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

Dental Amalgam Dangerous? (Silver Fillings)

Once again, dental amalgam (silver filling) is in the news. Last week on NBC's Evening News with Brian Williams, they ran a story about the FDA's concerns about amalgam fillings and the possible risks of the mercury content.



Personally, I have not used silver amalgam in my practice since around 1994. I believe it is simply an inferior material to a well-placed bonded composite (white) filling. White fillings are the standard at Palm Beach Smiles (click to learn more).  The teeth in the photos below belong to my wife.  :-)

Silver amalgam starts off as a fine metal powder composed of silver, copper, and other metals which is mixed with a droplet of mercury. This forms a sort of paste which quickly hardens into a solid amalgam. Once hardened, the components are chemically locked together.

The concern is about the possibility of mercury release from those fillings in your mouth over time. There has been a LOT of controversy about this over literally 150 years. To date, no recognized scientific entity has determined that there are any negative health issues with amalgam fillings. And, I am inclined (so far) to believe that there are no real health issues with the mercury that is locked up in amalgam fillings. However, I am open to REAL scientific evidence to the contrary.

A far bigger source of mercury in our environment is from coal-burning electric plants that put tons of mercury in the atmosphere. That mercury ends up in the ground and water. You've probably heard about mercury concerns when it comes to eating fish.

Oddly enough, the government or regulatory bodies in some parts of the U.S. have deemed scrap amalgam as a hazardous waste. Meanwhile, some other government entities assure us it is safe for use in dentistry. So, it's against the law to put it in the garbage or landfills in some places. But, it's safe to put in your mouth? Things that make you go, "Hmmmmm."

Another thing that will make you go, "Hmmmm" is that the goverment is banning incandescent (traditional) light bulbs in favor of the so-called "green" compact fluorescent bulbs. Those are the "curly-cue" bulbs. And, they contain mercury. Click here to see what the EPA recommends if you drop and break one in your house! This is a clear illustration of the contradictory agendas we see, and it should definitely make you go, "hmmmmm."

Some countries around the world have restricted the use of amalgam. And, every so often, the notion of banning it in the United States comes up. And, so here we are again. I believe it will be banned eventually - possibly for the wrong reasons - But, it will be banned some day.

There are some valid concerns over banning it, however. Amalgam has some advantages over other materials. It's EASY to place. It's cheap. And, it WORKS.

By contrast, bonded composites require painstaking attention to detail to place them correctly. If meticulous technique is not used, they tend to fail catastrophically and quickly. They are more expensive in terms of material costs and time (to be meticulous). Most insurance plans do not pay for composite fillings. So, dentists who have patients depending on insurance will face financial concerns. Banning amalgam will put those people between the proverbial rock and a hard place.

Fortunately, in my practice, I simply haven't had those issues in the 16 years I've been "amalgam-free." I've cultivated a practice based on what I would do for my own family rather than cater to insurance executives' and shareholders' interests.

I do not advocate the wholesale replacement of amalgams in order to prevent or treat any medical condition. And, I won't until credible scientific evidence supports the notion. However, I do understand that some patients do not want them in their mouths for a variety of reasons, including cosmetic concerns. "Silver" fillings are really BLACK fillings.  And, who wants that? 

Stay tuned, as I believe this will be an ongoing issue. And, please visit us at www.PalmBeach-Smiles.com to keep up with what we're doing at Palm Beach Smiles.

Don't listen to Dr. Oz about teeth whitening!

Recently, the famous TV doctor, Dr. Oz, blogged about natural dental "remedies." With all due (or not) respect to Dr. Oz, he is no more qualified to give advice on dentistry than I am an expert on cardio-thoracic surgery (his specialty).

The theme of his blog post was natural remedies to whiten teeth.

One of his suggested remedies was to eat raisins. The rationale is that raisins will stimulate salivary flow (true), rinsing away plaque (ummm.... baloney!). Raisins are classified as a "sticky sugar." Combine sticky sugars with plaque, and that's how you get cavities (tooth decay). The notion that saliva will rinse away the sticky bacterial mass that is "plaque" on your teeth is utter nonsense. The only way to remove plaque from your teeth is MECHANICALLY. That means brushing and flossing. Period!

