Posts filed under 'Q & A'

Dr. Oz and Thyroid Cancer fears from Dental X-rays

Dr. Dave —
 I just received the following message about x-rays and thyroid cancer.  Also, consider THIS.  Would you have anything more to contribute to the confusion?
   — Z

Ladies, listen up!!

Thyroid cancer
On  Wednesday, Dr. Oz had a show on the fastest growing cancer in women,
thyroid cancer. It was a very interesting program and  he mentioned  that
the increase could possibly be related to the use of dental x-rays and
mammograms. He demonstrated that on the apron  the dentist puts on you for
your dental x-rays there is a little flap that can be lifted up and wrapped
around  your neck. Many dentists don’t bother to use it. Also, there is
something called a “thyroid guard” for use during mammograms.
   By  coincidence, I had my yearly mammogram yesterday. I felt a little
silly, but I asked about the guard and sure enough, the technician had one
in a drawer. I asked why it wasn’t routinely used. Answer: “I don’t know.
You  have to ask for it.” Well, if I hadn’t seen the show,  how would I have
known to ask?
   We  need to pass this on to our daughters, nieces, mothers  and all our
female friends and husbands tell your  wives !! I just did, now you send
it on to your list.
Someone was nice  enough to forward this to me. I hope you pass  this  on
to your friends and family.

Thank you for your question.  Yes we do  have the lead aprons with thyroid collars.  It is most likely not necessary but we have them anyway.  To debunk the myth propagated by Dr. Oz, I’ll explain further:

Firstly, there are 2 types of dental radiograph mediums; film and digital.  It was once true that digital radiographs used less radiation or energy than radiographs by film.  But lately, there have been huge advancements in the quality and speed of the film.  Just like film for cameras; the higher “speed” the film, the less exposure you need to capture an image.  Dental “X-ray” units have exposure adjustments on them.  You adjust the amount of radiation, by adjusting the interval of time that the unit is emitting the energy.  Low quality, low speed, films need more exposure time; hence more energy.  In fact, there is a digital mode on the units.  If you flip the switch, the exposure times are a fraction of the times for film.  However, the film is so fast and of such quality these days, we are using the lower settings in DIGITAL mode.   Also, the image captured with film is higher detail that the digital medium allows.

Now with all this said; the higher speed films are MUCH more expensive for the dentist then the lower speed film.  Here, we only buy the highest quality film available.  Every time there is an upgrade we change and spare no expense for the safety and well being of our patients and staff.  Unfortunately, not all dentist do.  In my tenure, the film has advanced several times.

Dr. Oz’s second concern is radiation scatter.  Does the energy significantly scatter beyond the target?   The answer is NO.  Besides the advancements in film, the dental units have been improving too.  Scatter used to be more of a problem on the earlier units but the newer lead lined collimators do not allow for that any more.  The collimator on a dental unit is that tube that the dental technician aims at the tooth.  These direct the energy specifically at the tooth and not the surrounding tissues.  This is wonderful for the safety of the patient, but can be a headache for the the dental technician because it causes a familiar problem we call “Cone Cutting”.  If the collimator is not aimed directly at the film….if we are off just a little bit,  we get an area of zero exposure.  The outline in the developed film is EVEN THE SAME SHAPE AND SIZE of the collimator head!!!!!  That proves there is almost zero scatter.

So like a lot of things on TV, a little bit of truth and knowledge mixed with self serving promotion can be dangerous.  To be at any significant risk of exposure, the practice would have to use very dated materials and equipment.  Someone almost had to cherry pick  facts to end up with the misleading conclusions that were stated in the television show as described.  In doing so, he has put unnecessary fear into millions of people.


Add comment January 24, 2012


The following scenario appears time and again and it repeated itself today.  It prompted me to blog about it here:

A patient comes in for his 6 month check-up.  We detect heavy plaque (build up on the teeth) and gingivitis (swollen, inflamed gums).  I ask him how many times a day he is brushing to which he proclaims, “Two or three times a day!”  Eye-roll from the dental staff.  We think this guy brushes once a week!  Then we bore the patient with the brushing instructions that you’ve all heard a thousand times

Well, some time ago, I realized that maybe all these people aren’t exaggerating.  So I started to consider other possibilities.  Finally, I asked the proper question, “How often do you change your toothbrush?”  And I always heard the same answer, “I’m using the one you gave me the last time I was in for my cleaning!”  Wow!  6 months!  No wonder your mouth is in that condition!  In effect, you haven’t been brushing your teeth for months!

