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Friday, March 29, 2013

Dr. Oz at it again... Are your silver fillings making you sick?

Here we go again... with a debate that is 150 years old. Yep!  One hundred and fifty years old!  Dr. Oz had a show yesterday about silver fillings.  The implication was that silver fillings, which contain mercury (as a chemically-bound component), can cause illness.  This notion isn't new. But, it's never once been proven by any credible scientific studies.

I haven't used silver fillings at Palm Beach Smiles in at least 15 years.  A long time ago, I decided to use composite instead.  It's more conservative (requires less removal of healthy tooth structure) and it's certainly more cosmetically attractive.  Who wants silver fillings that end up turning black?  Today, most people want white fillings (which are not completely without risks, either, by the way).

Silver fillings replaced by composite.  Actual Palm Beach Smiles case.

Dr. Oz's show was sensationalistic, which is what TV is all about.   Furthermore, the premises and "guidelines" were completely without any scientific basis.  Yes... I realize that Dr. Oz is a famous TV celebrity (whose training is in cardio-thoracic surgery), and I'm "just a dentist."  But, I dare say that I know more about dentistry than he does.  I am an expert on dentistry.  He is not.   Of course, he could find some dentists to be on the show to support the premise.  But, that doesn't make their arguments any more scientific or based in fact.  The real facts contradict their assertions.

Actual Palm Beach Smiles case.

We dentists serve two masters: Science and business.  If we were to focus on business, we should WISH that silver amalgam fillings have been deemed harmful.  It would make us all VERY busy (and wealthy).

Finally, my point is that the scientist in me cannot endorse the categorical or routine removal of of silver amalgam in order to cure or prevent medical illness.  I do understand that some patients would like their silver fillings removed for cosmetic purposes.   And, I'm happy to do it... as long as patients know the risks.  Removing and replacing fillings can be traumatic to teeth.  This can lead to other issues down the road that may require root canal treatment or crown restorations.

If you'd like more information, you can click on my webpage:  Should I have my mercury-silver fillings removed?

Large fillings may need to be replaced with crowns.

If you have any questions about your silver fillings, give us a call at Palm Beach Smiles in Boynton Beach.

Friday, June 1, 2012

You'll Shoot Your Tooth Out!

Just when I thought I had heard EVERYTHING... well you know the rest.  But, this one is new.

A man had a toothache and decided to SHOOT it out with his gun.  Of course, only a MAN would consider this.  Women are far smarter!

Maybe we shouldn't be surprised that the man was also drinking, and I dare say... lives in Alabama.  Oh, I'm going to get flamed for that!  It was probably his last tooth!  ;-)  Drinking and do-it-yourself dentistry don't mix!

Click here to read "Decatur man tries to ‘shoot out’ aching tooth."  

Tuesday, April 10, 2012

Dental X-rays "Tied" to Brain Tumors?

Here we go again. Another "study" warning of the dangers of dental x-rays was featured on a morning news show. I'm sure the other news programs will pick up on it quickly. And, dentists across the country will collectively sigh.

Here's a link to a report about the study.

Strange Science

What's most frustrating is that it's as invalid a "study" as any scientist could dream up. Real science does not rely on anecdote (stories). And, this study relies on interviewing the subjects and asking them to recollect how many dental x-rays they had since childhood. I'm shaking my head as I type this. They could have asked them to recall just about anything, including how many carrots they ate or how much time they spent under fluorescent lighting.

Real scientific studies rely on HARD DATA, not what someone remembers from their childhood. By asking questions that rely on anecdote, I could fashion a "study" to prove just about anything.

Some basic tenets of science are:
  • "Multiple anecdotes are not data."
  • "Correlation does not equal causation."
As mentioned before, anecdotes / stories cannot be considered when creating a study to prove cause and effect.

The second quote above means that because two things are related or happen together, it does not mean one caused the other.  "Correlation does not equal causation."  It bears repeating, because it's true.

Just the FACTS, Ma'am

Unfortunately, this type of "popular science" creates tremendous headaches for dentists and endangers the health of our patients.  Today's dentists have gone to great lengths to reduce radiation exposure while maintaining optimal diagnostic capabilities.  And, dentists order x-rays based on a number of factors including individual patient histories.

