We used to joke that we preferred the mannequin’s to real people because we could manipulate them, and twist their heads in positions that no real person could possibly achieve. No longer – Fast forward to today, and new dentists-to-be are the beneficiaries of highly realistic mannequins, new technology, and impressive computer simulation.
Instead of having 20-30 students gathering around a single instructor, standing on chairs for a better view, and straining to see what the instructor is doing (something I did), students these days can sit at their own chair and view the preparations on their own individual high-def computer monitors. The mannequins are more sophisticated, some with real time feedback for students and instructors, showing computer tracings of the student’s preparations. Workstations are equipped with interactive computer monitors, high speed internet access, electronic keypads, two-way microphones and simulations of live patients with running water and air. Amazing!
I’d have to think that all of this new technology can only help students. One can be nostalgic for the ‘old’ days when we walked through 3 feet of snow to get to school, or had to use unrealistic models with fake teeth to practice on, but one must admit that this is something any dentist probably wished they had access to.
The flip side of all this technology though is cost. None of this comes cheap, and at some level, the costs are probably getting passed on to the students. For those of you who are curious, Tufts School of Dental Medicine (the aforementioned school with amazing views and simulation lab) projects the cost of ONE year of dental school at $104,000. It is not unheard of for new dentists to be graduating with over $300-400,000 in school loans.
But at least they got to practice on some pretty awesome mannequins.
One never ever hears of a mouse developing a cavity. That may be because they either never do in fact get cavities (ie. their teeth are somewhat resistant to decay) or that the NIDH (National Institute of Dental Health) has determined that federal funding for research is better off spent in other areas.
Or maybe it’s because they like cheese.
Let me explain. A May/June 2013 article in General Dentistry, the peer reviewed journal of the Academy of General Dentistry (aka a pretty reliable source) found that cheese changes the pH of the oral environment, suggesting that it may 
help reduce the risk of tooth erosion. If you remember High School chemistry, an increase in pH means the environment is less acidic. Studies have shown that a pH of over 5.5 lessens the chance of tooth erosion, and hence also cavities.
The study, which examined 68 subjects between the ages of 12 and 15, divided these subjects into 3 separate groups and tested their pH levels both before and after their consumption of sugar free yogurt, milk or cheddar cheese. They found that a rapid rise in oral pH levels was found only in individuals who had consumed the cheese. This could be because that the very act of chewing stimulates saliva production which in of itself causes a rise in pH. The authors also hypothesize that there are compounds in cheese which adhere to teeth and are anti-cariogenic in effect. What these ‘compounds’ are is unclear.
Further google sleuthing by us here at Dentistry For Children, did find that mice can indeed develop cavities. None other than the most famous mouse of all has had to seek out dental care, as shown by this 1938 sketch titled, “Mickey’s Toothache”. We particularly enjoyed the animators portrayal of the dentist as a bearded, one legged and saw wielding fellow, though we do take issue with the saw.
The takeaway from this sketch is that at least in Walt Disney’s mind, mice can get cavities and that dentists are kinda scary. Fortunately, we now know that if Mickey had stuck to an all Cheese diet maybe he would have had a fighting chance of having a cavity free life.
A few Sunday nights ago, while sitting down to dinner, I received a frantic call from a mother of one of our patients. She was extremely panicked as Billy (a pediatric dentist’s favorite pseudonym for a boy patient) had just fallen and knocked out a front tooth. The source of her anxiety was that she didn’t know if the tooth he had just lost was a baby or permanent tooth. A quite upsetting scenario.
Billy was 7, and so in my mind, it was possible that he had lost a permanent tooth. This would have necessitated immediate re-implantation within 1 hour in order to ensure a favorable long term prognosis. However, if this were only a baby tooth, we could wait until the next day to see him. Dilemma time – drive in to the office or not?
A light bulb went off in my head. “Mrs. P, do you have a smartphone that can take pictures?” Silly question as like most parents of a 7 year old, she had an iPhone. I asked that she take a picture of her son’s mouth and of the tooth that had popped out, and text it to me.
Fortunately, Mrs. P is a good photographer and 5 minutes later, the following pictures popped up on my phone:
Any pediatric dentist (I hope) who is worth the many certificates and diplomas hanging on their walls, would have, like me, breathed a big sigh of relief. Based on his age, the fact that he had his lower permanent incisors growing in and the picture, this was clearly a baby central incisor. Billy’s fall had simply accelerated it’s inevitable loss. Mom was beyond relieved.
Out of an abundance of caution (in case the tooth in question was the World’s smallest permanent central incisor) I had Billy follow-up the next day, where an x-ray confirmed my smartphone diagnosis.
Sometimes technology is a good thing. Billy’s mom slept better knowing he had only lost a baby tooth. The tooth fairy paid Billy a visit. And I got to enjoy my Sunday dinner.
Least one thinks that teeth are only good for eating and smiling, Tanya Smith, an associate professor of evolutionary biology at Harvard University, has found that microscopic examination of teeth can help one determine the age of the person from whom the tooth came from.This groundbreaking research has allowed her to prove that our earliest ancestors, the Neanderthals, developed faster and had shorter childhoods than early humans.
She explains – “Teeth have rhythms inside them that are very precise, regular, and consistent, like rings in tree trunks. And like tree rings, they can show you how long the organism has been growing – but on an even finer scale. Children’s teeth lay down a mineralized record of growth eery day. Your entire childhood is recorded in your teeth.”
So chew on this -, one can estimate (with a high degree of accuracy) the age of a child or even adult simply by looking at their teeth (with some help from a powerful synchotron microscope), and counting the number of ‘microscopic rings’ found within the tooth. In fact, Professor Smith says that there is a line, called the ‘birth certificate’ which can be used as a marker for the day of birth, and henceforth reconstruct the age of an individual by using this ‘birth certificate’ line as a starting point. And unlike in the past, where one would have to section (or slice open) a tooth in order to look inside, this newer x-ray imaging technique allows scientists to peer inside teeth without physically slicing pieces from them.
So possibly, sometime in the near future, if we wanted to to determine the exact age of a child, we may be calling Harvard and asking to borrow their synchotron microscope. Or we could just ask their parents as long as they aren’t Neanderthals.
For more on this fascinating topic, click on the following links:
http://harvardmagazine.com/2014/09/tanya-smith-biological-anthropologist-studies-teeth
dentistryforchildren.com 