Next I started to ponder why patients thought it was ok to keep a toothbrush that long.   Well, its because they used to last that long…when they were much different…

Years ago, toothbrushes were manufactured with firm bristles for maximum scrubbing power.  But because people are keeping their teeth longer than ever before, we now see the long term effects of firm or even medium bristled brushes.   They can damage the teeth and gums by wearing them away.

So toothbrush manufactures now produce soft toothbrushes.  In fact, I don’t even know of a firm bristled toothbrush on the market and the medium bristles are becoming ever harder to find.  And that’s great because the soft bristled toothbrushes are much better for us.  The soft bristles will not damage our gums or teeth and they are much more comfortable to use.  HOWEVER; they do not last nearly as long.

So as dentists, I think we need to re-train the public about toothbrush renewal.  The softer bristles lose their performance after about 60 uses.  So if you are brushing your teeth twice a day, you should replace your tooth brush every 30 days or 4 weeks.  If you brush 3 times a day, you should change your brush every 20 days.   I would even go so far as to say that if the bristles are splayed, bent, or flared, you’ve waited too long.   You need to think of it like this: every time you use your brush, the performance is a little less.  And lower quality brushes have an even shorter lifespan.

But I remind my patients, “Every dollar yon spend on a toothbrush, is $100 you will save in the dentist office!”  So think of spending your money on toothbrushes as an investment in time, money, and comfort!

By the way, here are some tips to make your toothbrush last longer:

  • Don’t bite or chew the bristles as you brush
  • Wash out all of the toothpaste out of every use.  Don’t let any toothpaste dry in the bristles.
  • Buy higher quality toothbrushes.
  • Do not store the toothbrush with the bristles face down.
  • Use a Philips Sonicare brush.  With proper care, a Sonicare head can last 6 months

Add comment January 7, 2011

Signs, Symptoms, and Why You May Need a Root Canal

There are two primary reasons that a tooth may need to be treated with a “root canal” (also known as  endodontic treatment).

1.  Dead Tooth (Necrotic Tooth)

Once a nerve dies, the nerve tissue rots, or “necrosis”.  Bacteria, that are ever present in our bodies, feed off the dead tissue.  Moreover, the now empty chamber is an environment that is warm, moist, and dark. Hence, it is the perfect incubator for bacteria to thrive and multiply.

The bacteria multiply at the expense of the bone around the tip of the root and a fluid-filled cyst eventually forms at the apex.  This can be quite painful  resulting in the following symptoms:

  • A constant throbbing
  • Pain that is exacerbated by heat and alleviated by cold.   Heat expands and cold shrinks.  So heat can make more pressure in the cyst & hallow tooth; on the contrary, cold can mitigate the pressure.
  • A blister forms next to the tooth .  Also, subsequent draining or popping of the blister.  The infection that forms in the bone drains next to the tooth, creating a fistula tract or a blister.
  • Nocturnal pain (aka nighttime pain)  Once you lay down flat, the blood pressure equalizes to your head because your heart is not pumping against gravity.  This increase in BP to the head can make the throbbing much worse.
  • Pain while chewing, tapping on the tooth, or even pain to pressure or touch.

So as you can see, dead teeth can be the most painful teeth.  Although there is no nerve, the bone and armamentum around the tooth can become infected and quite inflamed.

Once a diagnosis is made of a necrotic pulp, antibiotics can provide short term relief.  However, the tooth will eventually need to be treated with a “root canal” procedure or extracted.

2.  Irreversible Pulpitis

Irreversible pulpitis is a condition where the nerve (pulp) is inflamed (itis) to a degree that it can not heal (irreversible).   This usually occurs with some form of trauma.  This can also be quite painful, as the nerve is alive and not happy.  Irreversible pulpitis usually results with the following symptoms:

  • Spontaneous pain.    Patients feel an electrical shock through the tooth.  It is commonly described as a lightening bolt through the tooth.  The attacks come on quickly at irregular, unpredictable moments.
  • Pain that is brought on by a cold stimulus, that once the cold stimulus is removed, the pain lingers for a minute or two.  If the pain goes away in 10 or 15 seconds, then that is a sign of REVERSIBLE pulpitis and will most likely need a simpler treatment.
  • The tooth may also be painful to chewing or pressure.

