Dental Answers

Here are some answers to some of your questions.

Baby Teeth vs Yellow Adult Teeth

I have always told people it is because the adult tooth has more dentin than the baby tooth. Dentin is yellow and thus shows through the translucent enamel as yellow. It could also be a combination of that and the orientation of the enamel refracting light differently since the enamel is oriented differently in the two types of teeth. Anyway, it is normal and fine and dandy. White teeth are not normal.

Baby Tooth Spacing

In the baby teeth it is good to have spacing. It they are touching then he will most likely need braces or have crowded/crooked teeth. It does depend at how much space/lack thereof there is. IF there is extra space they should be fine. If there is no extra space/all touching then braces are a maybe. If they are already crowded/crooked then braces a definite.

As far as cleaning them: brush twice a day and floss. All the pediatric dentists here on base recommend to use the Reach Access Flosser. It's design makes it really easy to use on kids.
Floss: Before or After?

It doesn't really matter if you floss before or after brushing. If I had to pick I'd go with before, this way the brush carries away the stuff you've flossed off your teeth. The main thing is to floss!

If I missed anyone's questions let me know and I'll add them. Sorry for the delay, I was away on sabbatical.

National Children's Dental Health Month

My popular demand I have decided to offer some free dental advice for your kids. Here are some of the common questions I get from parents.When should my child first see the dentist?

The recommended time is within 6 months of the first tooth erupting or by 1 year old.
Why so early?

So we can keep you from making any early mistakes. J/K Too make sure the parents know how to care for the teeth, diet habits, catch any problems early, basically to educate the parents and to acclimate the children to the happy world of dentistry. (Imagine how much easier it would be to fix a cavity on a 3 year old who knows you and has already been to the office 3 or 4 times for happy things, rather than have to do a filling at the first visit. Much easier.)
When should I start flossing my child's teeth?

Now! Well, as soon as he has two teeth that are touching and the brush cannot go in between. I recommend the Reach Access Flosser. It's great! And yes you should floss them. And yes you should be brushing their teeth for them too, believe me you are only fooling yourself if you thing your kids are brushing adequately. (I'm sure some of them are but most are not.)
Fluoride?

Yes fluoride is safe and I support water fluoridation.

And one last question because I'm getting really angry with the dell tech support guy named Mithun! I hate talking to these people! (My blogging seems to keep being interrupted by my anger issues these days.)

Cavities is not as much based on how much candy/sugar/carbohydrates you/the child eats, rather on the frequency. Example, drinking a coke all at once is not too damaging to the tooth, but the same amount spread throughout the day will have a much more damaging effect on the teeth. So try to control and limit the amount of times the kids are snacking and drinking between meals and only let them/you drink water between meals.

Well, if you have any dental questions, let me have 'em!

The Clinic

Ok, so here is an update about what my "job" entails. I've been seeing patients for the last 2 1/2 weeks now. It's been really nice. i feel a bit rusty at times, but have been having a good time. I work out of two DTR's (Dental Treatment Room). In one, one of my two assistants, does all the cleanings for the kids coming in for check-ups, and then I come over and do their exam. The other DTR is for operative patients, i.e. doing fillings etc. At times it is really busy, especially as I try to get used to the new system of charting and writing the treatment notes. Other days patients will miss their appointments and the days will be slow. At least in the AF I can get paid whether or not I have the patients come.

The kids seem fairly well behaved here. I see a lot more young kids then I did in residency. Here we are seeing the kids 9 and younger, whereas in RI we say from 1-18 and it was usually 6-18. I like treating these littler kids. The Air Force is a cross section of America, meaning we see all the same things as in the civilian world, but on a smaller scale. We will be taking some kids to the OR for treatment under general anesthesia, but the list is A LOT shorter then in Rhode Island. I am also going to start doing oral sedation in the clinic. I'm also starting to get some kids coming in on whom I will be doing some small orthodontic work.

One day last week we had an emergency response drill. They, the wing command, took the whole base through an exercise simulating a terrorist attack. The AF has different threat level like Homeland Security has now, but different terms. We practiced through the highest threat level. For the most part I just sat in my office getting caught up on things. Sometimes they have us wear our "MOPP" gear (Mission Oriented Protective Posture) i.e. protective gear like bullet proof vest and/or gas mask, etc.

My assistants are really good. I have one with a lot of experience who is doing the exams and the one assisting me is pretty new and still training. He does a good job, esp. for only being out of tech school for 3 months. One draw back to Air Force assistants, called techs, is that they don't stay in one specialty too long. It hurts their rank advancement to do so. So they get switched around. They are fun to work with.

The clinic has 9 general dentists, one orthodontist, one periodontist, and me. I think that makes 12, and we will be getting an oral surgeon next month.

I even got to do my first "home dental visit" tonight. One of our friends called me after one of the kids they were babysitting hurt his teeth on a trampoline. They brought him over and I got to check him out.* It's nice to be able to help these little kids.

*The kid is fine.

These are from the flop (it got rained out so no stunts were done) of an air show a week or two ago (time has been hard to judge lately).

Max in a Navy rescue helicopter.

One of the F-16's from our base. They are fun to see flying around each day.

