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Tuesday, August 13, 2013

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What is your opinion of Dr. Ellie's recommended home care regimen? , My boss passed this article from the New Yorker onto me several months ago. At first I was appalled that Dr.Phillips so publicly "bashed" flossing. On my second and third thoughts and then many more I understood that her message was not "don't floss, or it doesn't work" but more about how we as a profession communicate to our clients that if they don't floss they are bad, and that if they do all their dental problems will be solved -both statements are incorrect. I think that Dr. Philips message is that flossing is important but so are other things like brushing, rinsing, soft picking, xyltiol and fluoride rinsing etc. that are just as important and can yield amazing results. I won't give up on trying to get my patients to floss, but ill make double sure they don't feel guilty about not flossing and in the meantime provide them with supplements and alternatives and help them feel great that every little bit counts! What do you guys think? Has anyone tried Dr. Phillips regimen? What was your experience? Dr. Ellie Philips New Yorker article: Earlier this year David Sedaris, the American humourist, took as his subject European dental care. He had, he wrote in The New Yorker, proudly told his French dentist he had been flossing every night. “Hey,” she retorted, “enough with the flossing. You have better ways to spend your evenings.” To an American audience this was a cue for big laughs. Big, white, toothy laughs, from the nation that invented dental floss and went on to elevate flossing to the status of semi-religious devotion — they use nearly 5 million kilometres of it a year. Americans don’t flagellate themselves, they attack their teeth with nylon wire until they sting and bleed. And now, increasingly, so do we. I laughed at the Sedaris piece myself, probably even while flossing. Probably even in bed, for you do not know true intimacy until you have flossed in the presence of your loved one. According to Clint Eastwood’s former partner Sondra Locke, in her book The Good, the Bad and the Very Ugly, the Hollywood star would whisper, “Sweetie, did you floss?” as a prelude to sex. But in my bathroom floss digs into my mouth like a Jew’s harp. The song it plays is not of love, as unspeakable objects are exhumed from my gums. Flossing doesn’t feel good, it is drooly and disgusting, but it feels like the right, dutiful, morally superior thing to do. We all know we should floss, even if we don’t. The sight of a floss packet triggers a secular guilt. But what if we don’t need to floss? What if the reproachful sermon of every dentist you have ever known, to floss more, floss harder, was wrong? What if we looked back on ourselves 50 years from now and laughed at our attempts to clean our teeth by wedging bits of string between them? Well, I discovered a dentist who believes just that. My first instinct when Ellie Phillips cheerfully told me, “Oh, I haven’t flossed in 20 years, and I’ve never taught any of my children to either,” was of utter shock. Are dentists even allowed to say this? Don’t they get struck down by some flossing god? My second thought was that she was obviously a kook, not aided by the fact that her book is somewhat jauntily entitled Kiss Your Dentist Goodbye. But it turns out that Dr Phillips was one of the first female dentists trained by Guy’s Hospital in London in the 1960s. On her first day in the job in a school clinic she faced a row of 20 children with teeth to be extracted — “strained little faces looked at me with round moist eyes”. She vowed then to devote herself to preventative dentistry. Her work took her to America , where she is now based; her book is endorsed by Richard Carmona, the former Surgeon General of the United States . And its 21 pages of footnoted references to scientific studies lead to astounding conclusions: first, that flossing is useless at preventing tooth decay. Yes, you heard that right. In all the reviews of flossing studies, no amount of flossing — daily, twice daily — has shown any reduction in your chances of tooth decay. There was only one exception: in which schoolchildren received a professional 15-minute flossing from a hygienist five days a week for nearly two years. “Self-flossing,” researchers concluded, “failed to show an effect on tooth decay”. In terms of gum health, some studies are more positive, but many show that flossing does not improve dental health over brushing alone. But, writes Phillips in her book, despite a total lack of evidence for the preventative effect of flossing on tooth decay, “dentists have repeated the flossing mantra for 50 years. In the world of dentistry it is politically incorrect to question the usefulness of flossing ... those who have asked such questions have received hate mail, complaints from their peers and worse.” So, I