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Beware the “Smile Peddlers”

October 15th, 2019

If your mouth is healthy, your teeth are snuggled safely within your gums, with the space between your gum tissue and the tooth only one to three millimeters in depth. But as bacteria in your mouth continually form, a sticky film of plaque on your teeth, particularly around the gum line, this plaque begins to harden into tartar -- only removable by a dentist or hygienist during a professional cleaning. Left unchecked however, this tartar can lead to gum disease.

Such was the case of a 29-year-old male patient who just completed treatment through Smile By Mail. Results weren’t too bad and in fact, his smile looked okay. However, the patient came to Dr. Razdolsky wanting a lower fixed retainer as one tooth would rotate back as soon as the aligner was taken off.

After a full comprehensive exam, Dr. Razdolsky discovered 6-9mm periodontal pockets. You see, inflammation and swelling due to plaque and tartar buildup can result in pocket formation between the gums and the teeth.

“As your gums pull away from your teeth, this inflamed tissue is now the perfect place for more plaque and tartar to hide,” said Dr. Razdolsky. “This deepens the pocket further and over time threatens the bone around your teeth putting your whole mouth at risk.”

Sadly, according to Dr. Razdolsky’s patient he only had an intraoral picture scan done through Smile By Mail without any x-rays or examination by a doctor. Thank goodness he sought out Forever Smiles! His story serves as a very serious warning to others -- if only you treat one thing without full benefit of a licensed medical provider, you can risk losing your teeth in the future!

Making matters worse, these Smile by Mail providers are taking to the streets and offering patients a smile by mobile truck or bus. Even on their own website there’s no assurances these services are supported by ongoing medical supervision of a licensed dentist or orthodontist, further endangering patients through this potentially neglectful treatment. But hey, they do offer to send you home with teeth whitening strips!

What a scary concept this Smile By Mail is to the future of orthodontics. It pains us to see it happen. When it comes to your health and well-being, you should always seek the advice of a licensed medical provider.

Visiting Portugal - Travelling Orthodontist

October 1st, 2019

On a recent trip to Portugal, the Razdolsky’s discovered the beauty of the culture and the people. Just bordering Spain on the Iberian Peninsula, Portugal is founding member of the North Atlantic Treaty Organization (NATO) and several other cooperative and developmental agencies including the European Union.

Hailed as enjoying its highest economic growth in nearly 20 years, the country enjoys millions of international and domestic tourists to is beautiful beaches and historic landmarks, some which date as far back as 1500s! Fascinated in not only partaking of the beautiful vistas and seeing first-hand the country’s emerging growth, Anna notes as she visits the sites and interacts with locals how many of them are wearing braces.

Surprisingly, a study released July 24 by OralMed Medicina Dentaria suggests that half of the Portuguese population have never heard of Orthodontics or have an incorrect perception of what this clinical area entails. In fact, one in 10 respondents confuses “dental braces” with “removable prothesis” or a denture like brace to replace missing teeth.

“It is astonishing that half the population does not know what orthodontics is,” said Dr. Razdolsky. “Even shocking is that those that do, do not have enough understanding of what it is about and the benefits it affords.”

The emergence of orthodontics as a specialty is only beginning to take hold in Portugal and at the cornerstone of its development is communicating and education through more effective visual and verbal means to the patient.

“This is such an exciting time for the people here,” said. Dr. Razdolsky. “I am like a kid in a candy store talking with people about the importance of orthodontics and the value it brings to the patient and their overall health.”

Despite this misunderstanding however, orthodontics and braces do not carry a negative stigma in the country. In fact, as part of its addition to the European Union, Portuguese citizens can often receive subsidized orthodontic care up to the age of 18 when referred by their dentist. Perhaps that’s why there are so many people now sporting braces in Portugal.

FRUIT JUICE... Not as ‘healthy’ as you may think.

September 17th, 2019

We all want what’s best for our children, and their health is of particular concern and focus. Often, we see articles and news reports that advocate eating certain foods over others or warning us to watch out for hidden sugars in snacks. Recently another warning has been issued, this time directed at the hidden dental health risks for infants and children triggered by fruit juice. If your infant is at the stage where they are developing teeth, they are old enough to have tooth decay. That’s right. For toddlers and even infants, the biggest threat to dental health is tooth decay and it’s often exacerbated by surgery fruit juice and fruit juice drinks.

In a 2017 study published by American Academy of Pediatrics (AAP), fruit juice and juice drink sales have declined. Likely this is due to competing beverage options, as well as increasing public awareness of healthier options like consumption of whole foods and fruits, rather than sugary substitutes. However, the study does suggest that children and adolescents continue to be the highest consumers of juice and juice drinks. In fact, their data suggests that children 2 to 18 consume nearly half of their daily fruit intake as juice which lacks dietary fiber. Taking that a step further, the American Academy of Pediatrics recommends no fruit juice for children under one year as it affords no nutritional benefit.

