X-RAY RADIATION 101

One question I get asked a lot is:  Why do dental staff leave the room when x-rays are taken?  Are x-rays dangerous?  While the average patient has an x-ray taken once a year with a lead apron on, a dentist, hygienist or dental assistant takes dozens of x-rays all day long, day after day.  This equates to a thousand or more a year.  It would be a serious health concern for dental personnel to stay in the room with the patient while the x-ray is taken.  So it is simply a safety protocol.

Let's further look at the amount of radiation dental x-rays emit and why patients fear and resist dental x-rays. Many dentists, including myself, have invested in digital x-ray systems, the latest technology, which drastically reduces the already small amount of radiation conventional dental x-rays emit.

The digital x-rays we utilize reduces radiation 80 to 90% over the film based x-rays everyone has experienced through the years.  Let's compare the radiation one would receive from a digital x-ray to a medical chest x-ray or lower GI x-ray segment.  A full set of dental x-rays has 50 times less radiation exposure than a GI series and 15 times less than a chest x-ray.

As one of my dental school professors taught me, dentists' x-ray machines are like little pop guns compared to medical radiography, which more resemble howitzers.  Dental radiography is truly safe.  In dentistry, radiation from our x-ray units is emitted through a round tube or collimator that reduces scatter radiation to a 2 1/2" area.  Furthermore, dentists place a lead apron over your lower extremities as an added precaution.  In the days of high scatter radiation machines, a lead shield was very important.  Today the lead apron offers more peace of mind than actual protection, because stray radiation from modern digital x-ray machines is almost nonexistent.  Dental x-rays taken in a judicious fashion provide the dentist with an invaluable tool to diagnose hidden cavities between teeth, abscesses, cysts, jawbone cancer and tumors, and gum disease, to name some of the benefits.  My day is filled with scores of patients who could have saved hundreds and sometimes thousands of dollars if they had had regular dental x-rays taken in a timely fashion.

Utilizing dental x-rays is like seeing not only the tip of an iceberg which floats in the ocean, but the total extent of the ice structure below the water surface.  We all know how that turned out for the Titanic!  The captain couldn't see, and therefore didn't have, the total picture to avert a terrible disaster!

BRUXISM (TEETH GRINDING/CLENCHING)

I deal with this issue almost daily with patients in my practice.  When you wake up with a stiff, tired, achy jaw that gets better as the day goes on, you most likely are grinding your teeth during the night.  Grinding at night, also known as bruxism, is a habit of tightly squeezing your top and bottom teeth together while at the same time sliding them back and forth over each other.  Clenching, on the other hand, is when you squeeze your teeth tightly together only, without sliding them back and forth on each other.  Bruxism can happen at any age to children or adults.  Many children do this at an early age but outgrow the habit.  Fortunately, when they do grind it is on their primary or baby teeth which will be lost anyway.

People who suffer from bruxism may have the following symptoms:  1)  Facial pain.  Grinding your teeth back and forth under high pressure will cause the muscles in your jaw and neck to contract and release 75% more than in normal use.  This lends to lactic acid building up in your muscles, resulting in spasm.  2)  Worn, broken and cracked teeth and fillings.  Studies show that the pressure on your teeth during grinding is five times higher than the pressure from normal chewing.  This extra force is pulverizing your teeth.  Studies indicate that those who grind their teeth experience up to 80 times the normal wear per day compared with those who don't.  3)  Loose teeth.  If left untreated, this powerful force of rocking your teeth back and forth will loosen your teeth in the jaw.  4)  Headaches and/or earaches from spasming muscles.  5)  Cold sensitivity and/or sore teeth when chewing.  The first symptom of an injured or inflamed nerve inside a tooth is cold sensitivity.  This will be resolved if the forces on teeth are eliminated.

So what causes bruxism?  Why do some individuals grind and others don't?  One of the major causes of bruxism is stress.  Bruxism can be a neuro-muscular reaction to stress.  We don't know the full process, but if you go to bed with undue stress, there is a good chance you will grind your teeth for a portion of your sleep.  Studies indicate bruxism occurs during the deep REM part of your sleeping pattern.  Abnormal biting, where teeth don't close correctly, can also lead to bruxism, as the body will try and grind teeth down until it feels proper.