accept the challenge. I go to my hygienist. She gives my mouth, at best, six out of ten, despite my usual guilty frenzy of flossing in the weeks leading up to the visit. Will she, I manage to mumble as she scrapes gunk out of my gums, be able to tell if I stop flossing? “Of course,” she says. “Your gums will bleed and there will be plaque climbing the walls.” I tell her I will do something different, I won’t tell her what, and be back in one month, the minimum amount of time Phillips says that her system takes to see results. I stop flossing, and head straight to the supermarket to stock up. Half of the effectiveness of Phillips’s system, she says, is from using mouthwash, the other half from eating xylitol, a natural type of sugar alternative that comes from birch trees. The underlying basis of her approach, as one dentist explains in the foreword to her book (warning: gross-out alert) is to think of your mouth as a fish tank, and the teeth as the stones. You could floss those stones night and day, but if the water remained dirty, you would be wasting your time. So the Phillips system aims to alter the chemistry of your mouth. She uses three different mouthwashes in a specific order. If you need reassurance, look at the trial of Listerine Original (one of her favoured p rod ucts), in which one group flossed daily and the other used Listerine twice daily. After six months, the Listerine group reduced their plaque by 52 per cent more than the flossing group, and their gum health improved by 21 per cent more than the flossers (whose dental health barely differed from those who didn’t floss or use mouthwash). As for the xylitol, well, that is a revelation to me. If you’re interested in the scientific research, type the words “xylitol” and “caries” into Google Scholar and see for yourself. There have been more than 300 studies showing its almost incredible effect on preventing and reversing tooth decay — by up to 50 per cent — and while it works for adults, the effect on kids is amazing. For instance, mothers who chewed xylitol gum during pregnancy have children who are 70 per cent less likely to have tooth decay at the age of 5. A group of children who chewed xylitol gum daily were a third less likely to get tooth decay than those using a placebo gum. Even wiping a baby’s new teeth with a daily xylitol wipe gave great protection against decay in the early years. So this is what I do: use mouthwashes twice a day and pop a couple of xylitol sweets after every meal. It feels decidedly counterintuitive, this eating of something so super-sweet to help your teeth. For long-time masochistic flossers, the idea of a public health initiative that is actually nice is hard to adapt to. But the kids would love it. After all this research, I really have just one question: why hasn’t any dentist ever mentioned this stuff to me before? First, I ask Nigel Carter, chief executive of the British Dental Health Foundation. He has said xylitol “may be the biggest advance against cavities since fluoride”. “The dental profession is generally slow to adapt to new ideas,” he said. “On xylitol, I think it’s probably lack of knowledge. Any dentist should be aware of the effects of xylitol, but as a profession we do get very bogged down in the mechanical removal of plaque.” In Scandinavia , where xylitol was first championed because of the ready access to birch trees, children are regularly given free xylitol sweets in schools and nurseries. And do they have better teeth? “Oh yes, they tend to.” Next I talk to Aubrey Sheiham, emeritus professor of dental public health at University College London. “Flossing is almost completely useless, it doesn’t stop tooth decay,” he says, adding that he has “slides of bacteria waving as the floss goes past”. “It is still useful for stopping gum disease, but you have to be meticulous — it’s time-consuming.” On the other hand, he, like so many at the forefront of preventative dentistry, “would advise people to use xylitol. I have some xylitol mints in my desk drawer. If you look at the evidence it is overwhelming that xylitol works. If a child gets it a couple of times a day, they will get less decay.” By the end of the month, I go back to the hygienist. I wait, open-mouthed, for the result. She says that she cannot find a single speck of plaque on my teeth or beneath the gum line, no bleeding, inflammation, nothing. She dramatically puts down her tools, saying there is simply no point her trying to do anything to such a perfectly clean mouth (this, needless to say, has never happened to me before). I immediately resolve to stick with the programme, find creative new uses for my packs of floss and, what’s more, begin to dole out xylitol sweets to my delighted children after meals. Oh, and take whatever bunkum my dentist tells me about prevention with a big spoonful of sugar. Helen Rumbelow Feature Writer The Tim es , http://community.pennwelldentalgroup.com/xn/detail/2013420:BlogPost:78855

