Devastating
November 26, 2012
I mentioned a couple of weeks ago that I was in travel mode for a few straight weeks of continuing education courses. This past week I was in Detroit, which I will discuss below. This coming weekend I was scheduled to travel to northern New Jersey. Well, Hurricane Sandy postponed those plans. My heart goes out to those affected by her devastation and I wish them the best as they try to pick up the pieces and return to normalcy.
This week I would like to discuss two other areas of devastation that I encountered on my most recent trip to Detroit. The course itself was a live-patient course utilizing a unique type of surgical extraction instruments. Although I was very impressed with the course and instruments, there is nothing really more to report that would interest the readers of this column. The two areas of devastation I encountered, however, are worth mentioning.
I saw numerous patients in Detroit who presented with the need for treatment that they could not otherwise afford. Two of the patients I treated needed full-mouth extractions. One was an older gentleman who had recently finished radiation treatment for cancer and the other was a 21-year-old man who has been using methamphetamine (crystal meth). The effects of both of their situations led to the demise of their teeth.
Meth is highly addictive; many users are hooked the first time they try it. Long-term abuse can cause serious dental deterioration, hallucinations, heart failure, brain damage, and stroke, not to mention devastating the lives of addicts and their families.
People think that all drug users look strange, but the reality is that some are normal, good-looking kids, high-school students, even parents. Although my patient did not report any use of drugs, it was apparent from the distinct look of his teeth that he was a heavy meth user.
The signs of possible meth use are many. In addition to physical and behavioral changes, one of the earliest symptoms is gum-line decay of the teeth, caused by both the chemicals in the drug and reduced hygiene (tooth brushing). In more advanced cases, the teeth take on a grayish-brown appearance, then become weak — cracking and breaking easily — and eventually spongy. After long-term decay, teeth take on a goblet shape and the term “meth mouth” is used to describe them. This describes my patient’s teeth exactly. Devastating.
Radiation treatment can have a similar effect on the teeth. It can have both an effect on the teeth themselves and the bone that supports them. My patient had quite a bit of good restorative dentistry performed on him in his younger years but had not seen a dentist for approximately 10 years.
When he was diagnosed with cancer, he underwent radiation treatment without working directly with a dentist. The treatment caused severe dry mouth (xerostomia) which led to rampant decay around the necks of all of his teeth. In addition, the radiation also made his bone extremely brittle, which further complicated the procedure I was doing. Patients who need to undergo radiation treatment should work directly with a dentist and consider intense fluoride treatments and any teeth that need to be extracted should be done prior to radiation treatment.
It is always saddening to see devastation. And, although there is gratification in helping those in need, we should be mindful of the steps we can take in our own individual situations to avoid the unnecessary.
Six Month Smiles
November 11, 2012
Typically, fall and winter tend to be my heaviest time for continuing education. What is continuing education for a dentist? It is a must. As in any profession, learning never stops. If you stop learning, you halt growth both professionally and personally.
Dentistry offers continuing education in every aspect of the profession. Dentists can learn everything from new techniques in “filling” teeth to using Botox. In the next month I am travelling to Detroit to learn some new surgical techniques, New Jersey to learn a different way to do root canals, and Arizona for a refresher course on treatment planning and communication with patients. Travelling and being away from home is not my favorite part of this learning process, but you have to go where the information is.
In the 18 years of continuing my education, I have taken courses that have been career changing and others that were of no interest to me. Recently I was in Indianapolis for an orthodontic course entitled ‘Six Month Smiles’.
Many adult patients are unhappy with crooked teeth. Some of them may have had braces when they were younger and didn’t wear their retainers and others may have never had braces but always wanted straighter teeth. I have numerous adult patients who are currently in braces with an orthodontist. I also have many patients that are not willing to make the commitment to wear metal brackets in their mouth for 2 or more years.
A few years ago I took a course for Invisalign. This is a system that uses scanned impressions of the mouth and provides a series of digitally produced removable clear trays called aligners. The patient wears the trays 24 hours a day and is only supposed to remove them to eat and brush their teeth. The trays are changed every 2 weeks and with each change the teeth are moved. The intended end result is straight teeth. Treatment time depends on the complexity of the movement desired. In my experience, treatment usually takes a year or more.
I have had my frustrations with Invisalign. Certain movements of teeth can be unpredictable. In addition, because the patient can remove the trays, there is a compliance issue. I limited the cases I did to patients who I knew would be compliant and had relatively easy tooth movements.
Six Month Smiles is a system that I am using to replace Invisalign. It uses clear braces and a white wire so they are barely noticeable from speaking distance. And, the patient can’t take them off so it makes the movements more predictable in that regard. Why is it called Six Month Smiles? Treatment is usually completed in 6 months with a range from 4-8 months.
These are considered cosmetic braces. That means that their purpose is to treat the patient’s chief complaint, which is usually crooked front teeth. It does not change the bite relationship and is not intended for people with bite issues. The system is absolutely NOT a replacement for traditional orthodontics in most cases. Traditional orthodontics should always be discussed and considered.
However, this is the perfect solution for many adults. If you wish your front teeth were straight, don’t have gum disease, and don’t have any significant bite issues, this system may be for you. Email me some questions so I can write the answers to them in a future column.