Dr. Oz also suggested that the vitamin C in strawberries would "clear away plaque." Again... simply not true. Brush and floss. And, get a professional cleaning twice a year. There is no magic elixir, rinse, fruit, or berry that will "rinse" or "clear" away plaque.

So, he might as well have suggested eating Tootsie-Pops to "rinse away" your plaque. Tootsie-Pops will also stimulate salivary flow. But, like raisins, candy can contribute to decay if not eaten in moderation. And, I certainly would not recommend either (or any kind of sticky sugar) to do anything beneficial for your teeth. NOT AT ALL.  I admit to enjoying the occasional orange or grape-flavored Tootsie-Pop!  😆

Dr. Oz's second, and even more frightening suggestion is to use a slurry mix of baking soda and lemon juice on your teeth to whiten them. Put simply... it's crazy! Lemon juice is acidic. And, it's not a little bit acidic. The pH is about 2. The pH scale goes from 0 to 14. The strongest acid is 0, where as the strongest base / alkali (opposite of acid) is a 14. Care to guess what the pH of Coca-cola is? It's about a 2! It's the same.

Now, let's add baking soda... an abrasive material. It's also a mildly basic material, which would cancel out some of the acidity of the lemon juice. That's why you'll see bubbles - a chemical reaction. But, I do not agree with the idea of putting an acid on your teeth in combination with an abrasive. It's a recipe for erosion of your enamel.

While Dr. Oz's blog suggests leaving it on for only 1 minute with the caveat that it's acidic and will dissolve enamel, it doesn't account for most people likely REPEATING this process over and over. And, over time... repeated (although short) applications of acid WILL ERODE THE ENAMEL. 100% certainty!

Please don't do this! Don't put acid on your teeth to whiten them. Don't get dental advice from non-dentists. Not medical doctors. Not podiatrists, optometrists, nurses, or veterinarians. Not even famous TV heart surgeons like Dr. Oz. I'm a doctor, too. But, I wouldn't suggest you ask me for advice about heart surgery.

The very idea that a celebrity heart surgeon like Dr. Oz would suggest a DESTRUCTIVE method to "whiten" your teeth in an effort to save a few hundred dollars (cost of professional and SAFE whitening) is stunningly ignorant and a danger to the public, in my opinion.

If you want to explore options on how to SAFELY and EFFECTIVELY whiten your teeth, click on the link in this sentence or please ask a DENTIST.

Stick to what you KNOW, Dr. Oz! Remember, "First do no harm." And, I promise I won't give out advice on how to save money with do-it-yourself heart surgery.

Was Your Mouth Made in China? Dr. Barr gets interviewed on TV.

In an earlier blog post, I opined about the outsourcing of dental lab work to China. The local CBS affiliate interviewed me about this issue. Here it is:

Mother's gum disease linked to infant's death???

More and more, periodontal disease (gum disease) which is a chronic inflammatory condition, is being linked to a variety of systemic health issues. Pre-term birth, diabetes, arthritis, pancreatic cancer, stroke, and heart attack are among them.

Here's a recent report linking periodontal disease to infant death:

http://www.msnbc.msn.com/id/34979552/ns/health-pregnancy/

Dr. Barr is now a Six Month Smiles instructor!

I just returned from presenting a 2-day course for Six Month Smiles. I spent the weekend teaching dentists about Six Month Smiles. Six Month Smiles is a system of providing short term cosmetic orthodontic treatment for patients who want a smile they can be proud of in a reasonable amount of time.

Most patients can achieve beautiful results without spending 2 years braces. In the time it takes between regular cleanings, Six Month Smiles can close spaces and straighten crooked teeth.

I'm proud to be among only 4 dentists selected to be an instructor and look forward to teaching dentists all over the country.