What is your opinion of Dr. Ellie's recommended home care regimen? , My boss passed this article from the New Yorker onto me several mon...
Apicoectomy – Definition, Indications, Contraindications, Surgical Procedure, Complications , Apicoectomy: Definition: It is the cutting off, of the apical portion of the root and curettage of the periapical necrotic, granulomatous, inflammatory or cystic lesion. Synonym: Apical Surgery, Root Resection, Endodontic Surgery, Root Amputation Indications of Apicoectomy: Apical anamoly of root tip-dilacerations, intracanal calcifications Presence of lateral/accessory canal/apical region perforations Roots with broken instruments Root with overfilling Fracture of apical third of root Formation of periapical granuloma and cyst Draining Sinus tract Non responsive to RCT Over extension of root canal cement beyond the Apex Teeth with Ceramic Crowns When patient with chronic periapical infection Teeth with Apical resorption Contraindications of Apicoectomy: Medically compromised patients Teeth with deep periodontal pocket and excessive mobility Teeth with poor Accessibility When there is extensive involvement of Bone Danger of involvement of anatomical structure Steps of Apicoectomy: Preoperative Preoperative Assessment Preoperative Consideration Preoperative preparation ( Intra oral and Extra oral) Armamentarium (Standard Surgical set) Anesthesia (LA, nasal intubation) Step by Step Surgical Procedure of Apicoectomy: Design of Mucoperiosteal Flap Reflection of Mucoperiosteal Flap Exposure of Periapical Pathology and Root Tip Removal of Periapical pathology Ressection of Root Apex (Apical 1/3rd) Sealing of the Apex Toilet of the wound Smoothing of the Sharp Bony margins Bleeding Control Closure of the Surgical Wound – Suturing Postoperative instructions, medication and care Complications of Apicoectomy: Infection Flare up Cellulitis Ludwigs Angina Fracture of Maxilla and Mandible Soft tissue injury Opening of Maxillary Sinus – Oro Antral Fistula Secondary Hemorrhage Secondary hemorrhage Non vitality of Adjacent teeth Nerve Injury Luxation of adjacent teeth , http://bit.ly/132Pqdx

Apicoectomy – Definition, Indications, Contraindications, Surgical Procedure, Complications , Apicoectomy: Definition: It is the cutting off...
Push-out bond strength and SEM analysis of two self-adhesive resin cements: An in vitro study - Corrected Proof , Abstract: Purpose: The retentive strength of two self-adhesive resin cements used for the cementation of fiber posts into root canals filled with methacrylate-based sealer and core material (Resilon) was evaluated using the thin-slices push-out test on human molars.Materials and methods: RelyX Fiber Posts #3 (3M ESPE, Seefeld, Germany) were luted with RelyX U200 (3M ESPE) (n = 10) and Maxcem Elite (Kerr Corporation, Orange, CA, USA) (n = 10). Mean values of push-out bond strength for each group and root region (cervical, middle and apical) were calculated. Data were statistically analyzed with one-way ANOVA and Tukey's test (P 60%) adhesive failures at the resin cement-dentine interface were observed. , http://bit.ly/13LCzJx