Dentistry in Japan

So…Work. I am the base’s only Pediatric Dentist, so it is weird to walk around the base and church and know that every one of the kids I see is my patient!! It is exciting and overwhelming. I have a lot of expectations to fulfill. A few of the general dentists have been filling in for pedo for the last year and have been very excited to see me. I should start seeing patients at the beginning of September. They have me busy/not busy doing base orientation (called in-processing), hospital orientation, taking CBT’s (computer based tests) like HIPPA, Security, etc. We also HAVE to take a Misawa tour (done) and a tour of Hachinohe (scheduled for Sept) as part of in-processing.

So my days have been real easy/boring/productive, so I’m trying to take the time to get everything in order and look up a million different acronyms: PCS- permanent change of station, used- I’m PCSing to Japan from Rhode Island; not used- Em I'm really PCS'd right now. TDY-temporary duty used- I did a TDY for COT at Maxwell AFB; not used-m Em that is a nice TDY. BX- Base Exchange; like a Walmart. ETC- etcetera. I’m also enjoying being home a bit more.

So I am the pediatric dentist. I will have two DTR’s (dental treatment rooms) and two assistants. Thus we will have one for cleanings and exams, while the other is scheduled for operative patients. I am currently trying to decide how I will want to do sedations. They have an OR facility to use, but I don’t think I’ll have as big a need as we had in RI. That’s good for the kids, but I really enjoy that part of my job. My supervisor is the base's Periodontist and a Lt Colonel. Above him is the dental squadron commander, a “full bird” colonel. Above him is the group commander, who is over the whole medical group, i.e. the hospital. Then there is the wing commander, another colonel. He is the man in charge of the whole base.

My days will be real busy, but quite manageable and probably not as busy as residency. It is nice to come home and be home. We have PT (physical training) 3 times a week. This has become so important that they schedule it into the end of the day during the week and make it mandatory. The idea is to have everyone fit for deployment. I made a goal to do the base’s triathlon next year. My friends just did it yesterday. Janeen won first place for the women’s!!!! So I need to get my swimming game on. I need to find a nice Speedo too!!! j/k (used-just kidding). We also have emergency medical, chem warfare, etc exercises to keep us on our toes. Misawa is a very safe small city (40,000+ people), but we have a lot of interesting neighbors [i.e. China, North Korea, Russia(that's a lot of red!)] who keep it a very important place to keep the 35th Fighter Wing.

I look forward to starting my patient care. I will have a great deal of say in how I do things and am excited to find my style of pediatric dentistry. I have a wonderful job and task ahead of me!!

What's Grosser than Gross?

Gross

poor hygiene combined with braces

Grosser than Gross

After cleaning off cheese-like plaque from child's teeth, picking out what looked like a stand of celery, but what turned out to be said child's thumb nail. This may have been one of the grossest things I've encountered so far.

This reminds me of Em's doctor during her first pregnancy. This OB-GYN asked me if I was sure I wanted to look in peoples mouths all my life. "There are worse places to look" I thought, but said "Yeah, I'm pretty sure."

Another Reason To Go Pedo

I was on my oral surgery rotation earlier this week. We had “a frenectomy” coming in. (Yes, I try not to refer to patients by their procedure, but the head assistant kept saying that. For the sake of my sister I try to refer to the patient not the sarcoma.) Anyway, a patient was coming in who needed a frenectomy. I asked Dr. Sam if I could do the frenectomy procedure. He said “We’ll see.” Just then the assistant came through the door with a sobbing 9 year old girl. Dr. Sam looks from the weeping child to me and says with a big smile “You can do this one!”

So I proceeded to allay the girl’s fears and help her to feel comfortable. I talked a lot about High School Musical and how much she likes Troy. She was able to calm down and did a wicked good job. She held still and didn’t have a single issue throughout the procedure.

I really enjoy helping these kids get past their fears and showing them how much they can accomplish. I don’t mind spending the first 10 or 40 minutes talking them through things. (Although it may be a little harder when my income depends on my speed.) It makes me feel so good to see a scared or crying patient leave the room happy.

There you go dad!

Why Pediatric Dentistry?

People have asked me many times why I want to do pediatric dentistry, especially my Dad and brother who are general dentists. In fact just the other day I called my dad and his assistant answered and as she was about to take my message Dad says: Tell him I'm busy doing real dentistry! And when he answers the phone when I call he says: Hello Baby Dentist!

Well, yesterday the cutest thing happened to me and it illustrates why I love Pediatric Dentistry. My patient was a 2 year old little girl coming for her first visit. She started crying right as her mom picked her up to sit in the dental chair. I did a "lap to lap" exam, which means I sat facing mom who held her on her lap with kid's head on my lap. Mom holds the hands and I support the head. Anyway, she cried while I I cleaned and examined her teeth and
I sang Christmas carols, then put on a sticky Fluoride varnish. She then goes back to mom and stops crying and is fine. Appointment over. On the way out the little girl stops and looks up at me and puckers her lips up at me to give me a kiss. I leaned down and gave her a hug and she kissed me with her sticky fluoride lips! It totally melted my heart and made my day. It was so nice.

This is ONE of the examples of why I love to work with kids.