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Thursday, June 30, 2011

Tongue Tied - what does it mean? What do you do?

Today a patient brought in her 4 year old son for the first time.  The child was great, no problems except we noticed that the tip of his tongue was tied to tissue attached to the floor of his mouth and rising up to the back of his lower front teeth.
This is called Ankyloglossia or Tongue Tie.
This attachment can interfere with the baby or child's eating or speech.  Often it is snipped by the paedatrician when the child is just a baby.   Often it is just left so they can see if it does interfere with speech and eating.  If it does interfere then it is removed.  What the paedatricians often forget is that because it is attached to the gingiva behind the lower front teeth it tends to pull the gingiva down and create gum problems which will affect the long term health of the lower front teeth.  In these cases the attachments must be removed. 
In addition to consultation with your family doctor you should consult with your family dentist.  It is a quick procedure but important to do before you develop any associated problems.  The best people to do these procedures are the dentists, periodontists or the oral surgeon.

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Wednesday, June 22, 2011

What about those Wisdom Teeth?

Every week I see a number of new patients and many times I end up recommending the extraction of wisdom teeth.

Inevitably I get some very similar questions:
Why do I need them out?  They aren't bothering me!
Why now, my last dentist didn't say anything?

Well for most people it is pretty straight forward, if the wisdom teeth are hurting and there isn't enough space for them to come in, they need to be extracted.  Pretty straightforward!

But what about those people whose wisdom teeth aren't hurting, why do they need to come out?
The answer to that  always depends on the specific case.

Of course if there is enough room in the jaws and the teeth come in properly then wisdom teeth are normal teeth and can stay. 

What does come in properly mean? 

The gums around the teeth must sit low around the tooth like any other tooth so that the tooth can be cleaned properly.  Also there must be enough room around the tooth so that it can be cleaned by a tooth brush and if need be, the dentist able to do a filling back there.  If not, the tooth will either eventually decay or get recurrent gum infections.  Since the tooth can not be cleaned or filled properly then the tooth will need to be extracted. Accordingly, as a dentist, our first thoughts are always, will this be a normal tooth or will it have to eventually be extracted.

That brings us to the question of why now if it is not hurting me?

Wisdom teeth when taken out when you are young, up till about age 24 get very good healing of the bone in the socket, after that not as much.  This is very important for the future health of the tooth in front of the wisdom tooth.  Also, wisdom teeth are easier to extract when you are younger as the bone is more pliable and the tooth will move easier.

In addition, as my dad always said to me, you do any surgeries while you are young and healthy.  People don't often think ahead but if you have to do even a minor surgery when you are older and your health is in decline and you are on multiple medications, sometimes a simple procedure can become complicated.

Of course we can't forget Murphy's Law, it may not hurt now but when you want to go on vacation or any event of significance in your life you can bet your bottom dollar that it will start to hurt.

This is really a simple overview and not meant to be a textbook on the subject.  If you have a question on the subject you can always e-mail me.  If you have a dentist, discuss it with your dentist as every case is different with it's unique set of circumstances which require a dentist or oral surgeon to give their expert opinion.

All the best

Dr. Ron Barzilay

A Dentist in Hamilton Ontario

Tuesday, June 7, 2011

Dr. Ron comments on Dr. Oz's show regarding thyroid collars

I received the following letter from a patient.

" I am sure you are already up to date."

Next part printed, most likely from an e-mail.
Precautions re:  Mammograms and Dental Xrays/ A Useful Warning

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-ray there is a little flap that can be lifted up and wrapped around your neck.  Many dentist 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?

" Since I have had breast cancer and many, many, many dental xrays and mammograms; I thought I would make you aware."

I received this letter from a patient who was concerned regarding dental x-rays.  She had had breast cancer and was now obviously concerned regarding thyroid cancer because Dr. Oz had suggested that a rise in thyroid cancer was related to dental x-rays and mammograms.

First thing I assured my patient that in our office it is standard practise to use a thyroid collar to cut down any radiation to the thyroid area.  Of course patients have x-rays done on  a routine basis and may not even be aware that a thyroid shield is being placed along with the regular shield.

Relating back to the show, I do feel that Dr. Oz's comments regarding the  rise in thyroid cancer among women being related to mammograms and dental x-rays was a bit more of a "wow" factor than substance.  If you watch the video he did not say that it was related but that it may be related to dental x-rays and mammograms.  I quite understand the regular individual watching this, his jaw dropping and as their jaw drops him or her saying "wow!"  The next thing that happens is that e-mails start to fly, if you know 10 people then have them send it to 10 people and you know how it goes.  This is what keeps TV shows on the air but to Dr. Oz's credit he did run another show with experts giving rebuttal.

The comments in rebuttal were:

1)  The increase in thyroid cancer is also occurring in men and since men are not having routine mammograms then there would be no connection between mammograms and an increase in thyroid cancer.  The comment was also made that thyroid collars are not given to women during a mammogram unless they ask for one because the shield may distort the image taken and may result in doing the mammogram a second time thereby doubling the actual dose of radiation.

2)  In dentistry we do place thyroid collars for protection.  Also I can tell you, as was stated on the show, that in dentistry, in the last decades, we are using faster speed film and digital x-rays which have reduced the radiation drastically so that we would expect to see actually less thyroid cancer if dental x-radiation was the cause.

So my feeling on Dr. Oz's comments is that there is a lot more hype than substance here.  When you have a daily show, you need a lot of the wow to maintain interest and there was a lot of that here.  I have links to  his videos here and you can decide for yourself.  Bear in mind that these are not the full shows  but this is what was available on their website and the time for a meaningful discussion is always limited by the length of the show.

When I said I would be writing comments on Dr. Oz, my wife said "ooooh, are you sure?'  I said "yes!"   She then said to me "just so you should know.  There are 3 people that you just don't mess with.  One is Oprah, two is Dr. Phil and Three is Dr. Oz." 

Accordingly,  I humbly submit this blog and Dr. Oz does do a good job bringing health issues forward.