Bruxism is primarily treated with an acrylic night guard that is worn while you sleep.  This night guard slips over either the upper or lower teeth preventing the teeth from touching.  It protects teeth and prevents them from wearing down.  When a dentist fabricates this night guard, he or she will adjust it so all teeth slide evenly over each other like a skating rink.  The once tense muscles will begin to relax and muscle fatigue will be eliminated.

DENTAL SEALANTS

Sealants are thin protective coatings that dvances in dentistry are awesome!!are bonded to the chewing surfaces of your teeth; usually the back molars, where food and bacteria pack into the biting surfaces.

Sealants are a thinned down liquid version of the hard white material called composite, like we use for fillings, with a bonding agent mixed in.  That makes them strong and durable.  This painted on liquid fills into the depressions and grooves on the biting surface of teeth, forming a protective shield over the enamel of each treated tooth.  The procedure is quick, with no discomfort associated with it.

First, each tooth is washed and primed with an etching solution for a few seconds.  The sealant material is then painted over all the biting surfaces of the tooth and hardened in place with a curing lightecond.  The sealant material is then painted over all that activates and finalizes the hardening process.  The whole process only takes a few minutes per tooth.

Typically, children six years and older who have catches in the grooves of their teeth should have sealants.  However, not all children need sealants.  Many children have flat, smooth strong enamel that will never develop a cavity.  It is the nooks and crannies in the enamel, that catch bacteria and sugars, that lead to cavities. 

Sealants will protect children’s teeth through the cavity prone years of six-eighteen.  I have even seen sealants last on patients’ teeth well into their thirties.

Furthermore, in our office, we will place sealants in adults when we find a catch in the enamel that our cavity detecting laser (known as the Diagnodent) indicates is not through the enamel.  In the event it does penetrate the enamel, the tooth would need a filling. Advances in dentistry are awesome!!

A fee is charged for each tooth treated with a sealant.   A portion of this fee is usually paid by dental insurance.  

SEDATION DENTISTRY

For many, even the thought of having their teeth cleaned makes their entire body tense with fear.  They would rather endure the agony of a toothache than step foot in a dentist's office.  A lot of people are so phobic about going to the dentist that they prefer not to have any treatment until it's too late.  Three words are the answer:  ORAL SEDATION DENTISTRY.  For people who avoid dentists like the plague, oral sedation dentistry may take away some of their anxiety.  Sedation can be used for everything from invasive procedures to a simple tooth cleaning.  How it's used depends on the severity of the fear.

Sedation dentistry uses medication to help patients relax during dental procedures.  It's sometimes referred to as "sleep dentistry," although that's not entirely accurate.  Patients are usually awake.

One type of sedation used in dentistry is called inhaled minimal sedation.  You breathe nitrous oxide, otherwise known as laughing gas, combined with oxygen through a mask that's placed over your nose.  This gas gives you an incredibly relaxed, enjoyable feeling.  Your anxiety is totally released.  Your dentist can control the amount of sedation you receive, and the gas wears off quickly once your procedure is over.    This is the only form of sedation where you may be able to drive yourself home after the procedure. Another type of sedation is called oral sedation.  Depending on the dose given, oral sedation can range from minimal to moderate.  For minimal sedation, you take a pill.  Typically, the pill is Halcion, which is a member of the same drug family as Valium, and it's usually taken about an hour before the procedure.  The pill will make you drowsy, although  you'll still be awake.  A larger dose may be given to become groggy enough to actually fall asleep during the procedure.  Patients usually can, though, be awakened with a gentle shake.  There are no intravenous tubes or needles, just a pill.  Total relaxation.  If my patient knows they will toss and turn all night just thinking about their appointment, I will prescribe an extra pill at bedtime so they will have a great night's sleep.

The best part is you will have little memory of the entire experience, as the sedative pill has an amnesic property.  I promise you can be relaxed and confident in a dental chair.  The power of advanced dentistry is AMAZING!!!