The truth is that dental x-rays are the LOWEST source of ionizing radiation from medical AND natural sources.  A series of four check-up bitewings is the same as a 2-hour flight in a passenger jet.  Likewise, the radiation you receive by living inside a concrete block house (most modern houses in Florida) for one year, is about the same as you get from a Full Mouth Series (18 films) of dental x-rays.  A chest CT scan is 700 times the radiation of a dental x-ray.  These are verifiable, measurable facts.

Dosages of radiation from various common sources (measured in "millirems"):

1 dental x-ray: 0.5 mrem

2 hours in an airliner: 2 mrem

1 dental panoramic x-ray: 3 mrem

Living in a concrete house / per year: 7 mrem

A full mouth set of x-rays (18 films): 9 mrem 

Chest x-ray: 10 mrem

1 pack of cigarettes per day / year: 36 mrem

Chest CT scan: 700 mrem

Whole Body CT scan: 1000 mrem

My Hands Are Tied

Ultimately, we cannot... neither ethically nor legally... treat patients without appropriate x-rays as part of an examination that meets the standard of care.  In our current system and environment, patients cannot consent to negligence.  In other words, a patient cannot sign a "waiver" and refuse x-rays.   If a diagnosis is missed, or incorrect treatment is rendered as a result of not having x-rays, the dentist WILL be held liable, regardless of any signed "waiver."  That's reality.

A patient does have the right to refuse TREATMENT.  But, they can't sign away their right to a proper DIAGNOSIS by the doctor.  X-rays are done for diagnostic purposes.  If we miss a diagnosis by not taking the proper x-rays, we will be hung out to dry... every time.  That's our reality.  A patient cannot legally consent to negligence.

But, even more important than that, patients may SUFFER from undiagnosed issues.

Don't Wait Until It Hurts!

I'm surely glad this patient didn't refuse x-rays.  She didn't know or feel this very large cyst that was destroying her jaw bone.  No symptoms.  No pain.  But, it's a very good thing we caught it.

In my opinion, it was grossly irresponsible, if not reckless, for the "Cancer" journal to publish this so-called "study."

Talk With Your Dentist

My suggestion is to have an open dialogue with your dentist.  He or she has your best interests at heart.  Getting medical or dental advice from TV (or even the internet) can be dangerous to your health.  Find a dentist you trust.  Trust is the foundation of the doctor-patient relationship.

One more tenet of science is that a VALID study must be REPEATABLE.  One study... even if it's a good study (this one is not)...  cannot be used to draw solid conclusions.  The study has to be repeated (usually by someone else) and have the same results.

American Cancer Society Responds (to me)

Finally, I have personally been communicating with the American Cancer Society, which publishes the journal, "Cancer."  I expressed my concerns and they have responded.  I won't paste the entire conversation here, but it's VERY puzzling why they would publish this laughable "report," when their Chief Medical Officer, Otis W. Brawley, M.D., said regarding this study, “We need more data before we can even begin to state there is a relationship between dental x-rays and these tumors."  It surely begs the question:  Then WHY did you publish it???

I won't speculate on what agenda(s) may be behind the release of this report.  Dental x-rays shouldn't even be on the "radiation radar" when compared to even natural sources of ionizing radiation.  But, ultimately, you don't want to risk your health based on "factoids" regurgitated by the talking heads on TV.  Ask your dentist questions.  He or she should be able to address them with scientific facts.

Sunday, January 15, 2012

Palm Beach Smiles is mobile!

No, we haven't rented an RV and taken our dental act on the road. We have a new website designed specifically for mobile (smart phone) users. It's easy to use, and it's fast!

You can visit by clicking Palm Beach Smiles mobile website.

Or if you have a QR code reader app on your smart phone, you can scan the code right here from your computer screen. Very cool! Try it!

Wednesday, April 27, 2011

Smile Makeover Video Testimonial

Check out this patient testimonial. Carol had been unhappy with her smile for many years. Be sure to see the before & after photos at the end of the video!

Monday, January 3, 2011

Don't Get Dental X-ray Advice from Dr. Oz!

Dr. Oz is at it again. He must be running low on ideas for his TV show. You'd think there is PLENTY of material out there in the medical world to fill his shows into perpetuity. But, noooooo.... He's spouting off nonsensically again about dentistry - a field in which he has ZERO training. He's as qualified to talk about dentistry as I am about his specialty - heart surgery.