Once a diagnosis is made of a irreversible pulpitis, the tooth will need to be treated with a “root canal” procedure or extracted.  Antibiotics are of no help here because there is no infection., rather inflammation Anti-inflammatory medications such as Ibuprofen or other NSAIDS may provide some relief, but the nerve will not survive.  Eventually it will die and become necrotic.

There are other reasons that a tooth may need to be treated endodontically, but these are the most common causes and the ones that are identifiable by symptoms.  I hope this helps.

David Slyby D.D.S

Add comment December 21, 2010

Care For Your Pets Teeth Too!

Recently, our cat, Enzo had some dental issues.  At first, I noticed that he was not eating his food as quickly as he used to.  And he was getting frustrated (growling) with our other cat, Lucy, who was rapidly gaining weight.  I soon realized that something was preventing him from eating, which is Enzo’s number one favorite thing to do in life!  I checked his teeth and noticed  tarter buildup.  His gums were swollen and his breath was tainted.   On closer inspection, I found a broken tooth…poor Enzo.  Of course, I occasionally  check our cats’ teeth so I was surprised how fast his dental health deteriorated.  This is just another reminder how quickly things can get out of control.   Sever days later,  our veterinarian gave him a thorough cleaning and addressed his other needs.  His mouth is healthy and he is devouring food again, like his old self.  Lucy is on a non-voluntary diet.

So here’s something to consider for all cat and dog lovers:

Imagine if you didn’t brush your teeth for a whole week.  Worse yet, imagine if you didn’t brush your teeth at all for five years!  Your dog would probably turn its head away from your “people breath.”   Since we know the importance of keeping our own teeth healthy, why don’t we take a minute to talk about our pet’s teeth.

●   Brush your pet’s teeth on a regular basis.  Always use a pet approved toothpaste, not a human product.  One local veterinarian recommends C.E.T toothpaste in either malt or poultry flavor.

●   Use Hills T/D or other specialty food as your pet’s primary diet.  A “tarter diet” is specially formulated to help keep your pet’s teeth clean.  It is available in Feline, Canine and Canine Small Bites

●   Feed a crunchy diet and avoid moist food when appropriate.  Moist food contains more preservatives that tend to stick to teeth causing tooth decay.  Some conditions require a special diet.  It is best to check with your veterinarian.

●   Give treats to your pets that help promote a healthy mouth.  Dog treats such as Pedigree Dentabone and similar products have been shown to reduce tarter formation.  Since most pets tend to really enjoy T/D, it may also be used as a treat.

●   Schedule professional hygiene, such as dental prophylaxis, on a regular basis.  At this time a complete oral exam is performed and all tarter is removed from the teeth.  The teeth are professionally cleaned and polished just like your dental professionals do to your teeth.

●   Please call your pet’s doctor if you have questions.

Add comment December 20, 2010

What’s Causing Your Bad Breath?

Halitosis (bad breath) can come from a number of sources.  Illness and certain foods can emit odors from the stomach, lungs or even the sinuses.  However, these circumstances account for less than 10 percent of all cases.

The typically healthy person is more likely to have bad breath as a result of Volatile Sulfur Compounds (VSCs) which are produced by bacteria populating the gums and teeth, but especially the back of the tongue and palate.  Most people know that brushing and flossing your teeth and the gums can help combat bad breath, and some even know enough to brush the tongue.  However, most people do not identify the palate as a source of halitosis.

The major source of these bacteria is the tongue.  The tongue is rough and has a large surface area.  It is not cleansed by chewing like the teeth.  Here the bacteria can flourish and, since the tongue is frequently in contact with the palate, the palate is the next major contributor to this nuisance.

Tongue scrapers are a popular tool used by people to cleanse the tongue, however, often times they do not see a marked improvement because a tongue scraper does nothing to combat the bacteria that the palate harbors.  Therefore, the best defense against bad breath is to brush the back of the tongue and the back of the palate. Although gagging may occur when reaching these areas, cleaning these critical areas will significantly reduce any unwelcome odor.

The next step in eliminating bad breath is restoring decayed teeth and treating any periodontal disease if present.  Obviously, for smokers, breaking the smoking habit is a major factor.

If a patient wants to go the extra step, there are new mouth rinses that contain chemicals that actually break down VSCs into a non-odor producing by-product.  Just let us know if you’re interested and we can special order one for you from our suppliers.     

Add comment October 2, 2010