Push-out bond strength and SEM analysis of two self-adhesive resin cements: An in vitro study - Corrected Proof , Abstract: Purpose: The ret...
Patient Complains of sensitive teeth on biting after Restoration. What to do? , A Pressure sensitive teeth after filling is an annoying condition. Many of us have such cases.Now lets see why this occurs and how to solve it.There are many causes for it lets see it one by one and consider the treatments NOTE- In this article we will consider the causes of sensitive teeth on biting only (Pressure Sensitive teeth ) and not for Hot and cold sensitive or continuous pain after filling. Cause 1. Composite restoration cases- if there is a bubble entrapment at the bonding interface of composite and dentin it will cause sensitivity. This occurs because the bubble shrinks during biting and applies pressure.Solution-Remove the restoration and replace it with corrected one,use Single bond agents which does not require separate etching and boning.Cause2. Deep caries.Dentin is too thin to protect the underlying pulp.Solution - After removal of caries apply a nice layer of Calcium Hydrroxide/Dycal and cover it with temporary restoration. Ask the patient not to bite heavy on the particular tooth and recall after 4 weeks. Ask about the symptoms.If not resolved then let it be there for 4 more weeks.If resolved then replace the temporary restoration with permanent one.Cause 3. Pulp hyperemia or thermal trauma during cavity preparation.Solution- Remove the restoration and replace it with ZOE filling ,Relieve the tooth from occlusion, Start any NSAID for three days Recall after 3 weeks ask about symptoms, if relieved then replace the ZOE with permanent restoration. [Additional]-Check your bur and replace it if its worn out, check for water spray of your handpiece it should be directed on the bur, Don't apply pressure will tooth preparation.Cause 4. High point on the restoration.Solution- Take an Articulating paper,Check for the high point and clear them. Recall after 5 days. If patient still have pain relieve the tooth from occlusion and start any NSAID. , http://bit.ly/17O5Vfv

Patient Complains of sensitive teeth on biting after Restoration. What to do? , A Pressure sensitive teeth after filling is an annoying cond...
County-level characteristics as predictors of dentists' ECC counseling in the USA: a survey study , Background: Transmission of Streptococcus mutans from mother-to-child can lead to Early Childhood Caries. A previous study identified characteristics and beliefs of general dentists about counseling pregnant women to reduce risk of infection and Early Childhood Caries. This study extends those findings with an analysis of county level factors. Methods: In 2006, we surveyed 732 general dentists in Oregon, USA about dental care for pregnant women. Survey items asked about individual and practice characteristics. In the present study we matched those data to county level factors and used multinomial logistic regression to test the effects of the factors (i.e., dentist to population ratio, percentage of female dentists, percentage of females of childbearing age, and percentage of individuals living in poverty) on counseling behavior. Results: County level factors were unrelated to counseling behavior when the models controlled for dentists' individual attitudes, beliefs, and practice level characteristics. The adjusted odds ratios for no counseling of pregnant patients (versus 100 percent counseling) were 1.1 (95% CI .8-1.7), 1.0 (1.0-1.1),1.2 (.9-1.5), and 1.1 (1.0-1.2) for dentist/population ratio, percent female dentists, percent females of childbearing age, and percent in poverty, respectively Similar results were obtained when dentists who counseled some patients were compared to those counseling 100 percent of patients. Conclusions: Community level factors do not appear to impact the individual counseling behavior of general dentists in Oregon, USA regarding the risk of maternal transmission of Early Childhood Caries. , http://bit.ly/YUJUba

County-level characteristics as predictors of dentists' ECC counseling in the USA: a survey study , Background: Transmission of Streptoc...
A need to educate postmenopausal women of their periodontal health, Leena Palomo, Rajeev Chitguppi, Maria Clarinda Buencamino, Dwetta Santos, Holly Thacker Journal of Indian Society of Periodontology 2013 17(2):225-227 Background: Postmenopausal women have shown proactive willingness to take responsibility for their changing health care needs. The example of osteoporosis is a model that when educated of their bone health status, this cohort follows through with prevention and treatment regimens. Postmenopausal status is considered to be a risk factor for periodontitis. It is known that up to 50% of periodontal disease goes undiagnosed. The goal of periodontal therapy is to prevent tooth loss. Objective: Is there a need, then to educate and inform postmenopausal women of their periodontal status? Can dentists provide a greater service to this cohort by increasing education and information? Materials and Methods: The current study compares patient perception to actual clinical findings in 94 postmenopausal women. Patients are informed of their diagnosis, and educated about the disease, its risk factors and preventive and treatment modalities. Detailed interviews examine the patient intentions to follow up on preventive and treatment regimens suggested. Results: Although 97.8% of participants reported having "healthy gums", 36.2% had severe periodontitis in at least one site. Interviews reveal that patients associated disease with abscess, and would be likely to follow prevetive and treatment regimens when they were informed of their diagnosis and educated on the topic. Conclusion: The findings suggest a need to make education a priority when treatment postmenopausal women. http://bit.ly/190lnXT