This time Dr. Oz is telling people they should avoid dental x-rays. His reason is a piece of "research" that purportedly links increased thyroid cancers to dental x-rays. There's a reason I put the word, research, in quotes. Here's an excerpt from the article he apparently referenced (but failed to include in his show):

The researchers studied 313 thyroid cancer patients in Kuwait where dental treatment is free and where the incidence of thyroid cancer is relatively high compared to Britain. They said the results of their study, although the largest case-control study on the subject, should be treated with caution because the data were necessarily based on self-reporting by the participants. Comprehensive historical dental x-ray records were not available from the clinics.

Pay particular attention to what is bolded in the excerpt above.  313 patients is a VERY small study.  The data is based on SELF-REPORTING.  That's not science, folks.   And, the real kicker that is quite stunning to me...  they are saying the cancer is related to dental x-rays, BUT they don't have ANY records of what kind, how many, if any, x-rays taken on each patient.  WHAAAAAAAAT?

There's an adage in science:  "Correlation does not equal causation."  To illustrate what that means, I submit the following analogy:

I did a study of 313 rabbits from Arkansas.  They ate a lot of carrots.  And, they all died.  I can't tell you how many carrots they ate, or how often.  I didn't keep any records.   But, the rabbits really seemed to like carrots.  So, I think they ate a lot, especially since they didn't have to pay for the carrots.  But, eventually, all the rabbits in the study died.

My "obvious" scientific (not!) conclusion is that carrots are LETHAL.  Don't eat carrots.  And, if a restaurant tries to force them on you in a salad, you should tell them that a famous TV hair stylist said you shouldn't eat carrots.  Carrots KILL!

Of course, we would be hard-pressed to logically conclude that carrots are dangerous. But, if a famous TV celebrity doctor blessed by Oprah says, "A study showed that carrots can kill you," you can bet people will watch. And, you can bet the celebrity doc won't give any details about a flawed "study."

Dental x-rays are a necessary part of a complete dental examination.  X-rays reveal decay that we cannot see with our eyes.  X-rays reveal bone loss from periodontal disease.  X-rays reveal abscessed teeth.  X-rays also reveal cysts, tumors, and even cancers.  If any of those conditions go undetected, they will invariably get worse and more difficult to treat.
Dental x-rays are the "standard of care."  That means any dentist who treats patients with out the proper examination, including x-rays, is practicing below what is accepted as a bare minimum of competency.

So, you see... we dentists must practice within at least the parameters of what is considered the standard of care.  An Oprah-endorsed TV personality (even a heart surgeon) is NOT the arbiter of how dentistry is practiced.  While he is a popular celebrity, Dr. Oz is NOT an expert on dentistry.  However, your dentist IS.  Some may argue that the dentist has a vested (financial) interest in doing x-rays.  But, I will counter that argument that it is minuscule compared to Dr. Oz's financial interest in gaining viewers by offering provocative topics to discuss on his TV show.  The more viewers he gets, the more he makes on advertising during his show.  We're talking MILLIONS of dollars, folks.  Rest assured that your dentist isn't "making his / her money" by over-prescribing x-rays. 

If you're interested in some real numbers, refer to the table below**   (You can view the table as a larger image by clicking on it.)  I've highlighted in green, the typical exposure level from annual dental x-rays:  0.008 millisieverts.  Now look at the first source listed in the table, "Natural Background."  The figure is 2.4 millisieverts.  So, you get 300 times MORE radiation from just being alive and walking around than you do from dental x-rays in any given year.

It sure makes for sensational TV when a famous Oprah-fied doctor says, "going to your dentist is dangerous."  But, it's a tremendous disservice to the public and outright misinformation.  But, that's television, facts be damned.

Your dentist should be happy to discuss the reasons for prescribing dental x-rays.  Don't be afraid to ask.  But, if you insist on no x-rays, in most cases, you can expect your dentist to decline seeing you as a patient.  That's the simple truth, and that's reality.  To provide dental care without x-rays is simply wrong, and it puts the dentist in a seriously liable and indefensible position.

I won't pretend to give you advice on heart surgery.  I wish Dr. Oz would stop giving unqualified dental advice.

**Source: Radiologic and Nuclear Medicine Studies in the United States and Worldwide: Frequency, Radiation Dose, and Comparison with Other Radiation Sources—1950–2007
November 2009 Radiology, 253, 520-531