So why is fruit juice bad? Most parents simply do not monitor their child’s dietary intake to ensure proper consumption and often turn to fruit juice and juice drinks as a go-to solution to pacify a thirsty child thinking it is better than soda. In fact, most fruit juice drinks can have as much sugar as a soda.

So, what is the proper guideline? The AAP recommends that human milk or prepared infant formula be the only nutrient fed to infants until about 6 months of age. They also suggest to completely avoid the introduction of juice for an infant before the age of 1 unless otherwise medically indicated. If then, the recommendation is to only give the juice in a cup, not a bottle to help protect the infant from baby bottle tooth decay.

Just about everything young children drink, from milk or formula to apple juice contains sugar. Most often, when a child drinks from a cup, the sugar in these drinks moves quickly through the mouth, past the teeth and causes little harm. However, when a child consumes these beverages by sucking them from a bottle, the sugars linger in the mouth and quickly form into harmful bacteria. Over time, these bacteria develop into acid which eats away at tooth enamel. This can be particularly damaging to newly emerging baby teeth.

If you must put baby down at night or for a nap with a bottle, the recommendation is plain water. To help protect teeth, parents can should also wipe baby’s teeth and gums with a clean, damp gauze pad or washcloth after having milk. When a child’s first tooth comes in, they should gently brush with a child-size toothbrush and non-fluoride toothpaste and schedule their first pediatric dentist or at least by age 1.

The AAP also suggests that fruit juice and fruit drinks are over consumed in toddlers and young children aged 1 to 6 because it is assumed these drinks are nutritious, they are convenient and they “taste good.” In most instances however, children should be encouraged to consume better options. The introduction of proper dental hygiene habits, and regular dental checkups are crucial to good oral health and parents should schedule their child’s first visit to the orthodontist by age 7.

What about older kids, age 7 to 18? Juice consumption presents fewer nutritional issues for older children because they typically consume less of these beverages. Nevertheless, intake of juice should be limited to 8 ounces a day, or half of the recommended daily fruit servings. Kids should be reminded to brush their teeth twice daily (especially if they have braces) and always, encouraged to drink lots of water.

Using 3D Cone beam To Discover New Pathologies

September 3rd, 2019

 

In our Harmony in Orthodontics article at right, Dr. Razdolsky talked of how 3D cone beam improves diagnostic and treatment in orthodontics, but did you know this type of dental imaging can also save lives? That’s right… 3D CBCT imaging when combined with computer aided diagnostics or (CAD) systems-based technologies can not only help dental radiologists see and diagnose various oral pathogens from dental caries (tooth decay) to cancer, they can also help prevent a stroke or hip fracture. Through expanding the scope of panoramic exams, 3D CBCT becomes a relevant screening method for osteoporosis, other cancers and even Carotid artery calcification!

Dr. Razdolsky uses CBCT in orthodontics for evaluation of bone structure and tooth orientation, as well as surgical planning for impacted teeth and even diagnosing temporomandibular joint disorder (TMJ). But it is in locating new regions of interest (ROI), or spotting suspicious signs and classifying the findings, especially when we widen the image scope to include the head and neck, we can see even greater benefit. It is then that we can allow for detection of more pathologies in one image, thereby increasing the advantage for dentists and patients.

“It’s true that we can see more than ever before, especially someone who is trained to look for such findings,” said Dr. Razdolsky. “For example, maxillary sinusitis is often caused by a dental pathology when effected roots are too close to the maxillary sinus. An experienced dentist or orthodontist will look for this and can adjust treatment or call in other specialists as needed.”

In one case, Dr. Razdolsky discovered a patient with multiple compound odontomas, or tumors. Although composed of normal dental tissue, these developmental anomalies grow in an irregular way and other than causing orthodontic pathologies, have also been linked to Gardner’s syndrome. Testing to rule out this syndrome is highly recommended as these patients can develop colorectal polyps and have an increased risk of developing colon cancer.

Another medical condition which can be evident to the trained eye is osteoporosis, a medical condition characterized by the loss of bone mineral density which increases bone fragility. This is particularly interesting as the tests to diagnose osteoporosis require special equipment and that can limit the availability of tests for the majority of patients. Since it has been proven that measuring bone mineral density in the area of the mandible can also provide accurate results in detection, panoramic dental x-rays are a much more reasonable options for screening.

“While measuring bone mineral density may not be easy for dental radiologists, the automation of CAD systems does help a lot,” said Dr. Razdolsky. “This puts dentists in a unique position to help older patients through screening and sharing that information back to the primary care physician for follow up.”

Dr. Razdolsky said the same CAD systems can be programmed to look for carotid artery calcification screening which can be spotted in dental panoramic x-ray images.

“Carotid artery calcification is a symptomless disease with potentially devastating consequences,” said Dr. Razdolsky. “A simple modification to an otherwise routine scan could save a life and just another example of how oral health can be tied to overall systemic health. As physicians, we are all in this together.”

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