A need to educate postmenopausal women of their periodontal health, Leena Palomo, Rajeev Chitguppi, Maria Clarinda Buencamino, Dwetta Santos...
In vitro Evaluation of the Effect of Mouth Rinse with Trimetaphosphate on Enamel Demineralization, http://www.karger.com/Article/FullText/350229

In vitro Evaluation of the Effect of Mouth Rinse with Trimetaphosphate on Enamel Demineralization, http://www.karger.com/Article/FullText/35...
Pairing as an instructional strategy to promote soft skills amongst clinical dental students , Abstract Training dentists today is challenging as they are expected to provide a wide range of dental care. In the provision of good dental care, soft skills are equally important as clinical skills. Therefore in dental education the development of soft skills are of prime concern. This study sought to identify the development of soft skills when dental students are paired in their clinical training. In this perception study, four open-ended items were used to elicit students' feedback on the appropriateness of using clinical pairing as an instructional strategy to promote soft skills. The most frequently cited soft skills were teamwork (70%) and communication (25%) skills. However, both negative and positive behaviours were reported. As for critical thinking and problem solving skills, more positive behaviours were reported for abilities such as to explain, analyze, find ideas and alternative solutions, and make decisions. Leadership among peers was not evident as leading without legitimate authority could be a hindrance to its development. If clinical pairing is to be used as an effective instructional strategy to promote soft skills amongst students, clear guidelines need to be developed to prepare students to work in a dental team and the use of appropriate assessment tools can facilitate the development of these soft skills. , http://onlinelibrary.wiley.com/resolve/doi?DOI=10.1111%2Feje.12058

Pairing as an instructional strategy to promote soft skills amongst clinical dental students , Abstract Training dentists today is challengi...
Clinical trial design for orthodontists [Research Design] , High-quality research should form the basis of all clinical practice. Randomized controlled trials currently provide the gold standard for investigating the effectiveness of treatment interventions and these are increasingly being used in orthodontics. Here we discuss the reasons why this form of investigation provides the most useful evidence for assessing treatment outcome. The methods available to achieve true randomization, a fundamental component in the design of these trials, are also discussed. In addition, we focus on how to minimize bias in clinical research, not only during the design and management of a trial, but also when disseminating results. We focus on the importance of using control groups correctly and describe methods that are available to adequately power a trial. Finally, we emphasise the importance of accurate and transparent reporting, which facilitates correct communication and assessment of the evidence. , http://jorthod.maneyjournals.org/cgi/content/short/40/2/93?rss=1

Clinical trial design for orthodontists [Research Design] , High-quality research should form the basis of all clinical practice. Randomized...
Dietary Behaviors and Oral-Systemic Health in Women , The impact of dietary behaviors and food consumption and their relation to oral health are significant public health issues. Women and men exhibit different dietary behaviors. Understanding the influences of dietary behaviors on oral health from the perspective of gender disparities, however, is limited. This article provides the intersections of dietary factors and oral-systemic health for which women are at greater risk than men. Topics include the effect of dietary choices on oral health disparities seen in female patients. Interventional strategies at the local and community level that are designed to influence the balance between dietary habits and oral-systemic health are discussed. , http://bit.ly/10HjJTF

Dietary Behaviors and Oral-Systemic Health in Women , The impact of dietary behaviors and food consumption and their relation to oral health...

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